AAOS Systematic Literature Review: Summary on the Management of Surgical Site Infections.

The purpose of this systematic review is to improve outcomes for the care of surgical site infections by presenting the current best evidence on important diagnostic and care issues. The findings led to ten recommendations and five consensus statements that address diagnosis and treatment of orthopaedic surgical site infections. There is strong evidence to supports anemia, obesity, HIV/AIDS, depression, dementia, immunosuppressive medications, duration of hospital stay, history of alcohol abuse, and history of congestive heart failure as factors that increased the risk of infection, some of which are modifiable before surgical intervention. Diagnostically, synovial fluid and tissue cultures were found to be strong "rule-in" tests for the diagnosis of infection, but negative synovial fluid and tissue cultures do not reliably exclude infection. C-reactive protein was found to be a strong rule-in and rule-out marker for patients with suspected surgical site infections. Therapeutically, only for patients with retained implants, antimicrobial protocols of 8 weeks of duration were found to be associated with outcomes that are not inferior to outcomes from protocols of 3- to 6-month duration. Also only for patients with retained implants, rifampin, used as a second antimicrobial, increases the probability of treatment success for staphylococcal infections. The surgical site infection work group identified a lack of high-level outcomes data, highlighting the need for high-quality clinical trials in the treatment of surgical site infections.

The Core Competencies for General Orthopaedic Surgeons.

BACKGROUND: With the changing delivery of orthopaedic surgical care, there is a need to define the knowledge and competencies that are expected of an orthopaedist providing general and/or acute orthopaedic care. This article provides a proposal for the knowledge and competencies needed for an orthopaedist to practice general and/or acute care orthopaedic surgery. METHODS: Using the modified Delphi method, the General Orthopaedic Competency Task Force consisting of stakeholders associated with general orthopaedic practice has proposed the core knowledge and competencies that should be maintained by orthopaedists who practice emergency and general orthopaedic surgery. RESULTS: For relevancy to clinical practice, 2 basic sets of competencies were established. The assessment competencies pertain to the general knowledge needed to evaluate, investigate, and determine an overall management plan. The management competencies are generally procedural in nature and are divided into 2 groups. For the Management 1 group, the orthopaedist should be competent to provide definitive care including assessment, investigation, initial or emergency care, operative or nonoperative care, and follow-up. For the Management 2 group, the orthopaedist should be competent to assess, investigate, and commence timely non-emergency or emergency care and then either transfer the patient to the appropriate subspecialist's care or provide definitive care based on the urgency of care, exceptional practice circumstance, or individual's higher training. This may include some higher-level procedures usually performed by a subspecialist, but are consistent with one's practice based on experience, practice environment, and/or specialty interest. CONCLUSIONS: These competencies are the first step in defining the practice of general orthopaedic surgery including acute orthopaedic care. Further validation and discussion among educators, general orthopaedic surgeons, and subspecialists will ensure that these are relevant to clinical practice. CLINICAL RELEVANCE: These competencies provide many stakeholders, including orthopaedic educators and orthopaedists, with what may be the minimum knowledge and competencies necessary to deliver acute and general orthopaedic care. This document is the first step in defining a practice-based standard for training programs and certification groups.