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Nothofer S, Haselbeck-Koebler M, Zeitlinger M, Dorn C, Petroff D, Wrigge H, Dumps C, Heller AR, Simon P. Surgical Antibiotic Prophylaxis Dosing in Adult Patients with Obesity: A Comprehensive Review of Pharmacokinetic and Pharmacodynamic Data. Anesthesiology 2025; 142:929-948. [PMID: 40197453 DOI: 10.1097/aln.0000000000005410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2025]
Abstract
Surgical antibiotic prophylaxis is an important measure to prevent postoperative surgical site infections. Current guideline recommendations do not treat obesity specifically, although it can affect pharmacokinetics and pharmacodynamics. The objective of this review was to synthesize current evidence on the need for obesity-related dosing adjustments in surgical antibiotic prophylaxis. MEDLINE and Cochrane Library were searched for studies investigating antibiotic prophylaxis dosing in surgical patients with obesity. Outcomes of interest were pharmacokinetic parameters such as plasma and interstitial fluid concentrations, area under the concentration time curve in plasma and in interstitial fluid, and other pharmacokinetic measures. Thirty studies investigating cefazolin, cefoxitin, cefuroxime, piperacillin/tazobactam, meropenem, ertapenem, metronidazole, vancomycin, ciprofloxacin, and gentamicin were included in this analysis. Except for metronidazole, cefoxitin, and gentamicin, there is currently no evidence suggesting the need for dosing adjustments.
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Affiliation(s)
- Stefanie Nothofer
- Anaesthesiology and Intensive Care Medicine, University of Augsburg, Augsburg, Germany
| | | | - Markus Zeitlinger
- Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Christoph Dorn
- Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - David Petroff
- Clinical Trial Centre Leipzig, Leipzig University, Leipzig, Germany
| | - Hermann Wrigge
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Halle, Germany; Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Christian Dumps
- Cardioanesthesia, Anaesthesiology and Intensive Care Medicine, University of Augsburg, Augsburg, Germany
| | - Axel R Heller
- Anaesthesiology and Intensive Care Medicine, University of Augsburg, Augsburg, Germany
| | - Philipp Simon
- Intensive Care Medicine and Research, Anaesthesiology and Intensive Care Medicine, University of Augsburg, Augsburg, Germany
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Yang J, Zhang F, Xue H, Chen N, Yao Y, Li K, Wang Y. Genetically Predicted Body Composition and Risk of Surgical Site Infection: A Mendelian Randomization Study. Surg Infect (Larchmt) 2025; 26:95-103. [PMID: 39531261 DOI: 10.1089/sur.2024.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
Objective: This study employed uni-variable and multi-variable Mendelian randomization (MVMR) analyses, utilizing publicly available genome-wide association study (GWAS) data, to assess the causal relationship between body composition measures such as body mass index (BMI), waist circumference (WC), and the occurrence of surgical site infection (SSI). Patients and Methods: GWAS summary statistical data were obtained for BMI, WC, and SSI from the MRC Integrated Epidemiology Unit (MRC-IEU) database, inverse variance weighted (IVW) method was used as the main analysis, and supplement sensitivity analysis (including heterogeneity test, pleiotropy analysis, leave-one-out analysis, and Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO)) was used to check the robustness of the results. Results: The MR analysis showed that the increase in BMI and WC predicted by genes had a substantial causal effect on the incidence of SSI (IVW: odds ratio [OR] = 1.003, 95% confidence interval [CI] = 1.002-1.004, p < 0.001; IVW: OR = 1.003, 95% CI = 1.002-1.005, p < 0.001), respectively, and the MVMR analysis showed that after jointly incorporating smoking and alcohol parameters, the impact of BMI and WC on SSI remained substantial (OR = 1.003, 95% CI = 1.002-1.004, p < 0.001; OR = 1.004, 95% CI = 1.002-1.005, p < 0.001). Conclusion: We further support the causal relationship between increased body composition including BMI and WC and the occurrence of SSI, highlighting the importance of SSI prevention in patients with obesity. Further research is required to mitigate the occurrence of surgical incisions in patients with obesity in the future.
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Affiliation(s)
- Jinru Yang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fen Zhang
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hui Xue
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Nuo Chen
- School of Public Health, Hubei University of Medicine, Shiyan, China
| | - Yonghua Yao
- Head Nurse, Operating Room, West China Second Hospital, Chengdu, China
| | - Kun Li
- Department of Hepatobiliary and Pancreatic Surgery, Hubei Provincial Clinical Medicine Research Center for Minimally Invasive Diagnosis and Treatment of Hepatobiliary and Pancreatic Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Hubei, China
| | - Ying Wang
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Hubei, China
- Department of Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, China
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Ford BT, Kong R, Wellington IJ, Segreto FA, Mai DH, Zhou J, Urban W. Impact of Obesity, Smoking, and Age on 30-Day Postoperative Outcomes of Patients Undergoing Arthroscopic Meniscus Surgery. Orthopedics 2024:1-5. [PMID: 39208398 DOI: 10.3928/01477447-20240826-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND The purpose of this study was to evaluate the impact that obesity, smoking, and older age have on 30-day postoperative complications, reoperations, and readmissions of patients undergoing arthroscopic meniscectomy or meniscus repair. MATERIALS AND METHODS The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried to identify meniscus surgeries and operative outcomes between 2008 and 2016. Controlled regression analysis was then performed to evaluate for an association between obesity, age, and smoking and these outcomes. RESULTS While obesity showed no influence on adverse postoperative complications or reoperations, class I obesity was associated with a lower rate of readmission. Older age, smoking, and comorbidity burden were significant predictors of postoperative complications, reoperations, and/or readmissions. Age 80 years or older was particularly predictive of 30-day complications (odds ratio, 3.5; P<.001) and readmissions (odds ratio, 2.5; P=.004). CONCLUSION Obesity is not a major risk factor for complications when undergoing meniscus surgery, while age older than 70 years predicts negative short-term postoperative outcomes. [Orthopedics. 20XX;4X(X):XXX-XXX.].
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Dietz MJ, Chaharbakhshi EO, Roberts AJ, Gilligan PH, Kasicky KR, Pincavitch JD. Maintenance of Surgical Optimization in Total Joint Arthroplasty Patients. J Arthroplasty 2024; 39:1650-1655.e1. [PMID: 38216000 DOI: 10.1016/j.arth.2024.01.013] [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: 11/11/2022] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND There are increased efforts to maximize medical optimization to improve the outcomes of total joint arthroplasty (TJA). However, there is a paucity of literature demonstrating that optimized parameters are maintained throughout the perioperative period. METHODS A retrospective review of 877 elective TJA patients from 2015 to 2019 was conducted. Patients who underwent medical optimization for body mass index (BMI), hemoglobin A1c (HbA1c), hemoglobin, albumin, and smoking status were reviewed at the initial visit, preoperatively, time of surgery, and one year postoperatively. For each of these variables at each time point, patients were stratified into 3 optimization groups. Analyses were performed to identify mean time to optimization, loss of optimization, and maintenance of optimization. RESULTS Patients considered not optimized due to specific parameters at the initial visit were as follows: BMI (19%), HbA1c (13.5%), hemoglobin (16%), albumin (19%), and smoking status (9.5%). The mean time to optimization was 187.7 days [longest being BMI (220.1 days), and the shortest being HbA1c (60.9 days) (P = .0003)]. Patients who had intermediate optimization of BMI at the preoperative visit were at higher risk [odds ratio: 2.1 (0.97 to 4.6)] of worsening BMI by time of surgery (P < .0001). Between the preoperative and surgery time points, over 93.5% of patients maintained or improved optimization. CONCLUSIONS Surgeon led medical optimization efforts alongside a TJA program provide maintenance of, or improvement in optimization in more than half of TJA patients up to one year postoperatively. Patients who had a BMI between 40 and 45 at the preoperative visit are at significant risk of increasing their BMI by the day of surgery.
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Affiliation(s)
- Matthew J Dietz
- Department of Orthopaedics, Health Sciences Center, WVU School of Medicine, Morgantown, West Virginia
| | - Edwin O Chaharbakhshi
- Department of Orthopaedics, Health Sciences Center, WVU School of Medicine, Morgantown, West Virginia
| | - Austin J Roberts
- Department of Orthopaedics, Health Sciences Center, WVU School of Medicine, Morgantown, West Virginia
| | - Patrick H Gilligan
- Department of Orthopaedics, Health Sciences Center, WVU School of Medicine, Morgantown, West Virginia
| | - Kathryn R Kasicky
- Department of Orthopaedics, Health Sciences Center, WVU School of Medicine, Morgantown, West Virginia
| | - Jami D Pincavitch
- Department of Orthopaedics, Health Sciences Center, WVU School of Medicine, Morgantown, West Virginia
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Gutierrez-Naranjo JM, Moreira A, Valero-Moreno E, Bullock TS, Ogden LA, Zelle BA. -A machine learning model to predict surgical site infection after surgery of lower extremity fractures. INTERNATIONAL ORTHOPAEDICS 2024; 48:1887-1896. [PMID: 38700699 DOI: 10.1007/s00264-024-06194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/22/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE This study aimed to develop machine learning algorithms for identifying predictive factors associated with the risk of postoperative surgical site infection in patients with lower extremity fractures. METHODS A machine learning analysis was conducted on a dataset comprising 1,579 patients who underwent surgical fixation for lower extremity fractures to create a predictive model for risk stratification of postoperative surgical site infection. We evaluated different clinical and demographic variables to train four machine learning models (neural networks, boosted generalised linear model, naïve bayes, and penalised discriminant analysis). Performance was measured by the area under the curve score, Youdon's index and Brier score. A multivariate adaptive regression splines (MARS) was used to optimise predictor selection. RESULTS The final model consisted of five predictors. (1) Operating room time, (2) ankle region, (3) open injury, (4) body mass index, and (5) age. The best-performing machine learning algorithm demonstrated a promising predictive performance, with an area under the ROC curve, Youdon's index, and Brier score of 77.8%, 62.5%, and 5.1%-5.6%, respectively. CONCLUSION The proposed predictive model not only assists surgeons in determining high-risk factors for surgical site infections but also empowers patients to closely monitor these factors and take proactive measures to prevent complications. Furthermore, by considering the identified predictors, this model can serve as a reference for implementing preventive measures and reducing postoperative complications, ultimately enhancing patient outcomes. However, further investigations involving larger datasets and external validations are required to confirm the reliability and applicability of our model.
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Affiliation(s)
| | - Alvaro Moreira
- Department of Pediatrics, UT Health San Antonio, San Antonio, TX, USA.
| | | | - Travis S Bullock
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, 78229-3900, USA
| | - Liliana A Ogden
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, 78229-3900, USA
| | - Boris A Zelle
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, 78229-3900, USA.
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Albright JA, Meghani O, Rebello E, Karim O, Testa EJ, Daniels AH, Cruz AI. A Comparison of the Rates of Postoperative Infection Following Distal Radius Fixation Between Pediatric and Young Adult Populations: An Analysis of 32 368 Patients. Hand (N Y) 2024; 19:629-636. [PMID: 36564988 PMCID: PMC11141423 DOI: 10.1177/15589447221142896] [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] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infection following surgical fixation of a distal radius fracture can markedly compromise a patient's functional outcome. This study aimed to compare infection rates in pediatric (5-14 years) and adolescent (15-17 years) patients undergoing fixation of a distal radius fracture to a cohort of young adult (18-30 years) patients. METHODS A matched retrospective study was performed using PearlDiver to determine the rates of postoperative infection following distal radius fixation. χ2 and logistic regression were used to assess differences in rates, while linear regression was used to analyze rates of infection over time. RESULTS In 32 368 patients, young adults experienced postoperative infection at a significantly increased rate (odds ratio [OR] = 1.81; 95% confidence interval [CI], 1.45-2.27). This trend was consistent among the male (OR = 1.96; 1.49-2.57) and female (OR = 2.11, 1.37-3.27) cohorts. In the multivariate model, the adult cohort remained at increased risk (OR = 1.40; 95% CI, 1.04-1.89), with open fracture (OR = 4.99; 3.55-6.87), smoking (OR = 1.76; 1.22-2.48), hypertension (OR = 1.69; 1.20-2.33), and obesity (OR = 1.37; 1.02, 1.80) identified as other significant risk factors. There was no significant change in the rate of postoperative infections over the 11-year study period. CONCLUSION This study demonstrated that although surgical site infections following distal radius fixation are low in patients aged 30 years or younger (0.97%), young adults develop infections at a significantly increased rate. This is important for surgeons to recognize when counseling patients on the risks of surgical fixation.
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Coelho A, Alier A, Martínez-Diaz S, Puig-Verdié L, Gómez-Junyent J, García-Bernedo C, Pérez-Prieto D. High Rate of Undetected Infections in Failed Osteosynthesis of Pertrochanteric Fractures. J Orthop Trauma 2024; 38:327-332. [PMID: 38466816 DOI: 10.1097/bot.0000000000002801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The objective of this study was to assess the incidence of infection in patients with cutout after proximal femur fracture (PFF) osteosynthesis. METHODS DESIGN Retrospective cohort study. SETTING Third-level trauma center. PATIENT SELECTION CRITERIA Patients presenting with a cutout following PFF (OTA/AO 31A) osteosynthesis, between January 2007 and December 2020. OUTCOME MEASUREMENTS AND COMPARISONS The primary outcome was infection according to the European Bone and Joint Infection Society criteria. RESULTS Sixty-seven patients presenting with a cutout were included, with mean age of 83.3 years (range 63-96), and 51 (76.1%) were women. Of all cases, 16 (24.7%) presented a concomitant infection. The presence of concomitant infection was suspected preoperatively in only 3 of the cases. A subgroup analysis was performed between the cases with infection and those without infection, the groups being comparable in terms of demographic data and postoperative radiological criteria. Patients with underlying infection had a higher rate of surgical wound complication (56.3% vs. 22%, P = 0.014) and higher rates of leukocytosis (11.560 vs. 7.890, P = 0.023). CONCLUSION Faced with a cutout after osteosynthesis of a PFF, underlying infection should be considered as a possible etiological factor. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexandre Coelho
- Department of Orthopaedics, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Albert Alier
- Department of Orthopaedics, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Santos Martínez-Diaz
- Department of Orthopaedics, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Lluis Puig-Verdié
- Department of Orthopaedics, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Joan Gómez-Junyent
- Department of Infectious Diseases, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain; and
| | - Carlos García-Bernedo
- Department of Anesthesiology, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Daniel Pérez-Prieto
- Department of Orthopaedics, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Gupta A, Jain VK. Effect of weight-adjusted antimicrobial antibiotic prophylaxis on postoperative dosage and surgical site infection incidence in total joint arthroplasty. World J Orthop 2024; 15:318-320. [PMID: 38680674 PMCID: PMC11045471 DOI: 10.5312/wjo.v15.i4.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 03/01/2024] [Indexed: 04/16/2024] Open
Abstract
Surgical site infections (SSI) following total joint arthroplasty pose a significant concern for both providers and patients across the globe. Currently, administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI. However, the correct dosage and frequency of administration remains debatable. In this editorial, we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty. The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI. In addition, weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration, drug resistance, drug toxicity, and costs.
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Affiliation(s)
- Ashim Gupta
- Department of Orthopaedics and Regenerative Medicine, Future Biologics, Lawrenceville, GA 30043, United States
- Department of Orthopaedics, South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, United States
- Department of Regenerative Medicine, BioIntegrate, Lawrenceville, GA 30043, United States
- Department of Orthopaedics and Regenerative Medicine, Regenerative Orthopaedics, Noida 201301, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
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Magruder ML, Jacofsky D, Springer B, Scuderi GR, Hameed D, Mont MA. Semaglutide and Other GLP-1 Agonists: A Boon for the Arthroplasty Industry? J Arthroplasty 2024; 39:277-282. [PMID: 38182322 DOI: 10.1016/j.arth.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | | | - Bryan Springer
- OrthoCarolina - Hip & Knee Center and Atrium Musculoskeletal Institute, Charlotte, North Carolina
| | - Giles R Scuderi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Orthopaedic Institute, New York, New York
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Redais C, Murison JC, Bazile F, de L'Escalopier N, Grosset A. Preoperative antibiotics reduce early surgical site infections after orthopaedic implant removal: a propensity-matched cohort study. J Hosp Infect 2024; 143:18-24. [PMID: 38511861 DOI: 10.1016/j.jhin.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Implant removal in orthopaedics after fracture consolidation is a very common procedure but is still associated with a high rate of surgical site infection (SSI). Antibiotic prophylaxis is not recommended but advocated by some. AIM To assess the efficacy of antibiotic prophylaxis in the prevention of early SSI following orthopaedic implant removal. METHODS A monocentric retrospective cohort study was conducted. Patients who underwent orthopaedic implant removal procedures performed from 2016 to 2021 were included. A 1:1 propensity score matching function was used to create a cohort with matched baseline characteristics and associated risk factors for SSI. Inter-cohort comparison of the occurrence of SSI (superficial or deep) and revision surgery for SSI, after propensity score matching, was performed using the odds ratio to determine the effect of preoperative antibiotic prophylaxis. FINDINGS In total, 965 distinct surgical procedures were included. Of these, 69 (7.15%) had an SSI, 24 (35.7%) of which required surgical revision; 214 procedures (22.18%) were performed under preoperative antibiotic prophylaxis. The propensity-matched cohort consisted of 396 procedures (198 with and without antibiotic prophylaxis). The SSI rates were 11.11% and 3.03%, respectively, in the control and antibiotic prophylaxis groups (odds ratio: 0.25; 95% confidence interval: 0.099; 0.63; P = 0.011). No difference was found for revision surgery. CONCLUSION Preoperative administration of antibiotic prophylaxis considerably reduces the risk of SSI during the removal of an orthopaedic implant without increasing the risk of side-effects.
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Affiliation(s)
- C Redais
- Department of Orthopaedic, Trauma and Limb Reconstructive Surgery, Percy Military Teaching Hospital, Clamart, France
| | - J-C Murison
- Department of Orthopaedic, Trauma and Limb Reconstructive Surgery, Percy Military Teaching Hospital, Clamart, France
| | - F Bazile
- Department of Orthopaedic, Trauma and Limb Reconstructive Surgery, Percy Military Teaching Hospital, Clamart, France
| | - N de L'Escalopier
- Department of Orthopaedic, Trauma and Limb Reconstructive Surgery, Percy Military Teaching Hospital, Clamart, France
| | - A Grosset
- Department of Orthopaedic, Trauma and Limb Reconstructive Surgery, Percy Military Teaching Hospital, Clamart, France.
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Marin E, Lanzutti A. Biomedical Applications of Titanium Alloys: A Comprehensive Review. MATERIALS (BASEL, SWITZERLAND) 2023; 17:114. [PMID: 38203968 PMCID: PMC10780041 DOI: 10.3390/ma17010114] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
Titanium alloys have emerged as the most successful metallic material to ever be applied in the field of biomedical engineering. This comprehensive review covers the history of titanium in medicine, the properties of titanium and its alloys, the production technologies used to produce biomedical implants, and the most common uses for titanium and its alloys, ranging from orthopedic implants to dental prosthetics and cardiovascular devices. At the core of this success lies the combination of machinability, mechanical strength, biocompatibility, and corrosion resistance. This unique combination of useful traits has positioned titanium alloys as an indispensable material for biomedical engineering applications, enabling safer, more durable, and more efficient treatments for patients affected by various kinds of pathologies. This review takes an in-depth journey into the inherent properties that define titanium alloys and which of them are advantageous for biomedical use. It explores their production techniques and the fabrication methodologies that are utilized to machine them into their final shape. The biomedical applications of titanium alloys are then categorized and described in detail, focusing on which specific advantages titanium alloys are present when compared to other materials. This review not only captures the current state of the art, but also explores the future possibilities and limitations of titanium alloys applied in the biomedical field.
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Affiliation(s)
- Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Kyoto 606-8585, Japan
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100 Udine, Italy
- Biomedical Research Center, Kyoto Institute of Technology, Sakyo-ku, Kyoto 606-8585, Japan
| | - Alex Lanzutti
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100 Udine, Italy
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Farid Mojtahedi M, Sepidarkish M, Almukhtar M, Eslami Y, Mohammadianamiri F, Behzad Moghadam K, Rouholamin S, Razavi M, Jafari Tadi M, Fazlollahpour-Naghibi A, Rostami Z, Rostami A, Rezaeinejad M. Global incidence of surgical site infections following caesarean section: a systematic review and meta-analysis. J Hosp Infect 2023; 139:82-92. [PMID: 37308061 DOI: 10.1016/j.jhin.2023.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is a health-threatening complication following caesarean section (CS); however, to the authors' knowledge, there is no worldwide estimate of the burden of post-CS SSIs. Therefore, this systematic review and meta-analysis aimed to estimate the global and regional incidence of post-CS SSIs and associated factors. METHODS International scientific databases were searched systematically for observational studies published from January 2000 to March 2023, without language or geographical restrictions. The pooled global incidence rate was estimated using a random-effects meta-analysis (REM), and then stratified by World-Health-Organization-defined regions as well as by sociodemographic and study characteristics. Causative pathogens and associated risk factors of SSIs were also analysed using REM. Heterogeneity was assessed with I2. RESULTS In total, 180 eligible studies (207 datasets) involving 2,188,242 participants from 58 countries were included in this review. The pooled global incidence of post-CS SSIs was 5.63% [95% confidence interval (CI) 5.18-6.11%]. The highest and lowest incidence rates for post-CS SSIs were estimated for the African (11.91%, 95% CI 9.67-14.34%) and North American (3.87%, 95% CI 3.02-4.83%) regions, respectively. The incidence was significantly higher in countries with lower income and human development index levels. The pooled incidence estimates have increased steadily over time, with the highest incidence rate during the coronavirus disease 2019 pandemic (2019-2023). Staphylococcus aureus and Escherichia coli were the most prevalent pathogens. Several risk factors were identified. CONCLUSION An increasing and substantial burden from post-CS SSIs was identified, especially in low-income countries. Further research, greater awareness and the development of effective prevention and management strategies are warranted to reduce post-CS SSIs.
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Affiliation(s)
- M Farid Mojtahedi
- Department of Obstetrics and Gynaecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | | | - Y Eslami
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - F Mohammadianamiri
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - S Rouholamin
- Department of Obstetrics and Gynaecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Razavi
- Department of Obstetrics and Gynaecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - M Jafari Tadi
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, IL, USA
| | - A Fazlollahpour-Naghibi
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Z Rostami
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - A Rostami
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - M Rezaeinejad
- Department of Obstetrics and Gynaecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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Chen T, Liu C, Zhang Z, Liang T, Zhu J, Zhou C, Wu S, Yao Y, Huang C, Zhang B, Feng S, Wang Z, Huang S, Sun X, Chen L, Zhan X. Using Machine Learning to Predict Surgical Site Infection After Lumbar Spine Surgery. Infect Drug Resist 2023; 16:5197-5207. [PMID: 37581167 PMCID: PMC10423613 DOI: 10.2147/idr.s417431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/26/2023] [Indexed: 08/16/2023] Open
Abstract
Objective The objective of this study was to utilize machine learning techniques to analyze perioperative factors and identify blood glucose levels that can predict the occurrence of surgical site infection following posterior lumbar spinal surgery. Methods A total of 4019 patients receiving lumbar internal fixation surgery from an institute were enrolled between June 2012 and February 2021. First, the filtered data were randomized into the test and verification groups. Second, in the test group, specific variables were screened using logistic regression analysis, Lasso regression analysis, support vector machine, and random forest. Specific variables obtained using the four methods were intersected, and a dynamic model was constructed. ROC and calibration curves were constructed to assess model performance. Finally, internal model performance was verified in the verification group using ROC and calibration curves. Results The data from 4019 patients were collected. In total, 1327 eligible cases were selected. By combining logistic regression analysis with three machine learning algorithms, this study identified four predictors associated with SSI, namely Modic changes, sebum thickness, hemoglobin, and glucose. Using this information, a prediction model was developed and visually represented. Then, we constructed ROC and calibration curves using the test group; the area under the ROC curve was 0.988. Further, calibration curve analysis revealed favorable consistency of nomogram-predicted values compared with real measurements. The C-index of our model was 0.986 (95% CI 0.981-0.994). Finally, we used the validation group to validate the model internally; the AUC was 0.987. Calibration curve analysis revealed favorable consistency of nomogram-predicted values compared with real measurements. The C-index was 0.982 (95% CI 0.974-0.999). Conclusion Logistic regression analysis and machine learning were employed to select four risk factors: Modic changes, sebum thickness, hemoglobin, and glucose. Then, a dynamic prediction model was constructed to help clinicians simplify the monitoring and prevention of SSI.
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Affiliation(s)
- Tianyou Chen
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Chong Liu
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Zide Zhang
- Spine Ward, Liuzhou People’s Hospital, Liuzhou, People’s Republic of China
| | - Tuo Liang
- Spine Ward, Liuzhou People’s Hospital, Liuzhou, People’s Republic of China
| | - Jichong Zhu
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Chenxing Zhou
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Shaofeng Wu
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yuanlin Yao
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Chengqian Huang
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Bin Zhang
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Sitan Feng
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Zequn Wang
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Shengsheng Huang
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Xuhua Sun
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Liyi Chen
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Xinli Zhan
- Department of Spine and Osteopathy Ward, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
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Lee D, Lee R, Weinreb J, Chalif E, Mohile N, Heyer JH, O'Brien J. Risk Factors for Surgical Site Infections After Single-Level Anterior Lumbar Interbody Fusion. Surg Infect (Larchmt) 2023. [PMID: 37327050 DOI: 10.1089/sur.2023.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Abstract Background: Anterior lumbar interbody fusion (ALIF) has become an increasingly popular and effective treatment modality for various conditions of the lumbar spine. However, complications after this procedure can be costly. Surgical site infections (SSIs) are one of these types of complications. The present study identifies independent risk factors for SSI after single-level ALIF to identify high-risk patients better. Patients and Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify single-level ALIF patients from 2005 to 2016. Multilevel fusions and non-anterior approach procedures were excluded. Mann-Pearson χ2 tests analyzed categorical variables, whereas one-way analysis of variance (ANOVA) and independent t-tests analyzed differences in mean values of continuous variables. Risk factors for SSI were identified via a multivariable logistic regression model. A receiver operating characteristic (ROC) curve was generated utilizing the predicted probabilities. Results: A total of 10,017 patients met inclusion criteria; 80 (0.80%) had developed SSI and 9,937 (99.20%) had not. On multivariable logistic regression models, class 3 obesity (p = 0.014), dialysis (p = 0.025), long-term steroid use (p = 0.010), and wound classification 4 (dirty/infected) (p = 0.002) all independently increased the risk for SSI in single-level ALIF. The area under the receiver operating characteristic curve (AUROC; C-statistic) was 0.728 (p < 0.001), indicating relatively strong reliability of the final model. Conclusions: Several independent risk factors including obesity, dialysis, long-term steroid use, and dirty wound classification all increased risk for SSI after single-level ALIF. By identifying these high-risk patients, surgeons and patients can have more informed pre-operative discussions. In addition, identifying and optimizing these patients prior to operative intervention may help to minimize infection risk.
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Affiliation(s)
- Danny Lee
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, Florida, USA
| | - Ryan Lee
- Department of Anesthesiology, Rutgers University Newark Health System, Newark, New Jersey, USA
| | - Jeffrey Weinreb
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Eric Chalif
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Neil Mohile
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, Florida, USA
| | - Jessica H Heyer
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Joseph O'Brien
- Washington Spine and Scoliosis Institute, OrthoBethesda, Bethesda, Maryland, USA
- Department of Spine Surgery, Virginia Hospital Center, Arlington, Virginia, USA
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15
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Liu X, Hou Y, Shi H, Zhao T, Shi H, Shi J, Shi G. A meta-analysis of risk factors for non-superficial surgical site infection following spinal surgery. BMC Surg 2023; 23:129. [PMID: 37194060 DOI: 10.1186/s12893-023-02026-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is the most common complications in spinal surgery. In SSI, non-superficial surgical site infections are more likely to result in poor clinical outcomes. It has been reported that there are multiple factors contributing to postoperative non-superficial SSI, but still remains controversial. Therefore, the aim of this meta-analysis is to investigate the potential risk factors for non-superficial SSI following spinal surgery. METHODS A systematic database search of PubMed, Embase, Web of Science, Cochrane Library and Clinical Trials was performed for relevant articles published until September 2022. According to the inclusion and exclusion criteria, two evaluators independently conducted literature screening, data extraction and quality evaluation of the obtained literature. The Newcastle-Ottawa Scale (NOS) score was used for quality evaluation, and meta-analysis was performed by STATA 14.0 software. RESULTS A total of 3660 relevant articles were initially identified and 11 articles were finally included in this study for data extraction and meta-analysis. The results of meta-analysis showed that the diabetes mellitus, obesity, using steroids, drainage time and operative time were related to the non-superficial SSI. The OR values (95%CI) of these five factors were 1.527 (1.196, 1.949); 1.314 (1.128, 1.532); 1.687(1.317, 2.162); 1.531(1.313, 1.786) and 4.255(2.612, 6.932) respectively. CONCLUSIONS Diabetes mellitus, obesity, using steroids, drainage time and operative time are the current risk factors for non-superficial SSI following spinal surgery. In this study, operative time is the most important risk factor resulting in postoperative SSI.
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Affiliation(s)
- Xiaowen Liu
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Yang Hou
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Hongyang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Tianyi Zhao
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Haoyang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Jiangang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Guodong Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China.
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Martín-Fuentes M, Varas de Dios B, Valverde Villar AM, Sánchez Almaraz R, Pérez Torres A, Iglesias Domínguez L, Muñoz García N, Guindal Pérez Y, Aragonés Maza P, Reche Sainz CM, Espina Flores I, Neira Borrajo I, Romero Estarlich V. [Nutritional, bone and body composition assessment of patients with knee and hip arthroplasty]. NUTR HOSP 2023. [PMID: 37073743 DOI: 10.20960/nh.04341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION malnutrition, both due to deficiency and excess of nutrients, is related to the morbidity of the surgical patient. OBJECTIVES to analyze the nutritional status, body composition and bone health of patients undergoing elective knee and hip arthroplasty. METHODS an observational cross-sectional study was carried out evaluating patients undergoing hip and knee replacement surgery from February to September 2019. The Malnutrition Universal Screening Tool (MUST), anthropometry, hand-grip dynamometry, bone densitometry, lumbar spine X-ray and bioimpedance analysis were performed. RESULTS eighty-six patients (61.6 % women) were evaluated, with a mean age of 69.5 ± 9.5 years. The mean body mass index (BMI) was 31.3 ± 4.5. According to MUST, 21.3 % were at risk of malnutrition; 16.9 % had decreased triceps skinfold with respect to p50 and 20 % had a pathological hand-grip dynamometry. In 91.4 %, vitamin D was < 30 pg/ml. In the bioimpedanciometry, the women presented significantly decreased muscle mass values. Age was correlated with a lower presence of fat-free mass, total and appendicular muscle mass. In those over 65 years of age, 52.6 % of men vs 14.3 % of women had a decreased muscle mass index; 58.5 % had low bone mineral density. We observed vertebral bone collapses in 13.9 %. CONCLUSION there is a high prevalence of obesity in patients who are candidates for arthroplasty and this does not exclude the existence of a risk of malnutrition. They may also have decreased muscle mass and strength. Nutritional education and physical exercise recommendations are essential in order to optimize nutritional status for surgery.
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Affiliation(s)
| | | | | | | | | | | | - Nuria Muñoz García
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
| | - Yolanda Guindal Pérez
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
| | - Paloma Aragonés Maza
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
| | | | - Irene Espina Flores
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
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Huang N, Miles DT, Read CR, White CC, Murray RD, Wilson AW, Doty JF. Postoperative Infection and Revision Surgery Rates in Foot and Ankle Surgery Without Routine Prescription of Prophylactic Antibiotics. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202303000-00005. [PMID: 36888925 PMCID: PMC9997784 DOI: 10.5435/jaaosglobal-d-23-00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Surgical site infections (SSIs) are associated with patient morbidity and increased healthcare costs. Limited literature in foot and ankle surgery provides guidance about routine administration of postoperative antibiotic prophylaxis. The purpose of this study was to examine the incidence and revision surgery rates of SSI in outpatient foot and ankle surgeries in patients not receiving oral postoperative antibiotic prophylaxis. METHODS A retrospective review of all outpatient surgeries (n = 1517) conducted by a single surgeon in a tertiary referral academic center was conducted through electronic medical records. Incidence of SSI, revision surgery rate, and associated risk factors were determined. The median follow-up was 6 months. RESULTS Postoperative infection occurred in 2.9% (n = 44) of the surgeries conducted, with 0.9% of patients (n = 14) requiring return to the operating room. Thirty patients (2.0%) were diagnosed with simple superficial infections, which resolved with local wound care and oral antibiotics. Diabetes (adjusted odds ratio, 2.09; 95% confidence interval, 1.00 to 4.38; P = 0.049) and increasing age (adjusted odds ratio, 1.02; 95% confidence interval, 1.00 to 1.04; P = 0.016) were significantly associated with postoperative infection. DISCUSSION This study demonstrated low postoperative infection and revision surgery rates without the routine prescription of prophylactic postoperative antibiotics. Increasing age and diabetes are signficant risk factors for developing a postoperative infection.
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Lian J, Wang Y, Yan X, Xu G, Jia M, Yang J, Ying J, Teng H. Development and validation of a nomogram to predict the risk of surgical site infection within 1 month after transforaminal lumbar interbody fusion. J Orthop Surg Res 2023; 18:105. [PMID: 36788621 PMCID: PMC9930234 DOI: 10.1186/s13018-023-03550-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/19/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Surgical site infection (SSI), a common serious complication within 1 month after transforaminal lumbar interbody fusion (TLIF), usually leads to poor prognosis and even death. The objective of this study is to investigate the factors related to SSI within 1 month after TLIF. We have developed a dynamic nomogram to change treatment or prevent infection based on accurate predictions. MATERIALS AND METHODS We retrospectively analyzed 383 patients who received TLIF at our institution from January 1, 2019, to June 30, 2022. The outcome variable in the current study was the occurrence of SSI within 1 month after surgery. Univariate logistic regression analysis was first performed to assess risk factors for SSI within 1 month after surgery, followed by inclusion of significant variables at P < 0.05 in multivariate logistic regression analysis. The independent risk variables were subsequently utilized to build a nomogram model. The consistency index (C-index), calibration curve and receiver operating characteristic curve were used to evaluate the performance of the model. And the decision curve analysis (DCA) was used to analyze the clinical value of the nomogram. RESULTS The multivariate logistic regression models further screened for three independent influences on the occurrence of SSI after TLIF, including lumbar paraspinal (multifidus and erector spinae) muscles (LPM) fat infiltration, diabetes and surgery duration. Based on the three independent factors, a nomogram prediction model was built. The area under the curve for the nomogram including these predictors was 0.929 in both the training and validation samples. Both the training and validation samples had high levels of agreement on the calibration curves, and the nomograms C-index was 0.929 and 0.955, respectively. DCA showed that if the threshold probability was less than 0.74, it was beneficial to use this nomograph to predict the risk of SSI after TLIF. In addition, the nomogram was converted to a web-based calculator that provides a graphical representation of the probability of SSI occurring within 1 month after TLIF. CONCLUSION A nomogram including LPM fat infiltration, surgery duration and diabetes is a promising model for predicting the risk of SSI within 1 month after TLIF. This nomogram assists clinicians in stratifying patients, hence boosting decision-making based on evidence and personalizing the best appropriate treatment.
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Affiliation(s)
- Jiashu Lian
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Yu Wang
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Xin Yan
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Guoting Xu
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Mengxian Jia
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Jiali Yang
- grid.417384.d0000 0004 1764 2632Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027 Zhejiang China
| | - Jinwei Ying
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Honglin Teng
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500, Zhejiang, China.
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Abstract
IMPORTANCE Approximately 0.5% to 3% of patients undergoing surgery will experience infection at or adjacent to the surgical incision site. Compared with patients undergoing surgery who do not have a surgical site infection, those with a surgical site infection are hospitalized approximately 7 to 11 days longer. OBSERVATIONS Most surgical site infections can be prevented if appropriate strategies are implemented. These infections are typically caused when bacteria from the patient's endogenous flora are inoculated into the surgical site at the time of surgery. Development of an infection depends on various factors such as the health of the patient's immune system, presence of foreign material, degree of bacterial wound contamination, and use of antibiotic prophylaxis. Although numerous strategies are recommended by international organizations to decrease surgical site infection, only 6 general strategies are supported by randomized trials. Interventions that are associated with lower rates of infection include avoiding razors for hair removal (4.4% with razors vs 2.5% with clippers); decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures (0.8% with decolonization vs 2% without); use of chlorhexidine gluconate and alcohol-based skin preparation (4.0% with chlorhexidine gluconate plus alcohol vs 6.5% with povidone iodine plus alcohol); maintaining normothermia with active warming such as warmed intravenous fluids, skin warming, and warm forced air to keep the body temperature warmer than 36 °C (4.7% with active warming vs 13% without); perioperative glycemic control (9.4% with glucose <150 mg/dL vs 16% with glucose >150 mg/dL); and use of negative pressure wound therapy (9.7% with vs 15% without). Guidelines recommend appropriate dosing, timing, and choice of preoperative parenteral antimicrobial prophylaxis. CONCLUSIONS AND RELEVANCE Surgical site infections affect approximately 0.5% to 3% of patients undergoing surgery and are associated with longer hospital stays than patients with no surgical site infections. Avoiding razors for hair removal, maintaining normothermia, use of chlorhexidine gluconate plus alcohol-based skin preparation agents, decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures, controlling for perioperative glucose concentrations, and using negative pressure wound therapy can reduce the rate of surgical site infections.
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Affiliation(s)
- Jessica L Seidelman
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Christopher R Mantyh
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
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Muacevic A, Adler JR, Liu JN, Ponce BA, Phipatanakul WP. Percutaneous Intramedullary Nailing of Complex Humeral Shaft Fractures: A Retrospective Case Series. Cureus 2022; 14:e32999. [PMID: 36712726 PMCID: PMC9879284 DOI: 10.7759/cureus.32999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Humeral diaphyseal fractures have been traditionally stabilized with plates and screws. However, surgical morbidity can be quite extensive, particularly in more complex segmental and comminuted fracture patterns. An intramedullary nail (IMN) has the biomechanical advantage of being a load-sharing device and can be placed with a more minimally invasive technique. The purpose of this study was to evaluate the clinical and radiographic outcomes of complex humeral shaft fractures treated with an IMN utilizing a percutaneous surgical technique. METHODS A retrospective review was performed on a consecutive series of patients who underwent treatment of a complex humeral shaft fracture with an IMN placed with a percutaneous technique. Clinical outcome scores and radiographic analysis were performed at a minimum one-year follow-up. RESULTS Of the 14 patients included, 12 had clinical and radiographic follow-ups at one year. The majority (64%) were obese and involved polytrauma (50%), and 79% were AO Foundation/Orthopaedic Trauma Association (AO/OTA) type C fractures. Union after the index procedure was 93%, with one nonunion requiring a secondary operation. The average operative time was 103 minutes. There were no other complications or additional procedures. The mean clinical outcome scores included American Shoulder and Elbow Society (ASES): 78.2, Constant Score: 72.1, Single Assessment Numerical Evaluation (SANE): 81.9, and Penn Shoulder Score: 82.7. CONCLUSION This study demonstrates complex comminuted and segmental humeral shaft fractures in a higher-risk patient population can be effectively managed with IMN. Percutaneous placement of an IMN should be considered as a treatment option in complex humeral shaft fractures, particularly in patients with secondary comorbidities such as obesity and polytrauma.
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Chua WC, Rahman SA, Deris ZZ. Prevalence, Risk Factors and Microbiological Profile of Orthopaedic Surgical Site Infection in North-Eastern Peninsular Malaysia. Malays Orthop J 2022; 16:94-103. [PMID: 36589372 PMCID: PMC9791909 DOI: 10.5704/moj.2211.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/31/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The devastating outcome of orthopaedic surgical site infections (SSI) are largely preventable if its risk factors, causative organisms and antimicrobial susceptibility patterns in the regional area are known. Materials and methods We conducted a retrospective study to address the lack of epidemiological and microbiological data on orthopaedic SSI in Malaysia. All the 80 patients diagnosed and treated for microbiologically proven orthopaedic SSIs in a tertiary hospital in Malaysia from April 2015 to March 2019 were included in a 1:2 case control study. Results The prevalence of SSI in clean and clean-contaminated surgeries was 1.243%, which is consistent with most of the studies worldwide, but is low compared to other studies done in Malaysia. The most common type of orthopaedics SSI were internal fixation infections (46.25%), superficial SSIs (25.2%) and Prosthetic joint infections (18.75%). Obesity and tobacco use were found to be significant risk factors of orthopaedic SSI. The most common perioperative prophylaxis used was IV cefuroxime. Majority of the cases (86.5%) received prolonged prophylactic antibiotics. The most common causative agent was Staphylococcus aureus (31.25%), followed by Pseudomonas aeruginosa (26.25%) and Enterobacter spp (7.5%). Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 20% of the S. aureus infections. Up to 19.4% of the Gram-negative organisms are multidrug resistant. The higher rate of isolation of organisms resistant to the prophylactic antibiotics being used may be related to the prolonged use of prophylactic antibiotics, which exerted selective pressure for the acquisition of resistant organisms. Conclusion Despite its relatively low prevalence in our local institution and worldwide, the prevention of SSI in orthopaedic practice is crucial to avoid morbidity, mortality and high healthcare cost. This may be achieved by control of modifiable risk factors such as obesity and tobacco use, appropriate use of prophylactic antibiotics and implementation of good surgical and infection control practices.
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Affiliation(s)
- WC Chua
- Department of Medical Microbiology and Parasitology, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - SA Rahman
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - ZZ Deris
- Department of Medical Microbiology and Parasitology, Universiti Sains Malaysia, Kubang Kerian, Malaysia,Corresponding Author: Zakuan Zainy Deris, Department Medical Microbiology and Parasitology, Universiti Sains Malaysia, Kubang Kerian, Malaysia ;
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22
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Dombovy-Johnson ML, D'Souza RS, Ha CT, Hagedorn JM. Incidence and Risk Factors for Spinal Cord Stimulator Lead Migration With or Without Loss of Efficacy: A Retrospective Review of 91 Consecutive Thoracic Lead Implants. Neuromodulation 2022; 25:731-737. [PMID: 35803679 DOI: 10.1111/ner.13487] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/12/2021] [Accepted: 06/07/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Lead migration after spinal cord stimulator (SCS) implant is a commonly reported complication and the most common reason for revision surgery in cases of loss of efficacy. The primary aims of this study are to describe the incidence and degree of lead migration in the subacute postoperative period after SCS implant and to report potential risk factors for lead migration. MATERIALS AND METHODS We performed a retrospective chart review of all patients at a single academic center who received an SCS implant from January 1, 2020, to December 31, 2020. Information on patient (age, sex, weight, and height) and operative factors (device manufacturer, epidural access level and method, and implantable pulse generator location) were extracted from medical records. Intraoperative imaging was compared to subacute follow-up imaging obtained less than 20 days postimplant to measure lead migration distance. Regression models were fitted to determine associations between lead migration distance and potential clinical risk factors. RESULTS A total of 91 cases (182 leads) were included in the study. Within 20 days of implantation, 88.5% of leads had migrated (86.3% caudal and 2.2% cephalad). Mean migration distance for leads with caudal migration only was 12.34 ± 12.19 mm based on anteroposterior radiographs and 16.95 ± 15.68 mm on lateral radiographs. There was an association of greater caudal lead migration as patient body mass index increased (β-coefficient 0.07 [95% confidence interval 0.01-0.13], p = 0.031). Within the entire cohort, one patient (1.1%) required lead revision for loss of efficacy. CONCLUSIONS In the subacute postoperative period after SCS implant, the majority of SCS leads migrated caudally with an average of two lead contacts. Knowledge of this expected migration and risk factors can better inform implanting physicians intraoperatively when deciding final lead placement location. The finding of high likelihood of caudal lead migration in the subacute postoperative period brings the need for a well-designed prospective study to the forefront of our field. This will allow implanting providers to make well-informed decisions for intraoperative lead placement.
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Affiliation(s)
- Marissa L Dombovy-Johnson
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chris Thuc Ha
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
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Krizsan G, Sallai I, Veres DS, Prinz G, Szeker D, Skaliczki G. Rifampicin resistance and risk factors associated with significantly lower recovery rates after two stage revision in patients with prosthetic joint infection. J Glob Antimicrob Resist 2022; 30:231-236. [PMID: 35764215 DOI: 10.1016/j.jgar.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/07/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Rifampicin plays a key role in the management of prosthetic joint infections (PJIs), however, the emergence of rifampicin resistance is associated with less favorable clinical outcomes. The purpose of this study was to investigate the impact of rifampicin resistance and other patient-related factors on recovery rates among patients with PJI undergoing two-stage revision. METHODS We reviewed medical records and microbiology reports of 73 patients (41 males and 32 females) undergoing two-stage revision due to PJI between 2017 and 2019. Patient-specific data, co-morbidities and the antibiotic resistance of microbiological isolates were registered. 48 patients had hip, 22 had knee, 2 had shoulder and 1 had elbow joint infection. Obtained data were statistically analyzed with a logistic regression model. RESULTS Rifampicin-sensitive organism was isolated in 53 cases (72.6%). Recovery rate was 92.5% in the sensitive and 60.0% in the resistant group. We observed that rifampicin resistance significantly reduced the probability of recovery. Furthermore, in the rifampicin-sensitive group, the probability of recovery decreased with advancing age with a significant drop above the age of 60 years. The effect of age is negligible in the rifampicin-resistant group. We also found that type 2 diabetes mellitus has a negative effect on recovery. Coagulase-negative Staphylococci were predominant in the rifampicin-sensitive (50% of the isolates) and Gram-negative rods in the resistant group (40%). CONCLUSIONS Rifampicin resistance was associated with lower recovery rates among patients undergoing two-stage revision due to PJI. Higher age and type 2 diabetes mellitus had negative impact on clinical outcome.
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Affiliation(s)
- Gergely Krizsan
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Imre Sallai
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Daniel Sandor Veres
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Gyula Prinz
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Donat Szeker
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gabor Skaliczki
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
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Song K, Zhu B, Jiang Q, Xiong J, Shi H. The radiographic soft tissue thickness is associated with wound complications after open reduction and internal fixation of patella fractures. BMC Musculoskelet Disord 2022; 23:539. [PMID: 35668370 PMCID: PMC9169402 DOI: 10.1186/s12891-022-05498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background Displaced patella fracture is commonly treated with open reduction and internal fixation (ORIF). Wound complications after surgery often lead to prolonged hospitalization and dissatisfaction of patients. Periarticular adiposity and swelling may be associated with wound complications. The purpose of this study is to determine the relationship between periarticular soft tissue thickness and wound complications after ORIF of patella fractures. Methods We retrospectively studied 237 patients undergoing ORIF for patella fractures from June 2017 to February 2021 at our institution. We established periarticular soft tissue thickness ratio (PSTTR) to evaluate soft tissue status on lateral knee X-ray radiographs. Univariate analysis was performed to identify the association between PSTTR and postoperative wound complication. A receiver-operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of PSTTR. Results The incidence of postoperative wound complication was 10.5%. Minor wound complication occurred in 24 patients, and major wound complication occurred in one patient. The average femoral PSTTR (fPSTTR) was 0.94 ± 0.17 and the average tibial PSTTR (tPSTTR) was 0.66 ± 0.16. fPSTTR proved to be associated with postoperative wound complication. In the ROC analysis of fPSTTR predicting postoperative wound complication, the area under curve (AUC) was 0.676, which indicated a moderate predictive value. Conclusions PSTTR was a feasible method to assess periarticular soft tissue. The increased fPSTTR was associated with wound complications after ORIF of patella fractures.
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Lu V, Zhang J, Patel R, Zhou AK, Thahir A, Krkovic M. Fracture Related Infections and Their Risk Factors for Treatment Failure—A Major Trauma Centre Perspective. Diagnostics (Basel) 2022; 12:diagnostics12051289. [PMID: 35626444 PMCID: PMC9141112 DOI: 10.3390/diagnostics12051289] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 12/25/2022] Open
Abstract
Fracture related infections (FRI) are debilitating and costly complications of musculoskeletal trauma surgery that can result in permanent functional loss or amputation. Surgical treatment can be unsuccessful, and it is necessary to determine the predictive variables associated with FRI treatment failure, allowing one to optimise them prior to treatment and identify patients at higher risk. The clinical database at a major trauma centre was retrospectively reviewed between January 2015 and January 2021. FRI treatment failure was defined by infection recurrence or amputation. A univariable logistic regression analysis was performed, followed by a multivariable regression analysis for significant outcomes between groups on univariable analysis, to determine risk factors for treatment failure. In total, 102 patients were identified with a FRI (35 open, 67 closed fractures). FRI treatment failure occurred in 24 patients (23.5%). Risk factors determined by our multivariate logistic regression model were obesity (OR 2.522; 95% CI, 0.259–4.816; p = 0.006), Gustilo Anderson type 3c (OR 4.683; 95% CI, 2.037–9.784; p = 0.004), and implant retention (OR 2.818; 95% CI, 1.588–7.928; p = 0.041). Given that FRI treatment in 24 patients (23.5%) ended up in failure, future management need to take into account the predictive variables analysed in this study, redirect efforts to improve management and incorporate adjuvant technologies for patients at higher risk of failure, and implement a multidisciplinary team approach to optimise risk factors such as diabetes and obesity.
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Affiliation(s)
- Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (J.Z.); (A.K.Z.)
- Correspondence:
| | - James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (J.Z.); (A.K.Z.)
| | - Ravi Patel
- Hull York Medical School, University Rd, Heslington, York YO10 5DD, UK;
| | - Andrew Kailin Zhou
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (J.Z.); (A.K.Z.)
| | - Azeem Thahir
- Addenbrookes Hospital, Hills Rd, Cambridge CB2 0QQ, UK; (A.T.); (M.K.)
| | - Matija Krkovic
- Addenbrookes Hospital, Hills Rd, Cambridge CB2 0QQ, UK; (A.T.); (M.K.)
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Mortality risk in patients with underweight or obesity with peripheral artery disease: a meta-analysis including 5,735,578 individuals. Int J Obes (Lond) 2022; 46:1425-1434. [PMID: 35577899 DOI: 10.1038/s41366-022-01143-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 04/24/2022] [Accepted: 05/03/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The "obesity paradox" - in which patients with obesity exhibit superior survival than normal-weight counterparts - has been reported for several diseases. However, obesity is a well-known risk factor for cardiovascular disease, and whether the obesity paradox is present in peripheral artery disease (PAD) is unknown. METHODS A comprehensive search for studies that reported mortality in patients with PAD grouped by BMI identified 12 studies. We compared the survival of underweight patients with those who were not underweight, and patients with obesity against those without. Underweight was defined by a BMI value of <18.5 kg/m2 in most studies and obesity by BMI ≥ 30 kg/m2. Subgroup analyses were performed according to length of follow-up, presentation of PAD, and mode of revascularization. Meta-regression analyses were conducted, with covariates including age, sex, presence of coronary artery disease (CAD) and diabetes mellitus (DM). RESULTS The mortality risk of underweight patients with PAD was significantly higher compared to those who are not underweight (HR 1.72, 95% CI 1.38-2.14; I2 = 84.2%). In contrast, the mortality risk of patients with obesity with PAD was significantly lower than those without (HR 0.78, 95% CI 0.62-0.97; I2 = 89.8%). These findings remained consistent regardless of the presentation of PAD, revascularization, age, sex, or presence of CAD. The risk of death in the short-term of underweight patients (HR 1.50, 95% CI 0.47-4.72) and patients with obesity (HR 0.86, 95% CI 0.66-1.13) were not significantly different from their counterparts. The meta-regression showed that of the association between obesity and better survival was more pronounced in studies with a greater proportion of patients with concomitant CAD (regression coefficient -0.029, 95% CI -0.054 to -0.004). CONCLUSIONS In patients with PAD, mortality is higher among underweight patients and lower among patients with obesity. The mechanisms underlying the obesity paradox in patients with PAD remain to be elucidated, and further evidence is required to guide optimal weight control strategies in these patients.
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Chen X, Lin GX, Rui G, Chen CM, Kotheeranurak V, Wu HJ, Zhang HL. Comparison of Perioperative and Postoperative Outcomes of Minimally Invasive and Open TLIF in Obese Patients: A Systematic Review and Meta‑Analysis. J Pain Res 2022; 15:41-52. [PMID: 35023969 PMCID: PMC8747800 DOI: 10.2147/jpr.s329162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/21/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Previous studies have demonstrated that minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) is comparable to the open approach in terms of efficacy and safety. However, few comparative studies of surgical procedures in patients with obesity show that they may react differently to open-TLIF (O-TLIF) and MI-LTIF approaches. PATIENTS AND METHODS The main indicators were complications, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) score, and secondary indicators were operative time, blood loss, and hospital stay. RESULTS No significant differences in the VAS and ODI scores for back pain at the last follow-up and wound infection rates were observed between the two groups. Dural tear incidence and complication rate were significantly lower in the MI-TLIF group than that in the O-TLIF group (P = 0.002 and 0.001, respectively). No significant difference in operative time was found between the two groups. There was less blood loss and shorter hospital stay (P = 0.001 and 0.002, respectively) in the MI-TLIF group than that in the O-TLIF group. CONCLUSION Compared with O-TLIF, MI-TLIF is an effective and safe surgical option for patients with obesity, which resulted in similar improvements in pain and functional disability, as well as a lower complication rate.
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Affiliation(s)
- Xin Chen
- Department of Fifth Surgical, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, People's Republic of China
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Vit Kotheeranurak
- Spine Unit, Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
| | - Hua-Jian Wu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Huang-Lin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
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Constantine RS, Le EL, Gehring MB, Ohmes L, Iorio ML. Risk Factors for Infection After Distal Radius Fracture Fixation: Analysis of Impact on Cost of Care. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:123-127. [PMID: 35601524 PMCID: PMC9120794 DOI: 10.1016/j.jhsg.2021.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Infection after distal radius fracture fixation can be a devastating complication, leading to potential hardware removal, prolonged antibiotic courses, multiple office visits, and increased costs. This study aimed to identify potential risk factors for infectious complications after distal radius fracture fixation and assess the impacts on cost. Methods This study used the PearlDiver national database, encompassing 53 million unique patients from January 1, 2010, to March 31, 2020. The cohort included patients undergoing distal radius fracture fixation. The endpoint was postoperative infection within 180 days of fixation. Two-sample t test was used to compare rates of infection between open and percutaneous fracture fixation techniques. A propensity-matched cohort was created using patient age, gender, and open fracture. Logistic regression analyses defined independent risk factors for developing a postoperative infection among all patients and within the matched cohorts. A Mann-Whitney U test was used to compare costs of care with and without infection. Results The database included 87,169 patients who underwent distal radius fracture fixation. Postoperative infections were identified in 781 patients (0.9%). There was a significant difference in rates of postoperative infection with percutaneous fixation (1.3%) versus open fixation (0.8%). Logistic regression analysis identified male gender, open fracture, lung disease, chronic kidney disease, diabetes, hypertension, liver disease, obesity, and tobacco to be independent risk factors for developing a postoperative infection. Logistic regression analysis of the propensity-matched cohorts identified tobacco use as a significant risk factor. The average cost of care for patients undergoing fracture fixation without an infection was $6,383, versus $23,355 for those with an infection, which was significantly different. Conclusions Multiple risk factors for postoperative infection were identified. Cost is significantly increased after postoperative infection, by almost 4-fold. Attempts to correct or optimize modifiable risk factors may lead to substantial cost savings, and potentially decreased rates of infection. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Ryan S. Constantine
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Elliot L.H. Le
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Michael B. Gehring
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Lucas Ohmes
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Matthew L. Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
- Corresponding author: Matthew L. Iorio, MD, Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 12631 E. 17th Ave, C309 (Room 6414), Aurora, CO 80045.
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Kilb MF, Moos Y, Eckes S, Braun J, Ritz U, Nickel D, Schmitz K. An Additively Manufactured Sample Holder to Measure the Controlled Release of Vancomycin from Collagen Laminates. Biomedicines 2021; 9:biomedicines9111668. [PMID: 34829897 PMCID: PMC8615449 DOI: 10.3390/biomedicines9111668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
The controlled release of antibiotics prevents the spread of pathogens and thereby improves healing processes in regenerative medicine. However, high concentrations may interfere with healing processes. It is therefore advantageous to use biodegradable materials for a controlled release. In particular, multilayer materials enable differential release at different surfaces. For this purpose, collagen sheets of different properties can be bonded by photochemical crosslinking. Here, we present the development and application of an easily accessible, additively manufactured sample holder to study the controlled release of vancomycin from modularly assembled collagen laminates in two directions. As proof-of-concept, we show that laminates of collagen sheets covalently linked by rose bengal and green light crosslinking (RGX) can be tightly inserted into the device without leakage from the upper to lower cavity. We used this sample holder to detect the release of vancomycin from symmetrically and asymmetrically loaded two-layer and three-layer collagen laminates into the upper and lower cavity of the sample holder. We show that these collagen laminates are characterized by a collagen type-dependent vancomycin release, enabling the control of antibiotic release profiles as well as the direction of antibiotic release.
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Affiliation(s)
- Michelle Fiona Kilb
- Clemens-Schöpf-Institute of Organic Chemistry and Biochemistry, Technical University of Darmstadt, Alarich-Weiss-Straße 8, 64287 Darmstadt, Germany; (M.F.K.); (S.E.)
| | - Yannik Moos
- Akademische Motorsportgruppe Darmstadt e.V., c/o Institut für Verbrennungskraftmaschinen und Fahrzeugantriebe, Otto-Berndt-Straße 2, 64287 Darmstadt, Germany;
| | - Stefanie Eckes
- Clemens-Schöpf-Institute of Organic Chemistry and Biochemistry, Technical University of Darmstadt, Alarich-Weiss-Straße 8, 64287 Darmstadt, Germany; (M.F.K.); (S.E.)
| | - Joy Braun
- Department of Orthopaedics and Traumatology, BiomaTiCS, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany; (J.B.); (U.R.)
| | - Ulrike Ritz
- Department of Orthopaedics and Traumatology, BiomaTiCS, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany; (J.B.); (U.R.)
| | - Daniela Nickel
- Berufsakademie Sachsen–Staatliche Studienakademie Glauchau, University of Cooperative Education, Kopernikusstraße 51, 08371 Glauchau, Germany;
| | - Katja Schmitz
- Clemens-Schöpf-Institute of Organic Chemistry and Biochemistry, Technical University of Darmstadt, Alarich-Weiss-Straße 8, 64287 Darmstadt, Germany; (M.F.K.); (S.E.)
- Correspondence: ; Tel.: +49-6151-16-21015
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Abstract
Surgical site infections (SSIs) are among the most common and most costly health care-associated infections, leading to adverse patient outcomes and death. Wound contamination occurs with each incision, but proven strategies exist to decrease the risk of SSI. In particular, improved adherence to evidence-based preventive measures related to appropriate antimicrobial prophylaxis can decrease the rate of SSI. Aggressive surgical debridement and effective antimicrobial therapy are needed to optimize the treatment of SSI.
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Affiliation(s)
- Jessica Seidelman
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC, USA.
| | - Deverick J Anderson
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC, USA
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Günther KP, Deckert S, Lützner C, Lange T, Schmitt J, Postler A. Clinical Practice Guideline: Total Hip Replacement for Osteoarthritis–Evidence-Based and Patient-Oriented Indications. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:730-736. [PMID: 34693905 DOI: 10.3238/arztebl.m2021.0323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/01/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Total Hip Replacement (THR) belongs to the most common inpatient operations in Germany, with over 240 000 procedures performed per year. 90% of the artificial joints are still functional at 15 years, and up to 60% at 20 years after surgery. It is essential that the indications for such procedures should be uniform, appropriate, and patient-oriented. METHODS This review is based on publications retrieved by a systematic literature search for national and international guidelines and systematic reviews on the topic of hip osteoarthritis and THR. RESULTS THR should be performed solely with radiologically demonstrated advanced osteoarthritis of the hip (Kellgren and Lawrence grade 3 or 4), after at least three months of conservative treatment, and in the presence of high subjective distress due to symptoms arising from the affected hip joint. Contraindications include refractory infection, acute or chronic accompanying illnesses, and BMI ≥ 40 kg/m2. Patients should stop smoking at least one month before surgery. In patients with diabetes mellitus, preoperative glycemic control to an HbA1c value below 8% is advisable. It is recommended that patients should lower their weight below a BMI of 30 kg/m2. CONCLUSION The decision to perform THR should be taken together by both the physician and the patient when the expected treatment benefit outweighs the risks. Evidence suggests that a worse preoperative condition is associated with a poorer surgical outcome.
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Surgical Site Infection Following Neuromuscular Posterior Spinal Fusion Fell 72% After Adopting the 2013 Best Practice Guidelines. Spine (Phila Pa 1976) 2021; 46:1147-1153. [PMID: 33826592 DOI: 10.1097/brs.0000000000004050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose of this study is to investigate the incidence of surgical site infection in neuromuscular scoliosis (NMS) patients at a tertiary children's hospital before and after the implementation of strategies mentioned in the 2013 Best Practice Guideline. SUMMARY OF BACKGROUND DATA Patients with NMS are at high risk for surgical site infection following spine surgery. In 2013, a Best Practice Guideline for surgical site infection prevention in high-risk pediatric spine surgery patients reported strategies to decrease incidence. To date, no studies have looked at the efficacy of these strategies. METHODS A retrospective review of surgical site infection in NMS patients was performed. NMS patients undergoing primary posterior spinal fusion from January 2008 to December 2012 (Group 1) and January 2014 to December 2018 (Group 2) were included, with 2013 excluded as a transition year. The primary outcome was incidence of surgical site infection within 1 year of surgery, as defined by the Centers for Disease Control and National Healthcare Safety Network. All patients had at least 1 year of documented follow-up. RESULTS One hundred ninety eight patients were included, 62 in Group 1 and 136 in Group 2. Age, BMI, sex, fusion to pelvis, preoperative Cobb angle, incontinence, drain use, blood loss, surgical time, and other perioperative values were similar (P > 0.05). Deep surgical site infection occurred in 10 (16.1%) patients in Group 1 and six (4.4%) patients in Group 2 (P = 0.005). Thirteen (59.1%) identified organisms were gram-negative, with 11 (84.6%) isolated from Group 1 (P = 0.047). Polymicrobial infections accounted for six (37.5%) infections overall. CONCLUSION The incidence of surgical site infection in NMS patients decreased significantly (16.1% vs. 4.4%) after the implementation of the strategies mentioned in the 2013 Best Practice Guideline. Further studies are required to continue to decrease the incidence in this high-risk population.Level of Evidence: 3.
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Gonçalves TJM, Gonçalves SEAB, Nava N, Jorge VC, Okawa AM, Rocha VA, Forato LCH, Furuya VAO, Martins SS, Oksman D. Perioperative Immunonutrition in Elderly Patients Undergoing Total Hip and Knee Arthroplasty: Impact on Postoperative Outcomes. JPEN J Parenter Enteral Nutr 2021; 45:1559-1566. [PMID: 33044001 PMCID: PMC8518379 DOI: 10.1002/jpen.2028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/20/2020] [Accepted: 10/01/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Arthroplasties in elderly patients are surgeries performed to ensure their quality of life. Perioperative care with specific nutrients can improve nutrition status and metabolic response to orthopedic surgeries, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA). METHODS Retrospective study with elderly patients divided into 2 groups: control and immunonutrition. The immunonutrition group was instructed to start oral intake of the nutrition supplement 5 days before and to resume it 5 days after arthroplasty (200 mL, 3 times per day). The following were analyzed as primary and secondary outcomes: length of stay (LOS), infectious and noninfectious complications, need for intensive care unit (ICU), transfusion requirement, and C-reactive protein. RESULTS A total of 3015 elderly patients met the inclusion criteria: control group (n = 1398) and immunonutrition group (n = 1617). Overall, 81.2% were women and mean age was 72.6 ± 6.9 years. Immunonutrition group had a shorter LOS in hours (32.0 ± 19.4 vs 56.0 ± 26.4; P < .001) and lower rates of infectious complications (2.2% vs 4.6%; P < .001). Noninfectious complications and need for ICU also had lower rates in the immunonutrition group. In the logistic regression analysis, immunonutrition reduced the chance of infectious complications by 55% (odds ratio [OR], 0.45; 95% CI, 0.30-0.68; P < .001) even after adjusting for variables (OR, 0.45; 95% CI, 0.28-0.71; P < .001). CONCLUSION Perioperative immunonutrition in elderly patients undergoing THA or TKA may shorten postoperative LOS and reduce infectious and noninfectious complications and transfusion requirement.
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Affiliation(s)
| | | | - Natássia Nava
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Valeria Conceição Jorge
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Andrea Massone Okawa
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Vanessa Azevedo Rocha
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | | | - Vicky Akemi Onizuca Furuya
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Sandra Salvador Martins
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Daniel Oksman
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
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Is obesity a risk factor in percutaneous hallux valgus surgery? Foot Ankle Surg 2021; 27:577-580. [PMID: 32800432 DOI: 10.1016/j.fas.2020.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/14/2020] [Accepted: 07/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Obesity and its relationship with higher rate of complications in orthopedic surgeries have been reported. There is no evidence of the relation between obesity and percutaneous foot surgery. Our objective was to evaluate obesity as a risk factor for complications and reoperations in percutaneous surgery of the hallux valgus. METHODS A total 532 feet were retrospectively reviewed in which a percutaneous hallux valgus correction was performed. Complications and surgical reoperations were recorded. Patients were divided into 2 groups: BMI less and greater than 30kg/m2. RESULTS There were no differences in the rate of complications or reoperations. The total complication rate was 8%. Obesity as an isolated risk factor, presented aOR=1.14 (95%CI 0.54-2.4, p=.714). The overall rate of reoperations was 9%. Obesity presented an aOR=0.64 (95%CI 0.27-1.49, p=.31). CONCLUSION Obesity has not been associated with a higher rate of complications and reoperations in percutaneous hallux valgus surgery. It is a safe procedure and BMI should not influence in the prognosis. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Horton SA, Hoyt BW, Zaidi SMR, Schloss MG, Joshi M, Carlini AR, Castillo RC, O'Toole RV. Risk factors for treatment failure of fracture-related infections. Injury 2021; 52:1351-1355. [PMID: 33863501 DOI: 10.1016/j.injury.2021.03.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/02/2021] [Accepted: 03/26/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Infection after fracture fixation is a potentially devastating outcome, and surgical management is frequently unsuccessful at clearing these infections. The purpose of this study is to determine if factors can be identified that are associated with treatment failure after operative management of a deep surgical site infection. METHODS We retrospectively reviewed the billing system at a Level I trauma center between March 2006 and December 2015. We identified 451 patients treated for deep surgical site infection after fracture fixation at our center. A multivariate regression analysis was then performed to evaluate for factors associated with treatment failure. RESULTS Mean follow-up was 2.3 years. One hundred fifty-six patients (35%) failed initial surgical management. Risk factors associated with treatment failure included initial culture results positive for polymicrobial organisms (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.0-2.4), removal of implants (OR, 1.9; 95% CI, 1.2-2.9), or Gustilo-Anderson IIIB/IIIC injury (OR, 2.0; 95% CI, 1.1-3.7). Increased body mass index and fulfilling the criteria to have a methicillin-resistant Staphylococcus aureus (MRSA) nasal swab screening showed a trend toward increased risk of failure. CONCLUSION Treatment failure after deep surgical site infection was relatively common. Three distinct factors (polymicrobial infection, removal of implants, and IIIB/C fracture) were associated with failure to eradicate the infection in the first series of surgeries and antibiotics. These data might help guide clinicians as they counsel patients on the risk of treatment failure and might focus efforts to improve treatment toward patients at higher risk of treatment failure.
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Affiliation(s)
- Steven A Horton
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Benjamin W Hoyt
- Department of Surgery, Orthopaedics, USU-Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Syed M R Zaidi
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael G Schloss
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Manjari Joshi
- R Adams Cowley Shock Trauma Center, Department of Infectious Disease, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anthony R Carlini
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Renan C Castillo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Seasonal impact on surgical site infections in hip fracture surgery: Analysis of 330,803 cases using a nationwide inpatient database. Injury 2021; 52:898-904. [PMID: 33082026 DOI: 10.1016/j.injury.2020.10.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND As the aging population progresses, the number of elderly hip fracture patients is increasing. Elderly patients with hip fractures have a high risk of perioperative complications. One of the major complications after surgery is surgical site infection (SSI), which requires additional surgical interventions and is associated with increased mortality. Previous literature has shown that the risk of SSI is higher during the summer season in orthopedic surgery. However, little is known about the seasonal differences in the risk of SSI after hip fracture surgery. In this study, we aimed to identify the association between seasonality and SSI. METHODS We enrolled a total of 330,803 patients undergoing hip fracture surgery (65 years or older) using the Japanese Diagnosis Procedure Combination database. The study period was from April 1, 2011, to March 31, 2016. The data were analyzed to determine the association between seasonality and the incidence of SSI, debridement procedure. The primary outcome was the incidence of SSI and debridement. Other risk factors of SSI and debridement were investigated including seasons and confounders such as sex, age, BMI, smoking status, anticoagulant intake, comorbidities, surgical procedure based on medical diagnosis, waiting times for the surgery, and hospital surgical volume based on the previous literature, the risk of SSI and debridement. RESULTS Hip fracture surgeries performed in summer showed the highest risk for SSI and debridement. The risk for SSI was significantly associated with spring, and summer compared to winter (odds ratio [OR], 1.18; p, 0.016; OR, 1.19; p, 0.012, respectively). The incidence of debridement procedures after the initial surgery was also associated with spring, summer, and fall: the risk was the highest in summer (OR, 1.34; p, <0.001). Obesity, smoking history, number of comorbidities, anticoagulant intake before surgery, longer waiting time for surgery, and small hospital surgical volume were significantly associated with the risk of SSI. CONCLUSIONS We found a significant association between SSI after surgery for hip fractures and seasonality. Surgeries performed in summer had the highest risk for SSI and subsequent debridement procedures.
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Teymourzadeh E, Bahadori M, Fattahi H, Rahdar HA, Mirzaei Moghadam S, Shokri A. Prevalence and Predictive Factors for Nosocomial Infection in the Military Hospitals: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:58-68. [PMID: 34178764 PMCID: PMC8213630 DOI: 10.18502/ijph.v50i1.5072] [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] [Indexed: 11/29/2022]
Abstract
Background: To assess prevalence and predictive factors for Nosocomial Infection (NI) in the military hospitals. Methods: PubMed, Scopus, Cochrane and PreQuest databases were systematically searched for studies published between Jan 1991 and Oct 2017 that reported the prevalence of NI and predictive factors among military hospitals. We performed the meta-analysis using a random effects model. Subgroup analysis was done for heterogeneity and the Egger test to funnel plots was used to assess publication bias. Results: Twenty-eight studies with 250,374 patients were evaluated in meta-analysis. The overall pooled estimate of the prevalence of NI was 8% (95% 6.0–9.0). The pooled prevalence was 2% (95% CI: 2.0–3.0) when we did sensitivity analysis and excluding a study. The prevalence was highest in burn unit (32%) and ICU (15%). Reported risk factors for NI included gender (male vs female, OR: 1.45), age (Age≥65, OR: 2.4), diabetes mellitus (OR: 2.32), inappropriate use of antibiotics (OR: 2.35), received mechanical support (OR: 2.81), co-morbidities (OR: 2.97), admitted into the ICU (OR: 2.26), smoking (OR: 1.36) and BMI (OR: 1.09). Conclusion: The review revealed a difference of prevalence in military hospitals with other hospitals and shows a high prevalence of NI in burn units. Therefore careful disinfection and strict procedures of infection control are necessary in places that serve immunosuppressed individuals such as burn patient. Moreover, a vision for the improvement of reports and studies in military hospitals to report the rate of these infections are necessary.
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Affiliation(s)
- Ehsan Teymourzadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohamadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamed Fattahi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.,Center for Health Human Resources Research & Studies, Ministry of Health and Medical Education, Tehran, Iran
| | - Hossein Ali Rahdar
- Department of Microbiology, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Sima Mirzaei Moghadam
- Department of Midwifery, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Azad Shokri
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Resende VAC, Neto AC, Nunes C, Andrade R, Espregueira-Mendes J, Lopes S. Higher age, female gender, osteoarthritis and blood transfusion protect against periprosthetic joint infection in total hip or knee arthroplasties: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:8-43. [PMID: 30413860 DOI: 10.1007/s00167-018-5231-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/17/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE The goal of this systematic review and meta-analysis was to identify the main risk factors for periprosthetic joint infection (PJI) in patients undergoing total hip or knee arthroplasties. METHODS A systematic review was conducted of the potential risk factors for PJI in total hip or total knee arthroplasty. Risk factors were compared and grouped according to demographics, comorbidities, behavior, infections, native joint diseases and other patient-related and procedure-related factors. Meta-analysis (random-effects models) was conducted using odds ratio (OR) and mean difference (MD). Risk of bias (ROBBINS-I) and strength of the evidence (GRADE) were assessed. RESULTS The study included 37 studies (2,470,827 patients). Older age was a protective factor (MD = - 1.18). Male gender (OR 1.34), coagulopathy (3.05), congestive heart failure (2.36), diabetes mellitus (1.80), obesity (1.61), systemic neoplasia (1.57), chronic lung disease (1.52), and hypertension (1.21) increased the risk for PJI. Behavioral risk factors comprised alcohol abuse (2.95), immunosuppressive therapy (2.81), steroid therapies (1.88), and tobacco (1.82). Infectious risk factors included surgical site infections (6.14), postoperative urinary tract infections (2.85), and prior joint infections (2.15). Rheumatoid arthritis, posttraumatic native joint disease, high National Nosocomial Infections Surveillance (NNIS) system surgical patient index score, prior joint operation, American Society of Anesthesiologists score ≥ 3 and obesity were also significantly associated with higher risk of PJI. Osteoarthritis and blood transfusion were protective factors. CONCLUSIONS The main risk factors for PJI in each category were male gender, coagulopathy, alcohol abuse, surgical site infection (highest score) and high NNIS system surgical patient index score. Protective factors were age, female gender in TKA, osteoarthritis and blood transfusion. Optimization of modifiable risk factors for PJI should be attempted in clinical practice. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Vera Alice Correia Resende
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.
- Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido de Pinho, 4520-211, Santa Maria da Feira, Portugal.
| | - Artur Costa Neto
- Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido de Pinho, 4520-211, Santa Maria da Feira, Portugal
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal
- Faculty of Sports, University of Porto, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopaedics Department of Minho University, Braga, Portugal
| | - Sílvia Lopes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
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Perioperative management of patients undergoing penile prosthesis surgery in the UK: A survey of current practice. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820931263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: This study aimed to define contemporary perioperative management of patients undergoing penile implant surgery in the UK. Methods: All consultant urological surgeons responsible for the insertion of penile prostheses in the UK were invited to complete an online survey comprising of 25 questions relating to surgeon demographics, patient selection, preoperative work-up, intraoperative management and postoperative care. Anonymised responses underwent descriptive statistical analysis, with particular focus on measures employed to reduce the risk of perioperative infection. Results: Of the 34 invited surgeons, 26 (76.5%) responded to the survey. The majority reported undertaking between 10 and 30 cases in 2018 ( n=17; 65.4%). A total of 23 (88.5%) respondents reported employing a threshold for diabetic control, although the exact limit varied between surgeons. Most respondents ( n=22; 84.6%) reported routinely sampling urine for microscopy, culture and sensitivity. All but one ( n=25; 96.2%) reported routinely performing cavernosal washouts, with the most common solution being a mixture of gentamicin and vancomycin (42.3%). All reported routinely giving intravenous antibiotics on induction of anaesthesia, and although there was no clear consensus, most surgeons preferentially used an aminoglycoside in combination with one other agent (including penicillins or teicoplanin). Conclusion: The variation in current perioperative management demonstrates a potential need for the development and introduction of evidence-based guidelines to standardise practice nationwide. Level of evidence: 5
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Braun J, Eckes S, Rommens PM, Schmitz K, Nickel D, Ritz U. Toxic Effect of Vancomycin on Viability and Functionality of Different Cells Involved in Tissue Regeneration. Antibiotics (Basel) 2020; 9:E238. [PMID: 32397094 PMCID: PMC7277215 DOI: 10.3390/antibiotics9050238] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 01/10/2023] Open
Abstract
To prevent infections local delivery of antibiotics is a useful tool. Especially in bone fractures, vancomycin impregnated bone cements are often used allowing high concentrations of antibiotics at the infection side without high serum concentrations. However, besides potential pathogens, cells involved in tissue regeneration may also be affected by the drug. We investigated the effect of vancomycin on the viability and functionality on osteoblasts, endothelial cells, fibroblasts and skeletal muscle cells. Our results show that the viability of all cells analyzed was reduced by vancomycin and that the observed effects were time and concentration dependent. The most pronounced toxic effect was detected on day three when even the lowest concentration of 0.01 mg/ml led to a significant decrease in proliferation compared to control. Functionality assays of osteoblasts and skeletal muscle cells revealed a sensitive reaction of the cells to the drug, indicating that vancomycin is toxic to these cells during the process of differentiation. These data suggest that the vancomycin administration is critical for cell survival and function. Therefore, the concentration of administered antibiotics needs to be carefully evaluated to find a balance between defense against pathogens and functionality of host cells and tissues.
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Affiliation(s)
- Joy Braun
- Department of Orthopaedics and Traumatology, BiomaTiCS, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany; (J.B.); (P.M.R.)
| | - Stefanie Eckes
- Clements-Schöpf-Institute of Organic Chemistry and Biochemistry, Technische Universität Darmstadt, Alarich-Weiss-Straße 4, 64287 Darmstadt, Germany; (S.E.); (K.S.)
| | - Pol Maria Rommens
- Department of Orthopaedics and Traumatology, BiomaTiCS, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany; (J.B.); (P.M.R.)
| | - Katja Schmitz
- Clements-Schöpf-Institute of Organic Chemistry and Biochemistry, Technische Universität Darmstadt, Alarich-Weiss-Straße 4, 64287 Darmstadt, Germany; (S.E.); (K.S.)
| | - Daniela Nickel
- Berufsakademie-Sachsen—Staatliche Studienakademie Glauchau, University of Cooperative Education, Kopernikusstraße 51, 08371 Glauchau, Germany;
| | - Ulrike Ritz
- Department of Orthopaedics and Traumatology, BiomaTiCS, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany; (J.B.); (P.M.R.)
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Palacios-Flores M, Alfaro-Fernandez P, Gutarra-Vilchez R, Suarez-Peña R. Factors associated with infection of primary total knee prosthesis in older adults in a referral hospital in Peru. 2012–2015. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sang C, Chen X, Ren H, Meng Z, Jiang J, Qin Y. Correlation between lumbar multifidus fat infiltration and lumbar postoperative infection: a retrospective case-control study. BMC Surg 2020; 20:35. [PMID: 32093662 PMCID: PMC7041265 DOI: 10.1186/s12893-019-0655-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 11/27/2019] [Indexed: 01/05/2023] Open
Abstract
Background The aim of this study was to investigate the correlation between lumbar multifidus fat infiltration and lumbar postoperative surgical site infection (SSI). Several clinical studies have found that spine postoperative SSI is associated with age, diabetes, obesity, and multilevel surgery. However, few studies have focused on the correlation between lumbar multifidus fat infiltration and SSI. Method A retrospective review was performed on patients who underwent posterior lumbar interbody fusion (PLIF) between 2011 and 2016 at our hospital. The patients were divided into SSI and non-SSI groups. Data of risk factors [age, diabetes, obesity, body mass index (BMI), number of levels, and surgery duration] and indicators of body mass distribution (subcutaneous fat thickness and multifidus fat infiltration) were collected. The degree of multifidus fat infiltration was analyzed on magnetic resonance images using Image J. Results Univariate analysis indicated that lumbar spine postoperative SSI was associated with urinary tract infection, subcutaneous fat thickness, lumbar multifidus muscle (LMM) fat infiltration, multilevel surgery (≥2 levels), surgery duration, drainage duration, and number of drainage tubes. In addition, multiple logistic regression analysis revealed that spine SSI development was associated with sex (male), age (> 60 years), subcutaneous fat thickness, LMM fat infiltration, and drainage duration. Receiver operating characteristic curve analysis indicated that the risk of SSI development was higher when the percentage of LMM fat infiltration exceeded 29.29%. Furthermore, Pearson’s correlation analysis demonstrated that LMM fat infiltration was correlated with age but not with BMI. Conclusion Indicators of body mass distribution may better predict SSI risk than BMI following PLIF. Lumbar Multifidus fat infiltration is a novel spine-specific risk factor for SSI development.
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Affiliation(s)
- Chaohui Sang
- Department of Orthopedics, Zhuhai People's Hospital, NO. 79 Kangning Road, Zhuhai, 519000, Guangdong, China
| | - Xushi Chen
- Department of Spinal surgery, Huizhou Municipal Central Hospital, Huizhou, China
| | - Hailong Ren
- Department of Spinal Surgery, Nangfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhandong Meng
- Department of Spinal Surgery, Nangfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianming Jiang
- Department of Spinal Surgery, Nangfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Yi Qin
- Department of Orthopedics, Zhuhai People's Hospital, NO. 79 Kangning Road, Zhuhai, 519000, Guangdong, China.
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Comparison of Supine and Lateral Decubitus Positions for Total Hip Arthroplasty with the Direct Lateral Approach in Overweight and Obese Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8684067. [PMID: 32149141 PMCID: PMC7053468 DOI: 10.1155/2020/8684067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/21/2020] [Accepted: 02/10/2020] [Indexed: 11/17/2022]
Abstract
Background The purpose of our study is to compare the results of supine and lateral decubitus positions for total hip arthroplasty (THA) with the direct lateral (DL) approach in overweight and obese patients. Methods Patients who had a THA with the DL approach using the lateral decubitus position (LD group) (n = 54) or supine position (S group) (n = 54) or supine position (S group) ( Results Both groups did not differ from each other by means of age, gender, BMI, and affected side (p = 0.814, p = 0.814, p = 0.814, p = 0.814, p = 0.814, p = 0.814, p = 0.814, p = 0.814, Conclusions The LD and S groups had comparable functional outcomes one year postoperatively. However, the S group was associated with worse intraoperative outcomes than the LD group.
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Palacios-Flores MA, Alfaro-Fernandez PR, Gutarra-Vilchez RB, Suarez-Peña R. Factors associated with infection of primary total knee prosthesis in older adults in a referral hospital in Peru. 2012-2015. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:191-198. [PMID: 31987781 DOI: 10.1016/j.recot.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 08/19/2019] [Accepted: 11/15/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the risk factors associated with prosthetic knee infection in elderly patients in a referral hospital in Peru. PATIENTS AND METHODS A case and control study was performed. The calculated sample was 44 cases and 132 controls. The data were collected retrospectively from clinical records. U-Mann Whitney and Chi-square tests were performed in the comparison of cases and controls. Odds ratios (OR) were calculated in a binary logistic regression analysis to identify the risk factors, a P<.05 and a 95% confidence interval (CI) were considered significant. RESULTS Significant (P<.05) risk factors evidenced in the bivariate analysis were obesity (OR=9.72; 95%CI: 4.47-21.14), smoking (OR=4.06; 95%CI: 1.59-10.39), rheumatoid arthritis (OR=4.66; 95%CI: 1.52-14.32), diabetes mellitus type2 (OR=5.63; 95%CI: 2.69-11.78), persistent drainage (OR=9.27; 95%CI: 3.85-22.31), superficial infection (OR=6.87; 95%CI: 3.25-14.49) and prolonged hospital stay (OR=4.67; 95%CI: 2.26-9.64). In the multivariate analysis where it was adjusted for confounding variables, it was determined that risk factors were obesity (ORa=9.14; 95%CI: 3.28-25.48), diabetes mellitus (ORa=3.77; 95%CI: 1.38-10.32), persistent drainage (ORa=4.64; 95%CI: 1.03-20.80) and superficial wound infection (ORa=27.35; 95%CI: 2.57-290.64). CONCLUSIONS Risk factors for prosthetic knee infection identified in this study are preventable. The main risk factors were obesity, diabetes mellitus type2, superficial wound infection and persistent drainage, which were considered together or separately to be risk factors in the population studied.
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Affiliation(s)
- M A Palacios-Flores
- Unidad de Rodilla, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú.
| | | | | | - R Suarez-Peña
- Unidad de Rodilla, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
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Antonelli B, Chen AF. Reducing the risk of infection after total joint arthroplasty: preoperative optimization. ARTHROPLASTY 2019; 1:4. [PMID: 35240760 PMCID: PMC8787890 DOI: 10.1186/s42836-019-0003-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/20/2019] [Indexed: 12/13/2022] Open
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Woodmass JM, Lee J, Johnson NR, Wu IT, Camp CL, Dahm DL, Krych AJ. Nonoperative Management of Posterior Shoulder Instability: An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 10 Years After Diagnosis. Arthroscopy 2019; 35:1964-1970. [PMID: 31196692 DOI: 10.1016/j.arthro.2019.01.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To (1) define the rate of delayed surgery, between 1 and 10 years after injury, in a population-based study of patients with posterior shoulder instability (PSI), (2) evaluate predictive factors associated with delayed repair, and (3) identify differences between the nonoperative and operative groups at long-term follow-up. METHODS A population-based retrospectively reviewed study of all patients with PSI from January 1, 1994, to December 31, 2015, was performed. Inclusion required a clinical diagnosis of PSI combined with supporting imaging. Complete medical records were reviewed for 2,091 potential cases. Kaplan-Meier estimates were used to calculate survival. Landmark survival analysis was performed to identify predictors of conversion to surgery. RESULTS The study included 143 patients with PSI, 79 of whom were managed nonoperatively for at least 1 year after diagnosis. After the first year, survival free of surgery was 78.3% at 1 year, 63.1% at 5 years, and 51.5% at 10 years. There was a trend toward increased surgery in patients with a body mass index > 35 (P = .10; hazard ratio = 2.32; confidence interval, 0.8-6.8). Nonthrowing athletes (including contact/weight-lifting athletes) showed a trend toward an increased risk for surgery (P = .07). Patients who underwent surgery were significantly more likely to have progression in arthritis (P = .02; hazard ratio = 4.0; confidence interval, 1.2-13.2). CONCLUSIONS Nonoperative management was performed for at least 1 year in over half of patients diagnosed with PSI. Overall, long-term follow-up demonstrates that 46% of these patients converted to surgery between 1 and 10 years after initial diagnosis. Ultimately, 70% of patients diagnosed with PSI go on to surgical intervention. Patients who underwent surgery at any time point were at an increased risk of radiographic progression of arthritis at a minimum of 5 years of follow-up. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Jarret M Woodmass
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.; Department of Orthopedic Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julia Lee
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.; Sierra Pacific Orthopedics, Fresno, California, U.S.A
| | - Nick R Johnson
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Isabella T Wu
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Diane L Dahm
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A..
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Liang Z, Rong K, Gu W, Yu X, Fang R, Deng Y, Lu L. Surgical site infection following elective orthopaedic surgeries in geriatric patients: Incidence and associated risk factors. Int Wound J 2019; 16:773-780. [PMID: 30790453 PMCID: PMC7948685 DOI: 10.1111/iwj.13096] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/21/2019] [Accepted: 01/26/2019] [Indexed: 11/27/2022] Open
Abstract
The purposes of this study were to investigate the incidence of surgical site infection (SSI) following geriatric elective orthopaedic surgeries and identify the associated risk factors This was a retrospective two-institution study. Between January 2014 and September 2017, patients aged 60 years or older undergoing elective orthopaedic surgeries were included for data collection and analysis. SSI was identified through the review of patients' medical records for the index surgery and through the readmission diagnosis of SSI. Patients' demographics, characteristics of disease, surgery-related variables, and laboratory examination indexes were inquired and documented. Univariate and multivariate logistic analyses were performed to determine independent risk factors for SSI. There were 4818 patients undergoing elective orthopaedic surgeries, and within postoperative 1 year, 74 patients were identified to develop SSIs; therefore, the overall incidence of SSI was 3.64%, with 0.4% for deep and 1.1% for superficial infection. Staphylococcus aureus (25/47, 53.2%) and coagulase-negative staphylococci (11/47, 23.4%) were the most common causative pathogens; half of S. aureus SSIs were caused by Methicillin-resistant Staphylococcus aureus (MRSA) (12/25, 48.0%). Five risk factors were identified to be independently associated with SSI, including diabetes mellitus (odds ratio [OR], 3.7; 95% confidence interval [95% CI], 1.7-5.6), morbid obesity (OR, 2.6; 95% CI, 1.3-3.9), tobacco smoking (OR, 4.2; 95% CI, 2.1-6.4), surgical duration>75th percentile (OR, 1.9; 95% CI, 1.0-2.9), and ALB < 35.0 g/L (OR, 2.3; 95% CI, 1.3-3.4). We recommend the optimisation of modifiable risk factors such as morbid obesity, tobacco smoking, and lower serum albumin level prior to surgeries to reduce the risk of SSI.
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Affiliation(s)
- Zhiquan Liang
- Department of Hand and Foot SurgeryThe First Hospital of Jilin UniversityChangchunJilin ProvinceChina
| | - Kai Rong
- Department of Hand and Foot SurgeryThe First Hospital of Jilin UniversityChangchunJilin ProvinceChina
| | - Wenfei Gu
- Department of Spine Surgery, Traditional Chinese HospitalXinjiang Medical UniversityUrumqiXinjiangP.R. China
| | - Xin Yu
- Department of Hand and Foot SurgeryThe First Hospital of Jilin UniversityChangchunJilin ProvinceChina
| | - Rui Fang
- Department of Joint Surgery, Traditonal Chinese HospitalXinjiang Medical UniversityXinjiangP.R. China
| | - Yingjie Deng
- Department of Joint Surgery, Traditonal Chinese HospitalXinjiang Medical UniversityXinjiangP.R. China
| | - Laijin Lu
- Department of Hand and Foot SurgeryThe First Hospital of Jilin UniversityChangchunJilin ProvinceChina
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48
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Xu H, Yu L, Li Y, Gong Z. Prolonged surgical duration, higher body mass index and current smoking increases risk of surgical site infection after intra-articular fracture of distal femur. ANZ J Surg 2019; 89:723-728. [PMID: 31087540 DOI: 10.1111/ans.15263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/31/2019] [Accepted: 04/04/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND This study aimed to investigate incidence of surgical site infection (SSI) following the surgery of intra-articular fractures of distal femur. METHODS Between July 2014 and December 2017, inpatient medical records of consecutive patients who had intra-articular fractures of distal femur treated by open reduction and plate/screw fixation were inquired to identify whether they had a SSI. After discharge, patients who had a SSI and were readmitted for treatment of SSI were also allocated to the case group. Univariate and multivariate logistic regression analyses were performed to determine whether some clinical factors were independently associated with SSI, after adjustment for confounding variables. RESULTS During the study period, 434 patients were evaluated and 21 patients were confirmed to develop a SSI, indicating the accumulated incidence of 4.8% within 1 year. A total of six deep and 15 superficial SSIs were identified, with respective incidence being 1.4% and 3.4%. The most common causative pathogen was Staphylococcus aureus (8, 50.0%), followed by mixed bacteria (5, 31.3%). Open fracture, prolonged surgical duration, increased body mass index and current smoking were identified as independent risk factors for development of SSI (P < 0.05). CONCLUSIONS It should be noted that it was likely difficult to modify these risk factors, but they do prove useful for preoperative counselling of patients and their relatives regarding their own risk profile of SSI, and the perioperative medical optimization.
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Affiliation(s)
- Hang Xu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lili Yu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yansen Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Foot and Ankle Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhixin Gong
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Hebert KJ, Kohler TS. Penile Prosthesis Infection: Myths and Realities. World J Mens Health 2019; 37:276-287. [PMID: 30929326 PMCID: PMC6704299 DOI: 10.5534/wjmh.180123] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 01/09/2023] Open
Abstract
Penile prosthesis infection is the most significant complication following prosthesis implant surgery leading to postoperative morbidity, increased health care costs, and psychological stress for the patient. We aimed to identify risk factors associated with increased postoperative penile prosthesis infection. A review of the literature was performed via PubMed using search terms including inflatable penile prosthesis, penile implant, and infection. Articles were given a level of evidence score using the 2011 Oxford Centre for Evidence-Based Medicine Guidelines. Multiple factors were associated with increased risk of post-prosthesis placement infection (Level of Evidence Rating) including smoking tobacco (Level 1), CD4 T-cell count <300 (Level 4), Staphylococcus aureus nasal carriage (Level 2), revision surgery (Level 2), prior spinal cord injury (Level 3), and hemoglobin A1c level >8.5 (Level 2). Factors with no effect on infection rate include: preoperative cleansing with antiseptic (Level 4), history of prior radiation (Level 3), history of urinary diversion (Level 4), obesity (Level 3), concomitant circumcision (Level 3), immunosuppression (Level 4), age >75 (Level 4), type of hand cleansing (Level 1), post-surgical drain placement (Level 3), and surgical approach (Level 4). Factors associated with decreased rates of infection included: surgeon experience (Level 2), "No Touch" technique (Level 3), preoperative parenteral antibiotics (Level 2), antibiotic coated devices (Level 2), and operative field hair removal with clippers (Level 1). Optimization of pre-surgical and intraoperative risk factors is imperative to reduce the rate of postoperative penile prosthesis infection. Additional research is needed to elucidate risk factors and maximize benefit.
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50
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Cizmic Z, Feng JE, Huang R, Iorio R, Komnos G, Kunutsor SK, Metwaly RG, Saleh UH, Sheth N, Sloan M. Hip and Knee Section, Prevention, Host Related: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S255-S270. [PMID: 30348549 DOI: 10.1016/j.arth.2018.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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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