Elective Orthopaedic Surgery Research Articles

"I Can’t Exercise Because My Foot Hurts Me Too Much." Does BMI Change after Common Foot and Ankle Surgeries? A Retrospective Review

Introduction/Purpose: The World Health Organization reports that 1.9 billion people worldwide have a body mass index (BMI) that classifies them as being either overweight (BMI > 25) or obese (BMI > 30). Patients often claim, prior to orthopaedic surgery, that their physical activity and exercise is negatively impacted by their orthopaedic condition. Hip and Knee arthroplasty literature has established that patients with high preoperative BMI continue to have high BMI post-operatively, despite also reporting improvements in their joint pain. No such studies exist in foot and ankle surgery. The purpose of this study was to analyze changes in BMI after many common foot and ankle surgeries. Methods: A retrospective review of all patients undergoing bunion correction, flatfoot correction, 1st MTP arthrodesis, and midfoot arthrodesis procedures between November 2018 and December 2022 was conducted in this IRB approved, single center study. BMI data was collected from the electronic medical record for preoperative and 12 months postoperative time points. Descriptive statistics were reported for age, gender, diabetes, A1c for diabetic patients, smoking status, and overall follow up time. Repeated measures of analysis of variation were conducted with one between-groups factor being type of surgery. Results: 196 patients were included in the study. The average age was 62.1 years, 151(76.6%) patients were female. Average BMI amongst all patients preoperatively was 29.58 +/- 5.21, and postoperatively 29.79 +/- 5.33, with an overall average increase in BMI of 0.2182 +/- 2.21. Upon subgroup analysis, all surgical cohorts yielded an increase in postoperative BMI (bunion +0.2489 +/- 2.06, double arthrodesis +0.4767 +/- 1.37, 1st MTP fusion +0.2293 +/- 2.07, midfoot arthrodesis +0.0251 +/- 3.10) although these changes did not reach significance (p value 0.425). There was no significant difference observed in changes in BMI between surgical groups (p value 0.958). BMI outcomes were normally distributed with acceptable equality of error variances (Levene’s test p- values > 0.270). Conclusion: The current statistics surrounding the prevalence of overweight and obesity are staggering. The results of this study demonstrate that elective orthopaedic surgery of common foot and ankle procedures do not facilitate a change in BMI one year postoperatively, despite the goal of reducing chronic pain and increasing physical function, which is often cited as the primary restriction to exercise amongst patient populations. Additional studies are warranted to further elucidate changes in BMI to adequately council patients regarding postoperative expectations. Study Data Summary

Preoperative comprehensive geriatric assessment and multidisciplinary team input in older people undergoing elective orthopaedic surgery: A feasibility trial.

To determine the feasibility of preoperative comprehensive geriatric assessment (CGA) and multidisciplinary team (MDT) input for older people undergoing elective orthopaedic surgery in a tertiary New Zealand setting. This single-centre retrospective study included elective orthopaedic patients older than 65 years (and Māori/Pasifika aged greater than 55 years) with hyperpolypharmacy, frailty, neurocognitive disorders and poor functional status. Patients attended a preoperative clinic where they had a geriatrician-led CGA along with MDT input. The feasibility of this preoperative model was assessed using outcomes of acceptability, accessibility and adherence. A qualitative description of patient demographics along with clinic assessment and interventions further describes this pilot experience. Sixty patients met inclusion criteria. This group were vulnerable older people (median age 77 years), with a high incidence of hyperpolypharmacy (85%), frailty (80%) and neurocognitive disorders (30%). Acceptability was high (97%), along with CGA accessibility (100%); however, MDT accessibility varied (53-90%). Adherence to MDT intervention was low; with only 26% of patients completing physiotherapy sessions and only 29% adhering to dietary advice. Accurate recall was a significant factor contributing to poor adherence. Comprehensive geriatric assessment was demonstrated to be a broad and flexible intervention. CGA with MDT input is an acceptable and accessible intervention to be utilised as part of improved preoperative care for the older person undergoing elective orthopaedic surgery. Further consideration around methods to increase adherence in this patient group should be explored. Future research should focus on refining the intervention, and quantifying impact on patient outcomes.

Risk Factors for Postoperative Cognitive Decline After Orthopedic Surgery in Elderly Chinese Patients: A Retrospective Cohort Study.

We aimed to identify the risk factors for postoperative cognitive decline (POCD) by evaluating the outcomes from preoperative comprehensive geriatric assessment (CGA) and intraoperative anesthetic interventions. Data used in the study were obtained from the Aged Patient Perioperative Longitudinal Evaluation-Multidisciplinary Trial (APPLE-MDT) cohort recruited from the Department of Orthopedics in Xuanwu Hospital, Capital Medical University between March, 2019 and June, 2022. All patients accepted preoperative CGA by the multidisciplinary team using 13 common scales across 15 domains reflecting the multi-organ functions. The variables included demographic data, scales in CGA, comorbidities, laboratory tests and intraoperative anesthetic data. Cognitive function was assessed by Montreal Cognitive Assessment scale within 48 hours after admission and after surgery. Dropping of ≥1 point between the preoperative and postoperative scale was defined as POCD. We enrolled 119 patients. The median age was 80.00 years [IQR, 77.00, 82.00] and 68 patients (57.1%) were female. Forty-two patients (35.3%) developed POCD. Three cognitive domains including calculation (P = 0.046), recall (P = 0.047) and attention (P = 0.007) were significantly worsened after surgery. Univariate analysis showed that disability of instrumental activity of daily living, incidence rate of postoperative respiratory failure (PRF) ≥4.2%, STOP-Bang scale score, Caprini risk scale score and Sufentanil for maintenance of anesthesia were different between the POCD and non-POCD patients. In the multivariable logistic regression analysis, PRF ≥ 4.2% (odds ratio [OR] = 2.343; 95% confidence interval [CI]: 1.028-5.551; P = 0.046) and Sufentanil for maintenance of anesthesia (OR = 0.260; 95% CI: 0.057-0.859; P = 0.044) was independently associated with POCD as risk and protective factors, respectively. Our study suggests that POCD is frequent among older patients undergoing elective orthopedic surgery, in which decline of calculation, recall and attention was predominant. Preoperative comprehensive geriatric assessments are important to identify the high-risk individuals of POCD.

Responsiveness of Subjective and Objective Measures of Pain and Function Following Operative Interventions for Musculoskeletal Conditions: A Narrative Review.

Musculoskeletal (MSK) disorders affect ~50% of US adults and 75% of those over the age of 65, representing a sizable economic and disability burden. Outcome measures, both objective and subjective, help clinicians and investigators determine whether interventions to treat MSK conditions are effective. This narrative review qualitatively compared the responsiveness of different types of outcome measures, a key measurement characteristic that assesses an outcome measure's ability to detect change in patient status. We evaluated elective orthopedic interventions as a model for assessing responsiveness because the great majority of patients improves following surgery. We searched for articles reporting responsiveness (quantified as effect size [ES]) of subjective and objective outcome measures after orthopedic surgery and included 16 articles reporting 17 interventions in this review. In 14 of 17 interventions, subjective function measures had an ES 10% greater than that of objective function measures. Two reported a difference in ES of <10%. The sole intervention that demonstrated higher ES of objective function used a composite measure. Sixteen interventions reported measures of subjective pain and/or mixed measures and subjective function. In nine interventions, subjective pain had a higher ES than subjective function by >10%, in three, subjective function had a higher ES than subjective pain by >10%, and in the remaining four, the difference between pain and function was <10%. These findings reinforce the clinical observation that subjective pain generally changes more than function following elective orthopedic surgery. They also suggest that subjective function measures are more responsive than objective function measures, and composite scores may be more responsive than individual performance tests.

Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery.

Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss, improve visualization in the surgical field, and to potentially reduce surgical time. There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure, placement site, and duration of use. There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery. To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery. Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken. Intraoperative tourniquet duration, tourniquet pressure and site, and postoperative pain scores using Visual Analogue Score were collected in immediate recovery, at six hours and at 24 h post-op. Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure, duration, site, and pain scores using Pearson correlation coefficient. All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh. There was no correlation between the site of the tourniquet and pain scores in recovery, at six hours and after 24 h. There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op (r = 0.14, P = 0.04) but not at six or 24 h post-operatively. This study shows that there was no statistically significant correlation between tourniquet pressure, site and post-op pain in patients undergoing foot and ankle surgery. The choice of using a tourniquet is based on the surgeon's preference, with the goal of minimizing the duration of its application at the operative site.

The impact of ketamine on delayed neurocognitive recovery in elderly patients undergoing spinal anaesthesia for orthopaedic procedures, a pilot study.

Delayed neurocognitive recovery is an objectively measurable decline in the cognitive status at varying intervals after surgery under both general and spinal anaesthesia. In this study, we used the Short Portable Mental Status Questionnaire to evaluate the protective effect of ketamine infusion on cognitive function of elderly patients undergoing spinal anaesthesia for orthopaedic procedures. A randomised, double-blinded placebo-controlled trial. Forty-two geriatric patients listed for elective orthopaedic surgery under spinal anaesthesia were randomly assigned to receive an intravenous infusion of either ketamine (0.3mg/kg) or isotonic saline (control group) after receiving spinal anaesthesia, which continued throughout the procedure. Cognitive performance was evaluated, as a primary outcome, with Short Portable Mental Status Questionnaire. Baseline cognitive performance was comparable in both groups. Patients in the ketamine group showed statistically significant fewer errors in the postoperative Short Portable Mental Status Questionnaire compared with the baseline evaluations (p = 0.038). Patients in the ketamine group showed significantly lower verbal numerical scale scores than the control group (p = 0.04) at six hours after surgery. Elderly patients undergoing spinal anaesthesia showed a better cognitive status after receiving an intravenous infusion of 0.3mg/kg ketamine. However, further research with a larger sample size and different assessment tools might be required to verify our results.

The Association of Preoperative Diabetes With Postoperative Delirium in Older Patients Undergoing Major Orthopedic Surgery: A Prospective Matched Cohort Study.

Postoperative delirium (POD) is a common form of postoperative brain dysfunction, especially in the elderly. However, its risk factors remain largely to be determined. This study aimed to investigate whether (1) preoperative diabetes is associated with POD after elective orthopedic surgery and (2) intraoperative frontal alpha power is a mediator of the association between preoperative diabetes and POD. This was a prospective matched cohort study of patients aged 60 years or more, with a preoperative diabetes who underwent elective orthopedic surgery. Nondiabetic patients were matched 1:1 to diabetic patients in terms of age, sex, and type of surgery. Primary outcome was occurrence of POD, assessed using the 3-minute Diagnostic Confusion Assessment Method (3D-CAM) once daily from 6 pm to 8 pm during the postoperative days 1-7 or until discharge. Secondary outcome was the severity of POD which was assessed for all participants using the short form of the CAM-Severity. Frontal electroencephalogram (EEG) was recorded starting before induction of anesthesia and lasting until discharge from the operating room. Intraoperative alpha power was calculated using multitaper spectral analyses. Mediation analysis was used to estimate the proportion of the association between preoperative diabetes and POD that could be explained by intraoperative alpha power. A total of 138 pairs of eligible patients successfully matched 1:1. After enrollment, 6 patients in the diabetes group and 4 patients in the nondiabetes group were excluded due to unavailability of raw EEG data. The final analysis included 132 participants with preoperative diabetes and 134 participants without preoperative diabetes, with a median age of 68 years and 72.6% of patients were female. The incidence of POD was 16.7% (22/132) in patients with preoperative diabetes vs 6.0% (8/134) in patients without preoperative diabetes. Preoperative diabetes was associated with increased odds of POD after adjustment of age, sex, body mass index, education level, hypertension, arrhythmia, coronary heart disease, and history of stroke (odds ratio, 3.2; 95% confidence interval [CI], 1.4-8.0; P = .009). The intraoperative alpha power accounted for an estimated 20% (95% CI, 2.6-60%; P = .021) of the association between diabetes and POD. This study suggests that preoperative diabetes is associated with an increased risk of POD in older patients undergoing major orthopedic surgery, and that low intraoperative alpha power partially mediates such association.

Comparison Between Dexamethasone Versus Clonidine as Adjuvants to 0.75% Ropivacaine in Ultrasound Guided Brachial Plexus Block for Upper Limb Orthopedic Surgeries: A Randomized Prospective Clinical Study

Background: Ropivacaine is an amino-amide local anesthetic, extensively used for peripheral nerve blocks, numerous adjuvants have been added to Ropivacaine to prolong the duration of analgesia. Aim: To compare the effectiveness of adding Dexamethasone to Ropivacaine versus adding Clonidine to Ropivacaine in ultrasound guided supraclavicular brachial plexus block in terms of analgesic duration, onset &amp; duration of sensory and motor blockade.&#x0D; Methods: A prospective randomized single blinded study carried out in 70 patients of ASA grade I and II, aged 20 to 60 years scheduled for elective upper limb orthopedic surgeries. Patients were randomly allocated into two groups, Group RC - patients received 20ml of 0.75% ropivacaine along with 1mcg/kg of clonidine diluted to 2ml of normal saline, Group RD - patients received 20ml of 0.75% ropivacaine along with 8mg of dexamethasone (2ml). Statistical Analysis: Onset &amp; duration of sensorimotor blockade, duration of analgesia was assessed by Unpaired t-test. If p-value &lt;0.05, results were statistically significant &amp; p-value &lt;0.001 were highly significant.&#x0D; Results: Duration of analgesia is superior and statistically significant in Group RD (1,172.57± 18.37 vs 931.09± 16.3). Onset time for sensory (3.14 ± 1.00 vs 9.71± 1.23) and motor (7.60 ± 1.54 vs 13.66± 1.03) block is rapid in Group RD. Duration of sensory (1,106.57± 20.28 vs 786.26± 31.43) and motor (997.74 ± 24.9 vs 674.57 ± 2.18) block is enhanced in Group RD.&#x0D; Conclusion: Dexamethasone as an adjuvant to ropivacaine provided superior post-operative analgesia, faster onset and longer duration of sensory and motor blockade.

EFFECTS OF NUTRITION STATUS AND PERIOPERATIVE NUTRITION SUPPLEMENT COMPLETION ON POSTOPERATIVE OUTCOMES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE UNDERGOING SURGERY

Abstract BACKGROUND Malnutrition is common in inflammatory bowel disease, (IBD) and is associated with poor disease activity, greater hospital length of stay (LOS), higher 30-day readmission rates, and increased risk of postoperative complications. Structured, multimodal prehabilitation including nutrition counseling improves various outcomes after elective cancer and orthopedic surgeries. We examined the effects of malnutrition and perioperative nutrition supplementation on surgical outcomes in IBD patients participating in a multimodal prehabilitation program. METHODS This was a retrospective study of patients aged 18-80 enrolled in a 10-week prehabilitation program undergoing surgery for IBD. Beginning 4 weeks prior to surgery, patients met with a multidisciplinary team including a nurse practitioner, physical therapist and registered dietitian. Patients were provided 3 preoperative carbohydrate loading oral nutrition supplements (ONS) 48 hours prior to surgery, and 20 perioperative immunonutrition ONS. Malnutrition was defined using the Global Leadership in Malnutrition criteria as moderate or severe. We used Fisher’s exact test to determine associations between malnutrition, ONS use, and postoperative complications (defined by the comprehensive complication index (CCI, with CCI scores &amp;gt;20 classified as severe)), and 30-day readmission. Logistic and linear regression were used to analyze length of stay (LOS), opioid use (defined as morphine milligram equivalents, MME), nutrition status, and ONS completion. RESULTS 25 patients (48% female, mean age 44, 18 (72%) with Crohn’s disease) completed the prehabilitation program between 05/2022 and 10/2023. 10 patients (40%) met criteria for malnutrition (of these, 50% were moderate and 50% severe). Malnutrition was not significantly associated with CCI severity (p=0.07), LOS (p =0.07), opioid use (p=0.07) or 30 day readmission rates (0.06). Higher ONS use for carbohydrate loading and immunonutrition were more likely to have a LOS&amp;lt;5 days (p=0.05 and p=0.03 respectively). CONCLUSION ONS for preoperative carbohydrate loading and perioperative immunonutrition may shorten LOS after surgery among patients with IBD. In our study, higher amounts of ONS consumption led to a shorter LOS. Larger, controlled studies will help to further clarify the effects of malnutrition, carbohydrate loading, and immunonutrition among patients with IBD preparing for surgery.

A predictive nomogram for surgical site infection in patients who received clean orthopedic surgery: a retrospective study

BackgroundSurgical site infection (SSI) is a common and serious complication of elective clean orthopedic surgery that can lead to severe adverse outcomes. However, the prognostic efficacy of the current staging systems remains uncertain for patients undergoing elective aseptic orthopedic procedures. This study aimed to identify high-risk factors independently associated with SSI and develop a nomogram prediction model to accurately predict the occurrence of SSI.MethodsA total of 20,960 patients underwent elective clean orthopedic surgery in our hospital between January 2020 and December 2021, of whom 39 developed SSI; we selected all 39 patients with a postoperative diagnosis of SSI and 305 patients who did not develop postoperative SSI for the final analysis. The patients were randomly divided into training and validation cohorts in a 7:3 ratio. Univariate and multivariate logistic regression analyses were conducted in the training cohort to screen for independent risk factors of SSI, and a nomogram prediction model was developed. The predictive performance of the nomogram was compared with that of the National Nosocomial Infections Surveillance (NNIS) system. Decision curve analysis (DCA) was used to assess the clinical decision-making value of the nomogram.ResultsThe SSI incidence was 0.186%. Univariate and multivariate logistic regression analysis identified the American Society of Anesthesiology (ASA) class (odds ratio [OR] 1.564 [95% confidence interval (CI) 1.029–5.99, P = 0.046]), operative time (OR 1.003 [95% CI 1.006–1.019, P < 0.001]), and D-dimer level (OR 1.055 [95% CI 1.022–1.29, P = 0.046]) as risk factors for postoperative SSI. We constructed a nomogram prediction model based on these independent risk factors. In the training and validation cohorts, our predictive model had concordance indices (C-indices) of 0.777 (95% CI 0.672–0.882) and 0.732 (95% CI 0.603–0.861), respectively, both of which were superior to the C-indices of the NNIS system (0.668 and 0.543, respectively). Calibration curves and DCA confirmed that our nomogram model had good consistency and clinical predictive value, respectively.ConclusionsOperative time, ASA class, and D-dimer levels are important clinical predictive indicators of postoperative SSI in patients undergoing elective clean orthopedic surgery. The nomogram predictive model based on the three clinical features demonstrated strong predictive performance, calibration capabilities, and clinical decision-making abilities for SSI.

Independent sector and peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists.

The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest including those that occurred in the independent healthcare sector, which provides around 1 in 6 NHS-funded care episodes. In total, 174 (39%) of 442 independent hospitals contacted agreed to participate. A survey examining provider preparedness for cardiac arrest had a response rate of 23 (13%), preventing useful analysis. An activity survey with 1912 responses (from a maximum of 45% of participating hospitals) showed that, compared with the NHS caseload, the independent sector caseload was less comorbid, with fewer patients at the extremes of age or who were severely obese, and with a large proportion of elective orthopaedic surgery undertaken during weekday working hours. The survey suggested suboptimal compliance rates with monitoring recommendations. Seventeen reports of independent sector peri-operative cardiac arrest comprised 2% of NAP7 reports and underreporting is likely. These patients were lower risk than NHS cases, reflecting the sector's case mix, but included cases of haemorrhage, anaphylaxis, cardiac arrhythmia and pulmonary embolus. Good and poor quality care were seen, the latter including delayed recognition and treatment of patient deterioration, and poor care delivery. Independent sector outcomes were similar to those in the NHS, though due to the case mix, improved outcomes might be anticipated. Assessment of quality of care was less often favourable for independent sector reports than NHS reports, though assessments were often uncertain, reflecting poor quality reports. Overall, NAP7 is unable to determine whether peri-operative care relating to cardiac arrest is more, equally or less safe than in the NHS.

Effect of Low-Dose Dexmedetomidine on Intestinal Barrier and Functional Recovery in Elderly Patients Undergoing Orthopedic Surgery for Lower Limbs

Objective: This study used the minimum recommended clinical dose of dexmedetomidine to investigate whether it can protect the intestinal barrier and the effects on intestinal function recovery in elderly patients undergoing lower limb orthopedic surgery. Methods: 56 patients, who underwent elective lower limb orthopedic surgery in our hospital from November 1, 2019 to November 1, 2021, were divided into control group (saline group) and DEX group (dexmedetomidine group) by random numbers method. The DEX group received dexmedetomidine at 0.5 μg/kg, pumped within 15 min and then maintained at 0.1 μg/kg/h until 30 min before the skin suture. The control group performed the same procedure with normal saline instead. The primary outcomes included the time of first hepatic gate exhaust, serum diamine oxidase, and D-lactate levels. Secondary outcomes include total amount of sufentanil, mean arterial pressure, heart rate, duration of anesthesia, duration of surgery, tumor necrosis factor- α, C-reactive protein, lipopolysaccharide levels. Results: The time of first anal exhaust in the DEX group was significantly shorter compared with the control group (13.23 ± 4.98 hours vs19.67±5.16 hours; p&lt;0.001), and the total amount of sufentanyl in the DEX group was significantly lower than that in the control group (35.32±10.23ug vs 42.33±12.19ug; p=0.002). At 24 hours after surgery, serum diamine oxidase, tumor necrosis factor-α, and C-reactive protein levels increased in both groups, but no difference was statistically significant (p&gt;0.05), and there was no significant difference in LPS levels in the two groups before and 24 hours after surgery (p&gt;0.05). D-lactate was increased in both groups at 24 hours after surgery, but the D-lactate increased more in control patients than in the DEX group (36.17±14.69 mg/L vs 29.10±12.19 mg/L;p=0.017). Correlation analysis showed that diamine oxidase, D lactate, age, APACHE II score, total amount, and time to first anal discharge in the DEX group (p&lt;0.05). Conclusion: The intraoperative administration of dexmedetomidine can accelerate the recovery of gastrointestinal function, which may be related to the protective effect of DEx on the gastrointestinal barrier.

Expert Consensus on the Significance of Intravenous Iron using Ferric Carboxymaltose Perioperatively and in Elective Major Orthopedic Surgeries

Anemia has emerged as a significant healthcare crisis in India and often remains undiagnosed, with broad implications across all age groups. Iron deficiency remains the most important and correctable cause of anemia in our country. It often leads to significant morbidity during major operative procedures such as hip and knee arthroplasties, due to the substantial intraoperative bleeding associated with these procedures. To address this challenge and mitigate complications related to blood transfusions, peri-operative iron therapy, notably parenteral iron therapy, has become common practice. Nevertheless, there is a lack of consensus on managing peri-operative anemia and the role of ferric carboxymaltose (FCM) in pre-operative and post-operative orthopedic surgeries in India. A group of 14 experts, primarily orthopedic surgeons and an hematologist in India, convened an in-person expert group meeting. Their primary focus was on the approach of FCM in managing anemia in elective orthopedic surgeries within the diverse landscape of the Indian healthcare system. The consensus strongly advocated using FCM as a rapid and adequate source of iron replacement, especially in cases of significant pre-operative and post-operative anemia in patients undergoing elective orthopedic surgery. Keywords: Pre-operative, post-operative, orthopedic surgery, anemia, ferric carboxymaltose.

A systematic review of tourniquet use in paediatric orthopaedic surgery: can we extrapolate from adult guidelines?

Tourniquets are commonly used intraoperatively in orthopaedic surgery to control bleeding and improve visibility in the surgical field. Recent evidence has thrown into question the routine use of tourniquets in the adult population resulting in a British Orthopaedic Association standard for intraoperative use. This systematic review evaluates the evidence on the practice, benefits, and risks of the intraoperative use of tourniquets for trauma and elective orthopaedic surgery in the paediatric population. A prospectively registered systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO: CRD42022359048). A search of MEDLINE, Embase, the Cochrane Library and a Grey literature search was performed from their earliest record to 23 March 2023. Studies reporting tourniquet data in paediatric patients undergoing orthopaedic surgery were included. Data extracted included demographics, involved limb, trauma versus elective use, tourniquet use as primary or secondary measure, and tourniquet parameters and complications. Thirty-nine studies were included. Tourniquet practices and information reporting varied considerably. Tourniquets were used uneventfully in the majority of patients with no specific benefits reported. Several physiological and biochemical changes as well as complications including nerve injury, compartment syndrome, skin burns, thrombosis, post-operative limb swelling, and pain were reported. Tourniquets are routinely used in both trauma and elective paediatric orthopaedic surgery with no high-quality research affirming benefits. Severe complications associated with their use are rare but do occur. High-quality studies addressing their benefits, the exact indication in children, and the safest way to use them in this population are necessary.

Selection of new pathogens during antibiotic treatment or prolonged antibiotic prophylaxis in orthopedic surgery

In orthopedic surgery regarding open or infected wounds, both the current antibiotic therapy as well as the perioperative antibiotic prophylaxis, may select new pathogens leading to iterative debridement and changing the antibiotic regimens targeting more resistant microorganisms. The risk of finding new and more resistant pathogens is relatively high (5%-15%) and exceeds the incidence of primary surgical site infections (SSI) after elective orthopedic surgery with primary wound closures. Based on a narrative review of the current scientific literature, we summarize mechanisms and associations of such a pathogen selection by therapeutic or prophylactic agents and focus on the importance of an adequate initial debridement and on an effective antibiotic stewardship.

Major Metropolitan Area COVID-19 - Positive Patients Undergoing Emergency and Elective Orthopaedic Surgeries: A Case-matched Control Study

Major Metropolitan Area COVID-19 - Positive Patients Undergoing Emergency and Elective Orthopaedic Surgeries: A Case-matched Control Study

Effects of parecoxib on postoperative cognitive dysfunction and serum levels of NSE and S100β in elderly patients undergoing surgery.

To investigate the effects of parecoxib on postoperative cognitive dysfunction, and serum levels of neuron-specific enolase (NSE) and S100β protein (S100β) in elderly patients undergoing surgery. The retrospective cohort study method was used to collect the clinical data of 94 elderly patients who underwent elective orthopedic and general anesthesia surgery in our hospital from September 2020 to February 2022. 94 patients were divided into the control group (47 cases) and the study group (47 cases), according to different intervention methods. In the study group, 40 mg of parecoxib was injected intravenously into patients 30 min before the induction of anesthesia, and the patients in the control group were given the same dose of normal saline intravenously before the operation. The basic clinical data of the patients were collected. The levels of the indexes before operation and 6 hours after operation were compared between the two groups, including the Montreal Cognitive Scale (MoCA) score, inflammatory factor indicators [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), interleukin-10 (IL-10), interleukin-1β (IL-1β), monocyte chemokine-1 (MCP-1), and inducible nitric oxide synthase (iNOS)], serum cortisol (CORT), beta-amyloid (β-AP), adiponectin (ADP), NSE, and S100β. No significant differences in the preoperative MoCA score, TNF-α, IL-6, CRP, IL-10, IL-1β, MCP-1, iNOS, CORT, β-AP, ADP, NSE, and S100β levels were observed between the two groups (p>0.05). The postoperative MoCA score in the study group was significantly higher than that in the control group (p<0.05). The postoperative levels of TNF-α, IL-6, CRP and IL-1β in the study group were significantly lower than those in the control group (p<0.05), and the postoperative levels of IL-10, MCP-1 and iNOS in the study group were significantly higher than those in the control group (p<0.05). Parecoxib can notably inhibit the levels of postoperative inflammatory cytokines, improve neurological dysfunction, and reduce the occurrence of postoperative cognitive dysfunction in patients. The contents of serum NSE and S100β have potential value in the diagnosis of postoperative cognitive dysfunction in elderly patients.

Effects of 4 mg and 8 mg Dexamethasone Added to Intrathecal Bupivacaine on Perioperative Analgesia Among Adult Orthopedic Patients at Sodo Christian Hospital: A Prospective Cohort Study.

Background: Several adjuvant drugs have been tried to prolong spinal anesthesia block. Currently, dexamethasone appears to be effective in extending the duration of sensory block and enhancing analgesia during surgery. It is unclear, however, whether administering dexamethasone at a dose of 8 mg offers any advantages over administering it at a dose of 4 mg. Objective: To compare the effect of adding 4 and 8 mg dexamethasone to intrathecal bupivacaine on perioperative analgesia among adult orthopedic patients at Sodo Christian Hospital from June 1 to October 31, 2021. Methodology: A total of 178 adult patients undergoing elective orthopedic surgery were randomly assigned to one of the two groups through a prospective cohort research design. A systematic random sampling method was used. For analysis, data were imported into EpiData v.4.6 and exported to SPSS v.25. Levene's test was used to verify homogeneity of variance, whereas the Shapiro-Wilk test was used to assess data distribution. The Mann-Whitney test and the independent sample t-test were employed to compare numerical variables between study groups. Category variables were determined using the chi-square test. p values were deemed statistically significant if they were less than 0.05. Result: Between groups, the perioperative and demographic features were similar. The mean durations of sensory block (347.42 ± 91.06 versus 341.46 ± 68.84), motor block (308.36 ± 80.91 versus 310.84 ± 75.50), and overall analgesia (421.51 ± 121.62 versus 412.40 ± 107.0) minutes did not show a statistically significant difference between the groups. In addition, there was no significant difference (p > 0.05) in postoperative analgesic use, initial analgesia rescue time, or pain severity, as measured by the Numerical Rating Scale (NRS). The addition of dexamethasone did not result in any issues, nor was there a statistically significant difference in the onset time between the two groups. Conclusion: Dexamethasone at a dose of 4 mg extends the duration of sensory, motor, and overall analgesia in a manner similar to that of 8 mg dexamethasone with comparable durations for both the initial analgesic request and overall analgesic use.

Educational video for teaching safe practices in the perioperative period: randomized controlled trial.

to assess the effectiveness of an educational video on hospitalized patients' knowledge of safe practices in the perioperative period. randomized, double-blind controlled trial carried out in a teaching hospital in the countryside of Minas Gerais. 100 participants undergoing elective orthopaedic surgery were randomly allocated (50 participants in the experimental group and 50 participants in the control group). Patient knowledge was assessed using a questionnaire constructed by the researchers and validated by specialists, before and after the intervention (educational video) or standard guidelines were applied. Descriptive statistics were used for quantitative variables and Student's t-test for independent samples to analyze the mean difference in knowledge between the experimental and control groups (α = 0.05). 100 participants took part in the study, 50 participants in the experimental group and 50 participants in the control group. The experimental group showed a significantly higher gain in knowledge (t =3.72 ±1.84; p<0.001) than the control group. Cohen's d was 1.22, indicating a large magnitude of the effect. the educational video was effective in improving patients' knowledge and can contribute to nurses in the practice of health education, optimizing time and disseminating knowledge about safe practices in the perioperative period. Brazilian Registry of Clinical Trials (REBEC): RBR-8x5mfq. (1) Development of a valid patient knowledge assessment questionnaire. (2) Production of a valid educational video on perioperative safety. (3) The final version of the educational video is 7 minutes and 50 seconds long. (4) The educational video was effective in improving patient knowledge. (5) It contributes to patient involvement in safe care.

Effect of tumour necrosis factor-a inhibitors exposure on surgical site infections in rheumatoid arthritis patients undergoing elective orthopaedic surgery: A meta-analysis.

A meta-analysis investigation was executed to evaluate the effect of tumour necrosis factor-a inhibitor exposure on surgical site infections in rheumatoid arthritis patients undergoing elective orthopaedic surgery. A comprehensive literature investigation till October 2023 was applied, and 82 470 individuals with orthopaedic surgery were in the chosen investigations' starting point. Odds ratio (OR) in addition to 95% confidence intervals (CIs) was utilized to compute the value of the effect of tumour necrosis factor-a inhibitors exposure on surgical site infections in rheumatoid arthritis patients undergoing elective orthopaedic surgery by the dichotomous approaches and a fixed or random model. Tumour necrosis factor uses had significantly higher surgical site infections (OR, 1.65; 95% CI, 1.21-2.25, p = 0.001) compared with tumour necrosis factor non-use in rheumatoid arthritis patients undergoing elective orthopaedic surgery. However, no significant difference was found between discontinued and continued tumour necrosis factor on surgical site infections (OR, 0.61; 95% CI, 0.35-1.05, p = 0.07) in rheumatoid arthritis patients undergoing elective orthopaedic surgery.Significantly higher surgical site infections was found comparing tumour necrosis factor uses to non-use; however, no significant difference was found between discontinued and continued tumour necrosis factor on surgical site infections in rheumatoid arthritis patients undergoing elective orthopaedic surgery. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.