Complications and its impact in patients with closed and open tibial shaft fractures requiring open reduction and internal fixation

Chitnis, A.S.; Vanderkarr, M.; Sparks, C.; McGlohorn, J; Holy, Chantal E.

doi:10.2217/cer-2019-0108

Cited by 10 publications

(18 citation statements)

References 17 publications

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“…Chitnis et al reported that patients with infection had significantly higher rates of hospital readmissions, emergency department visits, and healthcare expenses than patients without infection in a retrospective, observational cohort study [ 19 ]. This indicates a greater strain on the healthcare system, which is already plagued by financial constraints and expenses borne by the patient and his caregivers.…”

Section: Discussionmentioning

confidence: 99%

C-reactive Protein Is a Diagnostic Tool for Postoperative Infection in Orthopaedics

Shetty¹,

Ethiraj²,

Shanthappa³

2022

Cureus

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BackgroundOrthopedic fracture-associated infection is a prevalent complication with a huge burden on the healthcare infrastructure. C-reactive protein (CRP) is a widely used serum inflammatory marker in patients with infections in orthopaedics. It could be difficult to distinguish between CRP elevation caused by surgical site infection and CRP elevation caused by surgery and trauma in orthopaedic procedures. In most situations, a clinical diagnosis of post-surgical infection is sufficient, however, the use of a biomarker with predictive value for acute post-op complications could prompt an earlier diagnosis. This study, therefore, aims at assessing CRP levels in post-operative orthopaedic trauma patients and determining the reliability of CRP as an early indicator of postoperative infection. Materials and methodsA prospective study was conducted between December 2020 and November 2021 in the department of orthopaedics in Sri Devaraj Urs medical college, Kolar. Patients with an open and closed fracture of the upper and lower extremities treated by osteosynthesis on an elective or emergency basis were included. The clinical parameters were studied on the day of trauma, postoperative days first, third and seventh. Blood samples for CRP were taken prior to the surgical procedure and on the same days as clinical monitoring. The CRP levels were compared between patients with postoperative infection and patients without postoperative infections using independent samples t-test. A p-value of < 0.05 was considered statistically significant. ResultsA total of 51 patients were included in the study meeting the inclusion criteria, of which mean standard deviation for age was 37.5 (15.7%), 44 were men (86.2%) and seven were women (13.7%), Patients according to Tscherene classification grade I were 10 (19.6%), grade II were eight (15.6%), grade III were 15 (29.4%) and grade IV was 18 (35.2%), type of fracture surgery diaphyseal were 27 (52.9%), proximal was 11 (21.5%) and distal were 13 (25.4%). 15 patients developed postoperative infection with CRP levels of 96 µg/mL in nine (17.6%), 48 µg/mL in four (7.8%) and 24 µg/mL in two (3.9%). Thirty-six patients who did not develop postoperative infection had CRP levels of 6 µg/mL in 31 (60.8%) and 12 µg/mL in five (9.8%). The p-value for the first postoperative day was 0.289 and statistically insignificant and on the third and seventh postoperative days was <0.001 and was found to be statistically significant. ConclusionC-reactive protein is a useful parameter to detect and monitor post-operative infections in orthopaedic trauma surgeries. The rise in C-reactive protein on the third and seventh postoperative days can be used as a reliable predictor of post-operative infections.

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Section: Discussionmentioning

confidence: 99%

C-reactive Protein Is a Diagnostic Tool for Postoperative Infection in Orthopaedics

Shetty¹,

Ethiraj²,

Shanthappa³

2022

Cureus

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“…This real-world study revealed a two-year increase in infection rates, as well as a considerable increase in healthcare resource utilization and expenses. However, we did not include the cost, but our institution is currently working on a paper that will include several other factors [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors and Association of Cluster of Differentiation (CD) Markers With Conventional Markers in Delayed Fracture Related Infection for Closed Fracture

Raikwar¹,

Singh²,

Verma³

et al. 2021

Cureus

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Background: Fracture-related infections (FRI) remain a difficult consequence for orthopedic trauma patients, their relatives, the treating physicians, and the healthcare systems. Delayed fracture-related infection is an important step in the infection process that can be controlled by diagnosing and preventing it from moving to the next level. Neutrophils CD64 and CD66b were identified as sensitive indicators in the event of infection. Normal sequential changes, on the other hand, occur after surgery and are extremely high. They are back to normal on the 10 th day after the operation. The aim of this study was, therefore, to examine the risk factors associated with fracture-related infection by comparing cluster of differentiation (CD) indicators with conventional markers and comparing them with gold standards culture reports. As a result, it could be an early sign of a closed fracture infection.

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“…In the 18 studies that estimated the cost from the provider perspective, in addition to the inpatient cost, capital and overhead costs, 35,[63][64][65] opportunity costs, 58,60,63 and outpatient costs, 30,34,50,55 were considered. Inpatient and outpatient costs 33,43,48,[66][67][68][69] as well as productivity losses 56,57,66 and out-ofpocket costs 47,47,68 were included in 13 studies in which the payer perspective was adopted. With patient perspective, 30,46 inpatient, outpatient and out-of-pocket costs were included.…”

Section: Types Of Costmentioning

confidence: 99%

“…In total, 63 studies (90%) stated the duration over which cost was calculated, ranging from 1-3 months to lifetime (Table 4). 70 Discounting was applicable when the time horizon was 1 year or more 33,47,54,59,66,69,71 in 8 studies; however, costs were discounted only in 1 study, 70 and 2 studies 32,51,70 discounted their costs although they were collected over 3 months only.…”

Section: Time Horizon and Discountingmentioning

confidence: 99%

Evaluation of the costing methodology of published studies estimating costs of surgical site infections: A systematic review

Shaaban

Yassine

Bedwani

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objectives: Surgical site infections (SSIs) are associated with increased length of hospitalization and costs. Epidemiologists and infection control practitioners, who are in charge of implementing infection control measures, have to assess the quality and relevance of the published SSI cost estimates before using them to support their decisions. In this review, we aimed to determine the distribution and trend of analytical methodologies used to estimate cost of SSIs, to evaluate the quality of costing methods and the transparency of cost estimates, and to assess whether researchers were more inclined to use transferable studies. Methods: We searched MEDLINE to identify published studies that estimated costs of SSIs from 2007 to March 2021, determined the analytical methodologies, and evaluated transferability of studies based on 2 evaluation axes. We compared the number of citations by transferability axes. Results: We included 70 studies in our review. Matching and regression analysis represented 83% of analytical methodologies used without change over time. Most studies adopted a hospital perspective, included inpatient costs, and excluded postdischarge costs (borne by patients, caregivers, and community health services). Few studies had high transferability. Studies with high transferability levels were more likely to be cited. Conclusions: Most of the studies used methodologies that control for confounding factors to minimize bias. After the article by Fukuda et al, there was no significant improvement in the transferability of published studies; however, transferable studies became more likely to be cited, indicating increased awareness about fundamentals in costing methodologies.

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Complications and its impact in patients with closed and open tibial shaft fractures requiring open reduction and internal fixation

Cited by 10 publications

References 17 publications

C-reactive Protein Is a Diagnostic Tool for Postoperative Infection in Orthopaedics

C-reactive Protein Is a Diagnostic Tool for Postoperative Infection in Orthopaedics

Analysis of Risk Factors and Association of Cluster of Differentiation (CD) Markers With Conventional Markers in Delayed Fracture Related Infection for Closed Fracture

Evaluation of the costing methodology of published studies estimating costs of surgical site infections: A systematic review

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