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The effects of anesthsia techniques on mobidity-mortality in geriatric patients underwent orthopedic surgery

Yıl 2014, Cilt: 4 Sayı: 3, 143 - 150, 18.01.2015
https://doi.org/10.16899/ctd.99763

Öz

Aim:The purpose of this retrospective study is to investigate the effect of preoperative risk factors and anaesthesia techniques on perioperative complications and mortality in elderly patients.

Material and Methods:The records of the  patients aged 65 or older who underwent orthopedic surgery between  January 2013 and December 2013 were evaluated retrospectively. Demographic data, comorbidities, preoperative hemoglobin and creatinine levels, ASA, Lee index, type and length of surgery, anaesthesia technique, anesthetics and analgesics, peroperative and postoperative complications were recorded. Patients were divided into two groups; general anaesthesia and regional anaesthesia.

Results:A total of 255 patients including 160 (%62,7) females and 95 (%37,3) males over 65 years those underwent orthopedic surgery were included into this study. Since regional anesthesia was detected as a preferred anesthesia technique in patients with chronic obstructive lung disease (p = 0.001), there was no significance existed in comparison with the other comorbidities (p > 0.05). There was no significant difference found between general and regional anesthesia performed patients in comparison with peroperative and postoperative complications. A total of 12 (%4.7) patients underwent lower extremity surgery were resulted in exitus. A lower positive correlation was found between the ASA values of the patients and mortality (r = 0.205, p = 0.001).

Conclusion:It was concluded that the anesthesia method has no effect on early morbidity and mortality in geriatric patients underwent orthopedic surgery.

 

 

Kaynakça

  • -Kinsella K, Wan H. U.S. Census Bureau: Internetional Population Reports. An Aging World: 2008, Washington: U.S. Government Printing Office, DC, 2009: 1-209. http://www.census.gov/prod/2009pubs/p95-09-1. (accessed on November 2009)
  • -Murray D, Dodds C. Pre-operative Assessment of the Elderly. BJA CEPD Reviews 2001;1(6): 181-4
  • -Partridge JSL, Harari D, Martin FC, Dhesi JK.Pre-operative Comprehensive Geriatric Assessment. Anaesthesia 2014; 69(1): 8-16
  • -Salive EM. Multimorbidity in Older Adults. Epidemiol Rev 2013; 35(1):75-83
  • -Cook DJ, Rooke GA. Priorities in Perioperative Geriatrics. Anesth Analg 2003; 96: 1823-36
  • -Manku K, Bacchetti P, Leung J. Prognostic Significance of Postoperative In-Hospital Complications in Elderly Patients. I. Long Term Survival. Anesth Analg 2003; 96: 583-9
  • -Harari D, Hopper A, Dhesi J, Babic-Illman G, Lockwood L, Martin F. Proactive Care of Older People Undergoing Surgery(‘POPS’): Designing, Embedding, Evaluating and Funding a Comprehensive Geriatric Assessment Service for Older Elective Surgical Patients. Age and Ageing 2007; 36: 190-6
  • -Harsteni A, Kehlet H, Toksvig-Larsen. Recovery After Total Intravenous General Anaesthesia or Spinal Anaesthesia for Total Knee Arthroplasty: a Randomized Trial. Br J Anaesth 2013; 111(3): 391-9
  • - Memtsoudis SG, Sun X, Chiu YL et al. Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients. Anesthesiology 2013; 118: 1046-58
  • -Lee TH, Mercantonia ER, Manqione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100(10): 1043-9.
  • - Roche JJW, Wenn RT, Sahota O, Moran CG. Effect of Comorbidities and Postoperative Complications on Mortality After Hip Fracture in Elderly People: Prospective Observational Cohort Study. BMJ 2005; 331 (7529): 1374
  • -Khasraghi FA, Lee EJ, Christmas C, Wenz JF.The Economic İmpact of Medical Complications in Geriatric Patients with Hip Fracture. Orthopedics 2003; 26(1): 49-53
  • -McNicol L, Story DA, Leslie K et al. Postoperative Complications and Mortality in Older Patients Having Non-Cardiac Surgery at Three Melbourne Teaching Hospitals. MJA 2007; 186(9): 447-51
  • -Lee-Wendling L, Bihorac A, Baslanti TO et al. Regional Anesthesia as Compared with General Anesthesia for Surgery in Geriatric Patients with Hip Fracture: Does it Decrease Morbidity, Mortality, And Health Care Costs? Results of a Single-Centered Study. Pain Medicine 2012; 13:948-56
  • -Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E. Patient Risk Factors, Operative Care, and Outcomes Among Older Community-Dwelling Male Veterans with Hip Fracture. J Bone Joint Surg Am 2008; 90: 34-42
  • -Fritsch G, Flamm M, Hepner DL, Panisch S, Seer J, Soennichsen A. Abnormal Pre-operative Tests, Pathologic Findings of Medical History, and Their Predictive Value for perioperative Complications. Acta Anaesthesiol Scand 2012; 56(3): 339-50
  • -Barnett S, Moonesinghe SR. Clinical Risk Scores to Guide Perioperative Management. Postgrad Med J 2011; 87(1030): 535-41
  • - Poldermans D, Bax JJ, Boersma E. Guidelines for Pre-Operative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-Cardiac Surgery. Eur Heart J 2009; 30(22): 2769-812
  • -Prause G, Ratzenhofer-Comenda B, Pierer G, Smolle-Jüttner F, Glanzer H, Smolle J. Can ASA grade or Goldman's Cardiac Risk Index Predict Peri-operative Mortality? A Study of 16,227 Patients. Anaesthesia 1997; 52(3): 203-6
  • -Gilbert K, Larocque BJ, Patrick LT. Prospective Evaluation of Cardiac Risk Indices for Patients Undergoing Noncardiac Surgery. Ann Intern Med 2000; 133: 356-9
  • -Ford MK, Beattie WS, Wijeysundera DN. Systematic Review: Prediction of Perioperative Cardiac Complications and Mortality by The Revised Cardiac Risk Index. Ann Intern Med 2010; 152(1): 26-35
  • -Park WY, Thompson JS, Lee KK. Effect of Epidural Anesthesia and Analgesia on Perioperative Outcome A Randomized, Controlled Veterans Affairs Cooperative Study. Ann Surg 2001; 234(4): 560-71
  • -Rodgers A, Walker N, Schug S et al. Reduction of Postoperative Mortality and Morbidity with Epidural or Spinal Anaesthesia: Results from Overview of Randomised trials. BMJ 2000; 321: 1-12
  • -Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA.Comparative Effectiveness of Regional versus General Anesthesia for Hip Fracture Surgery in Adults. Anesthesiology 2012; 117(1): 72-92
  • -Deiner S, Silverstein JH. Postoperative Delirium and Cognitive Dysfunction. Br J Anaesth 2009; 103(1): i41-6
  • -Atay İM, Aslan A, Atay T, Burç H. Genel ve Spinal Anestezi uygulanan yaşlı kalça kırığı olgularında deliryum yaygınlığı, risk faktörleri ve bilişsel fonksiyonlar. Turk J Geriatr 2012; 15(3): 273-8
  • -Rasmussen LS, Johnson T, Kuipers HM, Kristensen D et al. Does Anaesthesia Cause Postoperative Cognitive Dysfunction?A Randomised Study of Regional versus General Anaesthesia in 438 Elderly Patients. Acta Anaesthesiaol Scand 2003; 47(3): 260-6
  • -Ellard L, Katznelson R, Wasowicz M et al. Type of Anesthesia and Postoperative Delirium After Vasculer Surgery. J Cardiothorac Vasc Anesth 2014.doi: 10.1053/j.jvca.2013.12.003
  • -Sarıcaoğlu F, Akıncı SB, Atay S, Çağlar Ö, Aypar Ü. Femur Kırığı ile Opere Olan Yaşlı Hastalarda Anestezi Tekniklerinin Postoperatif Mortaliteye Etkisinin Retrospektif Olarak İncelenmesi. Turk J Geriatr 2012; 15(4):434-8
  • -Urwin SC, Parker MJ, Griffiths R. General versus Regional Anaesthesia For Hip Fracture Surgery: A Meta-analysis of Randomized Trials. Br J Anaesth 2000; 84: 450-5
  • -Koç M, Arıkan M, Arıkan O, Dikmen B. İleri yaşlı hastalarda kalça artroplastisi için uygulanan farklı anestezi yöntemlerinin retrospektif olarak değerlendirilmesi. Ortadoğu Tıp Dergisi 2012; 4: 182-7
  • -Kara I, Çelik JB, OC Bahar, Apıllıoğulları S, Karabağlı H. Comparison of Spinal and General Anaesthesia in Lumbar Disc Surgery. J Neurol Sci (turk) 2011; 28(4): 487-96
  • -Hanada S, Kawakami H, Goto T, Morita S. Hypertension and Anesthesia. Curr Opin Anaesthesiol 2006; 19: 315-9
  • -Richman JM, Rowlingson AJ, Maline DN, Courpas GE, Weller JF, Wu CL. Does neuraxial anesthesia reduce intraoperative blood loss? a meta-analysis. J Clin Anesth 2006; 18(6):427-35
  • -Sadrolsadat SH, Mahdavi AR, Moharari RS, Khajavi MR, Khashayar P, Najafi A, Amirjamshidi A. A prospective randomized trial comparing the technique of spinal and general anesthesia for lumbar disk surgey: a study of 100 cases. Surg Neurol 2009; 71(1): 60-5
  • - Darijani M, Taheri A, Vaez A, Emami F. The geriatric outpatient and hospitalization costs as compared to non-geriatric groups. International Journal of Healthcare, Insurance and Equity 2013; 1(1):1-4.
  • - Polanczky CA, Marcantonio E, Goldman L et al. İmpact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 2001; 134(8): 637-43.
  • -Casati A, Aldegheri G, Vinciguerra E, Marsan A, Frashini G, Torri G. Randomized comaprison between sevoflurane anesthesia and unilateral spinal anesthesia in elderley patinets undergoing orthopedic surgery. Eur J Anaesthesiol 2003; 20(8): 640-6.

Ortopedik Cerrahi Uygulanan Geriyatrik Hastalarda Anestezi Tekniklerinin Morbitite-MortaliteÜzerine Etkisininİncelenmes

Yıl 2014, Cilt: 4 Sayı: 3, 143 - 150, 18.01.2015
https://doi.org/10.16899/ctd.99763

Öz

Amaç: Bu retrospektifçalışmanın amacı, ortopedik cerrahi uygulanan geriyatrik hastalarda preoperatif risk faktörleri ve uygulanan anestezi yönteminin perioperatif komplikasyonlar ve mortalite üzerine etkisini incelemektir.

Gereç ve yöntemler: Ocak 2013-Aralık 2013 tarihleri arasında ortopedik cerrahi uygulanan 65 yaş üstü hastalarda retrospektif dosya incelenmesi yapıldı. Hastaların yaşı, cinsiyeti, mevcut hastalıkları, preoperatif hemoglobin ve kreatinin değerleri, ASA sınıfı, Lee indeksi, ameliyat tipi ve süresi, anestezi türü, kullanılan anestezik ve analjezik ajanlar, peroperatif ve postoperatif komplikasyonlar kaydedildi. Hastalar genel ve rejyonel anestezi olarak iki gruba ayrıldı.

Bulgular: Çalışmaya ortopedik cerrahi geçiren 65 yaş üstü 160 (%62,7) kadın ve 95 (%37,3) erkek olmak üzere toplam 255 hasta dahil edildi. Preoperatif dönemde kronik obstrüktif akciğer hastalığı mevcut olan hastalarda rejyonel anestezi tercih edildiği saptanmışken (p = 0.001), diğer ek hastalıklar açısından karşılaştırıldığında her iki anestezi tipi arasında anlamlı fark saptanmadı (p > 0.05). Genel ve rejyonel anestezi uygulanan hastalar peroperatif ve postoperatif komplikasyon gelişimi açısından karşılaştırıldığında anlamlı fark saptanmadı. Alt ekstremite cerrahisi geçiren 12 (%4,7) hastanın exitus olduğu tespit edildi. Hastaların ASA değerleri ile mortalite arasında düşük derecede pozitif korelasyon saptandı (r = 0.205, p = 0.001).

Sonuç: Ortopedik cerrahi geçiren geriyatrik hastalarda erken dönem morbitite ve mortalite  üzerine uygulanan anestezi yönteminin etkisi olmadığı  bulunmuştur.

 

 

Kaynakça

  • -Kinsella K, Wan H. U.S. Census Bureau: Internetional Population Reports. An Aging World: 2008, Washington: U.S. Government Printing Office, DC, 2009: 1-209. http://www.census.gov/prod/2009pubs/p95-09-1. (accessed on November 2009)
  • -Murray D, Dodds C. Pre-operative Assessment of the Elderly. BJA CEPD Reviews 2001;1(6): 181-4
  • -Partridge JSL, Harari D, Martin FC, Dhesi JK.Pre-operative Comprehensive Geriatric Assessment. Anaesthesia 2014; 69(1): 8-16
  • -Salive EM. Multimorbidity in Older Adults. Epidemiol Rev 2013; 35(1):75-83
  • -Cook DJ, Rooke GA. Priorities in Perioperative Geriatrics. Anesth Analg 2003; 96: 1823-36
  • -Manku K, Bacchetti P, Leung J. Prognostic Significance of Postoperative In-Hospital Complications in Elderly Patients. I. Long Term Survival. Anesth Analg 2003; 96: 583-9
  • -Harari D, Hopper A, Dhesi J, Babic-Illman G, Lockwood L, Martin F. Proactive Care of Older People Undergoing Surgery(‘POPS’): Designing, Embedding, Evaluating and Funding a Comprehensive Geriatric Assessment Service for Older Elective Surgical Patients. Age and Ageing 2007; 36: 190-6
  • -Harsteni A, Kehlet H, Toksvig-Larsen. Recovery After Total Intravenous General Anaesthesia or Spinal Anaesthesia for Total Knee Arthroplasty: a Randomized Trial. Br J Anaesth 2013; 111(3): 391-9
  • - Memtsoudis SG, Sun X, Chiu YL et al. Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients. Anesthesiology 2013; 118: 1046-58
  • -Lee TH, Mercantonia ER, Manqione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100(10): 1043-9.
  • - Roche JJW, Wenn RT, Sahota O, Moran CG. Effect of Comorbidities and Postoperative Complications on Mortality After Hip Fracture in Elderly People: Prospective Observational Cohort Study. BMJ 2005; 331 (7529): 1374
  • -Khasraghi FA, Lee EJ, Christmas C, Wenz JF.The Economic İmpact of Medical Complications in Geriatric Patients with Hip Fracture. Orthopedics 2003; 26(1): 49-53
  • -McNicol L, Story DA, Leslie K et al. Postoperative Complications and Mortality in Older Patients Having Non-Cardiac Surgery at Three Melbourne Teaching Hospitals. MJA 2007; 186(9): 447-51
  • -Lee-Wendling L, Bihorac A, Baslanti TO et al. Regional Anesthesia as Compared with General Anesthesia for Surgery in Geriatric Patients with Hip Fracture: Does it Decrease Morbidity, Mortality, And Health Care Costs? Results of a Single-Centered Study. Pain Medicine 2012; 13:948-56
  • -Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E. Patient Risk Factors, Operative Care, and Outcomes Among Older Community-Dwelling Male Veterans with Hip Fracture. J Bone Joint Surg Am 2008; 90: 34-42
  • -Fritsch G, Flamm M, Hepner DL, Panisch S, Seer J, Soennichsen A. Abnormal Pre-operative Tests, Pathologic Findings of Medical History, and Their Predictive Value for perioperative Complications. Acta Anaesthesiol Scand 2012; 56(3): 339-50
  • -Barnett S, Moonesinghe SR. Clinical Risk Scores to Guide Perioperative Management. Postgrad Med J 2011; 87(1030): 535-41
  • - Poldermans D, Bax JJ, Boersma E. Guidelines for Pre-Operative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-Cardiac Surgery. Eur Heart J 2009; 30(22): 2769-812
  • -Prause G, Ratzenhofer-Comenda B, Pierer G, Smolle-Jüttner F, Glanzer H, Smolle J. Can ASA grade or Goldman's Cardiac Risk Index Predict Peri-operative Mortality? A Study of 16,227 Patients. Anaesthesia 1997; 52(3): 203-6
  • -Gilbert K, Larocque BJ, Patrick LT. Prospective Evaluation of Cardiac Risk Indices for Patients Undergoing Noncardiac Surgery. Ann Intern Med 2000; 133: 356-9
  • -Ford MK, Beattie WS, Wijeysundera DN. Systematic Review: Prediction of Perioperative Cardiac Complications and Mortality by The Revised Cardiac Risk Index. Ann Intern Med 2010; 152(1): 26-35
  • -Park WY, Thompson JS, Lee KK. Effect of Epidural Anesthesia and Analgesia on Perioperative Outcome A Randomized, Controlled Veterans Affairs Cooperative Study. Ann Surg 2001; 234(4): 560-71
  • -Rodgers A, Walker N, Schug S et al. Reduction of Postoperative Mortality and Morbidity with Epidural or Spinal Anaesthesia: Results from Overview of Randomised trials. BMJ 2000; 321: 1-12
  • -Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA.Comparative Effectiveness of Regional versus General Anesthesia for Hip Fracture Surgery in Adults. Anesthesiology 2012; 117(1): 72-92
  • -Deiner S, Silverstein JH. Postoperative Delirium and Cognitive Dysfunction. Br J Anaesth 2009; 103(1): i41-6
  • -Atay İM, Aslan A, Atay T, Burç H. Genel ve Spinal Anestezi uygulanan yaşlı kalça kırığı olgularında deliryum yaygınlığı, risk faktörleri ve bilişsel fonksiyonlar. Turk J Geriatr 2012; 15(3): 273-8
  • -Rasmussen LS, Johnson T, Kuipers HM, Kristensen D et al. Does Anaesthesia Cause Postoperative Cognitive Dysfunction?A Randomised Study of Regional versus General Anaesthesia in 438 Elderly Patients. Acta Anaesthesiaol Scand 2003; 47(3): 260-6
  • -Ellard L, Katznelson R, Wasowicz M et al. Type of Anesthesia and Postoperative Delirium After Vasculer Surgery. J Cardiothorac Vasc Anesth 2014.doi: 10.1053/j.jvca.2013.12.003
  • -Sarıcaoğlu F, Akıncı SB, Atay S, Çağlar Ö, Aypar Ü. Femur Kırığı ile Opere Olan Yaşlı Hastalarda Anestezi Tekniklerinin Postoperatif Mortaliteye Etkisinin Retrospektif Olarak İncelenmesi. Turk J Geriatr 2012; 15(4):434-8
  • -Urwin SC, Parker MJ, Griffiths R. General versus Regional Anaesthesia For Hip Fracture Surgery: A Meta-analysis of Randomized Trials. Br J Anaesth 2000; 84: 450-5
  • -Koç M, Arıkan M, Arıkan O, Dikmen B. İleri yaşlı hastalarda kalça artroplastisi için uygulanan farklı anestezi yöntemlerinin retrospektif olarak değerlendirilmesi. Ortadoğu Tıp Dergisi 2012; 4: 182-7
  • -Kara I, Çelik JB, OC Bahar, Apıllıoğulları S, Karabağlı H. Comparison of Spinal and General Anaesthesia in Lumbar Disc Surgery. J Neurol Sci (turk) 2011; 28(4): 487-96
  • -Hanada S, Kawakami H, Goto T, Morita S. Hypertension and Anesthesia. Curr Opin Anaesthesiol 2006; 19: 315-9
  • -Richman JM, Rowlingson AJ, Maline DN, Courpas GE, Weller JF, Wu CL. Does neuraxial anesthesia reduce intraoperative blood loss? a meta-analysis. J Clin Anesth 2006; 18(6):427-35
  • -Sadrolsadat SH, Mahdavi AR, Moharari RS, Khajavi MR, Khashayar P, Najafi A, Amirjamshidi A. A prospective randomized trial comparing the technique of spinal and general anesthesia for lumbar disk surgey: a study of 100 cases. Surg Neurol 2009; 71(1): 60-5
  • - Darijani M, Taheri A, Vaez A, Emami F. The geriatric outpatient and hospitalization costs as compared to non-geriatric groups. International Journal of Healthcare, Insurance and Equity 2013; 1(1):1-4.
  • - Polanczky CA, Marcantonio E, Goldman L et al. İmpact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 2001; 134(8): 637-43.
  • -Casati A, Aldegheri G, Vinciguerra E, Marsan A, Frashini G, Torri G. Randomized comaprison between sevoflurane anesthesia and unilateral spinal anesthesia in elderley patinets undergoing orthopedic surgery. Eur J Anaesthesiol 2003; 20(8): 640-6.
Toplam 38 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Orjinal Çalışma
Yazarlar

Serkan Karaman Bu kişi benim

Tugba Karaman Bu kişi benim

Serkan Dogru Bu kişi benim

Aynur Sahin Bu kişi benim

Semih Arici Bu kişi benim

Yayımlanma Tarihi 18 Ocak 2015
Yayımlandığı Sayı Yıl 2014 Cilt: 4 Sayı: 3

Kaynak Göster

APA Karaman, S., Karaman, T., Dogru, S., Sahin, A., vd. (2015). The effects of anesthsia techniques on mobidity-mortality in geriatric patients underwent orthopedic surgery. Çağdaş Tıp Dergisi, 4(3), 143-150. https://doi.org/10.16899/ctd.99763
AMA Karaman S, Karaman T, Dogru S, Sahin A, Arici S. The effects of anesthsia techniques on mobidity-mortality in geriatric patients underwent orthopedic surgery. J Contemp Med. Ocak 2015;4(3):143-150. doi:10.16899/ctd.99763
Chicago Karaman, Serkan, Tugba Karaman, Serkan Dogru, Aynur Sahin, ve Semih Arici. “The Effects of Anesthsia Techniques on Mobidity-Mortality in Geriatric Patients Underwent Orthopedic Surgery”. Çağdaş Tıp Dergisi 4, sy. 3 (Ocak 2015): 143-50. https://doi.org/10.16899/ctd.99763.
EndNote Karaman S, Karaman T, Dogru S, Sahin A, Arici S (01 Ocak 2015) The effects of anesthsia techniques on mobidity-mortality in geriatric patients underwent orthopedic surgery. Çağdaş Tıp Dergisi 4 3 143–150.
IEEE S. Karaman, T. Karaman, S. Dogru, A. Sahin, ve S. Arici, “The effects of anesthsia techniques on mobidity-mortality in geriatric patients underwent orthopedic surgery”, J Contemp Med, c. 4, sy. 3, ss. 143–150, 2015, doi: 10.16899/ctd.99763.
ISNAD Karaman, Serkan vd. “The Effects of Anesthsia Techniques on Mobidity-Mortality in Geriatric Patients Underwent Orthopedic Surgery”. Çağdaş Tıp Dergisi 4/3 (Ocak 2015), 143-150. https://doi.org/10.16899/ctd.99763.
JAMA Karaman S, Karaman T, Dogru S, Sahin A, Arici S. The effects of anesthsia techniques on mobidity-mortality in geriatric patients underwent orthopedic surgery. J Contemp Med. 2015;4:143–150.
MLA Karaman, Serkan vd. “The Effects of Anesthsia Techniques on Mobidity-Mortality in Geriatric Patients Underwent Orthopedic Surgery”. Çağdaş Tıp Dergisi, c. 4, sy. 3, 2015, ss. 143-50, doi:10.16899/ctd.99763.
Vancouver Karaman S, Karaman T, Dogru S, Sahin A, Arici S. The effects of anesthsia techniques on mobidity-mortality in geriatric patients underwent orthopedic surgery. J Contemp Med. 2015;4(3):143-50.