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1.
BMC Musculoskelet Disord ; 22(1): 420, 2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33957917

RESUMO

PURPOSE: Surgical antibiotic prophylaxis (SAP) prevents surgical site infections (SSI). In orthopaedic surgery, the use of prolonged SAP (PSAP) has been reported in daily routine, despite guidelines advising against it. Therefore, we asked: What is the proportion of PSAP use, defined as administration of SAP ≥24 h after elective orthopaedic surgery? Are there patient- and surgery-related predictors of PSAP use? METHODS: This cross-sectional analysis investigated 1292 patients who underwent elective orthopaedic surgery including total joint arthroplasties at one Swiss centre between 2015 and 2017. Patient comorbidities, surgical characteristics and occurrence of SSI at 90 days in PSAP group were compared to the SAP group (< 24 h post-operative). RESULTS: PSAP use was 12% (155 of 1292). Patient-related factors associated with PSAP compared to the SAP group included older age (63 vs. 58y; p < 0.001), higher BMI (29 vs. 27 kg/m2; p < 0.001), ASA classification ≥3 (31% vs. 17%; p < 0.001) and lung disease (17% vs. 9%; p = 0.002). Surgery-related factors associated with PSAP were use of prosthetics (62% vs. 45%; p < 0.001), surgery of the knee (65% vs. 25%; p < 0.001), longer surgery duration (87 vs. 68 min; p < 0.001) and presence of drains (90% vs. 65%; p < 0.001). All four SSI occurred in the SAP group (0 vs. 4; p = 1.0). Surgeons administered PSAP with varying frequencies; proportions ranged from 0 to 33%. CONCLUSION: PSAP use and SSI proportions were lower than reported in the literature. Several patient- and surgery-related factors associated with PSAP use were identified and some were potentially modifiable. Also, experienced surgeons seemed to implement differing approaches regarding the duration of SAP administration.


Assuntos
Antibioticoprofilaxia , Procedimentos Ortopédicos , Idoso , Antibacterianos/uso terapêutico , Estudos Transversais , Humanos , Procedimentos Ortopédicos/efeitos adversos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle
2.
Eur J Med Res ; 26(1): 39, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33931102

RESUMO

BACKGROUND: The purpose of this article is to summarize the epidemiologic characteristics and double-buffered strategy for patients in orthopedic surgery during the COVID-19 outbreak in Wuhan, China, based on our own experience in our hospital. METHODS: A retrospective and comparative study was performed to identify all inpatients at our clinic from February 17 to April 20, 2020 (epidemic group), and from February 17 to April 20, 2019 (control group). Epidemiologic characteristics, screening effect, perioperative complications, and nosocomial infection were analyzed. RESULTS: In the epidemic group, 82 patients were identified, a decrease by 76.0% than the 342 patients in the same period in the 2019. Patients in the epidemic group (54.6 ± 20.2 years) were older than those in the control group (49.6 ± 22.5 years). For the epidemic group, the proportion rates of traumatic factures (69.5%) and low-energy injuries (86.0%) were higher than that in the control group, respectively (35.4% and 37.2%). The preoperative waiting time (7.0 ± 2.6 days) in the epidemic group was longer than that in the control group (4.5 ± 2.1 days). The postoperative complication rate (12.2%) in the epidemic group was higher than that in the control group (3.5%). No nosocomial infection of orthopedic staff and patients with COVID-19 was noted in the epidemic group. CONCLUSION: During the COVID-19 outbreak in Wuhan, China, orthopedic inpatients showed unique epidemiological characteristics. The double-buffered strategy could effectively avoid nosocomial infections among medical staff and patients. Doctors should fully evaluate the perioperative risks and complications.


Assuntos
/epidemiologia , Procedimentos Ortopédicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Infecção Hospitalar/epidemiologia , Tratamento de Emergência , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Equipamento de Proteção Individual , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Adulto Jovem
3.
BMC Infect Dis ; 21(1): 370, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33879083

RESUMO

BACKGROUND: Native valves infective endocarditis due to Escherichia coli is still a rare disease and a particular virulence of some E.coli isolate may be suspected. CASE PRESENTATION: A 79-year-old woman presented during the post-operative period of an orthopedic surgery a urinary tract infection following obstructive ureteral lithiasis. E. coli was isolated from a pure culture of urine and blood sampled simultaneously. After evidence of sustained E.coli septicemia, further investigations revealed acute cholecystitis with the same micro-organism in biliary drainage and a native valve mitral endocarditis. E.coli was identified as O2:K7:H6, phylogenetic group B2, ST141, and presented several putative and proven virulence genes. The present isolate can be classified as both extra-intestinal pathogenic E.coli (ExPECJJ) and uropathogenic E. coli (UPECHM). CONCLUSIONS: The relationship between the virulent factors present in ExPEC strains and some serotypes of E. coli that could facilitate the adherence to cardiac valves warrants further investigation.


Assuntos
Endocardite/diagnóstico , Escherichia coli Extraintestinal Patogênica/isolamento & purificação , Idoso , Animais , Endocardite/microbiologia , Escherichia coli Extraintestinal Patogênica/classificação , Escherichia coli Extraintestinal Patogênica/patogenicidade , Feminino , Humanos , Procedimentos Ortopédicos/efeitos adversos , Filogenia , Período Pós-Operatório , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia , Urolitíase/cirurgia , Virulência/genética
4.
Medicine (Baltimore) ; 100(10): e24030, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725816

RESUMO

ABSTRACT: The aim of the study was to determine if multiple intraspinal anomalies increase the risk of scoliosis correction compared to the normal intraspinal condition or 1 or 2 intraspinal anomalies in congenital scoliosis (CS) and whether correction for multiple intraspinal anomalies need to be performed with preliminary neurosurgical intervention before scoliosis correction.A total of 318 consecutive CS patients who underwent corrective surgery without preliminary neurosurgical intervention at a single institution from 2008 to 2016 were retrospectively reviewed, with a minimum of 2 years of follow-up. The patients were divided into 3 groups according to different intraspinal conditions. In the normal group (N group; n = 196), patients did not have intraspinal anomalies. In the abnormal group (A group; n = 93), patients had 1 or 2 intraspinal anomalies. In the multiple anomaly group (M group; n = 29), patients had 3 or more intraspinal anomalies including syringomyelia, split cord malformation [SCM], tethered cord, low conus, intraspinal mass, Chiari malformation or/and arachnoid cyst. The occurrence of complications as well as perioperative and radiographic data were analyzed.The incidence rate of multiple intraspinal anomalies in CS patients was 9.1% (29/318). No significant difference was observed in the perioperative outcomes or radiographic parameters at the final follow-up. There were no significant differences among the 3 groups in the total, major or neurological complication rates (all P > .05). Two patients (1 in the N group and 1 in the A group) experienced transient neurological complications, whereas no patient experienced permanent neurological deficits during surgery or follow-up.To our knowledge, the current study reported the largest cohort of intraspinal anomalies in patients with CS that has been reported in the literature. The results of our study demonstrated that patients with congenital scoliosis associated with intraspinal anomalies, even multiple intraspinal anomalies that coexist with more complex intraspinal pathologies, may safely and effectively achieve scoliosis correction without preliminary neurological intervention. More complex intraspinal pathologies do not seem to increase the risk of neurosurgical complications during corrective surgery.


Assuntos
Anormalidades Múltiplas/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Escoliose/cirurgia , Doenças da Medula Espinal/complicações , Medula Espinal/anormalidades , Anormalidades Múltiplas/epidemiologia , Adolescente , Tomada de Decisão Clínica , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Neurocirúrgicos/normas , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Procedimentos Ortopédicos/normas , Procedimentos Ortopédicos/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Escoliose/complicações , Escoliose/congênito , Escoliose/epidemiologia , Medula Espinal/cirurgia , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(10): e24430, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725821

RESUMO

OBJECTIVE: It remains unclear whether transfusion strategies during orthopedic surgery and infection are related. The purpose of this study is to evaluate whether liberal blood transfusion strategies contribute to infection risk in orthopedic patients by analyzing randomized controlled trials (RCTs). METHODS: RCTs with liberal versus restrictive red blood cell (RBC) transfusion strategies were identified by searching PubMed, Embase, the Cochrane Central Register of Controlled Trials from their inception to July 2019. Ten studies with infections as outcomes were included in the final analysis. According to the Jadad scale, all studies were considered to be of high quality. RESULTS: Ten trials involving 3938 participants were included in this study. The pooled risk ratio (RR) for the association between liberal transfusion strategy and infection was 1.34 (95% confidence intervals [CI], 0.94-1.90; P = .106). The sensitivity analysis indicated unstable results, and no significant publication bias was observed. CONCLUSION: This pooled analysis of RCTs demonstrates that liberal transfusion strategies in orthopedic patients result in a nonsignificant increase in infections compared with more restrictive strategies. The conclusions are mainly based on retrospective studies and should not be considered as recommendation before they are supported by larger scale and well-designed RCTs.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Infecções/epidemiologia , Cuidados Intraoperatórios/efeitos adversos , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Infecções/etiologia , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco/estatística & dados numéricos , Fatores de Risco
6.
J Int Med Res ; 49(3): 300060521992995, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33706564

RESUMO

OBJECTIVE: To investigate the clinical characteristics and long-term mortality of patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) after orthopaedic surgery. METHODS: This retrospective, single-centre study enrolled patients that underwent inpatient orthopaedic surgery from 2009 to 2017 in Beijing Jishuitan Hospital. The patients were screened for a cardiac troponin I elevation and fulfilled the Fourth Universal Definition of Myocardial Infarction within 30 days of surgery. RESULTS: A total of 180 patients that developed perioperative myocardial infarction (MI) were included in the study. Among them, 14 patients (7.8%) were classified as STEMI, and 166 (92.2%) had NSTEMI. Compared with those with NSTEMI, STEMI patients had significantly higher 30-day and long-term mortality rates (50.0% versus 5.4%; 71.4% versus 22.3%; respectively). Multivariate Cox regression model analysis among the entire cohort demonstrated that STEMI (hazard ratio [HR] 5.78, 95% confidence interval [CI] 2.50, 13.38) and prior MI (HR 2.35, 95% CI 1.02, 5.38) were the most significant independent predictors of long-term mortality. CONCLUSION: Perioperative MI after orthopaedic surgery was associated with a high mortality rate. STEMI was independently associated with a significant increase in short- and long-term mortality.


Assuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST , Procedimentos Ortopédicos , Infarto do Miocárdio com Supradesnível do Segmento ST , Mortalidade Hospitalar , Humanos , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Fatores de Tempo
7.
Medicine (Baltimore) ; 100(10): e24974, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725865

RESUMO

RATIONALE: Custom-made implant is an accepted treatment option for treatment of chest deformity in Poland syndrome. Unlike the raised concerns and awareness for the long-term consequences of breast implants, the long-term complications of customized implants for special purposes like Poland syndrome has not been reported in the literature. PATIENT CONCERNS: A 44-year-old male with Poland syndrome presented to our institution complaining of a large bulge and fluctuation on the right chest wall. This occurred after 14 years from the initial implant surgery for correction of chest wall deformity. Upon failure of resolution by multiple aspirations, workup was carried out under suspicion of implant associated malignancy. INTERVENTION: Total Capsulectomy and implant removal was done. OUTCOMES: Histology revealed chronic inflammation with fibrosis. Implant-associated malignancy was not found. He is being followed up with no signs of recurrence. LESSONS: For rare cases of implant insertion such as Poland syndrome, awareness of delayed complications and workups based on suspicion of implant-associated malignancy is needed. Surgeon awareness and patient education is required.


Assuntos
Implantes de Mama/efeitos adversos , Procedimentos Ortopédicos/efeitos adversos , Síndrome de Poland/cirurgia , Seroma/diagnóstico , Adulto , Neoplasias da Mama Masculina/diagnóstico , Neoplasias da Mama Masculina/etiologia , Remoção de Dispositivo , Diagnóstico Diferencial , Humanos , Masculino , Procedimentos Ortopédicos/instrumentação , Músculos Peitorais/anormalidades , Músculos Peitorais/diagnóstico por imagem , Músculos Peitorais/cirurgia , Seroma/etiologia , Seroma/cirurgia , Tomografia Computadorizada por Raios X
8.
Instr Course Lect ; 70: 355-366, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438921

RESUMO

Osteoporosis is common, affecting more than 40 million people, and is associated with increased fracture risk, loss of independence, chronic pain, and disability. Osteoporosis is underdiagnosed and undertreated even after fracture where secondary fracture prevention has been shown to be cost effective in reducing further fracture risk and mortality. Osteoporosis is also undiagnosed in patients undergoing orthopaedic and spine surgery in up to one-third of cases and negatively affects outcomes, need for revision surgery, and risk of complications. The diagnosis of osteoporosis was previously based on bone mineral density; however, recent clinical definitions include T-scores less than -2.5, the presence of hip and spine fractures, and high fracture risk. Surgeons should adopt bone health optimization for elective surgery. This program screens patients to determine whether a bone mineral density test is indicated and provides counseling for nutritional supplements, elimination of toxins, fall risk assessment, and education regarding bone health. Following assessment, patients meeting the criteria for osteoporosis are referred to a bone health specialist or a fracture liaison program. Both antiresorptive and anabolic antiosteoporotic medications appear effective at improving outcomes and reducing complications of orthopaedic and spine surgery, although a delay in surgery may be required.


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Procedimentos Ortopédicos , Ortopedia , Osteoporose , Densidade Óssea , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Fraturas Ósseas/cirurgia , Humanos , Procedimentos Ortopédicos/efeitos adversos
9.
J Clin Neurosci ; 84: 42-45, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33485597

RESUMO

Psychiatric diagnoses (PD) present a significant burden on elective surgery patients and may have potentially dramatic impacts on outcomes. As ailments of the spine can be particularly debilitating, the effect of PD on outcomes was compared between elective spine surgery patients and other common elective orthopedic surgery procedures. This study included 412,777 elective orthopedic patients who were concurrently diagnosed with PD within the years 2005 to 2016. 30.2% of PD patients experienced a post-operative complication, compared to 25.1% for non-PD patients (p < 0.001). Mood Disorders (bipolar or depressive disorders) were the most commonly diagnosed PD for all elective Orthopedic procedures, followed by anxiety, then dementia (p < 0.001). Logistic regression analysis found PD to be a significant predictor of higher cost to charge ratio (CCR), length of stay (LOS), and death (all p < 0.001). Between, hand, elbow, and shoulder specialties, spine patients had the highest odds of increased CCR and unfavorable discharge, and the second highest odds of death (all p < 0.001).


Assuntos
Procedimentos Cirúrgicos Eletivos/efeitos adversos , Transtornos Mentais/complicações , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
11.
BMC Musculoskelet Disord ; 22(1): 104, 2021 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-33485328

RESUMO

BACKGROUND: The medical community is beginning to recognize the contribution of prescription opioids in the growing national opioid crisis. Many studies have compared the safety and efficacy of alternative analgesics to opioids, but none utilizing a completely opioid-free perioperative protocol in orthopedics. METHODS: We developed and tested an opioid-free perioperative analgesic pathway (from preoperative to postoperative period) among patients undergoing common elective orthopedic procedures. Patients will be randomized to receive either traditional opioid-including or completely opioid-free perioperative medications. This study is being conducted across multiple orthopedic subspecialties in patients undergoing the following common elective orthopedic procedures: single-level or two-level ACDF/ACDA, 1st CMC arthroplasty, Hallux Valgus/Rigidus corrections, diagnostic knee arthroscopies, total hip arthroplasty (THA), and total shoulder arthroplasty/reverse total shoulder arthroplasty (TSA/RTSA). The primary outcome measure is pain score at 24 h postoperatively. Secondary outcome measures include pain scores at additional time points, medication side effects, and several patient-reported variables such as patient satisfaction, quality of life, and functional status. DISCUSSION: We describe the methods for a feasibility randomized controlled trial comparing opioid-free perioperative analgesics to traditional opioid-including protocols. We present this study so that it may be replicated and incorporated into future studies at other institutions, as well as disseminated to additional orthopedic and/or non-orthopedic surgical procedures. The ultimate goal of presenting this protocol is to aid recent efforts in reducing the impact of prescription opioids on the national opioid crisis. TRIAL REGISTRATION: The protocol was approved by the local institutional review board and registered with clinicaltrials.gov (Identifier: NCT04176783 ) on November 25, 2019, retrospectively registered.


Assuntos
Analgesia , Procedimentos Ortopédicos , Ortopedia , Analgésicos Opioides/efeitos adversos , Humanos , Procedimentos Ortopédicos/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
BMC Musculoskelet Disord ; 22(1): 51, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419417

RESUMO

BACKGROUND: Transthyretin and immunoglobulin light-chain amyloidoses cause amyloid deposition throughout various organ systems. Recent evidence suggests that soft tissue amyloid deposits may lead to orthopedic conditions before cardiac manifestations occur. Pharmacologic treatments reduce further amyloid deposits in these patients. Thus, early diagnosis improves long term survival. QUESTIONS/PURPOSES: The primary purpose of this systematic review was to characterize the association between amyloid deposition and musculoskeletal pathology in patients with common orthopedic conditions. A secondary purpose was to determine the relationship between amyloid positive biopsy in musculoskeletal tissue and the eventual diagnosis of systemic amyloidosis. METHODS: We performed a systematic review using PRISMA guidelines. Inclusion criteria were level I-IV evidence articles that analyzed light-chain or transthyretin amyloid deposits in common orthopedic surgeries. Study methodological quality, risk of bias, and recommendation strength were assessed using MINORS, ROBINS-I, and SORT. RESULTS: This systematic review included 24 studies for final analysis (3606 subjects). Amyloid deposition was reported in five musculoskeletal pathologies, including carpal tunnel syndrome (transverse carpal ligament and flexor tenosynovium), hip and knee osteoarthritis (synovium and articular cartilage), lumbar spinal stenosis (ligamentum flavum), and rotator cuff tears (tendon). A majority of studies reported a mean age greater than 70 for patients with TTR or AL positive amyloid. CONCLUSIONS: This systematic review has shown the presence of amyloid deposition detected at the time of common orthopedic surgeries, especially in patients ≥70 years old. Subtyping of the amyloid has been shown to enable diagnosis of systemic light-chain or transthyretin amyloidosis prior to cardiac manifestations. LEVEL OF EVIDENCE: Level IV.


Assuntos
Neuropatias Amiloides Familiares , Amiloidose de Cadeia Leve de Imunoglobulina , Procedimentos Ortopédicos , Osteoartrite do Quadril , Osteoartrite do Joelho , Idoso , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico , Procedimentos Ortopédicos/efeitos adversos
13.
APMIS ; 129(4): 225-231, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33496970

RESUMO

This study aimed to evaluated ischemic metabolites in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone before, during, and after tourniquet application in a simultaneous paired comparison of tourniquet-exposed and non-tourniquet-exposed legs. Ten patients scheduled for hallux valgus or hallux rigidus surgery were included. Microdialysis catheters were placed to simultaneously and continuously sample the metabolites glucose, lactate, pyruvate, and glycerol bilaterally for 12 h in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. A tourniquet was applied on the leg planned for surgery (inflation time: 15 min, mean tourniquet duration time (range): 65 (58;77) min). During tourniquet inflation, a 2- to 3-fold increase of the mean lactate/pyruvate ratio was found for all investigated tissues in the tourniquet-exposed leg compared with the non-tourniquet-exposed leg. The lactate/pyruvate ratio recovery time after tourniquet release was within 30 min for skeletal muscle, 60 min for subcutaneous tissue, and 130 min for calcaneal cancellous bone. Only the tourniquet-exposed skeletal muscles were found to be ischemic during tourniquet inflation, defined by a significant increase of the lactate/pyruvate ratio exceeding the ischemic cutoff level of 25; however, this level decreased below 25 immediately after tourniquet release. The glycerol ratio increased instantly after inflation in the tourniquet-exposed leg in skeletal muscle and subcutaneous tissue, and recovered within 60 (skeletal muscle) and 130 min (subcutaneous tissue) after tourniquet release. These findings suggest that applying tourniquet for approximately 1 h results in limited tissue ischemia and cell damage in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone.


Assuntos
Osso Esponjoso/metabolismo , Músculo Esquelético/metabolismo , Procedimentos Ortopédicos/efeitos adversos , Traumatismo por Reperfusão/metabolismo , Tela Subcutânea/metabolismo , Torniquetes/efeitos adversos , Idoso , Calcâneo/metabolismo , Calcâneo/cirurgia , Feminino , Deformidades Adquiridas do Pé/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Estudos Prospectivos , Traumatismo por Reperfusão/etiologia
14.
BMC Infect Dis ; 21(1): 3, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397322

RESUMO

BACKGROUND: Surgical Site Infections (SSIs) are among the leading causes of the postoperative complications. This study aimed at investigating the epidemiologic characteristics of orthopedic SSIs and estimating the under-reporting of registries using the capture-recapture method. METHODS: This study, which was a registry-based, cross-sectional one, was conducted in six educational hospitals in Tehran during a one-year period, from March, 2017 to March, 2018. The data were collected from two hospital registries (National Nosocomial Infection Surveillance System (NNIS) and Health Information Management database (HIM)). First, all orthopedic SSIs registered in these sources were used to perform capture-recapture (N = 503). Second, 202 samples were randomly selected to assess patients` characteristics. RESULTS: Totally, 76.24% of SSIs were detected post-discharge. Staphylococcus aureus (11.38%) was the most frequently detected bacterium in orthopedic SSIs. The median time between the detection of a SSI and the discharge was 17 days. The results of a study done on 503 SSIs showed that the coverage of NNIS and HIM was 59.95 and 65.17%, respectively. After capture-recapture estimation, it was found that about 221 of orthopedic SSIs were not detected by two sources among six hospitals and the real number of SSIs were estimated to be 623 ± 36.58 (95% CI, 552-695) and under-reporting percentage was 63.32%. CONCLUSION: To recognize the trends of SSIs mortality and morbidity in national level, it is significant to have access to a registry with minimum underestimated data. Therefore, according to the weak coverage of NNIS and HIM among Iranian hospitals, a plan for promoting the national Infection Prevention and Control (IPC) programs and providing updated protocols is recommended.


Assuntos
Infecção Hospitalar/epidemiologia , Procedimentos Ortopédicos/efeitos adversos , Sistema de Registros , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Infecção Hospitalar/microbiologia , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Controle de Infecções , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Infecções Estafilocócicas/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/mortalidade
15.
Sports Health ; 13(1): 65-70, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32639180

RESUMO

CONTEXT: Malnutrition is well-studied in various aspects of the orthopaedic literature, most commonly in relation to arthroplasty, spine surgery, and trauma. However, the management of nutritional deficiencies is commonly overlooked among orthopaedic sports medicine providers. The purpose of this article is to analyze the available sports medicine literature to review the associations between malnutrition and the management of orthopaedic sports medicine patients from a treatment and performance standpoint. EVIDENCE ACQUISITION: PubMed was searched for relevant articles published from 1979 to 2019. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: Few studies exist on the implications of macronutrient deficiencies specific to orthopaedic sports medicine procedures. Interestingly, micronutrient disorders-namely, hypovitaminosis D and iron deficiency-have been well studied and may lead to worse postoperative outcomes, injury rates, and athletic performance. Nutritional supplementation to correct such deficiencies has been shown to mitigate these effects, though further study is required. CONCLUSION: Nutritional deficiencies are highly prevalent in orthopaedic sports medicine patients, and practitioners should be aware of their potential effects on treatment and performance outcomes. Management of such deficiencies and their effect on surgical patients remain an area of potential future research. Future studies are warranted in order to explore the potential therapeutic role of nutritional supplementation to prevent complications after common orthopaedic sports medicine procedures, improve athletic performance, and reduce injury rates.


Assuntos
Traumatismos em Atletas/cirurgia , Desempenho Atlético/fisiologia , Desnutrição/complicações , Procedimentos Ortopédicos , Anemia Ferropriva/complicações , Anemia Ferropriva/terapia , Traumatismos em Atletas/complicações , Suplementos Nutricionais , Humanos , Desnutrição/terapia , Nutrientes/deficiência , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/terapia
16.
J Pediatr Orthop ; 41(1): e85-e89, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32852367

RESUMO

BACKGROUND: The purpose of this study was to determine the intraoperative and 30-day postoperative complication rates in a large consecutive cohort of pediatric patients who had orthopaedic surgery at a freestanding ambulatory surgery center (ASC). The authors also wanted to identify the rates of same-day, urgent hospital transfers, and 30-day hospital admissions. The authors hypothesized that pediatric orthopaedic procedures at a freestanding ASC can be done safely with a low rate of complications. METHODS: A retrospective review identified patients aged 17 years or younger who had surgery at a freestanding ASC over a 9-year period. Adverse outcomes were divided into intraoperative complications, postoperative complications, need for the secondary procedure, unexpected hospital admission on the same day of the procedure, and unexpected hospital admission within 30 days of the index procedure. Complications were graded as grade 1, the complication could be treated without additional surgery or hospitalization; grade 2, the complication resulted in an unplanned return to the operating room (OR) or hospital admission; or grade 3, the complication resulted in an unplanned return to the OR or hospitalization with a change in the overall treatment plan. RESULTS: Adequate follow-up was available for 3780 (86.1%) surgical procedures. Overall, there were 9 (0.24%) intraoperative complications, 2 (0.08%) urgent hospital transfers, 114 (3%) complications, and 16 (0.42%) readmissions. Seven of the 9 intraoperative complications resolved before leaving the OR, and 2 required return to the OR.Neither complications nor hospitalizations correlated with age, race, gender, or length or type of surgery. There was no correlation between the presence of medical comorbidities, body mass index, or American Society of Anesthesiologists score and complication or hospitalization. CONCLUSIONS: Pediatric orthopaedic surgical procedures can be performed safely in an ASC because of multiple factors that include dedicated surgical teams, single-purpose ORs, and strict preoperative screening criteria. The rates of an emergency hospital transfer, surgical complications, and 30-day readmission, even by stringent criteria, are lower than those reported for outpatient procedures performed in the hospital setting. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Instituições de Assistência Ambulatorial , Procedimentos Cirúrgicos Ambulatórios , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Adolescente , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/normas , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/normas , Estudos de Coortes , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/normas , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
17.
J Pediatr Orthop ; 41(3): 182-189, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33323879

RESUMO

BACKGROUND: There are reports of spinal cord injury (SCI) occurring after lower extremity (LE) surgery in children with mucopolysaccharidoses (MPS). Intraoperative neurological monitoring (IONM) has been adopted in some centers to assess real-time spinal cord function during these procedures. The aim of this investigation was to review 3 specialty centers' experiences with MPS patients undergoing LE surgery. We report how IONM affected care and the details of spinal cord injuries in these patients. METHODS: All pediatric MPS patients who underwent LE surgery between 2001 and 2018 were reviewed at 3 children's orthopaedic specialty centers. Demographic and surgical details were reviewed. Estimated blood loss (EBL), surgical time, positioning, use of IONM, and changes in management as a result of IONM were recorded. Details of any spinal cord injuries were examined in detail. RESULTS: During the study period, 92 patients with MPS underwent 252 LE surgeries. IONM was used in 83 of 252 (32.9%) surgeries, and intraoperative care was altered in 17 of 83 (20.5%) cases, including serial repositioning (n=7), aggressive blood pressure management (n=6), and abortion of procedures (n=8). IONM was utilized in cases with larger EBL (279 vs. 130 mL) and longer operative time (274 vs. 175 min) compared with procedures without IONM. Three patients without IONM sustained complete thoracic SCI postoperatively, all from cord infarction in the upper thoracic region. These 3 cases were characterized by long surgical time (328±41 min) and substantial EBL (533±416 mL or 30.5% of total blood volume; range, 11% to 50%). No LE surgeries accompanied by IONM experienced SCI. CONCLUSIONS: Patients with MPS undergoing LE orthopaedic surgery may be at risk for SCI, particularly if the procedures are long or are expected to have large EBL. One hypothesis for the etiology of SCI in this setting is hypoperfusion of the upper thoracic spinal cord due to prolonged intraoperative or postoperative hypotension. IONM during these procedures may mitigate the risk of SCI by identifying real-time changes in spinal cord function during surgery, inciting a change in the surgical plan. LEVEL OF EVIDENCE: Level III-retrospective comparative series.


Assuntos
Monitorização Neurofisiológica Intraoperatória/estatística & dados numéricos , Extremidade Inferior/cirurgia , Mucopolissacaridoses/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Traumatismos da Medula Espinal/etiologia , Criança , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Retrospectivos , Traumatismos do Sistema Nervoso
18.
Am J Sports Med ; 49(2): 505-511, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33332176

RESUMO

BACKGROUND: Ambulatory surgeries have increased in recent decades to help improve efficiency and cost; however, there is a potential need for unplanned postoperative admission, clinic visits, or evaluation in the emergency department (ED). PURPOSE/HYPOTHESIS: The purpose was to determine the frequency, reasons, and factors influencing hospitalizations, return to clinic, and/or ED encounters within 24 hours of ambulatory surgery. The time frame for data collection was the first 2 years of operation of a university sports medicine ambulatory surgery center (ASC). We hypothesized that the percentage of encounters would be low and primarily because of pain or postoperative complication. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A retrospective review was performed of all patients undergoing ambulatory surgery at an ASC during the first 2 years of its operation (November 2016 to October 2018). Data including age, sex, Current Procedural Terminology code, procedure performed, American Society of Anesthesiologists classification, body mass index, medical history, and tobacco use were collected. Patients seeking care in the ED, inpatient, or outpatient setting within the first 24 hours after surgery were identified and the reasons for these encounters were categorized into 1 of 3 groups: (1) medical complication, (2) postoperative pain, or (3) other postoperative complication. Logistic regression models were used to assess risk factors for these encounters. RESULTS: A total of 4650 sports medicine procedures were performed at the university ASC during the study period. A total of 35 patients (0.75%) sought additional care within 24 hours of surgery. Medical complications were the primary reason for seeking care (n = 16; 45.7%). Patients who sought treatment within 24 hours of surgery tended to be older, had more medical comorbidities, and were more likely to have undergone upper extremity (particularly shoulder) procedures. In the multivariable analysis, patients with higher ASA scores were more likely to seek additional care (P < .005) and there was a trend toward increased risk of seeking additional care with upper extremity surgery (P = .077). CONCLUSION: Orthopaedic procedures performed in an ASC result in a relatively low percentage of patients seeking additional care within the first 24 hours after surgery, consistent with other reports in the literature. Upper extremity procedures, particularly those of the shoulder, may carry an increased risk of requiring medical treatment within 24 hours of surgery. Even in the first 2 years of operation of a university-based ASC, low rates of postoperative complications and unplanned admissions can be maintained.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Estudos de Casos e Controles , Humanos , Procedimentos Ortopédicos/efeitos adversos , Estudos Retrospectivos , Universidades
19.
Rev Fac Cien Med Univ Nac Cordoba ; 77(3): 161-167, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32991109

RESUMO

INTRODUCTION: Postoperative complications (PCs) constitute any deviation from the normal postoperative course. Reporting of PCs remains a challenge, multiple classification systems have been proposed, however these have not been validated across surgical specialties. Clavien and Dindo (DCCS) developed a system for General Surgery and has been adopted in different fields. Nonetheless, this classification has not been adapted to Orthopedics. The objective of this study was to adapt the Clavien-Dindo classification to orthopedic scenarios and to determine the intra and interobserver reliability. METHODS: The designer team adapted the Clavien Dindo classification to orthopedic scenarios. Ten orthopedic observers with different degrees of training and experience were selected to evaluate the classification. 48 simulated clinical scenarios of complications and another negative outcomes such as failure to cure and sequelae were sent by electronic format independently. A second round of scoring was performed 30 days later to assess the intraobserver concordance. RESULTS: We found a high interobserver and intraobserver reliability for both the first and second evaluation (Kappa 0.88 and 0.91, respectively). In addition, the intraobserver analysis showed a very good correlation (Kappa 0.93). DISCUSSION: The DCCS classification has been developed for general surgery and has been widely applied in the different surgical subspecialties. In Orthopedics, this classification was validated to hip and pediatric surgery. Therefore, our study involved an adaptation of the classification to general and specific orthopedic scenarios of the different orthopedic subspecialties. This classification may be a useful tool for documenting complications in orthopedic surgery.


Assuntos
Procedimentos Ortopédicos , Ortopedia , Complicações Pós-Operatórias/classificação , Criança , Quadril/cirurgia , Humanos , Procedimentos Ortopédicos/efeitos adversos , Período Pós-Operatório , Reprodutibilidade dos Testes
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