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Lalit Puri, M.D.

Lalit Puri, M.D.

Lalit Puri, M.D.

  • Locations

    NorthShore Medical Group

    9650 Gross Point Rd.
    Suite 2900
    Skokie, IL 60076
    847.866.7846 866.954.5787 fax Get Directions This location is wheelchair accessible.

    NOI NorthShore Orthopedics Chicago

    680 N Lake Shore Dr
    Ste 924
    Chicago, IL 60611
    847.866.7846 866.954.5787 fax Get Directions This location is wheelchair accessible.
  • Publications
    • Stratifying Venous Thromboembolism Risk in Arthroplasty: Do High-Risk Patients Exist?

      The Journal of arthroplasty 2020 May

      Authors: Landy DC, Bradley AT, King CA, Puri L
      While there are many possible complications associated with total joint arthroplasty (TJA), venous thromboembolism (VTE) is both frequent and potentially severe. Despite this importance, there are inconsistent recommendations for prophylaxis based on patient risk factors.
      A predictive model was constructed to compare low-molecular-weight heparin(LMWH) and aspirin (ASA) for prevention of VTE-associated complications following TJA.The model used risks from prior prophylaxis studies to estimate the risk of developing a symptomatic deep vein thrombosis, pulmonary embolism, thrombocytopenia, and operative or nonoperative site bleeding. We also evaluated the progression to 4 possible final health states: postphlebitis syndrome, intracranial hemorrhage, death, or baseline health. Within published ranges, we selected assumptions that were favorable to LMWH such that these analyses represent a best case scenario for LMWH or an alternative more aggressive low-molecular-weight heparin alternative (LMWHA). Events and outcomes were assigned quality-adjusted life-year (QALY) losses according to prior studies to determine the effect on patients' outcomes for ASA and LMWHA prophylaxis.
      Assessing VTE risk populations from 0.2% to 2% with life expectancies ranging from 5 to 40 years postoperatively, patients with a risk ratio less than 3.7 showed increased expected QALY with ASA compared to LMWHA. For patients with a baseline VTE risk of 1% and a 15 year life expectancy, a risk ratio of 13.4 was needed to identify patients that would benefit from LMWHA. With life expectancy increased to 30 years, the risk ratio needed to idetify these patients was 7.4.
      Patients undergoing TJA should receive ASA chemoprophylaxis in nearly all situations, unless the patient has a significantly increased VTE risk compared to the baseline population and a long life expectancy.
      PMID: 32057606 [PubMed - as supplied by publisher]
    • The Role of Potentially Retrievable Inferior Vena Cava Filters in High-Risk Patients Undergoing Joint Arthroplasty.

      Journal of clinical and diagnostic research : JCDR 2015 Dec

      Authors: Dhand S, Stulberg SD, Puri L, Karp J, Ryu RK, Lewandowski RJ
      Some patients undergoing total joint arthroplasty are at increased risk for venous thromboembolism (VTE). The aim of the present study was to evaluate the safety and efficacy of prIVCF in preventing PE in patients undergoing joint replacement surgery who are at high-risk for VTE.
      In this prospective, IRB-approved study, prIVCF were placed in consecutive patients who met specific high-risk criteria (history of VTE or hypercoaguable state) prior to total joint arthroplasty. Patients were followed until the IVC filter was removed. Outcomes and complications were recorded per Society of Interventional Radiology guidelines.
      One hundred and nine potentially retrievable IVC filters were placed in 105 patients, who all subsequently underwent joint arthroplasty. One hundred eight IVC filters (98.9%) were retrieved successfully in a mean time of 44.1 days (range 13-183 days). There was 1 failed IVC filter retrieval attempt (0.9%) at 46 days post implantation. Two patients (1.9%) presented with recurrent PE and were successfully treated with anticoagulation prior to IVC filter retrieval. There were no fatalities from perioperative PE. In 1 patient (0.9%), a fractured filter leg had embolized during retrieval.
      Potentially retrievable IVC filters are safe and effective for prophylaxis against PE in patients at high-risk for VTE undergoing joint arthroplasty.
      PMID: 26816965 [PubMed - as supplied by publisher]
    • The 72-Hour Medicare Mandate After Total Joint Arthroplasty: Is This Medically Necessary?

      The Journal of arthroplasty 2016 05

      Authors: Sisko ZW, Lu M, Puri L
      Currently, Medicare total joint arthroplasty patients are required to stay postoperatively 3 days in the hospital before discharge to a skilled nursing facility (SNF). We evaluated Medicare's mandated 3-night hospital stay rule to find out how many total joint arthroplastic patients are safe for discharge to SNFs on postoperative day 2 (POD2).
      This is a retrospective case series analyzing Medicare primary total hip or total knee arthroplastic patients at a single hospital over 1 year. Patients meeting 15 separate criteria by POD2 were considered safe for discharge home rather than to a SNF.
      Of 259 patients, 47.88% met discharge criteria to SNF POD2. 31.66% did not meet 1, 13.13% did not meet 2, and 6.95% did not meet ≥3 criteria on POD2. Common criteria delaying discharge were blood pressure abnormalities, increasing or elevated white blood cell count, cardiac abnormalities, and fever. Thirty-day readmission rate for patients in the group safe for discharge POD2 was 1.75%.
      Of the total, 47.88% of patients required to stay by the Medicare 3-night stay rule were safe for discharge to SNF on POD2 without an increase in readmission rate at 30 days when compared to our institutional mean.
      PMID: 26723859 [PubMed - as supplied by publisher]

      Physician leadership journal

      Authors: Wanke TR, McDevitt JL, Jung MJ, Meyer M, Puri L, Gonzalez CM, Saucedo JM
      PMID: 26685462 [PubMed - as supplied by publisher]
    • Radiographically Silent Loosening of the Acetabular Component in Hip Arthroplasty.

      American journal of orthopedics (Belle Mead, N.J.) 2015 Sep

      Authors: Patel AR, Sweeney P, Ochenjele G, Wixson R, Stulberg SD, Puri LM
      Polyethylene wear and subsequent osteolysis are major obstacles to the long-term success of total hip arthroplasty (THA). We conducted a study to determine the incidence of loose acetabular components that did not show frank signs of loosening on either plain radiography or computed tomography (CT), or radiographically silent loosening (RSL). In this retrospective study, we evaluated patients who underwent revision THA and were evaluated with plain radiography and CT between 2000 and 2012. Any patient with imaging that showed signs of component movement was excluded. Of the 104 patients who met the study inclusion criteria, 17 (16.3%) met the criteria for RSL of the acetabular shell. Patients with RSL presented at a similar age (P = .961) and with a similar sex profile (P = .185) compared with patients with stable acetabular components and were more likely to present with pain (P = .0487). Acetabular components may be loose even if there is no evidence of component migration on radiographic studies. Surgeons should be aware of the incidence of RSL and the potential of RSL to affect patient care and potential surgical options.
      PMID: 26372749 [PubMed - as supplied by publisher]
    • A dose-ranging study of 0.5% bupivacaine or ropivacaine on the success and duration of the ultrasound-guided, nerve-stimulator-assisted sciatic nerve block: a double-blind, randomized clinical trial.

      Regional anesthesia and pain medicine

      Authors: Nader A, Kendall MC, De Oliveira GS
      Before bifurcation, the sciatic nerve is composed of 2 component nerves encased in a common investing extraneural layer (CIEL). We examined the effect of various volumes injected beneath the CIEL on the success and duration of sciatic nerve block.
      Ultrasound-guided nerve-stimulator-assisted sciatic nerve blocks were performed on 142 subjects. Subjects were randomized into 14 groups (0.5% ropivacaine or bupivacaine) with epinephrine 1:300,000 in volumes ranging from 2.5 to 30 mL. Successful block was defined as a complete sensory and motor block at 60 minutes. The minimum threshold current, time to complete block, duration of sensory and motor block, postoperative pain, and analgesic requirements were recorded.
      The mean threshold current external to the CIEL was 0.52 (0.15) mA compared to 0.19 (0.09) mA beneath the CIEL (P < 0.001). Successful block was achieved in 30 of 40 subjects that received 5 mL or less of ropivacaine or bupivacaine compared with 97 of 99 that received 10 mL or greater volume (P = 0.006). Injection volumes greater than or equal to 10 mL produced complete sensory and motor block within 30 minutes. Volumes greater than 10 mL did not extend the duration of the sensory or motor block. Injection volumes of 2.5 and 5 mL were associated with delayed onset and decreased block duration and a greater fraction of subjects experiencing pain behind the knee.
      Injecting 10 mL of 0.5% bupivacaine or ropivacaine below the CIEL produces comparable onset and duration of sensory and motor blockade as volumes as large as 30 mL.
      PMID: 24108248 [PubMed - as supplied by publisher]
    • Understanding readmission after primary total hip and knee arthroplasty: who's at risk?

      The Journal of arthroplasty 2014 Feb

      Authors: Saucedo JM, Marecek GS, Wanke TR, Lee J, Stulberg SD, Puri L
      Readmission has been cited as an important quality measure in the Patient Protection and Affordable Care Act. We queried an electronic database for all patients who underwent Total Hip Arthroplasty or Total Knee Arthroplasty at our institution from 2006 to 2010 and identified those readmitted within 90 days of surgery, reviewed their demographic and clinical data, and performed a multivariable logistic regression analysis to determine significant risk factors. The overall 90-day readmission rate was 7.8%. The most common readmission diagnoses were related to infection and procedure-related complications. An increased likelihood of readmission was found with coronary artery disease, diabetes, increased LOS, underweight status, obese status, age (over 80 or under 50), and Medicare. Procedure-related complications and wound complications accounted for more readmissions than any single medical complication.
      PMID: 23958236 [PubMed - as supplied by publisher]
    • Impact of preoperative myocardial infarction on surgical outcomes in inpatient orthopaedic surgery.

      International orthopaedics 2013 Dec

      Authors: Lim S, Edelstein AI, Jain U, Puri L, Kim JY
      The purpose of this study was to evaluate the impact of a preoperative myocardial infarction (MI) on outcomes of inpatient orthopaedic operations.
      The National Surgical Quality Improvement Program database was used to identify patients who underwent common orthopaedic operations from 2006 to 2010. Patient demographic data, comorbidities, complications, and lengths of stay were collected. Multivariate logistic regression and linear regression models were used to compare outcomes for patients with and without a history of MI in the six months prior to surgery.
      Of the 32,462 patients identified, 86 had sustained an MI in the six months prior to surgery. The MI cohort had no cardiac complications but had increased incidences of superficial surgical site infection, unplanned re-intubation, ventilator-assisted respiration for more than 48 hours, pneumonia, sepsis or septic shock, and postoperative mortality within 30 days of surgery, as well as prolonged lengths of stay. Following logistic regression to adjust for baseline differences, a history of MI showed no association with cardiac complications and was significantly associated with superficial surgical site infection (OR 3.6, 95% CI 1.1-11.8), ventilator dependence for over 48 hours (OR 4.0, 95% CI 1.1-14.0), and extended length of stay (median with interquartile range 4 [4-4] vs. 5 [5-5] days).
      A myocardial infarction within six months prior to orthopaedic surgery is not associated with a higher risk of 30-day perioperative cardiac complications; however, it is associated with increased rates of surgical site infection, prolonged ventilator dependence, and longer hospital stay.
      PMID: 23860790 [PubMed - as supplied by publisher]
    • How accurately are we coding readmission diagnoses after total joint arthroplasty?

      The Journal of arthroplasty 2013 Aug

      Authors: Saucedo J, Marecek GS, Lee J, Huminiak L, Stulberg SD, Puri L
      Readmission rates have been cited as an important quality measure in the Affordable Care Act. Accordingly, understanding and accurately tracking the causes for readmission will be increasingly important. We queried an electronic database for all patients who underwent primary THA or TKA at our institution from 2006 through 2010. We identified those readmitted within 90 days of surgery and analyzed 87 random de-identified medical records. We then assigned a clinical diagnosis for each readmission, which was then compared with the coder-derived diagnosis by ICD-9 code. The overall 90-day readmission rate was 7.9%. We identified 22 of 87 patients for whom there was disagreement (25.3%, 95% CI=16.6-35.8%). The most common were procedure-related complications. Coded diagnoses frequently did not correlate with the physician-derived diagnoses. The unverified use of coded readmission diagnoses in calculating quality measures may not be clinically relevant.
      PMID: 23768916 [PubMed - as supplied by publisher]
    • Demonstration of saw blade accuracy and excursion: a cadaveric comparison study of blade types used in total knee arthroplasty.

      The Journal of arthroplasty 2013 Jun

      Authors: Wetzel RJ, Shah RR, Puri L
      In total knee arthroplasty, outcomes partly depend on accurate osteotomies and integrity of stabilizing structures. We compared accuracy and excursion between a conventional and an oscillating tip saw blade. Two sets of osteotomies were made on cadaveric knees. Bi-planar accuracy was compared using computer navigation, and excursion was compared using methylene blue. Wilcoxon-Mann-Whitney testing demonstrated no significant difference in blade accuracy (p=0.35). Blades were within 0.5 degrees of neutral coronally and 2.0 degrees sagittally. The oscillating tip blade demonstrated less dye markings on the surrounding tissues. Accurate osteotomies and soft tissue protection are critical to successful arthroplasties. Although comparative accuracy was equal, the oscillating tip blade exhibited less excursion displaying potential for less iatrogenic soft tissue injuries leading to catastrophic failure.
      PMID: 23523505 [PubMed - as supplied by publisher]
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