Quality Reporting Windows May Not Capture the Effects of Surgical Site Infections After Orthopaedic Surgery

Shapiro, Lauren M.; Graham, Laura A.; Hawn, Mary T.; Kamal, Robin N.

doi:10.2106/jbjs.21.01278

Cited by 5 publications

(5 citation statements)

References 26 publications

(45 reference statements)

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“…The average infection rate of 2% among all patients who received follow‐up in these three studies is much lower than that reported in other studies examining infection rates after similar procedures. For example, post‐surgical infection rates are higher following traumatic injuries treated by ORIF in LMICs (6.4%) [53] and following orthopaedic surgery in the USA (about 4%) [54, 55], perhaps representing a lack of follow‐up and/or under‐reporting within the studies in this review [5, 54, 56]. The discrepancies in these numbers and the high complication rates highlight how outreach organizations have a responsibility to conduct follow‐up or ensure follow‐up is attainable.…”

Section: Discussionmentioning

confidence: 99%

Patient Follow‐up After Orthopaedic Outreach Trips – Do We Know Whether Patients are Improving?

Leversedge¹,

Castro

Appiani³

et al. 2022

World j. surg.

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Background The burden of traumatic musculoskeletal injuries falls greatest on low- and middle-income countries (LMICs). To help address this burden, organizations host over 6,000 outreach trips annually, 20% of which are orthopaedic. Monitoring post-surgical outcomes is critical to ensuring care quality; however, the implementation of such monitoring is unknown. The purpose of this review is to identify published follow-up practices of short-term orthopaedic surgery outreach trips to LMICs. Methods We completed a systematic review of Pubmed, Web of Science, EMBASE, and ProQuest following PRISMA guidelines. Follow-up method, rate, duration, and types of outcomes measured along with barriers to follow-up were collected and reported. Results The initial search yielded 1,452 articles, 18 of which were eligible. The mean follow-up time was 5.4 months (range: 15 days-7 years). The mean follow-up rate was 65.8% (range: 22%-100%), the weighted rate was 57.5%. Fifteen studies reported follow-up at or after 3 months while eight studies reported follow-up at or after 9 months. Fifteen studies reported follow-up in person, three reported follow-up via phone call or SMS. Outcome reporting varied among mortality, complications, and patient-reported outcomes. The majority (75%) outlined barriers to follow-up, most commonly noting transportation and costs of follow-up to the patient. Conclusions There is minimal and heterogeneous public reporting of patient outcomes and follow-up after outreach trips to LMICs, limiting quality assessment and improvement. Future work should address the design and implementation of tools and guidelines to improve follow-up as well as outcome measurement to ensure provision of high-quality care.

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Section: Discussionmentioning

confidence: 99%

Patient Follow‐up After Orthopaedic Outreach Trips – Do We Know Whether Patients are Improving?

Leversedge¹,

Castro

Appiani³

et al. 2022

World j. surg.

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“…Although this limits comparison with the bundle time horizon that other studies have used,43 their results are still applicable to health payers and systems making short-term resource-allocation decisions. Due to their focus on short-term, TJA-specific costs and benefits, the authors also did not consider long-term diabetes-related or other sequelae avoided by screening and treatment, which would further increase the effectiveness of screening 36…”

Section: Discussionmentioning

confidence: 99%

“…Due to their focus on short-term, TJA-specific costs and benefits, the authors also did not consider long-term diabetes-related or other sequelae avoided by screening and treatment, which would further increase the effectiveness of screening. 36…”

Section: Limitations and Future Perspectivesmentioning

confidence: 99%

Costs and benefits of routine hemoglobin A1c screening prior to total joint arthroplasty: a cost-benefit analysis

Zhuang

Shapiro

Amanatullah

et al. 2022

Current Orthopaedic Practice

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Background:Poorly controlled diabetes mellitus (DM) increases the risk for periprosthetic joint infection (PJI) after total joint arthroplasty (TJA). While institutional protocols include hemoglobin A1c (HbA1c) screening in TJA patients, the costs and benefits of routine preoperative screening have not been described. Methods:The authors created a decision tree model to evaluate short-term costs and risk reduction for PJIs with routine screening of primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Probabilities and costs were obtained from published sources. They calculated net costs and absolute risk reduction in PJI for routine screening versus no screening. The authors also performed sensitivity analyses of model inputs, including probabilistic sensitivity analyses (PSAs) consisting of 10,000 Monte Carlo simulations. Results:In patients with DM, one routine screening before THA resulted in net cost savings of $81 per patient, with 286 patients needing to be screened to prevent one PJI, while screening before TKA incurred net additional costs of $25,810 per PJI prevented. Routine screening in patients with DM undergoing THA or TKA was cost-saving across 75.5% or 21.8% of PSA simulations, respectively. In patients with no history of DM, routine screening before THA or TKA

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“…Surgical site infections (SSIs) are apparent worldwide, with reports that in England, deep wound infection after proximal femoral fracture incurred total costs of treatment per infected case of £24,410 compared with £7210 for patients without infection [ 3 ]. A recent study from the US reported a significant increase in healthcare costs over 16 months due to SSI after orthopedic surgeries, with a 64% increase in the two-year costs due to SSI [ 4 ]. Infections lead to longer hospital stays; in the case of SSI in hip fractures, the mean length of stay of patients was 76 days (50 days for superficial wound infections, 100 days for deep wound infections) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Ability of Different Allografts to Act as Carrier Grafts for Local Drug Delivery

Bormann,

Schmock,

Hanke

et al. 2023

JFB

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Bone defects and infections pose significant challenges for treatment, requiring a comprehensive approach for prevention and treatment. Thus, this study sought to evaluate the efficacy of various bone allografts in the absorption and release of antibiotics. A specially designed high-absorbency, high-surface-area carrier graft composed of human demineralized cortical fibers and granulated cancellous bone (fibrous graft) was compared to different human bone allograft types. The groups tested here were three fibrous grafts with rehydration rates of 2.7, 4, and 8 mL/g (F(2.7), F(4), and F(8)); demineralized bone matrix (DBM); cortical granules; mineralized cancellous bone; and demineralized cancellous bone. The absorption capacity of the bone grafts was assessed after rehydration, the duration of absorption varied from 5 to 30 min, and the elution kinetics of gentamicin were determined over 21 days. Furthermore, antimicrobial activity was assessed using a zone of inhibition (ZOI) test with S. aureus. The fibrous grafts exhibited the greatest tissue matrix absorption capacity, while the mineralized cancellous bone revealed the lowest matrix-bound absorption capacity. For F(2.7) and F(4), a greater elution of gentamicin was observed from 4 h and continuously over the first 3 days when compared to the other grafts. Release kinetics were only marginally affected by the varied incubation times. The enhanced absorption capacity of the fibrous grafts resulted in a prolonged antibiotic release and activity. Therefore, fibrous grafts can serve as suitable carrier grafts, as they are able to retain fluids such as antibiotics at their intended destinations, are easy to handle, and allow for a prolonged antibiotic release. Application of these fibrous grafts can enable surgeons to provide longer courses of antibiotic administration for septic orthopedic indications, thus minimizing infections.

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Quality Reporting Windows May Not Capture the Effects of Surgical Site Infections After Orthopaedic Surgery

Cited by 5 publications

References 26 publications

Patient Follow‐up After Orthopaedic Outreach Trips – Do We Know Whether Patients are Improving?

Patient Follow‐up After Orthopaedic Outreach Trips – Do We Know Whether Patients are Improving?

Costs and benefits of routine hemoglobin A1c screening prior to total joint arthroplasty: a cost-benefit analysis

Analysis of the Ability of Different Allografts to Act as Carrier Grafts for Local Drug Delivery

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