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Sereda AP, Rukina AN, Trusova YV, Dzhavadov AA, Cherny AA, Bozhkova SA, Shubnyakov II, Tikhilov RM. Dynamics of C-reactive protein level after orthopedic surgeries. J Orthop 2024; 47:1-7. [PMID: 38046451 PMCID: PMC10689206 DOI: 10.1016/j.jor.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
Background Only two studies present the results of the dynamics of C-reactive protein (CRP) after a large number of orthopedic surgeries. The aim of the study was to investigate the dynamics of CRP levels and determine the influence of various factors on the CRP level after various orthopedic surgeries using big data tools. Methods A total of 16042 operated patients were included in the study. Results The tendency of peak values to increase by 2-3 days after surgery with subsequent decrease was the same in all subgroups without surgical site infections (SSI). In patients with SSI, the higher preoperative CRP level changed to a peak on day 3 after surgery with a subsequent drop and increase after day 6 in case of probably unsuccessful sanitation. The peak value of CRP significantly correlates with the duration of surgery (r = 0.1072, p < 0,0001). Older patients tend to exhibit higher CRP value (r = 0.2219, p < 0.001). The peak values of CRP in women were significantly greater than those in men. Conclusion In cases without SSI, the peak of CRP values occurs on the second or third day after surgery, a secondary increase in CRP levels may indicate a risk of complications. The peak CRP value correlates with the duration of surgery. In clinical practice, relationship between gender, age and the level of CRP should not be one of the indicators influencing the assessment of the risk of a threat to the patient's health, since the results of various studies are contradictory.
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Affiliation(s)
- Andrei P. Sereda
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
- Department of the Academy of Postgraduate Education of Federal Medical Biological Agency, Moscow, Russian Federation
| | - Anna N. Rukina
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Yulia V. Trusova
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Alisagib A. Dzhavadov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Alexander A. Cherny
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Svetlana A. Bozhkova
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Igor I. Shubnyakov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - Rashid M. Tikhilov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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Domecky P, Rejman Patkova A, Mala-Ladova K, Maly J. Inflammatory blood parameters as prognostic factors for implant-associated infection after primary total hip or knee arthroplasty: a systematic review. BMC Musculoskelet Disord 2023; 24:383. [PMID: 37189111 DOI: 10.1186/s12891-023-06500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/07/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Implant-associated infection (IAI) is a potential complication following total hip (THA) or knee arthroplasty (TKA). The initial phase of the inflammatory process can be measured by applying one of the inflammatory blood parameters (IBP). This systematic review aims to assess the response of IBP to trauma caused by orthopedic surgery and evaluate the clinical utility of quantitative measurements of IBP as prognostic factors for infection. METHODS All studies indexed in Ovid MEDLINE (PubMed), Ovid EMBASE, the Cochrane Library and the ISI Web of Science databases, from inception until January 31, 2020, were analyzed. Studies included were those on adults who underwent THA or TKA with minimum follow up of 30 days after surgery. In addition to minimum follow up, data on the prognostic factors for pre- or post-THA/TKA IAI were mandatory. The Quality Assessment of Diagnostic Accuracy tool (version 2) (QUADAS-2) and Standards for Reporting of Diagnostic Accuracy Studies guideline 2015 (STARD) were used for quality assessment. RESULTS Twelve studies fulfilled the inclusion and exclusion criteria. C-reactive protein was analyzed in seven studies, interleukin-6 in two studies and erythrocyte sedimentation rate in eight studies. White blood cell count and procalcitonin were analyzed in the only study. The overall quality of included studies was low. A potential for other cytokines (IL-1ra, IL-8) or MCP-1 was observed. CONCLUSIONS This is the first systematic review of IBP response to orthopedic surgery which identified some IBP for pre/post-operative screening, despite insufficient data supporting their prognostic potential for patient risk stratification.
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Affiliation(s)
- Petr Domecky
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Ak. Heyrovskeho 1203/8, 500 05, Hradec Kralove, Czech Republic
| | - Anna Rejman Patkova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Ak. Heyrovskeho 1203/8, 500 05, Hradec Kralove, Czech Republic
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Ak. Heyrovskeho 1203/8, 500 05, Hradec Kralove, Czech Republic
| | - Josef Maly
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Ak. Heyrovskeho 1203/8, 500 05, Hradec Kralove, Czech Republic.
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Rohe S, Röhner E, Windisch C, Matziolis G, Brodt S, Böhle S. Sex Differences in Serum C-Reactive Protein Course after Total Hip Arthroplasty. Clin Orthop Surg 2022; 14:48-55. [PMID: 35251541 PMCID: PMC8858890 DOI: 10.4055/cios21110] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Gender-specific medicine has become an important part in investigating the course of various diseases. C-reactive protein (CRP) is used as an inflammatory marker for detecting inflammations and even infections after total hip arthroplasty (THA). The general course of CRP after THA is well known, but there is controversy about its association with sex. Therefore, we aimed to investigate if there is an influence of sex on the CRP after THA in the first 10 days after operation in a complication-free course in male and female patients and to re-evaluate the specific postoperative CRP course with its maximum on the second to third postoperative days. Methods We retrospectively reviewed patients who had been treated with THA due to primary osteoarthritis through the same approach using an equal model of a cementless stem and a cup and complication-free between 2013 and 2016. Patients with active inflammation, rheumatoid arthritis, secondary arthrosis, active cancer disease, and documented postoperative complications were not included. The CRP values before THA and up to 10 days after THA were recorded and tested for sex discrepancy. Factor analyses were performed, and CRP values were adjusted for confounders (age, operation time, diabetes mellitus, and body mass index [BMI]). Results A total of 1,255 patients (728 women and 527 men) were finally analyzed. Men were younger and had a longer operation time and a higher BMI compared to women. The prevalence of overweight was higher in men, while obesity (BMI > 40 kg/m2), diabetes mellitus, renal failure, and American Society of Anaesthesiologists status showed no significant difference between men and women. Men had significantly higher CRP values than women between the 2nd and the 7th postoperative days, with the largest difference on the 4th postoperative day (men, 130.48 mg/L; women, 87.26 mg/L; p = 0.018). Conclusions Based on the results of more precise sex-specific evaluation of the postoperative CRP course after THA, the present study showed for the first time that there was a gender discrepancy in the CRP course after complication-free THA in the first 7 postoperative days. Furthermore, this study confirmed the postoperative CRP course with its maximum on the third postoperative day.
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Affiliation(s)
- Sebastian Rohe
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | | | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Sabrina Böhle
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
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Cho MR, Choi WK, Jun CM, Song SK. The natural trends of C-reactive protein after hip arthroplasty for femoral neck fracture without infection. Medicine (Baltimore) 2021; 100:e27299. [PMID: 34559143 PMCID: PMC8462584 DOI: 10.1097/md.0000000000027299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/02/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of this study was to estimate the degree of normalization of C-reactive protein (CRP) at 2-weeks and 4-weeks after hip arthroplasty after femoral neck fracture. We also wished to determine whether the degree of CRP normalization differs after total hip arthroplasty (THA) compared to bipolar hemiarthroplasty (BH). We also wanted to analyze the patient factors that may influence CRP normalization.We conducted a retrospective study of 135 patients who had undergone THA (32 cases) or BH (103 cases) for femoral neck fracture by single surgeon from January 2015 to December 2019. We analyzed CRP levels during the preoperative period, the early postoperative period, the 2-week postoperative period, and the 4-week postoperative period.In THA, CRP was normalized in 4 patients (12.5%) and in 15 patients (46.9%) within 2-weeks and 4-weeks after surgery, respectively. In BH, CRP was normalized in 16 patients (15.5%) and in 52 patients (50.5%) within 2-weeks and 4-weeks after surgery, respectively. There were no statistical differences between THA and BH. Compared to women, men were 3.78 (95% confidence interval, 1.05-13.63) times less likely to have normalized CRP at 2-weeks after surgery (P = .042). Compared to women, men were 3.01 (95% confidence interval, 1.44-6.27) times less likely to have normalized CRP at 4-weeks after surgery (P = .003).Only 50% of patient's CRP level was normalized during 4-week postoperative period. In men, CRP levels were significantly higher than women in whole period. In the case of THA, the CRP level was higher only in early postoperative period compared to BH, and there was no difference since then.
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Klingebiel S, Theil JC, Gosheger G, Schneider KN, Timme M, Schorn D, Liem D, Rickert C. Postoperative Trends of Serum C-Reactive Protein Levels after Primary Shoulder Arthroplasty-Normal Trajectory and Influencing Factors. J Clin Med 2020; 9:jcm9123893. [PMID: 33266181 PMCID: PMC7760886 DOI: 10.3390/jcm9123893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022] Open
Abstract
Background-Postoperative serum C-reactive protein (CRP) is an important diagnostic parameter for systemic inflammation and reflects surgical trauma. While trends and normal trajectories after total knee (TKA) or hip arthroplasty (THA) are established, there is no reference standard for shoulder arthroplasty (SA). Therefore, the aim of this study was to research CRP trends and influencing factors following SA. Methods-This retrospective study analyzed postoperative serum CRP levels and trajectories in 280 patients following SA. Influence of prosthesis design, sex, operating time, BMI, and humeral augmentation with bone cement were analyzed using descriptive statistics and (non-) parametric testing. Results-There is a CRP trend with a peak on day two or three, with a subsequent decrease until day seven. Reverse and stemmed prostheses show a statistically higher CRP peak than stemless prostheses or hemiarthroplasties (HA). There was no influence of gender, body mass index (BMI), operating time, or bone cement. Conclusion-The presented findings may contribute to a better understanding of the postoperative CRP course after SA. The results of this retrospective study should be validated by a prospective study design in the future.
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Affiliation(s)
- Sebastian Klingebiel
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, 48149 Münster, Germany; (J.C.T.); (G.G.); (K.N.S.); (C.R.)
- Correspondence: ; Tel.: +49-251-83-0
| | - Jan Christoph Theil
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, 48149 Münster, Germany; (J.C.T.); (G.G.); (K.N.S.); (C.R.)
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, 48149 Münster, Germany; (J.C.T.); (G.G.); (K.N.S.); (C.R.)
| | - Kristian Nikolaus Schneider
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, 48149 Münster, Germany; (J.C.T.); (G.G.); (K.N.S.); (C.R.)
| | - Maximilian Timme
- Department of Forensic Medicine, Institute for Legal Medicine, University Hospital Muenster, 48149 Münster, Germany;
| | - Dominik Schorn
- Department for Shoulder and Elbow Surgery, Paracelsus Clinic Bremen, 28329 Bremen, Germany;
| | - Dennis Liem
- Sporthopaedicum Berlin, Medical Practice, 10627 Berlin, Germany;
| | - Carolin Rickert
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, 48149 Münster, Germany; (J.C.T.); (G.G.); (K.N.S.); (C.R.)
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Nam JH, Cho MR, Lee SH, Song SK, Choi WK. C-reactive protein course after classical complication free total knee arthroplasty using navigation. Knee Surg Relat Res 2020; 32:56. [PMID: 33059760 PMCID: PMC7559145 DOI: 10.1186/s43019-020-00074-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The purpose is to estimate the degree of normalization of C-reactive protein (CRP) at 2 weeks and 4 weeks after uncomplicated total knee arthroplasty (TKA) using computer navigation. We also wish to determine whether the degree of normalization of CRP at 2 and 4 weeks differs after TKA performed in one knee and after TKA performed sequentially in both knees. We also want to analyze the patient factors that may influence the normalization of CRP. MATERIAL AND METHODS We studied 400 knees who underwent primary computer-navigated TKA for treatment of advanced osteoarthritis: the TKAs were all performed by the same surgeon. We retrospectively analyzed CRP levels during the preoperative period, the early postoperative period (5-7 days), the 2-week postoperative period (12-14 days), and the 4-week postoperative period (25-30 days). We have assumed gender, age, body mass index (BMI), staged bilateral TKA, and preoperative CRP as the potential patient factors associated with CRP normalization. RESULTS In unilateral TKA, CRP was normalized in 94 cases (34.3%) and in 219 cases (81.4%) within 2 weeks and 4 weeks after surgery, respectively. In second-knee, staged bilateral TKA, CRP was normalized in 46 cases (35.1%) and in 104 cases (79.4%) within 2 weeks and 4 weeks after surgery, respectively. There were no statistical differences between unilateral TKA and second-knee, staged bilateral TKA during the 2-week postoperative and the 4-week postoperative period. Compared to women, men were 1.99 times less likely to have normalized CRP at 2 weeks after surgery (P = 0.02). CONCLUSION CRP was less likely to normalize during the 2-week postoperative period in men than it is in women, while there was no difference between men and women in the normalization of CRP during the 4-week postoperative period. There were no statistical differences in the course of CRP levels after unilateral TKA and staged bilateral TKA during the 2-week postoperative and the 4-week postoperative period.
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Affiliation(s)
- Jun Ho Nam
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, 3056-6, Daemyung-4-dong, Nam-gu, Daegu, South Korea
| | - Myung Rae Cho
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, 3056-6, Daemyung-4-dong, Nam-gu, Daegu, South Korea
| | - Seo Ho Lee
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, 3056-6, Daemyung-4-dong, Nam-gu, Daegu, South Korea
| | - Suk-Kyoon Song
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, 3056-6, Daemyung-4-dong, Nam-gu, Daegu, South Korea
| | - Won-Kee Choi
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, 3056-6, Daemyung-4-dong, Nam-gu, Daegu, South Korea.
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Tarasov DA, Lychagin AV, Yavorovkiy AG, Lipina MM, Tarasova IA. C-reactive protein as marker of post-operative analgesic quality after primary total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2020; 44:1727-1735. [PMID: 32300831 DOI: 10.1007/s00264-020-04551-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
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Dong J, Min S, He KH, Peng LH, Cao J, Ran W. Effects of the nontourniquet combined with controlled hypotension technique on pain and long-term prognosis in elderly patients after total knee arthroplasty: a randomized controlled study. J Anesth 2019; 33:587-593. [PMID: 31428863 DOI: 10.1007/s00540-019-02671-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 08/08/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of this study was to confirm the alleviating effects of the nontourniquet technique on the postoperative acute and chronic pain of patients after total knee arthroplasty (TKA). METHODS 122 elderly patients undergoing TKA were randomly divided into two groups: group T (n = 58) and group H (n = 64). An electronic inflatable tourniquet was used during TKA in group T. The patients in group H received controlled hypotension but without tourniquet use during the operation. The numeric rating scale (NRS) score was used to evaluate pain level on day 1, day 2, day 3 and day 7 after the operation, and the incidence of chronic pain was judged at 3-month and 1-year follow-ups, and functional recovery of the knee joint was estimated by the active range of knee joint motion (AROM) at the same time points. Cognitive function was assessed by the montreal cognitive assessment scale (MoCA) for 7 days after operation. RESULTS There were no significant differences in the NRS scores and AROM for 7 days after surgery. The incidence rate of chronic pain in group H (25.0%) was lower than that in group T (41.4%) and the AROM in group H was greater at one year follow-up. The MoCA score in group H was lower than that in group T on day 1 and day 2. CONCLUSION The nontourniquet combined with controlled hypotension technique can alleviate chronic pain and promote the long-term rehabilitation of patients after TKA.
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Affiliation(s)
- Jun Dong
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China.
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Kai-Hua He
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Li-Hua Peng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Jun Cao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Wei Ran
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
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Zhang S, Huang Q, Xie J, Xu B, Cao G, Pei F. Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty. J Orthop Surg Res 2018; 13:29. [PMID: 29394902 PMCID: PMC5797406 DOI: 10.1186/s13018-018-0729-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/23/2018] [Indexed: 02/05/2023] Open
Abstract
Background Hospital length of stay (LOS) after primary total knee arthroplasty (TKA) has decreased obviously following the implementation of enhanced recovery after surgery (ERAS) program in the last few years. However, there are still some patients that cannot be discharged at early time for a variety of reasons, and it is necessary to explore factors leading to prolonged LOS. Therefore, the purpose of this study was to identify the complete preoperative, perioperative, and postoperative factors associated with prolonged postoperative LOS (PLOS) after primary TKA in a detailed ERAS program. Methods In a consecutive series from July 2015 to March 2017, all patients who underwent unilateral elective primary TKA were included in the retrospective study. A PLOS greater than 3 days was considered a prolonged PLOS. Multivariable logistic regression analysis was performed to identify patient characteristics and relevant preoperative, perioperative, and postoperative variables that were associated with prolonged PLOS and postoperative complications. Results A total of 241 patients were included with a mean PLOS of 3.8 days. Prolonged PLOS was significantly associated with preoperative valgus deformity of the knee (OR 4.95, 95%CI 1.56–15.77, P = 0.007), increased serum level of interleukin-6 on postoperative day 1 (OR 1.01, 95%CI 1.00–1.03, P = 0.039), increased visual analogue scale pain score and serum level of C-reactive protein on postoperative day 3 (OR 2.56, 95%CI 1.28–5.13, P = 0.008; OR 1.01, 95%CI 1.00–1.03, P = 0.019), increased day to achieve 90° active knee flexion after surgery (OR 2.19, 95%CI 1.27–3.79, P = 0.005), and postoperative wound complications (OR 8.58, 95%CI 2.10–35.03, P = 0.003) and other minor complications (OR 6.04, 95%CI 2.40–15.19, P < 0.001). Preoperative pulmonary infection (OR 2.75, 95%CI 1.20–6.28, P = 0.016), American Society of Anesthesiologists score 3/4 (OR 2.14, 95%CI 1.01–4.52, P = 0.046), and utilization of catheter after surgery (OR 2.53, 95%CI 1.23–5.19, P = 0.012) were significantly associated with postoperative complications. Conclusions Multiple factors were associated with prolonged PLOS and postoperative complications after TKA in the ERAS program. It is important to recognize all the factors to try to maximize the use of medical resources and ultimately optimize the care of our patients.
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Affiliation(s)
- Shaoyun Zhang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Qiang Huang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jinwei Xie
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Bin Xu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Guorui Cao
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Fuxing Pei
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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Xu Z, Zhang H, Luo J, Zhou A, Zhang J. Preemptive analgesia by using celecoxib combined with tramadol/APAP alleviates post-operative pain of patients undergoing total knee arthroplasty. PHYSICIAN SPORTSMED 2017; 45:316-322. [PMID: 28475475 DOI: 10.1080/00913847.2017.1325312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study was aimed to evaluate the efficacy of preemptive analgesia (PA) by using celecoxib combined with low-dose tramadol/acetaminophen (tramadol/APAP) in treating post-operative pain of patients undergoing unilateral total knee arthroplasty (TKA). METHODS A total of 132 patients scheduled for TKA were included in this study. Three-day pre-operative medication was administrated in PA group with subsequent effective intra- and post-operative multimodal analgesia, while control patients received multimodal analgesia without PA. Visual analog scale (VAS) was utilized to assess the pain intensity at rest and during movement. VAS scores of participants were recorded 3 days before surgery, 1 day, 3 days, 1 week, 3 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Moreover, the length of hospital stay, expense of hospitalization, C-reactive protein (CRP) values during hospitalization, and complications during medication were also recorded. RESULTS PA showed superiority over control at 3 weeks (P = 0.013) and 6 weeks (P = 0.046) in resting pain, and 1 week (P = 0.015), 3 weeks (P = 0.003), 6 weeks (P = 0.003) and 3 months (P = 0.012) postoperatively in movement pain. There was no statistically significant difference in the length of hospital stay, total expense, CRP values, as well as complications. CONCLUSIONS Based on satisfactory intra- and post-operative analgesia, PA by 3-day administration of celecoxib and low-dose tramadol/APAP might be an effective and safe therapy regarding patients undergoing TKA in terms of alleviating post-operative pain.
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Affiliation(s)
- Zhongwei Xu
- a Department of Orthopaedics , the First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Hua Zhang
- a Department of Orthopaedics , the First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Jiao Luo
- b West China School of Public Health , Sichuan University , Chengdu , China
| | - Aiguo Zhou
- a Department of Orthopaedics , the First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Jian Zhang
- a Department of Orthopaedics , the First Affiliated Hospital of Chongqing Medical University , Chongqing , China
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