Citations

Purpose To perform a systematic review of the literature to evaluate (1) activity level and knee function, (2) reoperation and failure rates, and (3) risk factors for reoperation and failure of autologous osteochondral transfer (AOT) at long‐term follow‐up. Methods A comprehensive review of the long‐term outcomes of AOT was performed. Studies reported on activity‐based outcomes (Tegner Activity Scale) and clinical outcomes (Lysholm score and International Knee Documentation Committee score). Reoperation and failure rates as defined by the publishing authors were recorded for each study. Modified Coleman Methodology Scores were calculated to assess study methodological quality. Results Twelve studies with a total of 495 patients and an average age of 32.5 years at the time of surgery and a mean follow‐up of 15.1 years (range, 10.4‐18.0 years) were included. The mean defect size was 3.2 cm 2 (range, 1.9‐6.9 cm 2 ). The mean duration of symptoms before surgery was 5.1 years. Return to sport rates ranged from 86% to 100%. Conversion to arthroplasty rates ranged from 0% to 16%. The average preoperative International Knee Documentation Committee scores ranged from 32.9 to 36.8, and the average postoperative International Knee Documentation Committee scores at final follow‐up ranged from 66.3 to 77.3. The average preoperative Lysholm scores ranged from 44.5 to 56.0 and the average postoperative Lysholm scores ranged from 70.0 to 96.5. The average preoperative Tegner scores ranged from 2.5 to 3.0, and the average postoperative scores ranged from 4.1 to 7.0. Conclusions AOT of the knee resulted in high rates of return to sport with correspondingly low rates of conversion to arthroplasty at long‐term follow‐up. In addition, AOT demonstrated significant improvements in long‐term patient‐reported outcomes from baseline. Level of Evidence Level IV, systematic review of Level I‐IV studies.

Abstract Aims An elevated risk of adverse events persists for years in cardiogenic shock (CS) survivors with high mortality rate and physical/mental disability. This study aims to link clinical CS-survivor phenotypes with distinct late host-response patterns at intensive care unit (ICU) discharge and long-term outcomes using model-based clustering. Methods and results In the original prospective, observational, international French and European Outcome Registry in Intensive Care Units (FROG-ICU) study, ICU patients with CS on admission were identified (N = 228). Among them, 173 were discharged alive from the ICU and included in the current study. Latent class analysis was applied to identify distinct CS-survivor phenotypes at ICU discharge using 15 readily available clinical and laboratory variables. The primary endpoint was 1 year of mortality after ICU discharge. Secondary endpoints were readmission and physical/mental disability [short form-36 questionnaire (SF-36) score] within 1 year after ICU discharge. Two distinct phenotypes at ICU discharge were identified (A and B). Patients in Phenotype B (38%) were more anaemic and had higher circulating levels of lactate, sustained kidney injury, and persistent elevation in plasma markers of inflammation, myocardial fibrosis, and endothelial dysfunction compared with Phenotype A. They had also a higher rate of non-ischaemic origin of CS and right ventricular dysfunction on admission. CS survivors in Phenotype B had higher 1 year of mortality compared with Phenotype A (P = 0.045, Kaplan–Meier analysis). When adjusted for traditional risk factors (i.e. age, severity of illness, and duration of ICU stay), Phenotype B was independently associated with 1 year of mortality [adjusted hazard ratio = 2.83 (95% confidence interval 1.21–6.60); P = 0.016]. There was a significantly lower physical quality of life in Phenotype B patients at 3 months (i.e. SF-36 physical component score). Conclusions A phenotype with sustained inflammation, myocardial fibrosis, and endothelial dysfunction at ICU discharge was identified from readily available data and was independently associated with poor long-term outcomes in CS survivors.

OBJECTIVE Diabetes mellitus (DM) is a known risk factor for postsurgical and systemic complications after lumbar spinal surgery. Smaller studies have also demonstrated diminished improvements in patient-reported outcomes (PROs), with increased reoperation and readmission rates after lumbar surgery in patients with DM. The authors aimed to examine longer-term PROs in patients with DM undergoing lumbar decompression and/or arthrodesis for degenerative pathology. METHODS The Quality Outcomes Database was queried for patients undergoing elective lumbar decompression and/or arthrodesis for degenerative pathology. Patients were grouped into DM and non-DM groups and optimally matched in a 1:1 ratio on 31 baseline variables, including the number of operated levels. Outcomes of interest were readmissions and reoperations at 30 and 90 days after surgery in addition to improvements in Oswestry Disability Index, back pain, and leg pain scores and quality-adjusted life-years at 90 days after surgery. RESULTS The matched decompression cohort comprised 7836 patients (3236 [41.3] females) with a mean age of 63.5 ± 12.6 years, and the matched arthrodesis cohort comprised 7336 patients (3907 [53.3%] females) with a mean age of 64.8 ± 10.3 years. In patients undergoing lumbar decompression, no significant differences in nonroutine discharge, length of stay (LOS), readmissions, reoperations, and PROs were observed. In patients undergoing lumbar arthrodesis, nonroutine discharge (15.7% vs 13.4%, p < 0.01), LOS (3.2 ± 2.0 vs 3.0 ± 3.5 days, p < 0.01), 30-day (6.5% vs 4.4%, p < 0.01) and 90-day (9.1% vs 7.0%, p < 0.01) readmission rates, and the 90-day reoperation rate (4.3% vs 3.2%, p = 0.01) were all significantly higher in the DM group. For DM patients undergoing lumbar arthrodesis, subgroup analyses demonstrated a significantly higher risk of poor surgical outcomes with the open approach. CONCLUSIONS Patients with and without DM undergoing lumbar spinal decompression alone have comparable readmission and reoperation rates, while those undergoing arthrodesis procedures have a higher risk of poor surgical outcomes up to 90 days after surgery. Surgeons should target optimal DM control preoperatively, particularly for patients undergoing elective lumbar arthrodesis.

Background: Chimeric Antigen Receptor T-cell (CAR-T) therapies were first approved by the FDA in 2017, and multiple commercial products are currently available. Hematopoietic stem cell transplantation (HSCT) is another treatment strategy often utilized for patients with advanced and/or relapsed hematologic malignancies. Both CAR-T and HSCT require significant, overlapping resources for their collection, storage, and processing. Understanding the impact of evolving standards of care in clinical practice is necessary in the planning of resource allocation and laboratory expansion. We aimed to characterize the trends of CAR-T and HSCT infusions over a five-year period. Methods: The processing lab database was reviewed to compile a list of patients that received either CAR-T or HSCT (autologous or allogeneic) infusions, between 01/01/2018 and 12/12/2022. The number of individual HSCTs and CAR-T infusions were plotted over time. We also calculated the percent contribution of both HSCT and CAR-T to the total number of products infused per year. We subsequently examined these parameters, within the specific diagnoses of diffuse large B-Cell lymphoma/large cell lymphoma (DLBCL/LCL, including double and triple hit DLBCL and High-Grade lymphoma) and multiple myeloma (MM), including MM with amyloid and MM with plasma cell leukemia/plasmacytoma. Simple linear regression was used to calculate statistical significance to determine if the slopes were non-zero, and the direction of change over time. Results: Overall, our study included 210 CAR-T infusions and 2366 HSCTs. 89/210 (42%) patients who received a CAR-T product also received HSCT between 2018 and 2022, with 85/89 receiving HSCT prior to CAR-T infusion and 4/89 receiving CAR-T prior to HSCT, including two patients who received HSCT before and after CAR-T. The median interval between the most recent HSCT and subsequent CAR-T was 37 months. DLBCL/LCL and MM were the disease indications for which CAR-T was most utilized, accounting for 87.6% of the 210 procedures. The total number of CAR-T procedures increased significantly over the five-year period, from 24 in 2018 to 74 in 2022 (Slope=13.8; p=0.02), accompanied by a marked decrease in the number of HSCT from 502 in 2018 to 393 in 2022 (Slope=-26.6; p=0.06). The overall number of infusions (calculated as number of HSCT + number of CAR-T) declined slightly, though this was not statistically significant (mean 511 + 30.6 per year; Slope=-12.8; p=0.22). When expressed as a percentage of the total number of infusions, we observed a significant increase in the proportion of CAR-T, from 4.6% in 2018 to 15.8 % in 2022, (Slope=2.98; p=0.02), and a significant decrease in the proportion of infusions that were HSCT, from 95.4% in 2018 to 84.2% in 2022 (Slope=-2.98; p=0.02). In DLBCL, we observed a slight decrease in the number of overall infusions, from 71 in 2018 to 58 in 2022 (Slope=-3.5; p=0.18) and a significant decrease in HSCT from 47 in 2018 to 26 in 2022 (Slope=-6.0; p=0.0172), while the number of CAR-T infusions remained stable (mean=27.4 + 5.3 per year; Slope=2.5; p=0.14). In MM, we observed a marked increase in CAR-T infusions, from none in 2018 to 33 in 2022 (p=0.0544), while the total number of infusions remained stable (Mean 231.8 + 16.54; slope=-3.5; p=0.58) and HSCT slightly decreased, from 228 in 2018 to 184 in 2022, though this was not statistically significant (Slope=-11.5; p=0.18). We observed a non-significant increase in the percent contribution of CAR-T to the total number of infusions performed for MM, from 0% in 2018 to 15.3% in 2022 (Slope=3.62; p=0.06) while in DLBCL we observed a significant increase, from 33.8% in 2018 to 55.2% in 2022 (slope=6.42; p=0.017). Conclusion: The findings from this study suggest a gradual trend in the clinical utilization of human cellular therapy products over time. Since many of the resources and personnel involved in the collection, storage, and processing of these products are shared, an increase in CAR-T is an important observation. These findings underscore key issues in lab management for cell manufacturing facilities when considering resource allocation and infrastructure development. More analysis is needed to determine if the decrease in HSCT and the increase in CART are related.