Background: Total elbow arthroplasty (TEA) was initially introduced for end-stage rheumatoid arthritis but has since expanded to include osteoarthritis and complex distal humerus fractures, particularly in elderly patients. Over the past two decades, TEA utilization trends have fluctuated, with a recent decline attributed to advancements in disease-modifying antirheumatic drugs. Despite its benefits, TEA presents a high complication rate, necessitating further investigation into clinical outcomes, costs, and postoperative management. Methods: This retrospective cohort study analyzed TEA procedures from 2016 to 2019 using the National Inpatient Sample (NIS) database. Patients were identified via ICD-10 codes, with elective procedures included to ensure homogeneity. This study examined temporal trends, patient demographics, comorbidities, complication rates, length of stay (LOS), and hospitalization costs. Statistical analyses included chi-square tests, t-tests, and multivariate regression to assess associations between patient characteristics and outcomes. Results: A total of 4110 TEA procedures were analyzed, revealing a 16% decline in annual volume from 2016 to 2019 (p = 0.012). The cohort had a mean age of 65.99 years, with a predominance of female (75.3%) and White (72.6%) patients. The median LOS was two days, and median hospitalization costs were USD 78,473 (IQR: 56,935–115,671 USD). The most prevalent complications included mechanical loosening (12.5%), blood loss anemia (10.6%), cardiac complications (5.7%), and prosthetic-related pain (3.3%). Multivariate analysis identified hypertension, anemia, and respiratory disease as significant predictors of adverse outcomes. Conclusions: TEA utilization has declined, likely due to medical advancements in rheumatoid arthritis management. The procedure remains associated with substantial complication rates, particularly in trauma-related cases. Findings highlight the importance of patient optimization, surgical expertise, and postoperative monitoring to improve outcomes.

Background: Opioid dependence is prevalent among patients undergoing lumbar spinal fusion and has been linked to poor postoperative outcomes. However, its specific impact on surgical complications and hospital resource utilization remains unclear. This study evaluates the association between opioid dependence and postoperative complications, length of stay (LOS), and hospital charges in lumbar fusion patients. Methods: A retrospective analysis was conducted using the National Inpatient Sample (NIS) database from 2016 to 2021. Adult patients (aged > 18 years) who underwent lumbar fusion surgery were identified and categorized based on opioid dependence using ICD-10 codes. Propensity score weighting (PSW) was employed to balance baseline characteristics. Primary outcomes included inpatient mortality, LOS, hospital charges, and postoperative complications. Statistical analyses were performed using survey-weighted generalized linear models. Results: Among 597,455 lumbar fusion patients, 7715 (1.3%) had documented opioid dependence. After PSW, opioid-dependent patients had significantly increased odds of blood loss anemia (OR 1.79, p < 0.001), respiratory complications (OR 2.17, p < 0.001), surgical site infections (OR 3.94, p = 0.001), and cardiac complications (OR 1.53, p = 0.002). They also had higher hospital charges (mean difference USD 17,739.2, p < 0.001) and prolonged LOS (mean difference 0.83 days, p < 0.001). Differences in urinary tract infections, acute renal failure, and stroke were not statistically significant after PSW. Conclusions: Opioid dependence is associated with increased postoperative complications, longer hospital stays, and higher healthcare costs in lumbar fusion patients. These findings highlight the need for improved perioperative pain management and opioid stewardship strategies to optimize surgical outcomes.

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: 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.