RESUMO
Despite many existing strategies used to reduce the rates of surgical site infection (SSI), these are still fairly frequent complications that pose a challenge for orthopedic surgeons. Therefore, the search for more effective methods of perioperative infection prophylaxis became a main subject of research, with the goal of decreasing postoperative morbidity, mortality, and costs. Thus, the present study sought to assess the effectiveness of intra-wound vancomycin powder in orthopedic surgery SSI prophylaxis. A systematic review and meta-analysis study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 (PRISMA-P 2015). A comprehensive literature search was performed to identify controlled studies on the rates of SSI with or without the local use of vancomycin powder. Exclusion and inclusion criteria were applied. A meta-analysis with random effects was performed. Out of 412 titles that met the criteria, 7 studies regarding spine surgery were included: 4 prospective and 3 retrospective studies. A total of 6,944 cases were identified, and they were divided into 2 groups: the control group (3,814 patients), to whom intrawound vancomycin was not administered, and the intervention group (3,130 patients), to who vancomycin was administered locally. We observed that 64 (2.04%) patients in the intervention group developed SSI, in contrast to 144 (3.75%) patients in the control group. The results of the meta-analysis showed that the local use of vancomycin powder had an statistically significant protective effect against SSI in cases of spine surgery, with a relative risk (RR) of 0.59 and a 95% confidence interval (95%CI) of 0.35-0.98. The use of prophylactic intrawound vancomycin powder has a protective effect against SSI in spine surgeries; however, further prospective trials are needed to endorse its use in orthopedic surgeries.
RESUMO
Abstract Despite many existing strategies used to reduce the rates of surgical site infection (SSI), these are still fairly frequent complications that pose a challenge for orthopedic surgeons. Therefore, the search for more effective methods of perioperative infection prophylaxis became a main subject of research, with the goal of decreasing postoperative morbidity, mortality, and costs. Thus, the present study sought to assess the effectiveness of intra-wound vancomycin powder in orthopedic surgery SSI prophylaxis. A systematic review and meta-analysis study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 (PRISMA-P 2015). A comprehensive literature search was performed to identify controlled studies on the rates of SSI with or without the local use of vancomycin powder. Exclusion and inclusion criteria were applied. A meta-analysis with random effects was performed. Out of 412 titles that met the criteria, 7 studies regarding spine surgery were included: 4 prospective and 3 retrospective studies. A total of 6,944 cases were identified, and they were divided into 2 groups: the control group (3,814 patients), to whom intrawound vancomycin was not administered, and the intervention group (3,130 patients), to who vancomycin was administered locally. We observed that 64 (2.04%) patients in the intervention group developed SSI, in contrast to 144 (3.75%) patients in the control group. The results of the meta-analysis showed that the local use of vancomycin powder had an statistically significant protective effect against SSI in cases of spine surgery, with a relative risk (RR) of 0.59 and a 95% confidence interval (95%CI) of 0.35-0.98. The use of prophylactic intrawound vancomycin powder has a protective effect against SSI in spine surgeries; however, further prospective trials are needed to endorse its use in orthopedic surgeries.
Resumo Apesar das diversas estratégias perioperatórias empregadas para diminuir a incidência de infecção no sítio cirúrgico (ISS), tais complicações ainda são frequentes, e representam um desafio para os ortopedistas. Por esse motivo, há uma necessidade permanente de buscar métodos cada vez mais eficazes de profilaxia anti-infecciosa, para que sejam reduzidas significativamente as taxas de morbidade pós-operatória, mortalidade, e os custos com os cuidados de saúde. Este estudo teve como objetivo avaliar a eficácia da profilaxia infecciosa com aplicação tópica de vancomicina em pó em cirurgias ortopédicas. Fez-se um estudo de revisão sistemática com metanálise, usando-se o Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 (PRISMA-P 2015). Fez-se uma busca abrangente na literatura por estudos controlados sobre as taxas de ISS com e sem o uso de vancomicina em pó na ferida. Entre os 412 títulos encontrados que preencheram os critérios, foram selecionados 7 estudos, 4 prospectivos e 3 retrospectivos, todos em cirurgia de coluna. A amostra total foi de 6.944 pacientes, que foram divididos em 2 grupos: controle (3.814 pacientes) e intervenção (3.130 pacientes). Observou-se que no grupo intervenção, no qual a vancomicina tópica foi aplicada, 64 (2,04%) pacientes desenvolveram ISS, e, no grupo controle 144 (3,75%) pacientes. Os resultados da metanálise demonstraram que o uso de vancomicina tem efeito protetor contra ISS em cirurgias de coluna, com risco relativo (RR) de 0,59, significância estatística, e intervalo de confiança de 95% (IC95%) entre 0,35-0,98. O uso da vancomicina em pó profilática, no leito da ferida, tem fator protetor contra ISS em cirurgias de coluna; entretanto, mais ensaios prospectivos randomizados são necessários para recomendar seu uso em cirurgias ortopédicas.
Assuntos
Ortopedia , Infecção da Ferida Cirúrgica , Vancomicina , Morbidade , Mortalidade , Custos e Análise de Custo , Atenção à Saúde , Prevenção de DoençasRESUMO
OBJECTIVE: The primary objective of this study was to determine the prevalence of osteoporosis and osteopenia prior to total knee arthroplasty (TKA) in female patients. As a secondary objective, we evaluated the incidence of hip fractures, types of drugs to treat osteoporosis and serum vitamin D levels. METHOD: This is a transversal, descriptive and observational study which evaluated 60 women above age 55 prior to total knee replacement. RESULTS: Mean patient age was 71.4 years. Osteoporosis was present in 16.7% of the sample and osteopenia in 15%. In the patients with osteoporosis, femur fracture (20%) was most frequent. Most of the group with osteopenia did not take any medication to treat this condition (55.6%), while most patients with osteoporosis took alendronate (30%) and 30% did not take any medication. CONCLUSION: The female population awaiting total knee replacement should be considered at risk for osteoporosis, confirming recent findings in the literature. Level of Evidence III, Control Case Study.
OBJETIVO: O objetivo primário do estudo foi determinar a prevalência de osteoporose e osteopenia no pré-operatório de artroplastia total de joelho (ATJ) em pacientes do sexo feminino. Como objetivos secundários, avaliamos a incidência de fraturas de fêmur, o uso de medicações para o tratamento da osteoporose e os níveis da 25-OH vitamina D. MÉTODO: É um estudo transversal, descritivo e observacional. A amostra foi composta por 60 mulheres com idade acima de 55 anos, no climatério, em pré-operatório de ATJ. RESULTADOS: A média de idade foi de 71,4 anos. A osteoporose estava presente em 16,7% e a osteopenia em 15% da amostra estudada. Entre os pacientes com osteoporose, a fratura de fêmur foi a mais frequente (20%). A maioria do grupo com osteopenia não usava medicação para tratar essa afecção (55,6%), enquanto a maior parte dos pacientes com osteoporose usava alendronato (30%) e 30% não usavam nenhum medicamento. CONCLUSÃO: A população do sexo feminino aguardando artroplastia total de joelho deve ser considerada em risco de acometimento pela osteoporose, confirmando dados recentes da literatura. Nível de Evidência III, Estudo de Caso Controle.
RESUMO
ABSTRACT OBJECTIVE: The primary objective of this study was to determine the prevalence of osteoporosis and osteopenia prior to total knee arthroplasty (TKA) in female patients. As a secondary objective, we evaluated the incidence of hip fractures, types of drugs to treat osteoporosis and serum vitamin D levels. METHOD: This is a transversal, descriptive and observational study which evaluated 60 women above age 55 prior to total knee replacement. RESULTS: Mean patient age was 71.4 years. Osteoporosis was present in 16.7% of the sample and osteopenia in 15%. In the patients with osteoporosis, femur fracture (20%) was most frequent. Most of the group with osteopenia did not take any medication to treat this condition (55.6%), while most patients with osteoporosis took alendronate (30%) and 30% did not take any medication. CONCLUSION: The female population awaiting total knee replacement should be considered at risk for osteoporosis, confirming recent findings in the literature. Level of Evidence III, Control Case Study.
RESUMO OBJETIVO: O objetivo primário do estudo foi determinar a prevalência de osteoporose e osteopenia no pré-operatório de artroplastia total de joelho (ATJ) em pacientes do sexo feminino. Como objetivos secundários, avaliamos a incidência de fraturas de fêmur, o uso de medicações para o tratamento da osteoporose e os níveis da 25-OH vitamina D. MÉTODO: É um estudo transversal, descritivo e observacional. A amostra foi composta por 60 mulheres com idade acima de 55 anos, no climatério, em pré-operatório de ATJ. RESULTADOS: A média de idade foi de 71,4 anos. A osteoporose estava presente em 16,7% e a osteopenia em 15% da amostra estudada. Entre os pacientes com osteoporose, a fratura de fêmur foi a mais frequente (20%). A maioria do grupo com osteopenia não usava medicação para tratar essa afecção (55,6%), enquanto a maior parte dos pacientes com osteoporose usava alendronato (30%) e 30% não usavam nenhum medicamento. CONCLUSÃO: A população do sexo feminino aguardando artroplastia total de joelho deve ser considerada em risco de acometimento pela osteoporose, confirmando dados recentes da literatura. Nível de Evidência III, Estudo de Caso Controle.
