Publications by authors named "Nicholas Kolodychuk"

8 Publications

  • Page 1 of 1

Fascia Iliaca Blocks Performed in the Emergency Department Decrease Opioid Consumption and Length of Stay in Hip Fracture Patients.

J Orthop Trauma 2021 Jul 17. Epub 2021 Jul 17.

Department of Orthopaedic Surgery, Cleveland Clinic Akron General Medical Center, Akron, OH Department of Emergency Medicine, Cleveland Clinic Akron General Medical Center, Akron, OH Department of Anesthesiology, Cleveland Clinic Akron General Medical Center, Akron, OH Department of Nursing, Cleveland Clinic Akron General Medical Center, Akron, OH.

Objectives: To examine the impact of fascia iliaca blocks performed in the emergency department on hip fracture patients on opioid consumption, length of stay, and readmission rate.

Design: Prospective cohort study.

Setting: Community-based level 1 trauma centerPatients/Participants: Ninety-eight patients with isolated femoral neck, intertrochanteric, and subtrochanteric femur fractures (OTA/AO 31-A and 31-B)1 presenting from January 1, 2020 to June 30, 2020.

Intervention: Ultrasound-guided fascia iliaca compartment block using 40mL of 0.25% bupivacaine.

Main Outcome Measurements: Opioid consumption, length of stay, discharge disposition, and 30-day readmission rate.

Results: Thirty-three patients had contraindication to FIB. Thirty-nine of 65 patients (60%) without contraindications to undergoing FIB received fascia iliaca block. Mean age, BMI, fracture type, and surgical procedure were similar between patients undergoing FIB and not receiving FIB. The FIB group had significantly lower opioid consumption pre-operatively (17.4 vs 32.0 MMEs), post-operatively (37.1 vs 85.5 MMEs), over total hospital stay (54.5 vs 117.5 MMEs), and mean opioid consumption per day of hospital stay (13.3 vs 24.0 MMEs). Patients in FIB group had shorter length of stay compared to control group (4.3 vs 5.2 days). There was no significant difference in discharge disposition destination between groups. No patients reported complications of FI block.

Conclusions: Undergoing fascia iliaca block in the emergency department was associated with decreased opioid consumption, decreased length of stay, and decreased hospital readmission within 30 days of hip fracture.

Level Of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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July 2021

Can robotic technology mitigate the learning curve of total hip arthroplasty?

Bone Jt Open 2021 Jun;2(6):365-370

Department of Orthopaedic Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.

Aims: Traditionally, acetabular component insertion during total hip arthroplasty (THA) is visually assisted in the posterior approach and fluoroscopically assisted in the anterior approach. The present study examined the accuracy of a new surgeon during anterior (NSA) and posterior (NSP) THA using robotic arm-assisted technology compared to two experienced surgeons using traditional methods.

Methods: Prospectively collected data was reviewed for 120 patients at two institutions. Data were collected on the first 30 anterior approach and the first 30 posterior approach surgeries performed by a newly graduated arthroplasty surgeon (all using robotic arm-assisted technology) and was compared to standard THA by an experienced anterior (SSA) and posterior surgeon (SSP). Acetabular component inclination, version, and leg length were calculated postoperatively and differences calculated based on postoperative film measurement.

Results: Demographic data were similar between groups with the exception of BMI being lower in the NSA group (27.98 vs 25.2; p = 0.005). Operating time and total time in operating room (TTOR) was lower in the SSA (p < 0.001) and TTOR was higher in the NSP group (p = 0.014). Planned versus postoperative leg length discrepancy were similar among both anterior and posterior surgeries (p > 0.104). Planned versus postoperative abduction and anteversion were similar among the NSA and SSA (p > 0.425), whereas planned versus postoperative abduction and anteversion were lower in the NSP (p < 0.001). Outliers > 10 mm from planned leg length were present in one case of the SSP and NSP, with none in the anterior groups. There were no outliers > 10° in anterior or posterior for abduction in all surgeons. The SSP had six outliers > 10° in anteversion while the NSP had none (p = 0.004); the SSA had no outliers for anteversion while the NSA had one (p = 0.500).

Conclusion: Robotic arm-assisted technology allowed a newly trained surgeon to produce similarly accurate results and outcomes as experienced surgeons in anterior and posterior hip arthroplasty. Cite this article:  2021;2(6):365-370.
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June 2021

Prior Admissions as a Risk Factor for Readmission in Patients Surgically Treated for Femur Fractures: Implications for a Potential Hip Fracture Bundle.

Geriatr Orthop Surg Rehabil 2021 25;12:2151459321996169. Epub 2021 Feb 25.

Department of Research, Cleveland Clinic Akron General, OH, USA.

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost.

Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed.

Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9).

Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients.

Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.
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February 2021

Prospective Evaluation of a Noninvasive Hemoglobin Measurement System in Total Joint Arthroplasty.

J Surg Orthop Adv 2020 ;29(2):94-98

Hospital for Special Surgery, New York, New York.

We sought to prospectively determine the efficacy of a noninvasive hemoglobin measurement system compared to a traditional blood draw in patients undergoing total joint arthroplasty. One hundred consecutive patients had their hemoglobin level measured by blood draw and the noninvasive device, simultaneously. Results were analyzed for the entire group and further stratified based on race and perfusion index measured by the device. The financial implications and patient satisfaction were compared. Hemoglobin measurements in the entire group and the two sub-groups were similar between the noninvasive device and the traditional blood draw. The noninvasive system was preferred by 100% of patients. Additionally, cost savings per patient using the noninvasive system was $16.50. This correlated to an 86% savings per case over the standard blood draw. The noninvasive hemoglobin monitoring system offers comparable measurements to a standard blood draw, while improving patient satisfaction and lowering costs. (Journal of Surgical Orthopaedic Advances 29(2):94-98, 2020).
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November 2020

Web-based patient portal access in an orthopedic adult reconstruction patient population.

Arthroplast Today 2019 Mar 22;5(1):83-87. Epub 2019 Feb 22.

Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA.

Background: We surveyed patients in an adult reconstruction practice as to their use of the Web-based portal provided by our electronic health record, seeking to reveal patterns of use and helpfulness.

Methods: A total of 150 completed surveys were received. The survey queried demographics, the number of clinic visits, Internet access, portal activation, portal use frequency, and portal information questions and how patients answered them. Helpfulness was rated from 1 (not helpful) to 5 (very helpful). Statistical analysis included bivariate analysis and logistic regression, with odds ratio (OR) and 95% confidence interval (CI) reported.

Results: The mean age was 67.6 years. Most were females (n = 97, 65.1%). Most (68.7%) patients used the portal. Younger age (OR, 0.94; CI, 0.90-0.99) and access to Internet (OR, 31.8; CI, 8.5-119.4) predicted portal use ( < .005), whereas gender and number of clinic visits did not ( > .373). Of all, 47.5% of patients were unclear about online chart information. Older age indicated being unclear of portal information (68.5 vs 66,  = .0002). Of those who clarified doubts regarding information (n = 67), 23 used the Internet (34.3%), 32 (47.7%) called the physician, and 12 (17.9%) asked a friend and/or family member. Most (90.3%) patients felt the portal was helpful in gathering health information.

Conclusions: Age and Internet access affected portal usage; ability to understand chart information decreased with age. Most patients used the Internet or a family member to clarify doubts regarding portal information. The use of portal data resulted in 32 extra communications to the physician.
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March 2019

YouTube is a poor source of patient information for knee arthroplasty and knee osteoarthritis.

Arthroplast Today 2019 Mar 7;5(1):78-82. Epub 2018 Nov 7.

Department of Orthopedic Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA.

Background: The objective of this study was to assess the educational quality of YouTube videos pertaining to total knee arthroplasty and knee osteoarthritis.

Methods: A systematic search for the terms "knee replacement" and "knee arthritis" was performed using YouTube's search function. Data from the 60 most relevant videos were collected for each search term. Quality assessment checklists with a scale of 0 to 10 points were developed to evaluate the video content. Videos were grouped into poor quality (grade 0-3), acceptable quality (grade 4-7), and excellent quality (grade 8-10), respectively.

Results: Overall, 106 videos were categorized. For videos regarding total knee arthroplasty (n = 50), 64% of videos were of poor educational quality (32/50), 28% were of acceptable quality (14/50), and 8% were of good educational quality (4/50). Common missing information included discussion of surgical complications and implant duration. For videos regarding knee arthritis (n = 56), 66% of videos were of poor educational quality (37/56), 32% were of acceptable quality (18/56), and 2% were of good educational quality. Common missing information were causes and risk factors for knee arthritis and long-term prognosis.

Conclusions: The present study suggests that YouTube is a poor educational source for patients regarding knee arthroplasty and knee arthritis. Recognizing the limitations of YouTube as well as which topics are not commonly presented may better guide physicians to educate their patients.
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March 2019

Patellofemoral Arthroplasty.

Ochsner J 2018 ;18(3):280-287

Ochsner Sports Medicine Institute, Ochsner Clinic Foundation, New Orleans, LA.

Background: Patellofemoral arthritis is a common cause of anterior knee pain and limits flexion-related activities of daily living and exercise. While frequently present in bicompartmental and tricompartmental osteoarthritis, patellofemoral arthritis can occur in isolation. Patellofemoral arthroplasty as a treatment option is gaining in popularity, especially with new implant designs. We report a case in which new inlay implants were used to resurface the patellofemoral joint in a patient with contralateral compromise secondary to a previous below-knee amputation.

Case Report: A 37-year-old female with a contralateral right below-knee amputation and progressive left patellofemoral arthritis had failed multiple conservative treatment modalities. She underwent isolated patellofemoral arthroplasty using an inlay-designed implant. The patient was followed for 2 years postoperatively. She noticed an immediate increase in her knee range of motion and her pain scores improved. Two years postoperatively, she demonstrated drastic improvement in all outcome measures: International Knee Documentation Committee score (16.1 to 88.5), Lysholm Knee Scoring Scale (22 to 100), Knee Injury and Osteoarthritis Outcome Score (KOOS) Symptoms (7.14 to 96.43), KOOS Pain (2.78 to 100), KOOS Activities of Daily Living (0 to 100), KOOS Sports (0 to 100), and KOOS Quality of Life (12.5 to 93.75).

Conclusion: Inlay patellofemoral arthroplasty is a valid treatment option for isolated patellofemoral arthritis. Successful results can be achieved with this procedure after failure of conservative measures in patients with limited or no evidence of tibiofemoral arthritis.
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January 2018