Llege of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Methods: The NSQIP database was queried to identify patients who had undergone primary unilateral total knee arthroplasty between 2006 and 2010. Patient demographics, medical history, and surgical characteristics were recorded, as were thirty-day postoperative complications, mortality, and length of hospital stay. Complications were divided into categories, which included major systemic complications (complications requiring complex medical intervention) and major local complications (including deep wound infection and peripheral nerve injury). Univariate testing and multivariate logistic regression analysis were used to identify significant independent predictors of the outcome measures. Results: A total of 15,321 individuals underwent primary unilateral total knee arthroplasty. The mean age (and standard deviation) of the patients was 67.3 ± 10.2 years. Obesity (a body mass index [BMI] of ≥30 kg/m2) was documented in 61.2% of cases, 18.2% of patients had diabetes, and 50% were graded as Class 3 or higher on the basis of the American Society of Anesthesiologists (ASA) classification system. The thirty-day mortality rate was 0.18%, and 5.6% of the patients experienced complications. Patient age (odds ratio [OR] = 1.12; 95% confidence interval [CI] = 1.06 to 1.17) and diabetes (OR = 2.99; 95% CI = 1.35 to 6.62) were independent predictors of mortality. A BMI of ≥40 kg/m2 was an independent predictor of postoperative complications (OR = 1.47; 95% CI = 1.09 to 1.98). Patient age of eighty years or older, an ASA classification of ≥3, and an operative time of >135 minutes influenced the development of any postoperative complication as well as major and minor systemic complications. Cardiac disease (OR = 4.32; 95% CI = 1.01 to 18.45) and a BMI of ≥40 kg/m2 (OR = 2.01; 95% CI = 1.02 to 3.97) were associated with minor local complications. Conclusions: Patient age and diabetes increased the risk of mortality after primary total unilateral knee arthroplasty. Predictive factors impacting the development of postoperative complications included an ASA classification of ≥3, increased operative time, increased age, and greater body mass. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence....

Provement Program was queried to identify all patients undergoing spine surgery in the years 2005 to 2008. Demographic data, comorbidities, medical history, body-mass index, and the type of procedure performed were obtained for all patients. Postoperative complications and mortality within thirty days after the spinal procedure were also documented. The chi-square test and univariate and multivariate logistic regression analyses were used to evaluate the effect of individual risk factors on mortality, as well as the probability of the development of complications. Results: From 2005 to 2008, 3475 patients undergoing spine surgery were registered in the database. The average age of patients was 55.5 years (range, sixteen to ninety years), and 54% of the cohort were men. Ten patients (0.3%) died after surgery, and there were 407 complications in 263 patients (7.6%). Increased patient age and contaminated or infected wounds were identified as independent predictors of mortality. Increased patient age, cardiac disease, preoperative neurologic abnormalities, prior wound infection, corticosteroid use, history of sepsis, American Society of Anesthesiologists classification of >2, and prolonged operative times were independent predictors for the development of one or more complications. Conclusions: Patient age, female sex, longer procedural times, and several types of medical comorbidities influenced the risk of postoperative complications or mortality. This information enhances estimates of morbidity and mortality following spine surgery and may improve patient selection for spine surgery as well as preoperative discussions related to the risks of spine surgery. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence....

There have been no large cohort studies examining the wounding patterns and injury mechanisms in Iraq and Afghanistan from 2005 to 2009. This investigation sought to characterize the incidence and epidemiology of combat-related injuries for this period. Using the Joint Theater Trauma Registry, a detailed description of the combat casualty care statistics, distribution of wounds, and injury mechanisms sustained by all US service members for wounds (DRG International Classification of Diseases-9th Rev. codes 800-960) during the Iraq and Afghanistan Wars from 2005 to 2009 was performed. Among the 1,992,232 military service members who were deployed, there were 29,624 distinct combat wounds in 7,877 combat casualties. The mean age of the combat casualty cohort was 26.0 years old. The combat casualties were predominantly male (98·8%), Army (77·5%), and junior enlisted (59·0%). The distribution of combat wounds was as follows: head/neck, 28·1%; thorax, 9·9%; abdomen, 10·1%; and extremities, 51·9%. Explosive injury mechanisms accounted for 74·4% of all combat casualties, which was significantly higher than those caused by gunshot wounds (19·9%) (p < 0.0001). From 2005 to 2007, explosive mechanisms of injury were significantly more common in Iraq than in Afghanistan (p < 0.001). The percentage of explosive mechanisms increased significantly in Afghanistan between the years 2007 (59·5%) and 2008 (73·6%) (p < 0.0003). The wounding patterns observed in Iraq and Afghanistan from 2005 to 2009 differ from previous conflicts. Explosive mechanisms accounted for 74·4% of combat casualties, which is a higher percentage than in previous US conflicts. A progressive increase in the use of explosive mechanisms in Afghanistan, eventually equaling that in Iraq, was observed during the study period.