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2. Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial.

Author

OHara, Nathan, Frey, Katherine, Stein, Deborah, Levy, Joseph, Slobogean, Gerard, Castillo, Renan, Firoozabadi, Reza, Karunakar, Madhav, Gary, Joshua, Obremskey, William, Seymour, Rachel, Mullins, C, OToole, Robert, and Cuschieri, Joseph

Abstract

BACKGROUND: Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients experiences with these medications, we compared patients satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin. METHODS: This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) twice daily or 81 mg of aspirin twice daily for thromboprophylaxis. The duration of the thromboprophylaxis, including post-discharge prescription, was based on hospital protocols. The study outcomes included patient satisfaction with and out-of-pocket costs for their thromboprophylactic medication measured on ordinal scales. RESULTS: The trial enrolled 12,211 patients (mean age and standard deviation [SD], 45 ± 18 years; 62% male), 9725 of whom completed the question regarding their satisfaction with the medication and 6723 of whom reported their out-of-pocket costs. The odds of greater satisfaction were 2.6 times higher for patients assigned to aspirin than those assigned to low-molecular-weight heparin (odds ratio [OR]: 2.59; 95% confidence interval [CI]: 2.39 to 2.80; p < 0.001). Overall, the odds of incurring any out-of-pocket costs for thromboprophylaxis medication were 51% higher for patients assigned to aspirin compared with low-molecular-weight heparin (OR: 1.51; 95% CI: 1.37 to 1.66; p < 0.001). However, patients assigned to aspirin had substantially lower odds of out-of-pocket costs of at least $25 (OR: 0.15; 95% CI: 0.12 to 0.18; p < 0.001). CONCLUSIONS: Use of aspirin substantially improved patients satisfaction with their medication after orthopaedic trauma. While aspirin use increased the odds of incurring any out-of-pocket costs, it protected against costs of ≥$25, potentially improving health equity for thromboprophylaxis. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2024

8. The Bioburden Associated with Severe Open Tibial Fracture Wounds at the Time of Definitive Closure or Coverage: The BIOBURDEN Study

Author

Bosse, Michael J., Joshi, Manjari, Carlini, Anthony R., Firoozabadi, Reza, Murray, Clinton K., Manson, Theodore, Yun, Heather C., Gary, Joshua L., Wenke, Joseph C., Castillo, Renan C., Carroll, Eben A., Goodman, James Brett, Holden, Martha B., Miller, Anna N., Spraggs-Hughes, Amanda, Tornetta, Paul, III, Osborn, Patrick M., DeLeon, Stephanie, Hsu, Joseph R., Karunakar, Madhav A., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Fraychineaud, Hannah Gissel, Trujillo, Corey Henderson, Zura, Robert D., Howes, Cameron, Mir, Hassan, Taylor, Benjamin C., Schmidt, Andrew H., Yoon, Patrick, McKinley, Todd O., Sorkin, Anthony, Virkus, Walter W., Krause, Peter C., Lee, Olivia C., Achor, Timothy S., Brinker, Mark R., Choo, Andrew, Munz, John W., Galpin, Matthew C., Frisch, H. Michael, Kaufman, Adam M., Large, Thomas M., LeCroy, C. Michael, Smith, Christopher S., Crickard, Colin V., Langford, Joshua, Reid, J. Spence, Horne, Andrea, O’Toole, Robert V., Eglseder, W. Andrew, Pensy, Raymond A., Crisco, M.J., Zych, Gregory A., Cannada, FAOA; Lisa K., Gardner, Michael J., Rehman, Saqib, Jones, Clifford B., Sietsema, Debra L., Ly, Thuan V., Miclau, Theodore, Morshed, Saam, Kwong, Jonny, Rothberg, David L., Bergin, Patrick F., Bhanat, Eldrin, Graves, Matt L., Spitler, Clay A., Teague, David, Ertl, William, Gorczyca, John T., Lester-Ballard, Veronica, McVey, Eric D., Agel, Julie, Obremskey, William, Burgos, Eduardo J., Gajari, Vamshi, Jahangir, A. Alex, Rodriguez-Buitrago, Andres, Trochez, Karen M., D’Alleyrand, Jean-Claude G., Gordon, Wade T., Ceniceros, Xochitl, Waggoner, Sandra L., and Collins, Susan C.

Published
2024
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10. Do Transtibial Amputations Outperform Amputations of the Hind- and Midfoot Following Severe Limb Trauma?: A Secondary Analysis of the OUTLET Study

Author

Fram, Brianna R., Bosse, Michael J., Odum, Susan M., Reider, Lisa, Gary, Joshua L., Gordon, Wade T., Teague, David, Alkhoury, Dana, MacKenzie, Ellen J., Seymour, Rachel B., Karunakar, Madhav A., Fox, W. Everett, Hsu, Joseph R., Kempton, Laurence, Robinson, Katherine Sample, Sims, Stephen H., Churchill, Christine, Teasdall, Robert D., Carroll, Eben A., Scott, Aaron T., Halvorson, Jason J., Pilson, Holly, Goodman, James Brett, Holden, Martha B., McAndrew, Christopher M., Gardner, Michael J., Miller, Anna N., Hughes, Amanda Spraggs, Stinner, Daniel J., Rivera, Jessica C., Osborn, Patrick M., Nadeau, Jason T., Howes, Cameron, Schenker, Mara L., Mir, Hassan, Taylor, Benjamin C., Schmidt, Andrew H., Mullis, Brian H., Shively, Karl D., Sorkin, Anthony T., Virkus, Walter, Konda, Sanjit R., Choo, Andrew, Munz, John W., Boutte, Sterling, Breslin, Mary A., Toledano, James E., Langford, Joshua Robert, Horne, Andrea, O’Toole, Robert V., Boulton, Christina, Manson, Theodore, Nascone, Jason, Pollak, Andrew N., Sciadini, Marcus F., Degani, Yasmin, Howe, Andrea L., Zych, Gregory A., Cannada, Lisa K., Dawson, Sarah A., Jones, Clifford B., Sietsema, Debra L., Miclau, Theodore, Morshed, Saam, Wilken, Jason M., Bergin, Patrick F., Graves, Matt L., Spitler, Clay A., Jones, LaRita C., Ertl, William, Moloney, Gele B., Evans, Andrew R., Weiss, David B., Yarboro, Seth R., Lester-Ballard, Veronica, McVey, Eric D., Firoozabadi, Reza, Agel, Julie, Obremskey, William, Archer, Kristin R., Burgos, Eduardo J., Gajari, Vamshi, Rodriguez-Buitrago, Andres, Tummuru, Rajesh R., Trochez, Karen M., D’Alleyrand, Jean-Claude G., Castillo, Renan C., Allen, Lauren E., and Carlini, Anthony R.

Published
2024
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11. Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial

Author

O’Hara, Nathan N., Frey, Katherine P., Stein, Deborah M., Levy, Joseph F., Slobogean, Gerard P., Castillo, Renan, Firoozabadi, Reza, Karunakar, Madhav A., Gary, Joshua L., Obremskey, William T., Seymour, Rachel B., Cuschieri, Joseph, Mullins, C. Daniel, and O’Toole, Robert V.

Published
2024
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16. Risk-stratified thromboprophylaxis effects of aspirin versus low-molecular-weight heparin in orthopedic trauma patients: A secondary analysis of the PREVENT CLOT trial

Author

OʼHara, Nathan N., OʼToole, Robert V., Frey, Katherine P., Castillo, Renan C., Cuschieri, Joseph, Haut, Elliott R., Slobogean, Gerard P., Firoozabadi, Reza, Christmas, A. Britton, Obremskey, William T., Carlini, Anthony R., Gaski, Greg E., Kutcher, Matthew E., Marvel, Debra, Stein, Deborah M., Levy, Joseph F., Wegener, Stephen T., Fowler, Brianna E., Taylor, Tara J., Weston-Farber, Elias, Herndon, Steven Craig, Jr., DeCoster, Thomas A., Jurkovich, Gregory J., Lee, Christopher, Malhotra, Ajai K., Riedel, Matthew D., Wells, Jeffrey L., Altman, Daniel T., Westrick, Edward R., Bosse, Michael J., Karunakar, Madhav A., Cunningham, Kyle W., Huynh, Toan, Jacobs, David G., Kempton, Laurence B., Phelps, Kevin D., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Carroll, Eben A., Babcock, Sharon, Miller, Preston R., Pilson, Holly T., Goodman, James Brett, Weaver, Michael J., Esposito, John G., Goldhaber, Samuel Zachary, Heng, Marilyn, McGovern, Madeline M., Velmahos, George C., von Keudell, Arvind G., Rivera, Jessica C., Gitajn, Ida Leah, Schneider, Prism S., Buckley, Richard E., Johal, Herman S., Gallant, Jodi L., McKay, Paula, Kleweno, Conor P., Agel, Julie, Arif, Hikmatullah, McKinley, Todd O., Natoli, Roman M., Heincelman, Carrie L., Jang, Yohan, Lopas, Luke A., Mullis, Brian H., Richard, Raveesh D., Virkus, Walter, Hill, Lauren C., Hymes, Robert A., Holzman, Michael, Malekzadeh, A. Stephen, Panjshiri, Farhanaz, Schulman, Jeff E., Ramsey, Lolita, Ahn, James, Cuff, Jaslynn A. N., Gary, Joshua L., Warner, Stephen J., Cotton, Bryan A., Vallier, Heather A., Claridge, Jeffrey A., Breslin, Mary A., Cowley, R Adams, Connelly, Daniel, Eglseder, W. Andrew, Haac, Bryce E., Healey, Kathleen Marie, LeBrun, Christopher T., Manson, Theodore, McKibben, Natasha S., Mulliken, Alexandra, Nascone, Jason, Pensy, Raymond A., Pollak, Andrew N., Sciadini, Marcus F., Udogwu, Ugochukwu N., Zingas, Nicolas, Burke, Cynthia Elaine, DeLeon, Genaro A., Hannan, Zachary D., Howe, Andrea L., Marinos, Dimitrius P., McKegg, Phillip C., Evans, Andrew R., Askam, Brad M., Joseph, Bellal, Lowe, Jason, Weinlein, John C., Bergin, Patrick F., Bhanat, Eldrin L., Khanna, Rajinder, Morellato, John, Nehete, Priyanka V., Domes, Christopher, Whiting, Paul S., Goodspeed, David C., Kuhn, Gabrielle R., Guillamondegui, Oscar D., Moreno-Diaz, Andres Fidel, Stinner, Daniel J., Pritchett, Charles, Jr., and Trochez, Karen M.

Published
2024
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17. Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes

Author

Gitajn, Ida Leah, Werth, Paul M., Carlini, Anthony R., Bosse, Michael J., Gary, Joshua L., Firoozabadi, Reza, Obremskey, William, McKinley, Todd O., Castillo, Renan C., O’Toole, Robert V., Westrick, Edward R., Carroll, Eben A., Goodman, James Brett, Holden, Martha B., Miller, Anna N., Spraggs-Hughes, Amanda, Brennan, Michael L., Tornetta, Paul, III, Weaver, Michael J., Heng, Marilyn, Osborn, Patrick M., Rivera, Jessica C., Murray, Clinton K., Kimmel, Joseph E., Moon, Charles, Hsu, Joseph R., Karunakar, Madhav A., Kempton, Laurence B., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Reilly, Rachel M., Zura, Robert D., Howes, Cameron, Mir, Hassan, Wagstrom, Emily A., Mullis, Brian, Anglen, Jeffrey O., Mullis, Leilani S., Shively, Karl D., Gaski, Greg E., Natoli, Roman M., Sorkin, Anthony, Virkus, Walter, Hymes, Robert A., Holzman, Michael A., Malekzadeh, A. Stephen, Schulman, Jeff E., Schwartzbach, Cary C., Lee, Olivia C., Krause, Peter C., Morandi, Massimo 'Max', Choo, Andrew, Munz, John W., Boutte, Sterling, Galpin, Matthew C., Frisch, H. Michael, Kaufman, Adam M., LeCroy, C. Michael, Smith, Christopher S., Stall, Alec C., Horne, Andrea, Nascone, Jason W., OʼHara, Nathan N., Paryavi, Ebrahim, Sciadini, Marcus F., Degani, Yasmin, Howe, Andrea L., Hayda, Roman, Evans, Andrew R., Sietsema, Debra L., Stawicki, Stanislaw P., Wojda, Thomas, Gardner, Michael J., Bishop, Julius A., Rehman, Saqib, Caroom, Cyrus, Sheridan, Elizabeth, Miclau, Theodore, Morshed, Saam, Higgins, Thomas F., Haller, Justin M., Matuszewski, Paul E., Aneja, Arun, Wright, Raymond D., Jr., Bergin, Patrick F., Bhanat, Eldrin, Graves, Matt L., Morellato, John, Spitler, Clay A., Teague, David, Ertl, William, Ahn, Jaimo, Hesketh, Patrick, Moloney, Gele B., Weinlein, John C., Zelle, Boris A., Agarwal, Animesh, Karia, Ravi A., Sathy, Ashoke, Sanders, Drew T., Weiss, David B., Yarboro, Seth R., Lester-Ballard, Veronica, McVey, Eric D., Dagal, Arman, Githens, Michael, Kleweno, Conor, Agel, Julie, Whiting, Paul S., Simske, Natasha M., Siy, Alexander B., Attum, Basem, Burgos, Eduardo, Gajari, Vamshi, Rodriguez-Buitrago, Andres, Sethi, Manish, Tummuru, Rajesh R., DʼAlleyrand, Jean-Claude G., Allen, Lauren E., Collins, Susan C., Huang, Yanjie, and Taylor, Tara J.

Published
2024
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18. Comparing Two Medicines to Prevent Blood Clots after Treatment for Fractures – The PREVENT CLOT Study

Author

O’Toole, Robert, primary, Stein, Deborah, additional, Nathan N. O’Hara_, Nathan, additional, _Katherine P. Frey_, Katherine, additional, Tara J. Taylor_, Tara, additional, Daniel O. Scharfstein_, Daniel, additional, Anthony R. Carlini, Anthony, additional, Kuladeep Sudini_, Kuladeep, additional, Yasmin Degani, Yasmin, additional, _Gerard P. Slobogean_, Gerard, additional, _Elliott R. Haut, Elliott, additional, _William Obremskey_, William, additional, _ Reza Firoozabadi, Reza, additional, _Michael J. Bosse_, Michael, additional, _Samuel Z. Goldhaber, Samuel, additional, __Debra Marvel____, Debra, additional, and Castillo, Renan, additional

Published
2023
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19. PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT): a randomised pragmatic trial protocol comparing aspirin versus low-molecular-weight heparin for blood clot prevention in orthopaedic trauma patients.

Author

O'Toole, Robert V, Stein, Deborah M, Frey, Katherine P, O'Hara, Nathan N, Scharfstein, Daniel O, Slobogean, Gerard P, Taylor, Tara J, Haac, Bryce E, Carlini, Anthony R, Manson, Theodore T, Sudini, Kuladeep, Mullins, C Daniel, Wegener, Stephen T, Firoozabadi, Reza, Haut, Elliott R, Bosse, Michael J, Seymour, Rachel B, Holden, Martha B, Gitajn, Ida Leah, Goldhaber, Samuel Z, Eastman, Alexander L, Jurkovich, Gregory J, Vallier, Heather A, Gary, Joshua L, Kleweno, Conor P, Cuschieri, Joseph, Marvel, Debra, Castillo, Renan C, and METRC

Subjects
METRC, orthopaedic & trauma surgery, thromboembolism, trauma management, Clinical Sciences, Public Health and Health Services, Other Medical and Health Sciences
Abstract

IntroductionPatients who sustain orthopaedic trauma are at an increased risk of venous thromboembolism (VTE), including fatal pulmonary embolism (PE). Current guidelines recommend low-molecular-weight heparin (LMWH) for VTE prophylaxis in orthopaedic trauma patients. However, emerging literature in total joint arthroplasty patients suggests the potential clinical benefits of VTE prophylaxis with aspirin. The primary aim of this trial is to compare aspirin with LMWH as a thromboprophylaxis in fracture patients.Methods and analysisPREVENT CLOT is a multicentre, randomised, pragmatic trial that aims to enrol 12 200 adult patients admitted to 1 of 21 participating centres with an operative extremity fracture, or any pelvis or acetabular fracture. The primary outcome is all-cause mortality. We will evaluate non-inferiority by testing whether the intention-to-treat difference in the probability of dying within 90 days of randomisation between aspirin and LMWH is less than our non-inferiority margin of 0.75%. Secondary efficacy outcomes include cause-specific mortality, non-fatal PE and deep vein thrombosis. Safety outcomes include bleeding complications, wound complications and deep surgical site infections.Ethics and disseminationThe PREVENT CLOT trial has been approved by the ethics board at the coordinating centre (Johns Hopkins Bloomberg School of Public Health) and all participating sites. Recruitment began in April 2017 and will continue through 2021. As both study medications are currently in clinical use for VTE prophylaxis for orthopaedic trauma patients, the findings of this trial can be easily adopted into clinical practice. The results of this large, patient-centred pragmatic trial will help guide treatment choices to prevent VTE in fracture patients.Trial registration numberNCT02984384.

Published
2021

32. Management and radiographic outcomes of femoral head fractures.

Author

Marecek, Geoffrey, Firoozabadi, Reza, Krieg, James, Routt, Milton, and Scolaro, John

Subjects
Femoral head, Fracture, Heterotopic ossification, Hip dislocation, Pipkin, Adolescent, Adult, Aged, Aged, 80 and over, Arthritis, Female, Femoral Fractures, Femur Head, Femur Head Necrosis, Humans, Incidence, Male, Middle Aged, Ossification, Heterotopic, Retrospective Studies, Trauma Centers, Young Adult
Abstract

BACKGROUND: Femoral head fractures are uncommon injuries. Small series constitute the majority of the available literature. Surgical approach and fracture management is variable. The purpose of this study was to evaluate the incidence, method of treatment, and outcomes of consecutive femoral head fractures at a regional academic Level I trauma center. MATERIALS AND METHODS: A retrospective review of a prospective database was performed over a 13-year period. All AO/OTA 31C femoral head fractures were identified. A surgical approach and fixation method was recorded. Clinical and radiographic evaluation was performed for patients with 6 months or greater follow-up. Radiographs were evaluated for fixation failure, heterotopic ossification (HO), avascular necrosis (AVN) and post-traumatic arthritis. RESULTS: We identified 164 fractures in 163 patients; 147 fractures were available for review. Treatment was operative reduction and internal fixation (ORIF) in 78 (53.1%), fragment excision in 37 (25.1%) and non-operative in 28 (19%). An anterior approach and mini-fragment screws were used in the majority of patients treated with fixation. Sixty-nine fractures had follow-up greater than 6 months. Sixty-two fractures (89.9%) proceeded to uneventful union. All Pipkin III fractures failed operative fixation. Six patients developed AVN, seven patients had a known conversion to hip arthroplasty; HO developed in 28 (40.6%) patients and rarely required excision. CONCLUSIONS: Fractures of the femoral head are rare. An anterior approach can be used for fragment excision or fixation using mini-fragment screws. Pipkin III fractures represent catastrophic injuries. Non-bridging, asymptomatic HO is common. AVN and posttraumatic degenerative disease of the hip occur but are uncommon. LEVEL OF EVIDENCE: IV-prognostic.

Published
2017

33. Management and radiographic outcomes of femoral head fractures

Author

Scolaro, John A, Marecek, Geoffrey, Firoozabadi, Reza, Krieg, James C, and Routt, Milton Lee Chip

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Physical Injury - Accidents and Adverse Effects, Clinical Research, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Injuries and accidents, Adolescent, Adult, Aged, Aged, 80 and over, Arthritis, Female, Femoral Fractures, Femur Head, Femur Head Necrosis, Humans, Incidence, Male, Middle Aged, Ossification, Heterotopic, Retrospective Studies, Trauma Centers, Young Adult, Femoral head, Fracture, Hip dislocation, Pipkin, Heterotopic ossification, Orthopedics, Clinical sciences
Abstract

BackgroundFemoral head fractures are uncommon injuries. Small series constitute the majority of the available literature. Surgical approach and fracture management is variable. The purpose of this study was to evaluate the incidence, method of treatment, and outcomes of consecutive femoral head fractures at a regional academic Level I trauma center.Materials and methodsA retrospective review of a prospective database was performed over a 13-year period. All AO/OTA 31C femoral head fractures were identified. A surgical approach and fixation method was recorded. Clinical and radiographic evaluation was performed for patients with 6 months or greater follow-up. Radiographs were evaluated for fixation failure, heterotopic ossification (HO), avascular necrosis (AVN) and post-traumatic arthritis.ResultsWe identified 164 fractures in 163 patients; 147 fractures were available for review. Treatment was operative reduction and internal fixation (ORIF) in 78 (53.1%), fragment excision in 37 (25.1%) and non-operative in 28 (19%). An anterior approach and mini-fragment screws were used in the majority of patients treated with fixation. Sixty-nine fractures had follow-up greater than 6 months. Sixty-two fractures (89.9%) proceeded to uneventful union. All Pipkin III fractures failed operative fixation. Six patients developed AVN, seven patients had a known conversion to hip arthroplasty; HO developed in 28 (40.6%) patients and rarely required excision.ConclusionsFractures of the femoral head are rare. An anterior approach can be used for fragment excision or fixation using mini-fragment screws. Pipkin III fractures represent catastrophic injuries. Non-bridging, asymptomatic HO is common. AVN and posttraumatic degenerative disease of the hip occur but are uncommon.Level of evidenceIV-prognostic.

Published
2017

34. Anatomic Knowledge and Perceptions of the Adequacy of Anatomic Education Among Applicants to Orthopaedic Residency

Author

Toogood, Paul, Shaw, Jeremy, Nussenbaum, Fernando, Acosta, Anna, Dawson, Jack, Perkins, Christopher, Firoozabadi, Reza, and Lee, Nicolas

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Quality Education
Abstract

BackgroundThe time dedicated to the study of human anatomy within medical school curriculums has been substantially reduced. The effect of this on the knowledge of incoming orthopaedic trainees is unknown. The current study aimed to evaluate both the subjective perceptions and objective anatomic knowledge of fourth-year medical students applying for orthopaedic residency.MethodsA multicenter prospective study was performed that assessed 224 students during the course of their interview day for an orthopaedic residency. Participants provided demographic data and a subjective assessment of the quality of their anatomic education, and completed either an upper or lower extremity anatomic examination. Mean total scores and subscores for various anatomic regions and concepts were calculated.ResultsStudents on average rated the adequacy of their anatomic education as 6.5 on a 10-point scale. Similarly, they rated the level of importance their medical school placed on anatomic education as 6.2 on a 10-point scale. Almost 90% rated the time dedicated to anatomy as good or fair. Of six possible methods for learning anatomy, dissection was rated the highest.On objective examinations, the mean score for correct answers was 44.2%. This improved to 56.4% when correct and acceptable answers were considered. Regardless of anatomic regions or concepts evaluated, percent correct scores did not reach 50%. There were no significant correlations between performance on the anatomic examinations and either prior academic performance measures or the student's subjective assessment of their anatomic education.ConclusionsCurrent students applying into orthopaedic residency do not appear to be adequately prepared with the prerequisite anatomic knowledge. These deficits must be explicitly addressed during residency training to produce competent, safe orthopaedic surgeons.

Published
2017

37. The 1-Year Economic Impact of Work Productivity Loss Following Severe Lower Extremity Trauma

Author

Levy, Joseph F., Reider, Lisa, Scharfstein, Daniel O., Pollak, Andrew N., Morshed, Saam, Firoozabadi, Reza, Archer, Kristin R., Gary, Joshua L., O’Toole, Robert V., Castillo, Renan C., Quinnan, Stephen M., Kempton, Laurence B., Jones, Clifford B., Bosse, Michael J., MacKenzie, Ellen J., Altman, Gregory T., McAndrew, Christopher M., Reilly, Rachel M., Mullis, Brian H., Mir, Hassan R., Shah, Anjan R., Reisman, William M., Taylor, Benjamin C., Schmidt, Andrew H., McKinley, Todd O., Sorkin, Anthony, Virkus, Walter W., Gaski, Greg E., Konda, Sanjit R., Vallier, Heather A., Frisch, H. Michael, Sheu, Robert G., Toledano, James E., Cannada, Lisa K., Langford, Joshua, Zych, Gregory A., Hutson, James J., Jr., Osborn, Patrick M., Spitler, Clay A., Miclau, Theodore, Wilken, Jason M., Bergin, Patrick F., Teague, David, Moloney, Gele B., Sathy, Ashoke K., Obremskey, William, Carroll, Eben A., Potter, Benjamin K., Carlini, Anthony R., Keita, Maningbe, and Luly, Jason

Published
2022
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39. Open Ankle Fractures: What Predicts Infection? A Multicenter Study

Author

Cooke, Margaret E., Tornetta, Paul, III, Firoozabadi, Reza, Vallier, Heather, Weinberg, Douglas S., Alton, Timothy B., Dillman, Megan R., Westberg, Jerald R., Schmidt, Andrew, Bosse, Michael, Leas, Daniel P., Archdeacon, Michael, Kakazu, Rafael, Nzegwu, Ifeanyi, OToole, Robert V., Costales, Timothy G., Coale, Max, Mullis, Brian, Usmani, Rashad H., Egol, Kenneth, Kottmeier, Stephen, Sanders, David, Jones, Cliff, Miller, Anna N., Horwitz, Daniel S., Kempegowda, Harish, Morshed, Saam, Belaye, Tigist, and Teague, David

Published
2022
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40. Patient-Specific Precision Injury Signatures to Optimize Orthopaedic Interventions in Multiply Injured Patients (PRECISE STUDY)

Author

McKinley, Todd O., Gaski, Greg E., Billiar, Timothy R., Vodovotz, Yoram, Brown, Krista M., Elster, Eric A., Constantine, Greg M., Schobel, Seth A., Robertson, Henry T., Meagher, Ashley D., Firoozabadi, Reza, Gary, Joshua L., OʼToole, Robert V., Aneja, Arun, Trochez, Karen M., Kempton, Laurence B., Steenburg, Scott D., Collins, Susan C., Frey, Katherine P., and Castillo, Renan C.

Published
2022
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41. Validation of the AO Spine Sacral Classification System: Reliability Among Surgeons Worldwide

Author

Schroeder, Gregory D., Karamian, Brian A., Canseco, Jose A., Vialle, Luiz R., Kandziora, Frank, Benneker, Lorin M., Rajasekaran, Shanmuganathan, Holstein, Jörg H., Schnake, Klaus J., Kurd, Mark F., Dvorak, Marcel F., Vialle, Emiliano N., Joaquim, Andrei F., Kanna, Rishi M., Fehlings, Michael, Wilson, Jefferson R., Chapman, Jens R., Krieg, James C., Kleweno, Conor P., Firoozabadi, Reza, Öner, F. Cumhur, Kepler, Christopher K., and Vaccaro, Alexander R.

Published
2021
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42. Risk-stratified thromboprophylaxis effects of aspirin versus low-molecular-weight heparin in orthopedic trauma patients: A secondary analysis of the PREVENT CLOT trial.

Author

O'Hara, Nathan N., O'Toole, Robert V., Frey, Katherine P., Castillo, Renan C., Cuschieri, Joseph, Haut, Elliott R., Slobogean, Gerard P., Firoozabadi, Reza, Christmas, A. Britton, Obremskey, William T., Carlini, Anthony R., Gaski, Greg E., Kutcher, Matthew E., Marvel, Debra, and Stein, Deborah M.

Published
2024
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43. Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial.

Author

O'Hara, Nathan N., Frey, Katherine P., Stein, Deborah M., Levy, Joseph F., Slobogean, Gerard P., Castillo, Renan, Firoozabadi, Reza, Karunakar, Madhav A., Gary, Joshua L., Obremskey, William T., Seymour, Rachel B., Cuschieri, Joseph, Mullins, C. Daniel, O'Toole, Robert V., Carlini, Anthony R., Fowler, Brianna E., Taylor, Tara J., Wegener, Stephen T., Weston-Farber, Elias, and Herndon, Steven Craig

Subjects
ASPIRIN, HEPARIN, ENOXAPARIN, LOW-molecular-weight heparin, PATIENTS' attitudes, CLINICAL trials, COST analysis, PATIENT experience
Abstract

Background: Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients' experiences with these medications, we compared patients' satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin. Methods: This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) twice daily or 81 mg of aspirin twice daily for thromboprophylaxis. The duration of the thromboprophylaxis, including post-discharge prescription, was based on hospital protocols. The study outcomes included patient satisfaction with and out-of-pocket costs for their thromboprophylactic medication measured on ordinal scales. Results: The trial enrolled 12,211 patients (mean age and standard deviation [SD], 45 ± 18 years; 62% male), 9725 of whom completed the question regarding their satisfaction with the medication and 6723 of whom reported their out-of-pocket costs. The odds of greater satisfaction were 2.6 times higher for patients assigned to aspirin than those assigned to low-molecular-weight heparin (odds ratio [OR]: 2.59; 95% confidence interval [CI]: 2.39 to 2.80; p < 0.001). Overall, the odds of incurring any out-of-pocket costs for thromboprophylaxis medication were 51% higher for patients assigned to aspirin compared with low-molecular-weight heparin (OR: 1.51; 95% CI: 1.37 to 1.66; p < 0.001). However, patients assigned to aspirin had substantially lower odds of out-of-pocket costs of at least $25 (OR: 0.15; 95% CI: 0.12 to 0.18; p < 0.001). Conclusions: Use of aspirin substantially improved patients' satisfaction with their medication after orthopaedic trauma. While aspirin use increased the odds of incurring any out-of-pocket costs, it protected against costs of ≥$25, potentially improving health equity for thromboprophylaxis. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Published
2024
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49. Henry Versus Thompson Approach for Fixation of Proximal Third Radial Shaft Fractures: A Multicenter Study

Author

Dashe, Jesse, Murray, Brett, Tornetta, Paul, III, Grott, Kelly M, Mullis, Brian, Bellevue, Kate D, Firoozabadi, Reza, Kempegowda, Harish, Horwitz, Daniel S, Patel, Shaan, Fontenot, Philip B, Mir, Hassan, Ruder, John A, Bosse, Michael J, Sandberg, Benjamin, Westberg, Jerald, Bramlett, Kasey J, Marcantonio, Andrew J, Sadauskas, Alex J, Cannada, Lisa K, Goodwin, Alexandra, Miller, Anna M, Fox, M Patricia, and Klatman, Samuel H

Published
2019
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50. Erectile dysfunction after acetabular fracture

Author

Elliott, Iain S., primary, Kleweno, Conor, additional, Agel, Julie, additional, Coale, Max, additional, Patterson, Joseph T., additional, Firoozabadi, Reza, additional, Githens, Michael, additional, and Johnsen, Niels V., additional

Published
2023
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