1
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Mainard D. Drainage in primary and revision hip and knee arthroplasty. Orthop Traumatol Surg Res 2024; 110:103764. [PMID: 37979677 DOI: 10.1016/j.otsr.2023.103764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 11/20/2023]
Abstract
Drainage after total hip or knee arthroplasty (THA, TKA) used to be systematic to prevent complications and notably hematoma and infection. However, improvement in practices, the introduction of blood-sparing protocols and above all the conclusions reported in many studies have cast doubt on this dogma. There is abundant literature on the pros and cons of drainage after primary THA and TKA. The main endpoints were transfusion rates and volumes, total blood loss and variations in hemoglobin levels. Clinical endpoints comprised pain, edema, postoperative hematoma and, more rarely, short-to-medium-term function. Except for a few studies reporting greater pain and edema without drainage, there is agreement that drainage not only provides no benefit but actually aggravates postoperative bleeding. There are fewer studies of drainage in revision procedures for the hip and very few for the knee. The interest of drainage has not been demonstrated and again postoperative bleeding is aggravated. Whether in primary or revision arthroplasty, tranexamic acid is recommended when not contraindicated, whatever the administration protocol. However, it should not be seen as the sole and determining reason for abandoning drainage. LEVEL OF EVIDENCE: V, expert opinion.
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Affiliation(s)
- Didier Mainard
- Service de chirurgie orthopédique, traumatologique et arthroscopique, hôpital Central, avenue de Lattre-de-Tassigny, 54000 Nancy, France.
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Garcia-Maya B, Morais S, Diez-Sebastian J, Antuña S, Barco R. Drain use can be avoided in reverse shoulder arthroplasty. Injury 2023; 54 Suppl 7:111041. [PMID: 38225162 DOI: 10.1016/j.injury.2023.111041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 08/19/2023] [Accepted: 09/09/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Drains have demonstrated no clear benefits and some potentially harmful effects in hip and knee replacements. There is little evidence about the effects of its use in shoulder arthroplasty. We hypothesized that drain use would increase postoperative blood loss without reducing wound complications. METHODS We included 103 reverse shoulder arthroplasties (RSA), 71 were operated for degenerative pathology, 32 due to a fracture. All complications were recorded. Hemoglobin (Hb) and hematocrit (Htc.) level were collected and compared to postoperative data. Length of hospitalization and volume output were also noted. RESULTS 45 patients received a closed-suction drain. Patients with coagulopathy had significant higher bleeding and were excluded (p = 0.03). Patients operated for a fracture were older (80.1y.o vs 72.1 p < 0.01) and had higher blood drop (∆Hb p = 0.01; ∆Htc p = 0.03). There were neither differences between drain and control group in ∆Hb or ∆Htc in the degenerative RSA group (1.84+/-0.89 vs 1.68+/-0.84, p = 0.36; 5.78+/-2.89 vs 5.53+/-2.87 p = 0.50) nor in the fracture RSA group (2.65+/-0.94 vs 2.65+/-1.01, p = 0.90; 7.91+/-2.99 vs. 7.09+/-4.21, p = 0.56). There were neither differences in complications (degenerative p = 0.33; fracture p = 0.21). Drain use was related to a longer hospital stay in elective surgery (2.6 vs 1.8 days; p < 0.01). DISCUSSION The rate of complication is similar between patients with and without drain use. Drain use after shoulder arthroplasty does not affect postoperative bleeding but increases the length of hospital stay. Drains seems to be an unnecessary intervention after RSA that may increase associated costs and can be safely abandoned. LEVEL OF EVIDENCE Level III retrospective comparative study.
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Affiliation(s)
- Beatriz Garcia-Maya
- Department of Orthopedic Surgery, Hospital Universitario Infanta Elena, Av. de los Reyes Catolicos, 21, 28342 Valdemoro, Spain.
| | - Sara Morais
- Department of Orthopedic Surgery, Hospital Universitario de Alava- Txagorritxu, Jose Atxotegi Kalea, s/n, 01009 Gasteiz, Araba, Spain
| | - Jesus Diez-Sebastian
- Department of Statistics, Hospital Universitario La Paz, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Samuel Antuña
- Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Raul Barco
- Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, CP 28046, Madrid, Spain
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Lee CY, Jin SY, Jeong H, Yoon TR, Park KS. An analysis of the usefulness for using skin adhesive without closed-suction drainage in primary total hip arthroplasty: A retrospective propensity score matched study. Medicine (Baltimore) 2023; 102:e35181. [PMID: 37713819 PMCID: PMC10508427 DOI: 10.1097/md.0000000000035181] [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: 06/14/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
The closed suction surgical drainage system (CSSD) is routinely used after total hip arthroplasty (THA) by orthopedic surgeons in many institutions. However, it has not been shown to decrease the rate of wound infection significantly and may even increase blood loss. This study aimed to evaluate the usefulness of using skin adhesive without CSSD in uncomplicated THA. From July 2015 to September 2017, 200 patients undergoing unilateral THA were enrolled and divided into 2 groups, either receive CSSD (134 patients) or not receive CSSD (66 patients). Then, the propensity matched was performed. Calculated total blood loss, changes in hemoglobin (Hgb) level, transfusions were evaluated. In addition, data on the length of hospital stay, operation time, closure time, time to using crutches following THA were collected. Finally, Harris hip score (HHS), total estimated cost, and complications were assessed. The non-CSSD group had comparatively less blood loss (508.5 ± 280.3 mL compared with 742.1 ± 330.3 mL, P < .001), fewer transfusions (0.03 units compared with 0.3 units, P = .02), less transfusion rate (1.9% compared with 17.3 %, P = .02), lower change of Hgb from immediate postoperative period to 3 days later(1.6 ± 1.0 g/dL compared with 2.0 ± 0.8 g/dL, P = .03), than the CSSD group. There was a longer duration of hospital stay in the CSSD groups (7.2 days compared with 7.8 days, P = .03) The mean total cost in the non-CSSD group was $162.1, which was less than that of the CSSD group, which spent $288.5 on average (P < .001). there was 1 allergic reaction in the non-CSSD group (P = .32). The use of skin adhesive without CSSD could help decrease blood loss, the need for transfusion, and the length of hospital stay, and seems to more cost-effectiveness than using CSSD. It may also provide superior results and allow the patient to recover faster. Using this type of skin adhesive without CSSD is an efficient wound closure method for patients undergoing uncomplicated THA. However, care must be taken for allergic reactions, especially for patients with known or suspected allergies to cyanoacrylate or formaldehyde.
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Affiliation(s)
- Chan Young Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun, Republic of Korea
| | - Sheng-Yu Jin
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun, Republic of Korea
| | - Hwiwoo Jeong
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun, Republic of Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun, Republic of Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun, Republic of Korea
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Okuzu Y, Goto K, Kuroda Y, Kawai T, Matsuda S. Closed Suction Drainage May Not be Beneficial in Revision Total Hip Arthroplasty: A Propensity Score-Matched Cohort Study. Indian J Orthop 2023; 57:1041-1048. [PMID: 37384005 PMCID: PMC10293491 DOI: 10.1007/s43465-023-00901-x] [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: 01/07/2023] [Accepted: 04/27/2023] [Indexed: 06/30/2023]
Abstract
Background Many studies on closed suction drainage (CSD) in primary total hip arthroplasty (THA) have demonstrated that it has no definite benefit. However, evidence of the clinical benefits of CSD in revision THA has not yet been established. Therefore, this retrospective study aimed to investigate the benefits of CSD in revision THA. Materials and Methods We reviewed 107 hips of patients who underwent revision THA between June 2014 and May 2022, excluding cases of fracture and infection. We compared perioperative blood test results, calculated total blood loss (TBL), and postoperative complications, including allogenic blood transfusion (ABT), wound complications, and deep venous thrombosis (DVT), between the groups with and without CSD. Propensity score matching was conducted to balance patients' demographics and surgical factors. Results ABT, wound complications, and DVT were observed in 10.3% (n = 11), 5.6% (six), and 5.6% (six) of patients, respectively. There were no significant differences in ABT, calculated TBL, wound complications, and DVT between all patients and propensity score-matched patients with or without CSD. The calculated TBL was approximately 1200 mL and showed no significant difference between the two groups in the matched cohort (p = 0.40) but tended to have a greater volume in the drain group than in the non-drain group. Conclusion The routine use of CSD in revision THA for aseptic loosening may not be useful in clinical practice.
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Affiliation(s)
- Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
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Bujnowski D, Scheidt M, Diaz A, Burnham R, Adams W, Harold Rees, Hopkinson W, Brown N. Outcomes of Total Knee and Hip Arthroplasty in Patients With Perioperative Thrombocytopenia. J Am Acad Orthop Surg 2023; 31:405-412. [PMID: 36749882 PMCID: PMC10079634 DOI: 10.5435/jaaos-d-22-00834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/29/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Thrombocytopenia is an abnormally low level of blood platelets (less than 150,000/mL) resulting in an increased risk for bleeding. Typically, patients with platelet levels below 50,000/mL should delay arthroplasty or be transfused with platelets before surgery. However, existing studies are mixed regarding the effects of more moderate thrombocytopenia in terms of total knee and hip arthroplasty outcomes. METHODS This level III retrospective chart review examined the effects of different severities of preoperative thrombocytopenia on length of hospitalization, readmission, and transfusion rates in 5,617 primary total knee and hip arthroplasties at one tertiary academic medical center. Preoperative platelet levels were sectioned into clinically relevant groups and compared with clinical outcomes using univariable and multivariable models. RESULTS On univariate analysis, having platelet levels of <100,000/mL and 100 to 149,000/mL was associated with a longer length of stay. However, after controlling individual demographics, there was no association between platelet levels and length of stay, nor with 30-day readmission. Finally, on univariate analysis, patients with platelet levels of <100,000/mL and 100 to 149,000/mL were more likely to have a blood transfusion, which remained true for those with <100,000/mL after controlling for individual demographics. CONCLUSIONS Total hip and total knee arthroplasty are safe in patients with varying platelet levels and not associated with increased length of stay or 30-day readmission. However, patients with more severe thrombocytopenia are more likely to receive red blood cell transfusions than patients with milder thrombocytopenia.
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Affiliation(s)
- Daniel Bujnowski
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Michael Scheidt
- Department of Orthopedic Surgery, Loyola University Medical Center, Maywood IL, USA
| | - Ashley Diaz
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Robert Burnham
- Department of Orthopedic Surgery, Loyola University Medical Center, Maywood IL, USA
| | - William Adams
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Harold Rees
- Department of Orthopedic Surgery, Loyola University Medical Center, Maywood IL, USA
| | - William Hopkinson
- Department of Orthopedic Surgery, Loyola University Medical Center, Maywood IL, USA
| | - Nicholas Brown
- Department of Orthopedic Surgery, Loyola University Medical Center, Maywood IL, USA
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Najafi F, Stein JM, Peterson NV, Meghpara M, Sherman MB, Restrepo C, Parvizi J. Routine Use of Closed Suction Drains Following Revision Arthroplasty May Not be Necessary. J Arthroplasty 2023; 38:530-534.e3. [PMID: 36162709 DOI: 10.1016/j.arth.2022.09.021] [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: 07/20/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are numerous studies demonstrating that closed suction drainage (CSD) usage after primary total joint arthroplasty (TJA) has little to no benefit. There are little data on the role of CSDs after revision TJA. The purpose of our study was to evaluate whether there is any clinical advantage to CSD usage after revision TJA. METHODS This retrospective study evaluated the clinical records of 2,030 patients undergoing revision TJA between 2007 and 2021. CSD was used in 472 patients and not used in 1,558 patients. Primary outcome was blood transfusion rate and secondary outcomes included total blood loss (TBL), as determined by Gross formula, wound complications (hematoma, infection, and dehiscence), and length of hospital stay. Patients undergoing revision TJA for oncologic reasons or those with incomplete datasets were excluded. RESULTS There were no statistically significant differences in rates of allogeneic blood transfusion, TBL, and wound complications (hematoma, infection, and dehiscence) between the two groups (P = .159, .983, .192, .334, and .548, respectively). When adjusted for demographic and surgical confounders, there was no difference in transfusion and TBL rates between groups (Odds Ratio 1.04, 95% Confidence Interval 0.78-1.38, P = .780 and estimate -105.71 mL, 95% confidence interval -333.96 to 122.55, P = .364, respectively). CSD cohort had a shorter length of stay (4.30 versus 5.82 days, P < .001). CONCLUSION We acknowledge that there is a role for CSD usage in a selected group of patients. Nevertheless, our study revealed that routine use of CSD after revision TJA does not provide an additional clinical benefit.
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Affiliation(s)
- Farideh Najafi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jonah M Stein
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nicholas V Peterson
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, California
| | - Michael Meghpara
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew B Sherman
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Camilo Restrepo
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Okuzu Y, Goto K, Kuroda Y, Kawai T, Matsuda S. Closed suction drainage is not beneficial in hybrid total hip arthroplasty with intra-articular administration of tranexamic acid: a propensity score-matched cohort study. INTERNATIONAL ORTHOPAEDICS 2022; 46:1281-1287. [DOI: 10.1007/s00264-022-05366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
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Sarpong NO, Chiu YF, Rodriguez JA, Boettner F, Westrich GH, Chalmers BP. Simultaneous Bilateral Total Hip Arthroplasty With Contemporary Blood Management is Associated With a Low Risk of Allogeneic Blood Transfusion. J Arthroplasty 2022; 37:544-548. [PMID: 34883254 DOI: 10.1016/j.arth.2021.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is a paucity of data on blood loss and the risk of allogeneic blood transfusion after simultaneous bilateral total hip arthroplasty (SBTHA) with contemporary blood management including neuraxial anesthesia, routine tranexamic acid use, and a restrictive transfusion protocol. As such, we sought to determine the in-hospital outcomes of SBTHA, specifically analyzing blood loss and the rate and risk factors for transfusion. METHODS We identified 191 patients who underwent SBTHA at a single institution from 2016 to 2019. No drains were utilized and no patients donated blood preoperatively. Mean age was 59 years with 96 females (50.3%). The surgical approach was posterior in 138 (72.3%) and direct anterior in 53 (27.7%) patients. We analyzed blood loss, the rate of allogeneic blood transfusions, and in-hospital thromboembolic complications. We analyzed risk factors for transfusion with a logistic regression analysis. RESULTS Twenty-two patients (11.5%) underwent allogeneic blood transfusion. All transfused patients were female. Univariate analysis revealed female gender as a transfusion risk factor since it had statistically significant higher proportion in the transfusion group than the nontransfusion group (100% vs 43.5%, respectively, P < .001). We did not identify any other singular significant risk factors for transfusion in a multivariable regression analysis. However, females with a preoperative Hb <12 had an elevated risk of transfusion at 37.5% (15/40 patients). CONCLUSION With contemporary perioperative blood management protocols, there is a relatively low (11.5%) risk of a blood transfusion after SBTHA. Females with a lower preoperative Hb (<12 g/dL) had the highest risk of transfusion at 37.5%.
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Affiliation(s)
- Nana O Sarpong
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Yu-Fen Chiu
- Department of Biostatistics, Hospital for Special Surgery, New York, NY
| | - Jose A Rodriguez
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | | | | | - Brian P Chalmers
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
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Yang M, Yan C, Niu N, Lu Y, Yue W, Pan L. Analysis of the Need for Postoperative Drainage Application for Hip Arthroplasty: A Systematic Review and Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2069468. [PMID: 35251296 PMCID: PMC8894062 DOI: 10.1155/2022/2069468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To synthesize the evidence regarding the effect and safety of drainage after the hip arthroplasty in randomized control trials. BACKGROUND Although the standard of hip replacement has matured in recent years, the need for postoperative drainage is still controversial which also is a clinical problem that needs to be addressed. DESIGN A systematic review and meta-analysis based on the Cochrane methods and Prisma guideline. Data Resources. A systematic search of the Cochrane Library, PubMed, EMBASE, CINAHL, Ovid, Wan Fang database, CNKI, and CBM database was carried out from January 1, 2000, to December, 2021. Review Methods. The quality of included randomized controlled trials was assessed individually by two reviewers independently using criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. RESULTS Nineteen randomized control trials involving 3354 participants were included in this analysis. From the above analysis, we can know that compared with nondrainage, there was a statistically significant difference in VAS score on the postoperative first day (SD = -0.6; 95% CI: -0.79, -0.41) and second day (SD = -0.38, 95% CI: -0.58, -0.18), hematocrit reduction (MD =2.89; 95% CI: 1.3, 4.48), blood transfusion rate (OR =1.47; 95% CI: 1.12, 1.92), change of thigh circumstance (SMD = -0.48; 95% CI: -0.66, -0.31), and hospital stay (MD = 1.06; 95% CI: 0.73, 1.39) in drainage. However, there were no statistically significant differences in hemoglobin and hematocrit level, hip function, total blood loss, transfusion volume, dressing use, and complications between them. CONCLUSION Drainage after hip arthroplasty can reduce swelling in the thigh and relieve pain while no drainage can bring down hematocrit reduction, decrease dressing uses, and shorten the hospital stay which promotes rapid recovery. This review provides a detailed theoretical reference for the proper clinical application of drains and improves the efficient use of resources.
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Affiliation(s)
- Min Yang
- Department of Nursing, Hainan Provincial Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Haikou, Hainan 570203, China
| | - Chunwen Yan
- Department of Nursing, Hainan Provincial Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Haikou, Hainan 570203, China
| | - Nasha Niu
- Department of Nursing, Hainan Provincial Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Haikou, Hainan 570203, China
| | - Yingzi Lu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Wei Yue
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Li Pan
- Department of Nursing, Hainan Provincial Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Haikou, Hainan 570203, China
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Bartosz P, Grzelecki D, Chaberek S, Para M, Marczyński W, Białecki J. A prospective randomized study, use of closed suction drainage after revision hip arthroplasty may lead to excessive blood loss. Sci Rep 2022; 12:881. [PMID: 35043012 PMCID: PMC8766571 DOI: 10.1038/s41598-022-05023-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Suction drainage after primary total hip arthroplasties (THA) offers no benefits. Revision hip arthroplasties (RHA) are more demanding procedures and associated with greater blood loss compared to primary cases. There is still a lack of literature regarding the application of drainage in RHA. A total of 40 patients who underwent RHA were included in this prospective study. Simple randomization with an allocation ratio 1:1 was performed. Primary outcomes: total blood loss, hemoglobin drop, joint hematoma size in USG, infection. Secondary outcomes: blood transfusion rate, soft tissue hematomas, C-reactive protein levels, Visual Analogue Scale before and on 3rd day after surgery, Harris Hip Score before and 6 weeks after surgery. An intention to treat analysis was performed, with a 2-year follow up. Statistically significant differences between groups was in blood loss: drainage 1559.78 ml, non-drainage 1058.27 ml, (p = 0.029) and hemoglobin level on 1st day after surgery: drainage 10.58 g/dl, non-drainage 11.61 g/dl (p = 0.0496). In terms of the other analyzed parameters, statistical differences were not found. Our study revealed that the use of suction drainage may lead to higher blood loss in the early postoperative period. Further studies are needed to evaluate our results.
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Affiliation(s)
- Paweł Bartosz
- Orthopedic Department, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400, Otwock, Poland.
| | - Dariusz Grzelecki
- Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Otwock, Poland
| | | | - Marcin Para
- Orthopedic Department, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400, Otwock, Poland
| | - Wojciech Marczyński
- Orthopedic Department, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400, Otwock, Poland
| | - Jerzy Białecki
- Orthopedic Department, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400, Otwock, Poland
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Stratos I, Heller KD, Rudert M. German surgeons' technical preferences for performing total hip arthroplasties: a survey from the National Endoprosthesis Society. INTERNATIONAL ORTHOPAEDICS 2021; 46:733-739. [PMID: 34904195 PMCID: PMC8930942 DOI: 10.1007/s00264-021-05188-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/08/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE The goal of our study was to conduct an online survey that highlights patterns of practice during total hip arthroplasty (THA). METHODS The survey was conducted in June and August 2020. Three hundred thirteen members of the German Society for Endoprosthesis participated in the survey. RESULTS The anterolateral approach is by far the most popular approach used for primary total hip arthroplasty, followed by the anterior approach during minimally invasive (55% for the anterolateral and 29% for the anterior) and regular surgery (52% for the anterolateral and 20% for the anterior). Two-thirds of the orthopaedic surgeons do not use drainages during THA. Moreover, 80% of the survey participants routinely apply tranexamic acid during surgery. Surgeons who perform minimally invasive surgery for THA use more frequently fast-track-concepts for post-operative rehabilitation. According to the interviewees, the application of fast-track-concepts leads to reduced periods of hospital stay after THA. CONCLUSION Our data demonstrate that patterns of practice during THA in Germany are in line with the evidence provided by current literature. This study can be seen as a stimulus to conduct similar surveys in other countries in order to promote minimally invasive surgery for THA.
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Affiliation(s)
- Ioannis Stratos
- Department of Orthopaedic Surgery, Julius-Maximilians-University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074, Wuerzburg, Germany.
| | - Karl-Dieter Heller
- Department of Orthopaedic Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, Julius-Maximilians-University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074, Wuerzburg, Germany
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Abdallah AA, Sallam AA, Arafa MS, Henawy AT. Topical Tranexamic Acid in Total Knee Arthroplasty: Does It Augment the Effect of the Intravenous Administration in Patients with Moderate-to-High Risk of Bleeding? A Randomized Clinical Trial. J Knee Surg 2021; 34:1570-1578. [PMID: 32434234 DOI: 10.1055/s-0040-1710549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study aimed to compare the superimposed clinical value of topical tranexamic acid (TXA) application when it is simultaneously combined with intravenous (IV) administration versus the use of either IV TXA alone or IA TXA alone during primary total knee arthroplasty (TKA) in patients with moderate-to-high risk of bleeding. We hypothesized that the combined administration approach will result in a more adequate reduction in the perioperative blood loss and blood transfusion rate. Ninety-four patients undergoing primary TKA were randomly allocated into intra-articular (IA) alone, IV alone, and combined group. We used 2 g of IV TXA in the IV TXA alone and combined groups 10 minutes before tourniquet deflation. However, we applied 1.5 g TXA in 100 mL isotonic saline half topically before arthrotomy closure and half retrogradely after wound closure through the drain. Follow-up period was 6 weeks. The primary outcome measures included the drainage blood volume, total blood loss, hidden blood loss, intraoperative blood loss, and the allogenic transfusion rate. Secondary outcomes included postoperative hemoglobin drop, amount of transfused blood units, thromboembolism, and wound complications. Combined administration of TXA provided significantly better results in terms of blood volume collected by the drain, total blood loss, and hidden blood loss (p < 0.01). Contrarily, the intraoperative blood loss, the allogeneic transfusion rate, and the number of transfused units were similar in all groups (p > 0.05). The subgroup analysis revealed that a combined IA and IV TXA administration significantly reduced the total blood loss in patients with either moderate or high risk of bleeding. Moreover, the degree of hemoglobin drop was significantly lesser with the combined approach. No thromboembolic complications or wound infection occurred. In conclusion, the combined use of topical and IV tranexamic acid resulted in a significant reduction in postoperative blood loss and hemoglobin level following TKA but did not influence the rate of allogeneic blood transfusion. This is a Level I, therapeutic study.
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Affiliation(s)
- Ahmed A Abdallah
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Asser A Sallam
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Mohamed S Arafa
- Department of Orthopaedic Surgery, Fayoum University Hospital, Fayoum, Egypt
| | - Ayman T Henawy
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
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Bartosz P, Marczyński W, Para M, Kogut M, Białecki J. Comparative study of suction drainage placement in cementless hip replacement among patients undergoing extended thromboprophylaxis: a prospective randomized study. BMC Musculoskelet Disord 2021; 22:688. [PMID: 34389016 PMCID: PMC8364014 DOI: 10.1186/s12891-021-04583-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 08/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background The use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary hip replacement. This study aimed to assess the safety of not using suction drainage after primary hip replacement in a population of patients undergoing extended thromboprophylaxis. Methods In this prospective randomized study, all patients were qualified for primary hip replacement and were divided into two groups: with and without drainage. The inclusion criterion was idiopathic hip osteoarthritis. The exclusion criteria were secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. We performed an intention-to-treat analysis. Clinical, laboratory, and radiographic parameters were measured for the first three days after surgery. Hematoma collection, due to extended thromboprophylaxis, in the joint and soft tissues was evaluated precisely. The patients underwent follow-up for 30 days. Results The final analysis included a total of 100 patients. We did not find any significant statistical differences between groups in terms of hip fluid collection (9.76 vs. 10.33 mm, with and without drainage, respectively; mean difference, 0.6 mm; 95 % confidence interval [CI] -2.8 to 3.9; p = 0.653), estimated blood loss (1126 vs. 1224 ml; mean difference, 97.1 ml; 95 % CI -84.1 to 278.2; p = 0.59), and hemoglobin levels on postoperative day 3 (11.05 vs. 10.85 g/dl; mean difference, 0.2; 95 % CI -2.1 to 2.5; p = 0.53). In addition, the other parameters did not show significant differences between groups. Notably, two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group. Conclusions We conclude that the use of closed suction drainage after primary hip replacement is a safe procedure in patients undergoing extended thromboprophylaxis. Further research is warranted to validate these findings. Trial registration The study was successfully registered retrospectively at Clinicaltrial.gov with the identification number NCT04333264 03 April 2020.
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Affiliation(s)
- Paweł Bartosz
- Orthopedic Department, Centre of Postgraduate Medical Education, Konarskiego 13, Kosciuszki 3/10B, 05-400, Otwock, Poland.
| | - Wojciech Marczyński
- Orthopedic Department, Centre of Postgraduate Medical Education, Konarskiego 13, Kosciuszki 3/10B, 05-400, Otwock, Poland
| | - Marcin Para
- Orthopedic Department, Centre of Postgraduate Medical Education, Konarskiego 13, Kosciuszki 3/10B, 05-400, Otwock, Poland
| | - Maciej Kogut
- Orthopedic Department, Centre of Postgraduate Medical Education, Konarskiego 13, Kosciuszki 3/10B, 05-400, Otwock, Poland
| | - Jerzy Białecki
- Orthopedic Department, Centre of Postgraduate Medical Education, Konarskiego 13, Kosciuszki 3/10B, 05-400, Otwock, Poland
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Migliorini F, Maffulli N, Betsch M, Eschweiler J, Tingart M, Baroncini A. Closed suction drainages in Lower Limb Joint Arthroplasty: A level I evidence based meta-analysis. Surgeon 2021; 20:e51-e60. [PMID: 33863671 DOI: 10.1016/j.surge.2021.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/25/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The role of closed suction drainage during elective total joint arthroplasty is still unclear. The present study compared the use of closed suction drains to no drainage for elective total knee arthroplasty (TKA) and in total hip arthroplasty (THA) through a meta-analysis of randomized clinical trials (RCTs). METHODS Following the PRISMA guidelines, a meta-analysis of randomized controlled trials identified in December 2021. All randomized clinical trials comparing the use of closed suction drains to no drainage for elective THA or TKA were considered. RESULTS Twenty-five RCTs were included in the final analysis. 49% (1722 of 3505) of patients received no-drainage, and 51% (1783 of 3505) received closed suction drainage. There was no evidence of a statistically significant evidence between the two groups in occurrence of postoperative infections (P = 0.4), mean total postoperative hemoglobin (P = 0.2) or length of hospital stay (P = 0.1). The no-drainage group showed a lower rate of blood transfusion (P < 0.0001). CONCLUSION There is no evidence to support the routine use of closed suction drainage in THA or TKA patients. LEVEL OF EVIDENCE Level I, meta-analysis of randomized clinical trials.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England, UK; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK.
| | - Marcel Betsch
- University of Toronto Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, ON, Canada.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Alice Baroncini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
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Effects of disusing closed suction drainage in simultaneous bilateral total hip arthroplasty: A retrospective cohort study. PLoS One 2021; 16:e0247845. [PMID: 33657165 PMCID: PMC7928457 DOI: 10.1371/journal.pone.0247845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/13/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose Increased blood loss remains a major drawback of simultaneous bilateral total hip arthroplasty (SBTHA). We examined the effects of disusing closed suction drainage (CSD) on postoperative blood loss and transfusion requirement in cementless SBTHA. Methods A retrospective cohort study was conducted with a consecutive series of cementless SBTHAs performed by a single surgeon between January 2014 and March 2017. The surgeon routinely used CSD until May 2015 and refrained from CSD in all primary THAs thereafter. This study included SBTHAs with intravenous administration of tranexamic acid (TXA). Postoperative hemoglobin drop, blood loss, transfusion rate, pain scores, complication rates, and implant survivorships were compared between the groups of SBTHA with and without CSD. The minimum follow-up duration was 1 year. Results Among the 110 patients (220 hips), 46 (92 hips) and 64 (128 hips) underwent SBTHA with and without CSD, respectively. Maximum hemoglobin drop (mean, 4.8 vs. 3.9 g/dL; P = 0.001), calculated blood loss (mean, 1530 vs. 1190 mL; P<0.001), transfusion rate (45.7% vs. 21.9%; P = 0.008), and length of hospital stay (mean, 6.6 vs. 5.8 days; P = 0.004) were significantly lower in patients without CSD. There were no significant differences in postoperative pain scales and wound complication rates. The mean Harris Hip scores at final follow-up (92.5 vs. 92.1; P = 0.775) and implant survivorships with an end-point of any revision at 4 years (98.9% vs. 98.4%; log-rank, P = 0.766) were similar between groups. Conclusions Disusing CSD significantly reduced postoperative blood loss and transfusion requirement without increasing postoperative pain and surgical wound complications in cementless SBTHA with concurrent administration of intravenous TXA.
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Hassan RSEE, Osman SOS, Aabdeen MAS, Mohamed WEA, Hassan RSEE, Mohamed SOO. Incidence and root causes of surgical site infections after gastrointestinal surgery at a public teaching hospital in Sudan. Patient Saf Surg 2020; 14:45. [PMID: 33372624 PMCID: PMC7722425 DOI: 10.1186/s13037-020-00272-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023] Open
Abstract
Background Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays, additional financial burden, and significantly hamper the potential benefits of surgical interventions. Causes of SSIs are multi-factorials and patients undergoing gastrointestinal tract procedures carry a high risk of bacterial contamination. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries. Methods A hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between 1st September and 31st December 2017. We collected data about the socio-demographic characteristics, risk factors of SSI, and isolated microorganisms from patients with SSIs. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05. Results A total of 80 participants were included in the study. The mean age was 51 +/- 16 years and most of the patients (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) of them underwent large bowel surgery. Twenty-two patients (27.5%) developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated from SSI patients was E coli (47.8%), followed by Enterococcus fecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%). Conclusions The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.
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Manara J, Sandhu H, Wee M, Odutola A, Wainwright T, Knowles C, Middleton R. Prolonged operative time increases risk of blood loss and transfusion requirements in revision hip surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1181-1186. [PMID: 32367218 DOI: 10.1007/s00590-020-02677-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 04/22/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Revision hip surgery is well documented to have a high association with substantial blood loss and the associated need for a blood transfusion. This exposes the patient to increased risk of transfusion reaction and blood borne infection. There are many strategies to minimize allogeneic transfusion rates in revision surgery such as pre-operative autologous donation, peri-operative tranexamic acid, thrombin sealants, normovolaemic haemodilution, intra-operative blood salvage and the use of post-operative autologous drains. PATIENTS AND METHODS We prospectively looked at 177 consecutive cases performed at one centre by a single surgical and anaesthetic team to identify which patient and operative factors were most significant in minimizing the requirement for an allogeneic blood transfusion. RESULTS Our results identified the duration of surgery as being the only significant variable affecting the level of blood loss. We noted a 3% increase in the probability of massive blood loss (> 2000 mls) for every minute of increased surgical time in our series. CONCLUSIONS We conclude that measures to minimize the duration of surgery would be beneficial in reducing blood loss and the risks of requiring blood transfusions in revision hip surgery.
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Affiliation(s)
- Jonathan Manara
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
| | - Harvey Sandhu
- Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
| | - Michael Wee
- Poole Hospital NHS Foundation Trust, Bournemouth University, Poole, BH15 2JB, UK
| | | | - Thomas Wainwright
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB, UK
- Physiotherapy Department, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Castle Lane East, Bournemouth, BH7 7DW, UK
| | - Charles Knowles
- Barts and The London School of Medicine and Dentistry, 1st Floor, Abernethy Building, 2 Newark Street, London, E1 2AT, UK
| | - Robert Middleton
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB, UK
- Orthopaedic Department, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Castle Lane East, Bournemouth, BH7 7DW, UK
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Yang G, Zhu Y, Zhang Y. Prognostic risk factors of surgical site infection after primary joint arthroplasty: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e19283. [PMID: 32080142 PMCID: PMC7034688 DOI: 10.1097/md.0000000000019283] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Surgical site infection (SSI) can be a devastating complication in joint arthroplasty. Objective of this study was to identify potential risk factors associated with SSI following primary joint arthroplasty.This retrospective cohort study was performed from January 2016 to October 2017. A total of 986 patients were enrolled. We extracted the patients' baseline information, treatment-related variables and indexes of laboratory examination during their hospitalization. Receiver operating characteristic (ROC) analysis was performed to find the optimum cut-off value for serum albumin. Univariate and multivariate logistic analysis models were performed respectively to determine independent predictors of SSI.Nine hundred eighty-six patients with complete data were included in the final analysis. There were 314 male and 672 females in this study with a mean age of 64.6 years, and twenty patients developed SSI. The overall incidence of SSI was 2.03%, with 0.20% for deep infection and 1.83% for superficial SSI. Independent predictors of SSI identified by multivariate analysis were ALB < 36.7 g/L (odds ratio = 3.42; 95% CI = 1.24-9.48; P = .018), BMI ≥28 (odds ratio = 5.08; 95%CI = 1.52-17.01; P = .008) and ASA class 3 or higher (odds ratio = 3.36; 95% CI = 1.22-9.30; P = .019). Drain use was demonstrated as a protective factor of postoperative wound healing.The incidence of SSI following primary joint arthroplasty was 2.03%. ASA ≥3, BMI ≥28 and ALB < 36.7 g/L were demonstrated as risk factors of postoperative wound infection. Supplementary nutrition support is necessary to reduce the risk of infection in patients who underwent artificial joint arthroplasty.
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Affiliation(s)
- Guang Yang
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, PR China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, PR China
| | - Yingze Zhang
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, PR China
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Liu X, Dong Z, Li J, Feng Y, Cao G, Song X, Yang J. Factors affecting the incidence of surgical site infection after geriatric hip fracture surgery: a retrospective multicenter study. J Orthop Surg Res 2019; 14:382. [PMID: 31752900 PMCID: PMC6873468 DOI: 10.1186/s13018-019-1449-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/31/2019] [Indexed: 12/26/2022] Open
Abstract
Background Geriatric hip fracture is a common type of osteoporotic fracture with high mortality and disability; surgical site infection (SSI) can be a devastating complication of this injury. By far, only a few studies identified easily remediable factors to reduce infection rates following hip fracture and less researches have focused on geriatric patients. The objective of this study was to identify potentially modifiable factors associated with SSI following geriatric hip fracture surgery. Methods This retrospective, multicenter study involves three level I hospitals. A total of 1240 patients (60 years or older) underwent hip surgery with complete data were recruited between January 2016 and June 2018. Demographics information, medications and additional comorbidities, operation-related variables, and laboratory indexes were extracted and analyzed. Receiver operating characteristic (ROC) analysis was performed to detect the optimum cut-off value for quantitative data. Univariate and multivariate logistic analysis model were performed respectively to identify the independent predictors. Results Ninety-four (7.58%) patients developed SSI in this study, and 76 (6.13%) had superficial infection, while 18 (1.45%) were diagnosed with deep infection. Results of univariate and multivariate analysis showed age > 79 years (OR, 2.60; p < 0.001), BMI > 26.6 kg/m2 (OR, 2.97; p < 0.001), operating time > 107 min (OR, 2.18; p = 0.001), and ALB < 41.6 g/L (OR, 2.01; p = 0.005) were associated with an increased incidence of SSI; drainage use (OR, 0.57; p = 0.007) could reduce the incidence of wound infection for patients after geriatric hip fracture. Conclusion Accurate modifiable variables, operating time > 107 min, serum albumin < 41.6 g/L, BMI > 26.6 kg/m2, and age > 79 years could be applied to distinguish geriatric patients with high-risk of postoperative surgical site infection.
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Affiliation(s)
- Xiaopo Liu
- Third Department of Orthopaedics, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China.
| | - Zhijie Dong
- Department of Orthopaedic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, 063000, People's Republic of China
| | - Jun Li
- Second Department of Orthopaedic Surgery, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 063000, People's Republic of China
| | - Yunbo Feng
- Third Department of Orthopaedics, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
| | - Guolong Cao
- Third Department of Orthopaedics, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
| | - Xin Song
- Department of Radiology, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
| | - Jie Yang
- First Department of Geriatric, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
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Muoghalu ON, Eyichukwu GO, Iyidobi E, Anyaehie UE, Madu KA, Okwesili IC. A comparison of the use and non-use of closed suction wound drainage in open reduction and internal fixation of femoral shaft fractures. INTERNATIONAL ORTHOPAEDICS 2019; 43:2003-2008. [PMID: 31250086 DOI: 10.1007/s00264-019-04364-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to determine if the routine use of closed suction wound drainage is justified following open reduction and internal fixation (ORIF) of femoral shaft fractures. METHOD This was a prospective comparative study of two study groups: those with post-operative closed suction drainage (WCSD) and those not with closed suction drainage (NWCSD). RESULTS Fifty-six patients, twenty-eight each for the two cohorts, were recruited for this study. Five patients (17.9%) in the WCSD group and only one patient (3.6%) in NWCSD group had surgical site infection (p = 0.20). Four patients (14.3%) in the WCSD group and nine (32.1%) in NWCSD group had wound dressing reinforcements (p = 0.21). CONCLUSION There was generally no statistically significant difference in the incidence of wound infections, strike through bloodstain with wound dressing reinforcement and duration of hospital stay in patients with and without closed suction wound drainage after ORIF of femoral shaft fractures. The duration of the injury may however influence the decision to use or not use wound drain after surgery.
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Affiliation(s)
- Obiora N Muoghalu
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria.
| | | | - Emmanuel Iyidobi
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria
| | - Udo E Anyaehie
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria
| | - Kenechi A Madu
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria
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Nishitani K, Kuriyama S, Nakamura S, Ito H, Matsuda S. A Multivariate Analysis on the Effect of No Closed Suction Drain on the Length of Hospital Stay in Total Knee Arthroplasty. Knee Surg Relat Res 2019; 31:25-30. [PMID: 30871289 PMCID: PMC6425893 DOI: 10.5792/ksrr.18.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022] Open
Abstract
Purpose Despite the long history of drain use in total knee arthroplasty (TKA), no drain has been gaining popularity. The purpose of this study was to investigate whether drainage is related to the length of hospital stay. Materials and Methods A total of 166 consecutive unilateral TKAs performed on 135 patients with osteoarthritis were retrospectively reviewed. Closed suction drainage was used in 111 cases (67%). Length of hospital stay after surgery was recorded, and a multivariate linear regression analysis was performed to evaluate various variables (patient factors, surgical factors, and post-surgical factors) and to investigate whether drainage was an independent variable. Results Hospital stay was shorter in no drain cases (21.7±4.8 days) than in drain cases (24.2±3.7 days, p<0.001). The multivariate analysis showed that older age (β=0.12, p=0.02), drain use (β=2.81, p=0.03), and occurrence of comorbidity (β=1.46, p=0.04) were the independent variables associated with the extended hospital stay. There was no difference in comorbidity between drain cases (39.6%) and no drain cases (27.2%, p=0.13). Conclusions The drain use, age, and occurrence of comorbidity were related to the length of hospital stay. TKA without drain is an effective procedure both medically and economically.
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Affiliation(s)
- Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuicih Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Trofa DP, Paulino FE, Munoz J, Villacis DC, Irvine JN, Jobin CM, Levine WN, Ahmad CS. Short-term outcomes associated with drain use in shoulder arthroplasties: a prospective, randomized controlled trial. J Shoulder Elbow Surg 2019; 28:205-211. [PMID: 30658773 DOI: 10.1016/j.jse.2018.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/13/2018] [Accepted: 10/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study examined the immediate outcomes during the perioperative period associated with drains in the setting of total shoulder arthroplasty or reverse shoulder arthroplasty. We hypothesized that drain use would result in lower postoperative hemoglobin and hematocrit levels that would increase transfusion rates and longer hospital stays that would increase hospital costs. METHODS The study prospectively randomized 100 patients (55% women; average age, 69.3 years) who underwent total shoulder arthroplasty or reverse shoulder arthroplasty to receive a closed-suction drainage device (drain group, n = 50) or not (control group, n = 50) at the time of wound closure. Basic demographic information and intraoperative and postoperative data were collected. RESULTS The groups were similar with respect to basic patient demographics. Postoperatively, drains had no effect on transfusion rates or any perioperative complication (P > .715). There were also no significant differences in hemoglobin or hematocrit levels immediately after surgery or on postoperative day 1. On average, patients were discharged from the hospital 1.6 days and 2.1 days postoperatively in the control and drain groups, respectively (P = .124). The average cost associated for the control cohort's hospital stay was $35,796 ± $13,078 compared with $43,219 ± $24,679 for the drain cohort (P = .063). DISCUSSION Drain use after shoulder arthroplasty had no appreciable difference on short-term perioperative outcomes, postoperative anemia, length of hospital stay, or cost. It is possible that the potential negative effects of postoperative drainage are blunted by the routine use of tranexamic acid.
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Affiliation(s)
- David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA.
| | - Franklin E Paulino
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Julianne Munoz
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Diego C Villacis
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - James N Irvine
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Christopher S Ahmad
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
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Al-Houraibi RK, Aalirezaie A, Adib F, Anoushiravani A, Bhashyam A, Binlaksar R, Blevins K, Bonanzinga T, Chih-Kuo F, Cordova M, Deirmengian GK, Fillingham Y, Frenkel T, Gomez J, Gundtoft P, Harris MA, Harris M, Heller S, Jennings JA, Jiménez-Garrido C, Karam JA, Khlopas A, Klement MR, Komnos G, Krebs V, Lachiewicz P, Miller AO, Mont MA, Montañez E, Romero CA, Schwarzkopf R, Shaffer A, Sharkey PF, Smith BM, Sodhi N, Thienpont E, Villanueva AO, Yazdi H. General Assembly, Prevention, Wound Management: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S157-S168. [PMID: 30360978 DOI: 10.1016/j.arth.2018.09.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Vidali N, Chevet-Noel A, Ringenbach P, Andreoletti JB. [Should surgeons keep performing drainage after breast reduction?]. ANN CHIR PLAST ESTH 2018; 64:54-60. [PMID: 29650263 DOI: 10.1016/j.anplas.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Despite the absence of "evidence-based medicine", the use of closed suction drainage in breast surgery is currently the standard practice. Its goal is to minimize the amount of fluid at the operation site, the dead space that can involve postoperative complications. The purpose of this study is to demonstrate that with or without drainage the complication rate is unchanged. METHODS We conducted a retrospective and comparative study of two groups of breast reduction with and without drainage. Every complication has been recorded and statistically analyzed: seroma and hematoma, infections, wound breakdown, skin flap or nipple-areola complex necrosis, fat necrosis and reoperation. RESULTS A total of 138 breast reductions were performed (37 drained patients and 32 non-drained). Data collection of complications was done on average 10months after the operation (1-15). There was no statistical difference between the two groups regarding the complication rate. Our results confirm the ones found in the literature. CONCLUSION Except for specific cases (e.g. gigantomasty), this study demonstrates that after breast reduction, drainage is not appropriate. Drains do not reduce postoperative complications and can increase hospitalization length of stay (inducing higher costs). Furthermore, it is often source of pain, anxiety and discomfort for patients.
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Affiliation(s)
- N Vidali
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier de Mulhouse, 20, avenue du Dr-René-Laennec, 68100 Mulhouse, France.
| | - A Chevet-Noel
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier de Belfort, 14, rue de Mulhouse, 90000 Belfort, France
| | - P Ringenbach
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier de Mulhouse, 20, avenue du Dr-René-Laennec, 68100 Mulhouse, France
| | - J B Andreoletti
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier de Belfort, 14, rue de Mulhouse, 90000 Belfort, France
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Zan P, Yao JJ, Fan L, Yang Y, Zhou Z, Wu Z, Zhu C, Yang D, Li G. Efficacy of a Four-Hour Drainage Clamping Technique in the Reduction of Blood Loss Following Total Hip Arthroplasty: A Prospective Cohort Study. Med Sci Monit 2017; 23:2708-2714. [PMID: 28577369 PMCID: PMC5467705 DOI: 10.12659/msm.904864] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background During total hip arthroplasty (THA) drainage is used by most surgeons. However, the optimal drainage strategy remains controversial. The aim of this prospective cohort study was to determine the safety and efficacy of a four-hour drainage clamping technique in patients undergoing THA. Material/Methods There were 64 patients who underwent THA from March 2012 to December 2015 who were enrolled in the study; 32 patients were randomly assigned to four hours of a drainage clamping technique (clamping group); 32 patients were treated with a non-clamping drainage technique (non-clamping group). All perioperative clinical details were recorded for comparative analysis. Results The postoperative drainage volume and calculated blood loss were significantly greater in the drainage non-clamping group, p<0.001 and p=0.028, respectively. Significantly more patients in the drainage non-clamping group required a blood transfusion, seven cases versus one case (p=0.023). Significantly more units of blood were transfused in the drainage non-clamping group (p=0.001). No significant differences were found for all other clinical outcome factors. Conclusions The four-hour drainage clamping technique following THA, compared with drainage non-clamping technique reduced blood loss and requirement for blood transfusion. There was no increase in adverse clinical events using the four-hour drainage clamping method. Therefore, four-hour drainage clamping has the potential for routine use in THA.
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Affiliation(s)
- Pengfei Zan
- Department of Orthopedic Surgery, The Tenth Peoples' Hospital, Affiliated to Tongji University, Shanghai, China (mainland)
| | - Jie J Yao
- Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lin Fan
- Department of Orthopedic Surgery, The Tenth Peoples' Hospital, Affiliated to Tongji University, Shanghai, China (mainland)
| | - Yong Yang
- Department of Orthopedic Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China (mainland)
| | - Zifei Zhou
- Department of Orthopedic Surgery, Shanghai East Hospital, Affiliated to Tongji University, Shanghai, China (mainland)
| | - Zhong Wu
- Department of Orthopedic Surgery, The Tenth Peoples' Hospital, Affiliated to Tongji University, Shanghai, China (mainland)
| | - Chunyan Zhu
- Department of Surgery, The Tenth Peoples' Hospital, Affiliated to Tongji University, Shanghai, China (mainland)
| | - Dong Yang
- Department of Orthopedic Surgery, The Tenth Peoples' Hospital, Affiliated to Tongji University, Shanghai, China (mainland)
| | - Guodong Li
- Department of Orthopedic Surgery, The Tenth Peoples' Hospital, Affiliated to Tongji University, Shanghai, China (mainland)
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Makhni EC, Trofa DP, Watling JP, Bobman JT, Bigliani LU, Jobin CM, Levine WN, Ahmad CS. Risk factors associated with blood transfusion after shoulder arthroplasty. JSES OPEN ACCESS 2017; 1:10-14. [PMID: 30675532 PMCID: PMC6340832 DOI: 10.1016/j.jses.2017.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Closed-suction drainage has been studied extensively in hip and knee arthroplasty literature. However, little is known about outcomes in patients treated with drainage after shoulder arthroplasty, particularly relative to transfusion requirements. Methods All primary total and reverse total shoulder arthroplasties (TSAs and RSAs) performed at a single institution during a 5-year period were retrospectively reviewed. Data collected included patient demographic information, estimated blood loss (EBL), drain output, length of drain use, changes in hemoglobin (Hgb) level postoperatively, transfusions, and complications. A multivariable regression analysis was performed to identify independent risk factors for transfusion. Results There were no differences in surgery duration, EBL, or complications between TSA and RSA patients (P > .05). Patients undergoing RSA were older (74.0 vs. 68.4 years; P < .001) and had lower preoperative and postoperative Hgb levels (P < .001) compared with TSA patients. Reverse arthroplasty was also associated with longer hospital stays (2.8 vs. 2.2 days; P < .001), longer drain durations (1.6 vs. 1.2 days; P < .001), increased total wound drainage (209 vs. 168 m; P = .006), and higher transfusion rates (11.7% vs. 3.1%; P = .002). Independent risk factors for transfusion included low preoperative Hgb levels in both TSA (P = .024) and RSA (P = .002) and higher EBL in TSA (P = .031). Conclusion Low preoperative Hgb level is an independent risk factor for requiring blood transfusion after TSA and RSA. Increased wound drainage was not a risk factor for transfusion, and the 40-mL increase in wound drainage found in RSA is of questionable clinical significance.
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Affiliation(s)
- Eric C Makhni
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Jonathan P Watling
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Jacob T Bobman
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Louis U Bigliani
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Christopher S Ahmad
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
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George DA, Drago L, Scarponi S, Gallazzi E, Haddad FS, Romano CL. Predicting lower limb periprosthetic joint infections: A review of risk factors and their classification. World J Orthop 2017; 8:400-411. [PMID: 28567344 PMCID: PMC5434347 DOI: 10.5312/wjo.v8.i5.400] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/05/2017] [Accepted: 03/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To undertook a systematic review to determine factors that increase a patient's risk of developing lower limb periprosthetic joint infections (PJI). METHODS This systematic review included full-text studies that reviewed risk factors of developing either a hip or knee PJI following a primary arthroplasty published from January 1998 to November 2016. A variety of keywords were used to identify studies through international databases referencing hip arthroplasty, knee arthroplasty, infection, and risk factors. Studies were only included if they included greater than 20 patients in their study cohort, and there was clear documentation of the statistical parameter used; specifically P-value, hazard ratio, relative risk, or/and odds ratio (OR). Furthermore a quality assessment criteria for the individual studies was undertaken to evaluate the presence of record and reporting bias. RESULTS Twenty-seven original studies reviewing risk factors relating to primary total hip and knee arthroplasty infections were included. Four studies (14.8%) reviewed PJI of the hip, 3 (11.21%) of the knee, and 20 (74.1%) reviewed both joints. Nineteen studies (70.4%) were retrospective and 8 (29.6%) prospective. Record bias was identified in the majority of studies (66.7%). The definition of PJI varied amongst the studies but there was a general consensus to define infection by previously validated methods. The most significant risks were the use of preoperative high dose steroids (OR = 21.0, 95%CI: 3.5-127.2, P < 0.001), a BMI above 50 (OR = 18.3, P < 0.001), tobacco use (OR = 12.76, 95%CI: 2.47-66.16, P = 0.017), body mass index below 20 (OR = 6.00, 95%CI: 1.2-30.9, P = 0.033), diabetes (OR = 5.47, 95%CI: 1.77-16.97, P = 0.003), and coronary artery disease (OR = 5.10, 95%CI: 1.3-19.8, P = 0.017). CONCLUSION We have highlighted the need for the provider to optimise modifiable risk factors, and develop strategies to limit the impact of non-modifiable factors.
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Lee GW, Park KS, Kim DY, Shin YR, Yoon TR. New strategy of closed suction drainage after primary total hip arthroplasty. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:223-226. [PMID: 28336196 PMCID: PMC6197411 DOI: 10.1016/j.aott.2017.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/06/2016] [Accepted: 07/03/2016] [Indexed: 12/02/2022]
Abstract
Objective The purpose of this study was to evaluate the effect of late applied negative pressure on postoperative drain output after primary total hip arthroplasty (THA). Patients and methods 100 patients (100 hips) were treated by closed suction drainage applying negative pressure immediately after THA (group I). The remaining 100 patients (100 hips) were treated by the same drainage system, but the negative pressure was not applied in the first 24 h after THA and then negative pressure was applied (group II). Results The mean total drain output was different between the two groups (group I: 597 ± 200.1 mL, group II: 403 ± 204.1 mL; p < 0.05). Reported drain output from immediate postoperative to postoperative day one was 369 ± 125.5 ml in group I and 221 ± 141.3 ml in group II (p < 0.05). The change of hemoglobin from immediate postoperative to 24 h after THA was lower in group II (group I: 1.5 ± 0.62 g/dL, group II: 1.1 ± 0.73 g/dL; p = 0.004). The mean unit number of blood transfusions was 1.0 (range, 0.0–5.0) in group I and 0.3 (range, 0.0–2.0) in group II (p < 0.05). There was no difference in Harris hip score between the two groups at postoperative 1 year or last follow-up (p = 0.073). Conclusion The minor change in drain system management can reduce postoperative blood loss after primary THA and the need for transfusion. Level of evidence: Level III, Therapeutic study
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Sharma GM, Palekar G, Tanna DD. Use of closed suction drain after primary total knee arthroplasty - an overrated practice. SICOT J 2016; 2:39. [PMID: 27855775 PMCID: PMC5115035 DOI: 10.1051/sicotj/2016034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/07/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The age-old practice of closed suction drain following orthopedic procedures has been challenged since past few decades. Our aim was to assess the effectiveness of closed suction drain after total knee arthroplasty. MATERIALS AND METHODS One hundred twenty patients (135 knees) with primary Total Knee Arthroplasty were divided into a study group (no drain) and a control group (drain used). Inclusion criteria were grade 3 and grade 4 osteoarthritis of the knee. Revision cases and rheumatoid arthritis were excluded. Parameters assessed were pain, pre and post-op Hb, dressing change, early infection, ecchymosis and duration of stay. Results were calculated using Western Ontario and McMaster Universities Osteoarthritis Index and Oxford Knee scoring systems at two weeks, six months and one year. RESULTS Mean age was 72.03 ± 6.68 in study group and 71.38 ± 7.02 in control group. Pre and post op Hb was 12.1678 ± 1.3220 (study group), 12.1803 ± 1.2717 (control group) and 9.8373 ± 1.5703 (study group), 9.7918 ± 1.4163 (control group). There was one case of early infection in both groups which was controlled by oral antibiotics. Change of dressing and ecchymosis were more in the study group. Duration of hospital stay was more in the control group p < 0.0006 (statistically significant). CONCLUSION There is no added advantage of closed suction drain over no drain usage and this practice can safely be brought to a halt.
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Affiliation(s)
- Gaurav M Sharma
- Lotus Hospital, Mama Parmanand Marg, 400004 Mumbai, Maharashtra, India
| | - Gauresh Palekar
- Lotus Hospital, Mama Parmanand Marg, 400004 Mumbai, Maharashtra, India
| | - Dilip D Tanna
- Lotus Hospital, Mama Parmanand Marg, 400004 Mumbai, Maharashtra, India
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Raja A, Manzoor H, Jan WM, Assad S. Comparison Between Closed Suction Drainage and No Drainage Following Total Knee Arthroplasty in a Tertiary Care Setting in Pakistan. Cureus 2016; 8:e842. [PMID: 27909630 PMCID: PMC5120967 DOI: 10.7759/cureus.842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Total knee arthroplasty is associated with hematoma formation and extensive blood loss up to 1.5 liters. The placement of a closed suction drain to control this complication is controversial. The purpose of this study is to determine the efficacy between total knee arthroplasty without a drain and with a closed suction drain. Methods: A retrospective cohort study was conducted between January 2014 and December 2015 on 100 patients to assess the hemoglobin and hematocrit levels, the rate of allogeneic blood transfusion, and the length of hospital stay in patients with a closed suction drain versus no suction post-total knee arthroplasty. RESULTS Fifty-six units of packed red blood cells were transfused in 36 out of 50 patients (72%) in the closed suction group compared to 21 units of packed red blood cells in 18 out of 50 patients (36%) in the no suction group after 24 hours post-surgery. The hemoglobin levels at multiple intervals were lower in the closed suction group (p < 0.05). The closed suction group also had an extra one-day stay in the hospital (p = 0.0492, 95% CI = 0.70 - 0.94). CONCLUSION Closed suction drain placement is associated with low hemoglobin levels, an increased rate of allogeneic blood transfusion, and a longer hospital stay.
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Affiliation(s)
- Avais Raja
- Department of Orthopaedic Surgery, Shifa College of Medicine, Islamabad, Pakistan
| | - Hana Manzoor
- Department of Neurology, Shifa International Hospital, Islamabad, Pakistan
| | - Waqar M Jan
- Department of Orthopaedic Surgery, Shifa International Hospital, Islamabad, Pakistan
| | - Salman Assad
- Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan
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Escobar MA, Tehranchi R, Karim FA, Caliskan U, Chowdary P, Colberg T, Giangrande P, Giermasz A, Mancuso ME, Serban M, Tsay W, Mahlangu JN. Low-factor consumption for major surgery in haemophilia B with long-acting recombinant glycoPEGylated factor IX. Haemophilia 2016; 23:67-76. [DOI: 10.1111/hae.13041] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 11/27/2022]
Affiliation(s)
- M. A. Escobar
- University of Texas Health Science Center and the Gulf States Hemophilia and Thrombophilia Center; Houston TX USA
| | - R. Tehranchi
- Medical and Science; Haemophilia R&D Portfolio; Novo Nordisk A/S; Søborg Denmark
| | - F. A. Karim
- National Blood Centre; Kuala Lumpur Malaysia
| | - U. Caliskan
- Department of Pediatric Hematology; NEU Meram Faculty of Medicine; Konya Turkey
| | - P. Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Royal Free Hospital; London UK
| | - T. Colberg
- Medical and Science; Haemophilia R&D Portfolio; Novo Nordisk A/S; Søborg Denmark
| | - P. Giangrande
- Oxford Haemophilia Centre and Thrombosis Unit; Churchill Hospital; Oxford UK
| | - A. Giermasz
- Division of Hematology Oncology; University of California; San Francisco CA USA
| | - M. E. Mancuso
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca' Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - M. Serban
- Spitalul Clinic de Urgenta pentru Copii Louis Turcanu; IIIrd Paediatric Clinic; Timisoara Romania
| | - W. Tsay
- Department of Hematology; National Taiwan University Hospital; Taipei Taiwan
| | - J. N. Mahlangu
- Department of Molecular Medicine and Haematology; Faculty of Health Sciences; University of the Witwatersrand; NHLS and Haemophilia Comprehensive Care Centre; Charlotte Maxeke Johannesburg Academic Hospital; Johannesburg South Africa
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Abstract
Background and purpose - Although the results of primary total hip replacements (THRs) are generally excellent, sometimes serious complications arise. Some of these severe complications are considered to be patient injuries. We analyzed primary THR-related patient injuries in a nationwide setting. Patients and methods - We evaluated all the primary THR-related patient injury claims in Finland between 2008 and 2010. We used the original medical records and 2 nationwide registries, the Care Register for Social Welfare and Health Care and the Patient Injury Claim Register. Results - We identified 563 claims, 44% of which were compensated (n = 250). Of these 250 compensated claims, 79% were considered to be avoidable (treatment injuries) and 21% were severe unexpected infections (with a preoperative infection risk of less than 2%). The most common type of technical error was cup malposition (31%). High-volume hospitals (with an annual primary THR volume ≥ 400) had a lower patient injury rate. In lower-volume hospitals (with an annual primary THR volume of < 400), the relative risks (RRs) of patient injury for any reason, due to technical errors, or because of cup malposition were 2-fold (95% CI: 1.6-3.1), 4-fold (95% CI: 2.3-6.2), and 9-fold (95% CI: 3-28), respectively, compared to high-volume hospitals. Interpretation - Our study provides the first comprehensive nationwide data on THR-related patient injury types. Hospital volume was associated with the quality and quantity of errors detected. An annual hospital volume of ≥ 400 primary THRs was established as a protective factor against patient injuries.
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Affiliation(s)
- Teemu Helkamaa
- Department of Orthopedics and Traumatology, Helsinki University Central Hospital,,Correspondence:
| | - Eero Hirvensalo
- Department of Orthopedics and Traumatology, Helsinki University Central Hospital,,Patient Insurance Center, Helsinki,
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere,
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Cao JG, Wang L, Liu J. The use of clamped drainage to reduce blood loss in total hip arthroplasty. J Orthop Surg Res 2015; 10:130. [PMID: 26302784 PMCID: PMC4549090 DOI: 10.1186/s13018-015-0259-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/09/2015] [Indexed: 01/30/2023] Open
Abstract
Background Drainage is a routine practice used to reduce hematoma and blood loss following total hip arthroplasty. The aim of this study was to assess the effect of clamped drainage on blood loss and wound healing after total hip arthroplasty. Methods A prospective cohort of 44 patients with hip osteoarthritis or femur head necrosis undergoing total hip arthroplasty was randomized equally into two groups: 6-h postoperative clamped or non-clamped suction tube drainage. Body mass index, gender distribution, preoperative hemoglobin, hip pathology, and affected side were comparable between the two groups. Blood loss, hemoglobin levels, and wound healing complications were recorded and compared between groups. Results The drainage blood loss and calculated blood loss volumes were higher for the non-clamped group. About 100 mL more blood loss was noticed in the non-clamped group. There was no significant difference in adverse events or need for transfusion. Conclusions The present study showed a statistically significant reduction in postoperative drainage amount between clamped and unclamped drainage groups, but this difference was not large enough to warrant increased blood transfusion requirements in patients with unclamped drainage. Further studies are essential to define the critical period of clamping that is compatible with the dual objectives of reduced blood loss and lack of wound complications from hematoma.
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Affiliation(s)
- Jian-Gang Cao
- Department of Sport Injuries and Arthroscopy, Tianjin Hospital, Tianjin, 300211, China
| | - Lei Wang
- Center of Joint Diseases, Tianjin Hospital, Tianjin, 300211, China
| | - Jun Liu
- Center of Joint Diseases, Tianjin Hospital, Tianjin, 300211, China.
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Closed suction drainage has no benefits in revision total hip arthroplasty: a randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2015; 40:453-7. [PMID: 26278675 DOI: 10.1007/s00264-015-2960-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/03/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE Several studies have failed to show significant benefits of closed suction drainage (CSD) in routine primary total hip arthroplasty (THA). However, blood loss, haematoma formation and wound complications are generally much greater in revision THA as compared to primary THA. The purpose of this study was to determine if CSD is beneficial for revision THA patients. METHODS We conducted a prospective, randomized, controlled trial at our institution between July 2013 and July 2014. Eighty-eight patients undergoing revision THA were enrolled and randomly assigned to receive a CSD (n = 44) or to not receive a CSD (n = 44). All first-stage revision surgeries for infection were excluded. Primary outcomes were haemoglobin loss and number of patients transfused. Secondary outcomes included functional outcome evaluated with Harris hip score (HHS), pain evaluated with visual analogue scale (VAS), and length of hospital stay. RESULTS There were significantly more patients in the CSD group that required blood transfusions (20/44 as compared to 11/44, p = 0.04). Patients in the no CSD group were discharged earlier than patients in the CSD group (4.3 days as compared to 5.4 days, p = 0.002). No statistical significant difference was found in the HHS or pain VAS between the groups. CONCLUSIONS This study did not demonstrate any benefit with the use of CSD for revision THA with regard to wound related complications, infection or early functional outcome. Post-operative blood loss, transfusion rate, and length of hospital stay may be higher with CSD.
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Ma Z, Guo F, Qi J, Xiang W, Zhang J. Meta-analysis shows that obesity may be a significant risk factor for prosthetic joint infections. INTERNATIONAL ORTHOPAEDICS 2015; 40:659-67. [DOI: 10.1007/s00264-015-2914-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 07/01/2015] [Indexed: 12/17/2022]
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Is closed suction drainage effective in early recovery of hip joint function? Comparative evaluation in one-stage bilateral total hip arthroplasty. J Arthroplasty 2015; 30:74-8. [PMID: 25216791 DOI: 10.1016/j.arth.2014.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 08/01/2014] [Accepted: 08/06/2014] [Indexed: 02/01/2023] Open
Abstract
One-stage primary bilateral cementless total hip arthroplasty with unilateral closed suction drainage (CSD) was prospectively performed for 51 patients (102 hips), and local effects of CSD were quantitatively evaluated. Postoperatively, pain scores evaluated by visual analog scale and periwound temperatures measured by thermography were lower in the CSD side than the non-CSD side. CT measurements also showed that postoperative cross-sectional area of the thigh was smaller in the CSD side. Active straight leg raising and weight bearing were more accelerated in the CSD side., showing earlier recovery of hip joint function. CSD for hip arthroplasty has an advantage in reducing postoperative local inflammation and be recommended from the viewpoint of postoperative pain relief and early recovery of hip joint function.
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Poorman CE, Passias PG, Bianco KM, Boniello A, Yang S, Gerling MC. Effectiveness of postoperative wound drains in one- and two-level cervical spine fusions. Int J Spine Surg 2014; 8:14444-1034. [PMID: 25694927 PMCID: PMC4325495 DOI: 10.14444/1034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Cervical drains have historically been used to avoid postoperative wound and respiratory complications such as excessive edema, hematoma, infection, re-intubation, delayed extubation, or respiratory distress. Recently, some surgeons have ceased using drains because they may prolong hospital stay, operative time, or patient discomfort. The objective of this retrospective case-control series is to investigate the effectiveness of postoperative drains following one- and two-level cervical fusions. Methods A chart review was conducted at a single institution from 2010-2013. Outcome measures included operative time, hospital stay, estimated blood loss and incidence of wound complications (infection, hematoma, edema, and complications with wound healing or evacuation), respiratory complications (delayed extubation, re-intubation, and respiratory treatment), and overall complications (wound complications, respiratory complications, dysphagia, and other complications). Statistical analyses including independent samples t-test, chi-square, analysis of covariance, and linear regression were used to compare patients who received a postoperative drain to those who did not. Results The study population included 39 patients who received a postoperative drain and 42 patients who did not. There were no differences in demographics between the two groups. Patients with drains showed increased operative time (100.1 vs 69.3 min, p < 0.001), hospital stay (38.9 vs. 31.7 hrs, p = 0.021), and blood loss (62.7 vs 29.1 mL, p < 0.001) compared to patients without drains. The frequency of wound complications, respiratory complications, and overall complications did not vary significantly between groups. Conclusions/Level of Evidence Cervical drains may not be necessary for patients undergoing one- and two-level cervical fusion. While there were no differences in incidence of complications between groups, patients treated with drains had significantly longer operative time and length of hospital stay. Clinical relevance This could contribute to excessive costs for patients treated with drains, despite the lack of compelling evidence of the advantages of this treatment in the literature and in the current study.
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Affiliation(s)
- Caroline E Poorman
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York
| | - Peter G Passias
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York
| | - Kristina M Bianco
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York
| | - Anthony Boniello
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York
| | - Sun Yang
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York
| | - Michael C Gerling
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York
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Li N, Li P, Liu M, Wang D, Xia L. Comparison between autologous blood transfusion drainage and no drainage/closed-suction drainage in primary total hip arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 2014; 134:1623-31. [PMID: 25288027 DOI: 10.1007/s00402-014-2090-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Indexed: 02/09/2023]
Abstract
PURPOSE Primary aim of this meta-analysis of randomized controlled trials (RCTs) was to compare blood loss, transfusion rate and postoperative hemoglobin levels at 24-48 h after primary total hip arthroplasty (THA) between autologous blood transfusion (ABT) drainage and no drainage/closed-suction drainage and to obtain a powerful conclusion which way of drainage had the best clinical efficacy. Secondary aim was to compare the postoperative complication rates during the first year to indentify which way of drainage was safest. METHODS We searched the PubMed, Embase and Cochrane Central Register of Controlled Trials and identified 12 RCTs (including a total of 1,574 patients) for the meta-analysis. Methodological quality was assessed by the Physiotherapy Evidence Database scale. Two researchers extracted relevant data including study characteristics, blood loss, transfusion rate, hemoglobin levels, hospital stay and complications. After data extraction, we compared results using fixed-effects or random-effects models depending on the heterogeneity of the included studies. RESULTS Autologous blood transfusion drainage had less total blood loss and lower superficial infection rate than no drainage/closed-suction drainage. While there were no statistical differences in postoperative pain, hematoma, hemoglobin levels, hospital stay and other complications between ABT drainage and no drainage/closed-suction drainage. CONCLUSIONS Autologous blood transfusion drainage and no drainage/closed-suction drainage have similar clinical efficacy and safety in primary THA with regard to clinical outcomes and complication rates.
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Affiliation(s)
- Ning Li
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China
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Zeng WN, Zhou K, Zhou ZK, Shen B, Yang J, Kang PD, Pei FX. Comparison between drainage and non-drainage after total hip arthroplasty in Chinese subjects. Orthop Surg 2014; 6:28-32. [PMID: 24590990 DOI: 10.1111/os.12092] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 12/16/2013] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess the difference between drainage and non-drainage after total hip arthroplasty (THA) in Chinese subjects by evaluating post-operative complications and joint function. METHODS One hundred and sixty-eight patients undergoing THA were randomly allocated into drainage (83 patients) and non-drainage groups (85 patients). All surgeries were performed by one surgical team using the same pre-, intra-, and postoperative techniques. Measured items included: hemoglobin (Hb), superficial and deep wound infection, volume of blood transfusion, wound hematoma thickness, range of motion (ROM) of the hip, wound healing time, ecchymosis and tension vesicles around the wound. RESULTS Early after THA, the Hb decreased significantly in the drainage group. There was no significant difference between non-drainage and drainage groups in need for or volume of blood transfusions (9.6% vs 8.2%, P = 0.100; 3.8 units vs 2.9 units, P = 0.089, respectively). In the non-drainage group, the incidence of superficial infection, ecchymosis and tension vesicles was significantly higher than in the drainage group (10.6% vs 2.4%, P = 0.031; 12.9% vs 3.6%, P = 0.026; 16.5% vs 4.8%, P = 0.013, respectively). In addition, the non-drainage group had a greater volume of hematomas (P = 0.000). Patients in the non-drainage group had smaller ROMs early after surgery but the final ROMs did not differ significantly between groups. No deep infection occurred in either group. CONCLUSION Non-drainage may reduce postoperative blood loss but has no benefits regarding blood transfusion or deep infection. It may cause more post-operative complications because of restriction of early postoperative exercise by pain and swelling. Therefore we suggest routine use of drainage after THA.
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Affiliation(s)
- Wei-nan Zeng
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China; Centre for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
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Thomassen BJW, den Hollander PHC, Kaptijn HH, Nelissen RGHH, Pilot P. Autologous wound drains have no effect on allogeneic blood transfusions in primary total hip and knee replacement: a three-arm randomised trial. Bone Joint J 2014; 96-B:765-71. [PMID: 24891576 DOI: 10.1302/0301-620x.96b6.33021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We hypothesised there was no clinical value in using an autologous blood transfusion (ABT) drain in either primary total hip (THR) or total knee replacement (TKR) in terms of limiting allogeneic blood transfusions when a modern restrictive blood management regime was followed. A total of 575 patients (65.2% men), with a mean age of 68.9 years (36 to 94) were randomised in this three-arm study to no drainage (group A), or to wound drainage with an ABT drain for either six hours (group B) or 24 hours (group C). The primary outcome was the number of patients receiving allogeneic blood transfusion. Secondary outcomes were post-operative haemoglobin (Hb) levels, length of hospital stay and adverse events. This study identified only 41 transfused patients, with no significant difference in distribution between the three groups (p = 0.857). The mean pre-operative haemoglobin (Hb) value in the transfused group was 12.8 g/dL (9.8 to 15.5) versus 14.3 g/dL (10.6 to 18.0) in the non-transfused group (p < 0.001, 95% confidence interval: 1.08 to 1.86). Post-operatively, the median of re-transfused shed blood in patients with a THR was 280 mL (Interquartile range (IQR) 150 to 400) and in TKR patients 500 mL (IQR 350 to 650) (p < 0.001). ABT drains had no effect on the proportion of transfused patients in primary THR and TKR. The secondary outcomes were also comparable between groups.
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Affiliation(s)
- B J W Thomassen
- Medical Center Haaglanden, Department of Orthopaedic Surgery , Lijnbaan 32, 2501 CK Den Haag, The Netherlands
| | - P H C den Hollander
- Medical Center Haaglanden, Department of Orthopaedic Surgery , Lijnbaan 32, 2501 CK Den Haag, The Netherlands
| | - H H Kaptijn
- The Lange Land Hospital, Department of Orthopaedic Surgery, Toneellaan 1, 2725 NA Zoetermeer, The Netherlands
| | - R G H H Nelissen
- Leiden University Medical Centre, Department of Orthopaedic Surgery, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - P Pilot
- Reinier de Graaf Groep, Department of Orthopaedic Surgery, Reinier de Graafweg 3-11, 2625: AD Delft, The Netherlands
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Gombár C, Horvath G, Gálity H, Sisák K, Tóth K. Comparison of minor bleeding complications using dabigatran or enoxaparin after cemented total hip arthroplasty. Arch Orthop Trauma Surg 2014; 134:449-57. [PMID: 24488447 DOI: 10.1007/s00402-014-1933-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Orally administered chemical thromboprophylactic agents for total hip replacement (THR) have become popular in recent years. Certain clinical trials suggest that the efficacy and the risk of major bleeding after administration of direct thrombin inhibitor dabigatran etexilate are equivalent to the clinical trial comparator, subcutaneous low-molecular-weight heparin enoxaparin. Our aim was to compare and evaluate the incidence of minor haemorrhagic and soft-tissue adverse effects of enoxaparin and dabigatran. MATERIALS AND METHODS 122 patients who were treated by elective cemented primary THR were enrolled in our quasi-randomised study. Two groups were formed according to which perioperative thromboprophylactic agent was used: 61 patients in enoxaparin group versus 61 patients in dabigatran group. Thigh volume changes, calculated perioperative blood loss, area of haematoma, wound bleeding, duration of wound discharge and intensity of serous wound discharge on postoperative day 3 and day 7 were recorded. RESULTS The duration and intensity of serous wound discharge differed significantly between the two groups. Duration of wound discharge after drain removal was 2.2 (±2.7) days in the dabigatran group and 1.2 (±1.9) days in the enoxaparin group (p < 0.05). Significant increase in serous discharge was found in the dabigatran group (p < 0.05) on third and seventh postoperative days compared to the enoxaparin group. CONCLUSION Both thromboprophylactic agents were found to have appropriate antithrombotic effects after THR. However, dabigatran was associated with an increased incidence of prolonged serous wound discharge, which might cause longer hospitalization and might instigate the use of prolonged antibiotic prophylaxis.
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Affiliation(s)
- Csaba Gombár
- Department of Orthopaedics, Szent-Györgyi Albert Clinical Center, University of Szeged, Semmelweis Street 6, 6725, Szeged, Hungary,
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Lindeque B, Hartman Z, Noshchenko A, Cruse M. Infection after primary total hip arthroplasty. Orthopedics 2014; 37:257-65. [PMID: 24762833 DOI: 10.3928/01477447-20140401-08] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 09/30/2013] [Indexed: 02/03/2023]
Abstract
The number of primary total hip arthroplasties (THAs) performed in the United States each year continues to climb, as does the incidence of infectious complications. The changing profile of antibiotic-resistant bacteria has made preventing and treating primary THA infections increasingly complex. The goal of this review was to summarize (1) the published data concerning the risk of surgical site infection (SSI) after primary THA by type of bacteria and (2) the effect of potentially modifying factors. The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, EMBASE, Web of Science, and PubMed were searched. Studies dated between 2001 and 2011 examining primary THA in adults were included. Meta-analysis of the collected data was performed. The pooled SSI rate was 2.5% (95% confidence interval [Cl], 1.4%-4.4%; P<.001; n=28,883). The pooled deep prosthetic joint infection (PJI) rate was 0.9% (95% Cl, 0.4%-2.2%; P<.001; n=28,883). The pooled rate of methicillin-resistant Staphylococcus aureus SSI was 0.5% (95% Cl, 0.2%-1.5%; P<.001; n=26,703). This is approximately 20% of all SSI cases. The pooled rate of intraoperative bacterial wound contamination was 16.9% (95% Cl, 6.6%-36.8%; P=.003; n=2180). All these results had significant heterogeneity. The postoperative risk of SSI was significantly associated with intraoperative bacterial surgical wound contamination (pooled rate ratio, 2.5; 95% Cl, 1.4%-4.6%; P=.001; n=19,049).
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Zhou XD, Wu LD. Reply to Comment on Zhou et al.: Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. INTERNATIONAL ORTHOPAEDICS 2013; 37:2531-2. [PMID: 24114245 DOI: 10.1007/s00264-013-2125-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Xin-die Zhou
- Department of Orthopaedics Surgery, The Second Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, China
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Zhang S, Guo T, Zhao J. Comment on Zhou et al.: Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. INTERNATIONAL ORTHOPAEDICS 2013; 37:2529. [PMID: 24085149 DOI: 10.1007/s00264-013-2124-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 09/12/2013] [Indexed: 01/20/2023]
Affiliation(s)
- Shu Zhang
- Medical School of Nanjing University, Nanjing, 210093, Jiangsu Province, China
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Zhou XD, Li J, Xiong Y, Jiang LF, Li WJ, Wu LD. Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. INTERNATIONAL ORTHOPAEDICS 2013; 37:2109-18. [PMID: 23982636 DOI: 10.1007/s00264-013-2053-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/22/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE The clinical use of closed-suction drainage, which aims to reduce postoperative wound haematomas and infection, is common. This study was performed to determine whether closed-suction drainage is safe and effective in promoting wound healing and reducing blood loss and other complications compared with no-drainage in total hip arthroplasty. METHODS The literature search was based on PubMed, the Cochrane Library, MEDLINE, and EMBASE. The data were evaluated using the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group, and then analysed using RevMan 5.0. Twenty randomised controlled trials involving 3,186 patients were included in our analysis. RESULTS The results of our meta-analysis indicate that closed-suction drainage reduces the requirement for dressing reinforcement, but increases the rate of homologous blood transfusion. No significant difference was observed in the incidence of infection, blood loss, changes in haemoglobin and haematocrit, functional assessment, or other complications when the drainage group was compared with the no-drainage group. CONCLUSIONS Our results of the comparison between closed-suction drainage and no drainage in THA have indicated that the routine use of closed-suction drainage for elective total hip arthroplasty may be of more harm than benefit.
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Affiliation(s)
- Xin-die Zhou
- Department of Orthopedics Surgery, The Second Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, China
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Chen ZY, Gao Y, Chen W, Li X, Zhang YZ. Is wound drainage necessary in hip arthroplasty? A meta-analysis of randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:939-46. [PMID: 23917702 DOI: 10.1007/s00590-013-1284-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/21/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE The use of closed suction drainage systems for hip arthroplasty (HA) is a common practice. However, the effectiveness and safety are still questionable. Thus, the aim of this meta-analysis was to review the advantages and adverse effects of closed suction drainage systems in hip arthroplasty. METHODS All randomized or quasi-randomized trials comparing the use of closed suction drainage systems with no drainage systems for hip arthroplasty were searched in PubMed, Medicine, EMBASE and other internet databases. We assessed the methodological quality of the studies and abstracted the relevant data independently. RESULTS Sixteen studies involving 1,663 participants with surgical wounds comparing HA with and without the use of drainage were included in our analysis. Our results demonstrated blood transfusion was required more frequently the same as the persistent discharge in those who received drains. No significant differences in the incidence of wound hematoma, dehiscence or deep vein thrombosis were found between those allocated to drains and the non-drained wounds. Wound infection and the range of movement of the joint after surgery were similar between the two groups. CONCLUSIONS Based on the current evidence, there is insufficient evidence to support the routine use of closed suction drainage in hip arthroplasty. At the same time, our meta-analysis study suggested that using of closed suction drainage in HA increased requirement for postoperative blood transfusion. However, there is a moderate possibility of selection bias and publication bias in this review. Because of the limited number of studies which may weaken the strength of the evidence of our results, more samples, high-quality randomized trials are needed to increase the reliability of evidences. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Zhao-Yu Chen
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
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Nanni M, Perna F, Calamelli C, Donati D, Ferrara O, Parlato A, D'Arienzo M, Faldini C. Wound drainages in total hip arthroplasty: to use or not to use? Review of the literature on current practice. Musculoskelet Surg 2013; 97:101-107. [PMID: 23709186 DOI: 10.1007/s12306-013-0270-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 05/08/2013] [Indexed: 06/02/2023]
Abstract
Aim of this study is to analyze data reported in literature concerning the efficacy of using wound low-vacuum suction drainages in orthopedic surgery after total hip arthroplasty. We analyzed studies concerning the use of drainages in prosthetic hip replacement surgery, performing our research through Pubmed, Cochrane database and Google Scholar, and selecting the ones evaluating the following parameters: bleeding, the need for blood transfusions, number or reinforcement of post-operative medications, length of hospitalization, functional results, periprosthetic and surgical wound infection, post-operative hematoma. Our review did not show any demonstrated advantage from the use of wound drainages in total hip arthroplasty. Moreover, some studies enlighted a possible complication related to their employment, represented by the greater need for blood transfusions. Despite the absence of a statistically demonstrated positive influence on wound outcome using suction drains after total hip replacement, many orthopedic surgeons still recommend using drainages, just because there is no certified proof of a negative effect.
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Affiliation(s)
- M Nanni
- Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, University of Bologna, Bagheria, Bologna, Italy.
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Reiffel AJ, Barie PS, Spector JA. A multi-disciplinary review of the potential association between closed-suction drains and surgical site infection. Surg Infect (Larchmt) 2013; 14:244-69. [PMID: 23718273 PMCID: PMC3689179 DOI: 10.1089/sur.2011.126] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Despite the putative advantages conferred by closed-suction drains (CSDs), the widespread utilization of post-operative drains has been questioned due to concerns regarding both efficacy and safety, particularly with respect to the risk of surgical site infection (SSI). Although discipline-specific reports exist delineating risk factors associated with SSI as they relate to the presence of CSDs, there are no broad summary studies to examine this issue in depth. METHODS The pertinent medical literature exploring the relationship between CSDs and SSI across multiple surgical disciplines was reviewed. RESULTS Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine post-operative CSD have yielded conflicting results. A few studies do suggest an increased risk of SSI associated with drain placement, but are usually associated with open drainage and not the use of CSDs. No studies whatsoever attribute a decrease in the incidence of SSI (including organ/space SSI) to drain placement. CONCLUSIONS Until additional, rigorous randomized trials are available to address the issue definitively, we recommend judicious use and prompt, timely removal of CSDs. Given that the evidence is scant and weak to suggest that CSD use is associated with increased risk of SSI, there is no justification for the prolongation of antibiotic prophylaxis to "cover" an indwelling drain.
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Affiliation(s)
- Alyssa J. Reiffel
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Philip S. Barie
- Department of Surgery, Weill Cornell Medical College, New York, New York
- Department of Public Health, Weill Cornell Medical College, New York, New York
| | - Jason A. Spector
- Department of Surgery, Weill Cornell Medical College, New York, New York
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Is the infection rate in primary THA increased after steroid injection? Clin Orthop Relat Res 2012; 470:3213-9. [PMID: 22610526 PMCID: PMC3462846 DOI: 10.1007/s11999-012-2390-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/01/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injection of the hip is performed for diagnostic and therapeutic reasons. Articular cartilage deterioration and increased risk of prosthetic infection have been reported with steroid injections. However, the literature contains contradictory reports on an increased risk of infection after a subsequent THA. QUESTIONS/PURPOSES We asked whether intraarticular steroid injection increased the rate of infection of a subsequent THA. METHODS We retrospectively reviewed records of 175 patients in whom intraarticular steroid injections were given under strictly aseptic conditions using a lateral approach within 1 year before THA. These patients were matched with others from our database who had not received an injection for comorbidities, and for American Society of Anesthesiologists score, age, BMI, sex, type of implant, and year of THA. RESULTS We found no differences in the rate of deep or superficial infection between the two groups. One patient in the injected group and one in the control group had a late chronic infection. In three patients in the injected group and one in the control group, one of the intraoperative cultures was positive. Five patients in the injected group and seven in the control group had superficial infections develop. In seven patients in the injected group and five in the control group, there was prolonged wound drainage (> 5 days). None of these patients had a deep wound infection at latest followup. CONCLUSIONS When used in strictly aseptic conditions, intraarticular steroid injection of the hip did not increase the risk of infection in patients subsequently undergoing THA. LEVEL OF EVIDENCE Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Akinyoola A, Odunsi A, Yusuf M. Use of wound drains following open reduction and internal fixation of femoral shaft fractures. J Wound Care 2012; 21:279-80, 282-4. [DOI: 10.12968/jowc.2012.21.6.279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - A. Odunsi
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - M.B. Yusuf
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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