RESUMO
BACKGROUND: Periprosthetic infection is commonly caused by Staphylococcus aureus and, if resistant to methicillin (MRSA), is associated with increase in severity and costs to patient and healthcare systems. MRSA colonizes 1-5% of the population, therefore using a screening and decolonisation protocol the risk of periprosthetic infection could be reduced. The objective of our study is to report the results of a preoperative MRSA screening and management protocol utilised at our hospital. METHODS: All patients undergoing a total joint arthroplasty at our hospital were preoperatively screened for MRSA colonization with swab samples of five different locations. Exposure to risk factors were investigated in colonised patients and they were treated for 5 days prior surgery with nasal mupirocin, chlorhexidine sponges and oral tablets. RESULTS: During the 48 months of the study, MRSA colonisation was identified in 22 (1.01%) of 2188 patients operated. The culture was positive only in the nasal swab in 55 patients. In five patients the nasal culture was negative, but they had another positive swab culture (three in the groin and two perianal). None of the patients reported a history of recent antibiotic treatment or hospitalization. CONCLUSION: At our institution, the prevalence of MRSA colonisation is 1.01% in patients undergoing hip and knee arthroplasty. Interestingly, our screening protocol included samples from five different anatomic locations, and it is important to highlight that we found patients with negative nares culture and positive cultures in other locations. Therefore, the number of carriers may be underdiagnosed if only nasal samples are obtained. LEVEL OF EVIDENCE: IV.
RESUMO
Objetivo. a) Valorar la efectividad de la implementación del fast-track en PTR-PTC; y b) evaluar la eficiencia en la estancia hospitalaria, las cirugías de revisión y los costes. Material y métodos. Estudio observacional en 2 tiempos: 1) Estudio prospectivo con 200 pacientes (PTR=100, PTC=100) en 2005-2007. Se analizó la edad, el sexo, la estancia hospitalaria, la escala visual analógica (EVA), el balance articular (BA) de rodilla, las complicaciones y la rehabilitación tras el alta. 2) Estudio prospectivo a 3.094 PTR y 1.664 PTC, desde el 2005-2015. Se analizó la estancia hospitalaria, el porcentaje de cirugías de revisión y el ahorro estimado. Resultados. En la validación en PTR el 68% (n=68) eran mujeres y el 32% (n=32) varones. La edad media fue de 71 años y la estancia hospitalaria de 6 días. La EVA preoperatoria/6 meses/año/2 años disminuyó progresivamente (7; 1,8; 1,4 y 1,2). El BA al alta/mes/2 años mejoró progresivamente (82°, 90° y 93°). Complicaciones 3% (n=3; fractura postraumática y 2 inestabilidades). Rehabilitación ambulatoria 8% (n=8). En la validación en PTC el 48% (n=48) eran mujeres y el 52% (n=52) varones, con una edad media de 70 años. La estancia hospitalaria fue de 5 días. Hubo complicaciones en 3 pacientes (3%) (fractura, luxación y TVP). Rehabilitación ambulatoria 3% (n=3). En PTR la estancia media (11 años) fue 5,96 días, las revisiones 5,96% y el ahorro estimado (2013-2015) 117.776 euros. En PTC la estancia media (11 años) fue 6,24 días, las revisiones 10,62% y el ahorro estimado (2013-2015) 116.316 euros. Conclusiones. La implantación/seguimiento del protocolo fast-track en PTR-PTC disminuye el dolor, las complicaciones, la rehabilitación ambulatoria, la estancia hospitalaria, la tasa de revisiones y los costes (AU)
Objective. a) To validate the effectiveness of the implementation of a fast-track protocol for TKA-THA; b) to evaluate efficiency in reducing length of stay, hospital costs and revision surgeries. Material and methods. A two-phase observational study was performed: 1) A prospective study in 200 patients (100 TKA and 100 THA) between 2005 and 2007. Age, sex, length of stay, visual analog scale (VAS) for pain, knee range of movement (ROM), complications and post-discharge rehabilitation were analyzed. 2) A prospective study was conducted in 3094 TKA and 1664 THA patients between 2005 and 2011. Length of stay, revision surgery and estimated savings were analyzed. Results. In the TKA evaluation, 68% of the patients were female (n=68) and 32% were male (n=32). The mean age was 71 years. Length of stay was 6 days. Pain diminished progressively at discharge/6 months/1 year/2 years (7; 1.8; 1.4 and 1.2), respectively. The ROM progressively increased at discharge/1 month/2 years (82°, 90° and 93°), respectively. The complications rate was 3% (n=3) (fracture and instability). Ambulatory rehabilitation was provided in 8% (n=8). In the THA evaluation, 48% of the patients were female (n=48) and 52% were male (n=52). The mean age was 70 years. Length of stay was 5 days. The complications rate was 3% (n=3) (fracture, dislocation and deep vein thrombosis). Ambulatory rehabilitation was provided in 3% (n=3). In TKA (11 years), the length of stay was 5.96 days, revision surgeries were carried out in 5.96%, and the cost saving in 2013-2015 was 117,776 euros. In THA (11 years), the length of stay was 6.24 days, revision surgeries were performed in 10.62%, and the cost saving in 2013-2015 was 116,316 euros. Conclusions. The implementation/follow-up of the fast-track protocol in THA-TKA was effective in decreasing pain, complications, ambulatory rehabilitation, length of stay, the rate of revision surgery, and costs (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Artroplastia de Quadril/métodos , Artroplastia de Quadril/reabilitação , Prótese de Quadril , Prótese do Joelho , Artroplastia do Joelho/reabilitação , Artroplastia de Quadril/economia , Artroplastia do Joelho/economia , Estudos Prospectivos , Avaliação de Eficácia-Efetividade de Intervenções , 50303 , Protocolos Clínicos , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Avaliação de Resultado de Intervenções Terapêuticas/economiaRESUMO
No disponible
No disponible
Assuntos
Humanos , Osteoartrite do Joelho/cirurgia , Artroplastia do Joelho , Procedimentos Cirúrgicos Minimamente InvasivosRESUMO
No disponible
Assuntos
Humanos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgiaRESUMO
La osteonecrosis abarca un amplio campo de enfermedades de etiología multifactorial que se inicia en el árbol vascular nutriente del cartílago y la matriz ósea. Las fases finales se caracterizan por su carácter avascular y, por tanto, de desvitalización del tejido óseo. La clínica se caracteriza por dolor e impotencia funcional creciente, y el tratamiento depende de la fase de la enfermedad en el momento de la detección y del grado de afectación ósea. Se presentan dos casos, con circunstancias y tratamientos diferentes (AU)
No disponible
