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Lei P, Zhong D, Wu H, Gao F, Qi J, Li Z, Lai L, Su S. A New Dressing System for Wound in Enhanced-Recovery Total Hip Arthroplasty: A Randomized and Controlled Trial. J Arthroplasty 2023:S0883-5403(23)00136-5. [PMID: 36805119 DOI: 10.1016/j.arth.2023.02.029] [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: 11/08/2022] [Revised: 02/03/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Currently, there is a paucity of recommendations in regards to dressing selection within the enhanced recovery after surgery protocol. We devised a new dressing system to accelerate the recovery after total hip arthroplasty (THA). We aimed to present our experience with this new dressing system as an adjunct to wound management in THA and to evaluate its performance. METHODS From September 2020 to August 2021, we prospectively enrolled 124 patients who underwent a primary THA. The patients were randomly assigned to the intervention (the new dressing system group) or the control (the traditional gauze dressing) group. The primary outcome measures of this study were numbers of dressing changes, postoperative lengths of stay, wound scores including the Stony Brook Scar Evaluation Scale and ASEPSIS scores and wound-related complications. The secondary outcomes include satisfaction scores, dressing-related costs, and pain and functional recovery scores. RESULTS The intervention group numbers of dressing changes and postoperative lengths of stay were significantly less than the control group (P < .001, P < .001). During the one-month follow-up, the Stony Brook Scar Evaluation Scale in the intervention group was significantly better than that in the control group (P < .001). The intervention group satisfaction was significantly higher than that in the control group (P < .001). There were no statistically significant differences between the two groups in terms of dressing-related costs and pain and function scores. CONCLUSION The new dressing system could significantly reduce the number of dressing changes and postoperative lengths of stay and increase patient satisfaction scores, which can be an ideal adjunct to wound management in enhanced-recovery THA.
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Affiliation(s)
- Pengfei Lei
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Da Zhong
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Honghao Wu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Fawei Gao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jun Qi
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Zhigang Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Lili Lai
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Shilong Su
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Orthopedics, Peking University Third Hospital, Beijing, China
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Yuan Y, Li J, Wang K, Zheng G, Chai S. The effect of different wound dressing materials used in postoperative treatment of wounds after total hip arthroplasty and total knee arthroplasty: A meta-analysis. Int Wound J 2022; 19:2107-2114. [PMID: 35470964 PMCID: PMC9705168 DOI: 10.1111/iwj.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 12/05/2022] Open
Abstract
A meta‐analysis was performed to assess the effect of different wound dressing materials used in the postoperative treatment of wounds after total hip arthroplasty (THA) and total knee arthroplasty (TKA). A systematic literature search up to January 2022 incorporated 16 trials involving 2765 subjects after THA or TKA at the beginning of the study: 1447 were using active and interactive dressings, and 1318 were using passive dressings. The statistical tools like the dichotomous or continuous method were used within a random or fixed‐influence model to establish the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to evaluate the influence of different wound dressing materials used in postoperative treatment of wounds after THA and TKA. Active and interactive dressings had significantly lower overall wound complications (OR, 0.32; 95% CI, 0.26–0.40, P < 0.001), number of dressing changes (MD, −1.53; 95% CI, −2.09 to −0.96, P < 0.001), and early dressing change need (OR, 0.14; 95% CI, 0.04–0.47, P = 0.002) compared with passive dressings for subjects after THA and TKA. Active and interactive dressings had significantly lower overall wound complications, the number of dressing changes, and early dressing change need compared with passive dressings for subjects after THA and TKA. Furthermore, evidence is needed to confirm the outcomes.
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Affiliation(s)
- Yingjia Yuan
- Bone Injury Rehabilitation Research Department, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Jin Li
- Bone Injury Rehabilitation Research Department, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Ke Wang
- Bone Injury Rehabilitation Research Department, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Guanqiang Zheng
- Rehabilitation Department, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Shengting Chai
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
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Jo YK, Heo SJ, Peredo AP, Mauck RL, Dodge GR, Lee D. Stretch-responsive adhesive microcapsules for strain-regulated antibiotic release from fabric wound dressings. Biomater Sci 2021; 9:5136-5143. [PMID: 34223592 DOI: 10.1039/d1bm00628b] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bacterial infection of a wound is a major complication that can significantly delay proper healing and even necessitate surgical debridement. Conventional non-woven fabric dressings, including gauzes, bandages and cotton wools, often fail in treating wound infections in a timely manner due to their passive release mechanism of antibiotics. Here, we propose adhesive mechanically-activated microcapsules (MAMCs) capable of strongly adhering to a fibrous matrix to achieve a self-regulated release of antibiotics upon uniaxial stretching of non-woven fabric dressings. To achieve this, a uniform population of polydopamine (PDA)-coated MAMCs (PDA-MAMCs) are prepared using a microfluidics technique and subsequent oxidative dopamine polymerization. The PDA-MAMC allows for robust mechano-activation within the fibrous network through high retention and effective transmission of mechanical force under stretching. By validating the potential of a PDA-MAMCs-laden gauze to release antibiotics in a tensile strain-dependent manner, we demonstrate that PDA-MAMCs can be successfully incorporated into a woven material and create a smart wound dressing for control of bacterial infections. This new mechano-activatable delivery approach will open up a new avenue for a stretch-triggered, on-demand release of therapeutic cargos in skin-mountable or wearable biomedical devices.
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Affiliation(s)
- Yun Kee Jo
- Department of Chemical and Biomolecular Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Hut-Mossel L, Ahaus K, Welker G, Gans R. Understanding how and why audits work in improving the quality of hospital care: A systematic realist review. PLoS One 2021; 16:e0248677. [PMID: 33788894 PMCID: PMC8011742 DOI: 10.1371/journal.pone.0248677] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care. METHODS A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context-mechanism-outcome configurations (CMOcs). RESULTS From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration. CONCLUSIONS This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts. PROSPERO REGISTRATION CRD42016039882.
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Affiliation(s)
- Lisanne Hut-Mossel
- Centre of Expertise on Quality and Safety, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Kees Ahaus
- Department Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Gera Welker
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rijk Gans
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Choosing the Optimal Wound Dressing for Bathing After Total Knee Arthroplasty. J Arthroplasty 2021; 36:970-977. [PMID: 33046327 DOI: 10.1016/j.arth.2020.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Many surgical dressings claim to be waterproof and safe for bathing postoperatively. The purpose of this study is to evaluate and compare the effectiveness of commonly used dressings' ability to prevent water penetration while bathing. Additionally, a survey was used to determine satisfaction and cost analysis performed. METHODS Four different dressings were applied to 17 subjects' knees: Aquacel, Opsite, Acticoat, and Tegaderm. A folded Medline Gauze Sponge was weighed and placed under each dressing before and after showering and bathing (submergence under water) in order to measure water penetration (change in weight of sponge in grams). A failure was defined as any dressing that allowed a sponge weight change greater than 1 standard deviation, or 3.9 g. All participants were additionally asked to complete a short survey after testing about the dressings. RESULTS Tegaderm was found to have significantly less water penetration than all other dressings except Aquacel and demonstrated no failures with showering, significantly less than all other dressings. Tegaderm was also found to have significantly less water penetration than all other dressings except Acticoat with bathing and had significantly less failures than all other dressings. Furthermore, Tegaderm was found to be the most comfortable and lowest cost per dressing. CONCLUSION Tegaderm was overall the most effective at preventing water penetration, most comfortable, and most cost-effective. Aquacel was found to be equally as effective at preventing water penetration while showering but overall had more water penetration, had more failures, caused more discomfort, and was more expensive.
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Yan CH, Arciola CR, Soriano A, Levin LS, Bauer TW, Parvizi J. Team Approach: The Management of Infection After Total Knee Replacement. JBJS Rev 2019; 6:e9. [PMID: 29664872 DOI: 10.2106/jbjs.rvw.17.00058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Chun Hoi Yan
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Spain
| | - L Scott Levin
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Pierboni L, Fabbri E, Santullo A, Ambrosi E, Gazineo D, Chiari P. Predictive factors for the formation of tape blisters: An observational, prognostic prospective study. Int J Nurs Stud 2019; 91:1-5. [PMID: 30641403 DOI: 10.1016/j.ijnurstu.2018.09.018] [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: 02/26/2018] [Revised: 09/13/2018] [Accepted: 09/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tape blisters are common complications in the peri-lesional area of the surgical incision, forming below the layer of dressing adhesive applied and causing numerous complications for patients. OBJECTIVES The purpose of this study was to investigate the incidence of the phenomenon, and to identify and quantify the main prognostic factors associated. DESIGN Multicentric, prognostic prospective cohort study. SETTING Shoulder Orthopaedic surgery, General surgery, Advanced Oncology therapies, Gastro-entero mininvasive surgery and Endocrine surgery. PARTICIPANTS One thousand and two patients who underwent chest, abdominal, upper limb and joint laparotomic surgery consecutively admitted to the surgical units involved, were included. METHODS Data regarding individual and patient care variables, such as intrinsic (e.g. age and gender) and extrinsic (e.g. surgery type and time) data were collected. A multivariate logistic regression model was used to identify the variables which independently influenced the onset of the tape blister. RESULTS In the multivariate analysis, patients who underwent chest (Odds Ratio = 8.99, 95% CI 5.33-15.13), and upper limb and joint surgery (Odds Ratio = 2.09, 95% CI 1.22-3.58) were more likely to develop tape blisters in the postoperative period, At the same time, having drainage (Odds Ratio = 1.98, 95% CI 1.11-3.53), being female (Odds Ratio = 1.56, 95% CI 1.01-2.44) and having a high Body Mass Index (BMI) score (Odds Ratio: 1.06, 95% CI 1.02-1.11) were also predictors of tape blister formation. CONCLUSIONS A higher BMI score, chest, upper limb and joint surgery, female gender and the presence of drainage were predictive factors of the tape blister event while, in contrast with the literature, the type of dressing used in this study was not significantly associated with the event.
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Affiliation(s)
- Lara Pierboni
- Nursing and Technical Direction, AUSL Romagna, Rimini's Area, FC, Italy.
| | - Elisabetta Fabbri
- Department of Research and Innovation, AUSL Romagna, Rimini's Area, FC, Italy.
| | - Antonietta Santullo
- Quality and organization research and innovation, AUSL Romagna, Rimini's Area, FC, Italy.
| | - Elisa Ambrosi
- Department of Medical and Surgical Sciences, University of Bologna, Italy.
| | - Domenica Gazineo
- Evidence Based Nursing Centre, S.Orsola-Malpighi, Teaching Hospital, Bologna, Italy.
| | - Paolo Chiari
- Department of Medical and Surgical Sciences, University of Bologna, Italy.
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López-Parra M, Gil-Rey D, López-González E, González-Rodríguez EM, Simó-Sánchez I, Zamora-Carmona F, Roqueta-Andreu L, Arizu-Puigvert M, Abril-Sabater D, Moreno-Álvarez À, López-Bonet À, López-Hidalgo G, Costa-Ventura H, García-Pardo L, Rico-Liberato M, García-Borràs M, Arnal-Leris MT, Sianes-Gallén M, Vives R. Open-label randomized controlled trial to compare wound dressings for patients undergoing hip and knee arthroplasty: study protocol for a randomized controlled trial. Trials 2018; 19:357. [PMID: 29976227 PMCID: PMC6034240 DOI: 10.1186/s13063-018-2755-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background Surgical wounds are covered to prevent bleeding, absorb the exudates, and provide a barrier against external contamination. Currently, in our hospital, after orthopedic surgery, traditional occlusive dressing of sterile gauze and non-woven hypoallergenic adhesive tape is placed. Some of the newest dressings have been shown to reduce the incidence of blisters compared with traditional dressing or colloid adhesive dressings. However, there are no comparative evaluations between the different types of dressings and their contribution to the overall results of the healing process. Methods/design This is a randomized, controlled, open-label trial to compare five types of dressings used in total knee and hip arthroplasty surgical wounds. A total of 550 patients will be randomly allocated to one of the following dressings: (1) traditional occlusive dressing, (2) Aquacel Surgical®, (3) Mepilex® Border Post-Op, (4) OpSite Post-Op Visible, or (5) UrgoTul® Absorb Border. The dressing assigned is placed right after surgery. Patients will be followed up to 14 days after surgery when the dressing is definitively removed and will be tracked up to 3 months to record any late complications. During the immediate postoperative period and patient hospitalization and at the ambulatory visits after discharge, every time that the dressing is changed, nurses perform the study assessments. The main study outcome will be the percentage of patients with skin integrity at all times when the dressing has been changed. Skin integrity is a composite of the absence of blisters, erosion, erythema, maceration, swelling, wound dehiscence, and purulent exudates. Secondary outcomes include time to first change of dressing; percentage of patients with presence/absence of blisters, erosion, erythema, maceration, swelling, wound dehiscence, and purulent exudates; number of dressing changes needed; days of hospital stay; and nurse and patient satisfaction. Differences in the main variable between each treatment group and group 1 will be tested by means of a chi-squared test or Fisher’s exact test. Subgroup analyses of diabetic and non-diabetic patients, patients with a body mass index of more than 30 or not more than 30, and type of surgery (hip or knee) are planned. Discussion The results of this study will be useful for clinical decision making by giving information on the contribution of the dressings studied to the outcome of the wound and may also show which dressing offers better results depending on the characteristics of patients. Trial registration This trial has been registered at ClinicalTrials.gov (NCT03190447). Retrospectively registered on 16 June 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2755-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria López-Parra
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Dolors Gil-Rey
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Esmeralda López-González
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Eva-Maria González-Rodríguez
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Isabel Simó-Sánchez
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Francisco Zamora-Carmona
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Lidia Roqueta-Andreu
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Marta Arizu-Puigvert
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Dolors Abril-Sabater
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Àngels Moreno-Álvarez
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Àngels López-Bonet
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Gisela López-Hidalgo
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Helena Costa-Ventura
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Laura García-Pardo
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Mireia Rico-Liberato
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Miriam García-Borràs
- Capresa, prevención de riesgos laborales, C/ Badajoz, 145, 08018, Barcelona, Spain
| | - Maria Teresa Arnal-Leris
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Mònica Sianes-Gallén
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain
| | - Roser Vives
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain. .,Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallés (Barcelona), Spain.
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A randomized controlled trial on the effect of a silver carboxymethylcellulose dressing on surgical site infections after breast cancer surgery. PLoS One 2018; 13:e0195715. [PMID: 29791437 PMCID: PMC5965831 DOI: 10.1371/journal.pone.0195715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/27/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The incidence of surgical site infections (SSIs) after breast cancer surgery is relatively high; ranging from 3 to 19%. The role of wound dressings in the prevention of SSI after breast cancer surgery is unclear. This study compares a silver carboxymethylcellulose dressing (AQUACEL Ag Surgical (Aquacel) with standard wound dressing in SSI rate after breast cancer surgery. PATIENTS AND METHODS A single-centre randomized controlled trial among women ≥18 years, diagnosed with breast cancer, undergoing breast conserving or ablative surgery, was conducted in a combined in and outpatient setting. The intervention was the use of Aquacel, compared with standard gauze dressing. Primary outcome measure was SSI following CDC criteria. RESULTS A total of 230 patients were analysed: 106 in the Aquacel group and 124 controls. Seven patients (6.6%) developed SSI in the Aquacel group and 16 patients (12.9%) in the control group (RR 0.51 [95% Confidence Interval (CI): 0.22-1.20]; p = 0.112; adjusted OR 0.49 [0.19-1.25] p = 0.135)). Unplanned exploratory subgroup analysis of breast conserving surgery patients showed that SSI rate was 1/56 (1.8%) in the Aquacel group vs. 7/65 (10.8%) in controls; adjusted OR 0.15 [0.02-1.31] p = 0.087. The Aquacel group showed better patient satisfaction (median 8 vs. 7 on a Numerical Rating Scale, p = 0.006), fewer dressing changes within 48 hours(adjusted OR 0.12 [0.05-0.27] p<0.001), fewer re-operations (0% vs. 3.2%, p = 0.062), and lower mean wound-related treatment costs, both in a high (€265.42 (SD = 908) vs. €470.65 (SD = 1223) [p<0.001]) and low (€59.12 (SD = 129) vs. €67.55 (SD = 172) [p<0.001]) attributable costs of SSI model. CONCLUSION In this randomized controlled trial in women undergoing surgery for breast cancer, the use of AQUACEL Ag Surgical wound dressing did not significantly reduce the occurrence of SSIs compared to standard gauze dressing. The use of Aquacel resulted in significantly improved patient satisfaction, reduced dressing changes and reduced wound-related costs. TRIAL REGISTRATION www.trialregister.nl: NTR5840.
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10
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Sharma A, Subramanian P, Shah S, Remani M, Shahid M. Massive haemorrhagic blister formation following total knee arthroplasty. JRSM Open 2018; 9:2054270418758569. [PMID: 29770226 PMCID: PMC5946637 DOI: 10.1177/2054270418758569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Skin blistering following trauma is not uncommon; however, large haemorrhagic bullous blisters following total knee arthroplasty is relatively rare and not widely documented in the literature.
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Affiliation(s)
- Aadhar Sharma
- 1Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | | | - Sunil Shah
- 2Royal Free London NHS Foundation Trust, Barnet Hospital, London EN5 3DJ, UK
| | - Mohan Remani
- 2Royal Free London NHS Foundation Trust, Barnet Hospital, London EN5 3DJ, UK
| | - Muhammad Shahid
- 2Royal Free London NHS Foundation Trust, Barnet Hospital, London EN5 3DJ, UK
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Chen KK, Elbuluk AM, Vigdorchik JM, Long WJ, Schwarzkopf R. The effect of wound dressings on infection following total joint arthroplasty. Arthroplast Today 2018; 4:125-129. [PMID: 29560407 PMCID: PMC5859663 DOI: 10.1016/j.artd.2017.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 11/24/2022] Open
Abstract
Background The use of perioperative surgical wound dressings is an important factor in the mitigation of infection following total joint arthroplasty (TJA). Few studies have been published comparing wound dressings and infection rates after TJA. Methods MEDLINE, PubMed, and EMBASE were searched for studies published between 2006 and 2016 reporting infection rates in patients using various wound dressings after undergoing TJA. All studies comparing Hydrofibre dressings to Standard dressings or Absorbent dressings were included in this meta-analysis. Studies looking at TJA secondary to trauma were excluded. Two individuals independently extracted data, and study results were divided based on type of treatment. The primary outcome was to compare the infection rate of Hydrofibre dressings to that of both Standard Dressings and Absorbent dressings. Results Of a total of 3721 participants, 1483 were treated with Standard dressings (non-impregnated gauze), 1911 with Hydrofibre dressings, and 327 with Absorbent dressings. The risk ratio for infection comparing Standard with Hydrofibre was 4.16 (95% confidence interval, 1.71-10.16) as compared to 2.60 (95% confidence interval, 0.66-10.27) when comparing Absorbent with Hydrofibre dressings. Conclusions Our analysis suggests that Hydrofibre dressings may be significantly better than Standard and Absorbent dressings with respect to reducing infection. However, given the observed heterogeneity and small number of studies included, more comparative studies are needed to definitively recommend superiority among dressings following TJA. Level of Evidence Level 1.
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Affiliation(s)
- Kevin K Chen
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - Ameer M Elbuluk
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - Jonathan M Vigdorchik
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - William J Long
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
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AQUACEL® Ag Surgical Dressing Reduces Surgical Site Infection and Improves Patient Satisfaction in Minimally Invasive Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1262108. [PMID: 28831390 PMCID: PMC5558629 DOI: 10.1155/2017/1262108] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/06/2017] [Accepted: 06/28/2017] [Indexed: 11/17/2022]
Abstract
The use of modern surgical dressings to prevent wound complications and surgical site infection (SSI) after minimally invasive total knee arthroplasty (MIS-TKA) is lacking. In a prospective, randomized, controlled study, 240 patients were randomized to receive either AQUACEL Ag Surgical dressing (study group) or a standard dressing (control group) after MIS-TKA. The primary outcome was wound complication (SSI and blister). The secondary outcomes were wear time and number of dressing changes in the hospital and patient satisfaction (pain, comfort, and ease of use). In the intention-to-treat analysis, there was a significant reduction in the incidence of superficial SSI (0.8%, 95% CI∶ 0.00-2.48) in the study group compared to 8.3% (95% CI∶ 3.32-13.3) in the control group (p = 0.01). There were no differences in blister and deep/organ-space SSIs between the two groups. Multivariate analysis revealed that AQUACEL Ag Surgical dressing was an independent risk factor for reduction of SSI (odds ratio: 0.07, 95% CI: 0.01-0.58, p = 0.01). The study group had longer wear time (5.2 ± 0.7 versus 1.7 ± 0.4 days, p < 0.0001) and lower number of dressing changes (1.0 ± 0.2 versus 3.6 ± 1.3 times, p < 0.0001). Increased patient satisfaction (p < 0.0001) was also noted in the study group. AQUACEL Ag Surgical dressing is an ideal dressing to provide wound care efficacy, patient satisfaction, reduction of SSI, and cost-effectiveness following MIS-TKA.
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Shohat N, Parvizi J. Prevention of Periprosthetic Joint Infection: Examining the Recent Guidelines. J Arthroplasty 2017; 32:2040-2046. [PMID: 28366315 DOI: 10.1016/j.arth.2017.02.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The global rise in infectious disease has led the Center for Disease Control and Prevention and the World Health Organization to release new guidelines for the prevention of surgical site infection. METHODS In this article, we summarize current recommendations based on level of evidence, review unresolved and unaddressed issues, and supplement them with new literature. RESULTS Although the guidelines discuss major issues in reducing surgical site infection, many questions remain unanswered. CONCLUSION These guidelines will hopefully help in setting a standard of care based on best evidence available and focus investigators on areas where evidence is lacking.
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Affiliation(s)
- Noam Shohat
- Tel Aviv University, Tel Aviv, Israel; Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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14
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In search of the optimal wound dressing material following total hip and knee arthroplasty: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2017; 41:1295-1305. [DOI: 10.1007/s00264-017-3484-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
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15
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McDonald DA, Deakin AH, Ellis BM, Robb Y, Howe TE, Kinninmonth AWG, Scott NB. The technique of delivery of peri-operative analgesia does not affect the rehabilitation or outcomes following total knee arthroplasty. Bone Joint J 2016; 98-B:1189-96. [DOI: 10.1302/0301-620x.98b9.36250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/20/2016] [Indexed: 11/05/2022]
Abstract
Aims This non-blinded randomised controlled trial compared the effect of patient-controlled epidural analgesia (PCEA) versus local infiltration analgesia (LIA) within an established enhanced recovery programme on the attainment of discharge criteria and recovery one year after total knee arthroplasty (TKA). The hypothesis was that LIA would increase the proportion of patients discharged from rehabilitation by the fourth post-operative day but would not affect outcomes at one year. Patients and Methods A total of 242 patients were randomised; 20 were excluded due to failure of spinal anaesthesia leaving 109 patients in the PCEA group and 113 in the LIA group. Patients were reviewed at six weeks and one year post-operatively. Results There was no difference in the proportion of patients discharged from rehabilitation by the fourth post-operative day, (77% in the PCEA group, 82% in the LIA group, p = 0.33), mean length of stay (four days in each group, p = 0.540), day of first mobilisation (p = 0.013) or pain (p = 0.278). There was no difference in mean Oxford Knee Scores (41 points in each group, p = 0.915) or the rate of complications in the two groups. Conclusion Both techniques provided adequate pain relief, enabled early mobilisation and accelerated rehabilitation and good patient-reported outcomes up to one year post-operatively. PCEA and LIA are associated with similar clinical outcomes following TKA. Cite this article: Bone Joint J 2016;98-B1189–96.
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Affiliation(s)
- D. A. McDonald
- Golden Jubilee National Hospital, Agamemnon
St, Clydebank G81 4DY, UK
| | - A. H. Deakin
- Golden Jubilee National Hospital, Agamemnon
St, Clydebank G81 4DY, UK
| | - B. M. Ellis
- Glasgow Caledonian University, Cowcaddens
Road, Glasgow G4 0BA, UK
| | - Y. Robb
- Glasgow Caledonian University, Cowcaddens
Road, Glasgow G4 0BA, UK
| | - T. E. Howe
- Glasgow Caledonian University, Cowcaddens
Road, Glasgow G4 0BA, UK
| | | | - N. B. Scott
- Hamad Medical Corporation, PO
Box 3050, Doha, Qatar
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16
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Abstract
The purpose of this article is to provide the reader with a seven-step checklist that could help in minimising the risk of PJI. The check list includes strategies that can be implemented pre-operatively such as medical optimisation, and reduction of the bioburden by effective skin preparation or actions taking during surgery such as administration of timely and appropriate antibiotics or blood conservation, and finally implementation of post-operative protocols such as efforts to minimise wound drainage and haematoma formation.
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Affiliation(s)
- S Heller
- Rothman Institute of Orthopaedics at Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, 19107, USA
| | - M Rezapoor
- Rothman Institute of Orthopaedics at Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, 19107, USA
| | - J Parvizi
- Rothman Institute of Orthopaedics at Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, 19107, USA
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Eastburn S, Ousey K, Rippon MG. A review of blisters caused by wound dressing components: Can they impede post-operative rehabilitation and discharge? Int J Orthop Trauma Nurs 2016; 21:3-10. [DOI: 10.1016/j.ijotn.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/14/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
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Chowdhry M, Chen AF. Wound dressings for primary and revision total joint arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:268. [PMID: 26605314 DOI: 10.3978/j.issn.2305-5839.2015.09.25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Preventing post-surgical complications after total joint arthroplasty (TJA) is of great importance, and application of an appropriate wound dressing is necessary. Since no dressing encompasses all the parameters required for ideal wound healing, a comparison of the available dressing types can assist the surgeon to choose the best dressing after TJA. METHODS Studies evaluating postoperative wound dressings after TJA were reviewed in order to assess the outcomes, complications and costs associated with dressing types. RESULTS Traditional cotton dressings have a high ability to absorb exudate. However, they dry out sooner and there is a risk of pain and additional trauma during dressing changes. Although vapor permeable dressings allow transmission of moisture, but they have low absorptive capacity and require frequent changes even with moderately exudating wounds. On the other hand, hydrofiber and hydrocolloid dressings have high absorptive capacity and permeability, and can cope with exudate production. They are changed less often and have low blistering rates, which may reduce surgical site infection (SSI). Although the unit cost associated with advanced dressings is much higher than the traditional dressings, the decreased rate of periprosthetic joint infection (PJI) and the cost associated with treating PJI more than compensate for it. CONCLUSIONS Choice of dressing type after TJA should depend upon permeability, absorptive capacity, documented rate of SSI and cost effectiveness with its use, apart from a surgeon's past clinical experience and familiarity.
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Affiliation(s)
- Madhav Chowdhry
- Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Antonia F Chen
- Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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19
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Wong KL, Peter L, Liang S, Shah S, Johandi F, Wang W. Changes in dimensions of total knee arthroplasty anterior knee dressings during flexion: Preliminary findings. Int J Orthop Trauma Nurs 2015; 19:179-83. [PMID: 26547680 DOI: 10.1016/j.ijotn.2015.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 05/14/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Wound care is critical to the management of patients post total knee arthroplasty, requiring prudent selection of dressings that can accommodate changes in wound length during knee flexion. This study aims to quantify differences in dressing dimensions based on the position of the knee during the application of the dressing and subsequent flexion. METHODS Our study involved 40 knees divided into 2 groups, an extension group and a flexion group, each consisting of 20 knees. These groups had dressings applied to the knee in full extension and in 90° of flexion respectively. Measurements of the dressings were taken for the extension group with the knee in extension and for both groups at 90° of flexion. RESULTS For the extension group, the changes in length and breadth of the dressings when measured in 90° of flexion were 3.42 ± 0.15 cm, p < 0.001 and -0.43 ± 0.10 cm, p < 0.001 respectively. Compared to the flexion group, the differences in length and breadth between the dressings when measured in 90° of flexion were 3.48 ± 0.15 cm, p < 0.001 and -0.14 ± 0.12 cm, p < 0.001 respectively. CONCLUSION There are significant differences and changes in the dimensions of knee dressings depending on the position of the knee during the application of dressing and subsequent flexion.
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Affiliation(s)
- Keng Lin Wong
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Luke Peter
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore.
| | - Shen Liang
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siddharth Shah
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Faisal Johandi
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Wilson Wang
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
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Abstract
Periprosthetic joint infection (PJI) has moved into the first place as the cause of failure following total knee arthroplasty (TKA). Recent studies have shown that PJI results in higher mortality in patients than many cancers. The economic burden of treating PJI is likely to exceed $1 billion this year in the US. Thus, it is paramount that all efforts are invested to prevent this dreaded complication after total joint arthroplasty (TJA). This article summarizes some of the most effective and proven strategies for prevention of PJI. It is hoped that the article will be of benefit to the readers of the journal.
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21
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Langlois J, Zaoui A, Ozil C, Courpied JP, Anract P, Hamadouche M. Randomized controlled trial of conventional versus modern surgical dressings following primary total hip and knee replacement. INTERNATIONAL ORTHOPAEDICS 2015; 39:1315-9. [DOI: 10.1007/s00264-015-2726-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/25/2015] [Indexed: 11/25/2022]
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23
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Khan SK, Malviya A, Muller SD, Carluke I, Partington PF, Emmerson KP, Reed MR. Reduced short-term complications and mortality following Enhanced Recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures. Acta Orthop 2014; 85:26-31. [PMID: 24359028 PMCID: PMC3940988 DOI: 10.3109/17453674.2013.874925] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 10/17/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Enhanced Recovery (ER) is a well-established multidisciplinary strategy in lower limb arthroplasty and was introduced in our department in May 2008. This retrospective study reviews short-term outcomes in a consecutive unselected series of 3,000 procedures (the "ER" group), and compares them to a numerically comparable cohort that had been operated on previously using a traditional protocol (the "Trad" group). METHODS Prospectively collected data on surgical endpoints (length of stay (LOS), return to theater (RTT), re-admission, and 30- and 90-day mortality) and medical complications (stroke, gastrointestinal bleeding, myocardial infarction, and pneumonia within 30 days; deep vein thrombosis and pulmonary embolism within 60 days) were compared. Results ER included 1,256 THR patients and 1,744 TKR patients (1,369 THRs and 1,631 TKRs in Trad). The median LOS in the ER group was reduced (3 days vs. 6 days; p = 0.01). Blood transfusion rate was also reduced (7.6% vs. 23%; p < 0.001), as was RTT rate (p = 0.05). The 30-day incidence of myocardial infarction declined (0.4% vs. 0.9%; p = 0.03) while that of stroke, gastrointestinal bleeding, pneumonia, deep vein thrombosis, and pulmonary embolism was not statistically significantly different. Mortality at 30 days and at 90 days was 0.1% and 0.5%, respectively, as compared to 0.5% and 0.8% using the traditional protocol (p = 0.03 and p = 0.1, respectively). INTERPRETATION This is the largest study of ER arthroplasty, and provides safety data on a consecutive unselected series. The program has achieved a statistically significant reduction in LOS and in cardiac ischemic events for our patients, with a near-significant decrease in return to theater and in mortality rates.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/mortality
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/mortality
- Arthroplasty, Replacement, Knee/rehabilitation
- Cardiovascular Diseases/etiology
- Clinical Protocols
- Delivery of Health Care/organization & administration
- England/epidemiology
- Female
- Humans
- Length of Stay/statistics & numerical data
- Male
- Middle Aged
- Patient Care Team/organization & administration
- Patient Readmission/statistics & numerical data
- Perioperative Care/methods
- Program Evaluation
- Reoperation/statistics & numerical data
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- Sameer K Khan
- Department of Trauma and Orthopaedics , Northumbria Healthcare NHS Foundation Trust, Ashington, Northumberland , UK
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24
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Ghanem E, Heppert V, Spangehl M, Abraham J, Azzam K, Barnes L, Burgo FJ, Ebeid W, Goyal N, Guerra E, Hitt K, Kallel S, Klein G, Kosashvili Y, Levine B, Matsen L, Morris MJ, Purtill JJ, Ranawat C, Sharkey PF, Sierra R, Stefansdottir A. Wound management. J Orthop Res 2014; 32 Suppl 1:S108-19. [PMID: 24464883 DOI: 10.1002/jor.22554] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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25
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Ousey K, Gillibrand W, Stephenson J. Achieving international consensus for the prevention of orthopaedic wound blistering: results of a Delphi survey. Int Wound J 2013; 10:177-84. [PMID: 22405132 PMCID: PMC7950649 DOI: 10.1111/j.1742-481x.2012.00965.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This article presents the results of an international 2 stage Delphi survey carried out via e-mail to achieve consensus as to the most effective postoperative wound management to prevent blistering and other complications. Seventeen prospective participants were invited to be members of the Delphi Panel of which 13 agreed to be involved. The panel suggested that an ideal wound dressing would conform easily to the wound, be easy to apply and remove, allow for swelling and minimise pain on removal. Participants were in agreement that the primary wound dressing should be left in situ for as long as possible, providing there was no excessive oozing or signs of infection. The authors recognise that the Delphi Panel was relatively compact; however, the study arguably provides some useful data that can be used to identify the consequences of wound blistering and important factors that need to be considered when choosing a wound dressing to prevent blistering.
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Affiliation(s)
- Karen Ousey
- Reader Advancing Clinical Practice, Ramsden Building, School of Human and Health Sciences, Centre for Health and Social Care, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, UK.
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26
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27
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Abstract
In this paper, we consider wound healing after total knee arthroplasty.
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Affiliation(s)
- K. G. Vince
- Whangarei Hospital, Northland
District Health Board, 118 Crane Road, RD1, Kamo 0185, New
Zealand
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28
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Burke NG, Green C, McHugh G, McGolderick N, Kilcoyne C, Kenny P. A prospective randomised study comparing the jubilee dressing method to a standard adhesive dressing for total hip and knee replacements. J Tissue Viability 2012; 21:84-7. [DOI: 10.1016/j.jtv.2012.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/19/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
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29
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Hopper G, Deakin A, Crane E, Clarke J. Enhancing patient recovery following lower limb arthroplasty with a modern wound dressing: a prospective, comparative audit. J Wound Care 2012; 21:200-3. [DOI: 10.12968/jowc.2012.21.4.200] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- G.P. Hopper
- Department of Trauma and Orthopaedics, Forth Valley Royal Hospital, Stirling, Scotland
| | - A.H. Deakin
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland
| | - E.O. Crane
- Department of Trauma and Orthopaedics, Forth Valley Royal Hospital, Stirling, Scotland
| | - J.V. Clarke
- Department of Trauma and Orthopaedics, Forth Valley Royal Hospital, Stirling, Scotland
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Ravnskog FA, Espehaug B, Indrekvam K. Randomised clinical trial comparing Hydrofiber and alginate dressings post-hip replacement. J Wound Care 2011; 20:136-42. [DOI: 10.12968/jowc.2011.20.3.136] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- F-A. Ravnskog
- Kysthospitalet i Hagevik, Haukeland University Hospital, Bergen, Norway
| | - B. Espehaug
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - K. Indrekvam
- Kysthospitalet i Hagevik, Haukeland University Hospital, Bergen, Norway
- Department of Surgical Science, University of Bergen, Norway
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31
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Collins A. Does the postoperative dressing regime affect wound healing after hip or knee arthroplasty? J Wound Care 2011; 20:11-6. [DOI: 10.12968/jowc.2011.20.1.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A. Collins
- Belfast Health and Social Care Trust, Belfast, UK
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32
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Tustanowski J. Effect of dressing choice on outcomes after hip and knee arthroplasty: a literature review. J Wound Care 2009; 18:449-50, 452, 454, passim. [DOI: 10.12968/jowc.2009.18.11.44985] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Tustanowski
- Main Theatres (Orthopaedics), Edith Cavell Hospital, Peterborough, UK
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