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Jenny JY, Godier A, Heim C, Langenecker S, Thienpont E, Eikelboom J. European guidelines on peri-operative venous thromboembolism prophylaxis: first update.: Chapter 13: Nonambulatory orthopaedic surgery. Eur J Anaesthesiol 2024; 41:622-626. [PMID: 38957031 DOI: 10.1097/eja.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Affiliation(s)
- Jean-Yves Jenny
- From the ELSAN Clinique Sainte Odile, Haguenau, France; ESH (J-YJ), Service d'anesthésie réanimation, Hôpital Européen Georges Pompidou; INSERM UMRS-1140; Université Paris Cité, ESAIC (AG), CHUV - University Hospital Lausanne, Switzerland; Department of Anesthesiology, ESAIC (CH), Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna and Sigmund Freud Private University, Vienna, Austria; ESAIC (SL), Cliniques universitaires Saint Luc, Bruxelles, Belgique, EKS (ET), and McMaster University, Hamilton, Canada (JE)
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Sanz Ruiz P, Caeiro Rey JR, Martínez Pastor JC, Martín Alguacil JL, Murcia Asensio A, Moreta Suárez J. Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:97-107. [PMID: 36934806 DOI: 10.1016/j.recot.2023.03.009] [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: 11/21/2022] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE In orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. METHOD an ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. RESULTS A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). CONCLUSIONS There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.
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Affiliation(s)
- P Sanz Ruiz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - J R Caeiro Rey
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - J C Martínez Pastor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - J L Martín Alguacil
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vithas de Granada, Granada, España
| | - A Murcia Asensio
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Reina Sofía, Murcia, España
| | - J Moreta Suárez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Galdakao-Usansolo, Bizkaia, España
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Sanz Ruiz P, Caeiro Rey JR, Martínez Pastor JC, Martín Alguacil JL, Murcia Asensio A, Moreta Suárez J. [Translated article] Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T97-T107. [PMID: 37992859 DOI: 10.1016/j.recot.2023.11.005] [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: 11/21/2022] [Accepted: 03/11/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVE In orthopaedic surgery, it is clear that an optimal standardised closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyse the clinical practice of surgical wound closure in orthopaedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. MATERIAL AND METHOD An ad hoc group of specialists in orthopaedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. RESULTS A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). CONCLUSIONS There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.
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Affiliation(s)
- P Sanz Ruiz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - J R Caeiro Rey
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - J C Martínez Pastor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J L Martín Alguacil
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vithas de Granada, Granada, Spain
| | - A Murcia Asensio
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - J Moreta Suárez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Galdakao-Usansolo, Bizkaia, Spain
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Moore MC, Dubin JA, Bains SS, Hameed D, Nace J, Delanois RE. Trends in deep vein thrombosis prophylaxis after total hip arthroplasty: 2016 to 2021. J Orthop 2024; 48:77-83. [PMID: 38059214 PMCID: PMC10696429 DOI: 10.1016/j.jor.2023.11.030] [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: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Venous thromboembolism (VTE) has long been acknowledged as a potential complication of total hip arthroplasty (THA) contributing to heightened patient morbidity, mortality, and substantial healthcare costs. We aimed to: 1) assess trends in VTE prophylaxis utilization between 2016 and 2021; 2) determine the incidence of postoperative VTE and transfusions; and 3) identify independent risk factors for 90-day VTE and transfusion risks following THA in relation to the use of aspirin, dabigatran, enoxaparin, rivaroxaban, and warfarin. Methods A national, all-payer database was queried from January 1, 2016 and December 31, 2022. Use trends for aspirin, enoxaparin, rivaroxaban, dabigatran, and warfarin as thromboprophylaxis following THA was assessed. Incidence of ninety-day postoperative outcomes assessed included rates of 90-day postoperative VTE and transfusion. Results From 2016 to 2021, aspirin (n = 36,346) was the most used agent for VTE prophylaxis after THA, followed by dabigatran (n = 13,065), rivaroxaban (n = 11,790), enoxaparin (n = 11,380), and warfarin (n = 6326). Independent risk factors for 90-day VTE included CKD, COPD, CHF, obesity, dabigatran, enoxaparin, rivaroxaban, and warfarin (all p < 0.05). Conclusion Aspirin was used with increasing frequency and demonstrated lower rates of VTE and transfusion following THA, compared to dabigatran, enoxaparin, rivaroxaban, and warfarin. These findings seem to indicate that the increasing use of aspirin in VTE prophylaxis has been accomplished in appropriately selected patients.
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Affiliation(s)
- Mallory C. Moore
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy A. Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E. Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Chen S, Luo F, Lin Y, Yu G, Luo J, Xu J. Effect of intravenous low-dose norepinephrine on blood loss in non-tourniquet total knee arthroplasty under general anesthesia: a randomized, double-blind, controlled, single-center trial. J Orthop Surg Res 2023; 18:933. [PMID: 38057870 DOI: 10.1186/s13018-023-04360-w] [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: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE This prospective trial aimed to evaluate the effects of low-dose intravenous norepinephrine (NE) on intraoperative blood loss and bleeding from osteotomy sites during non-tourniquet total knee arthroplasty (TKA) under general anesthesia. METHODS A total of 120 patients who underwent TKA between December 2020 and May 2022 were enrolled and randomly assigned to the intravenous low-dose NE Group (NE Group) or the control group (C Group). During surgery, NE Group received 0.05-0.1 μg/(kg min) of NE intravenously to raise and maintain the patient's mean arterial pressure (MAP). C Group received the same dose of saline as placebo. Intraoperative blood loss, bleeding score at osteotomy sites, Δlactate levels (Lac), postoperative complications, and transfusion rate during hospitalization were compared between groups. RESULTS Intraoperative and osteotomy blood loss was significantly lower in the NE Group than in the C Group (P < 0.001). No significant difference was observed in ΔLac between groups (P > 0.05). There was no significant difference in complications between the groups 3 days after surgery (P > 0.05). In addition, there was no significant difference in blood transfusion rates between the two groups during hospitalization (P > 0.05). CONCLUSION In non-tourniquet TKA under general anesthesia, low-dose intravenous NE safely and effectively reduced intraoperative blood loss and provided a satisfactory osteotomy site while maintaining a higher MAP.
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Affiliation(s)
- Shijie Chen
- Shengli Clinical College of Fujian Medical University, No. 134 East Street, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, No. 134 East Street, Fuzhou, Fujian, China
| | - Fenqi Luo
- Shengli Clinical College of Fujian Medical University, No. 134 East Street, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, No. 134 East Street, Fuzhou, Fujian, China
| | - Yuan Lin
- Shengli Clinical College of Fujian Medical University, No. 134 East Street, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, No. 134 East Street, Fuzhou, Fujian, China
| | - Guoyu Yu
- Shengli Clinical College of Fujian Medical University, No. 134 East Street, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, No. 134 East Street, Fuzhou, Fujian, China
| | - Jun Luo
- Shengli Clinical College of Fujian Medical University, No. 134 East Street, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, No. 134 East Street, Fuzhou, Fujian, China
| | - Jie Xu
- Shengli Clinical College of Fujian Medical University, No. 134 East Street, Fuzhou, Fujian, China.
- Department of Orthopedic, Fujian Provincial Hospital, No. 134 East Street, Fuzhou, Fujian, China.
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Koettnitz J, Jäcker J, Migliorini F, Trost M, Peterlein CD, Götze C. The risk analysis of perioperative complications of cementless hip arthroplasty in octogenarians. Arch Orthop Trauma Surg 2023; 143:3551-3559. [PMID: 36018368 PMCID: PMC10191984 DOI: 10.1007/s00402-022-04575-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Hip arthroplasty is exposed to demographic change as patients age. Analysis of risk factors for surgical treatment decisions in the group of ≥ 80-year-old patients is crucial. Healthcare systems in developed countries are being tested medically and financially by the ageing population. Therefore, this study analysed the perioperative complications of cementless primary hip arthroplasty in octogenarians and compared them with patients aged ≤ 60 years. METHODS A retrospective data analysis of the year 2017 was done in a maximum care hospital of General Orthopaedic Surgery. Patients aged ≥ 80 years or ≤ 60 years with primary cementless hip arthroplasty were included. The outcome of interest was surgery-related and systemic complications, the development of haemoglobin and the incidence of blood transfusion after cementless primary hip arthroplasty in octogenarians during the hospitalisation and the follow-up treatment. Chi-square tests and Fischer's exact test were used for nominal variables. The two-factorial variance analysis-mixed model was used for Hb analyses and the Welch test for group comparison for metric parameters. RESULTS There was a significantly increased incidence of systemic complications during hospitalisation in the ≥ 80-year-old patients (phi 0.26; Std. Ri - 0.8 (A), 2.2 (B); p = 0.007), as well as a significantly increased rate of blood transfusions (phi 0.403; Std. Ri - 1.3 (A), 3.2 (B); p = < 0.001). No clustered pre-existing conditions in the ≥ 80-year-old patients pointed out a significant association with the incidence of systemic complications. Surgery-related complications showed no significant difference during hospitalisation and follow-up treatment. CONCLUSION The study reveals that primary cementless hip prosthesis implantation is a safe procedure without increased incidence of surgery-related complications. Increased attention should be paid to interdisciplinary preoperative optimisation (adjustment of blood pressure, blood transfusions, if necessary, safe exclusion of urinary tract infections) and postoperative care of octogenarians (tight laboratory examinations, geriatric co-attendance).
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Affiliation(s)
- Julian Koettnitz
- Department of Orthopaedic Surgery, Auguste-Viktoria Clinic, Ruhr University Bochum, 32545, Bad Oeynhausen, Germany.
| | - Justus Jäcker
- Department of Orthopaedic Surgery, Auguste-Viktoria Clinic, Ruhr University Bochum, 32545, Bad Oeynhausen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, 52064, Aachen, Germany
- Department of Orthopaedic and Trauma Surgery, RWTH Aachen University Hospital, Pauwelsstraße 31, 52074, Aachen, Germany
| | - Michael Trost
- Department of Orthopaedics and Traumatology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christian Dominik Peterlein
- Department of Orthopaedic Surgery, Auguste-Viktoria Clinic, Ruhr University Bochum, 32545, Bad Oeynhausen, Germany
| | - Christian Götze
- Department of Orthopaedic Surgery, Auguste-Viktoria Clinic, Ruhr University Bochum, 32545, Bad Oeynhausen, Germany
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