Model for End-Stage Liver Disease score and orthopaedic trauma surgery: can we anticipate poor outcomes?

ORTHOPAEDIC SURGERY Model for End-Stage Liver Disease score and orthopaedic trauma surgery: can we anticipate poor outcomes? Jennifer Keller, MS, Robert J Avino, BA, Heidi Israel, PhD, FNP, Lisa Cannada, MD, Dirk H Alander, MD, FACS Saint Louis University School of Medicine, Saint Louis, MO INTRODUCTION: Trauma patients typically have co-morbidities that cannot be addressed before surgery. These preoperative factors can affect outcomes following surgery. One such factor is liver disease. The Model for End-Stage Liver Disease (MELD) system was created to classify liver dysfunction and it’s relation to surgical outcomes. There has been research using the MELD score in general surgery and little in the orthopaedic setting. We attempt to use the MELD score to predict poor surgical outcomes in trauma patients undergoing orthopaedic procedures. METHODS: Using ICD-9 codes patients were identified with liver disease and an orthopaedic injury at a level 1 trauma center over a 10 year setting. 69 patients were included in the study; 31 of those were trauma. A MELD score was calculated for each patient with collected data. Patients who had either intraoperative blood transfusion, hospital stay >14 days, or had complications were labeled with a “poor outcome”. Statistical analysis using Chi-squared and t-test compared elective to trauma patients, with significance set at p < 0.05. RESULTS: Of our trauma patients, 13 (42%) were classified as having a poor outcome. Mean MELD score of trauma patients was 10.2 + 7.22 while mean MELD of poor outcome patients was 11 + 5.9. These findings are not statistically significant. CONCLUSIONS: The MELD score has been shown to be a good tool for evaluating liver disease. We have found that the application of this tool in an orthopaedic setting does not predict poor outcomes of trauma patients. Free flap for limb salvage following oncologic resection: 12-year experience Edward I Chang, MD, Alexander T Nguyen, MD, FACS, Melissa A Crosby, MD, FACS, Hong Zhang, PhD, Jennifer K Hughes, OTR, Julie A Moeller, PT, Roman J Skoracki, MD, FACS, Valerae O Lewis, MD, David W Chang, MD, Matthew M Hanasono, MD, FACS University of Texas MD Anderson Cancer Center, Houston, TX

CONCLUSIONS: Free flaps can be performed reliably for limb salvage (86.4%) following tumor extirpation. While fasciocutaneous and myocutaneous flaps were less likely to develop infections, they were at significantly higher risk for take-backs and total flap loss. Pedicle screws vs minimally invasive posterior-lumbarinterbody-fusion with spinous process fixation in the workers compensation population: early outcomes with minimum one year follow up Christian I Fras, MD, FACS, Amanda Castilleja Institute for Spinal Surgery and Research, Broomall, PA INTRODUCTION: Patients with work-related back pain are a surgical challenge: they may have lower success rates and prolonged hospital stays. We compared minimally invasive (MIS) posteriorlumbar-interbody-fusion (PLIF) performed with a spinous process fixation device (SPF) with traditional PLIF with pedicle screws (PS). METHODS: 39 patients underwent PLIF for work-related injuries. 20 MIS PLIF with SPF (SPF group); 19 open PLIF using PS (PS group). Operative time; hospital stay; transfusion requirement; complications; and pre-and-post-operative visual-analogue-scales (VAS) and Oswestry Disability Index (ODI) scores were noted. Minimum follow up was 1 year.

INTRODUCTION: A knowledge gap exists regarding the optimal flap choice for limb reconstruction following oncologic resection, particularly whether muscle or fasciocutaneous flaps have superior outcomes. METHODS: Retrospective review of all free flaps performed for extremity salvage from 2000 to 2012. RESULTS: Overall 220 patients (mean age 51.7 years, mean BMI 27.7 kg/m2) underwent free flap reconstruction for limb salvage (64 upper extremity, 156 lower extremity). Flaps were classified as muscle-only (n¼77), myocutaneous (n¼67), or fasciocutaneous (n¼76). Comorbidities including smoking, diabetes, peripheral

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vascular disease, and prior chemotherapy or radiation had no impact on complications. Osteomyelitis was significantly associated with infection (odds ratio: 19.5, CI: 3.77-100.64; p¼0.0004), wound healing complications (odds ratio: 7.51, CI: 2.21-25.49; p¼0.001), and amputation (odds ratio: 4.63, CI: 1.41-15.19; p¼0.01). Placement of hardware did not increase complications, although it was associated with higher risks for total flap loss (odds ratio: 4.92, CI: 1.33-18.23; p¼0.017). Fasciocutaneous and myocutaneous flaps were associated with hematoma requiring operative evacuation (p¼0.02) and an unplanned return to the operating room for microvascular complications (p¼0.005). However, they were at lower risk for infection (odds ratio: 0.14, CI: 0.02-0.87; p¼0.03) compared to muscle-only flaps. There were 11 total flap losses (5.0%) with fasciocutaneous and myocutaneous flaps at significantly increased risk for flap loss (odds ratio: 2.58, CI: 1.06-6.26; p¼0.03). Overall, 190 patients were successfully reconstructed while 30 patients (13.6%) ultimately required amputation.

RESULTS: SPF group: 17 1-level PLIF, 3 2-level PLIF. PS group: 17 1-level PLIFs, 2 2-level PLIFs. SPF group mean surgical time: 93 min for 1-level PLIF, 118 min for 2-level PLIF. PS group mean surgical time: 159 min for 1-level PLIF, 177 min for 2-level PLIF. Mean hospital stay: 2.1 days for SPF group, 3.4 days for PF group. No patient received a blood transfusion in either group. There were 2 SPF group complications: 2 cage dislodgements. There were 2 PS group complications: 1 cage dislodgement; 1 post-op neurologic deficit. SPF mean pre-operative / post-operative VAS and ODI scores were 8.1 / 5.8 and 78.3 / 56.2. Mean PS group pre-operative / post-operative VAS and ODI scores were 8.4 / 5.7 and 79.1 / 59.6. Operative time and hospital stay were

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http://dx.doi.org/10.1016/j.jamcollsurg.2014.07.714 ISSN 1072-7515/14