role of pre-operative inflammatory markers in predicting postoperative infection in patients undergoing total knee arthroplasty

Background: C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR] are frequently used to aid the diagnosis of postoperative peri-prosthetic infections [PPIs] following total knee arthroplasty [TKA]. The role of using these inflammatory markers preoperatively to predict the risk of postoperative PPIs in patients undergoing TKAs has not been well documented to date

Objective: To evaluate the role and cost-effectiveness of preoperative markers; ESR and CRP in predicting postoperative PPIs in patients undergoing elective primary TKA

Design: A Prospective Study

Setting: Department of Orthopedic Surgery, Salmaniya Medical Complex, Kingdom of Bahrain

Method: All patients who underwent primary or simultaneous bilateral TKA from 1 September 2014 to 31 December 2016 were included in the study. Patients who had uncontrolled diabetes, previous surgery or septic arthritis on the same knee, or lost for follow-up were excluded. Inflammatory markers were documented 1-2 days preoperatively. Patients were followed up over a period of 12 months postoperatively. All necessary data were collected prospectively and documented. The data were analyzed using SPSS 20

Result: One hundred thirty-nine patients were included in this study. One hundred and forty-two primary TKAs were performed during the study period, three patients underwent simultaneous bilateral TKA. Eighty-seven [62.59%] patients were females and 52 [37.41%] were males. The mean age was 64 years. Ninety-five [68.34%] patients had one or more preoperative comorbidities. High preoperative levels of CRP and/or ESR were found in thirty-seven [26.62%] patients. Two [1.44%] patients developed postoperative infection and were treated successfully. No other complications were recorded

Conclusion: In our study, we found no significant link between elevated preoperative inflammatory markers and the presence of PPI. Therefore, we do not support the routine use of preoperative inflammatory markers

Cancellation of elective procedures on the day of surgery

Objective: To evaluate the rate and causes of cancellation of elective procedures

Design: A Retrospective Study

Setting: Salmaniya Medical Complex, Bahrain

Method: Data were collected for four months from the operation theatre register and were analyzed

Result: Day of surgery [DOS] cancellation rate in our study was found to be 7.3%. The causes of cancellation were lack of time, high blood pressure, cardiology consultation, chest infection and upper respiratory tract infection. Most cancellations in the OT were because of high blood pressure. These causes can be avoided if proper preoperative assessment and control were applied

Conclusion: DOS cancellation is a universal problem. Several common factors that play a role in increasing cancellation rate and these should be considered individually for a better outcome. A general understanding and cooperation between the caring firm, anesthesia department, nursing team and other medical departments is paramount in reducing the incidence to a minimum and to increase the efficacy of the hospital