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BACKGROUND: Patients with skin and soft tissue infections (SSTIs) are often admitted by the emergency department for intravenous antibiotic therapy and surgical drainage of abscesses if necessary. As part of the initial diagnostic workup, blood cultures are routinely drawn at our institution in patients with SSTIs. This study seeks to identify the utility of performing blood cultures in patients with upper extremity abscesses as it relates to the number of incision and drainage (I&D) procedures performed, patient readmission rates, and length of hospital stay. METHODS: A retrospective chart review of 314 patients aged 18 to 89 years who underwent 1 or more I&D procedures of upper extremity abscesses were included in the study. Patient demographic data, comorbidities, laboratory values, wound and blood culture results, number of I&D procedures performed, length of stay, and readmission rates were evaluated. RESULTS: Increasing age and white blood count were associated with an increased number of I&Ds performed. Obtaining blood cultures, whether positive or negative, was associated with increased length of stay. There was no association between obtaining blood cultures and number of procedures performed on multivariable analysis. Positive blood cultures were associated with increased readmission rates. CONCLUSIONS: Routinely obtaining blood cultures in patients with upper extremity abscesses may not be beneficial. Obtaining blood cultures is not associated with an increased number of I&D procedures or readmission rates. Furthermore, obtaining blood cultures, regardless of positivity, is associated with increased lengths of hospital stay.
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Introduction When performing total knee arthroplasty (TKA), surgeons may use either the mechanical alignment (MA) or the kinematic alignment (KA) to guide implant placement and joint balancing. By measuring preoperative and postoperative patellar height (PH), surgeons can predict knee stability after TKA. Improper PH is associated with knee instability which may complicate the postoperative course and lead to patient dissatisfaction or need for revision. The purpose of this study is to measure patellar height using the Insall-Salvati Index (ISI), Caton-Deschamps Index (CDI), and Blackburne-Peel Index (BPI) preoperatively and postoperatively in patients who underwent TKA with either MA or KA to assess for changes in patellar height. Methods We performed a retrospective eight-year review of 256 patients who underwent TKA with either MA or KA by a single surgeon at a single hospital site. We obtained demographic data, including gender, age, and BMI, via the electronic health record. Furthermore, we calculated the ISI, CDI, and BPI using necessary parameters from preoperative and postoperative radiographs. We used these measurements to assess any statistically significant difference in postoperative PH. Results The MA cohort consisted of 104 patients with an average age of 63 years and an average BMI of 34.1 kg/m2. The KA cohort included 152 patients with an average age of 64 years and an average BMI of 34.9 kg/m2. For the MA population, the average postoperative score with ISI was 1.10 [1.05 to 1.16] (p < 0.001), with CDI was 1.05 [0.98 to 1.11] (p < 0.001), and with BPI was was 0.94 [0.89 to 0.99] (p < 0.001). While for the KA population, the average postoperative score with ISI was 1.03 [0.99 to 1.06] (p = 0.17), with CDI was 0.87 [0.82 to 0.91] (p = 0.15), and with BPI was 0.82 [0.78 to 0.86] (p = 0.34). Conclusion TKA with a KA has a statistically significant improvement in postoperative PH and better postoperative maintenance of preoperative PH. Improved PH may lead to increased patellofemoral stability and superior postoperative outcomes in patients undergoing TKA. Future studies should focus on whether differences in preoperative and postoperative PH measurements result in changes in clinical outcomes in patients with MA versus KA TKA.
