Purpose Intraoperative wound irrigation prior to closure during total joint arthroplasty (TJA) is an essential component of preventing infections and limiting health care system costs. While studies have shown the efficacy of dilute betadine in reducing infection risk, there remains concerns over its safety profile and theoretical inactivation by blood and serum. This study aims to compare infection and wound complications between chlorhexidine gluconate (CHG) and betadine lavage during TJA. Methods All primary TJA between 2019–2021 were analyzed at a single institution, and periprosthetic joint infection (PJI), wound drainage, 30 and 90-day emergency room (ER) readmission due to wound complications, aseptic loosening, and revision surgery rate were compared between patients undergoing intraoperative CHG versus betadine lavage prior to closure. Baseline demographics were controlled, and multivariate logistic regression was performed to compare complication rates. Results A total of 410 TJA, including 160 hip and 250 knee arthroplasties were included. Compared to the dilute betadine cohort, all TJA patients undergoing CHG lavage had a statistically significant lower 30 and 90-day emergency room readmission rate due to wound complications. Both hip and knee arthroplasty patients with CHG had a statistically significant lower rate of postoperative superficial drainage and dressing saturation at clinic follow-up, but only knee arthroplasty patients had significant decreased readmission rate for incisional wound vacuum placement and close inpatient monitoring of wound healing. Among all TJA, there was no significant association in the rate of PJI requiring return to the OR between groups. Conclusions Although betadine is cost-effective and has been shown to reduce PJI rates, there remains concerns in the literature over soft tissue toxicity and wound healing. This study suggests CHG may be as efficacious as dilute betadine in preventing PJI while also decreasing the risk of superficial drainage and wound complications needing unplanned ER visits during the acute postoperative period.
Auditory signals are often used by forest species to attract mates, define and defend territories, and locate prey, and thus these signals may be monitored and used to estimate species presence, richness and acoustic complexity of a patch of habitat. We analyzed recordings from a biodiversity hotspot in the rainforests of Batang Ai National Park in Sarawak, Malaysian Borneo. Three recording sites were established in the forest understory and continuous recordings were made for an acoustic snapshot of approximately 40 h. From these recordings, the bioacoustic index (BI) and acoustic complexity index (ACI) were computed. These acoustic indices exhibited clear periodicity with periods on the order of >6 h. The ACI and BI time series also showed oscillations, with peaks separated by 12 h corresponding to the alternation between bird and frog activity during the day and night, respectively. We quantified the relationships between the acoustic index values and anuran and avian richness, and environmental variables (rainfall intensity and time of day) using correlative and information theoretic techniques. ACI and BI were moderately positively and negatively correlated with rainfall intensity, respectively. ACI and BI were also weakly-to-moderately correlated to species richness, but with mixed directions between recording sites. However, the correlations and mutual information values, a model-free estimator of the relationship strength of random variables, were highest for the relationships between ACI and BI with respect to the rate of individual frog calls, rather than species richness alone. We conclude that acoustic indices are most useful for monitoring ecological dynamics on timescales longer than 6 h. We suggest that acoustic indices are best applied to studying changes in acoustic activity at the level of ecological populations rather than for estimating species richness, as they have been commonly applied in the past.
Background As healthcare economics shifts towards outcomes-based bundled payment models, providers must understand the evolving dynamics of medical optimization and fluid resuscitation prior to elective surgery. Dehydration is an overlooked modifiable risk factor that should be optimized prior to elective total knee arthroplasty (TKA) to reduce postoperative complications and inpatient costs. Methods All primary TKA from 2005 to 2019 were queried from the National Surgical Quality Improvement Program (NSQIP) database, and patients were compared based on dehydration status: Blood Urea Nitrogen Creatinine ratio (BUN/Cr) < 20 (non-dehydrated), 20 ≤ BUN/Cr ≤ 25 (moderately-dehydrated), 25 < BUN/Cr (severely-dehydrated). A sub-group analysis involving only elderly patients > 65 years and normalized gender-adjusted Cr values was also performed. Results The analysis included 344,744 patients who underwent TKA. Adjusted multivariate logistic regression analysis showed that the severely dehydrated cohort had a greater risk of non-home discharge, postoperative transfusion, postoperative deep vein thrombosis (DVT), and increased length of stay (LOS) (all p < 0.01). Among the elderly, dehydrated patients had a greater risk of non-home discharge, progressive renal insufficiency, urinary tract infection (UTI), postoperative transfusion, and extended LOS (all p < 0.01). Conclusion BUN/Cr > 20 is an important preoperative diagnostic tool to identify at-risk dehydrated patients. Providers should optimize dehydration to prevent complications, decrease costs, and improve discharge planning. Level of evidence Level III; Retrospective Case-Control Design; Prognosis Study.
Background: As healthcare economics shifts towards outcomes based bundled payment models, providers must understand the evolving dynamics of medical optimization and fluid resuscitation prior to elective surgery. Dehydration is an overlooked modifiable risk factor that should be optimized prior to elective total knee arthroplasty (TKA) to reduce postoperative complications and inpatient costs. Methods: All primary TKA from 2005-2019 were queried from the National Surgical Quality Improvement Project (NSQIP) database, and patients were compared based on dehydration status: BUN/Cr < 20 (non-dehydrated), 20 ≤ BUN/C ≤ 25 (moderately-dehydrated), 25 < BUN/Cr (severely-dehydrated). A sub-group analysis involving only elderly patients >65 years and normalized gender-adjusted creatinine (Cr) values was also performed. Results: The analysis included 344,744 patients who underwent TKA. Adjusted multivariate logistic regression analysis showed that the severely dehydrated cohort had a greater risk and rate of overall complications, postoperative deep vein thrombosis (DVT), urinary tract infections (UTI), progressive renal insufficiency, postoperative anemia requiring transfusion, nonhome discharge, and increased length of stay (LOS) (all p<0.01). Among the elderly, dehydrated patients had a greater risk of postoperative transfusion, cardiac complications, and nonhome discharge (all p<0.01). Conclusions: BUN/Cr>20 is an important preoperative diagnostic tool to identify at-risk dehydrated patients. Providers should optimize dehydration to prevent complications, decrease costs, and improve discharge planning. Level of evidence: Level III; Retrospective Case-Control Design; Prognosis Study
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