Decreased infection rates following total joint arthroplasty in a large county run teaching hospital: A single surgeon's experience and possible solution

Gottschalk, Michael B.; Johnson, Joey P.; Sadlack, Christopher K.; Mitchell, Phillip M.

doi:10.1016/j.arth.2014.03.012

Cited by 19 publications

(16 citation statements)

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“…Hastaya yerleştirilen implant, mobilizasyon zamanının ve hastanın fizyolojik özelliklerinin ameliyat sonrası sonucu etkilediği belirtilmektedir. [15] Gottschalk ve arkadaşlarının [21] yürüttüğü çalışmada, mobilizasyonun doğru zamanda yapılmamasına bağlı olarak en sık görülen komplikasyonun derin ven trombozu (%2.9) olduğu saptanmıştır. Sağlık ekibinin ameliyat sonrası planlı mobilizasyonu sağlaması, ortopedi ameliyatı olan hastalarda yeniden ameliyat olmayı önleyebilecek durumlar arasında gösterilmektedir.…”

Section: Ortopedik Cerrahiunclassified

“…Sağlık ekibinin ameliyat sonrası planlı mobilizasyonu sağlaması, ortopedi ameliyatı olan hastalarda yeniden ameliyat olmayı önleyebilecek durumlar arasında gösterilmektedir. [21,24] …”

Section: Ortopedik Cerrahiunclassified

“…Literatürde sıklıkla beyin cerrahisi, kalp-damar cerrahisi, ortopedik cerrahi, tiroid ve paratiroid cerrahisi sonrası ameliyat yinelemesinin gerçekleştirildiği görülmektedir (Tablo 1). [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Bununla birlikte, bireylerin yeniden ameliyat edilmesi, ameliyat sonrası yeni sorunların oluşmasına, mortalite ve komplikasyon gelişme olasılığının artmasına neden olmaktadır.…”

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Reoperation and Nursing Care

Aydιn¹,

Çilingir²

2017

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ÖZYeniden ameliyat olma (reoperasyon), ameliyata neden olan durumun tekrarlanması ya da komplikasyon nedeniyle hastanın yeniden ameliyata alınmasıdır. Ameliyat olan hastalar, ameliyat sonrası dönemde birçok sorunla karşılaşabilmektedir. Bu dönemde yaşanan sorunlar, hastayı olumsuz etkilemekte ve bazı durumlarda hastanın yeniden ameliyat edilmesi gerekmektedir. Bununla birlikte, ikinci kez ameliyat olan hastaların mortalite ve gelişebilecek komplikasyon oranları da artmaktadır. Hastanın ikinci kez ameliyat olmasına karar verilmesi sağlık çalışanı yönünden oldukça güç bir durumdur. Bireysel etmenler göz önünde bulundurularak kar-zarar ilişkisinin gözden geçirilmesi karar vermede etkili olmaktadır. Yeniden ameliyat olma riski taşıyan hastaların bulunduğu kliniklerde çalışan cerrahi hemşiresinin, uygulanacak girişimleri erken tespit edilebilmesi için klinik deneyim kazanmış olması gerekmektedir. Bu nedenle, cerrahi hemşiresi hastanın ameliyat öncesi dönemde öyküsünü doğru sorgulamalı, bireysel etmenleri değerlendirmeli, etkili hemşirelik bakımı uygulayarak yaşanan sorunların azaltılmasında ve komplikasyon yönetiminde etkin olmalıdır. Ayrıca ikinci kez ameliyat olan bireyin ameliyat sonrası taburculuğunun planlanmasında, cerrahi hemşiresinin riskleri bilmesi ve önlem alınacak durumları bireye iletmesi kaliteli iyileşmenin gerçekleşmesine katkı sağlayacaktır.Anahtar kelimeler: Hasta bakımı; perioperatif hemşirelik; reoperasyon. ABSTRACTReoperation refers to a patient re-undertaking an operation due to the reoccurrence of the condition or to correct the complications of a previous operation. Patients who have an operation may face many problems during the post-surgery period. Problems seen during this period may affect patients negatively and require reoperation in some cases. However, the rate of mortality and possible complications increases among those having an operation for the second time. It is a very difficult situation for the healthcare worker to make the decision for a second operation. In addition to individual factors, reviewing profit and loss balance may be influential upon this decision. It is necessary that surgical nurses working at clinics where patients with reoperation risk stay should have clinical experience so that they can determine the interventions early. Therefore, surgical nurses should thoroughly ask patients about history in pre-surgery period, assess individual factors, and be effective in reducing problems and in complication management by administering effective nursing care. This will contribute to the successful planning of post-operation discharge of the patients. Surgical nurses must know the risks and communicate which measures are to be taken in order to achieve a high-quality recovery.

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Reoperation and Nursing Care

Aydιn¹,

Çilingir²

2017

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“…[ 1 ] Despite the positive goal of the procedure, it is often hindered by malnutrition in patients. [ 2 ] Malnutrition increases postoperative morbidity and mortality, prolongs the rehabilitation time,[ 3 ] raises the infection rates,[ 4 ] and delays wound healing. [ 5 6 ] Preoperative and postoperative nutritional status (i.e., serum albumin [S.…”

Section: Introductionmentioning

confidence: 99%

Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty

et al. 2015

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Background:Surgical site infection (SSI) is considered one of the most serious complications in total joint arthroplasty (TJA). This study seeks to analyze the predictive value of preoperative and postoperative nutritional biomarkers for SSI in elective TJA.Methodology:Nutritional markers were gathered retrospectively utilizing patient's records from the orthopedics department at Benghazi Medical Center (BMC). The sample spanned cases admitted during the 20-month period between January 2012 and August 2013 and had undergone either elective total hip replacement or total knee replacement. The collected lab results included a complete blood count, total lymphocyte count (TLC), and serum albumin (S. alb.) levels. The patients were then divided into two groups based on the occurrence of an SSI.Results:A total of 135 total knee (81.5%, n = 110/135) and total hip (18.5%, n = 25/135) replacements were performed at BMC during the study period. Among these cases, 57% (n = 78/135) had patient records suitable for statistical analysis. The average preoperative TLC was 2.422 ×103 cells/mm3 (range = 0.8–4.7 ×103 cells/mm3) whereas that number dropped after the surgery to 1.694 ×103 cells/mm3 (range = 0.6–3.8 ×103 cells/mm3). S. alb. levels showed a mean of 3.973 g/dl (range = 2.9–4.7 g/dl) preoperatively and 3.145 g/dl (range = 1.0–4.1 g/dl) postoperatively. The majority of TJA patients did not suffer any complication (67.4%, n = 91/135) while eight cases (5.9%) suffered from a superficial SSI.Conclusion:Preoperative S. alb. was identified as the only significant predictor for SSI (P = 0.011). Being a preventable cause of postoperative morbidity, it is recommended that the nutritional status (especially preoperative S. alb.) of TJA patients be used as a screening agent and appropriate measures be taken to avoid SSI.

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“…Infection continues to be one of the most costly and clinically challenging issues in total joint arthroplasty. 1,2 While most of these infections are caused by gram-positive bacteria, 3 gramnegative organisms remain a significant problem, 4,5 and broad-spectrum protection is essential. Intravenous (IV) antibiotics have decreased the rates of infection effectively in major joint arthroplasty, but high rates still persist, 5 possibly because of limited delivery of antibiotics to the joint.…”

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confidence: 99%

Prophylactic peri-operative local antibiotic irrigation

Whiteside

2016

The Bone & Joint Journal

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An extensive review of the spinal and arthroplasty literature was undertaken to evaluate the effectiveness of local antibiotic irrigation during surgery. The efficacy of antibiotic irrigation for the prevention of acute post-operative infection after total joint arthroplasty was evaluated retrospectively in 2293 arthroplasties (1990 patients) between January 2004 and December 2013. The mean follow-up was 73 months (20 to 139). One surgeon performed all the procedures with minimal post-operative infection. The intra-operative protocol included an irrigation solution of normal saline with vancomycin 1000 mg/l and polymyxin 250,000 units/l at the rate of 2 l per hour. No patient required re-admission for primary infection or further antibiotic treatment. Two morbidly obese patients (two total hip arthroplasties) developed subcutaneous fat necrosis requiring debridement and one was revised because the deep capsular sutures were contaminated by the draining subcutaneous haematoma. One patient who had undergone total knee arthroplasty had unrecognised damage to the lateral superior geniculate artery and developed a haematoma that became infected secondarily four months after the surgery and underwent revision. The use of antibiotic irrigation during arthroplasty surgery has been highly effective for the prevention of infection in the author's practice. However, it should be understood that any routine prophylactic use of antibiotics may result in resistant organisms, and the wise stewardship of the use of antibiotics is an important part of surgical practice.

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Decreased infection rates following total joint arthroplasty in a large county run teaching hospital: A single surgeon's experience and possible solution

Cited by 19 publications

References 30 publications

Reoperation and Nursing Care

Reoperation and Nursing Care

Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty

Prophylactic peri-operative local antibiotic irrigation

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