1
|
Mabrouk A, Abouharb A, Stewart G, Palan J, Pandit H. National variation in prophylactic antibiotic use for elective primary total joint replacement. Bone Jt Open 2023; 4:742-749. [PMID: 37797952 PMCID: PMC10555491 DOI: 10.1302/2633-1462.410.bjo-2023-0055.r1] [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] [Indexed: 10/07/2023] Open
Abstract
Aims Prophylactic antibiotic regimens for elective primary total hip and knee arthroplasty vary widely across hospitals and trusts in the UK. This study aimed to identify antibiotic prophylaxis regimens currently in use for elective primary arthroplasty across the UK, establish variations in antibiotic prophylaxis regimens and their impact on the risk of periprosthetic joint infection (PJI) in the first-year post-index procedure, and evaluate adherence to current international consensus guidance. Methods The guidelines for the primary and alternative recommended prophylactic antibiotic regimens in clean orthopaedic surgery (primary arthroplasty) for 109 hospitals and trusts across the UK were sought by searching each trust and hospital's website (intranet webpages), and by using the MicroGuide app. The mean cost of each antibiotic regimen was calculated using price data from the British National Formulary (BNF). Regimens were then compared to the 2018 Philadelphia Consensus Guidance, to evaluate adherence to international guidance. Results The primary choice and dosing of the prophylactic antimicrobial regimens varied widely. The two most used regimens were combined teicoplanin and gentamicin, and cefuroxime followed by two or three doses of cefuroxime eight-hourly, recommended by 24 centres (22.02%) each. The alternative choice and dosing of the prophylactic antimicrobial regimen also varied widely across the 83 centres with data available. Prophylaxis regimens across some centres fail to cover the likeliest causes of surgical site infection (SSI). Five centres (4.59%) recommend co-amoxiclav, which confers no Staphylococcus coverage, while 33 centres (30.28%) recommend cefuroxime, which confers no Enterococcus coverage. Limited adherence to 2018 Philadelphia Consensus Guidance was observed, with 67 centres (61.50%) not including a cephalosporin in their guidance. Conclusion This analysis of guidance on antimicrobial prophylaxis in primary arthroplasty across 109 hospitals and trusts in the UK has identified widespread variation in primary and alternative antimicrobial regimens currently recommended.
Collapse
Affiliation(s)
- Ahmed Mabrouk
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
| | - Alexander Abouharb
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
| | - Gabriel Stewart
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
| | - Jeya Palan
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Hemant Pandit
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| |
Collapse
|
2
|
Edmiston CE, Spencer M, Gunja NJ, Holy CE, Ruppenkamp JW, Leaper DJ. Longitudinal Rates, Patient Risk Factors, and Economic Impact of Superficial and Deep Incisional Surgical Site Infection After Primary and Revision Total Hip Arthroplasty: A U.S. Retrospective Commercial Claims Database Analysis. Surg Infect (Larchmt) 2023; 24:366-375. [PMID: 36940292 DOI: 10.1089/sur.2022.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
Background: Longitudinal rates, risk factors, and costs of superficial and deep incisional surgical site infection (SSI) were evaluated six months after primary total hip arthroplasty (pTHA) and revision total hip replacement (rTHA). Patients and Methods: Patients who had pTHA or rTHA between January 1, 2016 and March 31, 2018 were identified using the IBM® MarketScan® administrative claims databases. Kaplan-Meier survival curves evaluated time to SSI over six months. Cox proportional hazard models evaluated SSI risk factors. Generalized linear models estimated SSI costs up to 12 months. Results: The total cohort included 17,514 pTHA patients (mean [standard deviation] age 59.6 [10.1] years, 50.2% female; 66.4% commercial insurance), and 2,954 rTHA patients (61.2 [12.0] years, 52.0% female; 48.6% commercial insurance). Deep and superficial post-operative SSI at six months affected 0.30% (95% confidence interval [CI], 0.22%-0.39%) and 0.67% (95% CI, 0.55%-0.79% of patients in the pTHA, and 8.9% (95%CI: 7.8%-10.0%) and 4.8% (95% CI, 4.0%-5.6%) of patients in the rTHA cohorts. Hazards for SSI were related to patient comorbidities that included diabetes mellitus, obesity, renal failure, pulmonary or circulatory disorders, and depression. The adjusted average all-cause incremental commercial costs associated with post-operative infection ranged from $21,434 to $42,879 for superficial incisional SSI and $53,884 to $76,472 for deep incisional SSI, over a 12-month post-operative assessment period. Conclusions: The SSI rate after revision total hip arthroplasty (rTHA) was nearly 9% compared with 1.0% after pTHA. The risk of infection was influenced by several comorbid risk factors. The incremental cost associated with SSIs was substantial.
Collapse
Affiliation(s)
- Charles E Edmiston
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Maureen Spencer
- Infection Prevention Consultants, Boston, Massachusetts, USA
| | - Najmuddin J Gunja
- Health Economics and Market Access, Johnson & Johnson, Ontario, Canada
| | - Chantal E Holy
- MedTech Epidemiology, Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, USA
| | - Jill W Ruppenkamp
- MedTech Epidemiology, Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, USA
| | - David J Leaper
- Universities of Newcastle and Huddersfield, Newcastle upon Tyne and Huddersfield, United Kingdom
| |
Collapse
|
3
|
Muacevic A, Adler JR, Albqami SN, Barri A, Albatly M, Arafah O. Use of Antibiotic Lavage in Total Knee Replacement to Prevent Postoperative Infection. Cureus 2022; 14:e32727. [PMID: 36686072 PMCID: PMC9850443 DOI: 10.7759/cureus.32727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To determine the effectiveness of using antibiotic lavage in preventing postoperative infections in total knee replacement (TKR) patients. Methods Data on all patients who underwent TKR, either primary or secondary, during the period from May 2015 to April 2019 were collected. Many factors (both patient-related and surgery-related) that can increase the risk of surgical site infection (SSI) were taken into consideration to eliminate confounding factors. Results A total of 685 patients were identified; out of those, 232 patients received intraoperative antibiotic lavage and 453 did not. We noted that out of all 13 patients who developed SSI, only one patient (7.7%) had received antibiotic lavage, while the other 12 (92.3%) patients did not receive antibiotic lavage. However, the difference was not statistically significant (p=0.078). Conclusion Using intraoperative vancomycin lavage was associated with a decrease in the incidence of SSI post-TKR, but the difference was not statistically significant. However, more studies are needed in this area.
Collapse
|
4
|
Badia JM, Amillo Zaragüeta M, Rubio-Pérez I, Espin-Basany E, González Sánchez C, Balibrea JM. What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations. Cir Esp 2022; 100:392-403. [PMID: 35283055 DOI: 10.1016/j.cireng.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 06/14/2023]
Abstract
Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3 surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed.
Collapse
Affiliation(s)
- Josep M Badia
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Granollers, Spain.
| | - Mireia Amillo Zaragüeta
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Granollers, Spain
| | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario la Paz, Madrid, Spain
| | - Eloy Espin-Basany
- Servicio de Cirugía General, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | | | - José M Balibrea
- Servicio de Cirugía General, Hospital Clínic de Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Badia JM, Amillo Zaragüeta M, Rubio-Pérez I, Espin-Basany E, González Sánchez C, Balibrea JM. ¿Qué hemos aprendido de las encuestas de la AEC, AECP y del Observatorio de Infección en Cirugía? Cumplimiento de las medidas de prevención de infección postoperatoria y comparación con las recomendaciones de la AEC. Cir Esp 2021. [DOI: 10.1016/j.ciresp.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
6
|
Crum RJ, de SA DL, Su FL, Lesniak BP, Lin A. Decreased complication profile and improved clinical outcomes of primary reverse total shoulder arthroplasty after 2010: A systematic review. Shoulder Elbow 2021; 13:154-167. [PMID: 33897847 PMCID: PMC8039761 DOI: 10.1177/1758573219852977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/31/2019] [Accepted: 04/29/2019] [Indexed: 01/23/2023]
Abstract
The purpose of this review was to update the complication profile of reverse total shoulder arthroplasty (rTSA) post-2010, given greater procedural familiarity, improved learning curves, enhanced implant designs, and increased attention to the nuances of patient selection. Three electronic databases were searched and screened in duplicate from 1 January 2010 to 16 December 2018 based on predetermined criteria. Twenty-two studies examining 1455 patients (26% male; mean age: 73.4 ± 3.6; mean follow-up: 23.4 ± 14.3 months) were reviewed. Post-operative motion ranged a mean 122.4° ± 11.5° flexion, 109° ± 19.4° abduction, and 33° ± 11.2°/41° ± 5° external/internal rotation. Post-operative mean Constant score was 58.9 ± 10.1, American Shoulder Elbow Surgeon score was 73.4 ± 6.1, Simple Shoulder Test score was 63.5 ± 6.5, and a Visual Analog Scale pain score was 1.6 ± 0.9. The overall complication rate was 18.2% and major complication rate was 15.4%. Compared to pre-2010, the overall complication rate of 18.2% is lower than previous rates of 19%-68%, with the rate of "major" complications dropping three-fold from 15.4% to 4.6%. The data suggest that rTSA is a safe and efficacious alternative to aTSA and HA, and the "stale" nature of previous complication profiles are points fundamental to perioperative discussions surrounding rTSA.
Collapse
Affiliation(s)
- Raphael J Crum
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Raphael J Crum, University of Pittsburgh
School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213, USA.
| | | | - Favian L Su
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bryson P Lesniak
- Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Albert Lin
- Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
7
|
Morsi SS, Omar A, Hebbar G, Al-Fadhli M, Hamza WS. Effect of multidimensional intervention to reduce surgical site infection rate after knee and hip arthroplasty. Germs 2021; 11:10-22. [PMID: 33898337 DOI: 10.18683/germs.2021.1236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/17/2020] [Accepted: 12/30/2020] [Indexed: 11/08/2022]
Abstract
Introduction Prevention strategies are critical to reduce infection rates in joint arthroplasty. This study aimed to investigate the effectiveness of a set of evidence-based practices to reduce surgical site infection (SSI) rates after knee and hip arthroplasty (HPRO & KPRO). Methods A quasi-experimental study design (comparing pre- and post-intervention phases) was applied. Interventions were selected, adapted, and implemented in knee and hip arthroplasty procedures as a prospective practice. They consisted of 13 processes throughout the surgical encounter, including preoperative, intraoperative, and postoperative elements. Results Regarding hip arthroplasty procedures, the overall SSI rate during the pre-intervention period was 11.9%, which was reduced significantly to 5.1% (57% reduction) in the intervention period (p=0.042). For knee arthroplasty procedures, the overall baseline SSI rate during the pre-intervention period was 2.7%, which was reduced to 2.0% (26% reduction) in the intervention period. However, this reduction was not statistically significant (p=0.561). Combined methicillin-resistant Staphylococcus aureus (MRSA) screening with appropriate decolonization and targeted prophylaxis were associated with a 50% reduction in SSI caused by MRSA in knee arthroplasty. Conclusions The implementation of multidimensional evidence-based practices was associated with a reduction in SSI following knee and hip arthroplasties.
Collapse
Affiliation(s)
- Samar Saeed Morsi
- PhD, Associate Professor at Department of Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt, Consultant of Infection Control, Al-Razi Orthopedic Hospital, Kuwait, Sabah health region, P.O. Box: 12414 Alshamiya, Kuwait
| | - Abeer Omar
- PhD, Head of Surveillance Department, at Infection Control Directorate, Ministry of Health, Sabah health region, P.O. Box: 12414 Alshamiya, Kuwait
| | - Gautam Hebbar
- MPH, Epidemiologist at Infection Control Directorate, Ministry of Health, Sabah health region, P.O. Box: 12414 Alshamiya, Kuwait
| | - Mariam Al-Fadhli
- PhD, Former Director of Infection Control Directorate, Ministry of Health, Sabah health region, P.O. Box: 12414 Alshamiya, Kuwait
| | - Wafaa S Hamza
- PhD, Associate Professor at Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Egypt, Consultant of Infection Control at Infection Control Directorate, Ministry of Health, Kuwait, Sabah health region, P.O. Box: 12414 Alshamiya
| |
Collapse
|
8
|
Resende VAC, Neto AC, Nunes C, Andrade R, Espregueira-Mendes J, Lopes S. Higher age, female gender, osteoarthritis and blood transfusion protect against periprosthetic joint infection in total hip or knee arthroplasties: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:8-43. [PMID: 30413860 DOI: 10.1007/s00167-018-5231-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/17/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE The goal of this systematic review and meta-analysis was to identify the main risk factors for periprosthetic joint infection (PJI) in patients undergoing total hip or knee arthroplasties. METHODS A systematic review was conducted of the potential risk factors for PJI in total hip or total knee arthroplasty. Risk factors were compared and grouped according to demographics, comorbidities, behavior, infections, native joint diseases and other patient-related and procedure-related factors. Meta-analysis (random-effects models) was conducted using odds ratio (OR) and mean difference (MD). Risk of bias (ROBBINS-I) and strength of the evidence (GRADE) were assessed. RESULTS The study included 37 studies (2,470,827 patients). Older age was a protective factor (MD = - 1.18). Male gender (OR 1.34), coagulopathy (3.05), congestive heart failure (2.36), diabetes mellitus (1.80), obesity (1.61), systemic neoplasia (1.57), chronic lung disease (1.52), and hypertension (1.21) increased the risk for PJI. Behavioral risk factors comprised alcohol abuse (2.95), immunosuppressive therapy (2.81), steroid therapies (1.88), and tobacco (1.82). Infectious risk factors included surgical site infections (6.14), postoperative urinary tract infections (2.85), and prior joint infections (2.15). Rheumatoid arthritis, posttraumatic native joint disease, high National Nosocomial Infections Surveillance (NNIS) system surgical patient index score, prior joint operation, American Society of Anesthesiologists score ≥ 3 and obesity were also significantly associated with higher risk of PJI. Osteoarthritis and blood transfusion were protective factors. CONCLUSIONS The main risk factors for PJI in each category were male gender, coagulopathy, alcohol abuse, surgical site infection (highest score) and high NNIS system surgical patient index score. Protective factors were age, female gender in TKA, osteoarthritis and blood transfusion. Optimization of modifiable risk factors for PJI should be attempted in clinical practice. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Vera Alice Correia Resende
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.
- Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido de Pinho, 4520-211, Santa Maria da Feira, Portugal.
| | - Artur Costa Neto
- Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido de Pinho, 4520-211, Santa Maria da Feira, Portugal
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal
- Faculty of Sports, University of Porto, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopaedics Department of Minho University, Braga, Portugal
| | - Sílvia Lopes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| |
Collapse
|
9
|
Badia JM, Rubio-Pérez I, López-Menéndez J, Diez C, Al-Raies Bolaños B, Ocaña-Guaita J, Meijome XM, Chamorro-Pons M, Calderón-Nájera R, Ortega-Pérez G, Paredes-Esteban R, Sánchez-Viguera C, Vilallonga R, Picardo AL, Bravo-Brañas E, Espin E, Balibrea JM. The persistent breach between evidence and practice in the prevention of surgical site infection. Qualitative study. Int J Surg 2020; 82:231-239. [PMID: 32877754 DOI: 10.1016/j.ijsu.2020.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite the dissemination of guidelines for surgical site infection (SSI) prevention, a gap between the theoretical measures and their compliance persists. Accurate estimates of the implementation of preventative measures is crucial before planning dissemination strategies. METHODS A web-based survey was distributed to members of 11 Associations of operative nurses and surgeons. Questions aimed to determine their awareness of evidence, personal beliefs and actual use of the main preventative measures. RESULTS Of 1105 responders, 50.5% receive no feed-back of their SSI rate. Responders show a moderate rate of awareness of the recommendations about not removing hair, hair clipping, skin antisepsis with alcoholic solutions, and normothermia. Antibiotic prophylaxis is given for more than 24 h by 18.8% of respondents. Screening for S. aureus is performed by 27.6%. Hair removal by shaving is used by 16.6% of responders. The most common antiseptic solutions are alcoholic chlorhexidine (57.2%) and aqueous povidone (23.3%). 62.8% of surgeons allow the solution to air dry before applying surgical drapes. Adhesive drapes in the surgical field are used routinely in 33.4% of cases. Perioperative normothermia, glucose control and hyperoxia are used in 84.3%, 65.9% and 23.3% of cases. Antimicrobial sutures and negative pressure therapy are used by 20.2% and 43.5% of teams, respectively. Prior to closing the incision, 83.9% replace surgical instruments always or selectively. Wound irrigation before closing is used in 78.1% of cases, mostly with saline. Check-lists, standardized orders, surveillance, feed-back and educational programs were rated most highly by respondents as a means to improve compliance with preventative guidelines, but few of these strategies were in place at their institutions. CONCLUSION Gaps in the translation of evidence into practice remain in the prevention of SSI among different surgical specialities. Several areas for improvement have been identified, as some core prevention measures are not in common use.
Collapse
Affiliation(s)
- Josep M Badia
- Department of Surgery, Hospital General de Granollers, Avinguda Francesc Ribas 1, 08402, Spain; Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Inés Rubio-Pérez
- Department of Surgery, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | - José López-Menéndez
- Department of Cardiac Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo Km. 9, 100, 28034, Madrid, Spain.
| | - Cecilia Diez
- Surgical Area, Hospital Universitari Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
| | - Bader Al-Raies Bolaños
- Department of Vascular Surgery, Hospital de Manises, Av. de La Generalitat Valenciana, 50, 46940, Manises, Valencia, Spain.
| | - Julia Ocaña-Guaita
- Department of Vascular Surgery, Hospital Ramón y Cajal, Ctra. de Colmenar Viejo Km. 9, 100, 28034, Madrid, Spain.
| | - Xose M Meijome
- Gerencia de Asistencia Sanitaria Del Bierzo, León, Gerencia de Asistencia Sanitaria Del Bierzo, Nursing and Healthcare Research Unit, C/ El Medio, 1, 24400, Ponferrada, León, Spain.
| | - Manuel Chamorro-Pons
- Department of Oral and Maxillofacial Surgery, Hospital Ruber Juan Bravo, Calle de Juan Bravo, 49, 28006, Madrid, Spain.
| | - Ramón Calderón-Nájera
- Department of Aesthetic, Plastic and Reconstructive Surgery, Hospital Ruber Internacional, Calle de La Masó, 38 28034, Madrid, Spain.
| | - Gloria Ortega-Pérez
- Department of Surgical Oncology, MD Anderson Cancer Center, Calle de Arturo Soria, 270, 28033, Madrid, Spain.
| | - Rosa Paredes-Esteban
- Unidad de Cirugía Pediátrica, Hospital Universitario Reina Sofía, Av. Menendez Pidal, S/n, 14004, Córdoba, Spain.
| | - Cristina Sánchez-Viguera
- Servicio de Neurocirugía, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 84, 29010, Málaga, Spain.
| | - Ramon Vilallonga
- Endocrine-Metabolic and Bariatric Surgery Unit, Hospital Universitari Vall D'Hebrón, Passeig de La Vall D'Hebron, 119, 08035, Barcelona, Spain.
| | - Antonio L Picardo
- Endocrine-Metabolic and Bariatric Surgery Unit, HM Montepríncipe, Avenida de Montepríncipe Nº 25, 28660, Boadilla Del Monte, Madrid, Spain.
| | - Elena Bravo-Brañas
- Department of Aesthetic, Plastic and Reconstructive Surgery, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | - Eloy Espin
- Department of Surgery, Hospital Universitari Vall D'Hebrón, Passeig de La Vall D'Hebron, 119, 08035, Barcelona, Spain.
| | - José M Balibrea
- Department of Surgery, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | | |
Collapse
|
10
|
Wang J, Li D, Yang R, Tang X, Yan T, Guo W. Outcome of surgical treatment of children and adolescents with primary malignant sacral tumours. INTERNATIONAL ORTHOPAEDICS 2020; 44:1841-1851. [DOI: 10.1007/s00264-020-04641-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/14/2020] [Indexed: 12/20/2022]
|
11
|
Anis HK, Mahmood BM, Klika AK, Mont MA, Barsoum WK, Molloy RM, Higuera CA. Hospital Volume and Postoperative Infections in Total Knee Arthroplasty. J Arthroplasty 2020; 35:1079-1083. [PMID: 31759799 DOI: 10.1016/j.arth.2019.10.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the associations of hospital volume with revision surgery for infection and superficial incisional infections. METHODS A review of 12,541 primary total knee arthroplasties (TKAs) at a large integrated health system from 2014 to 2017 was conducted. Sixteen hospitals were classified as low-volume, medium-volume, or high-volume hospitals according to the mean number of TKAs/year (<250, 250-500, and >500, respectively). Thresholds were guided by percentiles and the literature on volume-outcome relationships. Medical records were reviewed for revision surgery for infection and superficial incisional infections during a mean 2-year review period. Multivariate analyses, adjusted for clinical and patient characteristics, were performed to evaluate the association between hospital volume and infection. RESULTS The overall rate of revision surgery for infection was 0.7% (n = 82), and the overall rate of superficial incisional infection was 2.6% (n = 324). After accounting for potential confounders, hospital volume was not found to have a significant association with revision surgery for infection when comparing high-volume and low-volume hospitals (odds ratio, 1.615; 95% confidence interval, 0.761-3.427; P = .212) as well as when comparing high-volume and medium-volume hospitals (odds ratio, 1.464; 95% confidence interval, 0.853-2.512; P = .166). Moreover, the risk of superficial incisional infection at high-volume hospitals was similar to that at low-volume (P = .107) and medium-volume (P = .491) hospitals. CONCLUSION Infection outcomes are quality metrics that are frequently used to compare hospitals including those of varying volumes. Using contemporary thresholds, this study found that infection rates after TKA at high-volume hospitals are comparable to low-volume and medium-volume hospitals.
Collapse
Affiliation(s)
- Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Bilal M Mahmood
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY
| | - Wael K Barsoum
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL
| |
Collapse
|
12
|
Morrell AT, Golladay GJ, Kates SL. Surgical selection criteria compliance is associated with a lower risk of periprosthetic joint infection in total hip arthroplasty. Arthroplast Today 2019; 5:521-524. [PMID: 31886401 PMCID: PMC6921180 DOI: 10.1016/j.artd.2019.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 12/17/2022] Open
Abstract
Background Periprosthetic joint infection (PJI) is a devastating complication of total hip arthroplasty (THA). Patient optimization represents an important target for PJI prevention. Unfortunately, best practice screening guidelines are not consistently followed by all surgeons. Our study aimed to determine both the degree and the effect that compliance with our institutional preoperative surgical selection criteria had on PJI rates for patients undergoing elective primary THA. Methods A retrospective review was conducted on 455 elective primary THA procedures performed at an academic tertiary care center over a 2-year period. Institutional preoperative surgical selection criteria included the following: body mass index ≤40 kg/m2, hemoglobin A1c ≤7.5%, hemoglobin ≥12 g/dL, albumin ≥3.5 g/dL, no smoking within 30 days prior to surgery, and completion of a decolonization protocol if a nasal polymerase chain reaction was positive for Staphylococcus aureus. PJI was assessed for a minimum 1-year follow-up using Musculoskeletal Infection Society criteria from 2011. Rates of compliance and PJI were compared using a chi-squared test. Results Surgeon compliance with institutional preoperative selection criteria was 62.4% and ranged from 0.0% to 83.9%. Five of 455 patients developed a PJI. The total PJI rate was 1.1%. The compliant patient cohort had a PJI rate of 0.0%, while the noncompliant cohort had a PJI rate of 2.9% (P = .0038). Conclusions This study identified a statistically significant decrease in PJI rates among patients who met all preoperative screening criteria.
Collapse
Affiliation(s)
- Aidan T Morrell
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
13
|
Badia JM, Casey AL, Rubio-Pérez I, Arroyo-García N, Espin E, Biondo S, Balibrea JM. Awareness of Practice and Comparison with Best Evidence in Surgical Site Infection Prevention in Colorectal Surgery. Surg Infect (Larchmt) 2019; 21:218-226. [PMID: 31724910 PMCID: PMC7099413 DOI: 10.1089/sur.2019.203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: The use of mechanical bowel preparation and prophylaxis with oral antimicrobial agents can prevent surgical site infection (SSI) in colorectal surgical procedures, but routine adoption of these and other practices by surgeons has been limited. The aim of this study was to determine the actual practice and surgeon beliefs about preventative measures in elective colorectal operations and to compare them with established recommendations. Methods: Web-based survey was sent to colorectal surgeons assessing knowledge, beliefs, and practices regarding the use of preventative measures for SSI. Results: Of 355 surgeons, 33% had no feedback of SSI rate; 60% believed in evidence for normothermia, wound edge protection, and use of alcohol solution, and reported use of these strategies. There was a discrepancy in the assumed evidence and use of hyperoxia, glove replacement after anastomosis, surgical tools replacement, and saline surgical site lavage. Most of respondents believe that oral antibiotic prophylaxis diminishes infection, but is indicated only by one third of them. Few surgeons believe in MBP, but many actually use it. Most surgeons believe that there is a discrepancy between published guidelines and actual clinical practice. As proper means to implement guidelines, checklists, standardized orders, surveillance, feedback of SSI rates, and educational programs are rated most highly by surgeons, but few of these are in place at their institutions. Conclusions: Gaps in the translation of evidence into practice remain in the prevention of SSI in colorectal surgical procedures. Several areas for improvement have been identified. Specific implementation strategies should be addressed in colorectal units.
Collapse
Affiliation(s)
- Josep M Badia
- Department of Surgery, Hospital General de Granollers, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna L Casey
- Department of Clinical Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Inés Rubio-Pérez
- Department of Surgery, Hospital Universitario la Paz, Madrid, Spain
| | | | - Eloy Espin
- Department of Surgery, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Sebastiano Biondo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - José M Balibrea
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
14
|
Anis HK, Sodhi N, Faour M, Klika AK, Mont MA, Barsoum WK, Higuera CA, Molloy RM. Effect of Antibiotic-Impregnated Bone Cement in Primary Total Knee Arthroplasty. J Arthroplasty 2019; 34:2091-2095.e1. [PMID: 31109755 DOI: 10.1016/j.arth.2019.04.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/01/2019] [Accepted: 04/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the effect of commercially available antibiotic-impregnated bone cement (AIBC) on (1) prosthetic joint infections (PJIs) and (2) surgical site infections (SSIs) after primary total knee arthroplasty (TKA). METHODS A review of primary TKAs between 2014 and 2017 from an institutional database was conducted. This identified 12,541 cases which were separated into AIBC (n = 4337) and non-AIBC (8,164) cohorts. Medical records were reviewed for PJIs and SSIs (mean 2-year postoperative period). Infection rates between the cohorts were compared with univariate analyses followed by subanalysis of high risk patients (defined as having 2 or more of the following characteristics: >65 years, body mass index >40, or Charlson Comorbidity Index score >3). To control for confounders, multivariate analyses were performed with regression models adjusted for age, gender, body mass index, comorbidities, year, operative times, and lengths of stay. RESULTS On univariate analysis, PJI rates were higher in the AIBC cohort (1.0%) compared to the non-AIBC cohort (0.5%, P < .001). Subanalysis of the high risk patients also showed that PJI rates were higher in the AIBC cohort (1.9% vs 0.6%, P < .01). After adjusting for potential confounders, no significant associations between PJIs and AIBC use were found (odds ratio 1.4, 95% confidence interval 0.9-2.3, P = .133). Similarly, no significant differences in SSI rates were observed between the AIBC (2.9%) and non-AIBC cohorts (2.4%, P = .060) and no significant associations between SSIs and AIBC were found with multivariate analysis (odds ratio 1.0, 95% confidence interval CI 0.8-1.3, P = .948). CONCLUSION This study found that there was no clinically or statistically significant decrease in infection rates with AIBC in primary TKAs.
Collapse
Affiliation(s)
- Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Mhamad Faour
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Wael K Barsoum
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| |
Collapse
|
15
|
Qoreishi M, Abbasian M, Safdari F. Sterile Parts of Operating Gown during Lower Limb Joint Replacement Surgery. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:354-359. [PMID: 31448313 PMCID: PMC6686066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/10/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The prevention of surgical site infection is one of the most concerning issues in operating rooms. Surgical gowns are worn as one of the intraoperative strategies for infection prevention. The present study investigated whether the gowns remained sterile during the surgical procedure. Furthermore, this study examined which parts of the surgical gown were more prone to contamination. METHODS The sterility of the gowns was investigated during eight total joint arthroplasties all of which were performed by four surgeons. The samples were taken from the arms and frontal part of the sterile gowns pre- and postoperatively. In the anterior surface of the gown, the sampling was initiated at a strip with 50 cm height from the ground followed by the strips with 15 cm distances from caudal to cephalad. Furthermore, the frontal part of the gown was divided into three parts in relation to the operating room table. Finally, the contamination rate was evaluated in each part. A semiquantitative method was used for the analysis of bacterial culture. RESULTS Before the operation, there were four samples tested positive for bacterial culture (1.06%). All of these samples were taken from the most proximal strip near the neckline. After the surgery, the rate of contamination in the strips on the frontal part of the gown was reported as 3.1% to 53%. Based on the operating table, the contamination rate was 35.9%, 8.9%, and 47.3% in the distal, middle, and proximal parts of the gown, respectively. The contamination rate at the elbow crease was 23%, and at 5 and 10 cm above the creases were 24% and 36%, respectively. CONCLUSION The high rate of gown contamination during the operation is concerning. However, part of the gown that was in contact with the operating room table remained clean most of the time. More safe strategies should be used for infection prevention in operating rooms.
Collapse
Affiliation(s)
- Mohamad Qoreishi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research performed at Akhtar hospital, Tehran, Iran
| | - Mohammadreza Abbasian
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research performed at Akhtar hospital, Tehran, Iran
| | - Farshad Safdari
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research performed at Akhtar hospital, Tehran, Iran
| |
Collapse
|
16
|
Abouljoud MM, Alvand A, Boscainos P, Chen AF, Garcia GA, Gehrke T, Granger J, Kheir M, Kinov P, Malo M, Manrique J, Meek D, Meheux C, Middleton R, Montilla F, Reed M, Reisener MJ, van der Rijt A, Rossmann M, Spangehl M, Stocks G, Young P, Young S, Zahar A, Zhang X. Hip and Knee Section, Prevention, Operating Room Environment: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S293-S300. [PMID: 30343970 DOI: 10.1016/j.arth.2018.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
17
|
O'Connell RS, Clinger BN, Donahue EE, Celi FS, Golladay GJ. Dexamethasone and postoperative hyperglycemia in diabetics undergoing elective hip or knee arthroplasty: a case control study in 238 patients. Patient Saf Surg 2018; 12:30. [PMID: 30410577 PMCID: PMC6217772 DOI: 10.1186/s13037-018-0178-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/28/2018] [Indexed: 02/07/2023] Open
Abstract
Background Dexamethasone has been routinely used in the pre-operative setting to enhance analgesia and decrease the incidence of nausea and vomiting in patients undergoing primary arthroplasty. However, dexamethasone has the potential to increase blood glucose levels postoperatively, which is a known risk factor for complications after total joint arthroplasty. The aim of this study was to analyze the effect of dexamethasone administration on post-operative blood glucose levels in diabetic patients after primary hip and knee arthroplasty. Methods This study was a retrospective review of 238 diabetic patients who underwent primary hip and knee arthroplasty between May 1, 2014 and September 30, 2016 at a single urban academic medical center. A total of 77 patients (32.4%) received dexamethasone and 161 (67.7%) did not. Oral hyperglycemic agents were held during the inpatient stay and blood glucose was controlled either with sliding scale insulin or home insulin regimens were continued. All analyses were adjusted for age, BMI, gender, type of diabetes, pre-operative diabetic medication, type of surgical procedure, and pre-operative HgbA1c level. The primary outcome was post-operative hyperglycemia within 72 h of surgery defined as any blood glucose level greater than or equal to 200 mg/dL. Results Post-operative hyperglycemia was observed in 17.1 and 20.6% of the measurements during the first 24 and 72 h respectively. After controlling for confounding variables, patients who received dexamethasone had 4.07 (95% CI: 2.46, 6.72) and 3.08 (95% CI: 2.34, 4.04) higher odds of post-operative hyperglycemia in the first 24 and 72 h respectively. Conclusions Dexamethasone administration in diabetic patients undergoing primary arthroplasty increases post-operative hyperglycemia during the first 24 and 72 h. While our data did not investigate causation, dexamethasone use in this patient population should be thoughtfully considered, as post-operative hyperglycemia is a known risk factor for complications.
Collapse
Affiliation(s)
- Robert S O'Connell
- 1Department of Orthopaedic Surgery, Virginia Commonwealth University, P.O. Box 980153, Richmond, Virginia 23298 USA
| | - Bryce N Clinger
- 2School of Medicine, Virginia Commonwealth University, 1201 E Marshall St,, Richmond, Virginia 23298 USA
| | - Erin E Donahue
- 3Department of Biostatistics, School of Medicine, Virginia Commonwealth University, P.O. Box 980032, Richmond, Virginia 23298 USA
| | - Francesco S Celi
- 4Division of Endocrinology Diabetes and Metabolism, Department of Internal Medicine, Virginia Commonwealth University, 1101 East Marshall Street, Sanger Hall, PO Box 980111, Richmond, Virginia 23298 USA
| | - Gregory J Golladay
- 5Department of Orthopaedic Surgery, Virginia Commonwealth University, P.O. Box 980153, Richmond, Virginia 23298 USA
| |
Collapse
|
18
|
Zaruta DA, Qiu B, Liu AY, Ricciardi BF. Indications and Guidelines for Debridement and Implant Retention for Periprosthetic Hip and Knee Infection. Curr Rev Musculoskelet Med 2018; 11:347-356. [PMID: 29869769 PMCID: PMC6105472 DOI: 10.1007/s12178-018-9497-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Prosthetic joint infection is one the most common causes of revision surgery after hip or knee replacement. Debridement and implant retention (DAIR) is one method of treating these infections; however, significant controversy exists. The purpose of our review was to describe current knowledge about indications, intraoperative/postoperative patient management, and outcomes of DAIR. RECENT FINDINGS Patient selection affects the success of DAIR. Medical comorbidities, duration of symptoms, and nature of infectious organism all influence outcomes. Intraoperative techniques such as open arthrotomy, extensive debridement, copious irrigation, and exchange of modular parts remain current standards for DAIR. Postoperative administration of antibiotics tailored to operative cultures remains critical. Antibiotic suppression may increase the success of DAIR. DAIR provides reasonable infection eradication between 50 and 80% with improved outcomes in appropriately selected patients. More research is needed on the use of adjuvant therapies intraoperatively and the role of postoperative antibiotic suppression.
Collapse
Affiliation(s)
- Douglas A Zaruta
- Department of Orthopedic Surgery, University of Rochester School of Medicine, Highland Hospital, 1000 South Avenue, Rochester, NY, 14620, USA
| | - Bowen Qiu
- Department of Orthopedic Surgery, University of Rochester School of Medicine, Highland Hospital, 1000 South Avenue, Rochester, NY, 14620, USA
| | - Andrew Y Liu
- Department of Orthopedic Surgery, University of Rochester School of Medicine, Highland Hospital, 1000 South Avenue, Rochester, NY, 14620, USA
| | - Benjamin F Ricciardi
- Department of Orthopedic Surgery, University of Rochester School of Medicine, Highland Hospital, 1000 South Avenue, Rochester, NY, 14620, USA.
| |
Collapse
|
19
|
A survey to identify the breach between evidence and practice in the prevention of surgical infection: Time to take action. Int J Surg 2018; 54:290-297. [DOI: 10.1016/j.ijsu.2018.04.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/15/2018] [Accepted: 04/23/2018] [Indexed: 01/11/2023]
|
20
|
Syed UAM, Seidl AJ, Hoffman RA, Bianchini J, Beredjiklian PK, Abboud JA. Preoperative Sterilization Preparation of the Shoulder: A Comparative Study Evaluating Gauze Sponge and Commercially Available Applicator Prep Stick. THE ARCHIVES OF BONE AND JOINT SURGERY 2018; 6:34-38. [PMID: 29430493 PMCID: PMC5799598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/30/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Surgical site infection (SSI) remains a concern in shoulder surgery, especially during arthroplasty. While many studies have explored the characteristics and efficacy of different sterilizing solutions, no study has evaluated the method of application. The purpose of this study was to compare two popular pre-surgical preparatory applications (two 4 x 4 cm gauze sponges and applicator stick) in their ability to cover the skin of the shoulder. METHODS Two orthopedic surgeons simulated the standard pre-surgical skin preparation on 22 shoulders of volunteer subjects. Each surgeon alternated between an applicator stick and two sterile 4x4 cm gauze sponges. Skin preparation was performed with a commercially available solution that can be illuminated under UV-A light. Advanced image-analysis software was utilized to determine un-prepped areas. A two-tailed paired t-test was performed to compare percentage of un-prepped skin. RESULTS The applicator stick method resulted in a significantly higher percentage of un-prepped skin (27.25%, Range 10-49.3) than the gauze sponge method (15.37%, Range 5-32.8, P=0.002). Based on image evaluation, most un-prepped areas were present around the axilla. CONCLUSION Based on our findings, the use of simple gauze sponges for pre-surgical preparatory application of sterilization solution may result in a lower percent of un-prepped skin than commercially available applicator stick. Orthopaedic surgeons and operating room staff should be careful during the pre-surgical sterile preparation of the shoulder, especially the region around the axilla, in order to reduce the potential risk of surgical site infection.Level of evidence: III.
Collapse
Affiliation(s)
- Usman Ali M Syed
- Shoulder and Elbow Division, The Rothman Institute, Philadelphia, PA, USA
- Department of Orthopedics, University of Colorado, USA
- Medical Student, Drexel University College of Medicine, Philadelphia, PA
- Department of Biomedical Engineering, Drexel University, Philadelphia, PA, USA
- Division of Hand Surgery Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam J Seidl
- Shoulder and Elbow Division, The Rothman Institute, Philadelphia, PA, USA
- Department of Orthopedics, University of Colorado, USA
- Medical Student, Drexel University College of Medicine, Philadelphia, PA
- Department of Biomedical Engineering, Drexel University, Philadelphia, PA, USA
- Division of Hand Surgery Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan A Hoffman
- Shoulder and Elbow Division, The Rothman Institute, Philadelphia, PA, USA
- Department of Orthopedics, University of Colorado, USA
- Medical Student, Drexel University College of Medicine, Philadelphia, PA
- Department of Biomedical Engineering, Drexel University, Philadelphia, PA, USA
- Division of Hand Surgery Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Justin Bianchini
- Shoulder and Elbow Division, The Rothman Institute, Philadelphia, PA, USA
- Department of Orthopedics, University of Colorado, USA
- Medical Student, Drexel University College of Medicine, Philadelphia, PA
- Department of Biomedical Engineering, Drexel University, Philadelphia, PA, USA
- Division of Hand Surgery Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Pedro K Beredjiklian
- Shoulder and Elbow Division, The Rothman Institute, Philadelphia, PA, USA
- Department of Orthopedics, University of Colorado, USA
- Medical Student, Drexel University College of Medicine, Philadelphia, PA
- Department of Biomedical Engineering, Drexel University, Philadelphia, PA, USA
- Division of Hand Surgery Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A Abboud
- Shoulder and Elbow Division, The Rothman Institute, Philadelphia, PA, USA
- Department of Orthopedics, University of Colorado, USA
- Medical Student, Drexel University College of Medicine, Philadelphia, PA
- Department of Biomedical Engineering, Drexel University, Philadelphia, PA, USA
- Division of Hand Surgery Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
21
|
Athans V, Veve MP, Davis SL. Trowels and Tribulations: Review of Antimicrobial-Impregnated Bone Cements in Prosthetic Joint Surgery. Pharmacotherapy 2017; 37:1565-1577. [DOI: 10.1002/phar.2040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Vasilios Athans
- Department of Pharmacy Services; Cleveland Clinic; Cleveland Ohio
| | - Michael P. Veve
- Eugene Applebaum College of Pharmacy and Health Sciences; Wayne State University; Detroit Michigan
- Department of Pharmacy Services; Henry Ford Hospital; Detroit Michigan
| | - Susan L. Davis
- Eugene Applebaum College of Pharmacy and Health Sciences; Wayne State University; Detroit Michigan
- Department of Pharmacy Services; Henry Ford Hospital; Detroit Michigan
| |
Collapse
|
22
|
Severyns M, Briand S, Waast D, Touchais S, Hamel A, Gouin F. Postoperative infections after limb-sparing surgery for primary bone tumors of the pelvis: Incidence, characterization and functional impact. Surg Oncol 2017; 26:171-177. [PMID: 28577723 DOI: 10.1016/j.suronc.2017.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/12/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Surgical site infections (SSI) represent the most common postoperative complication after limb sparing surgery for primary malignant bone tumors, with incidence ranging from 10 to 47%. There is no consensus concerning about the optimal surgical strategy, or the adequate antibiotic prophylaxis in pelvic resections. A greater knowledge of these infections and their surgical trajectories seem essential to obtain. MATERIALS AND METHODS We retrospectively studied 45 cases of pelvic resection, including at least the periacetabular zone 2 of Enneking, performed between 1989 and 2013 in the same center. Infection rate, risk factors and surgical trajectories were analyzed. The impact of a postoperative infection on the quality of life and functional recovery was evaluated by the Musculoskeletal Tumor Society scoring system (MSTS). RESULTS Sixteen patients presented a SSI in the first post-operative year (35.6%). We found as risk factors the pre-operative ASA score, the age at surgery and the number of packed red cells transfused during surgery. In case of failure of an initial washout, an iterative procedure is responsible for a high failure rate of 88.9%. Irrespective of the type of reconstruction, our functional results show that this surgery is often a source of handicap with a MSTS score of 13.77 in infected patients versus 17.70 in non-infected patients, at two-year follow-up. DISCUSSION In case of failure of an initial wash, prosthetic material must be removed and a hip transposition procedure should be preferred to a second-look surgery. Concerning prophylactic antibiotherapy, a dual therapy for at least 48 h after surgery should probably be preferred.
Collapse
Affiliation(s)
- M Severyns
- Orthopedic and Traumatology Department, CHU Nantes, Hôtel Dieu, Place Alexis Ricordeau, 44093 Nantes, France.
| | - S Briand
- Orthopedic and Traumatology Department, CHU Nantes, Hôtel Dieu, Place Alexis Ricordeau, 44093 Nantes, France; Inserm UMR1238, Bone Sarcomas and Remodelling of Calcified Tissue, Faculté de Médecine, Université de Nantes, France
| | - D Waast
- Orthopedic and Traumatology Department, CHU Nantes, Hôtel Dieu, Place Alexis Ricordeau, 44093 Nantes, France
| | - S Touchais
- Orthopedic and Traumatology Department, CHU Nantes, Hôtel Dieu, Place Alexis Ricordeau, 44093 Nantes, France
| | - A Hamel
- Department of Pediatric Surgery, CHU Nantes, Pavillon de la Mère et de l'Enfant, 44093 Nantes, France
| | - F Gouin
- Orthopedic and Traumatology Department, CHU Nantes, Hôtel Dieu, Place Alexis Ricordeau, 44093 Nantes, France; Inserm UMR1238, Bone Sarcomas and Remodelling of Calcified Tissue, Faculté de Médecine, Université de Nantes, France
| |
Collapse
|
23
|
Ilchmann T, Zimmerli W, Bolliger L, Graber P, Clauss M. Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips. BMC Musculoskelet Disord 2016; 17:471. [PMID: 27842584 PMCID: PMC5109646 DOI: 10.1186/s12891-016-1332-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/09/2016] [Indexed: 02/07/2023] Open
Abstract
Background The direct anterior approach (DAA) is increasingly popular for hip replacement. However, the small incision and the location near to the groin might increase the risk of periprosthetic joint infection (PJI). We asked the questions (i) whether there is an increased risk of infection for this approach, and (ii) whether the spectrum of microorganisms differs between patients with DAA and those with lateral transgluteal approach (LAT). Methods All patients operated between 08/2006 and 12/2013 were followed prospectively in an in house register. The DAA was introduced as routine in 02/2009 at our hospital. Patients with primary elective hip replacement without previous operations were included. Follow-up was scheduled after 6, 12 weeks and 1, 2 years. PJI was defined according to standardized criteria. Results One thousand one hundred four patients were studied, 700 were operated with DAA and 404 with LAT. No patient was lost to follow-up. PJI was diagnosed in 23/1104 (2.1 %) patients, 16 (2.3 %) in the group with DAA, and 7 (1.7 %) in the group with LAT. Patients with infection had a higher BMI (p < 0.001) and a higher ASA score (p < 0.001). Only patients with the DAA had exogenous PJI caused by gramnegative bacilli (35.7 % vs 0 %, p = 0.26). In the DAA-group, the fraction of patients with polymicrobial infection was somewhat higher than in the LAT-group (50 % vs 33 %, P = 0.64). Conclusion There was no increased risk of infection for the DAA.
Collapse
Affiliation(s)
- Thomas Ilchmann
- Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland.,Leonardo, Hirslanden Klinik Birshof, Reinacherstrasse 28, 4142, Münchenstein, Switzerland
| | - Werner Zimmerli
- Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Lilianna Bolliger
- Department for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Peter Graber
- Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Martin Clauss
- Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland. .,Department for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland.
| |
Collapse
|
24
|
Single vs Repeat Surgical Skin Preparations for Reducing Surgical Site Infection After Total Joint Arthroplasty: A Prospective, Randomized, Double-Blinded Study. J Arthroplasty 2016; 31:1289-1294. [PMID: 26781394 DOI: 10.1016/j.arth.2015.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Preventing surgical site infection (SSI) after total joint arthroplasty (TJA) is a high priority and is partly linked to the efficacy of surgical site preparation solutions (SPSs) in reducing the number of pathogens on the skin before incision. The aim of this study is to investigate the effectiveness of SRS reapplication after draping to reduce the incidence of SSI after TJA. METHODS Six hundred patients undergoing primary TJA between 2010 and 2011 at a single institution were recruited and randomly assigned to one of 2 groups. The patients in the intervention group (n = 300) received SPS that included alcohol and povidone-iodine before draping and an additional SPS by iodine povacrylex and isopropyl alcohol before application of the final adhesive drape, whereas the patients in the control group (n = 300) received a single SPS with alcohol and povidone-iodine before draping. Randomization was performed by an opaque envelope, and the rates of SSI and blistering were compared between groups. RESULTS Five seventy-seven patients completed the study and were included in the final analysis. There was a significant reduction in the incidence of superficial SSI for the intervention group (1.8%, 5 of 283) compared to the control group (6.5%, 19 of 294, P = .02). There were 2 (0.7%, 2 of 294) deep incisional SSIs in the control group, and 2 (0.7%, 2 of 283) organ-space SSIs in the intervention group (P = 1.00). In addition, skin blistering was lower in the intervention group (3.5%, 10 of 283) vs the control group (6.5%, 19 of 294), but this difference also did not reach statistical significance (P = .13). CONCLUSION Reapplication of an SPS after draping and before the application of iodophor-impregnated incisive draping resulted in a significant reduction in the rate of SSI in patients undergoing elective TJA.
Collapse
|
25
|
Alfargieny R, Bodalal Z, Bendardaf R, El-Fadli M, Langhi S. Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty. Avicenna J Med 2015; 5:117-22. [PMID: 26629466 PMCID: PMC4637948 DOI: 10.4103/2231-0770.165122] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Surgical site infection (SSI) is considered one of the most serious complications in total joint arthroplasty (TJA). This study seeks to analyze the predictive value of preoperative and postoperative nutritional biomarkers for SSI in elective TJA. Methodology: Nutritional markers were gathered retrospectively utilizing patient's records from the orthopedics department at Benghazi Medical Center (BMC). The sample spanned cases admitted during the 20-month period between January 2012 and August 2013 and had undergone either elective total hip replacement or total knee replacement. The collected lab results included a complete blood count, total lymphocyte count (TLC), and serum albumin (S. alb.) levels. The patients were then divided into two groups based on the occurrence of an SSI. Results: A total of 135 total knee (81.5%, n = 110/135) and total hip (18.5%, n = 25/135) replacements were performed at BMC during the study period. Among these cases, 57% (n = 78/135) had patient records suitable for statistical analysis. The average preoperative TLC was 2.422 ×103 cells/mm3 (range = 0.8–4.7 ×103 cells/mm3) whereas that number dropped after the surgery to 1.694 ×103 cells/mm3 (range = 0.6–3.8 ×103 cells/mm3). S. alb. levels showed a mean of 3.973 g/dl (range = 2.9–4.7 g/dl) preoperatively and 3.145 g/dl (range = 1.0–4.1 g/dl) postoperatively. The majority of TJA patients did not suffer any complication (67.4%, n = 91/135) while eight cases (5.9%) suffered from a superficial SSI. Conclusion: Preoperative S. alb. was identified as the only significant predictor for SSI (P = 0.011). Being a preventable cause of postoperative morbidity, it is recommended that the nutritional status (especially preoperative S. alb.) of TJA patients be used as a screening agent and appropriate measures be taken to avoid SSI.
Collapse
Affiliation(s)
- Randa Alfargieny
- Department of Orthopedic Surgery, Benghazi Medical Center, Libyan International Medical University, Benghazi, Libya
| | - Zuhir Bodalal
- Department of Medicine, Faculty of Medicine, Libyan International Medical University, Benghazi, Libya
| | - Riyad Bendardaf
- Department of Oncology, University Hospital Sharjah, Sharjah, UAE
| | - Mustafa El-Fadli
- Department of Orthopedic Surgery, Benghazi Medical Center, Libyan International Medical University, Benghazi, Libya
| | - Salem Langhi
- Department of Orthopedic Surgery, Benghazi Medical Center, Libyan International Medical University, Benghazi, Libya
| |
Collapse
|
26
|
Markatos K, Kaseta M, Nikolaou VS. Perioperative Skin Preparation and Draping in Modern Total Joint Arthroplasty: Current Evidence. Surg Infect (Larchmt) 2015; 16:221-5. [DOI: 10.1089/sur.2014.097] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Konstantinos Markatos
- Second Orthopedic Department, University of Athens, School of Medicine, Athens, Greece
| | - Maria Kaseta
- Second Orthopedic Department, University of Athens, School of Medicine, Athens, Greece
| | - Vasileios S. Nikolaou
- Second Orthopedic Department, University of Athens, School of Medicine, Athens, Greece
| |
Collapse
|
27
|
Robertsson O, Ranstam J, Sundberg M, W-Dahl A, Lidgren L. The Swedish Knee Arthroplasty Register: a review. Bone Joint Res 2014; 3:217-22. [PMID: 24986492 PMCID: PMC4112790 DOI: 10.1302/2046-3758.37.2000289] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We are entering a new era with governmental bodies taking an increasingly guiding role, gaining control of registries, demanding direct access with release of open public information for quality comparisons between hospitals. This review is written by physicians and scientists who have worked with the Swedish Knee Arthroplasty Register (SKAR) periodically since it began. It reviews the history of the register and describes the methods used and lessons learned. Cite this article: Bone Joint Res 2014;3:217-22.
Collapse
Affiliation(s)
- O Robertsson
- Lund University Hospital, The Swedish Knee Arthroplasty Register, Department of Orthopaedics and Clinical Sciences, Lund, 221 85, Sweden
| | - J Ranstam
- Lund University Hospital, The Swedish Knee Arthroplasty Register, Department of Orthopaedics and Clinical Sciences, Lund, 221 85, Sweden
| | - M Sundberg
- Lund University Hospital, The Swedish Knee Arthroplasty Register, Department of Orthopaedics and Clinical Sciences, Lund, 221 85, Sweden
| | - A W-Dahl
- Lund University Hospital, The Swedish Knee Arthroplasty Register, Department of Orthopaedics and Clinical Sciences, Lund, 221 85, Sweden
| | - L Lidgren
- Lund University Hospital, The Swedish Knee Arthroplasty Register, Department of Orthopaedics and Clinical Sciences, Lund, 221 85, Sweden
| |
Collapse
|
28
|
Affiliation(s)
- Stergios Lazarinis
- Department of Orthopedics, Institute of Surgical Sciences,Uppsala University Hospital, Uppsala, Sweden
| | | | | | | |
Collapse
|