John Schoeneman Vorhies

All Publications

• Anterior release is not needed to restore kyphosis in moderate AIS with hypokyphosis. Spine deformity Louer, C. R., Pennings, J. S., Petcharaporn, M., Hariharan, A. R., Vorhies, J. S., Kelly, M. P., Shah, S. A., Newton, P. O., Yaszay, B., Group, H. S. 2025

  Abstract

  PURPOSE: The purpose of this study is to evaluate if AR offers improved 3D kyphosis restoration during PSF for hypokyphosis in moderate AIS (<70° coronal cobb), where the decision for AR is likely driven by sagittal concerns.METHODS: A multicenter pediatric spine registry was queried for hypokyphotic (<10°) Lenke 1-4 AIS patients aged<20years with>2-year surgical follow-up. Coronal curves were limited to<70°. A linear mixed model was created to predict 2-year 3D kyphosis by treatment and pre-op 3D kyphosis, while controlling for age, sex, thoracic coronal deformity and flexibility, osteotomy use, implant characteristics, surgery recency, and surgeon.RESULTS: 1384 patients were included with 53 (3.8%) undergoing PSF+AR. Mean preop 3D kyphosis was similar between PSF and PSF+AR groups (-3.7° vs. -0.5°; p=0.08). PSF-AR had similar 2-year 3D kyphosis (23.0° [95% CI 20.5-25.4°] vs. 23.3° [22.9-23.6°]) and correction (26.7° [23.3-29.9°] vs. 23.7° [23.3-24.2°]) compared to PSF. When controlling for covariates, the models demonstrated no difference between approach (p=0.058) or interaction of approach and preop 3D kyphosis (p=0.31). Post-hoc power analysis showed an adequate sample size to detect a difference of 5° between approaches. PSF+AR had longer surgical times (324 vs. 266min, p<0.001) though no significant increase in overall complications (17% vs. 12.4%) compared to PSF alone.CONCLUSION: In AIS patients with coronal curve<70° and 3D hypokyphosis of 10 to -40°, treatment with PSF+AR did not improve 2-year sagittal correction more than PSF alone. Surgeon identity and surgery recency influenced post-operative kyphosis more than any other patient or surgical factor.

  View details for DOI 10.1007/s43390-025-01119-7

  View details for PubMedID 40459687

• Bedside Aspiration for Workup of the Pediatric Septic Hip: Avoid Trips to the OR and Expedited Time to Diagnosis. Journal of pediatric orthopedics Skaggs, K. F., Okoli, O., Naz, H., Pham, N. S., Vorhies, J. S., Tileston, K. R. 2025

  Abstract

  Septic arthritis of the hip is a pediatric orthopaedic emergency. Joint synovial fluid aspiration is a critical step of diagnosis, which may be delayed due to limited personnel or operating room (OR) availability. To expedite diagnosis, orthopaedic residents perform ultrasound-guided bedside arthrocentesis in the emergency department (ED). This study aims to evaluate the impact of this practice on time to diagnosis and definitive treatment of septic arthritis of the hip and minimizing trips to the operating room.This is a retrospective study of patients presenting to our pediatric orthopaedic tertiary care emergency room requiring a hip aspiration to rule out septic arthritis between 2003 and 2023. We identified all patients who had resulted hip synovial fluid nucleated cell count during the above time period. Chart review was performed to determine how synovial fluid was collected via interventional radiology (IR), in the OR with an orthopaedic surgeon, or via bedside aspiration with the on-call resident. Clinical outcomes were primarily defined as time points in clinical care. Patient demographics, Kocher criteria values, time to aspiration, and final treatment are presented. Kruskal-Wallis and Fisher exact tests were used to compare demographic and clinical differences in RStudio using a two-sided level of significance of 0.05.Hip aspiration was performed in the workup of septic arthritis in 57 patients (median age 5.1 y; 58% female). Aspiration occurred in the ED for 28 patients, interventional radiology (IR) for 11, and in the OR for 18 patients. Bedside aspiration avoided a trip to the OR for 15 patients (54%). Median time to obtaining joint fluid was significantly shorter for patients undergoing bedside or IR-guided aspiration compared with OR aspiration (7.4 vs. 5.3 vs. 15.7 h, respectively; bedside vs. OR P=0.007, IR vs. OR P=0.013). Time from presentation to OR for open surgical debridement, total operative time, and the percentage of patients requiring open surgical debridement did not significantly differ between groups.Bedside aspiration decreases the time to diagnosis of septic arthritis and can prevent ~50% of children from going to the OR. This is beneficial for the patient as it may allow for earlier antibiotic administration, provide pain relief, and avoid possible complications of general anesthesia.Level III-retrospective chart review.

  View details for DOI 10.1097/BPO.0000000000002996

  View details for PubMedID 40391565

• Smartphone-based surface topography app accurately detects clinically significant scoliosis. Spine deformity Rohde, M. S., Albarran, M., Catanzano, A. A., Sachs, E. J., Naz, H., Jobanputra, A., Ribet, J., Tileston, K., Vorhies, J. S. 2025

  Abstract

  The purpose of this study was twofold: (1) to validate the predictive capabilities of the Scoliosis Assessment App using ST technology against X-ray "ground truth" in patients being evaluated for clinically significant scoliosis; and (2) to compare the diagnostic accuracy of the App versus the commonly used scoliometer tool.A multicenter, prospective validation study was conducted among patients with known or suspected scoliosis. The App determined an Asymmetry Index to predict the likelihood of clinically significant disease (MCM ≥ 20°) as determined by X-ray. Outcomes included the sensitivity, specificity, and area under the receiver operating characteristic curve (ROC AUC) associated with the Apps prediction of clinically significant disease.Fifty-five patients were evaluated with a mean age of 13.6 ± 2.1 years. The App correctly classified 91% (50/55) of the patients compared to 69% (38/55) for the scoliometer. The sensitivity of the App was 96.4% (89.6-100% CI) versus 50% (28.1-71.9% CI) for the scoliometer (P < 0.05), while the specificity values were 85.2% (71.8-98.9% CI) and 88.9% (74.4-100% CI), respectively. ROC analysis indicated a statistically significant difference in accuracy (AUC) in favor of the App (95% versus 71%; P = 0.015).The Scoliosis Assessment App using ST technology offers an accurate, accessible, and non-ionizing method of detecting clinically significant scoliosis, suggesting that the App can be used for detection and monitoring as an alternative to radiography and as a replacement for scoliometer without diminishing the standard of care. Further studies are required to assess variations of sensitivity in a large cohort of patients and clinical utility as an alternative to radiographs.

  View details for DOI 10.1007/s43390-025-01062-7

  View details for PubMedID 40172834

  View details for PubMedCentralID 5759132

• Delayed-Onset Neurologic Changes Following Posterior Spinal Fusion: A Case Series. The Journal of bone and joint surgery. American volume Fletcher, N. D., Harris, H., Fabregas, J., Vorhies, J. S., Sponseller, P. D., Lonner, B. A., George, S. G., Garg, S., Lovejoy, J. F., Vitale, M. G., Ramo, B. A., El-Hawary, R., Jain, V. V., Bauer, J. M. 2025

  Abstract

  Delayed-onset neurologic changes (DONCs) following spinal deformity surgery are poorly understood and are often devastating.A retrospective review of cases from 12 hospitals was performed. The clinical and radiographic parameters of patients who experienced a new DONC after spinal deformity correction were evaluated.Eighteen patients, with a mean preoperative major Cobb angle of 75° ± 24°, were included. The mean age at surgery was 13 ± 2 years, and 6 patients (33%) were male. Seven patients had temporary intraoperative neuromonitoring changes. Fourteen patients (78%) had neurologic changes within 24 hours postoperatively (range, 3 to 24 hours). Of 16 patients with blood pressure data, 8 (50%) had at least 1 documented episode of hypotension surrounding the change in neurologic status. No misaligned implants were seen on axial imaging. Fourteen patients (78%) were treated with vasopressors. Sixteen patients (89%) returned to the operating room, and 11 patients (61%) underwent implant removal. Seven patients (39%) sustained a spinal cord infarct, with only 1 (6%) experiencing recovery beyond an ASIA (American Spinal Injury Association Impairment Scale) score of B. Ten (91%) of the 11 patients without an infarct demonstrated recovery (5 patients with an ASIA score of D and 5 with a score of E).A DONC is a rare complication of spinal deformity surgery. This study represents the largest documented series of DONCs and highlights the multifactorial and still poorly understood nature of this condition. The primary modifiable risk factor may be hypotension in the postoperative period: 50% of patients had a mean arterial pressure below the 5th percentile for their height, as documented around the time of the neurologic change. Eighty-six percent of patients with a spinal cord infarct had minimal neurologic recovery, whereas nearly all of the patients without an infarct did recover function. The management of this condition may include elevation of blood pressure with temporary implant removal.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  View details for DOI 10.2106/JBJS.24.00164

  View details for PubMedID 39951514

• Correction: Mobile device-based 3D scanning is superior to scoliometer in assessment of adolescent idiopathic scoliosis. Spine deformity Oquendo, Y., Hollyer, I., Maschhoff, C., Calderon, C., DeBaun, M., Langner, J., Javier, N., Bryson, X., Richey, A., Naz, H., Tileston, K., Gardner, M., Vorhies, J. S. 2025

  View details for DOI 10.1007/s43390-025-01046-7

  View details for PubMedID 39847213

• Mobile device-based 3D scanning is superior to scoliometer in assessment of adolescent idiopathic scoliosis. Spine deformity Oquendo, Y., Hollyer, I., Maschhoff, C., Calderon, C., DeBaun, M., Langner, J., Javier, N., Bryson, X., Richey, A., Naz, H., Tileston, K., Gardner, M., Vorhies, J. S. 2024

  Abstract

  Screening for adolescent idiopathic scoliosis (AIS) currently relies on clinical evaluations by trained practitioners, most commonly using a scoliometer. Modern structured light 3D scanning can generate high-quality 3D representations of surface anatomy using a mobile device. We hypothesized that a mobile-based 3D scanning system would provide accurate deformity assessments compared to a scoliometer.Between August 2020 and June 2022, patients 10-18 years being evaluated for AIS in our clinic with a scoliosis radiograph obtained within 30 days of clinic evaluation and no history of spinal surgery were enrolled. Patients had 3D scans taken in the upright and forward bend positions, and the largest angle of trunk rotation (ATR) was measured by a scoliometer. Image processing software was used to analyze trunk shift (TS), coronal balance (CB), and clavicle angle (CL) in the upright position and the largest ATR in the forward bend position. 3D and scoliometer measurements were correlated to major curve magnitude. Multiple logistic regression models were created based on 3D and scoliometer measurements, controlling for demographic covariates.Two hundred and fifty-eight patients were included in this study. Mean coronal major curve magnitude was 25.7° (range 0-100), and 59% had a thoracic major curve. There were good-to-excellent correlations between 3D and radiographic measures of TS, CB, and CL (r = 0.79, rs = 0.80, and r = 0.64, respectively, p < 0.001). Correlations between 3D and radiographic measures of largest lumbar and thoracic ATR also demonstrated good correlations (r = 0.64 for both, p < 0.001). Using Akaike's Information Criterion (AIC), a multivariable logistic regression model based on 3D scanning outperformed a scoliometer model.Mobile device-based 3D scanning of TS, CB, and TS identifies clinically relevant scoliotic deformity and is more predictive of radiographic curve magnitude than scoliometer in this population. This new modality may facilitate scoliosis screening by decreasing the need for trained personnel or dedicated equipment and clinical space to perform screening tests.II.

  View details for DOI 10.1007/s43390-024-01007-6

  View details for PubMedID 39663336

  View details for PubMedCentralID 3913566

• Impact of Surgical Upper Lumbar Changes on Unfused Lower Lumbar Segments in Adolescent Idiopathic Scoliosis. Spine Hariharan, A. R., Bryan, T., Nugraha, H. K., Feldman, D. S., Vorhies, J. S., Louer, C. R., Newton, P. O., Shah, S. A., Shufflebarger, H. L., Fletcher, N. D., Lonner, B. S., Kelly, M. P., Harms Study Group, Larson, A. N., Buckland, A., Alanay, A., Samdani, A., Jain, A., Lonner, B., Roye, B., Yaszay, B., Yilgor, C., Hoernschmeyer, D., Hedequist, D., Sucato, D., Clements, D., Miyanji, F., Shufflebarger, H., Flynn, J., Mac Thiong, J. M., Murphy, J., Pahys, J., Bachmann, K., Neal, K., Blakemore, L., Haber, L., Lenke, L., Abel, M., Erickson, M., Glotzbecker, M., Kelly, M., Vitale, M., Marks, M., Gupta, M., Fletcher, N., Cahill, P., Sponseller, P., Gabos, P., Newton, P., Sturm, P., Betz, R., Cho, R. H., Parent, S., George, S., Hwang, S., Shah, S., Garg, S., Errico, T., Upasani, V. 2024

  Abstract

  STUDY DESIGN: Retrospective review.OBJECTIVE: To determine the impact of upper lumbar lordosis changes in the fused segment on compensatory kyphotic or lordotic changes in the unfused lower lumbar spine in patients with Adolescent Idiopathic Scoliosis (AIS).SUMMARY OF BACKGROUND DATA: While the distribution of lordosis and interplay between fused/unfused segments has been studied in adults, less is known about this in AIS. We hypothesize that increased FSLL can result in compensatory kyphosis of the unfused distal segments.METHODS: A retrospective review of Lenke 1/2 patients who underwent posterior spinal fusion (PSF) to L1, L2, or L3 with a minimum follow-up of two years. Coronal Cobb angles, thoracic kyphosis, lumbar lordosis, and spino-pelvic parameters (T4PA, L1PA, PT, SS, PI, PI-LL, SVA) were measured. Custom MATLAB scripts were used for 3D segmental lordosis calculations. Statistical analysis including linear regression analyses and interaction models assessed the relationship between fused segment lumbar lordosis (FSLL), LIV, and thoracic kyphosis (TK) on lower lumbar compensatory alignment.RESULTS: 158 patients met inclusion criteria. Changes in FSLL affected segmental lordosis of unfused segments, including loss of distal lordosis. In the L1 LIV group, increased FSLL increased L1-L2 lordosis (B=0.35 (P=0.003)). In LIV L2, increased FSLL increased L3-4 lordosis (B=0.2 (P=0.001)) and decreased L4-L5 lordosis (B=-0.23 (P=0.012). For LIV L3, increased FSLL caused reduction in lordosis of L4-5 (B=-0.14 (P=0.026)) and L5-S1 (B=-0.14 (P=0.034)). Changes in TK also had varying impacts on the unfused segments. The interaction model with LIV levels reveals that the compensation strategy can vary depending on specific fusion levels, although not significant. Overall sagittal alignment was maintained and PI-LL remained <10°. Pre- and postoperative T4-L1PA had minimal difference to each other indicating maintained sagittal harmony.CONCLUSIONS: In this observational study of segmental changes in lumbar lordosis in AIS, post-operative changes in the fused segments can result in iatrogenic changed in the unfused lower segments to maintain spinal balance. Understanding normal segmental lumbar lordosis distribution is critical in surgical planning (i.e. rod contouring) and in understanding the health of the unfused segments long term.

  View details for DOI 10.1097/BRS.0000000000005240

  View details for PubMedID 39668798

• Reply: Peripheral Nerve Blocks and Opioid Use After ACL Reconstruction in Adolescents. Orthopedics Vorhies, J. S. 2024; 47 (5): 262

  View details for DOI 10.3928/01477447-20240808-02

  View details for PubMedID 39284036

• Peripheral Nerve Blocks and Opioid Use After ACL Reconstruction in Adolescents ORTHOPEDICS Vorhies, J. 2024; 47 (5): 261-262

  View details for DOI 10.3928/01477447-20240808-01

  View details for Web of Science ID 001348283400009

  View details for PubMedID 39284037

• 3D CT modeling demonstrates the anatomic feasibility of S1AI screw trajectory for spinopelvic fixation in neuromuscular scoliosis. Spine deformity Bryson, X. M., Pham, N. S., Hollyer, I., Hu, S., Rinsky, L. A., Vorhies, J. S. 2024

  Abstract

  In patients with neuromuscular scoliosis undergoing posterior spinal fusion, the S2 alar iliac (S2AI) screw trajectory is a safe and effective method of lumbopelvic fixation but can lead to implant prominence. Here we use 3D CT modeling to demonstrate the anatomic feasibility of the S1 alar iliac screw (S1AI) compared to the S2AI trajectory in patients with neuromuscular scoliosis.This retrospective study used CT scans of 14 patients with spinal deformity to create 3D spinal reconstructions and model the insertional anatomy, max length, screw diameter, and potential for implant prominence between 28 S2AI and 28 S1AI screw trajectories.Patients had a mean age of 14.42 (range 8-21), coronal cobb angle of 85° (range 54-141), and pelvic obliquity of 28° (range 4-51). The maximum length and diameter of both screw trajectories were similar. S1AI screws were, on average, 6.3 ± 5 mm less prominent than S2AI screws relative to the iliac crests. S2AI screws were feasible in all patients, while in two patients, posterior elements of the lumbar spine would interfere with S1AI screw insertion.In this cohort of patients with neuromuscular scoliosis, we demonstrate that the S1AI trajectory offers comparable screw length and diameter to an S2AI screw with less implant prominence. An S1AI screw, however, may not be feasible in some patients due to interference from the posterior elements of the lumbar spine.

  View details for DOI 10.1007/s43390-024-00840-z

  View details for PubMedID 38733488

  View details for PubMedCentralID 8505341

• A New Look at Vertebral Body Tethering (VBT): Through the Modified Clavien-Dindo-Sink (mCDS) Classification. Journal of pediatric orthopedics Vorhies, J. S., Hauth, L., Garcia, S., Roye, B. D., Poon, S., Sturm, P. F., Glotzbecker, M., Fletcher, N. D., Stone, J. D., Cahill, P. J., Anari, J. B., Pediatric Spine Study Group 2024

  Abstract

  INTRODUCTION: Anterior vertebral body tethering (AVBT) is increasingly popular as an option for surgical treatment of idiopathic scoliosis (IS). While the technology remains new, it is important for families and patients to be able to compare it to the current standard of care, posterior spinal fusion (PSF). The purpose of this study is to describe the complication rate of AVBT in IS using the mCDS and to compare it to the recently reported complication rate of PSF in IS.METHODS: A multicenter pediatric spine deformity database was queried for all idiopathic scoliosis patients who underwent vertebral body tethering. There were 171 patients with a minimum 9-month follow-up included in this study. Complications were retrospectively graded by 2 attending pediatric spine surgeons using the mCDS classification system.RESULTS: Data from 171 patients with idiopathic scoliosis was available for analysis, with 156/171 (91%) of patients being female and an average age of 12.2 years old at surgery. There were 156 thoracic tethers (1 with an LIV below L2), 5 lumbar tethers, 9 staged double tethers, and only 1 patient with same-day double tether. Fifty-five (55) (32%) patients experienced a total of 69 complications. The most common complication type for VBT by mCDS was Grade IIIb, encompassing 29/69 (42%) of complications. The second most frequent complication grade was Grade I at 23/69 (33%). Thirty-four (34) out of 69 (49%) of the VBT complications reported required either procedural/surgical intervention or admission to the ICU.CONCLUSIONS: This is the first study to directly compare the complication profile of VBT to PSF using the mCDS. Forty-nine percent (49%) of the VBT complications reported were at least Grade III, while only 7% of complications in the control PSF cohort from the literature were Grade III or higher. The mCDS complication classification brings light to the early learning experience of a new technique compared to the widely accepted standard of PSF for IS.LEVEL OF EVIDENCE: III - Retrospective comparative study.

  View details for DOI 10.1097/BPO.0000000000002653

  View details for PubMedID 38454491

• Use of Peripheral Nerve Blocks Is Not Associated With Decreased Postoperative Opioid Prescription After ACL Reconstruction in Adolescents ORTHOPEDICS Kaur, J., Pham, N., Cahan, E., Halvorsen, K., Langner, J. L., Bryson, X. M., Chan, C. M., Vorhies, J. 2024; 47 (2): 83-88

  Abstract

  The rate of anterior cruciate ligament (ACL) injuries and reconstruction in pediatric patients is increasing. Perioperative peripheral nerve blocks (PNBs) are widely used for pain management in this population. We used a multi-state administrative claims database to describe the effect of PNB after ACL reconstruction on postoperative opioid consumption. We identified patients 10 to 18 years old undergoing primary ACL reconstruction between 2014 and 2016 in an administrative claims database. Patients filling an outpatient perioperative prescription for opioids with at least 1 year of follow-up were included. We stratified patients based on PNB. Our primary outcome was opioid prescription patterns (in morphine milligram equivalents [MMEs]) and incidence of opioid represcription. Of the 4459 cases, 2432 (54.5%) of the patients were given a PNB during ACL reconstruction while 2027 (45.5%) were not. Patients with PNB were prescribed more MMEs per day (76.1±41.7 vs 62.7±35.7 MMEs, P<.001), more pills (63.6±53.1 vs 54.4±40.6 pills, P<.001), higher MMEs per pill (10.0±9.5 vs 8.3±5.0 MMEs, P<.001), and more total MMEs (460.6±259.4 vs 355.7±215.1 MMEs, P<.001) than patients without PNB. Adjusting for prescription patterns and demographic variables with logistic regression, PNBs were associated with a 60% increase in the odds of opioid represcription within 30 days and a 32% increase in the odds of opioid represcription within 90 days. We demonstrated an increase in postoperative opioid prescription rates with PNB after ACL reconstruction. [Orthopedics. 2024;47(2):83-88.].

  View details for DOI 10.3928/01477447-20230616-05

  View details for Web of Science ID 001190541800001

  View details for PubMedID 37341565

• Cannabidiol Use Patterns and Efficacy for Children Who Have Cerebral Palsy ORTHOPEDICS Seltzer, R. A., Langner, J. L., Javier, N. M., Kaur, J., Shafau, A., Ezeonu, T., Bryson, X., Hastings, K., Tileston, K., Vorhies, J. S. 2024; 47 (1): 52-+

  Abstract

  Cannabidiol (CBD)-containing supplements are used by children with cerebral palsy (CP), but the prevalence and efficacy of their use have not been studied. We sought to describe CBD use patterns and perceived efficacy in the pediatric population with CP, evaluating any association between CBD use and health-related quality of life. Patients with CP were prospectively enrolled, and caregivers were offered the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) Questionnaire and a survey assessing CBD use. Of 119 participants, 20 (16.8%) endorsed CBD use (CBD+) and 99 (83.2%) denied it (CBD-). Participants in the CBD+ group had worse functional status (85% Gross Motor Function Classification System level IV-V for CBD+ vs 37.4% for CBD-, P<.001) and lower health-related quality of life (mean CPCHILD score of 49.3 for CBD+ vs 62.2 for CBD-, P=.001). Spasticity was the rationale most cited for CBD use (29%), followed by pain and anxiety (both 22.6%). CBD was perceived to be most effective for improving emotional health, spasticity, and pain. Fifty percent of the patients in the CBD+ group underwent surgery in the previous 2 years and most endorsed a general benefit in the postoperative setting. The most common side effects noted were fatigue and increased appetite (both 12%). Most participants endorsed no side effects (60%). CBD may serve as a useful adjunct for some children with CP, especially those with worse disease severity. Caregivers perceive CBD as offering some benefits, particularly in the domains of emotional health, spasticity, and pain. We found no evidence of severe adverse events in our small cohort. [Orthopedics. 2024;47(1):52-56.].

  View details for DOI 10.3928/01477447-20230517-06

  View details for Web of Science ID 001152481700018

  View details for PubMedID 37216564

• Variations in Duration of Clinical Follow-up After Spinal Fusion for Adolescent Idiopathic Scoliosis: A Survey of POSNA and SRS Membership. Journal of the Pediatric Orthopaedic Society of North America Johnson, T. R., Segovia, N. A., Bryson, X., Imrie, M. N., Vorhies, J. S. 2023; 5 (3): 645

  Abstract

  Background: There are currently no evidence-based guidelines addressing the optimal duration of follow-up after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Despite the safety and efficacy of PSF for AIS, long-term complications exist, including infection, pseudoarthrosis, adjacent segment disease, deformity progression, persistent pain, and junctional deformities. In this study, we describe practice variation existing among surgeons regarding duration and intervals of patient follow-up after surgical treatment of AIS in addition to factors influencing provider recommendations for duration of radiographic and clinical follow-up. This investigation of practice variation is important, as opportunities exist for both limiting unnecessary radiation exposure, while also identifying opportunities for timely intervention to help decrease the morbidity of late complications arising after spinal fusion.Methods: An anonymous online survey was created and subsequently distributed to members of POSNA and SRS to assess practice demographics and surgeon opinions surrounding duration of surveillance following surgery for AIS. Only surgeons who treated at least five operative AIS cases within the past year were included. Descriptive statistics and comparative sub-analyses are presented.Results: Forty-nine participants met inclusion criteria. Respondents were mainly pediatric orthopaedic surgeons (92%) in practice for 21-50 years (49%) who performed approximately 21-50 operative AIS cases per year (49%). Forty-eight percent of providers had an age limit in their practice, and 52% regularly followed operative AIS patients over 18 years of age. Sixty-two percent of surgeons followed operative AIS patients for 2-5 years postoperatively, whereas only 4% followed for more than 10 years. The most cited factors impacting follow-up recommendations were junctional deformities, adjacent segment disease, and symptomatic implants. There were no significant associations between years in practice, operative volume, and recommendations for duration of follow-up after routine operative AIS cases.Conclusions: Significant variability in duration of follow-up after PSF for AIS exists. Although most patients are clinically followed for 2 years after surgery, only a small percentage of providers follow AIS patients for more than 10 years postoperatively. Numerous AIS revisions occur more than 5 years after the index surgery. Further investigations to determine the optimal duration of surveillance following PSF for AIS should be conducted.Level of Evidence: V.•Late complications following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) may occur 5-10 years after the index surgery and currently, there are no guidelines that outline the optimal duration of postoperative follow-up.•Significant variability exists in pediatric orthopaedic provider recommendations for long-term follow-up after PSF for AIS and is not associated with surgeon experience or case volume.•Most providers follow operative AIS patients for 1-2 years postoperatively, and only a small minority follow operative AIS patients for more than 10 years after the index surgery.•Persistent back pain, junctional deformity, and symptomatic implants are the most common factors affecting provider recommendations for duration of follow-up.•These survey findings may be useful for pediatric orthopaedic providers to operatively manage AIS patients in determining the need and frequency for routine radiographic and/or clinical follow-up.

  View details for DOI 10.55275/JPOSNA-2023-645

  View details for PubMedID 40433342

  View details for PubMedCentralID PMC12088193

• Effectiveness of an early operating room start time in managing pediatric trauma. World journal of orthopedics Kym, D., Kaur, J., Pham, N. S., Klein, E., Langner, J. L., Wang, E., Vorhies, J. S. 2023; 14 (7): 516-525

  Abstract

  The timing of operative treatment for pediatric supracondylar humerus fractures (SCHF) and femoral shaft fractures (FSF) remains controversial. Many fractures previously considered to be surgical emergencies, such as SCHF and open fractures, are now commonly being treated the following day. When presented with an urgent fracture overnight needing operative treatment, the on-call surgeon must choose whether to mobilize resources for a late-night case or to add the case to an elective schedule of the following day.To describe the effect of a program allowing an early operating room (OR) start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight.Starting in October 2017, patients were eligible for the early slot in the OR at the discretion of the surgeon if they were admitted after 21:00 the previous night and before 05:00. We compared demographics and timing of treatment of SCHF and FSF treated one year before and after implementation as well as the survey responses from the surgical team.Of the 44 SCHF meeting inclusion criteria, 16 received treatment before implementation while 28 were treated after. After implementation, the mean wait time for surgery decreased by 4.8 h or 35.4% (13.4 h vs 8.7 h; P = 0.001). There were no significant differences in the operative duration, time in the post anesthesia care unit, and wait time for discharge. Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons. Whereas 57% of the surgeons believed that the program was effective, only 9% of anesthesiologists and 16% of nurses agreed. The program was ultimately discontinued given the dissatisfaction.Our findings demonstrate significantly reduced wait times for surgery for uncomplicated SCHF presenting overnight while discussing the importance of shared decision-making with the stakeholders. Although the program produced promising results, it also created new conflicts within the OR staff that led to its discontinuation at our institution. Future implementations of such programs should involve stakeholders early in the planning process to better address the needs of the OR staff.

  View details for DOI 10.5312/wjo.v14.i7.516

  View details for PubMedID 37485431

  View details for PubMedCentralID PMC10359751

• Temporary Flexible Rods for Correction of Severe Pediatric Spinal Deformity ORTHOPEDICS Kwong, J. W., Tileston, K. R., Kaur, J., Segovia, N. A., Imrie, M. N., Rinsky, L. A., Vorhies, J. S. 2023; 46 (4): 234-+

  Abstract

  Surgical correction of large, rigid scoliotic and kyphotic curves carries an increased risk of perioperative complications, such as neurological injury and excessive blood loss, compared with correction of less severe curves. Titanium temporary flexible rods (TFRs), designed for pediatric long bone fracture fixation, may be helpful as adjuncts to achieve gradual, stepwise intraoperative correction of severe pediatric spinal deformities. A retrospective review was conducted of spinal fusion cases for pediatric scoliosis or kyphosis at our institution that used TFRs as a correction technique from 2007 to 2019. Patients underwent posterior spinal fusion with predominantly pedicle screw instrumentation. Intraoperatively, a non-contoured titanium elastic nail was temporarily positioned in the screws unilaterally to achieve partial correction while the contralateral side was instrumented. Then, the TFR was removed and replaced with a permanent rod. Thirty-four patients with severe spinal deformities underwent posterior spinal fusion. Seventeen had scoliosis (mean major Cobb angle, 89.3°) and 17 had kyphosis (mean T5-T12 kyphosis, 73.8°). Idiopathic deformity was the most common etiology; neuromuscular, syndromic, and postsurgical causes contributed to the remainder of cases. All patients had Ponte osteotomies. Four patients (11.8%) had neuromonitoring alerts, 1 of which was related to insertion of the TFR; all were reversible. For patients with scoliosis, the mean postoperative Cobb angle measured 40.2° (53.6% correction). For patients with kyphosis, the mean postoperative T5-T12 angle measured 43.3° (30.4° of correction). TFRs appear to be helpful adjuncts for correction of severe pediatric spinal deformities, facilitating gradual intraoperative correction in a single-stage operation. Neuromonitoring alerts are common but reversible. [Orthopedics. 2023;46(4):234-241.].

  View details for DOI 10.3928/01477447-20230207-03

  View details for Web of Science ID 001036949800013

  View details for PubMedID 36779740

• Spinal fusion is an aerosol generating procedure. World journal of orthopedics Langner, J. L., Pham, N. S., Richey, A., Oquendo, Y., Mehta, S., Vorhies, J. S. 2023; 14 (5): 340-347

  Abstract

  Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures. Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons. Aerosolized particles containing infectious coronavirus are typically 0.5-8.0 μm.To measure the generation of aerosols during spinal fusion using a handheld optical particle sizer (OPS).We quantified airborne particle counts during five posterior spinal instrumentation and fusions (9/22/2020-10/15/2020) using an OPS near the surgical field. Data were analyzed by 3 particle size groups: 0.3-0.5 μm/m3, 1.0-5.0 μm/m3, and 10.0 μm/m3. We used hierarchical logistic regression to model the odds of a spike in aerosolized particle counts based on the step in progress. A spike was defined as a > 3 standard deviation increase from average baseline levels.Upon univariate analysis, bovie (P < 0.0001), high speed pneumatic burring (P = 0.009), and ultrasonic bone scalpel (P = 0.002) were associated with increased 0.3-0.5 μm/m3 particle counts relative to baseline. Bovie (P < 0.0001) and burring (P < 0.0001) were also associated with increased 1-5 μm/m3 and 10 μm/m3 particle counts. Pedicle drilling was not associated with increased particle counts in any of the size ranges measured. Our logistic regression model demonstrated that bovie (OR = 10.2, P < 0.001), burring (OR = 10.9, P < 0.001), and bone scalpel (OR = 5.9, P < 0.001) had higher odds of a spike in 0.3-0.5 μm/m3 particle counts. Bovie (OR = 2.6, P < 0.001), burring (OR = 5.8, P < 0.001), and bone scalpel (OR = 4.3, P = 0.005) had higher odds of a spike in 1-5 μm/m3 particle counts. Bovie (OR = 0.3, P < 0.001) and drilling (OR = 0.2, P = 0.011) had significantly lower odds of a spike in 10 μm/m3 particle counts relative to baseline.Several steps in spinal fusion are associated with increased airborne particle counts in the aerosol size range. Further research is warranted to determine if such particles have the potential to contain infectious viruses. Previous research has shown that electrocautery smoke may be an inhalation hazard for surgeons but here we show that usage of the bone scalpel and high-speed burr also have the potential to aerosolize blood.

  View details for DOI 10.5312/wjo.v14.i5.340

  View details for PubMedID 37304197

  View details for PubMedCentralID PMC10251270

• Does spinal deformity affect adolescents' quality of life before we tell them it should? Spine deformity Langner, J. L., Kaur, J., Pham, N. S., Richey, A., Hastings, K., Mehta, S., Bryson, X., Vorhies, J. S. 2023

  Abstract

  PURPOSE: The Scoliosis Research Society 22r Questionnaire(SRS-22r) is the standard for assessing health-related quality of life(HRQoL) in patients with adolescent idiopathic scoliosis. Here we investigate whether patients' perceptions of their HRQoL are influenced by knowledge of scoliosis and counseling by an orthopedic surgeon.METHODS: Patients ages 10-18years referred for their first visit with an orthopaedic surgeon for scoliosis were enrolled from 9/30/19 to 10/22/20. Patients completed the SRS-22r pre- and post-visit. A Wilcoxon signed-rank test was used to analyze the SRS-22r scores.RESULTS: 52 patients participated in the study at a mean age of 14.3years (95% CI 13.8-14.8years) with an average major curve magnitude of 23.2 degrees (95% CI 19.4-27.0 degrees). SRS-22r scores were not correlated to curve magnitude pre- or post-visit. The SRS-22r Satisfaction with care domain exhibited a small increase from pre- to post-visit (pre: 3.3, post: 3.6). All other SRS-22r domains and total scores did not exhibit clinically significant differences.CONCLUSION: Among new adolescent referrals for scoliosis, it is unlikely that counseling by a surgeon influences perceptions of HRQoL as measured by the SRS-22r.LEVEL OF EVIDENCE: III.

  View details for DOI 10.1007/s43390-023-00691-0

  View details for PubMedID 37166749

• The Influence of Race, Income, and Sex on Treatment and Complications of Common Pediatric Fractures ORTHOPEDICS Montgomery, B. K., Joseph, G., Segovia, N., Koltsov, J., Thomas, T. L., Vorhies, J. S., Tileston, K. R. 2023; 46 (3): E156-+

  Abstract

  Despite best intentions, health care disparities exist and can consequently impact patient care. Few studies have examined the impact of disparities in pediatric orthopedic populations. The current study aimed to determine if the treatment type or complication rates of supracondylar, both-bone forearm, or femur fractures are associated with race, ethnicity, sex, or socioeconomic status. The New York Healthcare Cost and Utilization Project's database was used to identify all pediatric patients treated for supracondylar humerus fractures, both-bone forearm fractures, and femoral shaft fractures in 2016. Risk-adjusted relationships with race, ethnicity, sex, hospital location, and median income by zip code were assessed with multivariable logistic regression. Patients who were non-White, resided in the zip codes with the lowest median income (<$42,999 annually), and were treated in metropolitan areas were more likely to receive nonoperative treatments for supracondylar humerus fractures. Female patients with a femoral shaft fracture were less likely to be treated with open reduction and internal fixation vs intramedullary fixation. Finally, complications were not associated with patient race, sex, or socioeconomic statuses. These findings bring attention to health care disparities in the treatment of common pediatric orthopedic fractures. Further studies investigating the underlying etiology behind these disparities are warranted. [Orthopedics. 2023;46(3):e156-e160.].

  View details for DOI 10.3928/01477447-20230104-06

  View details for Web of Science ID 000995876400007

  View details for PubMedID 36623278

• Introduction of a Novel Sequential Approach to the Ponte Osteotomy to Minimize Spinal Canal Exposure. Children (Basel, Switzerland) Hollyer, I., Johnson, T. R., Kha, S. T., Foreman, C., Ho, V., Klemt, C., Chan, C. K., Vorhies, J. S. 2023; 10 (3)

  Abstract

  Ponte osteotomy is an increasingly popular technique for multiplanar correction of adolescent idiopathic scoliosis. Prior cadaveric studies have suggested that sequential posterior spinal releases increase spinal flexibility. Here we introduce a novel technique involving a sequential approach to the Ponte osteotomy that minimizes spinal canal exposure. One fresh-frozen adult human cadaveric thoracic spine specimen with 4 cm of ribs was divided into three sections (T1-T5, T6-T9, T10-L1) and mounted for biomechanical testing. Each segment was loaded with five Newton meters under four conditions: baseline inferior facetectomy with supra/interspinous ligament release, superior articular process (SAP) osteotomy in situ, spinous process (SP) osteotomy in situ, and complete posterior column osteotomy with SP/SAP excision and ligamentum flavum release (PCO). Compared to baseline, in situ SAP osteotomy alone provided 3.5%, 7.6%, and 7.2% increase in flexion/extension, lateral bending, and axial rotation, respectively. In situ SP osteotomy increased flexion/extension, lateral bending, and axial rotation by 15%, 18%, and 10.3%, respectively. PCO increased flexion/extension, lateral bending, and axial rotation by 19.6%, 28.3%, and 12.2%, respectively. Our report introduces a novel approach where incremental increases in range of motion can be achieved with minimal spinal canal exposure and demonstrates feasibility in a cadaveric model.

  View details for DOI 10.3390/children10030470

  View details for PubMedID 36980028

• Opioid Represcriptions After ACL Reconstruction in Adolescents are Associated With Subsequent Opioid Use Disorder. Journal of pediatric orthopedics Cahan, E. M., Halvorsen, K. C., Pham, N. S., Kaur, J., Bryson, X. M., Chan, C. M., Vorhies, J. S. 2023

  Abstract

  INTRODUCTION: Postoperative opioid prescriptions may confer a risk for subsequent opioid use disorders (OUDs). For many children, postoperative analgesia is often the first opioid exposure. The rates of anterior cruciate ligament (ACL) reconstruction in pediatric populations are rising. Here, we use an administrative claims database to describe opioid prescription patterns after ACL reconstruction and their effect on subsequent risk of OUD.METHODS: Using International Classification of Diseases (ICD)-9, ICD-10, and CPT codes, we identified patients, with ages 10 to 18, undergoing primary ACL reconstruction between 2014 and 2016 with minimum 1 year follow-up in the Optum Clinformatics Data Mart, which is a nationally representative administrative claims database. Demographic variables and prescription patterns (in morphine milligram equivalents [MMEs]) were analyzed using univariate tests and multivariable logistic regression to determine any potential association with the appearance of anew an ICD-9 or ICD-10 code for OUD within 1 year of the initial procedure.RESULTS: A total of 4459 cases were included and 29 (0.7%) of these patients were diagnosed with an OUD within 1 year of surgery. Upon univariate analysis, opioid represcriptions within 6 weeks were significantly more common among patients with OUD; 27.6% vs. 9.7% of patients that did not develop a new diagnosis of OUD (P=0.005). Multivariable logistic regression indicated an independent significant relationship between total MMEs initially prescribed and the odds of a subsequent OUD diagnosis: for each additional 100 MMEs prescribed in total, the odds of OUD increased by 13% (P=0.002). Patients with a represcription within 6 weeks of surgery had an average increase in the odds of OUD by 161% (P=0.027).CONCLUSIONS: In this cohort of patient ages 10 to 18 undergoing primary isolated ACL reconstruction, we found substantial variability in opiate prescribing patterns and higher initial opioid prescription volume, as well as opioid represcription within 6 weeks were predictive of the subsequent development of OUD.LEVEL OF EVIDENCE: Level III.

  View details for DOI 10.1097/BPO.0000000000002340

  View details for PubMedID 36652547

• Effectiveness of psychosocial interventions for pediatric patients with scoliosis: a systematic review World Journal of Pediatric Surgery van Niekerk, M., Richey, A., Vorhies, J., Wong, C., Tileston, K. 2023; 6 (e000513)

  View details for DOI 10.1136/wjps-2022-000513

• Curve Characteristics and Surgical Outcomes in Scoliosis Associated With Childhood Sternotomy or Thoracotomy. Journal of pediatric orthopedics Langner, J. L., Ezeonu, T., Shafau, A., Javier, N., Bryson, X., Kaur, J., Poppino, K., Shivers, C., Chilakapati, S., Hall, K. E., Imrie, M. N., Rinsky, L., Riccio, A. I., Vorhies, J. S. 2022

  Abstract

  BACKGROUND: The purpose of this study is to describe curve characteristics and postoperative outcomes in patients undergoing spinal fusion (SF) to treat thoracogenic scoliosis related to sternotomy and/or thoracotomy as a growing child.METHODS: A retrospective review of electronic medical records of all patients with Post-Chest Incision scoliosis treated with SF was performed at 2 tertiary care pediatric institutions over a 19-year period. Curve characteristics, inpatient, and outpatient postoperative outcomes are reported.RESULTS: Thirty-nine patients (62% female) were identified. Eighteen had sternotomy alone, 14 had thoracotomy alone, and 7 had both. Mean age at the time of first chest wall surgery was 2.5 years (range: 1.0d to 14.2y). Eighty-five percent of patients had a main thoracic curve (mean major curve angle 72 degrees, range: 40 to 116 degrees) and 15% had a main lumbar curve (mean major curve angle 76 degrees, range: 59 to 83 degrees). Mean thoracic kyphosis was 40 degrees (range: 4 to 84 degrees). Mean age at the time of SF was 14 years (range: 8.2 to 19.9y). Thirty-six patients had posterior fusions and 3 had combined anterior/posterior. Mean coronal curve correction measured at the first postoperative encounter was 53% (range: 9% to 78%). There were 5 (13%) neuromonitoring alerts and 2 (5%) patients with transient neurological deficits. Mean length of hospital stay was 9±13 days. At an average follow-up time of 3.1±2.4 years, 17 complications (10 medical and 7 surgical) were noted in 9 patients for an overall complication rate of 23%. There was 1 spinal reoperation in the cohort. 2/17 (12%) complications were Clavien-Dindo-Sink class III and 5/17 (29%) were class IV.CONCLUSION: Kyphotic thoracic curves predominate in patients with Post-Chest Incision scoliosis undergoing SF. Although good coronal and sagittal plane deformity can be expected after a fusion procedure, postoperative complications are not uncommon in medically complex patients, often necessitating longer postoperative stays.LEVEL OF EVIDENCE: Level III.

  View details for DOI 10.1097/BPO.0000000000002229

  View details for PubMedID 36017932

• The effect of intraoperative lidocaine administration in a disrupted erector spinae fascial plane on intercostal transcranial motor evoked potentials. Journal of clinical anesthesia Pan, S. J., Vorhies, J. S., Lee, L. H., López, J. R., Tsui, B. C. 2022; 82: 110956

  Abstract

  Erector spinae plane (ESP) blocks have been recently described for postoperative pain management following spine surgery but their effects on intraoperative neuromonitoring are unknown.Retrospective cohort study.Pediatric patients at a tertiary care center.26 pediatric patients who received bilateral surgically-placed ESP catheters for single-stage posterior spine fusion (PSF) from August 2020 to June 2021.Patients in this study did not receive any special interventions as part of this observational retrospective study.This retrospective study investigated the effects of local anesthesia administration through bilateral surgically-placed ESP catheters on intraoperative intercostal transcranial motor evoked potentials (tcMEPs) in the setting of a disrupted erector spinae fascial plane in pediatric patients undergoing single-stage posterior spine fusion.Of the 26 patients that received bilateral surgically-placed ESP catheters for pediatric posterior spine fusion surgery, none exhibited any changes in intercostal tcMEPs attributable to intraoperative lidocaine administration through the ESP catheters.The administration of a local anesthetic into a disrupted erector spinae fascial plane does not appear to interfere with intraoperative neuromonitoring of posterior spine fusion surgeries.

  View details for DOI 10.1016/j.jclinane.2022.110956

  View details for PubMedID 36029703

• Complication risks and costs associated with Ponte osteotomies in surgical treatment of adolescent idiopathic scoliosis: insights from a national database. Spine deformity Shaheen, M., Koltsov, J. C., Cohen, S. A., Langner, J. L., Kaur, J., Segovia, N. A., Vorhies, J. S. 2022

  Abstract

  PURPOSE: Risks of Ponte osteotomies (POs) used for posterior spinal fusion (PSF) for Adolescent Idiopathic Scoliosis (AIS) are challenging to assess because of the rarity of complications. Using a national administrative claims database, we evaluated trends, costs and complications associated with PO used in PSF for AIS patients.METHODS: Using ICD-9/CPT codes, we identified patients (ages 10-18) with AIS who underwent PSF (±PO) between 2007 and 2015 in the IBM MarketScan Commercial Databases. Costs and trends of POs were evaluated. Odds of neurological complications and readmissions within 90days and reoperations within 90days and 2years were assessed.RESULTS: We identified 8881 AIS patients who had undergone PSF, of which 8193 had 90-day follow-up and 4248 had 2-year follow-up. Overall, 28.8% had PO. Annual rate of POs increased from 17.3 to 35.2% from 2007 to 2015 (p<0.001). Risk-adjusted multivariable logistic regression demonstrated no relationship between POs and neurologic complications (p=0.543). POs were associated with higher odds for readmission (1.52 [1.21-1.91]; p<0.001) and reoperation (2.03 [1.13-3.59]; p=0.015) within 90days, but there were no differences in the odds of reoperation within 2years (p=0.836). Median hospital costs were $15,854 (17.4%) higher for patients with POs (p<0.001) and multivariable modeling demonstrated POs to be an independent predictor of increased costs (p<0.001).CONCLUSION: Annual rate of POs increased steadily from 2007 to 2015. POs were not associated with increased odds of neurological complications but had higher costs and higher rates of readmissions and reoperations within 90days. By 2years, differences in reoperation rate were not significant.LEVEL OF EVIDENCE: III.

  View details for DOI 10.1007/s43390-022-00534-4

  View details for PubMedID 35810408

• Innovative technique for early-onset scoliosis casting using Jackson table. Spine deformity Montgomery, B. K., Tileston, K., Kaur, J., Kym, D., Segovia, N. A., Imrie, M., Policy, J., Rinsky, L., Vorhies, J. 2022

  Abstract

  PURPOSE: Early-onset scoliosis (EOS) can have harmful effects on pulmonary function. Serial elongation, derotation, and flexion (EDF) casting can cure EOS or delay surgical intervention. Most described casting techniques call for specialized tables, which are not available at many institutions. We describe an innovative technique for EDF casting utilizing a modified Jackson table (MJ) and compare results to a Risser frame (RF).METHODS: All patients who underwent EDF casting at our institution between January 2015 and January 2019 were identified and retrospectively reviewed. Patients were stratified by type of table used and clinical and radiographic outcomes were compared. Standard descriptive statistics were calculated.RESULTS: We identified 25 patients who underwent 77 casting events, 11 on an MJ table and 14 on a RF. Mean follow-up was 32months (range 11-61months). 28% of patients had idiopathic scoliosis. There was no significant difference in age at initiation of casting (P=0.3), initial Cobb angle (equivalence, P=0.009), or rate of idiopathic scoliosis between the MJ and RF groups. There was no significant difference in initial coronal Cobb angle percent correction (equivalence, P=0.045) or percent correction at 1-year follow-up (equivalence, P=0.010) between the two groups. There was no difference in cast related complications. There was a significant difference in surgical time, with the MJ group 11min shorter than the RF (P=0.005).CONCLUSION: The MJ table is a safe and effective alternative for applying EDF casts under traction without the need for a specialized table.LEVEL OF EVIDENCE: III.

  View details for DOI 10.1007/s43390-022-00526-4

  View details for PubMedID 35776363

• Indications for and Risks Associated With Implant Removal After Pediatric Trauma. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews Montgomery, B. K., Gamble, J. G., Kha, S. T., Hecht, G. G., Vorhies, J. S., Lucas, J. F. 2022; 6 (4)

  Abstract

  A wide range of implants are used in the treatment of pediatric fractures, including wires, plates, screws, flexible rods, rigid rods, and external fixation devices. Pediatric bones differ from adult bones both mechanically and biologically, including the potential for remodeling. Implants used in pediatric trauma patients present a unique set of circumstances regarding indications, risks, timing of implant removal, weight-bearing restrictions, and long-term sequelae. Indications for implant removal include wire/pin fixation, when substantial growth remains, and infection. When considering implant removal, the risks and benefits must be assessed. The primary risk of implant removal is refracture. The timing of implant removal varies widely from several weeks to a year or more with the option of retention depending on the fracture, type of implant, and skeletal maturity of the patient.

  View details for DOI e22.00050

  View details for PubMedID 35427259

• Indications for and Risks Associated With Implant Removal After Pediatric Trauma JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS Montgomery, B. K., Gamble, J. G., Kha, S. T., Hecht, G. G., Vorhies, J. S., Lucas, J. F. 2022; 6 (4)

  View details for DOI 10.5435/JAAOSGlobal-D-22-00050

  View details for Web of Science ID 000783752200002

• Systemic lidocaine absorption from continuous erector spinae plane catheters after paediatric posterior spine fusion surgery. Regional anesthesia and pain medicine Pan, S., Lee, C. K., Caruso, T. J., Vorhies, J. S., Tsui, B. C. 2022

  View details for DOI 10.1136/rapm-2021-103234

  View details for PubMedID 35012993

• Does Navigation Make Spinal Fusion for Adolescent Idiopathic Scoliosis Safer? Insights From a National Database. Spine Kaur, J., Koltsov, J. C., Kwong, J. W., Cheng, I., Vorhies, J. S. 2021; 46 (19): E1049-E1057

  Abstract

  STUDY DESIGN: Retrospective Cohort.OBJECTIVE: To evaluate the effect of computer-assisted navigation (NAV) on rates of complications and reoperations after spinal fusion (SF) for adolescent idiopathic scoliosis (AIS) using a nationally representative claims database.SUMMARY OF BACKGROUND DATA: Significant controversy surrounds the reported benefits of NAV in SF for AIS. Previous studies have demonstrated decreased rates of pedicle screw breaches with NAV compared to free-hand methods but no impact on complication rates. Thus, the clinical utility of NAV remains uncertain.METHODS: Analyses were performed using the IBM MarketScan databases. Patients aged 10 to 18 undergoing SF for AIS were grouped by use of NAV. Patients with nonidiopathic scoliosis were excluded. Univariate and risk-adjusted multivariate analyses were performed. Primary outcomes were neurological complications, any medical complications, and reoperations. Secondary outcomes included adjusted total reimbursements and length of stay.RESULTS: A total of 12,046 patients undergoing SF for AIS were identified, and 8640 had 90-day follow-up. NAV was used in 467 patients (5.4%), increasing from 2007 to 2015. After risk adjustment, the odds for any complication within 90 days were lower with NAV (OR = 0.61, P = 0.025), but neurological complications were unrelated to NAV (P = 0.742). NAV was not associated with reoperation within 90 days (P = 0.757) or 2 years (P = 0.095). We observed a $25,038 increase in adjusted total reimbursements (P < 0.001) and a 0.32-day decrease in length of stay (P = 0.022) with use of NAV.CONCLUSION: In this national sample, NAV was associated with a lower rate of total complications but no change in rates of neurological complications or reoperations. In addition, NAV was associated with a large increase in total payments, despite a modest decrease in hospital stay. Considering the increasing popularity of NAV, this study provides important context regarding the utility of NAV for AIS.Level of Evidence: 3.

  View details for DOI 10.1097/BRS.0000000000004037

  View details for PubMedID 34517402

• Remodeling of Sagittal Plane Malunion After Pediatric Supracondylar Humerus Fractures. Journal of pediatric orthopedics Gamble, J. G., Vorhies, J. S. 2021; 41 (8): e700-e701

  View details for DOI 10.1097/BPO.0000000000001912

  View details for PubMedID 34397787

• The Utility of Intraoperative Arthrogram in the Management of Pediatric Lateral Condyle Fractures of the Humerus ORTHOPEDICS Vorhies, J., Funk, S., Elliott, M., Riccio, A., Ramo, B. 2020; 43 (1): 30–35

  Abstract

  Intraoperative arthrograms are commonly used in conjunction with closed reduction and percutaneous pinning (CRPP) of pediatric lateral condyle fractures of the humerus. The authors sought to determine how arthrograms affect management of these fractures. They reviewed all lateral condyle fractures treated surgically at a pediatric level I trauma center from 2008 to 2014. They stratified patients managed with and without an arthrogram as well as by timing of arthrogram. The authors compared injury parameters, initial and postoperative fracture displacement, and complications between groups. They identified 107 patients who were taken to the operating room for attempted closed reduction, which they classified as either CRPP without arthrogram or arthrogram first and then a decision to treat open or with CRPP. Fifty-eight (54.21%) underwent CRPP without arthrogram and 49 (45.79%) underwent arthrogram. Of those who had arthrograms, 27 (25.23%) were prior to fixation and 22 (20.56%) were after fixation. There was no difference in age, weight, or preoperative displacement among the groups. Mean postoperative displacement was significantly lower in the no arthrogram group vs the arthrogram group (0.91 mm vs 1.68 mm; P<.0001), but it did not differ based on timing of arthrogram (P=.836). Arthrograms changed management in 4 (8%) of 49 patients who had them. There was no statistical difference in the rate of changed management by timing of arthrogram (before vs after fixation, 14.8% vs 0%; P=.060). The authors demonstrated that arthrograms may be useful for assessing final fracture alignment after CRPP, but are unlikely to result in a treatment change and are not associated with improved postoperative alignment. [Orthopedics. 2020; 43(1):30-35.].

  View details for DOI 10.3928/01477447-20191031-01

  View details for Web of Science ID 000508434100015

  View details for PubMedID 31693741

• Automatic Extraction of Skeletal Maturity from Whole Body Pediatric Scoliosis X-rays Using Regional Proposal and Compound Scaling Convolutional Neural Networks Ha, A., Vorhies, J., Campion, A., Fang, C., Fadell, M., Dou, S., Halabi, S., Larson, D., Wang, E., Lee, Y., Langner, J., Kaur, J., Do, B., Park, T., Cho, Y. R., Hu, Yoo, Woo, H. G., Wang, J., Facelli, J., Nam, S., Kang, M. IEEE COMPUTER SOC. 2020: 996-1000

  View details for DOI 10.1109/BIBM49941.2020.9313251

  View details for Web of Science ID 000659487101011

• Remodeling of Sagittal Plane Malunion After Pediatric Supracondylar Humerus Fractures. Journal of pediatric orthopedics Gamble, J. G., Vorhies, J. S. 2020

  Abstract

  Pediatric supracondylar humeral fractures (SCHFs) can heal in hyperextension malunion after casting or surgical treatment. Here the authors present quantitative evidence concerning the ability of children to remodel sagittal plane malunion. Their null hypothesis was that like varus and valgus malunion, children have little capacity to remodel sagittal plane malunion after SCHFs.The authors performed a prospective longitudinal radiographic study of 41 children, aged 22 to 126 months, who were registered during the study interval. They calculated the percent displacement of the center of the capitellum behind the anterior humeral line (AHL) as the distance of the midpoint of the capitellum from the AHL, divided by the diameter of the capitellum, multiplied by 100. Longitudinal measurements were made using the embedded software on our institution's digital radiographic system. The primary outcome focus was the percent displacement of the center of the capitellum relative to AHL on the initial and on the latest radiograph.The average initial displacement (hyperextension) of the capitellum behind the AHL for all patients was 61% (range, 23% to 134%). At an average follow-up of 21 months, 24 children (60%) had remodeled 100% the sagittal plane malunion, 12 children (30%) had remodeled such that the AHL passed through the central third of the capitellum, and 5 children (10%) had minimal or no remodeling.The authors rejected their null hypothesis. Children do have the capacity to remodel radiographically measurable sagittal plane malunion of SCHFs. Children younger than 5 years of age can remodel 100% displacement of the center of the capitellum, whereas those over 8 years of age have minimal remodeling capacity.

  View details for DOI 10.1097/BPO.0000000000001623

  View details for PubMedID 32604347

• The Impact of Subspecialty Fellows on Orthopaedic Resident Surgical Experience: A Multicenter Study of 51,111 Cases. The Journal of the American Academy of Orthopaedic Surgeons Jiang, S. Y., Carlock, K. D., Campbell, S. T., Vorhies, J. S., Gardner, M. J., Leucht, P. n., Bishop, J. A. 2020

  Abstract

  Meaningful participation in surgery is important for orthopaedic resident education. This study aimed to quantify the effect of fellows on resident surgical experience. We hypothesized that as fellowship programs expanded, resident caseload would decrease, whereas "double-scrubbed" cases would increase.This multicenter retrospective study included 9 years of surgical caselog data from two orthopaedic residency programs. Six subspecialty services on which fellow number varied over time were included (trauma, spine, foot and ankle, adult reconstruction, and hand). Case volume and personnel composition per case were extracted. Statistical analysis was performed with two-sample equal variance Student t-tests.A total of 51,111 cases were assessed. Surgical volume increased across all sites/services over time. Fellow numbers did not affect average resident caseload. However, in years with more fellows, an 11% decrease in one-on-one resident-attending cases (P = 0.002) and a 17% increase in resident-fellow-attending "double-scrubbed" cases was observed (P < 0.001).Increasing orthopaedic fellows did not affect resident case volume but resulted in fewer one-on-one cases with the attending and more "double-scrubbed" cases with a fellow. The implications of these findings to resident education require further study, but orthopaedic educators should be aware of these findings to try to maximize educational opportunities.Level III.

  View details for DOI 10.5435/JAAOS-D-20-00233

  View details for PubMedID 32649442

• Posterior Sternoclavicular Dislocation: Do We Need "Cardiothoracic Backup"? Insights from a National Sample. Journal of orthopaedic trauma Leonard, D. A., Segovia, N., Kaur, J., Lucas, J., Bishop, J., Vorhies, J. S. 2019

  Abstract

  OBJECTIVES: To describe the incidence of and risk factors for vascular injury associated with P-SCD.METHODS: We used data from the HCUP-NIS from 2015-2016 and defined a cohort of patients with sternoclavicular dislocation (SCD) using ICD-10-CM diagnosis codes. We further isolated a subset with P-SCD. We describe the incidence of thoracic vascular injury, demographics and injury severity score (ISS) in this cohort.RESULTS: Of an estimated 550 patients who had SCD, 140 (25%) were identified as having a P-SCD. No vascular injuries occurred in the P-SCD cohort. Among all patients with SCD, < 2% of patients had a vascular injury, all of whom had an ISS ≥ 15, independent of the vascular injury itself (Figure 1). Among patients with an isolated P-SCD injury (55), overall length of stay was 1.8 days and total charges averaged $29,724.45. There was no mortality among patients with isolated P-SCD.CONCLUSION: Here we report no vascular injuries in the largest known series of P-SCD. Among all patients with SCD, vascular injury was rare, occurring only in severely polytraumatized patients. The recommendation for routine involvement of cardiothoracic surgeons in all cases of P-SCD should be re-examined.LEVEL OF EVIDENCE: Level III.

  View details for DOI 10.1097/BOT.0000000000001685

  View details for PubMedID 31764407

• Debridement, antibiotic pearls, and retention of the implant (DAPRI): A modified technique for implant retention in total knee arthroplasty PJI treatment. Journal of orthopaedic surgery (Hong Kong) Calanna, F., Chen, F., Risitano, S., Vorhies, J. S., Franceschini, M., Giori, N. J., Indelli, P. F. 2019; 27 (3): 2309499019874413

  Abstract

  We describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining an infected total knee arthroplasty. This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration using calcium sulfate beads. The combination of three different surgical techniques (methylene blue staining, argon beam electrical stimulation, and chlorhexidine gluconate brushing) might enhance the identification, disruption, and finally removal of the bacterial biofilm, which is the main responsible of antibiotics and antibodies resistance. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous periprosthetic joint infection.

  View details for DOI 10.1177/2309499019874413

  View details for PubMedID 31554470

• Moving toward patients being pain- and spasm-free after pediatric scoliosis surgery by using bilateral surgically-placed erector spinae plane catheters. Canadian journal of anaesthesia = Journal canadien d'anesthesie Tsui, B. C., Esfahanian, M. n., Lin, C. n., Policy, J. n., Vorhies, J. n. 2019

  View details for DOI 10.1007/s12630-019-01543-0

  View details for PubMedID 31776896

• Treatment in a Nonpediatric Hospital Is a Risk Factor for Open Reduction of Pediatric Supracondylar Humerus Fractures: A Population-Based Study. Journal of orthopaedic trauma Vorhies, J. S., Uzosike, O. B., Imrie, M. N., Rinsky, L. n., Hoffinger, S. n. 2019; 33 (9): e331–e338

  Abstract

  To describe the distribution of open versus closed treatment and its relationship with the location of care in pediatric specialty versus general hospitals.Patient data were extracted from the Healthcare Cost and Utilization Project's Kid's Inpatient Database for the years 2000-2012. ICD9-CM diagnosis and procedure codes were used to identify open versus closed treatment of closed supracondylar humerus fractures in children younger than 12 years. A multilevel logistic regression model to control for confounders and identify drivers of open treatment was used.An estimated 40,706 inpatient surgical fixation procedures met our inclusion criteria. Overall rate of open treatment was 13.65%. Fractures were less likely to be treated open at pediatric hospitals versus general hospitals 7.61% versus 16.13% (P < 0.0001). Over the study period, rates of open treatment have fallen at nonpediatric hospitals from 20.21% in 2000 to 17.42% in 2012 (P < 0.001) but have remained stable at pediatric hospitals: 7.8% in 2000 and 8.62% in 2012 (P = 0.4369). Mean hospital length of stay was higher for patients who had open treatment 1.63 versus 1.20 days (P < 0.0001), and mean hospital charges were higher for patients who had open treatment $21,465 versus $15,026 (P < 0.0001). After controlling for time trends as well as demographic and hospital characteristics with a logistic regression model, treatment at a nonpediatric hospital was the single most significant predictor of open treatment for an isolated closed supracondylar humerus fractures with an odds ratio of 1.96 (95% confidence interval 1.56-2.46; P < 0.001).In this comprehensive population-based study of risk factors for open treatment of supracondylar humerus fractures in the United States, we identified differences in practice patterns by hospital type. Pediatric supracondylar fractures of the elbow have almost twice the odds of open treatment at nonpediatric hospitals.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  View details for DOI 10.1097/BOT.0000000000001502

  View details for PubMedID 31188255

• An Excellent Addition to Recent Studies in the US From Various Disciplines and Locations That Show Similar Results Response JOURNAL OF ORTHOPAEDIC TRAUMA Bishop, J., Vorhies, J., Paci, G. 2019; 33 (1): E38

  View details for Web of Science ID 000467798900013

• In response. Journal of orthopaedic trauma Bishop, J., Vorhies, J., Paci, G. 2019; 33 (1): e38

  View details for PubMedID 30562264

• Severity Adjusted Risk of Long-Term Adverse Sequelae Among Children with Osteomyelitis. The Pediatric infectious disease journal Vorhies, J. S., Lindsay, E. A., Tareen, N. G., Kellum, R. J., Jo, C. H., Copley, L. A. 2018

  Abstract

  BACKGROUND: The purpose of this investigation is to evaluate the risk for long-term, adverse outcomes among children with osteomyelitis.METHODS: Children with osteomyelitis were prospectively enrolled from 2012-2014. Care was accomplished by a multidisciplinary team according to an institutional algorithm. Data was collected to define the severity of illness during the initial hospitalization and assess short, intermediate and long-term outcomes. Clinical examination, radiographic assessment, and functional outcome survey administration were performed at a minimum of 2 year follow-up. A comparison cohort analysis was performed according to initial severity of illness score (SIS) of mild (0-2), moderate (3-6), and severe (7-10).RESULTS: Of 195 children enrolled, 139 (71.3%) returned for follow-up at an average of 2.4 years (range 2.0 to 5.0 years). Children with severe illness were less likely to have normal radiographs (Severe - 4.0%; Moderate - 38.2%; Mild - 53.2%, p<0.0001), and more likely to have osteonecrosis, chondrolysis, or deformity (Severe - 32.0%; Moderate - 5.9%; Mild - 1.3%, p<0.0001). Functional outcome measures did not significantly differ between severity categories.By regression analysis SIS, plus age less than 3 years and MRSA predicted severe sequelae with an area under the curve of 0.8617 and an increasing odds ratio of 1.34 per point of increase in severity score.CONCLUSION: Long term severe adverse outcomes among children with osteomyelitis occurred in 11 of 139 (7.9%) children and were predicted by initial severity of illness. Other risks that diminished the likelihood of complete resolution or increased the risk of severe sequelae included MRSA etiology and young age. The majority of children with osteomyelitis do not require long term follow-up beyond the initial treatment period.LEVEL OF EVIDENCE: Level II, Prognostic, Prospective Cohort Comparison.

  View details for PubMedID 29742649

• Treatment of Degenerative Lumbar Spondylolisthesis With Fusion or Decompression Alone Results in Similar Rates of Reoperation at 5 Years. Clinical spine surgery Vorhies, J. S., Hernandez-Boussard, T. n., Alamin, T. n. 2018; 31 (1): E74–E79

  Abstract

  Population-based analysis of administrative discharge records from California, Florida, and New York inpatient, ambulatory, and emergency department settings between 2005 and 2011, utilizing Healthcare Cost and Utilization Project data.We aimed to compare, and characterize rates of reoperation and readmission among patients with degenerative spondylolisthesis treated with surgical decompression alone versus fusion.Degenerative lumbar spondylolisthesis with stenosis can be treated by decompression with or without fusion. Fusion has traditionally been preferred. We hypothesized that rates of reoperation after decompression alone would be higher than after fusion.We undertook a population-based analysis of administrative discharge records from California, Florida, and New York inpatient, ambulatory, and emergency department settings between 2005 and 2011, with Healthcare Cost and Utilization Project data. We identified all patients who had degenerative spondylolisthesis who were treated with decompression alone or with fusion and compared their rates of reoperation at 1, 3, and 5 years from the index operation. We used descriptive statistics and a hierarchical logistic regression model to generate risk-adjusted odds of all-cause readmissions.Our study consisted of 75,024 patients with spondylolisthesis; 6712 (8.95%) of them underwent decompression alone and 68,312 (91.05%) of them underwent fusion. Rates of reoperation were higher for decompression versus fusion at 1 year; 6.87% versus 5.53% (P≤0.001), but at 3 years; 13.86% versus 12.91% (P=0.18) and 5 years; 16.9% versus 17.7% (P=0.398) years rates of reoperation were not statistically different. Patients treated with decompression alone that had a second operation tended to have the operation sooner 512.6 versus 567.4 days (P=0.008).Our study suggests that treatment of degenerative spondylolisthesis with fusion or decompression alone results in similar rates of reoperation at 5 years. This medium term data indicate that decompression alone may be a viable treatment for some patients with degenerative spondylolisthesis.

  View details for PubMedID 28671881

• Pediatric Supracondylar Humerus Fractures: Does After-Hours Treatment Influence Outcomes? Journal of orthopaedic trauma Paci, G. M., Tileston, K. R., Vorhies, J. S., Bishop, J. A. 2018; 32 (6): e215–e220

  Abstract

  To compare the outcomes of pediatric supracondylar humerus fractures treated during daytime hours to those treated after-hours.Retrospective.Academic Level I trauma center.Two hundred ninety-eight pediatric patients treated with surgical reduction and fixation of closed supracondylar fractures were included.Seventy-seven patients underwent surgery during daytime hours (06:00-15:59 on weekdays). One hundred eighty-six patients underwent surgery after-hours (16:00-05:59 on weekdays and any surgery on weekends or holidays).Surgeon subspecialty, operative duration, and radiographic and clinical outcomes, including range of motion and carrying angle, were extracted from the patient medical records.There were no patient-related demographic differences between the daytime hours and after-hours groups. Daytime surgery was more likely to be performed by a pediatric orthopaedic surgeon than after-hours surgery. Fractures treated after-hours had more severe injury patterns. After-hours surgery was not independently associated with rate of open reduction, operative times, complications, achievement of functional range of motion, or radiographic alignment. A late-night surgery subgroup analysis demonstrated an increased rate of malunion in patients undergoing surgery between the hours of 23:00 and 05:59.There is no difference in the operative duration or outcomes after surgical treatment of pediatric supracondylar humerus fractures performed after-hours when compared with daytime surgery. However, late-night surgery performed between 23:00 and 05:59 may be associated with a higher rate of malunion. Surgeons can use these data to make better-informed decisions about the timing of surgery in this patient population.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  View details for PubMedID 29432316

• Does the Watson-Jones or Modified Smith-Petersen Approach Provide Superior Exposure for Femoral Neck Fracture Fixation? Clinical orthopaedics and related research Lichstein, P. M., Kleimeyer, J. P., Githens, M. n., Vorhies, J. S., Gardner, M. J., Bellino, M. n., Bishop, J. n. 2018

  Abstract

  A well-reduced femoral neck fracture is more likely to heal than a poorly reduced one, and increasing the quality of the surgical exposure makes it easier to achieve anatomic fracture reduction. Two open approaches are in common use for femoral neck fractures, the modified Smith-Petersen and Watson-Jones; however, to our knowledge, the quality of exposure of the femoral neck exposure provided by each approach has not been investigated.(1) What is the respective area of exposed femoral neck afforded by the Watson-Jones and modified Smith-Petersen approaches? (2) Is there a difference in the ability to visualize and/or palpate important anatomic landmarks provided by the Watson-Jones and modified Smith-Petersen approaches?Ten fresh-frozen human pelvi underwent both modified Smith-Petersen (utilizing the caudal extent of the standard Smith-Petersen interval distal to the anterosuperior iliac spine and parallel to the palpable interval between the tensor fascia lata and the sartorius) and Watson-Jones approaches. Dissections were performed by three fellowship-trained orthopaedic traumatologists with extensive experience in both approaches. Exposure (in cm) was quantified with calibrated digital photographs and specialized software. Modified Smith-Petersen approaches were analyzed before and after rectus femoris tenotomy. The ability to visualize and palpate seven clinically relevant anatomic structures (the labrum, femoral head, subcapital femoral neck, basicervical femoral neck, greater trochanter, lesser trochanter, and medial femoral neck) was also recorded. The quantified area of the exposed proximal femur was utilized to compare which approach afforded the largest field of view of the femoral neck and articular surface for assessment of femoral neck fracture and associated femoral head injury. The ability to visualize and palpate surrounding structures was assessed so that we could better understand which approach afforded the ability to assess structures that are relevant to femoral neck fracture reduction and fixation.After controlling for age, body mass index, height, and sex, we found the modified Smith-Petersen approach provided a mean of 2.36 cm (95% confidence interval [CI], 0.45-4.28 cm; p = 0.015) additional exposure without rectus femoris tenotomy (p = 0.015) and 3.33 cm (95% CI, 1.42-5.24 cm; p = 0.001) additional exposure with a tenotomy compared with the Watson-Jones approach. The labrum, femoral head, subcapital femoral neck, basicervical femoral neck, and greater trochanter were reliably visible and palpable in both approaches. The lesser trochanter was palpable in all of the modified Smith-Petersen and none of the Watson-Jones approaches (p < 0.001). All modified Smith-Petersen approaches (10 of 10) provided visualization and palpation of the medial femoral neck, whereas visualization of the medial femoral neck was only possible in one of 10 Watson-Jones approaches (p < 0.001) and palpation was possible in eight of 10 Watson-Jones versus all 10 modified Smith-Petersen approaches (p = 0.470).In the hands of surgeons experienced with both surgical approaches to the femoral neck, the modified Smith-Petersen approach, with or without rectus femoris tenotomy, provides superior exposure of the femoral neck and articular surface as well as visualization and palpation of clinically relevant proximal femoral anatomic landmarks compared with the Watson-Jones approach.Open reduction and internal fixation of a femoral neck fracture is typically performed in a young patient (< 60 years old) with the objective of obtaining anatomic reduction that would not be possible by closed manipulation, thus enhancing healing potential. In the hands of surgeons experienced in both approaches, the modified Smith-Petersen approach offers improved direct access for reduction and fixation. Higher quality reductions and fixation are expected to translate to improved healing potential and outcomes. Although our experimental results are promising, further clinical studies are needed to verify if this larger exposure area imparts increased quality of reduction, healing, and improved outcomes compared with other approaches. The learning curve for the exposure is unclear, but the approach has broad applications and is frequently used in other subspecialties such as for direct anterior THA and pediatric septic hip drainage. Surgeons treating femoral neck fractures with open reduction and fixation should familiarize themselves with the modified Smith-Petersen approach.

  View details for PubMedID 29698292

• Admission Through the Emergency Department Is an Independent Risk Factor for Lower Satisfaction With Physician Performance Among Orthopaedic Surgery Patients: A Multicenter Study JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS Vorhies, J. S., Weaver, M. J., Bishop, J. A. 2016; 24 (10): 735-742

  Abstract

  Patient experience data are increasingly used to guide performance improvement and to determine physician and hospital reimbursement. We studied the relationship between emergency department (ED) admission and patient satisfaction with physicians' performance, and identified other associated predictors.We evaluated 6,524 inpatient Press Ganey patient experience surveys from two academic level I trauma centers over 5 years. We stratified patients by ED admission or other admission and compared the proportions of patients in each group who were satisfied with physician performance. We used logistic regression to control for demographic differences and characteristics of hospitalizations.Among patients admitted through the ED, 85.18% were satisfied, compared with 89.44% of patients admitted through other pathways (P < 0.001). Admission through the ED predicted decreased satisfaction, with an odds ratio of 0.67 (P = 0.032) after controls were applied through logistic regression.Admission through the ED is an independent risk factor for lower satisfaction with physician performance. Understanding the determinants of patient satisfaction will help improve physician-patient interactions and guide quality improvement and value-based reimbursement initiatives.This retrospective survey-based analysis of satisfaction does not fall clearly under any of the Journal's established categories of level of evidence. The most closely aligned choice would be Level III Prognostic.

  View details for DOI 10.5435/JAAOS-D-16-00084

  View details for Web of Science ID 000385408400010

  View details for PubMedID 27579815

• Growth mechanisms and geochemistry of carbonate concretions from the Cambrian Wheeler Formation (Utah, USA) SEDIMENTOLOGY Gaines, R. R., Vorhies, J. S. 2016; 63 (3): 662-698

  View details for DOI 10.1111/sed.12234

  View details for Web of Science ID 000372342200007

• Legal restrictions and complications of abortion: Insights from data on complication rates in the United States JOURNAL OF PUBLIC HEALTH POLICY Rolnick, J. A., Vorhies, J. S. 2012; 33 (3): 348-362

  Abstract

  Although US federal law requires all American states to permit abortion within their borders, states retain authority to impose restrictions.We used hospital discharge data to study the rates of major abortion complications in 23 states from 2001 to 2008 and their relationship to two laws: (i) restrictions on Medicaid – the state insurance programs for the poor – funding, and (ii) mandatory delays before abortion. Of 131 000 000 discharges in the data set, 10 980 involved an abortion complication. The national rate for complications was 1.90 per 1000 abortions (95 per cent CI: 1.57–2.23). Eleven states required mandatory delays and 12 restricted funding for Medicaid participants. After controlling for socioeconomic characteristics and the pregnancy complication rate, legal restrictions were associated with lower complication rates: mandatory delays (OR 0.79(0.65–0.95)) and restricted Medicaid funding (OR 0.74 (0.61–0.90)). This result may reflect the fact that states without restrictions perform a higher percentage of second-trimester abortions. This study is the first to assess the association between legal restrictions on abortion and complication rates.

  View details for DOI 10.1057/jphp.2012.12

  View details for Web of Science ID 000307793800010

  View details for PubMedID 22622483

• Decreased Length of Stay After TKA Is Not Associated With Increased Readmission Rates in a National Medicare Sample CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Vorhies, J. S., Wang, Y., Herndon, J. H., Maloney, W. J., Huddleston, J. I. 2012; 470 (1): 166-171

  Abstract

  There is a trend toward decreasing length of hospital stay (LOS) after TKA although it is unclear whether this trend is detrimental to the overall postoperative course. Such information is important for future decisions related to cost containment.We determined whether decreases in LOS after TKA are associated with increases in readmission rates.We retrospectively reviewed the rates and reasons for readmission and LOS for 4057 Medicare TKA patients from 2002 to 2007. We abstracted data from the Medicare Patient Safety Monitoring System. Hierarchical generalized linear modeling was used to assess the odds of changing readmission rates and LOS over time, controlling for changes in patient demographic and clinical variables.The overall readmission rate in the 30 days after discharge was 228/4057 (5.6%). The 10 most common reasons for readmission were congestive heart failure (20.4%), chronic ischemic heart disease (13.9%), cardiac dysrhythmias (12.5%), pneumonia (10.8%), osteoarthrosis (9.4%), general symptoms (7.4%), acute myocardial infarction (7.0%), care involving other specified rehabilitation procedure (6.3%), diabetes mellitus (6.3%), and disorders of fluid, electrolyte, and acid-base balance (5.9%); the top 10 causes did not include venous thromboembolism syndromes. We found no difference in the readmission rate between the periods 2002-2004 (5.5%) and 2005-2007 (5.8%) but a reduction in LOS between the periods 2002-2004 (4.1 ± 2.0 days) and 2005-2007 (3.8 ± 1.7 days).The most common causes for readmission were cardiac-related. A reduction in LOS was not associated with an increase in the readmission rate in this sample. Optimization of cardiac status before discharge and routine primary care physician followup may lead to lower readmission rates.

  View details for DOI 10.1007/s11999-011-1957-0

  View details for Web of Science ID 000298103100021

  View details for PubMedID 21720934

  View details for PubMedCentralID PMC3237965

• Readmission and Length of Stay After Total Hip Arthroplasty in a National Medicare Sample JOURNAL OF ARTHROPLASTY Vorhies, J. S., Wang, Y., Herndon, J., Maloney, W., Huddleston, J. I. 2011; 26 (6): 119-123

  Abstract

  Evaluation of hospital readmissions after total hip arthroplasty may help improve patient safety and cost reduction. This study investigates the rates and reasons for readmission as well as length of hospital stay (LOS) for 1802 total hip arthroplasty patients from 2002 to 2007. Data were abstracted from the Medicare Patient Safety Monitoring System. The overall 30-day rate of readmission was 6.8%. There was no difference in readmission rate from 2002 to 2004 (7.1%) to 2005 to 2007 (6.3%) (odds ratio, 0.90; 95% confidence interval, 0.63-1.30; P = .58). The overall mean LOS was 4.2 ± 2.2 days. There was a significant reduction in LOS from 2002 to 2004 (4.4 ± 2.5 days) to 2005 to 2007 (3.8 ± 1.7 days) (odds ratio, 1.28; 95% confidence interval, 1.25-1.31; P < .0001). The most common causes for readmission were cardiac related. A reduction in LOS was not associated with an increase in the rate of readmission in this sample. Efforts to optimize cardiac status before discharge may lead to lower rates of readmission in the future.

  View details for DOI 10.1016/j.arth.2011.04.036

  View details for Web of Science ID 000294393000023

  View details for PubMedID 21723700

• siRNA Versus shRNA for Personalized Cancer Therapy: Mechanisms and Applications GENE-BASED THERAPIES FOR CANCER Vorhies, J. S., Rao, D. D., Senzer, N., Nemunaitis, J., Roth, J. A. 2010: 51–62

  View details for DOI 10.1007/978-1-4419-6102-0_4

  View details for Web of Science ID 000280962600004

• siRNA vs. shRNA: Similarities and differences ADVANCED DRUG DELIVERY REVIEWS Rao, D. D., Vorhies, J. S., Senzer, N., Nemunaitis, J. 2009; 61 (9): 746-759

  Abstract

  RNA interference (RNAi) is a natural process through which expression of a targeted gene can be knocked down with high specificity and selectivity. Using available technology and bioinformatics investigators will soon be able to identify relevant bio molecular tumor network hubs as potential key targets for knockdown approaches. Methods of mediating the RNAi effect involve small interfering RNA (siRNA), short hairpin RNA (shRNA) and bi-functional shRNA. The simplicity of siRNA manufacturing and transient nature of the effect per dose are optimally suited for certain medical disorders (i.e. viral injections). However, using the endogenous processing machinery, optimized shRNA constructs allow for high potency and sustainable effects using low copy numbers resulting in less off-target effects, particularly if embedded in a miRNA scaffold. Bi-functional design may further enhance potency and safety of RNAi-based therapeutics. Remaining challenges include tumor selective delivery vehicles and more complete evaluation of the scope and scale of off-target effects. This review will compare siRNA, shRNA and bi-functional shRNA.

  View details for DOI 10.1016/j.addr.2009.04.004

  View details for Web of Science ID 000267476800008

  View details for PubMedID 19389436

• "Bifunctional" Short Hairpin RNA for Cancer Gene Therapy Rao, D. D., Wang, Z., Kumar, P., Yu, Y., Haddock, C., Vorhies, J., Tong, A. W., Maples, P. B., Senzer, N. N., Nemunaitis, J. NATURE PUBLISHING GROUP. 2009: S255

  View details for Web of Science ID 000278019801241

• Microbial dissolution of clay minerals as a source of iron and silica in marine sediments NATURE GEOSCIENCE Vorhies, J. S., Gaines, R. R. 2009; 2 (3): 221–25

  View details for DOI 10.1038/NGEO441

  View details for Web of Science ID 000264289900025

• Nucleic acid aptamers for targeting of shRNA-based cancer therapeutics. Biologics : targets & therapy Vorhies, J. S., Nemunaitis, J. J. 2007; 1 (4): 367-376

  Abstract

  Aptamers are nucleic acid ligands which have been validated to bind to epitopes with a specificity similar to that of monoclonal antibodies. Aptamers have been primarily investigated for their direct function in terms of inhibition of protein targets; however, recent evidence gives reason to actively explore aptamers as targeting moieties for delivery of anticancer therapeutics. Many aptamers have been developed to bind to extracellular membrane domains of proteins overexpressed on cancer cells and have the potential to be modified for use in targeting cancer therapeutics. The use of DNA vector-based short hairpin RNA (shRNA) for RNA interference (RNAi) is a precise means for the disruption of target gene expression but its clinical usage in cancer is limited by obstacles related to delivery into cancer cells. Nucleic acid aptamers are attractive candidates for targeting of shRNA therapies. Their small size, ease of production and modification, and high specificity are valued attributes in comparison to other targeting moieties currently being tested. Here we review the development of aptamers directed to PSMA, Nucleolin, HER-3, RET, TN-C, and MUC1 and focus on their potential for use in targeting of shRNA-based cancer therapeutics.

  View details for PubMedID 19707307

  View details for PubMedCentralID PMC2721292

• Proof concept for clinical justification of network mapping for personalized cancer therapeutics CANCER GENE THERAPY Nemunaitis, J., Senzer, N., Khalil, I., Shen, Y., Kumar, P., Tong, A., Kuhn, J., LaMont, J., Nemunaitis, M., Rao, D., Zhang, Y., Zhou, Y., Vorhies, J., Maples, P., Hill, C., Shanahan, D. 2007; 14 (8): 686-695

  Abstract

  To identify signature targets associated with patient-specific cancer lesions based on tumor versus normal tissue differential protein and mRNA coexpression patterns for the purpose of synthesizing cancer-specific customized RNA interference knockdown therapeutics. Analysis of biopsied tissue involved two-dimensional difference in-gel electrophoresis (2D-DIGE) analysis coupled with MALDI-TOF/TOF mass spectrometry for proteomic assessment. Standard microarray techniques were utilized for mRNA analysis. Priority was assigned to overexpressed protein targets with co-overexpressed genes with a high likelihood of functional nodal centrality in the cancer network as defined by the interactive databases BIND, HPRD and ResNet. HPLC-grade small interfering RNA (siRNA) duplexes were utilized to assess knockdown of target proteins in expressive cell lines as measured by western blot. Seven patients with metastatic cancer underwent biopsy. One patient (RW001) had biopsies from two disease sites 10 months apart. Seven priority proteins were identified, one for each patient (RACK 1, Ras related nuclear protein, heat-shock 27 kDa protein 1, superoxide dismutase, enolase1, stathmin1 and cofilin1). Prioritized proteins in RW001 from the two disease sites over time were the same. We demonstrated >80% siRNA inhibition of RACK 1 and stathmin1 of inexpressive malignant cell lines with correlated cell kill. Identification of functionally relevant target gene fingerprints, unique to an individual's cancer, is feasible 'at the bedside' and can be utilized to synthesize siRNA knockdown therapeutics. Further animal safety testing followed by clinical study is recommended.

  View details for DOI 10.1038/sj.cgt.7701057

  View details for Web of Science ID 000248146500002

  View details for PubMedID 17541424

• 10-year follow-up of gene-modified adenoviral-based therapy in 146 non-small-cell lung cancer patients CANCER GENE THERAPY Nemunaitis, J., Vorhies, J. S., Pappen, B., Senzer, N. 2007; 14 (8): 762-763

  View details for DOI 10.1038/sj.cgt.7701048

  View details for Web of Science ID 000248146500010

  View details for PubMedID 17514194

• Nonviral delivery vehicles for use in short hairpin RNA-based cancer therapies EXPERT REVIEW OF ANTICANCER THERAPY Vorhies, J. S., Nemunaitis, J. 2007; 7 (3): 373-382

  Abstract

  The use of DNA vector-based short hairpin (sh)RNA for RNA interference shows promise as a precise means for the disruption of gene expression to achieve a therapeutic effect. The in vivo usage of shRNA therapeutics in cancer is limited by obstacles related to effective delivery into the nuclei of target cancer cells. Nonviral delivery vehicles that are relevant for shRNA delivery into humans belong to a group of substances about which significant preclinical data has been amassed to show an acceptable safety profile, resistance to immune defenses and good transfection efficiency. Here, we review the most promising current nonviral gene delivery vehicles with a focus on their potential use in cancer shRNA therapeutics.

  View details for DOI 10.1586/14737140.7.3.373

  View details for Web of Science ID 000245134900015

  View details for PubMedID 17338656