Caring for the surgically anxious patient: a review of the interventions and a guide to optimizing surgical outcomes.

BACKGROUND: Preoperative surgical anxiety is an unpleasant and common reaction exhibited by patients who are scheduled for surgical procedures. Beyond emotional effects on the patient, it can also have negative repercussions on the surgery including longer hospital stays and poorer outcomes. Given the widespread impacts of preoperative anxiety, it is critical for surgeons to gain a better understanding of how to identify and reduce surgical anxiety in their patients. DATA SOURCES: This study used the PubMed database to review the current literature to evaluate screening tools and interventions for surgically anxious patients. CONCLUSIONS: Psychiatric anxiety surveys are currently the most appropriate form of assessment for surgical anxiety. Patient education is important for preventing and reducing anxiety levels in patients. Both nonpharmacological and pharmacological interventions have been shown to be effective in reducing patient anxiety and treatment should be based on patient preference, resources available, and the surgeon's experience.

Biomaterial hypersensitivity: is it real? Supportive evidence and approach considerations for metal allergic patients following total knee arthroplasty.

The prospect of biomaterial hypersensitivity developing in response to joint implant materials was first presented more than 30 years ago. Many studies have established probable causation between first-generation metal-on-metal hip implants and hypersensitivity reactions. In a limited patient population, implant failure may ultimately be related to metal hypersensitivity. The examination of hypersensitivity reactions in current-generation metal-on-metal knee implants is comparatively limited. The purpose of this study is to summarize all available literature regarding biomaterial hypersensitivity after total knee arthroplasty, elucidate overall trends about this topic in the current literature, and provide a foundation for clinical approach considerations when biomaterial hypersensitivity is suspected.

Treating periprosthetic joint infections as biofilms: key diagnosis and management strategies.

Considerable evidence suggests that microbial biofilms play an important role in periprosthetic joint infection (PJI) pathogenesis. Compared to free-floating planktonic bacteria, biofilm bacteria are more difficult to culture and possess additional immune-evasive and antibiotic resistance mechanisms, making infections harder to detect and eradicate. This article reviews cutting-edge advances in biofilm-associated infection diagnosis and treatment in the context of current PJI guidelines and highlights emerging technologies that may improve the efficacy and reduce costs associated with PJI. Promising PJI diagnostic tools include culture-independent methods based on sequence comparisons of the bacterial 16S ribosomal RNA gene, which offer higher throughput and greater sensitivity than culture-based methods. For therapy, novel methods based on disrupting biofilm-specific properties include quorum quenchers, bacteriophages, and ultrasound/electrotherapy. Since biofilm infections are not easily detected or treated by conventional approaches, molecular diagnostic techniques and next-generation antibiofilm treatments should be integrated into PJI clinical practice guidelines in the near future.

Impact of diabetes on early postoperative outcomes after total elbow arthroplasty.

BACKGROUND: Diabetes is known to be associated with poorer perioperative outcomes after hip, knee, and shoulder arthroplasty. This study is the first, to our knowledge, to examine the association between diabetes and in-hospital complications, length of stay, non-homebound discharge, transfusion risk, and total charges after total elbow arthroplasty (TEA). METHODS: By use of International Classification of Diseases, Ninth Revision codes, epidemiologic as well as patient and hospital demographic data for all patients undergoing TEA were extracted from the Nationwide Inpatient Sample from 2007 through 2011. We found 13,698 patients who underwent TEA and subsequently separated them into 2 cohorts, those patients with (16.5%) and without (83.5%) diabetes. Specific outcome measures between the diabetic and nondiabetic cohorts were compared through bivariate and multivariate analyses. RESULTS: Diabetic patients had significantly longer lengths of stay, increased rates of needing a transfusion perioperatively, and higher rates of a number of complications after TEA compared with the nondiabetic group. Significant differences in demographic factors in diabetic patients compared with nondiabetic patients included age, gender, insurance type, and geography. Diabetes was an independent predictor of both prolonged hospital stay and non-homebound discharge after TEA. DISCUSSION: Diabetic patients have significantly higher rates of several perioperative complications, and diabetes is an independent risk factor for prolonged hospital stay, as well as increased risk of non-homebound discharge. Future studies need to further investigate this relationship between diabetes and poorer TEA outcomes.