Determining factors on length of stay in primary total knee arthroplasty patients using enhanced recovery protocol after surgery (ERAS) pathway. / Factores determinantes de la duración de la estancia hospitalaria en pacientes operados de artroplastia primaria total de rodilla usando un protocolo de recuperación mejorada (ERAS).

INTRODUCTION: There is an increase in degenerative arthropathies because of the increase in the longevity of world's population, making primary knee arthroplasties a procedure to recover quality of life without pain. There are factors associated with the length of hospital stay after this procedure. OBJECTIVE: To determine the risk factors influencing the hospital stay during the postoperative period of patients undergoing primary total knee arthroplasty with an enhanced recovery after surgery protocol (ERAS). METHODS: A retrospective study is carried out on patients undergoing primary total knee arthroplasty at an University Hospital in the period 2017-2020 using the ERAS protocol, during which 957 surgeries were performed. RESULTS: Average age of 71.7±8.2years, 62.4% were women and the 77.3% were classified as ASAII. The significantly associated factors to an increased length of stay are: age (P=.001), ASA scale (P=.04), day of surgery (P<.001), blood transfusion (P<.001), postoperative hemoglobin level at 48-72h (P<.001), the time of first postoperative mobilization to ambulate and climb stairs (P<.001), the need for analgesic rescues (P=.003), and the presence of postoperative nausea and vomiting (P=.008). CONCLUSIONS: There are statistically significant and clinically relevant factors associated with hospital stay. Determining these factors constitutes an advantage in hospital management, in the development of strategies to improve and optimize the quality of care and available health resources.

Resultados de un programa de descolonización de Staphylococcus aureus en cirugía protésica primaria de cadera y rodilla / Results of a preoperative screening and decolonization program for Staphylococcus aureus in primary hip and knee arthroplasty

Introducción: La detección y descolonización del Staphylococcus aureus previo a la cirugía, se postula como la opción para disminuir el riesgo de infección en artroplastias. El objetivo de este estudio fue evaluar la efectividad de un programa de cribado de S. aureus en la artroplastia total de rodilla (ATR) y en la artroplastia total de cadera (ATC), la incidencia de infección respecto a una cohorte histórica y su viabilidad económica. Material y métodos: Estudio pre-postintervención en pacientes intervenidos de ATR y ATC en al año 2021. Se realizó protocolo de detección de colonización nasal por S. aureus y erradicación si procedía, con mupirocina intranasal, cultivo postratamiento con el resultado de 3 semanas entre cultivo postratamiento y cirugía. Se evalúan medidas de eficacia, se analizan costes y se comprara la incidencia de infección respecto a una serie histórica de pacientes intervenidos entre enero y diciembre de 2019, realizando análisis estadístico descriptivo y comparativo. Resultados: Los grupos fueron comparables estadísticamente. Se realizó el cultivo en el 89%, siendo 19 (13%) pacientes positivos. Se confirmó el tratamiento en 18, cultivo control en 14, todos descolonizados; ninguno sufrió infección. Un paciente con cultivo negativo sufrió infección por S. epidermidis. En cohorte histórica: 3 sufrieron infección profunda por S. epidermidis, E. cloacae y S. aureus. El coste del programa fue de 1.661,85€. Conclusión: El programa de cribado detectó el 89% de los pacientes. La prevalencia de infección en el grupo intervención era menor que en la cohorte, siendo S.epidermidis el microorganismo causante, diferente a S. aureus descrito en la literatura y en la cohorte. Consideramos que este programa es económicamente viable, siendo sus costes reducidos y asumibles.(AU)

Introduction: Detection and decolonization of Staphylococcus aureus prior to surgery is postulated as an option to reduce the risk of infection in arthroplasties. The aim of this study was to evaluate the effectiveness of a screening program for S. aureus in total knee arthroplasty (TKA) and total hip arthroplasty (THA), the incidence of infection with respect to a historical cohort, and its economic viability. Material and methods: Pre-post intervention study in patients undergoing primary knee and hip prostheses in 2021, a protocol was carried out to detect nasal colonization by S. aureus and eradication if appropriate, with intranasal mupirocin, post-treatment culture with results three weeks between post-treatment culture and surgery. Efficacy measures are evaluated, costs are analyzed and the incidence of infection is compared with respect to a historical series of patients operated on between January and December 2019, performing a descriptive and comparative statistical analysis. Results: The groups were statistically comparable. Culture was performed in 89%, with 19 (13%) positive patients. Treatment was confirmed in 18, control culture in 14, all decolonized; none suffered infection. One culture-negative patient suffered from Staphylococcus epidermidis infection. In historical cohort: 3 suffered deep infection by S. epidermidis, Enterobacter cloacae, S. aureus. The cost of the program is €1661.85. Conclusion: The screening program detected 89% of the patients. The prevalence of infection in the intervention group was lower than in the cohort, with S. epidermidis being the main microorganism, different from S. aureus described in the literature and in the cohort. We believe that this program is economically viable, as its costs are low and affordable.(AU)

[Translated article] Results of a preoperative screening and decolonization programme for Staphylococcus aureus in primary hip and knee arthroplasty / Resultados de un programa de descolonización de Staphylococcus aureus en cirugía protésica primaria de cadera y rodilla

Introducción: La detección y descolonización del Staphylococcus aureus previo a la cirugía, se postula como la opción para disminuir el riesgo de infección en artroplastias. El objetivo de este estudio fue evaluar la efectividad de un programa de cribado de S. aureus en la artroplastia total de rodilla (ATR) y en la artroplastia total de cadera (ATC), la incidencia de infección respecto a una cohorte histórica y su viabilidad económica. Material y métodos: Estudio pre-postintervención en pacientes intervenidos de ATR y ATC en al año 2021. Se realizó protocolo de detección de colonización nasal por S. aureus y erradicación si procedía, con mupirocina intranasal, cultivo postratamiento con el resultado de 3 semanas entre cultivo postratamiento y cirugía. Se evalúan medidas de eficacia, se analizan costes y se comprara la incidencia de infección respecto a una serie histórica de pacientes intervenidos entre enero y diciembre de 2019, realizando análisis estadístico descriptivo y comparativo. Resultados: Los grupos fueron comparables estadísticamente. Se realizó el cultivo en el 89%, siendo 19 (13%) pacientes positivos. Se confirmó el tratamiento en 18, cultivo control en 14, todos descolonizados; ninguno sufrió infección. Un paciente con cultivo negativo sufrió infección por S. epidermidis. En cohorte histórica: 3 sufrieron infección profunda por S. epidermidis, E. cloacae y S. aureus. El coste del programa fue de 1.661,85€. Conclusión: El programa de cribado detectó el 89% de los pacientes. La prevalencia de infección en el grupo intervención era menor que en la cohorte, siendo S.epidermidis el microorganismo causante, diferente a S. aureus descrito en la literatura y en la cohorte. Consideramos que este programa es económicamente viable, siendo sus costes reducidos y asumibles.(AU)

Introduction: Detection and decolonization of Staphylococcus aureus prior to surgery is postulated as an option to reduce the risk of infection in arthroplasties. The aim of this study was to evaluate the effectiveness of a screening program for S. aureus in total knee arthroplasty (TKA) and total hip arthroplasty (THA), the incidence of infection with respect to a historical cohort, and its economic viability. Material and methods: Pre-post intervention study in patients undergoing primary knee and hip prostheses in 2021, a protocol was carried out to detect nasal colonization by S. aureus and eradication if appropriate, with intranasal mupirocin, post-treatment culture with results three weeks between post-treatment culture and surgery. Efficacy measures are evaluated, costs are analyzed and the incidence of infection is compared with respect to a historical series of patients operated on between January and December 2019, performing a descriptive and comparative statistical analysis. Results: The groups were statistically comparable. Culture was performed in 89%, with 19 (13%) positive patients. Treatment was confirmed in 18, control culture in 14, all decolonized; none suffered infection. One culture-negative patient suffered from Staphylococcus epidermidis infection. In historical cohort: 3 suffered deep infection by S. epidermidis, Enterobacter cloacae, S. aureus. The cost of the program is €1661.85. Conclusion: The screening program detected 89% of the patients. The prevalence of infection in the intervention group was lower than in the cohort, with S. epidermidis being the main microorganism, different from S. aureus described in the literature and in the cohort. We believe that this program is economically viable, as its costs are low and affordable.(AU)

[Translated article] Results of a preoperative screening and decolonization programme for Staphylococcus aureus in primary hip and knee arthroplasty.

INTRODUCTION: Detection and decolonization of Staphylococcus aureus prior to surgery is postulated as an option to reduce the risk of infection in arthroplasties. The aim of this study was to evaluate the effectiveness of a screening programme for S. aureus in total knee arthroplasty (TKA) and total hip arthroplasty (THA), the incidence of infection with respect to a historical cohort, and its economic viability. MATERIAL AND METHODS: Pre-post intervention study in patients undergoing primary knee and hip prostheses in 2021, a protocol was carried out to detect nasal colonization by S. aureus and eradication if appropriate, with intranasal mupirocin, post-treatment culture with results three weeks between post-treatment culture and surgery. Efficacy measures are evaluated, costs are analyzed and the incidence of infection is compared with respect to a historical series of patients operated on between January and December 2019, performing a descriptive and comparative statistical analysis. RESULTS: The groups were statistically comparable. Culture was performed in 89%, with 19 (13%) positive patients. Treatment was confirmed in 18, control culture in 14, all decolonized; none suffered infection. One culture-negative patient suffered from Staphylococcus epidermidis infection. In historical cohort: three suffered deep infection by S. epidermidis, Enterobacter cloacae, Staphylococcus aureus. The cost of the programme is €1661.85. CONCLUSION: The screening programme detected 89% of the patients. The prevalence of infection in the intervention group was lower than in the cohort, with S. epidermidis being the main micro-organism, different from S. aureus described in the literature and in the cohort. We believe that this programme is economically viable, as its costs are low and affordable.

Results of a preoperative screening and decolonization program for Staphylococcus aureus in primary hip and knee arthroplasty. / Resultados de un programa de descolonización de Staphylococcus aureus en cirugía protésica primaria de cadera y rodilla.

INTRODUCTION: Detection and decolonization of Staphylococcus aureus prior to surgery is postulated as an option to reduce the risk of infection in arthroplasties. The aim of this study was to evaluate the effectiveness of a screening program for S. aureus in total knee arthroplasty (TKA) and total hip arthroplasty (THA), the incidence of infection with respect to a historical cohort, and its economic viability. MATERIAL AND METHODS: Pre-post intervention study in patients undergoing primary knee and hip prostheses in 2021, a protocol was carried out to detect nasal colonization by S. aureus and eradication if appropriate, with intranasal mupirocin, post-treatment culture with results three weeks between post-treatment culture and surgery. Efficacy measures are evaluated, costs are analyzed and the incidence of infection is compared with respect to a historical series of patients operated on between January and December 2019, performing a descriptive and comparative statistical analysis. RESULTS: The groups were statistically comparable. Culture was performed in 89%, with 19 (13%) positive patients. Treatment was confirmed in 18, control culture in 14, all decolonized; none suffered infection. One culture-negative patient suffered from Staphylococcus epidermidis infection. In historical cohort: 3 suffered deep infection by S. epidermidis, Enterobacter cloacae, S. aureus. The cost of the program is €1661.85. CONCLUSION: The screening program detected 89% of the patients. The prevalence of infection in the intervention group was lower than in the cohort, with S. epidermidis being the main microorganism, different from S. aureus described in the literature and in the cohort. We believe that this program is economically viable, as its costs are low and affordable.

Nivel de cumplimiento vía telemática de cuestionarios relacionados con la calidad de vida en artroplastia total de rodilla / Level of response to telematic questionnaires on health related quality of life on total knee replacement

Objetivo. La realización y obtención de cuestionarios de calidad de vida relacionada con la salud por el paciente y el profesional es complicada. Actualmente, disponemos de herramientas informáticas para recoger esta información. Nuestro objetivo fue evaluar la capacidad de los pacientes intervenidos de prótesis total de rodilla para rellenar cuestionarios de calidad de vida relacionada con la salud, utilizando una plataforma telemática. Material y métodos. Fueron incluidos 98 pacientes consecutivos intervenidos de artroplastia total de rodilla. A los que aceptaron participar en el estudio se les solicitó responder, en una página web, a 2 cuestionarios de calidad de vida relacionada con la salud (SF8 y WOMAC reducido) y 3 preguntas adicionales de opinión sobre dichos cuestionarios. Resultados. Noventa y ocho pacientes (45 hombres y 53 mujeres), con una media de edad de 72,7 años. Catorce no aceptaron participar por no disponer de acceso a Internet. De los 84 pacientes que aceptaron, el 50% entró en la página web, de los cuales solamente 36 contestaron correctamente a todas las preguntas. De estos, el 80% fue ayudado por un familiar o amigo y el 22% refirió dificultades para acceder a Internet. Conclusión. La utilización de sistemas telemáticos para responder a cuestionarios de calidad de vida debe ser usada de forma cautelosa, especialmente en población de edad avanzada. Probablemente, la población a la que va dirigida no está preparada para utilizar este tipo de tecnología. Por ello, antes de diseñar cuestionarios telemáticos debemos asegurarnos de si serán debidamente cumplimentados (AU)

Questionnaires measuring health-related quality of life are difficult to perform and obtain for patients and professionals. Computerised tools are now available to collect this information. The objective of this study was to assess the ability of patients undergoing total knee replacement to fill in health-related quality-of-life questionnaires using a telematic platform. Material and methods. Ninety eight consecutive patients undergoing total knee arthroplasty were included. Participants were given an access code to enter the website where they had to respond to 2 questionnaires (SF8 and the reduced WOMAC), and 3 additional questions about the difficulty in completing the questionnaires. Results. A total of 98 patients agreed to participate: 45 males and 53 females (mean age 72.7 years). Fourteen did not agree to participate due to lack of internet access. Of the final 84 participants, 50% entered the website, and only 36 answered all questions correctly. Of the patients who answered the questionnaire, 80% were helped by a relative or friend, and 22% reported difficulty accessing internet. Conclusion. The use of telematic systems to respond to health-related quality of life questionnaires should be used cautiously, especially in elderly population. It is likely that the population they are directed at is not prepared to use this type of technology. Therefore, before designing telematics questionnaires it must be ensured that they are completed properly (AU)

Level of response to telematic questionnaires on Health Related Quality of Life on total knee replacement.

UNLABELLED: Questionnaires measuring health-related quality of life are difficult to perform and obtain for patients and professionals. Computerised tools are now available to collect this information. The objective of this study was to assess the ability of patients undergoing total knee replacement to fill in health-related quality-of-life questionnaires using a telematic platform. MATERIAL AND METHODS: Ninety eight consecutive patients undergoing total knee arthroplasty were included. Participants were given an access code to enter the website where they had to respond to 2 questionnaires (SF8 and the reduced WOMAC), and 3 additional questions about the difficulty in completing the questionnaires. RESULTS: A total of 98 patients agreed to participate: 45 males and 53 females (mean age 72.7 years). Fourteen did not agree to participate due to lack of internet access. Of the final 84 participants, 50% entered the website, and only 36 answered all questions correctly. Of the patients who answered the questionnaire, 80% were helped by a relative or friend, and 22% reported difficulty accessing internet. CONCLUSION: The use of telematic systems to respond to health-related quality of life questionnaires should be used cautiously, especially in elderly population. It is likely that the population they are directed at is not prepared to use this type of technology. Therefore, before designing telematics questionnaires it must be ensured that they are completed properly.

Síndrome del desfiladero torácico arterial secundario a una fractura de clavícula / Arterial thoracic outlet syndrome associated to clavicle fracture

Se presenta un paciente con síndrome del desfiladero torácico arterial secundario a una antigua fractura de clavícula, sin síntomas ni signos específicos que lo aclaren, ni tampoco estudios por la imagen que lo certifiquen (AU)

We presented the diagnostic process of a patient with thoracic outlet syndrome secondary to an old clavicle fracture without specific symptoms nor signs clarify that it, nor either studies by the image certify that it (AU)