Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for Type 2 diabetes and obesity due to their cardiometabolic benefits. However, their effects on fracture healing remain controversial. This study investigates perioperative GLP-1 RA use and outcomes following surgical treatment of lower extremity (LE) fractures. A retrospective analysis utilizing a large multicenter database compared patients on GLP-1 RAs within one year prior to and after lower extremity index surgery (+GLP) with those not on GLP-1 RAs (-GLP). Propensity score matching was performed on 275,970 included patients, matching 1:1 on age, sex, tobacco use, diabetes mellitus, primary hypertension, hyperlipidemia, chronic ischemic heart disease, chronic lower respiratory disease, and body mass index (BMI), resulting in 6125 "best-matched" patients per group. This was conducted utilizing multivariate logistic regression with a 0.1 caliper. Outcomes were assessed at 1 month, 3 months, and 1 year. At 1-year follow-up, GLP-1 RA users demonstrated a significantly higher rate of nonunion compared to matched controls (5.4% vs 4.4%, Risk Ratio 1.2, 95% CI 1.0-1.4, P < 0.05) when assessing patients who also continued GLP-1 RAs postoperatively. There were no significant differences in wound dehiscence, deep or superficial surgical site infections, or hematoma. Importantly, the +GLP group experienced significantly lower rates of cardiac arrest (0.8% vs 1.6%, RR 0.5, 95% CI 0.3-0.7, P < 0.01) and all-cause mortality (4.4% vs 8.0%, RR 0.5, 95% CI 0.4-0.6, P < 0.01). Perioperative GLP-1 RA use was associated with a higher risk of nonunion following lower extremity fracture surgery, though without increased wound complication rates. Importantly, GLP-1 RA use was linked to reduced cardiac arrest and mortality within one year. These findings suggest that while the increased rate of nonunion is statistically significant, its clinically significance is limited. Thus, the mortality reduction may be more clinically meaningful for patient counseling and perioperative management. Further study is required to clarify the balance between systemic benefits and surgical outcomes of GLP-1 RAs in orthopedic trauma.

Spinal tumors present complex clinical challenges due to their proximity to vital neurological structures. Conventional open surgery may be associated with notable complications, contributing to a growing interest in minimally invasive approaches. This systematic review explored the role, safety, and effectiveness of full-endoscopic spine surgery in managing spinal tumors. A thorough literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across PubMed, EMBASE, and CINAHL databases. Recent studies describing full-endoscopic spinal tumor procedures and clinical outcomes, including pain relief, neurological improvement, surgical complications, and recovery metrics, were selected. Ten studies involving 65 patients, all retrospective case series or case reports, met the inclusion criteria. Most of the procedures involved gross total tumor resection with various endoscopic approaches. Postoperative outcomes demonstrated significant reductions in pain scores and improvement or stability in neurological function across nearly all patients. The average surgery duration was 121 minutes, estimated blood loss ranged from minimal to 100 mL, and hospital stays averaged 71 hours. Complication rates following full-endoscopic spinal surgeries were low and primarily transient, and no tumor recurrences or reoperations were noted within the follow-up period averaging 16.4 months. Full-endoscopic spine surgery appears to be a relatively safe and effective minimally invasive technique that is being increasingly adopted for selected spinal tumors. Preliminary evidence suggests a favorable safety profile, including reduced surgical trauma, decreased blood loss, shortened hospital stays, as well as accelerated recovery. Nevertheless, its broader use remains limited by the steep learning curve for spine surgeons, the rarity of spinal tumors, and a lack of larger prospective studies.

Frailty is a known critical determinant of surgical outcomes. However, it lacks routine integration into total knee arthroplasty (TKA) risk assessment. This study evaluated the association between preoperative frailty, measured by the 5-factor modified frailty index (mFI-5), and adverse medical and surgical outcomes following TKA. This retrospective cohort analysis utilized a large national database (2003 to 2020), including patients ≥ 50 years undergoing primary TKA. Patients were stratified by mFI-5 score: non-frail (0 to 1), moderately frail (2), and severely frail (≥ 3). Propensity score matching (1:1) balanced cohorts for age, sex, race, and body mass index. Outcomes included 90-day medical and surgical complications, 2- and 5-year surgical outcomes (revision, periprosthetic fracture, mechanical complications, and infection), mortality, and healthcare utilization (readmissions and emergency department [ED] visits). Relative risks (RR) with 95% confidence intervals (CI) were calculated, applying Bonferroni corrections (significance P < 0.0167). Frailty severity demonstrated a clear graded increase in complications. Severely frail patients had significantly higher 90-day risks of mortality, myocardial infarction, acute kidney failure, pneumonia, sepsis, anemia, falls, readmissions, and ED visits compared with non-frail patients (all P < 0.0167). Surgical risks similarly increased over time, with severely frail patients showing higher 5-year rates of revision, periprosthetic joint infection, mechanical complications, and periprosthetic fracture. Moderately frail patients demonstrated complication patterns that fell between those of non-frail and severely frail groups. Frailty was also associated with increased 2- and 5-year mortality. The mFI-5 effectively stratifies TKA patients by frailty severity and reveals a dose-dependent relationship with adverse outcomes. Moderate and severe frailty independently predict increased 90-day, 2-year, and 5-year morbidity, mortality, and healthcare use. Integrating mFI-5 into preoperative assessment may benefit orthopaedic surgeons in targeted optimization and counseling to mitigate risks in high-risk TKA patients.

Introduction: Preoperative methicillin-resistant Staphylococcus aureus (MRSA) colonization is a known risk factor for surgical site infections (SSIs) in orthopaedic procedures. However, its impact on a comprehensive range of postoperative complications, particularly in elective lumbar spine surgery (LSS), remains unexplored. This study evaluated the association between preoperative MRSA colonization and a comprehensive set of 30-day postoperative outcomes in patients undergoing LSS. Materials and methods: A retrospective cohort study was conducted using the TriNetX multi-institutional database, including 440,336 patients undergoing elective LSS. Patients were stratified into MRSA-colonized ( n = 3,711; 0.84%) and non-colonized controls ( n = 436,625). Propensity score matching (1:1) adjusted for demographics and comorbidities (age, race, sex, obesity, diabetes, tobacco use, malnutrition, chronic kidney disease), yielding balanced cohorts of 3,706 patients each. Primary outcomes included 30-day mortality, SSIs, systemic infections (sepsis, pneumonia), hematologic complications (anemia, transfusions), renal failure, and thromboembolic events. Risk ratios (RR) with 95% confidence intervals were calculated. Results: MRSA-colonized patients exhibited significantly higher complication risks versus matched controls: Wound complications: superficial SSI (RR = 2.291, p < 0.01), deep SSI (RR = 2.566, p < 0.01), wound dehiscence (RR = 1.722, p < 0.01). Systemic Infections: sepsis (RR = 2.865, p < 0.001), pneumonia (RR = 2.212, p < 0.001). Hematologic/renal events: transfusion (RR = 2.382, p < 0.001), anemia (RR = 2.826, p < 0.001), acute kidney failure (RR = 2.344, p < 0.001). Mortality: all-cause mortality was 2.05-fold higher (RR = 2.046, p < 0.01). Demographic analysis identified five major risk factors: obesity, diabetes, tobacco use, malnutrition, and chronic kidney disease (CKD) as independent predictors of MRSA colonization. Conclusions: Preoperative MRSA colonization is independently associated with significantly elevated risks of mortality, wound complications, systemic infections, hematologic morbidity, and acute renal injury after elective LSS. Clinically, preoperative recognition of MRSA colonization could prompt implementation of multimodal decolonization protocols and targeted counseling regarding heightened complication risks. This risk-stratified approach may optimize perioperative management and improve outcomes in high-risk LSS patients.

Background: With the widespread legalization and rising prevalence of cannabis use, understanding its impact on perioperative outcomes has become clinically critical. Although recent orthopaedic research has examined cannabis-related risks following various procedures, its implications following surgical fixation of ankle fractures remain unexplored. Given the increasing incidence and complexity of ankle fractures, clarifying these risks is essential for effective perioperative management and patient counseling. Methods: A retrospective cohort analysis was conducted using a nationally representative research database. Patients undergoing open reduction and internal fixation (ORIF) for rotational ankle fractures were identified using standardized Current Procedural Terminology ( CPT ) codes and stratified by preoperative active cannabis use. Propensity score matching (PSM) was used to control for 27 demographic and clinical confounders; data were drawn from the TriNetX Research Network; postmatch balance is reported. Outcomes assessed included medical complications and health care utilization at 90 days and 6 months, and surgical outcomes at 3 years postoperatively. Relative risks (RRs) with 95% confidence intervals were calculated. To account for multiple testing across 34 outcomes, a Bonferroni correction was applied, with statistical significance defined as P < .0015. Results: After PSM, 3126 matched pairs were included in the analysis. At 90 days postoperatively, cannabis use was significantly associated with increased risks of postoperative infection (RR = 1.696, 95% CI 1.230-2.337, P < .001), wound dehiscence (RR = 1.781, 95% CI 1.268-2.502, P < .001), and inpatient readmissions (RR = 1.724, 95% CI 1.221-2.435, P < .001). These associations persisted at 6 months, including elevated risks of postoperative infection (RR = 1.745, 95% CI 1.304-2.337, P < .001), sepsis (RR = 2.847, 95% CI 1.477-5.488, P < .001), and hardware infection (RR = 1.944, 95% CI 1.291-2.929, P < .001). At 3 years, the cannabis-use cohort was associated with significantly increased risks of nonunion (RR = 2.308, 95% CI 1.207-4.413, P < .001) and reoperation (RR = 2.168, 95% CI 1.353-3.475, P < .001). No significant differences were observed for other measured outcomes following Bonferroni adjustment. Conclusion: Preoperative cannabis use is associated with significantly increased complications following ankle ORIF, notably systemic and hardware infections, nonunion, and reoperation. These findings support recognizing cannabis use as a potentially modifiable perioperative risk factor, akin to tobacco use, underscoring the importance of targeted counseling and strategies aimed at optimizing surgical and patient outcomes.