Naohiro Shibuya D.P.M.

Graney, C., N. Shibuya, H. Patel and D. C. Jupiter (2019). “Popliteal Versus Local Field Block for Pain-Related Postoperative Unplanned Emergency Room Visits After Foot and Ankle Surgery.” Foot Ankle Spec Jan 10. [Epub ahead of print].

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Ultrasound-guided popliteal blocks for postoperative pain management have grown in popularity within foot and ankle surgery. The purpose of this study was to evaluate the efficacy of popliteal block in preventing postoperative emergency department visits after foot and ankle surgery. We compared rates of presentation to the emergency department for pain following foot and ankle surgery between surgeries with a popliteal block and those with local field block alone. We identified 101 charts, of which 26 presented to the emergency department for postoperative pain following popliteal block. Our results demonstrated that popliteal blocks did not perform better than local blocks, and that there is no statistically significant difference between the 2 methods of postoperative pain control in terms of rates of presentation to the emergency department for pain. Levels of Evidence: Level III, All statistical analyses were carried out using the R statistical package by the primary author (NS) (R Developmental, Core Team. R: A Language and Environment for Statistical Computing, 2012. http://www.R-project.org ).E

Shibuya, N., C. Graney, H. Patel and D. C. Jupiter (2018). “Predictors for Surgery-Related Emergency Department Visits within 30 Days of Foot and Ankle Surgeries.” J Foot Ankle Surg Sep 6. [Epub ahead of print].

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Presentation to an emergency department (ED) after foot and ankle surgeries not only causes inconvenience to patients but also increases healthcare costs. To minimize this, many major institutions have tracked these data as a part of quality improvement measures. Our previous study showed that factors associated with any (surgery-related and unrelated) postoperative ED visits were not easily modifiable by surgeons. Therefore, in the current study, we focused on factors associated specifically with surgery-related postoperative ED visits, because this may provide some insights for surgeons rather than just administrators. We examined 513 foot and ankle surgeries, of which 114 resulted in 30-day postoperative ED visits for surgery-related reasons. Demographic, medical, and surgical factors were evaluated, and risk factors were identified after adjusting for potential clinically relevant covariates. Both inpatient and outpatient surgical settings and outpatient surgical settings alone were analyzed separately. Regardless of the setting, we found that shorter surgery was protective against postoperative ED visits, as was having a previous ED visit within 6 months before surgery. In the outpatient setting, younger age and having no insurance were also proxies for a postoperative ED visit, in addition to the above factors.

Jupiter, D. C., X. Fang, Z. Ashmore, N. Shibuya and H. B. Mehta (2018). “The relative risk of Achilles tendon injury in patients taking quinolones.” Pharmacotherapy Jul 4. [Epub ahead of print].

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OBJECTIVE: To examine the association between quinolone use and Achilles tendon injury, comparing well matched cohorts of users of quinolone and non-quinolone antibiotics, and well matched cohorts of quinolone users and patients not using any non-quinolone antibiotics. PATIENTS AND METHODS: This retrospective cohort study used Clinformatics data from 2008 to 2014. Using propensity score, we matched quinolone users with other antibiotic users, and quinolone users with non-users. The primary outcome was Achilles tendon injury within 6 months. Bivariate analyses determined risk factors for Achilles tendon injury, and conditional logistic regression assessed impact of quinolone use on these injuries. RESULTS: Fluoroquinolone users (N=716,522) were matched with other antibiotic users, and fluoroquinolone users (N=645,034) were matched with non-users. Rates of Achilles tendon injury were less than 0.5% in all groups. Quinolone use increased risk of Achilles tendon injury compared to other antibiotic users (OR 1.24, 95% CI 1.17-1.31), and non-users (OR 1.54, 95% CI 1.44-1.64). Interaction with age did not significantly impact the relationship between quinolone use and Achilles injury; however, older quinolone users had slightly higher relative risk of injury than non-users vs. younger patients. Further, the youngest group of patients had similarly elevated relative risk for injury with quinolone use as did the elderly. CONCLUSION: While quinolone use increases risk of Achilles tendon injury, the absolute risk increase is minimal, especially when compared to similar morbidity patients taking other non-quinolone antibiotics. In relatively healthy populations, such as the one studied here, quinolone use may not make a clinically significantly contribution to risk of Achilles tendon injury, at any age range, among those in need of such drugs.

Shibuya, N., T. S. Roukis and D. C. Jupiter (2017). “Mobility of the first ray in patients with or without hallux valgus deformity: Systematic review and meta-analysis.” J Foot Ankle Surg: 2017 Jul [Epub ahead of print].

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The hypermobility theory of the first ray is the reason for the popularization of procedures such as the modified Lapidus procedure involving arthrodesis of the first tarsal-metatarsal joint for correction of hallux valgus deformity. Although many studies have involved motion of the first ray in hallux valgus patients, the presence and clinical significance of hypermobility in the first ray remains controversial. We performed a systematic review and meta-analysis to evaluate the difference in the first ray range of motion between patients with or without hallux valgus deformity. The databases used for the present review included Ovid EMBASE, Ovid MEDLINE, CINAHL, and the Cochrane Database. We searched for comparative studies that had evaluated the motion of the first ray in patients with or without hallux valgus. After screening for inclusion and exclusion criteria, we identified 3 studies that were relevant to our study question. All 3 studies showed more first ray motion in the hallux valgus group. Our quantitative synthesis showed a mean difference in the range of motion of the first ray of 3.62 mm (95% confidence interval 2.26 to 4.98) between those with and without hallux valgus deformity. Thus, we found statistically significantly increased first ray motion in patients with hallux valgus deformity compared with those without hallux valgus deformity. However, the clinical significance of this small amount of increased sagittal plane motion as a response to or a cause of hallux valgus remains unanswered.

Thorud, J. C., S. Mortensen, J. L. Thorud, N. Shibuya, Y. M. Maldonado and D. C. Jupiter (2017). “Effect of obesity on bone healing after foot and ankle long bone fractures.” J Foot Ankle Surg 56(2): 258-262.

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As obesity has become more common, fractures in the obese population have become more frequent. Concern exists regarding alterations in bone health and healing in obese patients. A matched case-control study was performed at 1 institution to evaluate whether an association exists between nonunion and a high body mass index in metatarsal and ankle fractures. A total of 48 patients with nonunion were identified, and control patients matched 2 to 1 (n = 96) were selected. The control patients were matched for age, sex, and fracture type. No association was identified between nonunion and the continuous body mass index (p = .23) or morbid obesity, with a body mass index of >/=40 kg/m2 (p = .51). However, the results from both univariate and multivariate analysis suggested that patients with a current alcohol problem or a history of an alcohol problem might have a greater risk of nonunion. The odds ratio of a patient with a history of alcohol use experiencing nonunion was 2.7 (95% confidence interval 1.2 to 6.2). Further studies are warranted to confirm these findings.