Resultados del tratamiento de la escoliosis idiopática del adolescente mediante instrumentación posterior híbrida / Adolescent idiopathic scoliosis: Results of treatment with hybrid posterior instrumentation

Objetivos: Describir los resultados clínicos y radiológicos así como la repercusión en la calidad de vida del enfermo tras el tratamiento quirúrgico de la escoliosis idiopática del adolescente mediante instrumentación posterior híbrida. Material y método: Estudio retrospectivo de 26 sujetos intervenidos desde 2001 hasta 2006, con un seguimiento medio de 37,8 meses. Se obtuvieron, mediante la clasificación de Lenke de las curvas, los siguientes resultados: el 42,3% fue de tipo i, el 46,2% fue de tipo iii, el 7,7% fue de tipo v y 3,8% fue de tipo vi. Se intervino a todos los sujetos mediante instrumentación posterior híbrida con tornillos pediculares distales y ganchos proximales. Se registraron las necesidades transfusionales y las complicaciones. Se realizó una evaluación clínica mediante el cuestionario SRS-22 (Scoliosis Research Society` Sociedad de Investigación de la Escoliosis¿). Asimismo, se realizó una evaluación radiológica prequirúrgica, posquirúrgica inmediata y al final del seguimiento. Resultados: Se registraron 3 infecciones superficiales, un hemotórax y una luxación de gancho. Mediante el cuestionario SRS-22 se obtuvieron las siguientes puntuaciones medias: 4,41 en dolor; 4,39 en actividad; 3,91 en autoimagen; 3,98 en salud mental, y 3,81 en satisfacción. La corrección radiológica media posquirúrgica en las curvas torácicas fue del 58% y en las curvas lumbares fue del 60%, con una pérdida media de 5,5° a 7° al final del seguimiento. No hubo casos de seudoartrosis. Discusión y conclusiones: La instrumentación y fusión posterior híbrida es una técnica eficaz y segura, con bajo índice de seudoartrosis y fracasos. Los resultados fueron buenos en cuanto al dolor y a la actividad, pero fueron discretos en cuanto a la autoimagen y a la satisfacción personal. No se encontró asociación estadísticamente significativa entre la edad de los sujetos, el grado de corrección de la curva y la puntuación del cuestionario SRS-22 (AU)

Purpose: Report on the clinical and radiological results obtained by surgical treatment of adolescent idiopathic scoliosis by means of hybrid posterior instrumentation. The repercussions of surgery on the patients¿ quality of life are also described. Materials and methods: Retrospective study of 26 patients operated between 2001 and 2006, with a mean follow-up of 37.8 months. In terms of the Lenke classification, 42.3% of patients had type 1 curves, 46.2% type 3 curves, 7.7% type 5 curves, and one case of type VI curves. All patients were subjected to a hybrid posterior instrumentation with distal pedicular screws and proximal hooks. Transfusion needs and complications were duly recorded. A clinical assessment was performed by means of the SRS-22 questionnaire. A radiological assessment was conducted preoperatively, postoperatively and at the end of follow-up. Results: There were three superficial infections, one hemothorax and one hook dislocation. The administration of the SRS-22 questionnaire produced the following mean scores: 4.41 for pain, 4.39 for activity, 3.91 for self-image, 3.98 for mental health and 3.81 for satisfaction. Mean post-surgical radiological correction for thoracic and lumbar curves was 58% and 60%, respectively, with a mean loss of 7 and 5.5 degrees at the end of follow-up. There were no cases of Pseudoarthrosis. Discussion and conclusions: Hybrid posterior instrumentation and fusion is an efficient and safe technique, with a low rate of pseudoarthrosis and failure. Results were good as regards pain and activity, but fair in terms of self-image and personal satisfaction. We found no statistically significant association between the patients´ age, the degree of curve correction and the score on the SRS-22 questionnaire (AU)

[Effect of surveillance on surgical site infection rate in knee and hip arthroplasty]. / Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla.

OBJECTIVE: To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. MATERIAL AND METHODS: Prospective surveillance in two time periods in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between them adherence to recommendations was reinforced. MAIN RESULTS: A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32.7% in the last year (p < 0,001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, the NNIS index-risk 2 being more frequent in period A (16.8%) than in period B (5.4%) (p<0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (COPD) (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. CONCLUSIONS: Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and most patient safety. Therefore, such a surveillance program for orthopedic surgery department seems to be beneficial.

Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla / Effect of surveillance on surgical site infection rate in knee and hip arthroplasty

Objetivo. Determinar la adherencia al protocolo de profilaxis quirúrgica y su influencia en la modificación de la tasa de infección de la herida quirúrgica en un departamento de Cirugía Ortopédica. Material y métodos. Los pacientes intervenidos de prótesis de cadera o rodilla en el Hospital Universitario Insular de Las Palmas de Gran Canaria fueron seguidos por personal entrenado en el control de infecciones durante tres años, recogiendo datos sobre infecciones y factores de riesgo en dos períodos de observación: período A, de 24 meses, y período B, de 12 meses. Entre ambos se realizaron actividades de promoción del uso adecuado de la pauta de profilaxis quirúrgica antibiótica. Resultados. Se estudiaron 1.088 pacientes. En el período A, el 3,3% de las intervenciones se infectaron, comparadas con el 2,0% del período B (p = 0,14). La profilaxis antibiótica adecuada pasó del 8,7% al 32,7% (p < 0,001). Se determinó el índice NNIS (National Nosocomial Infections Surveillance) en 383 pacientes, siendo más frecuente el riesgo 2 en el período A (16,8%) que en el B (5,4%) (p < 0,001). La frecuencia de insuficiencia renal fue mayor en el período A (3,4% frente a 1,6% ; p = 0,04); la diabetes y la neoplasia fueron similares en ambos períodos; en el período B predominaron enfermedad pulmonar obstructiva crónica (EPOC) (14,6 frente a 11,0; p = 0,05) y obesidad (12,8 frente a 10,3; p = 0,12). Las medias de duración de las intervenciones, edad y estancia fueron idénticas en ambos períodos. Conclusiones. La acción de mejora introducida, aunque no seguida por todos los traumatólogos, se acompaña de un descenso de la tasa de infecciones postquirúrgicas, posiblemente con menor coste para el hospital y más seguridad para los pacientes. Este programa de vigilancia parece ser beneficioso (AU)

Objective. To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. Material and methods. Prospective surveillance in two time periods in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between them adherence to recommendations was reinforced. Main results. A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32.7% in the last year (p < 0,001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, the NNIS index-risk 2 being more frequent in period A (16.8%) than in period B (5.4%) (p<0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (COPD) (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. Conclusions. Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and most patient safety. Therefore, such a surveillance program for orthopedic surgery department seems to be beneficial (AU)

Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla / Effect of surveillance on surgical site infection rate in knee and hip arthroplasty

Objetivo. Determinar la adherencia al protocolo de profilaxis quirúrgica y su influencia en la modificación de la tasa de infección de la herida quirúrgica en un departamento de Cirugía Ortopédica. Material y métodos. Los pacientes intervenidos de prótesis de cadera o rodilla en el Hospital Universitario Insular de Las Palmas de Gran Canaria fueron seguidos por personal entrenado en el control de infecciones durante tres años, recogiendo datos sobre infecciones y factores de riesgo en dos períodos de observación: período A, de 24 meses, y período B, de 12 meses. Entre ambos se realizaron actividades de promoción del uso adecuado de la pauta de profilaxis quirúrgica antibiótica. Resultados. Se estudiaron 1.088 pacientes. En el período A, el 3,3% de las intervenciones se infectaron, comparadas con el 2,0% del período B (p = 0,14). La profilaxis antibiótica adecuada pasó del 8,7% al 32,7% (p < 0,001). Se determinó el índice NNIS (National Nosocomial Infections Surveillance) en 383 pacientes, siendo más frecuente el riesgo 2 en el período A (16,8%) que en el B (5,4%) (p < 0,001). La frecuencia de insuficiencia renal fue mayor en el período A (3,4% frente al 1,6%; p = 0,04), la diabetes y la neoplasia fueron similares en ambos períodos; en el período B predominaron enfermedades pulmonares obstructivas crónicas (14,6 frente a 11,0; p = 0,05) y obesidad (12,8 frente a 10,3; p = 0,12). Las medias de duración de las intervenciones, edad y estancia fueron idénticas en ambos períodos. Conclusiones. La acción de mejora introducida, aunque no seguida por todos los traumatólogos, se acompaña de un descenso de la tasa de infecciones posquirúrgicas, posiblemente con menor coste para el hospital y más seguridad para los pacientes. Este programa de vigilancia parece ser beneficioso

Objective. To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. Material and methods. Prospective surveillance in two periods of time in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between these periods, adherence to recommendations was reinforced. Results. A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32,7% in the last year (p = 0.001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, with the NNIS index-risk 2 as more frequent in period A (16.8%) than the period B (5.4%) (p < 0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. Conclusions. Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and more patient safety. Thus, such a surveillance program for orthopedic surgery department seems to be beneficial

[Effect of surveillance on surgical site infection rate in knee and hip arthroplasty]. / Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla.

OBJECTIVE: To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. MATERIAL AND METHODS: Prospective surveillance in two periods of time in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between these periods, adherence to recommendations was reinforced. RESULTS: A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32,7% in the last year (p = 0.001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, with the NNIS index-risk 2 as more frequent in period A (16.8%) than the period B (5.4%) (p < 0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. CONCLUSIONS: Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and more patient safety. Thus, such a surveillance program for orthopedic surgery department seems to be beneficial.