Protocol changes to reduce implant‐associated infection rate after tibial plateau leveling osteotomy: 703 dogs, 811 TPLO (2006‐2014)

Stine, Samantha; Odum, Susan M.; Mertens, W. Daniel

doi:10.1111/vsu.12796

Cited by 27 publications

(28 citation statements)

References 32 publications

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“…When these concerns are combined with the previously discussed data that provide evidence that protocol changes in perioperative and postoperative animal care drastically diminished infection rates in TPLO surgeries without changing antibiotic regimens, it may be easier to argue that antibiotics used postoperatively in TPLO surgeries are not warranted. 14 Regardless of one's disposition on this issue, additional research is crucial to aid clinicians in clinical decision making and should address these concerns. This research must include a set of standardized treatment guidelines for each group in a study and should include culture and sensitivity results as part of the definition of an SSI.…”

Section: Discussionmentioning

confidence: 99%

“…As an example, authors of a recent article found that the changes in perioperative and postoperative protocols altered infection rates in TPLO surgeries without changing antibiotic regimens. 14 Furthermore, the determination of infection varied throughout the studies and may, in part, be responsible for the wide range of infection rates noted. Most studies used a broad category of subjective clinical signs, with limited emphasis or requirement for objective culture evaluation to confirm infection.…”

Section: Discussionmentioning

confidence: 99%

“…12 Therefore, several strategies have been employed clinically to attempt to lower the rate of infection, including use of antibiotic impregnated suture, extended postoperative antimicrobials, and implementation of preventive intraoperative and postoperative protocols. 6,9,11,[13][14][15] The objective of a systematic review is to identify, evaluate, and summarize the findings of all relevant individual studies about a specific issue, thereby making the available evidence more accessible to individuals and allowing them to make informed decisions. The objective of the systematic review reported here was to evaluate published data that could be used to determine whether the use of extended postoperative antibiotics after TPLO in dogs would reduce the risk of SSI.…”

Section: Introductionmentioning

confidence: 99%

“…Researchers in a recent study found that the cost of treating an SSI approached 50% of the original surgery cost and, in some, cases exceeded it 12 . Therefore, several strategies have been employed clinically to attempt to lower the rate of infection, including use of antibiotic impregnated suture, extended postoperative antimicrobials, and implementation of preventive intraoperative and postoperative protocols 6,9,11,13‐15 …”

Section: Introductionmentioning

confidence: 99%

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Efficacy of postoperative antibiotic use after tibial plateau leveling osteotomy in dogs: A systematic review

2021

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Objective: A systematic review of published data to determine whether postoperative antibiotic use after tibial plateau leveling osteotomy (TPLO) decreases infection rates. Study design: Systematic review.Methods: A broad bibliographic search was performed in three online databases through March 2020 for publications on postoperative antibiotic use after TPLO in dogs. Search terms included dog, canine, TPLO, tibial plateau leveling osteotomy, infection, antibiotic, and antimicrobial. Articles that met inclusion criteria were evaluated for level of evidence (LoE) by a modified Oxford Level of Evidence (mOLE) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) classification and evaluation.Results: Thirteen studies met the inclusion criteria. Effect of antibiotic use was the primary question in four studies. Among those, 50% (2/4) were assigned a mOLE of 1b and a GRADE of moderate, while the other 50% (2/4) were assigned a mOLE of 4b or 4c with a GRADE of low. The two studies with the highest LoE did not provide evidence of the benefit of antibiotic usage.Results of only one study provided evidence to support the use of postoperative antibiotics. The remaining nine studies provided evaluation of antibiotic use secondarily and were all assigned a low LoE. Among these, 78% (7/9) provided evidence to support the use of postoperative antibiotics. Conclusion:We found little evidence to support the use of postoperative antibiotics to reduce the risk of surgical site infections in dogs after TPLO. The answer to this clinical question is complicated by the lack of prospective studies and inconsistent treatment protocols in the evaluated studies.Clinical significance: The clinical impact of postoperative antibiotic administration on infection rates after TPLO is uncertain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of postoperative antibiotic use after tibial plateau leveling osteotomy in dogs: A systematic review

2021

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“…A recent study in dogs outlined an aseptic TPLO protocol that led to a significant decrease in post‐TPLO infection rate and implant removal . From the value‐based point of view, the lower incidence of complications improved the value (better outcomes and lower costs) provided to dogs that benefited from the aseptic protocol.…”

Section: Learning Toolmentioning

confidence: 99%

Why measuring outcomes is important in health care

Pantaleon¹

2019

Veterinary Internal Medicne

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A new strategy has been introduced in human health care, namely, achieving the best outcomes for the lowest cost and thus maximizing value for patients. In value‐based care, the only true measures of quality are the outcomes that matter to patients. When outcomes are measured and reported, it fosters improvement and adoption of best practices, thus further improving outcomes. Understanding outcomes is central in providing value and represents an opportunity for redefining veterinary patient care. Value is created by improving the outcomes of patients with a particular clinical condition over the full cycle of care, which normally involves multiple specialties and care sites. To be successful, a key aspect of value based care is working as teams (integrated practice units) centered around the patient's clinical condition. As veterinary medicine has become more specialized and more complex, multidisciplinary communication and trust among the care team are paramount in providing value to patients (and clients). Use of patient‐reported outcomes is an essential aspect for improving clinical care, because it enhances the connections among doctors and with patients. Designing and implementing owner‐reported outcomes in veterinary clinical practice will lead to an understanding of the effects of treatments on outcomes and quality of life (QOL) of our patients from the owner's perspective, a key way to assess a veterinary patient's QOL.

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Complications Associated with Arthroscopic Evaluation of the Stifle and Decision Making

Beale¹,

Jones²,

Tinga³

2021

Complications in Canine Cranial Cruciate Ligament Surgery

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Protocol changes to reduce implant‐associated infection rate after tibial plateau leveling osteotomy: 703 dogs, 811 TPLO (2006‐2014)

Abstract: The protocol reported here may be used as a guide in clinics seeking to reduce their IAI rates after TPLO. Postoperative infections after implementation of this protocol should be monitored to evaluate its potential impact on the emergence of antibiotic resistance.

Cited by 27 publications

References 32 publications

Efficacy of postoperative antibiotic use after tibial plateau leveling osteotomy in dogs: A systematic review

Efficacy of postoperative antibiotic use after tibial plateau leveling osteotomy in dogs: A systematic review

Why measuring outcomes is important in health care

Complications Associated with Arthroscopic Evaluation of the Stifle and Decision Making

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