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Weber M, Chao M, Kaur S, Tran B, Dizdarevic A. A Look Forward and a Look Back: The Growing Role of ERAS Protocols in Orthopedic Surgery. Anesthesiol Clin 2024; 42:345-356. [PMID: 38705681 DOI: 10.1016/j.anclin.2023.11.014] [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] [Indexed: 05/07/2024]
Abstract
The success of enhanced recovery after surgery (ERAS) protocols in improving patient outcomes and reducing costs in general surgery are widely recognized. ERAS guidelines have now been developed in orthopedics with the following recommendations. Preoperatively, patients should be medically optimized with a focus on smoking cessation, education, and anxiety reduction. Intraoperatively, using multimodal and regional therapies like neuraxial anesthesia and peripheral nerve blocks facilitates same-day discharge. Postoperatively, early nutrition with appropriate thromboprophylaxis and early mobilization are essential. As the evidence of their improvement in patient outcomes and satisfaction continues, these pathways will prove invaluable in optimizing patient care in orthopedics.
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Affiliation(s)
- Marissa Weber
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA.
| | - Melissa Chao
- Department of Anesthesiology and Pain Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Simrat Kaur
- Virginia Commonwealth University, VCU School of Medicine, VCU Department of Anesthesiology, West Hospital, 1200 East Broad Street, 7th Floor, North Wing, Box 980695, Richmond, Virginia 23298, USA
| | - Bryant Tran
- Virginia Commonwealth University, VCU School of Medicine, VCU Department of Anesthesiology, West Hospital, 1200 East Broad Street, 7th Floor, North Wing, Box 980695, Richmond, Virginia 23298, USA
| | - Anis Dizdarevic
- Department of Anesthesiology and Pain Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
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2
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Cao Y, Wang B, Wang Y, Wang Y, Huai W, Bao X, Jin M, Jin Y, Jin Y, Zhang Z, Shan J. Construction of a postoperative infection outbreak investigation form: A tool for early detection and control measures. Am J Infect Control 2024; 52:588-594. [PMID: 38142776 DOI: 10.1016/j.ajic.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND To develop an investigation form for postoperative infection outbreak (PIO), and to identify sources of the outbreak in the early stage. METHODS After an exhaustive literature review, we used the Delphi method to determine the indicators and relative risk scores of the assessment tools through 2 rounds of specialist consultation and overall consideration of the opinions and suggestions of 20 specialists. RESULTS A total of 203 studies of PIO were eligible for inclusion. The mean authority coefficient (Cr) was 0.87. Kendall's W coefficient of the specialist consultation was 0.704 after 2 rounds of consultation (P < .005), suggesting that the specialists had similar opinions. Based on 4 primary items and 19 secondary items of the source of PIO, and tripartite distribution characteristics of infected patients, we constructed the PIO investigation form. CONCLUSIONS The PIO investigation form can be used in the investigation of the early-stage cluster of cases, it's a prerequisite for taking effective control measures, avoiding PIO occurrence. However, the effect of the investigation form needs to be further evaluated.
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Affiliation(s)
- Yulong Cao
- Department of Hospital-Acquired Infection Control, Peking University People's Hospital, Beijing, China
| | - Bin Wang
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Yanbin Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Yan Wang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Wei Huai
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Xiaoyuan Bao
- Medical Information Center, Peking University Health Science Center, Beijing, China
| | - Meng Jin
- Medical Information Center, Peking University Health Science Center, Beijing, China
| | - Yicheng Jin
- School of General Studies, Columbia University, New York, USA
| | - Yixi Jin
- Khoury College of Computer Science, Northeastern University, Seattle, USA
| | - Zexin Zhang
- Graduate School of Medicine Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Jiao Shan
- Department of Hospital-Acquired Infection Control, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
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3
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Deans CF, Kildow BJ, Garvin KL. Recurrent Periprosthetic Joint Infections: Diagnosis, Management, and Outcomes. Orthop Clin North Am 2024; 55:193-206. [PMID: 38403366 DOI: 10.1016/j.ocl.2023.09.002] [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] [Indexed: 02/27/2024]
Abstract
Periprosthetic joint infection (PJI) remains one of the most common complications after total joint arthroplasty. It is challenging to manage, associated with significant morbidity and mortality, and is a financial burden on the health care system. Failure of 2-stage management for chronic PJI is not uncommon. Repeat infections are oftentimes polymicrobial, multiple drug-resistant microorganisms, or new organisms. Optimizing the success of index 2-stage revision is the greatest prevention against failure of any subsequent management options and requires a robust team-based approach.
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Affiliation(s)
- Christopher F Deans
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Beau J Kildow
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Kevin L Garvin
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE 68198, USA
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4
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Sang G, Zou H, Guo X. Effect of nursing intervention in operation room on prevention of incision infection in gastrointestinal tract operation. Minerva Surg 2023; 78:726-728. [PMID: 35088979 DOI: 10.23736/s2724-5691.21.09298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Guifeng Sang
- Eastern Ward Operating Theatre, Yantai Yuhuangding Hospital, Yantai, China
| | - Haining Zou
- Eastern Ward Operating Theatre, Yantai Yuhuangding Hospital, Yantai, China
| | - Xiaoyan Guo
- Eastern Ward Operating Theatre, Yantai Yuhuangding Hospital, Yantai, China - ctgxylove163.com
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5
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Yan S, Zhang X, Zhang S, Wang Z, Dai Z, Zhou X, Liu J, Li B, Liu J. Influence of Inflammatory Bowel Disease on Patients Undergoing Primary Total Joint Arthroplasty: A Systematic Review and Meta-analysis of Cohort Studies. Orthop J Sports Med 2023; 11:23259671231205541. [PMID: 37941887 PMCID: PMC10629331 DOI: 10.1177/23259671231205541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/19/2023] [Indexed: 11/10/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) is recognized as a global disease. Although IBD is commonly diagnosed in the young male population, it also occurs in patients aged >60 years. With the advent of an aging society, it is expected that an increasing number of patients with IBD will undergo total joint arthroplasty (TJA). Purpose To assess the impact of IBD on the risk of complications and revision as well as the length of stay (LOS) and treatment costs after TJA. Study Design Systematic review; Level of evidence, 4. Methods Utilizing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, articles were searched in the PubMed/MEDLINE, Embase, and Cochrane Library databases from the date of inception to August 31, 2022, using the following search terms: (1) "Inflammatory Bowel Diseases"[MeSH] and (2) "Arthroplasty, Replacement"[MeSH]. The study quality was scored according to the Newcastle-Ottawa Scale. A fixed-effects or random-effects model was used to calculate odds ratios or mean differences with 95% confidence intervals. Results Of 232 studies initially retrieved, 8 retrospective cohort studies consisting of 33,758 patients with IBD and 386,238 patients without IBD were included. Patients with IBD had a higher incidence of complications (P < .05), readmission and revision (P < .05), experienced a longer LOS (P < .01), and paid higher treatment costs after TJA compared with patients without IBD . Conclusion The results of our review demonstrated that IBD increased the risk of postoperative complications, prolonged the LOS, and increased treatment costs.
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Affiliation(s)
- Shuo Yan
- Tianjin Union Medical Center, Nankai University, Tianjin, China
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Xiaofei Zhang
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Shuhao Zhang
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Zheng Wang
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Zhengxu Dai
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Xuyang Zhou
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Jianchao Liu
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Bing Li
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Jun Liu
- Department of Joints, Tianjin Hospital, Tianjin, China
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6
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Edmiston CE, Spencer M, Gunja NJ, Holy CE, Ruppenkamp JW, Leaper DJ. Longitudinal rates, risk factors, and costs of superficial and deep incisional surgical-site infection (SSI) after primary and revision total knee arthroplasty: A US retrospective claims database analysis. Infect Control Hosp Epidemiol 2023; 44:1587-1595. [PMID: 36726345 DOI: 10.1017/ice.2023.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We evaluated longitudinal rates, risk factors, and costs of superficial and deep incisional surgical-site infection (SSI) 6 months after primary total knee arthroplasty (pTKA) and revision total knee arthroplasty (rTKA). METHODS Patients were identified from January 1, 2016 through March 31, 2018, in the IBM MarketScan administrative claims databases. Kaplan-Meier survival curves evaluated time to SSI over 6 months. Cox proportional hazard models evaluated SSI risk factors. Generalized linear models estimated SSI costs up to 12 months. RESULTS Of the 26,097 pTKA patients analyzed (mean age, 61.6 years; SD, 9.2; 61.4% female; 60.4% commercial insurance), 0.65% (95% CI, 0.56%-0.75%) presented with a deep incisional SSI and 0.82% (95% CI, 0.71%-0.93%) with a superficial incisional SSI. Also, 3,663 patients who had rTKA (mean age, 60.9 years; SD, 10.1; 60.6% female; 53.0% commercial insurance), 10.44% (95% CI, 9.36%-11.51%) presented with a deep incisional SSI and 2.60% (95% CI, 2.07%-3.13%) presented with a superficial incisional SSI. Infections were associated with male sex and multiple patient comorbidities including chronic pulmonary disease, pulmonary circulatory disorders, fluid and electrolyte disorders, malnutrition, drug abuse, and depression. Adjusted average all-cause incremental commercial cost ranged from $14,298 to $29,176 and from $41,381 to 59,491 for superficial and deep incisional SSI, respectively. CONCLUSIONS SSI occurred most frequently following rTKA and among patients with pulmonary comorbidities and depression. The incremental costs associated with SSI following TKA were substantial.
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Affiliation(s)
- Charles E Edmiston
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Maureen Spencer
- Infection Prevention Consultants, Boston, Massachusetts, United States
| | - Najmuddin J Gunja
- MedTech Health Economics and Market Access, Johnson & Johnson, Markham, Ontario, Canada
| | - Chantal E Holy
- MedTech Epidemiology, Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, United States
| | - Jill W Ruppenkamp
- MedTech Epidemiology, Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, United States
| | - David J Leaper
- Newcastle University, Newcastle Upon Tyne, United Kingdom
- University of Huddersfield, Queensgate, United Kingdom
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Feng Y, Feng Q, Guo P, Wang DL. Independent risk factor for surgical site infection after orthopedic surgery. Medicine (Baltimore) 2022; 101:e32429. [PMID: 36596026 PMCID: PMC9803488 DOI: 10.1097/md.0000000000032429] [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] [Indexed: 12/31/2022] Open
Abstract
No significant progress has been made in the study of orthopedic surgical site infection (SSI) after different orthopedic surgery, and the analysis and prevention of risk factors for orthopedic SSI urgently need to be solved. A total of 154 patients underwent orthopedic surgery from April 2018 to December 2020. General information such as gender, age, marriage, diagnosis, surgical site, and anesthesia method was recorded. Statistical methods included Pearson chi-square test, univariate and multivariate logistic regression analyses, and receiver operating characteristic (ROC) curves. Based on Pearson's chi-square test, sex (P = .005), age (P = .027), marriage (P = .000), diagnosis (P = .034), and surgical site (P = .000) were significantly associated with SSI after orthopedic surgery. However, in the multiple linear regression analysis, only the surgical site (P = .035) was significantly associated with SSI after orthopedic surgery. In terms of multivariate logistic regression level, surgical site (odds ratio [OR] = 1.568, P = .039) was significantly associated with SSI. ROC curves were constructed to determine the effect of the surgical site on SSI after different orthopedic surgery (area under the curve [AUC] = 0.577, 95% CI = 0.487-0.0.666). In summary, the surgical site is an independent risk factor for SSI after orthopedic surgery, and "trauma" is more likely to develop SSI than spine, arthrosis, and others.
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Affiliation(s)
- Yingfa Feng
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Qi Feng
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Peng Guo
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Dong-lai Wang
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
- * Correspondence: Dong-lai Wang, Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang, Hebei 050011, P. R. China (e-mail: )
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8
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Technical Considerations and Avoiding Complications in Total Hip Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202211000-00011. [PMID: 36733988 PMCID: PMC9668563 DOI: 10.5435/jaaosglobal-d-22-00234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/25/2022] [Indexed: 11/22/2022]
Abstract
Total hip arthroplasty (THA) is considered to be the surgical procedure of the 20th century. Current projections show that by 2030, primary THA is expected to grow by 171%, with revision THA expected to increase by 142% in the same time frame. Although complications are not common, when they occur, they can cause notable morbidity to the patient. Understanding the unique anatomy and needs of each patient will prepare the surgeon to avoid soft-tissue or bony injury, optimize prosthesis placement, and decrease the risk of infection. This article aims to highlight common causes of early revision THA and provide specific technical strategies to avoid these complications. Following a systematic approach to the primary THA and using these techniques will assist the surgeon in avoiding complications to revision hip arthroplasty.
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9
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Edmiston CE, Leaper DJ. Prevention of Orthopedic Prosthetic Infections Using Evidence-Based Surgical Site Infection Care Bundles: A Narrative Review. Surg Infect (Larchmt) 2022; 23:645-655. [PMID: 35925775 DOI: 10.1089/sur.2022.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The number of primary/revision total joint replacements (TJR) are expected to increase substantially with an aging population and increasing prevalence of comorbid conditions. The 30-day re-admission rate, in all orthopedic specialties, is 5.4% (range, 4.8%-6.0%). A recent publication has documented that the surgical site infection (SSI) infection rate associated with revision total knee (rTKR, 15.6%) and revision total hip (rTHR, 8.6%) arthroplasties are four to seven times the rate of the primary procedures (2.1%-2.2%). These orthopedic infections prolong hospital stays, double re-admissions, and increase healthcare costs by a factor of 300%. Methods: A search of PubMed/MEDLINE, EMBASE and the Cochrane Library publications, which reported the infection risk after TKR and THR, was undertaken (January 1, 1995 to December 31, 2021). The search also included documentation of evidence-based practices that lead to improved post-operative outcomes. Results: The evidence-based approach to reducing the risk of SSI was grouped into pre-operative, peri-operative, and post-operative periods. Surgical care bundles have existed within other surgical disciplines for more than 20 years, although their use is relatively new in peri-operative orthopedic surgical care. Pre-admission chlorhexidine gluconate (CHG) showers/cleansing, staphylococcal decolonization, maintenance of normothermia, wound irrigation, antimicrobial suture wound closure, and post-operative wound care has been shown to improve clinical outcome in randomized controlled studies and meta-analyses. Conclusions: Evidence-based infection prevention care bundles have improved clinical outcomes in all surgical disciplines. The significant post-operative morbidity, mortality, and healthcare cost, associated with SSIs after TJR can be reduced by introduction of evidence-based pre-operative, intra-operative, and post-operative interventions.
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Affiliation(s)
- Charles E Edmiston
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin USA
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10
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Jones HL, Braly HL, Parsley BS, Gonzalez JL, Ausborn VAM, Noble PC. Do Ultraviolet Air Disinfection Units Reduce Contamination by Particulates in Total Knee Replacement Procedures? J Arthroplasty 2022; 37:S301-S305. [PMID: 35219817 DOI: 10.1016/j.arth.2022.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infections have become the leading cause of joint replacement failure. The primary sources of contamination are skin flora and bacteria from airborne particles. Portable ultraviolet air disinfection units are used in the Operating Room (OR) to prevent contamination from airborne particles; however, their effectiveness is not proven. The purpose of this study was to compare the rate of contamination of sites with and without Ultraviolet (UV) air disinfection units during active surgeries. METHODS Sedimentation rates of viable particles were measured during 40 primary TKA procedures. Half of the procedures were performed with ultraviolet air disinfection units. Air-borne particles were collected on nitrocellulose membranes at 5 locations within the OR. After incubation, all microbial colonies were counted and the sedimentation rates were reported in CFUs/m2/hr. 10 additional trials were performed in an empty OR with no staff present. RESULTS The average contamination rate of all sites was 22 ± 1.1 CFUs/m2/hr in the empty OR vs. 21.3 ± 4.6 CFUs/m2/hr with UV units and 20.3 ± 4.9 CFUs/m2/hr without (P = .03, P = .03, P = .964). Viable contaminates were found in the sterile field in 25% of UV cases vs 45% non-UV. These differences were not statistically significant. There were differences found however, according to the number of staff in the room (6 vs 7 staff: P = .036, 6 vs 8 staff: P = .004). CONCLUSION There was no statistical difference in contamination rate with the usage or non-usage of UV units. These 40 cases shows that the largest variables affecting the contamination rate were the number of staff present and size of the OR.
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Affiliation(s)
- Hugh L Jones
- Center for Orthopaedic Resaeach, Innovation & Training, Department of Orthopedic Surgery, McGovern Medical School, University of Texas, Bellaire, Texas
| | | | - Brian S Parsley
- Department of Orthopedics, Houston Methodist Hospital, Houston, Texas
| | | | | | - Philip C Noble
- Center for Orthopaedic Resaeach, Innovation & Training, Department of Orthopedic Surgery, McGovern Medical School, University of Texas, Bellaire, Texas
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11
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Yang S, Wu Q, Wang Q, Lv F. Magnetic Resonance Imaging under Image Enhancement Algorithm to Analyze the Clinical Value of Placement of Drainage Tube on Incision Healing after Hepatobiliary Surgery. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9269695. [PMID: 35685898 PMCID: PMC9173963 DOI: 10.1155/2022/9269695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
This study was aimed at exploring the application value of magnetic resonance imaging (MRI) based on image enhancement algorithm in analyzing the placement of drainage tubes in the healing of incisions after hepatobiliary surgery. A total of 70 patients with liver cancer undergoing laparoscopic hepatobiliary surgery were selected, including 34 males and 36 females. According to the detection method of postoperative recovery, they were divided into a group A (conventional MRI detection) and a group B (MRI detection based on Retinex algorithm). Patients were divided into two groups according to whether subcutaneous drainage tubes were placed: group C (no subcutaneous drainage tubes were placed) and group D (subcutaneous drainage tubes were placed), with 35 patients in each group. The results showed that there was no significant difference between group A and group B in tumor residual or recurrence. The detection rate of tumor capsule in group B was significantly higher than that in group A (P < 0.05). The sensitivity, specificity, and accuracy of group A for the detection of recurrent lesions were 63.40%, 86.90%, and 78.60%, respectively; those in group B were 82.70%, 98.50%, and 93.20%, respectively. Therefore, the difference between the two groups was statistically significant (P < 0.05). The incidence of poor wound healing and infection in group C were significantly lower than those in group D (P < 0.05). Therefore, the effect of MRI detection based on image enhancement algorithm was more conducive to the evaluation of postoperative recovery due to the traditional MRI detection. In addition, the drainage tube was helpful to the postoperative wound healing and showed high clinical value.
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Affiliation(s)
- Shihai Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qihua Wu
- Department of Radiology, Chongqing Nanchuan District People's Hospital, Chongqing 408400, China
| | - Qi Wang
- Department of Radiology, Chongqing Nanchuan District People's Hospital, Chongqing 408400, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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12
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Zhao W, Libera M, Prysak M, Katz J, De Stefano L. An in vitro model of microbial contamination in the operating room. J Biomed Mater Res B Appl Biomater 2022; 110:2472-2479. [PMID: 35620867 DOI: 10.1002/jbm.b.35104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/12/2022] [Accepted: 05/09/2022] [Indexed: 11/08/2022]
Abstract
Infection associated with tissue-contacting biomedical devices is a compelling clinical problem initiated by the microbial colonization of the device surface. Among the possible sources of contaminating bacteria is the operating room (OR) itself, where viable bacteria in the atmosphere can sediment onto a device surface intraoperatively. We have developed an aerosolizing system that can reproducibly spray small quantities of aerosolized bacteria onto a surface to mimic OR contamination. This paper describes the design of the system and characterizes key aspects associated with its operation. The area density of sprayed bacteria is on the order of 102 /cm2 . Using titanium (Ti) alloy coupons as test substrates contaminated by staphylococci, we quantify the fraction of bacteria that are well adhered to the substrate, those that can be removed by sonication, and those that are not recovered after spraying. Despite the relatively low levels of surface contamination, we furthermore show that such a model is able to demonstrate a statistically significant reduction in colonization of Ti coupons modified by antimicrobial quaternary ammonium compounds relative to unmodified controls.
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Affiliation(s)
- Wenhan Zhao
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, New Jersey, USA
| | - Matthew Libera
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, New Jersey, USA
| | | | - Jordan Katz
- Orthobond Corporation, Princeton, New Jersey, USA
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13
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Ding M, Yang F, Lv Q, Liu Q. Two coordination polymers: Crystal structures, prevention and nursing values on postoperative infection. PROGRESS IN REACTION KINETICS AND MECHANISM 2022. [DOI: 10.1177/14686783221090376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this current work, two fresh transition metal coordination polymers (CPs) have been created with the reaction between terphenyl-3,3″,5,5″-tetracarboxylic acid (H4L), the symmetrical rigid carboxylic acid ligand and the relevant metal salts under the reaction conditions of solvothermal, and the chemical compositions of the compounds respectively are {[Cu2(TPTC) (DMF)2(H2O)]·2DMF·2H2O} (2) and {[Zn (TPTC) (1,2-bimb)2]·4(H2O)}n (1, bimb = 1,2-bis((1H-imidazol-1-yl)methyl)benzene). Moreover, the prevention and nursing values of the compound on postoperative infection was explored and their corresponding mechanism also was investigated. Firstly, enzyme linked immunosorbent assay kit (ELISA) was employed to detect the release of inflammatory cytokines into plasma. Additionally, the expression of the bacterial survival genes was determined via exploiting the real time reverse transcription-polymerase chain reaction (RT-PCR) after treated with the compound.
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Affiliation(s)
- Meng Ding
- Operating Room, Hankou Hospital of Wuhan City, Wuhan, China
| | - Fan Yang
- Anesthesia Department, Hankou Hospital of Wuhan City, Wuhan, China
| | - Qingquan Lv
- Medical Department, Hankou Hospital of Wuhan City, Wuhan, China
| | - Qiongfang Liu
- Hospital Infection Management Department, Hankou Hospital of Wuhan City, Wuhan, China
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14
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Weber M, Chao M, Kaur S, Tran B, Dizdarevic A. A Look Forward and a Look Back: The Growing Role of ERAS Protocols in Orthopedic Surgery. Clin Sports Med 2022; 41:345-355. [PMID: 35300845 DOI: 10.1016/j.csm.2021.11.007] [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: 11/03/2022]
Abstract
The success of enhanced recovery after surgery (ERAS) protocols in improving patient outcomes and reducing costs in general surgery are widely recognized. ERAS guidelines have now been developed in orthopedics with the following recommendations. Preoperatively, patients should be medically optimized with a focus on smoking cessation, education, and anxiety reduction. Intraoperatively, using multimodal and regional therapies like neuraxial anesthesia and peripheral nerve blocks facilitates same-day discharge. Postoperatively, early nutrition with appropriate thromboprophylaxis and early mobilization are essential. As the evidence of their improvement in patient outcomes and satisfaction continues, these pathways will prove invaluable in optimizing patient care in orthopedics.
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Affiliation(s)
- Marissa Weber
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA.
| | - Melissa Chao
- Department of Anesthesiology and Pain Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Simrat Kaur
- Virginia Commonwealth University, VCU School of Medicine, VCU Department of Anesthesiology, West Hospital, 1200 East Broad Street, 7th Floor, North Wing, Box 980695, Richmond, Virginia 23298, USA
| | - Bryant Tran
- Virginia Commonwealth University, VCU School of Medicine, VCU Department of Anesthesiology, West Hospital, 1200 East Broad Street, 7th Floor, North Wing, Box 980695, Richmond, Virginia 23298, USA
| | - Anis Dizdarevic
- Department of Anesthesiology and Pain Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
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15
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Shon OJ, Lee IJ, Kim GB. A novel open synovectomy technique using an arthroscopy shaver blade in revision surgery to treat infected total knee arthroplasty: a technical note. J Orthop Surg Res 2022; 17:132. [PMID: 35241107 PMCID: PMC8895592 DOI: 10.1186/s13018-022-03024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background This article introduces a novel open synovectomy technique using an arthroscopy shaver blade to effectively remove intra-articular synovitis during revision surgery for infected primary total knee arthroplasty. Methods (techniques) Open synovectomy is performed using a 4.2-mm arthroscopy shaver blade, and the handpiece is connected to suction drainage. Suction is supplied through the central cylinder of the shaver blade to bring the debrided fragments of soft tissue into the window. Grossly inflamed, reddened, diseased synovium is debrided to reveal yellowish, healthy synovium. The inflamed tissues of the knee joint (suprapatellar pouch, medial and lateral gutters, and peripatellar area) are debrided. Then, with maintaining full flexion of the knee joint, a shaver equipped with a longer bar can be used to easily access the medial and lateral posterior compartments, which are generally difficult to access. Results During a mean of 13.5-month follow-up, there was no recurrent infection in either group; however, patients who underwent the novel technique improved significantly faster in terms of acute serological markers during the first period. Conclusions This technique yielded favorable outcomes compared with the conventional technique. In particular, it may facilitate the approach to the posterior joint space, which is difficult to access. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03024-5.
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Affiliation(s)
- Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-ro Nam-gu, Daegu, 42415, Republic of Korea.,Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro Nam-gu, Daegu, 42415, Republic of Korea
| | - In Jun Lee
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro Nam-gu, Daegu, 42415, Republic of Korea
| | - Gi Beom Kim
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-ro Nam-gu, Daegu, 42415, Republic of Korea. .,Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro Nam-gu, Daegu, 42415, Republic of Korea.
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16
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Esteban J, Vallet-Regí M, Aguilera-Correa JJ. Antibiotics- and Heavy Metals-Based Titanium Alloy Surface Modifications for Local Prosthetic Joint Infections. Antibiotics (Basel) 2021; 10:1270. [PMID: 34680850 PMCID: PMC8532710 DOI: 10.3390/antibiotics10101270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/04/2023] Open
Abstract
Prosthetic joint infection (PJI) is the second most common cause of arthroplasty failure. Though infrequent, it is one of the most devastating complications since it is associated with great personal cost for the patient and a high economic burden for health systems. Due to the high number of patients that will eventually receive a prosthesis, PJI incidence is increasing exponentially. As these infections are provoked by microorganisms, mainly bacteria, and as such can develop a biofilm, which is in turn resistant to both antibiotics and the immune system, prevention is the ideal approach. However, conventional preventative strategies seem to have reached their limit. Novel prevention strategies fall within two broad categories: (1) antibiotic- and (2) heavy metal-based surface modifications of titanium alloy prostheses. This review examines research on the most relevant titanium alloy surface modifications that use antibiotics to locally prevent primary PJI.
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Affiliation(s)
- Jaime Esteban
- Clinical Microbiology Department, Jiménez Díaz Foundation Health Research Institute, Autonomous University of Madrid, Av. Reyes Católicos 2, 28040 Madrid, Spain
- Networking Research Centre on Infectious Diseases (CIBER-ID), 28029 Madrid, Spain
| | - María Vallet-Regí
- Department of Chemistry in Pharmaceutical Sciences, Research Institute Hospital 12 de Octubre (i+12), School of Pharmacy, Complutense University of Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain
- Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
| | - John J Aguilera-Correa
- Networking Research Centre on Infectious Diseases (CIBER-ID), 28029 Madrid, Spain
- Department of Chemistry in Pharmaceutical Sciences, Research Institute Hospital 12 de Octubre (i+12), School of Pharmacy, Complutense University of Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain
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17
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A Novel Biofilm-Disrupting Wound Care Technology for the Prevention of Surgical Site Infections Following Total Joint Arthroplasty: A Conceptual Review. Surg Technol Int 2021. [PMID: 34005832 DOI: 10.52198/21.sti.38.os1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Surgical site infections (SSIs) are a major driver for increased costs following lower extremity joint arthroplasty procedures. It has been estimated that these account for over $2 billion in annual costs in the United States. While many of the current strategies for the prevention and treatment of SSIs target planktonic bacteria, 80 to 90% of bacterial pathogens exist in a sessile state. These sessile bacteria can produce extracellular polymeric substance (EPS) as protective barriers from host immune defenses and antimicrobial agents and thus, can be exceedingly difficult to eradicate. A novel wound care gel that disrupts the EPS and destroys the inciting pathogens has been developed for the treatment and prevention of biofilm-related infections. This is achieved by the simultaneous action of four key ingredients: (1) citric acid; (2) sodium citrate; (3) benzalkonium chloride; and (4) polyethylene glycol. Together, these constituents create a high osmolarity, pH-controlled environment that deconstructs and prevents biofilm formation, while destroying pathogens and promoting a moist environment for optimal wound healing. The available clinical evidence demonstrating the efficacy of this technology has been summarized, as well as the economic implications of its implementation and the authors' preferred method of its use. Due to the multifaceted burden associated with biofilm-producing bacteria in arthroplasty patients, this technology may prove to be beneficial for patients who have higher risks for infection, or perhaps, as a prophylactic measure to prevent infections for all patients.
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18
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Zhou C, Ao HY, Han X, Jiang WW, Yang ZF, Ma L, Deng XY, Wan YZ. Engineering a novel antibacterial agent with multifunction: Protocatechuic acid-grafted-quaternized chitosan. Carbohydr Polym 2021; 258:117683. [PMID: 33593556 DOI: 10.1016/j.carbpol.2021.117683] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/31/2020] [Accepted: 01/16/2021] [Indexed: 12/15/2022]
Abstract
As a mild cationic antibacterial agent, hydroxypropyltrimethyl ammonium chloride chitosan (HACC) could kill gram-positive bacteria and gram-positive drug-resistant bacteria without cytotoxicity. Nevertheless, it was not effective against gram-negative bacteria. Herein, protocatechuic acid (PA) with broad-spectrum antibacterial properties and pharmacological activities was grafted on HACC. PA-g-HACC showed favourable antioxidant capacity and anti-inflammatory properties. Most importantly, the results of antibacterial assay indicated that the antibacterial rates of all PA-g-HACC groups against Staphylococcus aureus (S. aureus) and methicillin-resistant Staphylococcus aureus (MRSA) were above 92 %, and the antibacterial rate of PA-g-HACC against E. coli was increased with the amount of grafted PA. Furthermore, the cytocompatibility of PA-g-HACC was improved by appropriate grafting ratio of PA, while excessive grafted PA can lead to toxicity. We believe that PA-g-HACC in optimum grafting ratio of PA with favorable antibacterial properties, pharmacological activities and cytocompatibility will be potential antibacterial agent for treating infections.
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Affiliation(s)
- Chen Zhou
- Jiangxi Key Laboratory of Nanobiomaterials & Institute of Advanced Materials, East China Jiaotong University, Nanchang 330000, China
| | - Hai-Yong Ao
- Jiangxi Key Laboratory of Nanobiomaterials & Institute of Advanced Materials, East China Jiaotong University, Nanchang 330000, China.
| | - Xiao Han
- College of Materials Science and Engineering, East China Jiaotong University, Nanchang 330000, China
| | - Wen-Wen Jiang
- Jiangxi Key Laboratory of Nanobiomaterials & Institute of Advanced Materials, East China Jiaotong University, Nanchang 330000, China
| | - Zhi-Fei Yang
- Jiangxi Key Laboratory of Nanobiomaterials & Institute of Advanced Materials, East China Jiaotong University, Nanchang 330000, China
| | - Le Ma
- Jiangxi Key Laboratory of Nanobiomaterials & Institute of Advanced Materials, East China Jiaotong University, Nanchang 330000, China
| | - Xiao-Yan Deng
- Jiangxi Key Laboratory of Nanobiomaterials & Institute of Advanced Materials, East China Jiaotong University, Nanchang 330000, China
| | - Yi-Zao Wan
- Jiangxi Key Laboratory of Nanobiomaterials & Institute of Advanced Materials, East China Jiaotong University, Nanchang 330000, China.
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Schauberger A, Klug A, Hagebusch P, Kemmerer M, Hoffmann R, Gramlich Y. Explantation, Followed by Serial Debridement Without Antibiotic Spacers and Subsequent Revision With Cementless Components, Is Associated With High Remission Rates and Low Mortality in Periprosthetic Hip Joint Infections. J Arthroplasty 2020; 35:3274-3284. [PMID: 32624380 DOI: 10.1016/j.arth.2020.06.006] [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: 03/24/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In difficult-to-treat cases, it is necessary to add debridement steps in prosthesis-free interval of 2-stage exchange. We aimed to analyze the functional and clinical outcome of patients treated with a multistage exchange of total hip arthroplasty without the use of spacers, rather only cementless implants. METHODS Between 2009 and 2018, 84 patients (mean age: 67.3 [39-90] years) suffering chronic late-onset periprosthetic joint infection (PJI) were treated using a multistage prosthesis exchange without spacers. The mean follow-up was 70 ± 45.3 [14-210] months. The treatment included prosthesis exchange and at least 1 additional revision step before a reimplantation, owing to ongoing acute infection in the prosthesis-free interval. High-efficiency antimicrobial therapy was administered in between, which was discontinued after cementless revision implantation. RESULTS The mean number of revisions between explantation and implantation was 2.6 (1-9). The most common microorganism was Staphylococcus epidermidis (53.6%) followed by Staphylococcus aureus (16.7%) and Cutibacterium acnes (11.9%). The bacterial load was more than one bacterium per patient in 38% of cases. All patients could be treated using a cementless implant. PJI remission was achieved in 92% of cases. Overall, 9 prostheses (11%) were replaced because of an ongoing PJI or fracture. The mean modified Harrison Hip Score was 63.4 (22-88) points. No patient died. CONCLUSION Multistage total hip arthroplasty exchange showed high remission rates and low mortality in difficult-to-treat cases. Spacer-free and multistage treatment had no negative effect on the success rate or functional outcome, consistent with the results of published 2-stage exchange studies. Implantation of an uncemented press-fit prosthesis was possible in all patients with no elevated periprosthetic fracture rate.
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Affiliation(s)
- Alice Schauberger
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Alexander Klug
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Paul Hagebusch
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Matthias Kemmerer
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Yves Gramlich
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
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Pajor K, Pajchel Ł, Zgadzaj A, Piotrowska U, Kolmas J. Modifications of Hydroxyapatite by Gallium and Silver Ions-Physicochemical Characterization, Cytotoxicity and Antibacterial Evaluation. Int J Mol Sci 2020; 21:ijms21145006. [PMID: 32679901 PMCID: PMC7404191 DOI: 10.3390/ijms21145006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
Hydroxyapatite (HA) powders enriched with silver or gallium ions or both were synthesized by two different routes: standard precipitation and the solid-state method. The powders were characterized by using several methods: inductively coupled plasma optical emission spectrometry (ICP-OES), powder X-ray diffractometry (PXRD), transmission electron microscopy (TEM), infrared spectroscopy (FT-IR) and solid-state nuclear magnetic resonance spectroscopy (ssNMR). The effects of enrichment of the HAs in Ag+ or Ga3+ or both on in vitro cytotoxicity and microbiological activity were discussed. PXRD experiments showed that the samples obtained by the wet method consisted of single-phase nanocrystalline HA, while the samples prepared via the solid-state method are microcrystalline with a small amount of calcium oxide. The introduction of higher amounts of silver ions was found to be more effective than enriching HA with small amounts of Ag+. Gallium and silver ions were found not to affect the lattice parameters. Ga3+ affected the crystallinity of the samples as well as the content of structural hydroxyl groups. Among samples synthesized by the wet method, only one (5Ag-HAw) was cytotoxic, whereas all Ga-containing samples obtained by the dry method showed cytotoxicity. In the preliminary antimicrobial test all the materials containing "foreign" ions showed high antibacterial activity.
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Affiliation(s)
- Kamil Pajor
- Department of Analytical Chemistry, Chair of Analytical Chemistry and Biomaterials, Medical University of Warsaw, Faculty of Pharmacy, ul. Banacha 1, 02-097 Warsaw, Poland; (K.P.); (Ł.P.)
| | - Łukasz Pajchel
- Department of Analytical Chemistry, Chair of Analytical Chemistry and Biomaterials, Medical University of Warsaw, Faculty of Pharmacy, ul. Banacha 1, 02-097 Warsaw, Poland; (K.P.); (Ł.P.)
| | - Anna Zgadzaj
- Department of Environmental Health Sciences, Medical University of Warsaw, Faculty of Pharmacy, ul. Banacha 1, 02-097 Warsaw, Poland;
| | - Urszula Piotrowska
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities in Radom, Chrobrego 27 St., 26-600 Radom, Poland;
| | - Joanna Kolmas
- Department of Analytical Chemistry, Chair of Analytical Chemistry and Biomaterials, Medical University of Warsaw, Faculty of Pharmacy, ul. Banacha 1, 02-097 Warsaw, Poland; (K.P.); (Ł.P.)
- Correspondence:
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