Respuesta a «Cómo limitar los sesgos en estudios cuasiexperimentales» / Reply to "How to limit bias in quasiexperimental studies"

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Intra-abdominal Pressure Changes During Hip Arthroscopy: A Prospective Multicenter Study.

PURPOSE: To evaluate intra-abdominal pressure changes during hip arthroscopy and define its relationship with other patient related variables. METHODS: A prospective multicenter study evaluating intra-abdominal pressure (IAP) in patients undergoing arthroscopic treatment of femoroacetabular impingement was performed. The IAP was measured indirectly by a bladder catheter (AbViser Autovalve Intra-abdominal pressure monitor) and documented every 30 minutes during the entire procedure. The following risk factors were analyzed: traction time, duration surgery, previous abdominal surgery, capsule repair, psoas tenotomy, and surgical approach. RESULTS: One hundred and five patients with symptomatic femoroacetabular impingement that underwent hip arthroscopy met the inclusion criteria. There were significant differences in the IAP between the preoperative measurement of IAP and the IAP at different time points during surgery (P < .01). The IAP increased continuously from the commencement of surgery (considered as time point from portal establishment) until the first 60 minutes. After first 60 minutes of surgery, the IAP did not increase significantly. There were no significant associations between increased IAP and the risk factors analyzed. CONCLUSIONS: IAP increases significantly during the first 60 minutes of hip arthroscopy; it then stabilizes for the duration of surgery before decreasing just after the completion of surgery. The highest recorded IAP was not associated with additional complications. No symptomatic intra-abdominal hypertension was documented. Finally, patient- and procedure-specific risk factors did not predict changes in IAP. Systemic monitoring of IAP during the hip arthroscopy procedure can easily and effectively be done, allowing the surgeon to early detect any significant change. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Profilaxis dual con teicoplanina añadida a cefazolina en la prevención de la infección de prótesis articular / Dual prophylaxis with teicoplanin and cefazolin in the prevention of prosthetic joint infection

INTRODUCCIÓN: Existe un creciente aumento de las infecciones de prótesis articular (IPA) por bacterias resistentes a las cefalosporinas utilizadas en la profilaxis quirúrgica. La sustitución de estas por glucopéptidos no ha demostrado mejorar los resultados pero sí su asociación. MÉTODOS: Estudio comparativo de la asociación de teicoplanina y cefazolina antes de la cirugía de artroplastia frente a cefazolina sola de un grupo control previo. RESULTADOS: En el periodo control hubo 16 IPA de 585 cirugías, mientras que en el grupo de intervención fueron 6 de 579 (incidencia 2,7% vs. 1,03%; RR 0,4, p = 0,04). En el grupo control, 11 de las infecciones fueron causadas por bacterias grampositivas frente a 4 en el de intervención (1,8% vs. 0,7%, p = 0,08). CONCLUSIONES: La adición de teicoplanina a cefazolina en la profilaxis de la cirugía de artroplastia se asoció a una reducción de la incidencia de IPA, a expensas de un descenso de las causadas por grampositivos

INTRODUCTION: There is a growing increase in prosthetic joint infection (PJI) incidence due to cephalosporin-resistant bacteria, used in surgical prophylaxis. The replacement of these with glycopeptides has not been shown to improve the results, but they have been shown to improve with their combination. METHODS: Comparative study of combination of teicoplanin and cefazolin before arthroplasty surgery against cefazolin alone from a previous control group. RESULTS: During the control period, there were 16 PJIs from 585 surgeries, while in the intervention group there were 6 from 579 (incidence 2.7% vs. 1.03%, RR 0.4, P = .04). In control group, 11 of the infections were caused by Gram-positive bacteria versus 4 in the intervention group (1.8% vs. 0.7%, P = .08). CONCLUSIONS: The addition of teicoplanin to cefazolin in the prophylaxis of arthroplasty surgery was associated with a reduction in the incidence of PJI, thanks to a decrease in infections caused by Gram-positive bacteria

Dual prophylaxis with teicoplanin and cefazolin in the prevention of prosthetic joint infection. / Profilaxis dual con teicoplanina añadida a cefazolina en la prevención de la infección de prótesis articular.

INTRODUCTION: There is a growing increase in prosthetic joint infection (PJI) incidence due to cephalosporin-resistant bacteria, used in surgical prophylaxis. The replacement of these with glycopeptides has not been shown to improve the results, but they have been shown to improve with their combination. METHODS: Comparative study of combination of teicoplanin and cefazolin before arthroplasty surgery against cefazolin alone from a previous control group. RESULTS: During the control period, there were 16 PJIs from 585 surgeries, while in the intervention group there were 6 from 579 (incidence 2.7% vs. 1.03%, RR 0.4, P=.04). In control group, 11 of the infections were caused by Gram-positive bacteria versus 4 in the intervention group (1.8% vs. 0.7%, P=.08). CONCLUSIONS: The addition of teicoplanin to cefazolin in the prophylaxis of arthroplasty surgery was associated with a reduction in the incidence of PJI, thanks to a decrease in infections caused by Gram-positive bacteria.

Resultados de una intervención de descolonización de Staphylococcus aureusen pacientes portadores a los que se indica una prótesis articular / Eradication of Staphylococcus aureus in carrier patients undergoing joint arthroplasty

INTRODUCCIÓN: La infección de prótesis articular (IPA) es una complicación con graves repercusiones cuyo principal agente responsable en la mayoría de los casos es Staphylococcus aureus. El propósito del presente estudio es evaluar si la descolonización de los pacientes portadores de S. aureus a los que se indica una prótesis articular consigue una disminución en la incidencia de IPA por S. aureus. MATERIAL Y MÉTODOS: Estudio de intervención antes-después en el que se comparó la incidencia de IPA en pacientes bajo cirugía de prótesis articular de rodilla o cadera entre enero y diciembre de 2011 a los que se realizó estudio de detección de colonización nasal por S. aureus y erradicación si procedía, con un protocolo de mupirocina intranasal y ducha con clorhexidina, con respecto a una serie histórica de pacientes intervenidos entre enero y diciembre de 2010. RESULTADOS: En el período de control se realizaron 393 artroplastias en 391 pacientes. En el período de intervención se implantaron 416 prótesis en 416 pacientes. Se realizó estudio de colonización a 382 pacientes (91,8%), de los que 102 fueron positivos (26,7%) y se trataron según el protocolo. Se produjeron 2 casos de de IPA por S.aureus frente a 9 en el año control (0,5% vs 2,3%, odds ratio [OR]: 0,2, intervalo de confianza [IC] del 95%: 0,4 a 2,3, p = 0,04). CONCLUSIÓN: En nuestro estudio la aplicación de un protocolo de detección de colonización/ erradicación de S.aureus consiguió un descenso significativo de la incidencia de IPA por S.aureus respecto a un control histórico

INTRODUCTION: Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S. aureuscarriers helps to reduce the incidence of PJI by S. aureus. MATERIAL AND METHODS: An S. aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010.RESULTS: A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S. aureuscompared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P = .04). CONCLUSIONS: In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group

[Eradication of Staphylococcus aureus in carrier patients undergoing joint arthroplasty]. / Resultados de una intervención de descolonización de Staphylococcus aureus en pacientes portadores a los que se indica una prótesis articular.

INTRODUCTION: Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S.aureus carriers helps to reduce the incidence of PJI by S.aureus. MATERIAL AND METHODS: An S.aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010. RESULTS: A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S.aureus compared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P=.04). CONCLUSIONS: In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group.