Khalid, Syed

BACKGROUND AND OBJECTIVES: The Risk Analysis Index (RAI) is a comprehensive assessment of frailty for predicting neurosurgical outcomes. The aim of this study was to assess whether frailty, measured by a modified RAI (mRAI), was an independent predictor of adverse events (AEs), nonroutine discharge (NRD), and in-hospital mortality for patients with acute cervical spinal cord injuries (SCIs). METHODS: A retrospective cohort study was performed using the American College of Surgeons Trauma Quality Programs database. Adult patients with acute cervical SCI from 2016 to 2022 were stratified by mRAI score into 3 groups: Robust (mRAI 0-10), Frail (mRAI 11-20), and Very Frail (mRAI ≥21). Patient demographics, comorbidities, injury type, diagnostic and treatment modality, AEs, and in-hospital mortality were assessed. A multivariate logistic regression analysis was used to identify independent predictors of AEs, NRD, and in-hospital mortality. RESULTS: 71 048 patients were stratified by mRAI score: 59 796 Robust (84.2%), 9558 Frail (13.5%), and 1694 Very Frail (2.4%). The proportion of SCIs secondary to a fall (Robust: 44.1% vs Frail: 70.2% vs Very Frail: 82.3%; P < .001) and AEs (Robust: 21.5% vs Frail: 24.4% vs Very Frail: 25.0%; P < .001) significantly increased with frailty. Very Frail patients experienced higher NRDs (Robust: 72.3% vs Frail: 85.2% vs Very Frail: 91.0%; P < .001) and in-hospital mortality (Robust: 10.9% vs Frail: 18.3% vs Very Frail: 29.2%; P < .001). On multivariate regression analysis, both Frail (odds ratio [OR]: 1.42; 95% CI: 1.25-1.61; P < .001) and Very Frail (OR: 2.09; 95% CI: 1.46-2.99; P < .001) mRAI scores predicted NRD, but only Frail mRAI score (OR: 1.12; 95% CI: 1.05-1.21; P = .001) was significantly associated with AEs. In addition, Frail (OR: 1.50; 95% CI: 1.36-1.65; P < .001) and Very Frail (OR: 2.79; 95% CI: 2.36-3.29; P < .001) mRAI scores were independent predictors of in-hospital mortality. CONCLUSION: Our study suggests that mRAI may be used to assess morbidity and mortality in patients presenting with spinal cord injury.

BACKGROUND: Adult traumatic brachial plexus injuries (TBPIs) are life-altering events that can have detrimental effects on a patient's quality of life. OBJECTIVE: To examine how social determinants of health (SDOH) disparities influence the risk of developing new psychosocial conditions after TBPIs in previously psychiatric-naïve patients. METHODS: Between January 2010 and June 2019, a retrospective analysis was performed using PearlDiver's Mariner, an all-payer claims database, to create 3 cohorts: TBPI disparity cohort: patients with TBPI and presence of at least 1 SDOH disparity before injury, TBPI without disparity cohort: patients with TBPI and the absence of any SDOH disparity, and control cohort: patients without TBPIs. RESULTS: The matched population analyzed in this study consisted of 1176 patients who were equally represented in the TBPI disparity cohort (n = 392, 33.33%), TBPI without disparity cohort (n = 392, 33.33%), and control cohort (n = 392, 33.33%). A total of 301 patients developed any psychosocial condition with 4 years of their injury. Patients in the TBPI disparity cohort had significantly higher rates of developing any psychosocial condition (31.12%, P < .0005), depression (22.70%, P = .0032), anxiety (18.62%, P = .0203), drug abuse (7.91%, P = .0060), and alcohol abuse (4.85%, P = .03499) when compared with the other cohorts. Furthermore, the disparity cohort carried a significantly increased risk of developing any psychosocial condition (hazard ratio 1.42, 95% CI 1.09-1.86). The rates of suicide attempt, post-traumatic stress disorder, and divorce did not significantly differ between groups. CONCLUSION: TBPI patients with SDOH disparities are at increased risk of developing new-onset psychosocial conditions, such as depression, anxiety, drug abuse, and alcohol abuse. Level of Evidence: Prognostic Level III.

Objectives: To estimate the effects of obesity on all types of upper extremity compression neuropathies (UECN) (carpal tunnel syndrome and other median nerve, radial nerve, and ulnar nerve compression neuropathies) and to assess whether bariatric surgery modifies these effects. Background: UECN are increasingly prevalent and decrease the quality of life of affected individuals. Studies suggest obesity as a risk factor for carpal tunnel syndrome, the most common type of UECN. Methods: A retrospective cohort study was conducted using the PearlDiver Mariner Database, an all-payor claims database containing claims for over 53 million patients from 2010 to 2019 in all 50 US states. Rates and odds of all types of UECN were compared between 1:1:1 exact matched cohorts of obese patients who were medically managed, obese patients who underwent bariatric surgery, and nonobese patients (111,967 patients in each cohort). Results: Compared with nonobese patients, patients with obesity were significantly more likely to develop any UECN (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.09–1.18), carpal tunnel syndrome (OR, 1.15; 95% CI, 1.10–1.30), and 2 or more UECN (OR, 1.34; 95% CI, 1.20–1.48). Compared with obese patients who were managed medically, obese patients who underwent bariatric surgery were significantly less likely to develop any UECN (OR, 0.87; 95% CI, 0.84–0.91) and carpal tunnel syndrome (OR, 0.85; 95% CI, 0.81–0.89). Conclusions: Obese patients have higher odds of both single and concomitant UECN, specifically carpal tunnel syndrome, compared with nonobese patients. Bariatric surgery decreases the odds of developing UECN compared with obese patients not undergoing surgical intervention.

Background: This article compares the rates and time-to-development of new-onset Dupuytren disease in patients with trigger finger treated by steroid injection, surgical release, or both. Methods: PearlDiver’s Mariner 30 database was queried to identify patients with trigger finger between January 2010 and June 2019. One-to-one exact matching based on baseline patient demographics allowed us to create 4 identical groups defined by the type of trigger finger intervention received. Results: The matched population analyzed in this study consisted of 85 944 patients who were equally represented in the steroid injection cohort (n = 21 486, 25.00%), surgical release cohort (n = 21 486, 25.00%), steroids prior to surgery cohort (n = 21 486, 25.00%), and no intervention (control) cohort (n = 21 486, 25.00%). A new Dupuytren diagnosis after trigger finger treatment occurred in 1 in 128 patients overall, 1 in 156 patients treated with steroid injection, and 1 in 126 patients treated with surgical release. Trigger fingers treated by steroid injection only had the lowest rates of Dupuytren disease overall (n = 137, 0.64%, P = .0424) and treatment with fasciectomy (n = 14, 0.07%, P < .0005). In all, 171 patients in the surgery cohort developed Dupuytren disease 1 year after undergoing surgical trigger finger release. Furthermore, this cohort had the highest rates of fasciectomy (n = 55, 0.26%, P < .0005) and the lowest rates of no intervention (n = 103, 0.48%, P = .0471). Trigger fingers managed by surgical release developed Dupuytren disease (mean, 56.11 days; SD, 80.93 days, log-rank P = .02) and underwent fasciectomy (mean, 49.74 days; SD, 62.27 days; log-rank P < .0005) more quickly than all other cohorts. Conclusions: Patients solely undergoing surgical release of their trigger finger had significantly higher odds and expedited rate of developing new-onset Dupuytren disease overall and undergoing subsequent treatment by fasciectomy compared with trigger fingers managed by other interventions.