Patients Undergoing Hip Arthroplasty Research Articles

Perioperative Nursing Progress of Elderly Patients Undergoing Hip Arthroplasty

Perioperative Nursing Progress of Elderly Patients Undergoing Hip Arthroplasty

Application of Nerve Block Anesthesia Combined with General Anesthesia in Patients Undergoing Hip Arthroplasty

Application of Nerve Block Anesthesia Combined with General Anesthesia in Patients Undergoing Hip Arthroplasty

Thrombosis of deep veins of the lower extremities in patients undergoing hip arthroplasty

Ultrasound scan was used to examine 73 patients after total hip replacement. In 39 patients contrast phlebography (distal ascending or retrograde iliocavagraphy) was also performed. Deep vein thrombosis was detected in 14 (19,2%)) patients including proximal (10 patients) and distal (4 patients) thrombosis. Comparison of two methods showed no significant difference in sensitivity and specificity when detecting the proximal deep vein thrombosis. In diagnosis of distal deep vein thrombosis ultrasound scan gave 75%o of sensitivity and 100%o of specificity in comparison to phlebography.

The Relationship Between Postoperative Opioid Analgesia and Sleep Apnea Severity in Patients Undergoing Hip Arthroplasty: A Randomized, Controlled, Triple-Blinded Trial.

PurposeResidual postoperative pain after hip arthroplasty is usually treated with oral opioids. While classic opioids are associated with respiratory depression and worsening of sleep apnea, tramadol has been reported to preserve respiratory function. However, this has not been investigated in a prospective trial using respiratory polygraphy. This randomized controlled triple-blinded trial tested the hypothesis that postoperative treatment with oral opioids such as oxycodone would increase sleep apnea severity, measured with a respiratory polygraphy, compared with oral tramadol.Patients and MethodsSixty patients undergoing hip arthroplasty under spinal anesthesia with 15 mg isobaric bupivacaine 0.5% were randomized to receive postoperative pain treatment with either oral oxycodone (controlled-release 10 mg every 12 hours and immediate-release 5 mg every 4 hours as needed) or oral tramadol (controlled-release 100 mg every 8 hours and immediate-release 50 mg every 4 hours as needed). Respiratory polygraphy was performed on the first postoperative night. The primary outcome was the apnea-hypopnea index in the supine position. Secondary outcomes included the oxygen desaturation index, postoperative pain scores and intravenous morphine consumption.ResultsMean supine apnea-hypopnea index on postoperative night 1 was 11.3 events.h−1 (95% confidence interval, 4.8–17.7) in the oxycodone group and 10.7 (4.6–16.8) events.h−1 in the tramadol group (p=0.89). There were no significant differences between the oxycodone and tramadol groups with respect to any secondary sleep-related or pain-related outcomes.ConclusionOral oxycodone did not increase sleep apnea severity measured using respiratory polygraphy compared with oral tramadol on the first postoperative night after hip arthroplasty.Trial Registration NumberClinicaltrials.gov – NCT03454217 (date of registration: 05/03/2018).

A Systematic Review and Meta-Analysis of Efficacy of Ultrasound-Guided Single-Shot Quadratus Lumborum Block for Postoperative Analgesia in Adults Following Total Hip Arthroplasty.

To evaluate the efficacy of ultrasound-guided single-shot quadratus lumborum block (QLB) for postoperative analgesia in adults following total hip arthroplasty (THA). Systematic review and meta-analysis. Perioperative period. Adult patients undergoing THA. Studies were identified by performing searches in the following electronic databases, PubMed (Medline), Cochrane Central Registry of Trials (CENTRAL), and Google Scholar. We sought studies in adult patients undergoing THA, comparing QLB with a control group (no block, sham block or any other ultrasound guided regional nerve blocks). A total of 774 patients from 10 studies (7 randomized controlled, one controlled clinical and two retrospective study) were included in this meta-analysis. The 24 hour opioid consumption was similar in both the groups (WMD -4.09; 95% CI [-9.00, 0.83]; P = 0.10; I2 = 95%). The pain scores at rest at 24 hours was significantly less in QLB group (WMD -0.62; 95% CI [-1.15, -0.10]; P = 0.02; I2 = 75%). The difference in pain scores was however not clinically significant. The pain scores on movement at 24 hours, time to first analgesic request, and time to discharge from hospital were similar in both the groups. QLB as part of multimodal analgesia did not result in any significant analgesic benefits in patients undergoing hip arthroplasty in terms of either postoperative opioid consumption or pain scores at rest and on movement. Overall, the level of certainty is low. Further, well-designed trials are required to verify the results.

Effects of ultrasound-guided lumbar-sciatic nerve block and epidural anesthesia on the levels of IL-6, IL-8, TNF-α and coagulation factors in peripheral blood of elderly patients after hip arthroplasty.

To investigate the effects of ultrasound-guided lumbar-sciatic nerve block and epidural anesthesia on the levels of inflammatory factors such as Interleukin-6 (IL6), Interleukin-8 (IL-8), Tumor necrosis factor-a (TNF-α) and coagulation factors in peripheral blood of elderly patients after hip arthroplasty to provides reference value for the choice of intraoperative anesthesia. 96 elderly patients underwent hip arthroplasty in our hospital from March 2018 to December 2019 were selected and divided into ultrasound-guided lumbar-sciatic nerve block group (group A) and epidural anesthesia group (group B) randomly , there were 48 cases in each group. The onset time of intraoperative anesthesia, postoperative hemodynamic indexes, pain score, inflammatory factors and blood coagulation factor levels were compared between group A and group B. It was proved that: (1) The onset time of sensory block and motor block in group B were shorter compared with group A, and the maintenance time of anesthesia was prolonged (P<0.05); (2) Compared with group A, visual analogue scale (VAS) score of group B patients after operation was lower (P<0.05); (3) The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of group B were higher than group A (P<0.05) ) at T1 and T2, while the comparison of SBP and DBP between groups was not statistical difference at T3 and T4 (P>0.05); (3) Compared with group A, the levels of TNF, IL-8and IL-6 in peripheral blood of group B decreased after T2, T3 and T4 (P<0.05); (4) Statistical difference in plasma factor V activity (FV:C), coagulation factor VIII activity (FVIII:C) and fibrinogen (FIB) levels were showed between groups A and B at T2, T3 and T4 (P<0.05) with significantly lower values in group B compared to group A(P<0.05). (5) The half-year mortality rates of patients in two group were 5.56% and 8.33% respectively. There was no significant difference between group A and group B (P>0.05). Compared with epidural anesthesia, lumbarsciatic nerve block is showed significantly lower values in concentration of peripheral blood coagulation factors and inflammatory factors after surgery, thereby alleviating postoperative hypercoagulability and inflammation.

Study on Therapeutic Application of Huangqi Combined with Staged Care in Elderly Patients

To investigate the clinical effects of huangqi Bazhen decoction combined with traditional Chinese medicine staged rehabilitation care on elderly patients undergoing hip arthroplasty. A total of 200 elderly patients who underwent hip arthroplasty in our hospital from January 2020 to December 2021 were selected and divided into routine group (100 patients) and rehabilitation group (100 patients) according to random number table method. Routine nursing was given to patients in the routine group and huangqi decoction combined with traditional Chinese medicine staged rehabilitation care was given to patients in the rehabilitation group, to compare the effects of the application in the two groups. Compared with preoperative values, Harris scores were significantly higher at 4 w and 8 w postoperatively in both groups, and the scores of the rehabilitation group were higher and significantly different from those of the routine group (p<0.05); the rehabilitation group had a higher rate of excellent hip joint than the routine group, and the difference was significant (p<0.05); all the scores on the short form-36 scale in the two groups after intervention were higher than those before intervention and those of the rehabilitation group were higher than those of the routine group, with significant differences (p<0.05); the rehabilitation group had a lower incidence of postoperative complications than the routine group (p<0.05). The combination of huangqi Bazhen decoction and traditional Chinese medicine staged rehabilitation care can promote postoperative hip recovery in elderly patients undergoing hip arthroplasty, reduce the incidence of complications such as postoperative lower extremity deep vein thrombosis and improve the quality of life of patients.

Acetabular cartilage abnormalities in elderly patients with femoral neck fractures.

Introduction: Both hemiarthroplasty (HA) and total hip arthroplasty (THA) are widely accepted surgical procedures for hip replacement following displaced femoral neck fractures. However, in cases involving an intact joint line before surgery, the choice between HA and THA remains debatable. This study investigated the prevalence of acetabular cartilage and labral abnormalities in elderly patients with femoral neck fractures. Methods: Thirty-seven patients underwent hip arthroplasty for femoral neck fractures between April 2020 and February 2021. After excluding 4 patients, 33 patients (6 men and 27 women; mean age = 82.2 [range = 67–98] years) with fractures in 12 left and 21 right hips were included. After femoral head removal during arthroplasty, the acetabulum was macroscopically examined for the presence of cartilage and labral lesions. Acetabular cartilage abnormalities were classified as either overall degeneration or partial damage according to the cartilage damage classification system. Results: Acetabular cartilage abnormalities, including overall degeneration or partial damage, were found in all hips (100%). Out of the 33 hips, overall degeneration, partial damage, and labral abnormalities were detected in 32 (96.9%), 16 (48.4%), and 9 (27.2%) hips, respectively. Discussion: In this study, most elderly patients with femoral neck fractures exhibited acetabular cartilage and labral abnormalities, which were already present at the time of surgery. Therefore, surgeons should carefully examine these abnormalities as they may impact postoperative outcomes such as pain and function.

Comparison of Perioperative Blood Loss with and without Tranexamic Acid in Hip Arthroplasty

Objective: To compare the perioperative blood loss in patients undergoing hip arthroplasty for femur neckfractures with and without administering tranexamic acid before surgical incision.Study Design: Comparative Interventional study.Place and Duration of Study: The study was conducted at Orthopedic Department of Indus Hospital Karachi,st th from 1 January to 30 June 2015.Materials and Methods: After ethical committee approval, sixty patients, scheduled for hip arthroplasty wereincluded in this study. Patients were randomly allocated into two groups. Thirty patients in Group A (Tranexamic acid) treated with tranexamic acid with 15mg/kg dose in 10 ml syringe and Group B were given an equal volume of saline before surgery. In both groups, blood loss was calculated. The need for blood transfusion as well as the th amount of blood required was also noted. In both the groups, hematocrit was measured on 5 post-operative.Results: A total of sixty patients (mean age 65.33±9.50 years), scheduled for hip arthroplasty, were included.There were 26 (43.3%) male and 34 (56.7%) female patients. Patients were divided into two equal groups,Group A (Tranexamic acid) and Group B (Normal Saline). Postoperative mean estimated blood loss wassignificantly reduced in Group A than group B (203.8±141.81 vs. 281.6±130.31 p=0.031).Conclusion: Tranexamic acid is a cost-effective and safe means of minimizing perioperative blood loss andreduction in hemoglobin concentration in hip arthroplasty.

Predictors of Chronic Postsurgical Pain in Elderly Patients Undergoing Hip Arthroplasty: A Multi-Center Retrospective Cohort Study.

BackgroundIdentifying patients at high risk of developing chronic postsurgical pain (CPSP) is of extreme importance in order to help launch appropriate therapeutic strategies and intensive initiation of pain management.AimIn this study, we aimed to conduct a multi-center retrospective cohort study to establish a prognostic model and a nomogram to predict the risks of CPSP in elderly patients who underwent hip arthroplasty at 6 months postoperatively.MethodsWe collected data from 736 patients aged >65 years who had undergone hip arthroplasty from October 1, 2016 to September, 30, 2018 at multiple tertiary referral centers in Guangzhou, China. All data were randomly stratified into a training set and a testing set at a ratio of 8:2. Data were analyzed via multiple logistic regression analysis with receiver operating characteristic (ROC) curves and areas under the curve. This model was further validated by estimating calibration and discrimination. A nomogram was ultimately developed.ResultsA total of 736 eligible patients were enrolled, 27.20% of whom developed CPSP within 6 months postoperatively. Preoperative pain in the surgical area (OR=2.456, 95% CI:1.814–3.327, P<0.001), preoperative depression state (OR=1.256, 95% CI:1.146–1.378, P<0.001), surgical type (OR=7.138, 95% CI:3.548–14.364, P<0.001), acute postoperative numerical rating scale score (OR=5.537, 95% CI:3.607–8.499, P<0.001) and analgesic type (patient-controlled epidural analgesia: OR=0.129, 95% CI:0.055–0.299, P<0.001; patient-controlled intravenous analgesia: OR=0.033, 95% CI:0.011–0.097, P<0.001) were identified as independent significant factors associated with CPSP. A prognostic model was established and further validated. An ROC curve confirmed the predictive ability of this model with a high sensitivity value of 92.12% (95% CI:86.90–95.74) and specificity value of 91.72% (95% CI:88.77–94.11). A nomogram was developed to simplify the use of the predictive model in clinical practice.ConclusionThis prognostic model could be of great value in clinical practice, serving as the basis for early personalized analgesic management of elderly patients undergoing hip arthroplasty.

Comparison of total hip arthroplasty with conventional instrument OCM approach and posterolateral approach in supine position

To compare the clinical efficacy of total hip arthroplasty with conventional instrument OCM approach and posterolateral approach in supine position. From February 2017 to January 2019, 67 patients underwent hip arthroplasty due to hip diseases, including 21 patients in the minimally invasive group, 12 males and 9 females;there were 10 cases of femoral neck fracture, 5 cases of aseptic necrosis of femoral head and 6 cases of hip osteoarthritis. In the traditional group, 46 cases were treated by traditional posterolateral approach, including 28 males and 18 females;there were 24 cases of femoral neck fracture, 12 cases of aseptic necrosis of femoral head and 10 cases of hip osteoarthritis. All patientsused biological ceramic artificial joint prosthesis. The operation time, intraoperative bleeding, incision length, preoperative and postoperative creatine kinase (CK-NAC), underground activity time, hospital stay, abduction angle and anteversion angle of prosthesis were observed and compared between two groups. Harris scores before operation and 12 months after operation were compared between two groups. All cases were followed up for 14 to 26(18.4±3.6) months. There was no significant difference in intraoperative bleeding, postoperative anteversion and abduction angle between two groups (P>0.05). There were significant differences in operation time, incision length, postoperative creatine kinase, underground time and hospital stay between two groups (P<0.05). There was no significant difference in Harris function score between two groups before operation and 12 months after operation(P>0.05). The two approaches of total hip arthroplasty can obtain satisfactory results.OCM approach has less damage and rapid postoperative recovery. It is a reliable surgical approach and can be popularized and used.

MATrix LABoratory Algorithm in Ultrasound Image-Guided General Drug Anesthesia along with Lumbar and Sacral Plexus Block in Hip Replacement under

Objective. The study aimed to explore the application of ultrasound image-guided general drug anesthesia combined with lumbar and sacral plexus block based on MATrix LABoratory (MATLAB) algorithm in hip arthroplasty and to study its clinical effect. Methods. The classic geodesic active contour (GAC) algorithm and the improved fuzzy clustering level set algorithm were used to segment ultrasound images of waist plexus, and then their segmentation effects were compared. Both algorithms are from the MATrix LABoratory (MATLAB) platform. A total of 60 patients undergoing hip arthroplasty were selected and randomly enrolled into control and experimental groups. The control group accepted general drug anesthesia, and the experimental group accepted ultrasound-guided lumbar and sacral plexus block combined with general anesthesia. The mean arterial pressure and heart rate at t0 (before anesthesia), t1 (before ventilation), t2 (when the skin was incised), t3 (when the prosthesis was implanted), t4 (when the incision was closed), and t5 (at the end of ventilation) were observed, and the intraoperative sufentanil dosage and 24 h analgesic dosage, the incidence of postoperative delirium, and the incidence of cognitive dysfunction were recorded. Results. The improved fuzzy clustering level set algorithm was better than the GAC model algorithm in image segmentation and running time. In contrast with the control group, the average arterial pressure and heart rate of the experimental group at the four time points of t1, t2, t3, and t5 were obviously reduced ( P &lt; 0.05). In contrast with the control group, the amount of sufentanil and analgesics in the experimental group was obviously reduced ( P &lt; 0.05), and the incidence of postoperative cognitive dysfunction and delirium was obviously reduced ( P &lt; 0.05). Conclusion. The improved fuzzy clustering level set algorithm is superior to the GAC model in image segmentation and running time. Under its guidance, the lumbar and sacral plexus block combined with general anesthesia has a good clinical effect in hip arthroplasty, which is better than simple general anesthesia.

Study the Results of Antibiotic Prophylactic Protocol Adopted by Ain Shams University Hospitals for reducing the Risk of Surgical Site Infection in Patients undergoing Hip Arthroplasty, Pilot Study

Abstract Background Total hip arthroplasties are well-proven solutions in case of end-stage osteoarthritis of the hip joint. Although, presence of complications can be devastating for the patient, especially periprosthetic joint infection (PJI). To prevent PJI, antibiotic prophylaxis regimens are regularly used. Objectives To study the association of antibiotic choice, duration and dosage with prevalence of surgical site infection among patients with hip arthroplasty and identify risk factors for surgical site infection in patient with hip arthroplasty. Patients and Methods After obtaining the hospitals Research/Ethics Committee approval and written informed consents from the patients, this study was carried on. 30 patients with primary hip arthroplasty surgery and all operations were performed by senior staff members. All patients were screened for suitability by detailed clinical assessment of their history and physical examination as well as radiological investigations. Results The result of this study was that we have 2 cases infected from 30 cases with percent of infection among patient with primary hip arthroplasty is 6.7% and by studying the risk factors for infection there was no specific risk factor for infection except for patient with cardiac disease have increased risk of infection. Conclusion In conclusion, this study postulated that systemic antibiotic prophylaxis delivered preoperatively in primary THA procedures significantly reduces the incidence of infection. There is no significant difference in the efficacy of cephalosporins compared with that of quinolones. Prophylactic antibiotics should be taken IV before skin incision by 30-60 minutes and no need for antibiotics more than 24 hours after operation.

Perioperative Satisfaction and Health Economic Questionnaires in Patients Undergoing an Elective Hip and Knee Arthroplasty: A Prospective Observational Cohort Study.

Background:Early hospital discharge shifts the recovery burden toward the patient and can leave patients and their caregivers anxious about the recovery process. Postoperative home care must be broadened to include appropriate and adequate support to address recovery at home. In this prospective study, patient and caregiver perspectives on the level of preparation/satisfaction and cost associated with management of recovery in the postoperative period were evaluated.Methods:We designed this prospective study to measure patient-reported outcomes and to inform the design of a postoperative home monitoring system. Patients undergoing inpatient total hip or knee replacements were recruited from a preadmission clinic at a university hospital. Patients and caregivers completed preoperative, postoperative, and health economic questionnaires. Bivariate analyses were conducted to understand factors associated with satisfaction with care.Results:Of 239 patients and caregivers recruited, preoperative questionnaire was completed by 98.8% of patients, the postoperative follow-up questionnaire was completed by 94.2% of patients, 75% of informal caregivers completed the postoperative follow-up questionnaires, and 93.7% completed the health economic questionnaire. The postoperative satisfaction scores were higher than the preoperative needs/expectation scores for both the overall and individual subscales. Patients undergoing hip arthroplasty reported higher satisfaction scores for postoperative pain management than patients undergoing knee arthroplasty (hip arthroplasty vs. knee arthroplasty: 4.07 ± 1.11 vs. 3.37 ± 1.51; P < 0.001). Patients who underwent knee arthroplasty reported better satisfaction scores with regard to having enough information on how to manage leg stiffness at home compared to patients undergoing hip arthroplasty (knee arthroplasty vs. hip arthroplasty: 3.13 ± 1.35 vs. 2.78 ± 1.30; P = 0.04).Conclusion:Overall, patients are generally satisfied with perioperative care, but they have distinct needs and expectations regarding perioperative medication and postoperative pain management. Virtual postoperative monitoring may be a useful tool during postoperative care to address many of patients’ concerns.

Outcomes of Femoral Neck Fracture Treated With Hip Arthroplasty in Solid Organ Transplant Patients.

BackgroundSolid organ transplant (SOT) patients have increased risk of complications, infection, and mortality after elective total hip arthroplasty (THA). The study aims to compare SOT recipients' clinical outcomes to a matched group of nontransplant patients after nonelective THA and hemiarthroplasty for acute femoral neck fracture (FNF).MethodsA retrospective review identified 31 SOT patients undergoing hip arthroplasty (24 hemiarthroplasty and 7 THA) for FNF and were matched 1:1 to non-SOT patients based on age, sex, body mass index, surgical procedure, and year of surgery. Patient survivorship, perioperative outcomes, complications, and reoperations were compared. The mean follow-up was 3 years.ResultsThe estimated survivorship free from mortality for SOT and non-SOT patients at 1- year was not different (77% and 84%, respectively, P = .52). The 90-day readmission rate was significantly higher with 8 (26%) in the SOT cohort and none in the non-SOT group (P < .01). Major medical complications occurred in 16% of SOT patients compared to 5% in controls (P = .21). Three (10%) reoperations/revisions were required for SOT patients and none in non-SOT group (P = .24).ConclusionSOT recipients undergoing nonelective hip arthroplasty for FNF demonstrated increased readmission rates compared to matched controls. For this rare clinical scenario, diligent perioperative care by surgeons and multidisciplinary transplant specialists is necessary to mitigate increased risk of SOT patients.

208The Effect of General vs. Regional Anesthesia on Early Postoperative Mortality in Hip Arthroplasty Patients

Abstract Background There is conflicting evidence in the literature regarding whether type of anesthesia (regional vs. general) is associated with postoperative mortality in patients undergoing hip arthroplasty. The present study compares mortality between general or regional anesthesia administered to patients undergoing either total (THA) or partial hip arthroplasty (PHA). Methods A retrospective cohort was assembled using the 2015-2016 American College of Surgeons National Surgical Quality Improvement Program database. Adult patients undergoing hip arthroplasty under general or regional anesthesia were included. Adjusted odds of 30 days all-cause postoperative mortality according to type of anesthesia were estimated by fitting multiple logistic regression models that included potential confounders and effect modifiers. Results A total of 60,897 patients were included. Given that the interaction between type of anesthesia and type of arthroplasty was statistically significant, separated models were fitted for each type of arthroplasty. There was no evidence of an association between type of anesthesia and postoperative mortality in hip arthroplasty patients regardless of whether the arthroplasty was partial (OR = 0.85; CI 0.59-1.22) or total (OR = 0.68; CI 0.43-1.08). Conclusion The overall postoperative mortality in adult hip arthroplasty patients is low. Our findings support that mortality is not different between patients receiving regional vs general anesthesia regardless of type of hip arthroplasty (total vs. partial). Key Message In patients undergoing total hip arthroplasty or partial hip arthroplasty, the use of general or regional anesthesia does not impact early postoperative mortality.

Tranexamic Acid Was Not Associated with Increased Complications in High-Risk Patients with Hip Fracture Undergoing Arthroplasty.

Tranexamic acid (TXA) is considered safe and efficacious for elective total joint arthroplasty. However, evidence of TXA's safety in high-risk patients with hip fracture requiring nonelective arthroplasty has been lacking. This study aimed to assess whether TXA administration to high-risk patients with a hip fracture requiring arthroplasty increased the risk of thrombotic complications or mortality. All patients who underwent hip hemiarthroplasty (HHA) or total hip arthroplasty (THA) for displaced femoral neck fractures between 2011 and 2019 at 4 sites within 1 hospital system were retrospectively identified. Patients were grouped by risk (high-risk or low-risk) and TXA treatment (with or without TXA). Propensity scores were used for risk adjustment in comparisons between surgery with and without TXA for only the high-risk group (n = 1,066) and the entire population (n = 2,166). Differences in the occurrence of postoperative mortality, deep venous thrombosis, pulmonary embolism, myocardial infarction, and stroke within 90 days of hip arthroplasty were evaluated. TXA administration was not associated with an increased risk of thrombotic complications or mortality within 90 days in either high-risk or all-patient groups. Specifically, among 1,066 matched high-risk patients who did not or did receive TXA, there were no significant differences in mortality (14.82% and 10.00%; p = 0.295), deep venous thrombosis (3.56% and 3.04%; p = 0.440), pulmonary embolism (2.44% and 1.96%; p = 0.374), myocardial infarction (3.38% and 2.14%; p = 0.704), or stroke (4.32% and 5.71%; p = 0.225). In our review of 1,066 propensity-matched high-risk patients undergoing hip arthroplasty for displaced femoral neck fractures, we found that TXA administration (compared with no TXA administration) was not associated with an increased risk of mortality, deep venous thrombosis, pulmonary embolism, myocardial infarction, or stroke. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

13. The diagnostic utility of biomarkers: spinal instability or underlying infection

<h3>BACKGROUND CONTEXT</h3> Surgical site infection is a devastating complication of surgery that increases morbidity for patients undergoing spinal surgery. However, diagnosis in some cases remains challenging often requiring a trip to the operating room to obtain cultures. Current literature has provided evidence that preoperative blood markers are diagnostic of infection in patients undergoing hip arthroplasty and total knee replacement, but there has been limited investigation on biomarker diagnostic utility in patients undergoing spinal surgery. <h3>PURPOSE</h3> To identify the diagnostic utility of laboratory markers to diagnose postoperative spinal infection. <h3>STUDY DESIGN/SETTING</h3> Retrospective case-control analysis <h3>PATIENT SAMPLE</h3> Patients having undergone prior spine surgery with a confirmed positive intraoperative culture during revision for presumed infection. An additional aseptic cohort was established with patients undergoing revision surgery for reasons other than infection. <h3>OUTCOME MEASURES</h3> White blood cell (WBC), erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), mean platelet volume (MPV), platelet number, MPV/platelet ratio, diagnostic sensitivity, specificity and threshold values for the diagnosis of spinal infection. <h3>METHODS</h3> A retrospective review was conducted at a single center academic hospital. Patients undergoing spinal fusion with a diagnosis of surgical site infection (SSI) from the dates of 2013 to 2019 were identified. In the aseptic cohort, any individual that had overt signs of infection or had infection within one year of revision procedure was excluded. Patients with a history of cancer, trauma, autoimmune disease on suppressive therapy, or noncompliance with medical therapy were excluded. WBC, ESR, CRP, MPV, MPV/Platelet ratio and demographic data was compared between groups and an AUC analysis was performed to determine threshold values. <h3>RESULTS</h3> A total of 418 patients were included, 224 in the aseptic cohort and 194 in the infection cohort. In terms of baseline demographics, there were significant differences between the cohorts in BMI, CCI, and ASA (p<0.05). BMI in the infection cohort was found to be greater than the aseptic cohort with a mean value of 33.7 vs 30.9 respectively. CCI and ASA was also elevated in the infections cohort as compared to the aseptic cohort with mean values of 3.84 for CCI and 2.90 for ASA as compared to 1.08 and 2.45 in the aseptic cohort. Significant differences were found between the cohorts with respect to MPV/platelet ratios, platelet number, MPV, CRP, ESR and WBC (p<0.01). Platelet ratio, platelet number, CRP, ESR and WBC were all greater in the infection group as compared to the aseptic group (platelet ratio 36.1 vs 24.7, platelet number 347 vs 249, CRP 9.99 vs 4.81, ESR 76.6 vs 46.5, WBC 9.87 vs 7.82 p<0.01) These differences were used to determine predictive cutoffs. The most sensitive markers for predicting postoperative infection were platelet number (cutoff 284 AUC 0.751; sensitivity 0.662) and ESR (cutoff 40.00 AUC 0.715; sensitivity 0.838). The most specific markers for predicting postoperative infection were platelet ratio (cutoff 31.02 AUC 0.758; specificity 0.842) and platelet count (cutoff 284.00 AUC 0.715; specificity 0.804). <h3>CONCLUSIONS</h3> This study concluded that preoperative platelet number and ESR are best used as screening measures, while MPV/platelet ratio and count are useful confirmatory markers. Further analysis will allow for a more depth investigation into optimal combination of biomarkers to result in the greatest diagnostic utility, but this initial report serves as evidence that preoperative biomarker collection may be a valuable tool to confirm the diagnosis in suspected postoperative surgical site infections. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Ultrasound-guided lumbar ESP block for post-operative analgesia as an alternative mode of analgesia in hip arthroplasty with multiple systemic issues: a case report

BackgroundPatients with multiple systemic diseases present an anaesthetic challenge in terms of perioperative pain management. We propose that ultrasound-guided erector spinae plane block be used as an alternative mode of analgesia in patients undergoing hip arthroplasty.Case presentationWe report a case of a 54-year-old female, a known case of autosomal dominant polycystic kidney disease on continuous ambulatory peritoneal dialysis, hypertension, and deranged coagulation profile with fractured neck of femur planned for hemiarthroplasty. She was administered ultrasound-guided single-shot erector spinae plane block at L3 level with 20 mL of 0.25% ropivacaine and 4 mg dexamethasone. This block provided excellent post-operative analgesia for up to 24 h with early mobilisation.ConclusionSingle-shot ultrasound-guided erector spinae plane bock can be used as an alternative mode of analgesia in patients undergoing hip arthroplasty, with multiple systemic diseases in whom neuraxial blockade cannot be performed. This technique needs to be further explored in the form of randomised controlled trials.

Impact of edaravone on serum CXC chemokine ligand-13 levels and perioperative neurocognitive disorders in elderly patients with hip replacement.

Background:Perioperative neurocognitive disorders (PND) are a series of severe complications in the perioperative and anesthetic periods with a decline in memory, execution ability, and information processing speed as the primary clinical manifestation. This study aimed to evaluate the impact of edaravone (EDA) on PND and peripheral blood C-X-C motif chemokine ligand 13 (CXCL13) levels in elderly patients with hip replacement.Methods:A total of 160 elderly patients undergoing hip arthroplasty in Affiliated Dongguan People's Hospital of Southern Medical University (from March 2016 to March 2018) were randomly and double-blindly categorized into an EDA group and a control group (CON). Group EDA was administered intravenously EDA 30 min before surgery, and group CON was administered intravenously saline. The cognitive function of the two groups was evaluated 1-day before the operation and at 1 and 12 months after surgery, and the incidence of post-operative delirium was tested on days 1, 3, and 7 after surgery using the Chinese version of the confusion assessment method. Serum CXCL13 and interleukin (IL)-6 concentrations were measured before anesthesia, during surgery (30 min after skin incision), and on days 1, 3, and 7 after surgery. The continuous variables in accordance with normal distribution were tested using the Student's t test, the continuous variables without normal distribution using the Mann-Whitney U test, and categorical variables by the χ2 test or Fisher exact test.Results:The incidence of post-operative delirium within 7 days after surgery was significantly higher in group CON than that in group EDA (31.3% vs. 15.0%, t = −5.6, P < 0.001). The modified telephone interview for cognitive status and activities of daily life scores were significantly higher in the group EDA than those in the group CON at 1 month (39.63 ± 4.35 vs. 33.63 ± 5.81, t = −2.13, P < 0.05 and 74.3 ± 12.6 vs. 61.2 ± 13.1, t = −1.69, P < 0.05) and 12 months (40.13 ± 5.93 vs. 34.13 ± 5.36, t = −3.37, P < 0.05 and 79.6 ± 11.7 vs. 65.6 ± 16.6, t = −2.08, P < 0.05) after surgery; and the incidence of neurocognitive dysfunction was significantly lower in the group EDA than that in the group CON (P < 0.05). Serum CXCL13 and IL-6 concentrations were significantly lower in the group EDA than those in the group CON during and after surgery (P < 0.05).Conclusion:EDA can significantly reduce the serum concentrations of CXCL13 and IL-6 and improve the PND of patients.