The ACS NSQIP Risk Calculator Is a Fair Predictor of Acute Periprosthetic Joint Infection

Wingert, Nathaniel C.; Gotoff, James R.; Parrilla, Edgardo; Gotoff, Robert; Hou, Laura; Ghanem, Elie

doi:10.1007/s11999-016-4717-3

Cited by 70 publications

(44 citation statements)

References 14 publications

(5 reference statements)

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“… 41 , 42 Periprosthetic joint literature divides complications into “early” at 90 days and “late” at 6 months or later. 43 , 44 We tracked our complications at 30, 90, and 180 days postoperatively. All our complications occurred within 90 days for both expander and implant placement.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes

Bettinger

Waters

Reese

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Prepectoral breast reconstruction is increasingly popular. This study compares complications between 2 subpectoral and 1 prepectoral breast reconstruction technique.Methods:Between 2008 and 2015, 294 two-staged expander breast reconstructions in 213 patients were performed with 1 of 3 surgical techniques: (1) Prepectoral, (2) subpectoral with acellular dermal matrix (ADM) sling (“Classic”), or (3) subpectoral/subserratus expander placement without ADM (“No ADM”). Demographics, comorbidities, radiation therapy, and chemotherapy were assessed for correlation with Clavien IIIb score outcomes. Follow-up was a minimum of 6 months.Results:Surgical cohorts (n = 165 Prepectoral; n = 77 Classic; n = 52 No ADM) had comparable demographics except Classic had more cardiac disease (P = 0.03), No ADM had higher body mass index (BMI) (P = 0.01), and the Prepectoral group had more nipple-sparing mastectomies (P < 0.001). Univariate analysis showed higher expander complications with BMI ≥ 40 (P = 0.05), stage 4 breast cancer (P = 0.01), and contralateral prophylactic mastectomy (P = 0.1), whereas implant complications were associated with prior history of radiation (P < 0.01). There was more skin necrosis (P = 0.05) and overall expander complications (P = 0.01) in the Classic cohort, whereas the No ADM group trended toward the lowest expander complications among the 3. Multivariate analysis showed no difference in overall expander complication rates between the 3 groups matching demographics, mastectomy surgery, risks, and surgical technique.Conclusions:Prepectoral and subpectoral Classic and No ADM breast reconstructions demonstrated comparable grade IIIb Clavien score complications. BMI > 40, stage 4 cancer, and contralateral prophylactic mastectomy were associated with adverse expander outcomes and a prior history of radiation therapy adversely impacted implant outcomes. Ninety-day follow-up for expander and implant complications may be a better National Surgical Quality Improvement Program measure.

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Section: Discussionmentioning

confidence: 99%

Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes

Bettinger

Waters

Reese

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“… [31] Several excellent risk calculators and risk-stratification algorithms exist which attempt to quantify individual surgical risk for many different postoperative complications. [31] , [32] , [33] , [34] , [35] , [36] , [37] One practical risk calculator examines individual patient characteristics, with the goal of guiding orthopedic surgeons to select the most appropriate medication for chemoprophylaxis against venous thromboembolic disease. [37] Several other risk calculators predict risk of SSI or SSCs, [31] , [34] , [35] , [36] yet none make specific recommendations that might reduce this elevated risk in at-risk populations.…”

Section: Discussionmentioning

confidence: 99%

A risk-stratification algorithm to reduce superficial surgical site complications in primary hip and knee arthroplasty

et al. 2018

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BackgroundSurgical site complications (SSCs) are the most common cause for readmission after total joint arthroplasty (TJA), increasing costs while predisposing to inferior long-term outcomes. Prophylactic use of closed-incision negative pressure therapy (ciNPT) may lower the risk of these complications, especially in high-risk populations, but appropriate-use guidelines are lacking for patients undergoing primary TJA. We sought to develop a risk-stratification algorithm to guide use of ciNPT dressings and test its use in normalizing the rate of superficial SSCs among high-risk groups.MethodsWe reviewed 323 consecutive primary TJAs, where 38% of those patients considered at elevated risk were risk-stratified to receive ciNPT dressings. An individual risk score was developed, assigning points based on patient-specific risk factors. We identified a historical control population of 643 patients who all received the same postoperative dressing to test the impact of this risk score.ResultsCompared with historical controls, we observed a modest but significant improvement in superficial SSCs after implementation of risk-stratification (12.0% vs 6.8%; P = .013). Among high-risk patients, there was a marked improvement in SSCs when treated prophylactically with ciNPT dressings as compared with historical controls (26.2% vs 7.3%; P < .001). Low-risk patients, who continued to be treated with standard postoperative dressings, demonstrated no significant improvement (8.6% vs 6.5%; P = .344).ConclusionsciNPT dressings are effective at reducing and normalizing risks of superficial SSCs among high-risk primary arthroplasty patients. The proposed risk-stratification algorithm may help identify those patients who benefit most from these dressings.

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“…The use of ATP testing may identify environmental surfaces that require additional cleaning prior to the next surgical case. Improved cleanliness of hospital surfaces can reduce the risk of nosocomial postoperative surgical infections [7,10]. Within orthopaedic surgery, where implantation of hardware is common, reducing the risk of environmental contamination is imperative.…”

Section: How Do We Get There?mentioning

confidence: 99%

“…Decreasing the risk of postoperative infections is a major focus of all hospitals and surgeons [7]. For example, the Surgical Care Improvement Project and the American Academy of Orthopaedic Surgeons both emphasize the importance of minimizing nosocomial orthopaedic infections [4,10].…”

mentioning

confidence: 99%

CORR Insights®: What Orthopaedic Operating Room Surfaces Are Contaminated With Bioburden? A Study Using the ATP Bioluminescence Assay

Hennrikus

2017

Clinical Orthopaedics &Amp; Related Research

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The ACS NSQIP Risk Calculator Is a Fair Predictor of Acute Periprosthetic Joint Infection

Cited by 70 publications

References 14 publications

Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes

Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes

A risk-stratification algorithm to reduce superficial surgical site complications in primary hip and knee arthroplasty

CORR Insights®: What Orthopaedic Operating Room Surfaces Are Contaminated With Bioburden? A Study Using the ATP Bioluminescence Assay

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