Orthopedic Surgical Patients Research Articles

P-1409. Differential Impact of a Penicillin Allergy Assessment Tool on Orthopedic Surgical Patients from Areas of High Social Vulnerability

Abstract Background Penicillin allergy labels (PAL) have been associated with increased risk of surgical site infections. Many penicillin allergy assessment tools are being trialed to improve perioperative β-lactam utilization. We report on the sociodemographic characteristics associated with receipt of β-lactam antibiotics (BLA) in orthopedic surgical patients with a PAL after implementation of a penicillin allergy assessment tool built into the electronic health record (EHR).Table 1:Clinical and Sociodemographic Characteristics of Penicillin Allergy Label Patients by Preoperative β-Lactam Antibiotic (BLA) Administration Following Implementation of Penicillin Allergy Assessment Tool in the Electronic Health Record Methods We performed a retrospective cohort study of patients who underwent hip (HPRO) and knee arthroplasty (KPRO) procedures in a large health system between August 2022 and December 2023. Patients with a PAL were identified and demographic, clinical and antibiotic administration data were obtained from the EHR. Clinical data was merged with Social Vulnerability Index (SVI) census-track data comprising 4 subthemes (socioeconomic status, household characteristics, racial/ethnic minority status and housing type/transportation). Higher SVI indicates higher vulnerability. Patients with a PAL who did and did not receive a BLA post protocol implementation were compared.Figure 1:Impact of a Penicillin Allergy Assessment Tool on Beta Lactam Utilization in Patients who Live in High vs Low Social Vulnerability Index Census Tracks*Statistically significant p<0.05 Results 1851 patients with a PAL who had undergone a HPRO and/or KPRO were identified. After implementation of the penicillin allergy assessment tool, 443 (24%) did not receive a BLA preoperatively. PAL Patients that did not receive a BLA after implementation of the tool were more likely to be female and less likely to have an admit status at the time of surgery. Other clinical characteristics including surgical site infection rates were similar between the groups. (Table 1) PAL patients who did not receive BLA were more likely to live in areas with higher socioeconomic status SVI (26% vs 20%), higher household characteristics SVI (27% > vs 22%), and higher housing type SVI (20% vs 15%) than those who did receive BLA. (Figure 1) Conclusion Following implementation of an electronic penicillin assessment tool, most patients with a PAL were able to receive BLA safely. The subset of PAL patients who still did not receive BLA more frequently lived in areas with increased social vulnerability. Additional efforts may be needed to ensure the full benefit of tools is achieved in operative patients from areas with high SVI. Disclosures All Authors: No reported disclosures

Information and Access for Safe Narcotic Disposal: A Cluster-Randomized Trial Among Pediatric Orthopaedic Surgical Patients in Los Angeles County

Introduction: Greater than two-thirds of individuals report unused opioids following surgical procedures. The need for improved prescribing practices notwithstanding, efforts to improve safe narcotic disposal are requisite to decreasing aberrant narcotic availability and opioid-related hospitalizations. This study aimed to evaluate the additive efficacy of education and access to DEA-compliant narcotic return receptacles on narcotic disposal rates among pediatric orthopaedic surgical patients. Methods: From July 2021 to July 2023, patients aged 5 to 17 years at two disparate sites were recruited for enrollment. Cluster randomization was done weekly to determine whether education was given on safe narcotic disposal versus standard discharge instructions. Halfway through the study, narcotic disposal receptacles were introduced as an additive intervention. Postoperatively, participants were asked to self-report opioid disposal rates and complete the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Short Form to gauge pain control. Two sample z test of proportions and Fisher exact tests were used to compare disposal rates from both the isolated and combined interventions. Results: Analysis was restricted to 131 of 576 total patients: 44 (33.6%) disposed of unused narcotic medications and 87 (66.4%) did not. No notable difference was observed in disposal rates between those who received education or not (28/70 [40.0%] vs. 16/61 [26.2%], P > 0.05) and those who had bin access or not (18/59 [30.5%] vs. 26/72 [36.1%], P > 0.05). Furthermore, no notable difference was found between the control group and combination intervention group receptacles (6/25 [24.0%] vs. 8/23 [34.8%], P > 0.05) or the education only and combination intervention group (20/47 [42.5%] vs. 8/23 [34.8%], P > 0.05). Discussion: Neither preoperative education alone nor the addition of convenient disposal bins improved narcotic disposal rates following surgery. Conclusion: Retention rates remained high despite either intervention. Therefore, efforts to decrease narcotic availability must be nuanced and multimodal. Further studies may investigate the role of longitudinal patient education to better influence risk perception and subsequent behavioral changes.

Peri-Operative Hypothermia in Trauma Patients: A Retrospective Cohort Analysis at a Busy District General Hospital Within the National Health Service (NHS).

Perioperative hypothermia is defined as a patient's core body temperature of less than 36°C, whichcan lead to several complications. Even mild hypothermia increases the incidence of post-operative wound infection, post-operative ischaemic cardiac eventsand intra-operative blood loss and prolongs post-operative recovery. It is, hence, essential to maintain and provide normothermia during the perioperative phases for optimal surgical results and patient satisfaction. One of the most significant contributing factors to intra-operative hypothermia is the induction of general anaesthesia, where a significant amount of heat is shifted from the core to the peripheral circulation with consequent loss to an often-cold environment. The difference between the patient's skin and ambient temperature during the interval from entering the operating room through anaesthesia induction until draping and active warming may be significant. This study aims to look at the incidence of perioperative hypothermia in trauma and orthopaedics patients who present to a busy district general hospital in the National Health Service (NHS) and correlate this with the ambient theatre temperature and phases of surgery to draw a statistical significance. This retrospective observational study conducted at the North Manchester General Hospital's trauma and orthopaedics department included 300 patients listed in the trauma surgery list from 1 July 2023 to 31 August 2023. Inclusion criteria were trauma patients aged 16-85 years. Elective orthopaedic and other surgical speciality patients were excluded. The perioperative temperature measurements were collected from the anaesthesia records. Statistical calculations were conducted using the StatsDirect software (StatsDirect Ltd, Wirral, UK) from Manchester University NHS Foundation Trust, Manchester. Among the 300 patients, the overall incidence of hypothermia was 3% pre-operative, 18% pre-induction, 21% intra-operative, 21% post-operative, 3% in recovery and 0% post-recovery. Intra-operative hypothermia incidence was significant, given that active warming was applied to patients with pre-operative hypothermia. Multivariate regression analysis showed that pre-induction temperature and theatre ambient temperature were statistically significant in predicting intra-operative hypothermia. This study highlights the need for active interventions to recognise and prevent perioperative hypothermia in trauma and orthopaedics patients. Active pre-warming of patients and the operating rooms, regardless of surgery type and duration, is feasible and potentially beneficial. Further studies should include a randomised controlled trial comparing active and passive warming strategies to evaluate their effectiveness in improving perioperative outcomes.

Postoperative delirium among elderly elective orthopedic patients in Addis Ababa Ethiopia: a multicentere longitudinal study

BackgroundDelirium is a neurocognitive disorder characterized by an acute and relatively rapid decline in cognition, disturbance of consciousness, reduced ability to focus, and shift of attention. It mainly affects elderly patients with an incidence of about 8–23% after an operation. It frequently occurs between 24-hrs and 5 days after surgery. It results in serious medical management problems. Hence, identifying the incidence and associated factors may help prevent and manage its sequel in the elderly.ObjectiveAssessment of the incidence and associated factors of postoperative delirium(POD) among elderly elective orthopedic surgical patients in Addis Ababa public hospitals, Ethiopia, 2024.MethodsA multi-centered longitudinal study was conducted on 220 elderly (age ≥ 65 years) patients in four selected public hospitals of the study area from February 2024 to May 2024, and a systematic sampling technique was used to select the study units. Data was collected through chart review and interviews of patients, and postoperative delirium was assessed using the confusion assessment method (CAM). Both bivariable and multivariable logistic regression models were used for statistical analysis. The strength of association was determined with an adjusted odds ratio (AOR) with a 95% confidence interval(CI) at a p-value of < 0.05.ResultsA total of 220 patients were studied, and the incidence of POD among elderly elective orthopedic surgical patients was 33.7%. Age 65–75(AOR = 0.47, 95%CI (0.226–0.97)), Induction using ketamine (AOR = 1.32, 95%CI(1.109–3.87), p = 0.003)), perioperative opioid use (AOR = 2.20, 95%CI(1.073 4.5313)), intraoperative anticholinergic use(AOR = 2.24,95%CI(1.831–4.235)), recent hospitalization history (AOR = 2.24,95%CI(1.202–4.206)), and transfusion (AOR = 2.83,95%CI(1.295–6.193)) were significantly associated with POD (p < 0.05).Conclusion and recommendationsThe incidence of POD in the study area was high (33.7%); advanced age, hospitalization history, Anesthesia induction by Ketamine, perioperative anticholinergic uses, opioid use, and blood transfusion use were associated factors for postoperative delirium. We recommend giving due attention to elderly patients with advanced age, history of hospitalization, perioperative Ketamie use, perioperative anticholinergic uses, opioid use, and blood transfusion use undergoing elderly elective orthopedic surgery.

Hemoglobin-based transfusion strategies for cardiovascular and other diseases: restrictive, liberal, or neither?

AbstractA “restrictive” red blood cell transfusion threshold, a hemoglobin concentration <7 to 8 g/dL, has long been recommended for most hospitalized patients including anemic patients with stable cardiovascular disease (CVD). Although no threshold recommendation is given for acute coronary syndromes (ACSs), recent evidence suggests that “liberal” rather than “restrictive” transfusion strategies are associated with significantly improved safety for hospitalized patients with stable CVD and/or ACS. This finding suggests that previously available data were misinterpreted. Conclusions drawn from earlier transfusion trigger trials have been confounded by unintentional trial design and analysis flaws that have contributed to erroneous recommendations regarding the safety of a restrictive threshold. Subsequently, these conclusions have been incorporated into widely accepted guidelines and clinical practice. Management with a restrictive vs liberal transfusion strategy (<10 g/dL) increases the risk of new-onset ACS in patients with CVD by ∼2%. We estimate that since 2019, using hospital databases and a recent meta-analysis, this practice may have resulted in ∼700 excess ACS events per year in orthopedic surgical patients. Given these findings, transfusion practices in other clinical conditions, particularly those derived from similar transfusion trigger trials, should be questioned. Restrictive and liberal transfusion policies merit a general reconsideration. Rather than a single numerical transfusion trigger, transfusion therapy should be personalized. Consideration of an individual patient’s age, clinical status, and comorbidities is integral to transfusing. To avoid making similar errors, future trials of transfusion therapy should determine common practices before study inception and incorporate them as a usual-care “control” comparator arm into the trial design. Such studies should more reliably improve current transfusion practice.

Analysis of the 50 Most Impactful Publications Pertaining to COVID-19 and Orthopaedic Surgery: What Have we Learned?

Purpose There has been abundant research published regarding the impact of COVID-19 on orthopaedic surgical patients which have varying degrees of impact on clinical practice. Thus, the purpose of this study was to examine the most influential articles relating to COVID-19 and patients undergoing orthopaedic surgical procedures. Though the global pandemic is over, it is beneficial to understand how the resilience of the healthcare system adapted to guide policy development and improve patient care amidst a worldwide time of crisis. Methods The Clarivate Web of Science Core Collection was searched for ‘COVID-19 AND orthopaedic surgery’ and returned 388 articles. The most influential peer-reviewed publications were determined by citation number. Expert opinion and review articles were excluded. Article title, journal name, type of study, country of publication, and clinically relevant findings of each study were collected. Results The top-50 most influential manuscripts concluded these articles were collectively cited 1875 times. The total citations ranged from 13 to 111 citations per article with a mean of 38 (95% confidence interval [31, 44]). England (14), the United States (11), and Italy (10) had the top number of publications. The top affiliations were IRCCS Istituto Ortopedico Galeazzi (5) and the University of London (4). The most popular journals were Bone &amp; Joint Open (10) and International Orthopaedics (10). Though the articles were largely heterogeneous, they described the necessity of orthopaedic surgeons during the pandemic as well as safety precautions to prevent COVID-19 transmission in orthopaedic patients. Conclusion This comprehensive analysis identified the 50 most influential peer-reviewed clinical publications regarding COVID-19 and orthopaedic surgery, which is a concise resource that can be used to inform patient decision-making regarding orthopaedic care and COVID-19. The top-50 articles highlighted the importance of resource utilization, increased use of telemedicine, enhanced infection control measures, patient-centered care, and the well-being of healthcare workers during the COVID-19 pandemic.

Nicotine Screening and Cessation Education Among Patients Awaiting Total Joint Arthroplasty: A Quality Improvement Project.

Orthopedic surgical patients who use nicotine are at a high risk for postoperative complications including infection, respiratory failure, cardiac arrest, and death. Periprosthetic joint infections may result from nicotine-induced immunosuppression and microvascular changes, increasing perioperative morbidity and mortality. These complications result in higher health care costs, increased length of stay, and loss of reimbursement due to readmissions. Four weeks of nicotine cessation prior to arthroplasty decreases these risks; however, perioperative teams may lack reliable nicotine screening and cessation education methods. This project identified inconsistencies in nicotine screening and cessation counseling in the preoperative setting, which contributed to surgery cancellations among patients who required to demonstrate nicotine cessation preoperatively. Standardization of preoperative nicotine screening and patient cessation education resources can improve the identification of orthopedic patients who use nicotine and provide concrete, proven methods of achieving nicotine cessation prior to elective primary arthroplasty. Investment from perioperative staff is essential to ensure success.

Remote Patient Monitoring for Postoperative Pediatric Patients with Peripheral Nerve Catheters

Background: Close follow up of postoperative orthopedic and pectus excavatum surgical patients discharged with a nerve catheter is required to ensure adequate pain management and recognize medication toxicity. Assessing ambulatory pediatric patients using a smartphone application is convenient and effective. Methods: A novel Remote Patient Monitoring (RPM) program was developed to improve follow-up and ability to assess postoperative pain management, analgesic toxicity, and catheter site. Adherence and successful graduation were measured to determine the success of the program. Additionally, patient and caregiver experience and opioid use were measured. Interventions: Patients were enrolled in RPM postoperatively for four days. The RPM nursing team reviewed patient reported data in real-time to address concerns and develop a plan of care. Pain management education was provided via video prior to removing the nerve catheter. Results: Adherence to RPM is over 90% for both populations, with 82% success rate in orthopedic patients and 93% success rate in pectus excavatum patients. Experience scores have been high, and opioid prescriptions have been reduced by half for the orthopedic population. Conclusions: RPM is an effective tool used to manage pediatric postoperative orthopedic and pectus excavatum surgical patients with significant patient and caregiver buy-in.

Urinary tract infections in pediatric orthopedic surgical patients: a Single Institution National Surgical Quality Improvement Program Study.

Perioperative urinary tract infections (UTIs) are poorly studied among pediatric orthopedic surgical patients. We evaluated the incidence of and risk factors for UTI in a large volume of pediatric orthopedic surgical patients. Children <18 who underwent orthopedic surgery between March 2015 and December 2018 were analyzed using our institution's National Surgical Quality Improvement Program (NSQIP) data. Demographic, perioperative and outcome data of patients who developed a UTI within 30 days of surgery were compared to patients without UTI. NSQIP data were available for 520 surgeries (324 girls and 196 boys). Median age at surgery was 13.5 years. A Foley was placed in 301/520 cases (88/196 boys and 213/324 girls) in 264 children. Six cases of UTI occurred within 30 days of surgery (1.2% of surgeries). The UTI rate among patients with a Foley was 2.3%, and among girls with a Foley was 2.8%. No UTIs occurred without a Foley, nor any in boys. All six occurred in the American Society of Anesthesiologists Class 2 females, ages 7-15 undergoing elective surgery with Foley for over 48 h. Factors associated with an increased odds of developing UTI included: higher BMI [OR, 1.12 (CI, 1.01-1.22; P = 0.03)], developmental delay [OR, 7.82 (CI, 1.40-43.7; P = 0.02)], structural central nervous system abnormality [OR, 17.5 (CI, 3.89-90.4; P = 0.01)], longer duration with Foley [OR, 1.68 (CI, 1.22-2.32; P = 0.002)] and hospital readmission within 30 days [OR 14.2 (CI, 2.32-87.3; P = 0.004)]. Risk of UTI is low after pediatric orthopedic surgery. Girls with comorbidities including structural central nervous system abnormality, developmental delay and higher BMI with prolonged Foley catheterization may have higher postoperative UTI risk. Level of Evidence: II.

Pressure injury risk factors in adult orthopaedic surgical patients: a cross-sectional study and random forest.

To identify the most important risk factors for predicting pressure injury (PI) occurrence in adult orthopaedic surgical patients based on investigation data, thereby identifying at-risk patients and facilitating formulation of an effective patient care strategy. Patients were assessed with an instrument designed by the authors specifically for this study in a cross-sectional investigation following the STROBE checklist. The random forest method was adopted to select the most important risk factors and predict occurrence of PIs. A dataset of 27 risk factors from 1701 patients was obtained. A subset of the 15 most important risk factors was identified. The random forest method had a high prediction accuracy of 0.9733 compared with 0.9281 calculated with a logistic model. Results indicated that the selected 15 risk factors, such as activity ability, friction/shear force, skin type and anaesthesia score, performed very well in predicting the occurrence of PIs in adult orthopaedic surgical patients.

Quality of nursing care in pain management in orthopedic surgical patients: a scoping review.

To map the evidence on quality nursing care practices in pain management in orthopedic surgical patients. Scoping review, as per the JBI Manual recommendations. Searches were performed in the MEDLINE (PubMed), LILACS (Regional VHL), Scopus, Embase, Web of Science, Cochrane, Cinahl databases, and gray literature, regardless of language and period. Selection and extraction were performed by two independent reviewers, using inclusion/exclusion criteria, and the extracted data were organized to reflect key themes or recurring patterns related to the purpose of the review. A total of 94 studies were included, most from the United States, corresponding to 34% of the sample, and published between 1997 and 2022. The findings were categorized into: nursing quality practices in pain management related to the organization and monitoring of units, and pre- and post-operative period. The research revealed that quality nursing care practices in pain management in orthopedic surgical patients encompass a variety of approaches, from the use of nonpharmacological practices and patient education to the use of pain assessment scales, staff training, to innovative pharmacological procedures.

Quality of nursing care in pain management in orthopedic surgical patients: a scoping review

RESUMO Objetivo: Mapear as evidências sobre as práticas de qualidade do cuidado de enfermagem na gestão da dor em pacientes cirúrgicos ortopédicos. Método: Revisão de escopo, conforme as recomendações do Manual JBI. As buscas foram realizadas nas bases de dados MEDLINE (PubMed), LILACS (BVS Regional), Scopus, Embase, Web of Science, Cochrane, Cinahl e literatura cinzenta, independentemente do idioma e período. A seleção e a extração foram realizadas por dois revisores independentes, utilizando critérios de inclusão/exclusão, e os dados extraídos foram organizados para refletir os principais temas ou padrões recorrentes relacionados ao objetivo da revisão. Resultados: Foram incluídos 94 estudos, a maioria dos Estados Unidos, correspondendo a 34% da amostra, e publicados entre 1997 e 2022. Os achados foram categorizados em práticas de qualidade de enfermagem na gestão da dor relacionadas à organização e monitoramento das unidades, e período pré e pós-operatório. Conclusão: A pesquisa revelou que as práticas de qualidade do cuidado de enfermagem na gestão da dor em pacientes cirúrgicos ortopédicos abrangem uma variedade de abordagens, desde o uso de práticas não farmacológicas e educação ao paciente até o uso de escalas de avaliação da dor, capacitação da equipe, treinamento, até procedimentos farmacológicos inovadores.

Prevalence and risk factors of preoperative anemia in patients undergoing elective orthopedic procedures in Northwest Ethiopia: a multicenter prospective observational cohort study

BackgroundPreoperative anemia is a common hematologic problem in major orthopedic surgery in developing countries. It is a condition in which the number and size of red blood cells are insufficient to meet the body’s physiologic needs, consequently impairing the capacity of the blood to transport oxygen to the body. Preoperative anemia is common in elective orthopedic surgical patients and is an independent risk factor for perioperative morbidity and mortality. This study aimed to assess preoperative anemia prevalence and risk factors in patients undergoing elective orthopedic procedures.MethodA multicenter prospective observational cohort study was conducted from June 01 to August 30, 2022. A systematic random sampling technique was used to select the study unit. Data were collected using a structured questionnaire. Descriptive statistics were expressed in percentages and presented with tables and figures. Binary logistic regression was used to see the association between independent and dependent variables. A P-value < 0.05 was considered statistically significant.ResultPreoperative anemia’s prevalence and risk factors in patients undergoing elective orthopedic procedures was 24.1[95%CI= (18.2–30.6)]. Multivariable logistic analyses showed that low monthly income level [AOR:5,95%CI:(1.36–7.98)], patient with cancer [AOR:3.4,95%CI:(3.7–8.84)], patient with malaria infectious [AOR: 3.2,95%CI:( 1.13–8.91)], patient with anti-retroviral therapy [AOR: 5.2,95%CI:( 1.8-11.04)], and previous history of surgery [AOR:1,95%CI(1.43–2.4)], were factors significantly associated with preoperative anemia.ConclusionThe prevalence of preoperative anemia among adult patients who underwent elective orthopedics procedures was high. Low Monthly income, patients with cancer, patient with malaria infection, and patients with anti-retroviral therapy, previous histories of surgery were found significantly associated with preoperative anemia. So, we recommend to health professional’s early identification, diagnosis and treatment of preoperative anemia should be done to reduce the risks of anemia and related adverse outcomes.

Effect of Educational Program regarding Risk Assessment and preventive Strategies among Orthopedic Surgical Patients with Deep Vein Thrombosis

Effect of Educational Program regarding Risk Assessment and preventive Strategies among Orthopedic Surgical Patients with Deep Vein Thrombosis

The Value of Preoperative Systemic Immune-Inflammation Index as a Predictor of Prolonged Hospital Stay in Orthopedic Surgery: A Retrospective Study.

Many risk factors, such as the duration of surgery and higher ASA scores, are associated with longer hospitalization in patients undergoing orthopedic surgery. However, no studies have evaluated the relationship between the preoperative systemic immune-inflammation index (SII) and length of hospital stay in orthopedic surgical patients. Therefore, this study aimed to investigate whether the SII is associated with the length of hospital stay in orthopedic surgery in adults. This was a retrospective cohort study, and data were extracted from electronic health records. Patients were included if they were older than 18 years and had undergone orthopedic surgery between [2016-2021]. The patients were divided into two groups according to the median duration of hospitalization and according to SII cut-off value (high-SII group: ≥799.86, low-SII group: <799.86). Univariate and multivariate linear regression analyses were used to identify the association between SII and length of hospitalization. A total of 196 patients who underwent orthopedic surgery were included, and 62 were hospitalized for >21 days. There were significant differences in terms of ASA score (P = 0.041). Patients who required a longer hospitalization of >21 days had significantly lower hemoglobin level (P < 0.001), higher duration of surgery (P = 0.015), and increased requirement of ICU admission (P < 0.001). The optimal cut-off value for preoperative SII of 799.86 stratified the patients into high-SII and low-SII groups. Patients in high-SII group had higher median LOHS (22 days) compared to low-SII group (17 days; P = 0.006). In the multivariable linear regression analysis, the SII was significantly related to the length of hospital stay (β = 0.246, 95% confidence interval [CI] 0.000-0.005, P = 0.031). A high-SII value is associated with an increased risk of longer hospitalization after orthopedic surgery.

Examining the Association Between Serotonergic Antidepressants and Blood Transfusion Requirements in Orthopaedic Surgery: A Comprehensive Analysis.

The study aimed to investigate the association between the use of serotonergic antidepressants and blood transfusion requirements in orthopedic surgical patients. A retrospective follow-up study was conducted at Kota Trauma Hospital, Kota, Rajasthan focusing on patients who underwent orthopedic surgeries between November 2021 through December 2022. Patients were categorized into two groups: users of serotonergic antidepressants and users of other antidepressants (non-selective serotonergic antidepressants). The requirement for blood transfusion for both groups was assessed. Covariate factors, such as medication use and comorbidities (e.g., diabetes mellitus, cardiovascular diseases), were examined to control potential confounding variables. A total of 170 subjects with complete medical records were included in the study. The results presented a significant association between the usage of serotonergic antidepressants and blood transfusion requirements (p=0.001). While no significant differences between the two groups were observed in perioperative hemoglobin levels and fluid infusion, there was asignificant differencein blood loss and postoperative drainage. Serotonergic antidepressant usage was correlated withincreased blood transfusion requirements in orthopedic surgery patients on antidepressants. The study underscores the importance of considering medication factors in perioperative management and highlights potential implications for patient care strategies.

Effect of the Nurse Work Environment on Older Hispanic Surgical Patient Readmissions.

Readmissions following hospitalization for common surgical procedures are prevalent among older adults and are disproportionally experienced by Hispanic patients. One potential explanation for these disparities is that Hispanic patients may receive care in hospitals with lower-quality nursing care. The objective of this study was to evaluate the relationship between the hospital-level work environment of nurses and hospital readmissions among older Hispanic patients. Using linked data sources from 2014 to 2016, we conducted a cross-sectional analysis of 522 hospitals and 732,035 general, orthopedic, and vascular surgical patients (80,978 Hispanic patients and 651,057 non-Hispanic White patients) in four states. Multivariable logistic regression models were employed to determine the relationship between the work environment and older Hispanic patient readmissions at multiple time periods (7, 30, and 90 days). In final adjusted models that included an interaction between work environment and ethnicity, an increase in the quality of the work environment resulted in a decrease in the odds of readmission that was greater for older Hispanic surgical patients at all time periods. Specifically, an increase in three of the five work environment subscales (Nurse Participation in Hospital Affairs, Nursing Foundations for Quality of Care, and Staffing and Resource Adequacy) was associated with a reduction in the odds of readmission that was greater for Hispanic patients than their non-Hispanic White counterparts. System-level investments in the work environment may reduce Hispanic patient readmission disparities. This study's findings may be used to inform the development of targeted interventions to prevent hospital readmissions for Hispanic patients.

A Perioperative Mental Health Intervention for Depressed and Anxious Older Surgical Patients: Results From a Feasibility Study

The perioperative period is challenging and stressful for older adults. Those with depression and/or anxiety have an increased risk of adverse surgical outcomes. We assessed the feasibility of a perioperative mental health intervention composed of medication optimization and a wellness program following principles of behavioral activation and care coordination for older surgical patients. We included orthopedic, oncologic, and cardiac surgical patients aged 60 and older. Feasibility outcomes included study reach, the number of patients who agreed to participate out of the total eligible; and intervention reach, the number of patients who completed the intervention out of patients who agreed to participate. Intervention efficacy was assessed using the Patient Health Questionnaire for Anxiety and Depression (PHQ-ADS). Implementation potential and experiences were collected using patient surveys and qualitative interviews. Complementary caregiver feedback was also collected. Twenty-three out of 28 eligible older adults participated in this study (mean age 68.0 years, 65% women), achieving study reach of 82% and intervention reach of 83%. In qualitative interviews, patients (n=15) and caregivers (complementary data, n = 5) described overwhelmingly positive experiences with both the intervention components and the interventionist, and reported improvement in managing depression and/or anxiety. Preliminary efficacy analysis indicated improvement in PHQ-ADS scores (F=12.13, p <0.001). The study procedures were reported by participants as feasible and the perioperative mental health intervention to reduce anxiety and depression in older surgical patients showed strong implementation potential. Preliminary data suggest its efficacy for improving depression and/or anxiety symptoms. A randomized controlled trial assessing the intervention and implementation effectiveness is currently ongoing.

Efficacy of One Dose of Laxative on Postoperative Constipation Following Total Knee Arthroplasty.

Postoperative constipation is a common problem among orthopaedic surgical patients leading to discomfort, increased length of stay, and other complications. The primary purpose of this study was to determine the effectiveness of polyethylene glycol compared with docusate sodium for the prevention of constipation, after total knee arthroplasty. The secondary purpose was to examine the effectiveness of polyethylene glycol on pain and strain with bowel movement. A two-group nonequivalent cohort design was used to evaluate the effect of one 17-g dose of polyethylene glycol by mouth on postoperative day 1 compared with usual care with docusate sodium 100 mg starting the day of surgery and continued twice daily at home. There was no significant difference in the rate of constipation between the two cohorts in the 3 days after surgery. There was no difference in reported pain and strain. Future research should focus on the use of pharmacologic and nursing interventions together for prevention of postoperative constipation in patients with arthroplasty surgery.

Effectiveness of nursing intervention in the operating room to prevent wound infections in patients undergoing orthopaedic surgery: A meta-analysis.

Surgical site wound infection is one of the most common postoperative complications in orthopaedic clinical practice. This study employed a meta-analysis approach to comprehensively evaluate the effect of operating room nursing interventions on the prevention of surgical site wound infections in orthopaedic surgical patients. A computer search was conducted using PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP, and Wanfang databases from the inception of each database until May 2023 for randomised controlled trials (RCTs) that investigated the application of operating room nursing interventions in orthopaedic surgery. Two reviewers independently screened the literature, extracted data, and assessed study quality. The meta-analysis was conducted using Stata 17.0. A total of 29 studies involving 3567 patients were included, with 1784 patients in the intervention group, and 1783 patients in the control group. The results of the meta-analysis showed that compared with the control group, the use of operating room nursing interventions significantly reduced the incidence of surgical site wound infection after orthopaedic surgery (2.85% vs. 13.24%; odds ratio: 0.18, 95% confidence interval: 0.14-0.25; p < 0.001). Current evidence suggests that operating room nursing interventions reduce the incidence of surgical site wound infections. However, owing to the limited number and low quality of the studies, more high-quality, large-sample RCTs are needed to further verify these findings.