In-Hospital Complications following Arthrotomy versus Arthroscopy for Septic Knee Arthritis: A Cohort-Matched Comparison

AbstractThere is a paucity of literature comparing the relative merits of open arthrotomy versus arthroscopy for the surgical treatment of septic knee arthritis. The primary goal of this study is to compare the risk of perioperative complications between these two surgical techniques. To this end, 560 patients treated for septic arthritis of the native knee with arthroscopy were statistically matched 1:1 with 560 patients treated with open arthrotomy. The outcome measures included major complications, minor complications, mortality, inpatient hospital charges, and length of stay (LOS). Major complications were defined as myocardial infarction, cardiac arrest, stroke, deep vein thrombosis, pulmonary embolism, pneumonia, postoperative shock, unplanned ventilation, deep surgical site infection, wound dehiscence, infected postoperative seroma, hospital acquired urinary tract infection, and retained surgical item. Minor complications included phlebitis and thrombophlebitis, postprocedural emphysema, minor surgical site infection, peripheral nerve complication, and intraoperative hemorrhage. Mortality data were extracted from the database using the Uniform Bill patient disposition. Complications were analyzed using univariate and multivariate logistic regression models, whereas mean costs and LOS were compared using the Kruskal–Wallis H-test. Major complications occurred in 3.8% of the patients in the arthroscopy cohort and 5.4% of the patients in the arthrotomy cohort (p = 0.20). Too few patients in our sample died to report based on National (Nationwide) Impatient Sample (NIS) minimum reporting standards. Rates of minor complications were similar for the arthroscopy and arthrotomy cohorts (12.5 vs. 13.9%; p = 0.48). Multivariate analysis did not reveal any greater risk of minor or major complication between the two procedures. Inpatient hospital cost was similar for arthroscopy ( = $15,917; standard deviation [SD] = 14,424) and arthrotomy ( = $16,020; SD = 18,665; p = 0.42). LOS was also similar for both arthrotomy (6.78 days, SD = 6.75) and arthroscopy (6.24 days, SD = 5.95; p = 0.23). Patients undergoing arthroscopic treatment of septic arthritis of the knee showed no difference in relative risk of perioperative complications, LOS, or hospital cost compared with patients who underwent open arthrotomy.

Download Full-text

EP.TH.959Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer surgery: An ongoing dilemma

British Journal of Surgery ◽

10.1093/bjs/znab309.098 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahin Hajibandeh ◽

Shahab Hajibandeh ◽

Pratik Bhattacharya ◽

Reza Zakaria ◽

Christopher Thompson ◽

...

Keyword(s):

Rectal Cancer ◽

Adjuvant Chemotherapy ◽

Surgical Site Infection ◽

Hospital Stay ◽

Perioperative Complications ◽

Loop Ileostomy ◽

Length Of Hospital Stay ◽

Ileostomy Closure ◽

Site Infection ◽

Cancer Resection

Abstract Aims To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection. Methods We systematic searched MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during (n = 185) or after (n = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82-2.36, p = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47-16.56, p = 0.26), surgical site infection (OR 1.97; 95% CI 0.80-4.90, p = 0.14), ileus (OR 1.22; 95% CI 0.50-2.96, p = 0.66) or length of hospital stay (MD 0.02; 95% CI -0.85-0.89, p = 0.97) between two groups. Between-study heterogeneity was low in all analyses. Conclusions The meta-analysis of best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on completeness of chemotherapy and quality of life which can determine appropriateness of either approach.

Download Full-text

Arthrocentesis, arthroscopy or arthrotomy for septic knee arthritis in children: a systematic review

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.200129 ◽

2020 ◽

pp. 1-7

Author(s):

Cornelia M. Donders ◽

Anne J. Spaans ◽

Johannes H. J. M. Bessems ◽

Christiaan J. A. van Bergen

Keyword(s):

Systematic Review ◽

Septic Arthritis ◽

Meta Analysis ◽

Treatment Strategies ◽

Needle Aspiration ◽

Scientific Quality ◽

Knee Arthritis ◽

Level Of Evidence ◽

Septic Knee Arthritis

Purpose Septic knee arthritis in children can be treated by arthrocentesis (articular needle aspiration) with or without irrigation, arthroscopy or arthrotomy followed by antibiotics. The objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the knee in children. Methods The electronic PubMed, Embase and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the knee. The quality of all included studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO). Results Out of 2428 articles, 11 studies with a total of 279 knees were included in the systematic review. The quality of evidence was low (MINORS median 4 (2 to 7)). A meta-analysis could not be performed because of the diversity and low quality of the studies. In septic knee arthritis, additional drainage procedures were needed in 54 of 156 (35%) knees after arthrocentesis, in four of 96 (4%) after arthroscopy and in two of 12 (17%) after arthrotomy. Conclusion Included studies on treatment strategies for septic arthritis of the knee in children are diverse and the scientific quality is generally low. Knee arthroscopy might have a lower risk of additional drainage procedures as compared with arthrocentesis and arthrotomy, with acceptable clinical outcomes and no radiological sequelae. Level of evidence IV

Download Full-text

Implant contamination as a cause of surgical site infection in spinal surgery: are single-use implants a reasonable solution? – a systematic review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03653-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Friederike Schömig ◽

Carsten Perka ◽

Matthias Pumberger ◽

Rudolf Ascherl

Keyword(s):

Systematic Review ◽

Surgical Site Infection ◽

Spinal Surgery ◽

Orthopaedic Surgery ◽

English Language ◽

Perioperative Complications ◽

Convincing Evidence ◽

Site Infection ◽

Patient Morbidity ◽

Single Use

Abstract Background In spine surgery, surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization. Most factors associated with SSI are connected with asepsis during the surgical procedure and thus with contamination of implants and instruments used which can be caused by pre- and intraoperative factors. In this systematic review we evaluate the current literature on these causes and discuss possible solutions to avoid implant and instrument contamination. Methods A systematic literature search of PubMed addressing implant, instrument and tray contamination in orthopaedic and spinal surgery from 2001 to 2019 was conducted following the PRISMA guidelines. All studies regarding implant and instrument contamination in orthopaedic surgery published in English language were included. Results Thirty-five studies were eligible for inclusion and were divided into pre- and intraoperative causes for implant and instrument contamination. Multiple studies showed that reprocessing of medical devices for surgery may be insufficient and lead to surgical site contamination. Regarding intraoperative causes, contamination of gloves and gowns as well as contamination via air are the most striking factors contributing to microbial contamination. Conclusions Our systematic literature review shows that multiple factors can lead to instrument or implant contamination. Intraoperative causes of contamination can be avoided by implementing behavior such as changing gloves right before handling an implant and reducing the instruments’ intraoperative exposure to air. In avoidance of preoperative contamination, there still is a lack of convincing evidence for the use of single-use implants in orthopaedic surgery.

Download Full-text

Incidence and risk factors of surgical site infection and septic arthritis after elective arthroscopy in horses

Veterinary Surgery ◽

10.1111/vsu.12699 ◽

2017 ◽

Vol 47 (1) ◽

pp. 52-59 ◽

Cited By ~ 9

Author(s):

Julie Y. Brunsting ◽

Frederik J. Pille ◽

Maarten Oosterlinck ◽

Maarten Haspeslagh ◽

Hans C. Wilderjans

Keyword(s):

Risk Factors ◽

Septic Arthritis ◽

Surgical Site Infection ◽

Site Infection

Download Full-text

Development of an experimental model of septic knee arthritis in rats through intra-articular inoculation of Staphylococcus aureus

Laboratory Animals ◽

10.1177/0023677220978678 ◽

2020 ◽

pp. 002367722097867

Author(s):

Ainara Achaerandio-de Nova ◽

Mónica Gómez-Juárez Sango ◽

Ángel Escudero-Jiménez ◽

Sergio Losa-Palacios ◽

María Dolores Berenguer-Romero ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Septic Arthritis ◽

Positive Culture ◽

Sprague Dawley ◽

Knee Arthritis ◽

Sprague Dawley Rats ◽

Atcc Strain ◽

Colony Forming Units ◽

The Right ◽

Septic Knee Arthritis

Haematogenous models of septic arthritis have some inherent disadvantages, such as the manifestation of arthritis relies on chance, the size of the inoculum is unknown and the number of animals to be studied cannot be reduced because the animals cannot serve as their own controls. This study aimed to develop a rat model of knee septic arthritis by injecting a known inoculum of Staphylococcus aureus into the joint. The left knees of 27 Sprague Dawley rats were injected with four different inoculum concentrations of a sensitive strain of S. aureus (30,000 colony-forming units (CFUs), n = 3; 18,550 CFUs, n = 6; 15,500 CFUs, n = 9; and 7700 CFUs, n = 9); the right knees served as controls. Clinical, microbiological and histological variables were assessed two and seven days later. The main criterion for diagnosing septic arthritis was a positive culture of synovial fluid. The rate of microbiologically confirmed septic arthritis was high for all inoculum concentrations (3/3, 6/6, 8/9 and 7/9, respectively), and the rate of bacteraemia was also high. Animal welfare was better for the two lowest inoculum concentrations. No animal reached the pre-established humane end points. Overall, the third inoculum was considered the most suitable. Thus, acute septic arthritis can be caused in rats by inoculating 15,000 CFUs of an ATCC strain of S. aureus directly into the knee joint. Overall, the model seems to be useful for studying the effectiveness of drugs for the treatment of acute septic arthritis.

Download Full-text

Causes of Hospital Readmissions Within 7 Days From the Neurosurgical Service of a Quaternary Referral Hospital

Neurosurgery ◽

10.1093/neuros/nyz310_718 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Enyinna L Nwachuku

Keyword(s):

Postoperative Complications ◽

Surgical Site Infection ◽

Mental Status ◽

Medical Center ◽

Perioperative Complications ◽

Demographic Data ◽

Hospital Readmissions ◽

Altered Mental Status ◽

Csf Leak ◽

Site Infection

Abstract INTRODUCTION Unplanned hospital readmission after discharge is an important quality metric. Such readmissions are associated with greater healthcare costs, decreased patient satisfaction, decreased clinical outcomes, and sometimes financial penalties. A large amount of data has been documented regarding 30-d readmissions for neurosurgical populations. However, a focus on 7-d readmissions may provide an insight into the causes of unplanned readmissions, perhaps translate into decreases in 30-d readmissions. This study was performed in order to determine the causes of 7-d readmissions and to define risk factors that, if addressed, would allow for a reduction of such readmissions. METHODS All patients readmitted after discharge within 7 d from the neurosurgical service from the University of Pittsburgh Medical Center, Presbyterian Hospital, during 2018 were evaluated. There were 18 different providers. Demographic data were collected for all patients. The primary reason for readmission was organized using a 5-category system: surgical site infection, pain, altered mental status/seizures, other postoperative complications [eg, venous thromboembolism (VTE), urinary tract infection, pneumonia, CSF leak, hematoma, shunt failure] and “unrelated.” RESULTS Of 5184 discharges, 169 patients (3.3%) were readmitted within 7 d (55% men; mean age 62 yr). A total of 65% had undergone care for cranial pathology and 35% for spine (versus 55% and 45%, respectively, in the total discharge population). Other postoperative complications were the leading cause of readmission (40%), followed by altered mental status/seizure and unrelated (20% each). Surgical site infection and postoperative pain exhibited the lowest rates of 10% each. CONCLUSION The overall 7-d readmission rate was 3.3%. There was nearly a 2:1 ratio for cranial versus spinal patients for 7-d readmissions. The majority of readmissions were related to postoperative complications, whether directly related to surgical intervention or perioperative complications. Focal efforts to decrease specific postoperative complications should translate into a reduction in both 7- and 30-d unplanned readmissions.

Download Full-text

Attributable Costs of Surgical Site Infection and Endometritis after Low Transverse Cesarean Delivery

Infection Control and Hospital Epidemiology ◽

10.1086/650755 ◽

2010 ◽

Vol 31 (3) ◽

pp. 276-282 ◽

Cited By ~ 48

Author(s):

Margaret A. Olsen ◽

Anne M. Butler ◽

Denise M. Willers ◽

Gilad A. Gross ◽

Barton H. Hamilton ◽

...

Keyword(s):

Propensity Score ◽

Cesarean Section ◽

Surgical Site Infection ◽

Hospital Cost ◽

Total Hospital Cost ◽

Matched Pairs ◽

Site Infection ◽

Total Hospital ◽

Hospital Acquired Infections ◽

Hospital Acquired

Background.Accurate data on costs attributable to hospital-acquired infections are needed to determine their economic impact and the cost-benefit of potential preventive strategies.Objective.To determine the attributable costs of surgical site infection (SSI) and endometritis (EMM) after cesarean section by means of 2 different methods.Design.Retrospective cohort.Setting.Barnes-Jewish Hospital, a 1,250-bed academic tertiary care hospital.Patients.There were 1,605 women who underwent low transverse cesarean section from July 1999 through June 2001.Methods.Attributable costs of SSI and EMM were determined by generalized least squares (GLS) and propensity score matched-pairs by means of administrative claims data to define underlying comorbidities and procedures. For the matched-pairs analyses, uninfected control patients were matched to patients with SSI or with EMM on the basis of their propensity to develop infection, and the median difference in costs was calculated.Results.The attributable total hospital cost of SSI calculated by GLS was $3,529 and by propensity score matched-pairs was $2,852. The attributable total hospital cost of EMM calculated by GLS was $3,956 and by propensity score matched-pairs was $3,842. The majority of excess costs were associated with room and board and pharmacy costs.Conclusions.The costs of SSI and EMM were lower than SSI costs reported after more extensive operations. The attributable costs of EMM calculated by the 2 methods were very similar, whereas the costs of SSI calculated by propensity score matched-pairs were lower than the costs calculated by GLS. The difference in costs determined by the 2 methods needs to be considered by investigators who are performing cost analyses of hospital-acquired infections.

Download Full-text

Surgical management of septic knee arthritis with open arthrotomy and debridement-a case report

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214970 ◽

2021 ◽

Vol 8 (1) ◽

pp. 98

Author(s):

Neetin Pralhad Mahajan ◽

Kartik Prashant Pande ◽

Ravi Rameshbhai Dadhaniya ◽

Pritam Talukder

Keyword(s):

Septic Arthritis ◽

Surgical Intervention ◽

Symptomatic Relief ◽

Empirical Therapy ◽

Signs And Symptoms ◽

Irreversible Damage ◽

Surgical Interventions ◽

Post Surgery ◽

Septic Knee Arthritis ◽

Open Arthrotomy

Septic arthritis is an inflammatory destruction of the native joint following inoculation of pathogen. Most common organisms causing septic arthritis are Staphylococcus and Streptococcus. Large joints are commonly involved with hip and knee joint accounting for approximately 60% of the total cases. Diagnosis is usually straightforward with the patient presenting with obvious local signs and symptoms along with toxic constitutional symptoms owing to the aggressive nature of the disease. Medical management in form of intra-venous antibiotics forms the mainstay of treatment but it is often required for a prompt surgical intervention in order to provide acute relief from symptom and also to decrease the disease load so as to save the joint from irreversible damage. We have a 63-year-old male patient came presented to us with a right knee swelling and tenderness of 3 weeks duration with restricted ROM with severe toxic constitutional symptoms of 1 week duration. Patient was planned for open arthrotomy and debridement and drainage of the pus and was started on an empirical therapy of injection piperacillin and tazobactam combination for 3 weeks. Immediate relief from symptoms following arthrotomy with good range of motion at 4 weeks post-surgery. As is clear from our case, an early diagnosis of septic arthritis and starting of appropriate antibiotics along with appropriately aggressive surgical interventions in the form of open debridement is the key for treatment of septic arthritis in order to save the joint from irreversible inflammatory damage. Surgical intervention not only gives immediate symptomatic relief but also decreases the load over antibiotics and increases local blood supply subsequently helping in better healing.

Download Full-text