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Tedesco A, Sharma AK, Acharya N, Rublev G, Hashmi S, Wu HH, Lee YP, Scolaro J, Bhatia N. The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery: A Review of Postoperative Outcomes. JBJS Rev 2024; 12:01874474-202404000-00004. [PMID: 38619394 DOI: 10.2106/jbjs.rvw.23.00242] [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: 04/16/2024]
Abstract
» Identification of malnourished and at-risk patients should be a standardized part of the preoperative evaluation process for every patient.» Malnourishment is defined as a disorder of energy, protein, and nutrients based on the presence of insufficient energy intake, weight loss, muscle atrophy, loss of subcutaneous fat, localized or generalized fluid accumulation, or diminished functional status.» Malnutrition has been associated with worse outcomes postoperatively across a variety of orthopaedic procedures because malnourished patients do not have a robust metabolic reserve available for recovery after surgery.» Screening assessment and basic laboratory studies may indicate patients' nutritional risk; however, laboratory values are often not specific for malnutrition, necessitating the use of prognostic screening tools.» Nutrition consultation and perioperative supplementation with amino acids and micronutrients are 2 readily available interventions that orthopaedic surgeons can select for malnourished patients.
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Affiliation(s)
- Amanda Tedesco
- School of Medicine, University of California, Irvine, Irvine, California
| | - Abhinav K Sharma
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Nischal Acharya
- School of Medicine, University of California, Irvine, Irvine, California
| | - George Rublev
- David Tvildiani Medical University, Tbilisi, Georgia
| | - Sohaib Hashmi
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Hao-Hua Wu
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - John Scolaro
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Nitin Bhatia
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
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Johnson MJ, Conover BM, Frykberg RG, Raspovic KM, Lavery LA, Wukich DK. Outcomes of open reduction and internal fixation of calcaneus fractures: A database study comparing patients with and without diabetes. Wound Repair Regen 2024. [PMID: 38516794 DOI: 10.1111/wrr.13169] [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: 10/15/2023] [Revised: 01/22/2024] [Accepted: 02/11/2024] [Indexed: 03/23/2024]
Abstract
Treatment of calcaneal fractures in patients with diabetes mellitus (DM) is challenging. The purpose of this study was to compare post-operative outcomes after open reduction and internal fixation (ORIF) for calcaneus fracture in patients with complicated DM, uncomplicated DM, and patients without DM. A commercially available de-identified database was queried for all calcaneus fracture diagnoses undergoing ORIF from 2010 to 2021. The patients were separated into three groups for analysis: patients without DM (10,951, 82.6%), uncomplicated DM (1,500, 11.3%) and complicated DM (802, 6.1%). At 1 year, post-operative adverse events were assessed among the three groups. The odds of adverse event(s) for each group were compared between the three groups with and without characteristic matching. In the unmatched cohorts, patients with complicated DM, when compared with patients without DM and patients with uncomplicated DM, had significantly higher rates of all adverse events with exception of DVT. Rates of CNA were significantly higher in patients with complicated DM compared with no DM (OR 107.7 (CI 24.83-467.6) p < 0.0001) and uncomplicated DM (OR 44.26 (CI 3.86-507.93) p = 0.0002). After matching, non-union, AKI, sepsis, surgical site infection, and wound disruption were higher in patients with complicated DM compared with patients without DM. There were no significant differences in the three groups with regard to reoperation, DVT, MI, pneumonia, or below the knee amputation. Patients with DM who underwent ORIF for calcaneus fracture experienced higher rates of post-operative adverse events compared with those patients without DM.
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Affiliation(s)
- Matthew J Johnson
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Katherine M Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lawrence A Lavery
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Zaboli Mahdiabadi M, Farhadi B, Shahroudi P, Mohammadi M, Omrani A, Mohammadi M, Hekmati Pour N, Hojjati H, Najafi M, Majd Teimoori Z, Farzan R, Salehi R. Prevalence of surgical site infection and risk factors in patients after knee surgery: A systematic review and meta-analysis. Int Wound J 2024; 21:e14765. [PMID: 38351472 PMCID: PMC10864688 DOI: 10.1111/iwj.14765] [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: 01/09/2024] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/16/2024] Open
Abstract
The present systematic review and meta-analysis aimed to determine the prevalence of surgical site infection (SSI) and risk factors in patients after knee surgery. A comprehensive and systematic search was carried out across various international electronic databases, including Scopus, PubMed and Web of Science, as well as Persian electronic databases like Iranmedex and the Scientific Information Database (SID). This search involved the utilization of keywords derived from Medical Subject Headings, such as 'Prevalence', 'Surgical wound infection', 'Surgical site infection' and 'Orthopaedics', spanning from the earliest records up to 1 October 2023. To assess the quality of the included studies, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was utilized. The study encompassed a combined participant pool of 11 028 individuals who underwent knee surgery across seven selected studies. The collective prevalence of SSI in patients who underwent knee surgery, as reported in the seven included studies, was determined to be 3.0% (95% CI: 1.2% to 7.5%; I2 = 96.612%; p < 0.001). The combined prevalence of SSI in patients with DM, as reported in six studies, was 5.1% (95% CI: 1.7% to 14.5%; I2 = 79.054%; p < 0.001). Similarly, the pooled prevalence of SSI in patients with HTN, drawn from four studies, was 1.8% (95% CI: 0.7% to 4.5%; I2 = 63.996%; p = 0.040). Additionally, the collective prevalence of SSI in patients with a history of tobacco use, based on findings from six studies, was 4.8% (95% CI: 1.4% to 15.2%; I2 = 93.358%; p < 0.001). Subgroup analysis was conducted within six studies, categorizing them by two countries, namely China and the USA. These analyses revealed that the prevalence of SSI following knee surgery was 3.0% in China and 2.0% in the USA. It is noteworthy that variations in SSI prevalence across different studies may be attributed to a multitude of factors, particularly varying risk factors among patient populations. To address this issue and mitigate the impact of SSI on knee surgery patients, it is advisable to develop tailored interventions.
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Affiliation(s)
| | - Bahar Farhadi
- School of MedicineIslamic Azad University, Mashhad BranchMashhadIran
| | - Parinaz Shahroudi
- Department of Surgical TechnologyGuilan University of Medical SciencesRashtIran
| | - Mohsen Mohammadi
- Department of Medical Surgical NursingGuilan University of Medical SciencesRashtIran
| | - Amin Omrani
- Department of Physical Therapy, School of MedicineTehran University of Medical SciencesTehranIran
| | - Maryam Mohammadi
- Department of Physical Therapy, School of MedicineUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | - Nafiseh Hekmati Pour
- Department of NursingAliabad Katoul Branch, Islamic Azad UniversityAliabad KatoulIran
| | - Hamid Hojjati
- Nursing Research Center, Golestan University of Medical SciencesGorganIran
| | - Masoomeh Najafi
- Student Research Committee, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Zahra Majd Teimoori
- Shahid Beheshti School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Reza Salehi
- Department of Anesthesiology, School of MedicineIran University of Medical SciencesTehranIran
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Cheng J, Zhang L, Zhang J, Asadi K, Farzan R. Prevalence of surgical site infection and risk factors in patients after foot and ankle surgery: A systematic review and meta-analysis. Int Wound J 2024; 21:e14350. [PMID: 37606302 PMCID: PMC10781588 DOI: 10.1111/iwj.14350] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
The present systematic review and meta-analysis aimed to determine the prevalence of surgical site infection (SSI) and related factors in patients after foot and ankle surgery. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as 'Prevalence', 'Surgical wound infection', 'Surgical site infection' and 'Orthopaedics' from the earliest to 1 June 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. A total of 10 447 patients undergoing foot and ankle surgery participated in nine studies. The pooled prevalence of SSI in patients who underwent foot and ankle surgery was reported in nine studies was 4.2% (95% CI: 2.4%-7.2%; I2 = 96.793%; p < 0.001). The odds ratio of SSI prevalence in men was higher than that of women and was significant (OR: 1.335; 95% CI: 1.106-1.612; Z = 3.009; p = 0.003). The pooled prevalence of SSI in patients with hindfoot fracture sites reported in five studies was 4.9% (95% CI: 2.6%-8.9%; I2 = 90.768%; p < 0.001). The pooled prevalence of SSI in patients with diabetes mellitus (DM) reported in six studies was 9.1% (95% CI: 5.6%-14.6%; I2 = 73.957%; p = 0.002). The pooled prevalence of SSI in patients with hypertension (HTN) reported in five studies was 5.5% (95% CI: 2.5%-11.6%; I2 = 91.346%; p < 0.001). The pooled prevalence of SSI in patients with tobacco use reported in eight studies was 6.6% (95% CI: 4.1%-10.4%; I2 = 85.379%; p < 0.001). In general, the existing differences in the prevalence of SSI after foot and ankle surgery in different studies can be based on different risk factors such as comorbidities and gender. Therefore, it is suggested to design appropriate interventions to reduce SSI in these patients.
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Affiliation(s)
- Jiaguo Cheng
- Department of Hospital Infection ManagementAffiliated Hospital of Panzhihua UniversityPanzhihuaChina
| | - Luping Zhang
- Department of Blood TransfusionAffiliated Hospital of Panzhihua UniversityPanzhihuaChina
| | - Jing Zhang
- Department of Administrative OfficeAffiliated Hospital of Panzhihua UniversityPanzhihuaChina
| | - Kamran Asadi
- Department of Orthopedics, Orthopedic Research Center, Poorsina Hospital, Faculty of MedicineGuilan University of Medical SciencesRashtIran
| | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
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Deng GH. Construction and validation of a nomogram prediction model for postoperative incisional infection in ankle fractures. Medicine (Baltimore) 2023; 102:e36408. [PMID: 38050255 PMCID: PMC10695592 DOI: 10.1097/md.0000000000036408] [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: 04/23/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
The aim was to investigate the independent risk factors for postoperative incisional infection in ankle fractures and to establish a nomogram prediction model accordingly. Data were collected from ankle fracture patients in the Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2022. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for postoperative incisional infection in ankle fractures and to establish the corresponding nomogram. Receiver operating characteristic curves were plotted and area under the curve was calculated, and calibration curves and decision curve analysis were plotted to evaluate the model performance. A total of 722 patients with ankle fractures were included in the study, and 76 patients developed postoperative incisional infections, with an incidence of 10.53%. After univariate and multivariate logistic regression analysis, a total of 5 variables were identified as independent risk factors for postoperative incisional infection in ankle fractures, namely, age ≥ 60 years (OR, 1.885; 95% CI, 1.156-3.045), having diabetes (OR1.625; 95% CI, 1.095-2.876), open fracture (OR, 5.564; 95% CI, 3.099-9.990), albumin < 35 g/L (OR, 2.618; 95% CI, 1.217-4.215), and operative time ≥ 2 hours (OR, 1.606; 95% CI, 1.077-3.247). The nomogram for postoperative incisional infection after ankle fracture constructed in this study has good predictive accuracy and helps orthopedic surgeons to intervene earlier in patients at high risk of postoperative incisional infection after ankle fracture.
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Affiliation(s)
- Guang-Hua Deng
- Ya’an Hospital of Traditional Chinese Medicine, Xi'an City, Shaanxi Province, China
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Hu Y, Chen L, Qian Y, Wu J, Xu H. Emergency surgery of intra-articular calcaneal fractures using sinus tarsi approach with modified reduction technique. BMC Musculoskelet Disord 2023; 24:523. [PMID: 37365534 DOI: 10.1186/s12891-023-06636-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate emergency surgery of calcaneal fractures using the sinus tarsi approach (STA) with modified reduction technique in terms of complication rates, iconography results and functional outcome. METHODS We evaluated the outcomes of 26 patients treated in an emergency using STA with modified reduction technique. For that, we assessed Böhler´s angle, Gissane angle, reduction of the calcaneal body, and posterior facet, the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, complications, preoperative time, operative time, and in-hospital time. RESULTS Recovery of calcaneal anatomy and articular surface were found at final follow-up. The mean Böhler´s angle at final follow-up were 30.68° ± 3.69°, of which was 15.02° ± 3.88° preoperatively (p < 0.001). The mean Gissane angle at final follow-up were 114.54° ± 11.16° of which was 88.86° ±10.96° preoperatively (p < 0.001). All cases had the varus/valgus angle of the tuber within 5 degrees. At the final follow-up, the mean AOFAS score was 89.23 ± 4.63, and the VAS score was 22.73 ± 6.5. CONCLUSIONS Emergency surgery using STA with modified reduction technique is reliable, effective, and safe for treatment of calcaneal fractures. This technique can bring good clinical outcomes and a low rate of wound complications, reducing the in-hospital time, costs, and accelerating rehabilitation.
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Affiliation(s)
- Yanwen Hu
- Department of Nuclear Medicine, Suzhou Ninth Hospital, 215000, Suzhou, Wujiang, Jiangsu Province, People's Republic of China
| | - Lucheng Chen
- Department of Orthopaedics, RuiHua Orthopaedic Hospital of Suzhou, Jiangsu Province, 5, Tayun Road, 215000, WuZhong, People's Republic of China
| | - Yaxing Qian
- Yongding Hospital of Suzhou, 1000, Gaoxin Road, 215000, Wujiang, Jiangsu Province, People's Republic of China
| | - Junjie Wu
- Yongding Hospital of Suzhou, 1000, Gaoxin Road, 215000, Wujiang, Jiangsu Province, People's Republic of China
| | - Hao Xu
- Yongding Hospital of Suzhou, 1000, Gaoxin Road, 215000, Wujiang, Jiangsu Province, People's Republic of China.
- Department of Orthopaedics, Suzhou Yongding Hospital, 1388, Gaoxing Road, 215000, Suzhou, Wujiang, Jiangsu Province, People's Republic of China.
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