Risk factors for surgical site infection and delayed wound healing after orthopedic surgery in rheumatoid arthritis patients

Kadota, Yasutaka; Nishida, Keiichiro; Hashizume, Kenzo; Nasu, Y.; Nakahara, Ryuichi; Kanazawa, Tomoyuki; Ozawa, Masatsugu; Harada, Ryozo; Machida, Takahiro; Ozaki, Toshifumi

doi:10.3109/14397595.2015.1073133

Cited by 39 publications

(23 citation statements)

References 42 publications

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“…As meta-analyses confirmed an increased risk of operative site infections of patients with diabetes mellitus (odds ratio [OR] 1.53), nicotine abuse (OR 1.79), and rheumatoid arthritis (OR 3.17), these risk factors were recorded in our study. 10,19,24…”

Section: Methodsmentioning

confidence: 99%

Minimally Invasive vs Open Akin Osteotomy

et al. 2020

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Background: Minimally invasive techniques of Akin osteotomy have grown in popularity, as early results suggest faster recovery, earlier return to work, and minimized wound healing problems. Preserving lateral cortex integrity during first phalanx osteotomy thereby presents a challenge because of the lack of direct visual control. This retrospective comparative study investigated clinical and radiographic outcomes of minimally invasive and open Akin osteotomy with different fixation methods and analyzed whether or not intraoperative violation of the lateral cortex caused loss of correction or delayed bone healing. Methods: One hundred eighty-four patients (210 feet) with symptomatic hallux valgus and pathologic interphalangeal angle (IPA) of at least 10 degrees underwent surgery combined with Akin osteotomy. Minimally invasive Akin osteotomies were fixed in 124 feet with 2 crossing percutaneous K-wires and compared to 86 Akin osteotomies by open technique with double-threaded (head and shank) screw fixation. At 1 day and 6 and 12 weeks postoperatively, IPA and bony consolidation were radiographically and clinically assessed. Results: Mean preoperative IPA was 13.4 ± 3.6 degrees in minimally invasive (MI) and 13.3 ± 3.5 degrees in open surgery (OS) cases ( P > .05). Intraoperative breach of the lateral cortex occurred in 12 (13.9%) in OS and 64 (51.6%) in MI cases. Whereas the breach occurred in open technique mainly during manual correction by applying a medial closing force, it was caused predominantly by the use of the burr in minimally invasive technique. After 12 weeks, the mean IPA was 4.1 ± 1.4 degrees in MI and 4.8 ± 1.2 degrees in OS cases ( P > .05). Bony consolidation was complete after 6 and 12 weeks in OS and MI, respectively. Three deep infections occurred in the OS Group after Lapidus arthrodesis and 2 deep infections were registered in the MI Group after minimally invasive chevron and Akin osteotomy. The infections were not at the site of the Akin osteotomy. Conclusion: Breach of the lateral cortex did not impair bone healing or correction of IPA. Minimally invasive Akin osteotomy with K-wire fixation provided equivalent correction of IPA compared to open surgery with screw fixation. Level of Evidence: Level III, retrospective comparative series.

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Section: Methodsmentioning

confidence: 99%

Minimally Invasive vs Open Akin Osteotomy

et al. 2020

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“…However, patients in this trial were on a variety of medications, and multivariate analysis did find strong associations between steroids, penicillamine, cyclosporine, and hydroxychloroquine and adverse outcomes. Five observational studies 76 – 80 found no independent effect of immune-modulating therapy on wound or medical complications; however, these studies have methodologic limitations. None of these studies addressed the timing of discontinuation of agents nor did they address the ramifications of discontinuing therapy on rheumatoid symptoms.…”

Section: Resultsmentioning

confidence: 99%

Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

Childers

Siletz

Singer

et al. 2018

Geriatr Orthop Surg Rehabil

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Background:Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery—a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA).Study Design:This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format.Results:Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning.Conclusion:This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients.

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“…Caution should be exercised not only during perioperative management but also for the development of late infection in rheumatoid patients being treated with biological agents. 36,37…”

Section: Discussionmentioning

confidence: 99%

Mid-term results of alumina ceramic unlinked total elbow arthroplasty with cement fixation for patients with rheumatoid arthritis

Nishida

Hashizume

Nasu

et al. 2018

The Bone & Joint Journal

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Risk factors for surgical site infection and delayed wound healing after orthopedic surgery in rheumatoid arthritis patients

Abstract: Our results indicated foot and ankle surgery, and TKA and disease duration as risk factors for SSI and DWH, respectively. bDMARDs was not associated with an increased risk of SSI and DWH.

Cited by 39 publications

References 42 publications

Minimally Invasive vs Open Akin Osteotomy

Minimally Invasive vs Open Akin Osteotomy

Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

Mid-term results of alumina ceramic unlinked total elbow arthroplasty with cement fixation for patients with rheumatoid arthritis

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