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Sarraj M, Alqahtani A, Thornley P, Koziarz F, Bailey CS, Freire-Archer M, Bhanot K, Kachur E, Bhandari M, Oitment C. Management of deep surgical site infections of the spine: a Canadian nationwide survey. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:443-452. [PMID: 36606001 PMCID: PMC9808097 DOI: 10.21037/jss-22-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/07/2022] [Indexed: 01/09/2023]
Abstract
Background Deep surgical site infections after spinal instrumentation represent a significant source of patient morbidity and poorer outcomes. Given lack of evidence or guidelines on the variety of procedural options in the management of deep spine surgical site infections, the purpose of this survey was to document and investigate the use of these techniques across Canada. Methods A 34-question survey evaluating surgical techniques for irrigation and debridement in postoperative thoracolumbar infection was distributed to Canadian adult spine surgeons. Results were analyzed qualitatively, and comparisons by specialty, years of training, and number of cases were completed using Fischer's exact tests. We defined consensus as >70% agreement. Results We received 53 responses (62% response rate) from a comprehensive sample of Canadian adult spine surgeons. There was a consensus to retain hardware (80%) and interbody implants (93%) in acute infection, to retain interbody implants in chronic/recurrent infection (71%), and application of topical antibiotics in recurrent infection (85%). There was consensus on the use of absorbable suture to close fascia in acute (83%) and chronic (87%) infection. Eighty-five percent of surgeons used nonabsorbable materials such as Nylon or staples for skin closure in chronic infection, however, there was no consensus in acute infection. Surgeons varied significantly in type, volume and pressure of fluids, adjuvant solvents, graft management, use of topical antibiotics acutely, and the use of negative pressure wound therapy. Partial hardware exchange was controversial. Additionally, specialty or surgeon experience had no impact on management strategy. Conclusions This survey demonstrates significant heterogeneity amongst Canadian adult spine surgeons regarding key steps in the surgical management of deep instrumented spine infection, concordant with scarce literature addressing these steps.
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Affiliation(s)
- Mohamed Sarraj
- Division of Orthopedic Surgery, Hamilton General Hospital, McMaster University, Ontario, Canada
| | - Abdullah Alqahtani
- Division of Orthopedic Surgery, Hamilton General Hospital, McMaster University, Ontario, Canada
| | - Patrick Thornley
- Division of Orthopedic Surgery, Hamilton General Hospital, McMaster University, Ontario, Canada;,London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, Ontario, Canada
| | - Frank Koziarz
- Division of Neurosurgery, Hamilton General Hospital, McMaster University, Ontario, Canada
| | - Christopher S. Bailey
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, Ontario, Canada
| | | | - Kunal Bhanot
- Division of Orthopedic Surgery, Grand River Hospital, McMaster University, Ontario, Canada
| | - Edward Kachur
- Division of Neurosurgery, Hamilton General Hospital, McMaster University, Ontario, Canada
| | - Mohit Bhandari
- Division of Orthopedic Surgery, Hamilton General Hospital, McMaster University, Ontario, Canada
| | - Colby Oitment
- Division of Orthopedic Surgery, Hamilton General Hospital, McMaster University, Ontario, Canada
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Marmura H, Bryant DM, Birmingham TB, Kothari A, Spindler KP, Kaeding CC, Spalding T, Getgood AMJ. Same knee, different goals: patients and surgeons have different priorities related to ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:4286-4295. [PMID: 33876273 DOI: 10.1007/s00167-021-06550-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The priorities of patients should be shared by those treating them. Patients and surgeons are likely to have different priorities surrounding anterior cruciate ligament reconstruction (ACLR), with implications for shared decision-making and patient education. The optimal surgical approach for ACLR is constantly evolving, and the magnitude of treatment effect necessary for evidence to change surgical practice is unknown. The aim of this study was to determine (1) the priorities of surgeons and patients when making decisions regarding ACLR and (2) the magnitude of reduction in ACLR graft failure risk that orthopaedic surgeons require before changing practice. METHODS This study followed a cross-sectional survey design. Three distinct electronic surveys were administered to pre-operative ACLR patients, post-operative ACLR patients, and orthopaedic surgeons. Patients and surgeons were asked about the importance of various outcomes and considerations pertaining to ACLR. Surgeons were asked scenario-based questions regarding changing practice for ACLR based on new research. RESULTS Surgeons were more likely to prioritize outcomes related to the surgical knee itself, whereas patients were more likely to prioritize outcomes related to their daily lifestyle and activities. Knee instability and risk of re-injury were unanimous top priorities among all three groups. A mean relative risk reduction in ACLR graft failure of about 50% was required by orthopaedic surgeons to change practice regardless of the type of change, or patient risk profile. CONCLUSION There are discrepancies between the priorities of surgeons and patients, and orthopaedic surgeons appear resistant to changing practice for ACLR. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
| | - Dianne M Bryant
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Trevor B Birmingham
- Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Wolf Orthopaedic Biomechanics Lab, Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
| | - Anita Kothari
- Faculty of Health Sciences, Western University, London, ON, Canada
| | | | | | - Tim Spalding
- Department of Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Alan M J Getgood
- Faculty of Health Sciences, Western University, London, ON, Canada.
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada.
- Bone and Joint Institute, Western University, London, ON, Canada.
- Lawson Research, London Health Sciences Centre, London, ON, Canada.
- Department of Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada.
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Orthopaedic Academic Activity in the United States: Bibliometric Analysis of Publications by City and State. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e027. [PMID: 30280140 PMCID: PMC6145550 DOI: 10.5435/jaaosglobal-d-18-00027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: The purpose of this study was to conduct a bibliometric analysis of orthopaedic academic output in the United States. Methods: Publications based on city and state origin, corrected for population size, median household income, total number of surgeons, and the number of various subspecialties were evaluated. The 15 highest-ranked orthopaedic journals were audited from 2010 to 2014 and then subdivided into anatomic regions and 14 subspecialties. Results: A total of 8,100 articles were published during the study period. Most originated from New York, California, Pennsylvania, Massachusetts, and Minnesota. New York published the greatest number by city, followed by Philadelphia, Boston, Chicago, and Rochester. When adjusted for the number of publications per city, surgeons per population, publications per surgeon population, publications per population, and publications per median income per capita, Vail and New York led in two and Stanford in one of the metrics. Conclusions: New York was the leader for the total publications, greatest activity within subspecialties, and publications per surgeon/population and per median income/capita. Vail was the leader for publications/surgeon and population. The top four cities of New York, Philadelphia, Boston, and Chicago were responsible for 28% of the academic output over the 5-year study period.
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Barrow J, Divecha H, Board T. Skin closure in arthroplasty surgery: Current practice. Int Wound J 2018; 15:966-970. [PMID: 29978557 DOI: 10.1111/iwj.12956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/31/2018] [Indexed: 11/30/2022] Open
Abstract
The study by Smith et al. (2010) concluded that clips are associated with 3 times the infection rate compared with subcuticular sutures in orthopaedic surgery (P = .01).For hip surgery, there was a 4-fold increase. We aimed to determine the trends and influences in skin closure and wound care for hip and knee arthroplasty in the northwest region as well as what would change surgeons' current practice. A short online survey was emailed to consultants in the northwest of England enquiring about their current practice in superficial skin closure, what has influenced this, and finally what would change their practice. Returned surveys were then analysed. A total of 45 consultants responded (response rate of 40.2%). In both hip and knee arthroplasty, clips were the most commonly used superficial skin closure material (53% and 63%, respectively). Personal experience was the greatest influence on the choice of closure material in both hip and knees (84% and 93% respectively). A total of 66% of hip and 76% of knee surgeons would change their closure material if there was evidence to support this. Hip and knee arthroplasty surgeons are influenced by their personal experience, and most use clips as their skin closure method. Most would change their practice with evidence of one material over another. We conclude that there is need for a prospective, well-powered, multi-centre randomised control trial to determine the skin closure material that has the lowest return-to-theatre rate in arthroplasty surgery.
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Affiliation(s)
- Jonathan Barrow
- Trauma and Orthopaedic Registrar, North West Deanery, Manchester, UK
| | - Hiren Divecha
- Trauma and Orthopaedic Registrar, North West Deanery, Manchester, UK
| | - Tim Board
- Consultant Orthopaedic Hip Surgeon at Wrightington Hospital, Professor at Manchester University, Wrightington Hospital, Wigan, UK
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Morgenstern M, Moriarty TF, Kuehl R, Richards RG, McNally MA, Verhofstad MHJ, Borens O, Zalavras C, Raschke M, Kates SL, Metsemakers WJ. International survey among orthopaedic trauma surgeons: Lack of a definition of fracture-related infection. Injury 2018; 49:491-496. [PMID: 29433799 DOI: 10.1016/j.injury.2018.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/05/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fracture-related infection (FRI) is one of the most challenging musculoskeletal complications in orthopaedic-trauma surgery. Although the orthopaedic community has developed and adopted a consensus definition of prosthetic joint infections (PJI), it still remains unclear how the trauma surgery community defines FRI in daily clinical practice or in performing clinical research studies. The central aim of this study was to survey the opinions of a global network of trauma surgeons on the definitions and criteria they routinely use, and their opinion on the need for a unified definition of FRI. The secondary aims were to survey their opinion on the utility of currently used definitions that may be at least partially applicable for FRI, and finally their opinion on the important clinical parameters that should be considered as diagnostic criteria for FRI. METHODS An 11-item questionnaire was developed to cover the above-mentioned aims. The questionnaire was administered by SurveyMonkey and was sent via blast email to all registered users of AO Trauma (Davos, Switzerland). RESULTS Out of the 26'563 recipients who opened the email, 2'327 (8.8%) completed the questionnaire. Nearly 90% of respondents agreed that a consensus-derived definition for FRI is required and 66% of the surgeons also agreed that PJI and FRI are not equal with respect to diagnosis, treatment and outcome. Furthermore, "positive cultures from microbiology testing", "elevation of CRP", "purulent drainage" and "local clinical signs of infection" were voted the most important diagnostic parameters for FRI. CONCLUSION This international survey infers the need for a consensus definition of FRI and provides insight into the clinical parameters seen by an international community of trauma surgeons as being critical for defining FRI.
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Affiliation(s)
- M Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland
| | | | - R Kuehl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland
| | | | - M A McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - M H J Verhofstad
- Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - O Borens
- Department of Septic Surgery, Orthopaedic-Trauma Unit, Department for the Musculoskeletal System, CHUV, Lausanne, Switzerland
| | - C Zalavras
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - M Raschke
- Department of Orthopaedic and Trauma Surgery, University Hospital of Münster, Germany
| | - S L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, USA
| | - W J Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Belgium.
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Bozzo A, Oitment C, Evaniew N, Ghert M. The Journal Impact Factor of Orthopaedic Journals Does not Predict Individual Paper Citation Rate. J Am Acad Orthop Surg Glob Res Rev 2017; 1:e007. [PMID: 30211349 PMCID: PMC6132331 DOI: 10.5435/jaaosglobal-d-17-00007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The journal impact factor (JIF) is thought to reflect the average number of citations an article will receive and therefore can influence study impact and clinical decision making. However, analysis of citation rates across multiple scientific and research domains has shown that most articles will not reach this expected number of citations. This phenomenon is known as citation skew and it has not previously been examined in the orthopaedic literature. The objective of this study was to determine the extent to which citation skew exists within orthopaedic journals and thus to determine whether the JIF in the orthopaedic literature reflects individual study citation rates. METHODS We used data from the Thomson Reuters (now Clarivate Analytics) Web of Science to determine the 2015 JIF and citation distribution for all orthopaedic journals listed in the database. We calculated the percentage of articles with fewer citations than the JIF for each journal. Finally, we analyzed the citation distribution within groups of orthopaedic subspecialty publications. RESULTS We identified a total of 74 orthopaedic journals and 29,296 publications for the years 2013 and 2014. Across all orthopaedic journals, 85% of published articles are cited fewer times than the JIF would indicate. The median number of citations of all articles was zero for all journals (interquartile range = 0-0) except for seven journals, for which the median number of citations per article was 1. CONCLUSION Citation skew is prevalent across the orthopaedic literature. Most published work is not cited in the first 2 years following publication, and the JIFs are the result of a few highly cited articles. The assessment of an individual orthopaedic study's quality should not be determined by the JIF but rather by direct evaluation of the methodology, relevance, and appropriateness of the study's conclusions.
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Affiliation(s)
- Anthony Bozzo
- Division of Orthopaedic Surgery (Dr. Bozzo, Dr. Oitment, and Dr. Evaniew), Department of Surgery, McMaster University, Hamilton, Ontario, Canada, and Hamilton Health Sciences (Dr. Ghert), Juravinski Hospital and Cancer Center, Hamilton
| | - Colby Oitment
- Division of Orthopaedic Surgery (Dr. Bozzo, Dr. Oitment, and Dr. Evaniew), Department of Surgery, McMaster University, Hamilton, Ontario, Canada, and Hamilton Health Sciences (Dr. Ghert), Juravinski Hospital and Cancer Center, Hamilton
| | - Nathan Evaniew
- Division of Orthopaedic Surgery (Dr. Bozzo, Dr. Oitment, and Dr. Evaniew), Department of Surgery, McMaster University, Hamilton, Ontario, Canada, and Hamilton Health Sciences (Dr. Ghert), Juravinski Hospital and Cancer Center, Hamilton
| | - Michelle Ghert
- Division of Orthopaedic Surgery (Dr. Bozzo, Dr. Oitment, and Dr. Evaniew), Department of Surgery, McMaster University, Hamilton, Ontario, Canada, and Hamilton Health Sciences (Dr. Ghert), Juravinski Hospital and Cancer Center, Hamilton
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