December 19, 2018
 
Today’s Top Story

Study Identifies Risk Factors for SSI Following ACLR

A study published in the December issue of Knee Surgery, Sports Traumatology, Arthroscopy found that certain demographic characteristics may predict postoperative surgical site infection (SSI) risk in patients undergoing anterior cruciate ligament reconstruction (ACLR). Researchers queried the Diagnosis Procedure Combination database and identified 30,536 ACLR patients between 2010 and 2015, of whom 288 (094 percent) had an SSI and 86 (0.28 percent) had a deep SSI. Univariate analysis revealed that higher prevalence of SSI and deep SSI was associated with male sex, increased body mass index (BMI), atopic dermatitis, and preoperative steroid use; SSI was significantly more prevalent in diabetic patients and those with hepatic dysfunction. In multivariable analysis, researchers observed a significant association between SSI and male sex, BMI ≥ 30.0 kg/m 2, diabetes, atopic dermatitis, and preoperative steroid use.

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Other News

Study: Rate of Hospital-treated Infections After Hip Surgery Increases

The incidence of hospital-treated infections within the first 30 days following surgical treatment for hip fracture jumped from 10.8 percent in 2005–2006 to 14.3 percent in 2015–2016—an increase of 32 percent—according to a study published online in the Journal of Bone and Mineral Research. Researchers evaluated Danish population-based registry data for 74,771 patients aged 65 years and older who were undergoing their first hip fracture surgery. They observed an increased risk of infection at 15, 30, 90, and 365 days postoperatively between 2005 and 2016. Thirty-day hospital-treated pneumonia rates surged by 70 percent between 2005–2006 and 2015–2016 and community-based antibiotic prescriptions within 30 days postoperatively increased by 54 percent. The most significant increase was in broad-spectrum antibiotic use. Between 2005 and 2016, hip fracture patients had a significantly higher risk of infection than the general population.

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Study: Prior Bariatric Surgery Does Not Impact Long-term TJA Outcomes

A study published online in The Journal of Arthroplasty found that bariatric surgery prior to total joint arthroplasty (TJA) in morbidly obese patients may be associated with somewhat better short-term outcomes, but no association was observed for improved long-term outcomes. Researchers queried the EMBASE, PubMed, Web of Science, and Cochrane Library electronic databases for relevant studies published in English. Primary outcome measures were complications and revision; secondary outcome measures were length of stay (LOS) and operative time. Short- and long-term follow-up were defined as time from hospital discharge to 90 days and discharge to one year, respectively. Nine studies with 38,728 patients were included in the final analysis. Prior to TJA, the bariatric surgery group had more overall medical comorbidities than the control morbid obesity group. The incidence of bariatric surgery before TJA was correlated with fewer short-term medical complications and shorter LOS and operative time but not with reduced short-term risks for superficial wound infection or venous thromboembolism. There was no association with reduced long-term complication risks, including dislocation, periprosthetic infection, periprosthetic fracture, and revision. In further analysis, patients who underwent bariatric surgery had a reduced risk of short-term periprosthetic infection after total knee arthroplasty but not after total hip arthroplasty.

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Study Determines Risk Factors for Instrumentation-related Complication in Young NF-1 Scoliosis Patients

A retrospective study published in the Dec. 15 issue of Spine found that risk factors for instrumentation-related complication (IRC) in pediatric patients undergoing surgery to treat neurofibromatosis type 1 (NF-1) dystrophic scoliosis included younger age, kyphosis 50 degrees or greater, and growing-rod technique application. Researchers reviewed data on 59 pediatric NF-1 patients who underwent operative treatment, of whom 17 (28.8 percent) sustained IRCs—seven cases of curve progression, three cases of screw dislodgement, three cases of adding-on phenomenon, two cases of rod breakage, two cases of proximal junctional kyphosis, one case of cap loosing, and one case of pedicle cutting. Univariate logistic regression analysis identified age younger than 9 years, kyphosis 50 degrees or greater, and application of growing-rod technique as significant IRC risk factors. In binomial logistic regression analysis, the most significant risk factors were kyphosis 50 degrees or greater and growing-rod technique application.

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Study Evaluates the ‘July Effect’: Myth or Fact?

A study published online in The Journal of Bone & Joint Surgery analyzed the association between complication rates following orthopaedic trauma surgery involving residents and the level of resident training and time of year. Using the American College of Surgeons National Surgical Quality Improvement Program database, researchers identified 1,851 cases of operative fixation of proximal femoral fractures, femoral shaft fractures, and tibial shaft fractures from 2005 to 2012 that involved residents. During the first academic quarter, rates of serious adverse events (AEs) (10.96 percent), any AEs (18.57 percent), and surgical complications (9.62 percent) were similar to those observed for the rest of the year (11.40 percent, 17.81 percent, and 7.19 percent, respectively). During the beginning of the year, senior-level residents were more likely to have AEs (quarter 1, 20.58 percent; quarter 2, 20.05 percent) than junior residents (quarter 1, 11.76 percent; quarter 2, 12.44 percent). The “July effect”—a perceived increase in the risk of medical errors and surgical complications that occurs during the time in which U.S. medical school graduates begin residencies—was not observed in lower-extremity orthopaedic surgery, but evidence of this effect was present in superficial SSIs.

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AAOS Now

Frank Sesno to Headline Your Academy at AAOS 2019 Annual Meeting

Journalist Frank Sesno has been selected as the presidential guest speaker for the AAOS 2019 Annual Meeting in Las Vegas. Mr. Sesno, whose distinguished journalism career spans more than three decades and has taken him around the world, is a close friend of AAOS President David A. Halsey, MD. According to Dr. Halsey, attendees at Mr. Sesno’s speech can expect to gain invaluable knowledge not only pertaining to how generational differences shape our lives and educational experiences, but also about “the need to really listen to our patients, colleagues, and members of all our communities.”

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Learn more about the Annual Meeting…

 
 
 
Your AAOS

Take Part in CPG and AUC Workgroups

AAOS is seeking volunteers to take part in workgroups for the development of clinical practice guidelines (CPGs) and appropriate use criteria (AUC). Applications are currently open to join the following projects: The Decision to Pursue Limb Salvage or Perform Early Amputation and The Diagnosis and Management of Acute Compartment Syndrome. The deadline to submit an application for both projects is Jan. 11, 2019.

Learn more and submit your application…

 

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