Methods: Using the most recent pre-COVID National Inpatient Sample (2016–2019), we evaluated inpatient mortality and economic impact after elective primary total hip arthroplasty (THA) across 327,123 cases (1,635,615 weighted discharges).Results: Overall inpatient mortality was 0.04%, but was higher in patients ≥ 80 years (0.15%), with weekend admissions (0.10%), and with surgical delay ≥ 1 day (0.17%). Comorbidities with the greatest mortality association included congestive heart failure and chronic kidney disease (both with markedly elevated odds), and acute in-hospital complications (e.g., pulmonary embolism) carried substantial risk. Complications also increased resource use; for example, heart failure, pulmonary edema, and acute coronary artery disease were each associated with significantly higher costs and prolonged length of stay. Conclusion: These findings provide a contemporary, pre-pandemic national baseline that quantifies high-risk subgroups and the economic footprint of adverse events, supporting targeted perioperative strategies and hospital planning for elective THA.

Introduction: Cervical disc disease is a common cause of disability worldwide. Two surgical options for refractory CDD are anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA). While ACDF is well established, CDA offers motion preservation and has shown promising outcomes. This study compared utilization trends, patient characteristics, and hospitalization outcomes of ACDF and CDA using a large national dataset. Methods: We analyzed patients in the Nationwide Inpatient Sample (2016–2019) undergoing ACDF or CDA, identified using ICD-10 codes. After exclusions, 97,999 patients were included. Propensity score matching yielded 11,415 pairs, enabling balanced comparisons of demographics, comorbidities, complications, length of stay (LOS), and hospital charges. Results: CDA utilization increased during the study period. Compared with ACDF, CDA patients were younger and more likely to have private insurance. Following matching, both groups were demographically similar. CDA was associated with a slightly shorter LOS (1.32 vs. 1.39 days) but significantly higher charges (USD 82,431 vs. USD 58,472). In terms of complications, dysphagia was more frequent after ACDF, whereas cervical spinal cord injury and urinary tract infections were slightly more common after CDA, though rare overall. Conclusions: CDA is increasingly adopted in younger, privately insured patients and demonstrates comparable safety with ACDF. Its advantages include motion preservation, shorter hospitalization, and lower dysphagia rates, though at the expense of higher costs. These findings support the selective use of CDA as a viable alternative to ACDF in appropriately chosen patients.

Introduction: Femoral neck fractures pose significant health risks, particularly in the elderly population, leading to mortality, morbidity, and decreased quality of life. Surgery is the preferred treatment to restore function and alleviate pain, with options including total hip arthroplasty (THA) and hemiarthroplasty (HA). However, clinical guidelines for selecting surgical procedures remain heterogeneous, prompting the need for further investigation into treatment trends and influencing factors. Methods: Data from the NIS database spanning 2016–2019 were analyzed, focusing on patients diagnosed with intracapsular femoral neck fractures and undergoing THA or HA as primary in-hospital surgeries. Advanced statistical analyses using SPSS and MATLAB were conducted to identify trends and factors influencing surgical choices. Results: Comorbidity profiles varied significantly between HA and THA patients, with specific conditions such as Alzheimer’s disease showing higher prevalence in HA patients. Demographic differences included a higher proportion of females and Medicare-insured individuals in the HA group. Racial disparities were observed, with differences in surgical preferences among various ethnic groups. THA adoption gradually increased over the study period, indicating a shift in surgical priorities. Additionally, THA patients tended to be younger on average compared with HA patients. Conclusions: This study highlights evolving trends in surgical management for femoral neck fractures and identifies factors influencing treatment decisions in our cohort. Understanding these trends and disparities is crucial for optimizing patient care and informing future clinical guidelines. Further research should focus on assessing different surgical approaches’ long-term outcomes and cost-effectiveness.

Background: Whether coded rheumatoid arthritis (RA) among patients undergoing elective total hip arthroplasty (THA) is associated with excess short-term inpatient morbidity in contemporary U.S. practice remains uncertain. Methods: We performed a retrospective cohort study using the National Inpatient Sample (2016–2021). Adults undergoing elective primary THA were identified using ICD-10-CM/PCS codes. The exposure cohort included admissions with coded RA in any diagnosis position. The comparator cohort included admissions with narrow primary hip osteoarthritis (OA) as the principal diagnosis and no RA. Propensity scores were estimated from demographic, socioeconomic, hospital, and comorbidity variables. Inverse probability of treatment weighting (IPTW) with survey weighting was used for the primary analysis, followed by doubly adjusted regression models that included age and all variables with persistent post-weighting imbalance greater than 0.10 (female sex, osteoporosis, chronic obstructive pulmonary disease, chronic anemia, depression, and race). Additional sensitivity analyses included stricter weight truncation, a restriction analysis, conventional multivariable modeling, and sex-stratified analyses addressing residual sex imbalance. Results: A total of 274,582 admissions met eligibility criteria; 274,539 were included in the final analytic cohort after exclusion of 43 records with missing or invalid propensity-weight inputs. The analytic cohort included 7,264 RA admissions and 267,275 OA admissions. In the primary weighted analysis, RA was associated with higher odds of acute blood loss anemia (OR 1.30, 95% CI 1.23–1.38), red blood cell transfusion (OR 1.40, 95% CI 1.23–1.60), acute kidney injury (OR 1.47, 95% CI 1.26–1.71), non-home discharge (OR 1.27, 95% CI 1.19–1.36), and a composite hematologic/renal in-hospital complication (OR 1.31, 95% CI 1.24–1.39).RA was also associated with slightly longer length of stay (+ 0.14 days, 95% CI + 0.10 to + 0.19) and modestly higher total hospital charges (+$1,018, 95% CI +$89 to +$1,947). Findings were directionally consistent across sensitivity analyses, including stricter weight truncation, restriction to admissions with principal OA plus concomitant RA, and sex-stratified analyses. Conclusions: In this contemporary national THA cohort, coded RA was associated with a small but consistent increase in in-hospital complication and resource-utilization burden compared with OA. These findings should be interpreted as adjusted associations rather than causal effects, and the modest effect sizes should not be overstated. They may provide context for perioperative risk assessment and discharge planning among patients with coded RA undergoing elective THA.

Introduction: Cut-out is the most consequential mechanical complication after proximal femoral nailing and requires prompt recognition. General-purpose artificial intelligence (AI) models with image-interpretation capability are increasingly accessible, yet their diagnostic performance for this task is unknown. We evaluated ChatGPT’s accuracy for predicting cut-out following proximal femoral nailing and compared TFNA and Gamma nail subgroups. Materials and methods: In this retrospective predictive-accuracy study, 989 patients (683 TFNA, 306 Gamma nail; mean age 83.8 years; cut-out prevalence 2.5%) were analysed. For each case, three baseline radiographs — the injury anteroposterior and lateral views and the immediate postoperative control radiograph, all obtained before any complication could be radiographically present — together with the full clinical data set (excluding complication-related information) were submitted to ChatGPT, which returned a binary prediction (yes/no) and probability estimate (0–100%). The follow-up radiographs on which cut-out becomes apparent were not provided to the model. Ground truth was established on subsequent follow-up radiographs by a departmental review board requiring agreement of two senior surgeons. Accuracy metrics were calculated with Wilson 95% confidence intervals (CI); exact McNemar’s and Mann-Whitney U tests assessed directional bias and calibration. Reporting followed STARD guidelines. Results: ChatGPT showed a sensitivity of 68.0% (95% CI 48.4–82.8%), specificity of 62.7% (59.6–65.7%), PPV of 4.5% (2.8–7.1%), NPV of 98.7% (97.4–99.3%), and AUC of 0.694 (0.580–0.790). Performance was higher for TFNA (sensitivity 73.7%, AUC 0.730) than for Gamma nail (sensitivity 50.0%, AUC 0.606). The model over-predicted cut-out, with 360 false positives against 8 false negatives (45:1; McNemar’s p < 0.001, Holm-corrected). Calibration was inverted: the median predicted probability was lower for correct (9%) than for incorrect (40%) classifications (Mann-Whitney p < 0.001). Conclusions: ChatGPT demonstrated limited, clinically insufficient accuracy for predicting cut-out following proximal femoral nailing, with a prohibitive false-positive burden and inverted calibration. Subgroup point estimates were lower for Gamma nail cases, but this exploratory difference did not reach statistical significance. General-purpose AI models are not currently suitable as a substitute for, or adjunct to, surgeon-led surveillance of this complication. Task-specific training, external validation, and defined clinical boundaries are required before such tools can be considered for fracture follow-up pathways.

Introduction: Cervical disc diseases (CDD) are a significant cause of disability and diminished quality of life globally, with prevalence increasing with age. Two common surgical interventions for symptomatic CDD patients who do not respond to conservative treatments are Anterior Cervical Discectomy and Fusion (ACDF) and Cervical Disc Arthroplasty (CDA). While ACDF is more established and has a more extended history of use, CDA has been gaining popularity due to its motion-preserving benefits and comparable, if not superior, long-term outcomes. This study aims to compare these two procedures using a comprehensive dataset of 97,999 patients, focusing on patient demographics, complications, costs, length of hospital stay, and mortality rates to contribute valuable insights that can inform clinical practice and healthcare policy. Methods: In this study, data were sourced from the Nationwide Inpatient Sample (NIS) database, covering the period from January 1st, 2016, to December 31st, 2019. The dataset comprised 97,999 patients, with 85,584 undergoing ACDF and 11,415 CDA. Patients were identified using ICD-10 codes, with exclusions for non-elective admissions and surgeries performed prior to admission. Statistical analyses, including crosstabs and t-tests, were conducted, with a significance level of p < 0.05. Propensity score matching was utilized to control selection bias, resulting in a refined cohort of 11,415 matched pairs. Comorbidities and clinical outcomes were analyzed using the NIS dataset, including mortality, length of stay, complications, and hospitalization costs. Results: The study observed a significant increase in the utilization of CDA surgeries compared to ACDF from 2016 to 2019. ACDF patients were older (55.6 vs. 47.2 years, P< 0.001) and more likely to have Medicare coverage (33.9% vs. 10.7%, P< 0.001). Comorbidities such as hypertension, dyslipidemia, and diabetes mellitus were more prevalent in ACDF patients (P< 0.001). Propensity score matching balanced both groups, confirming comparable demographic and comorbidity profiles, with no significant differences in major conditions like hypertension (P=0.59) and dyslipidemia (P=0.93). Hospitalization outcomes revealed a slightly longer length of stay for ACDF (1.39 vs. 1.32 days, P< 0.001), while CDA incurred higher mean charges ($82,431 vs. $58,472, P< 0.001). Postoperatively, ACDF patients experienced more dysphagia (4.90% vs. 3.60%, P< 0.001), venous thromboembolism (0.13% vs. 0.04%, P=0.03), and sepsis (0.04% vs. 0.00%, P=0.03). Cervical spinal cord injury and urinary tract infections were more frequent in the CDA group (P=0.04 and P=0.02, respectively). Conclusions: This study highlights a growing trend in favor of CDA, particularly among younger patients and those with private insurance. The advantages of motion preservation, reduced adjacent-segment disease, shorter hospital stays, and lower complication rates make CDA an increasingly viable alternative to traditional ACDF, despite its higher initial costs. These findings align with recent literature, further supporting the adoption of CDA in appropriate patient populations.