Types Of Orthopaedic Surgery Research Articles

Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery

BackgroundThe Medical Outcomes General Health Survey (SF-36) is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36 subscales following orthopedic surgery.MethodsLongitudinal data on outcomes of total hip replacement (THR, n = 255), total knee replacement (TKR, n = 103), arthroscopic partial meniscectomy (APM, n = 74) and anterior cruciate ligament reconstruction (ACL, n = 62) were used to estimate the effect sizes (ES, magnitude of change) and minimal detectable change (sensitivity) at the group and individual level. To provide context for interpreting the magnitude of changes in SF-36 scores, we also compared patients' scores with age and sex-matched population norms. The studies were conducted in Sweden. Follow-up was five years in THR and TKR studies, two years in ACL, and three months in APM.ResultsOn average, large effect sizes (ES≥0.80) were found after orthopedic surgery in SF-36 subscales measuring physical aspects (physical functioning, role physical, and bodily pain). Small (0.20–0.49) to moderate (0.50–0.79) effect sizes were found in subscales measuring mental and social aspects (role emotional, vitality, social functioning, and mental health). General health scores remained relatively unchanged during the follow-up. Despite improvements, post-surgery mean scores of patients were still below the age and sex matched population norms on physical subscales. Patients' scores on mental and social subscales approached population norms following the surgery. At the individual level, scores of a large proportion of patients were affected by floor or ceiling effects on several subscales and the sensitivity to individual change was very low.ConclusionLarge to moderate meaningful changes in group scores were observed in all SF-36 subscales except General Health across the intervention groups. Therefore, in orthopedic settings, the SF-36 can be used to show changes for groups in physical, mental, and social dimensions and in comparison with population norms. However, SF-36 subscales have low sensitivity to individual change and so we caution against using SF-36 to monitor the health status of individual patients undergoing orthopedic surgery.

Associations Between Surgical Site Infection Risk and Hospital Operation Volume and Surgeon Operation Volume Among Hospitals in the Dutch Nosocomial Infection Surveillance Network

To examine the association between hospital operation volume and surgeon operation volume and the risk of surgical site infection (SSI). Prospective, multicenter cohort study based on surveillance data. Data were obtained from the Dutch surveillance network for nosocomial infections (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]) on 9 different types of orthopedic surgery, general surgery, and gynecology procedures performed during 1996-2003. Multilevel logistic regression analysis was performed to assess the independent effect of hospital volume and surgeon volume on SSI risk. Hospital volume was not significantly associated with SSI risk for any of the selected procedures. Low surgeon volume was associated with an increased risk for an infection for 7 of 9 types of procedures, although this effect was statistically significant only for knee arthroplasty. For 4 procedures, the odds of exceeding the 75th percentile for duration of surgery were greater when the surgeon volume was low than when the surgeon volume was moderate or high. Patients operated on by surgeons with a low operation volume seem to have a higher risk of developing an SSI with some procedures, particularly knee arthroplasty. The higher SSI risk for surgeons with a low operation volume is possibly partly mediated by the longer duration of surgery, a well-known risk factor for development of SSI.

If You Prick Us, Do We Not Bleed?

If You Prick Us, Do We Not Bleed?

Orthopaedic intervention in early rheumatoid arthritis. Occurrence and predictive factors in an inception cohort of 1064 patients followed for 5 years.

To assess the occurrence of and predictive factors for orthopaedic surgery in an inception cohort of rheumatoid arthritis (RA) patients recruited and followed prospectively for 5 yr in nine regions in England. Standard clinical, laboratory and radiological assessments and all interventions were recorded at baseline and yearly in RA patients (less than 2 yrs symptoms) prior to the use of disease-modifying drugs. One thousand and sixty-four patients completed 5 yr of follow-up. Two hundred and sixty-four orthopaedic procedures for RA were performed in 181 (17%) patients at a median of 36.5 months from baseline. Seventy-five (7%) had replacements of major joints. Risk factors at baseline for large joint replacement surgery were a low haemoglobin concentration [odds ratio scores (OR) 3.4, 95% confidence interval (CI) 2.1-5.8] and high scores for erythrocyte sedimentation rate (ESR) (OR 3.2, CI 1.8-5.3), disease activity (DAS) (OR 2.1, CI 1.2-3.5) and Larsen X-rays (OR 2.6, CI 1.4-4.8). For hand or foot joint surgery (4%), risk factors included female gender (OR 3.2, CI 1.3-7.6), joint score (OR 2.3, CI 1.2-4.3), erosions (OR 2.3, CI 1.1-4.8), DAS (OR 2.4, 1.3-4.5) and Health Assessment Questionnaire score (OR 1.9, CI 1.0-3.6). No significant associations were seen for tendon, soft tissue or other minor procedures (6%). The HLA-DRB1 RA shared epitope was associated with any type of orthopaedic surgery (OR 1.7, CI 1.1-2.7). Eleven per cent of RA patients treated with conventional drug therapy for 5 yr underwent large- or small-joint surgery, an outcome which could be compared against that for new disease-modifying drugs. Risk factors varied according to type of surgery, but included standard clinical and laboratory measures. In order to reduce the eventual need for surgery, a therapeutic target in the first year of RA is the suppression of disease activity, as measured by haemoglobin and ESR. These are useful details for clinicians, health professionals and patients.

Postoperative mental status in elderly hip surgery patients

Purpose To determine if elderly patients undergoing hip surgery became delirious postoperatively and, if so, whether age and/or time of day were related to delirium. Design Repeated measures. Sample A convenience sample of 70 hip surgery patients 60 years of age and older at a large Midwestern teaching hospital were studied. Patients were excluded who were unconscious, unable to hear, see, and/or verbally communicate in English. Patients were also excluded who had a known history of dementia, Alzheimer's dementia, addiction to alcohol and/or sedative hypnotics, functional psychosis, or any other psychiatric diagnosis. Of the 70 patients, 37 were female and 33 were male. Mean age of the patients was 72.9 years (S.D. = 8.13). Patients were placed into one of three groups: Group 1--age 60 to 69 years (n = 25); Group 2--age 70 to 79 years (n = 25); or Group 3--80 years and older (n = 20). The most common procedure for all groups was total hip replacement (n = 48). Method Data were collected primarily by both objective and subjective assessment of the patients. Both the Folstein's Mini Mental Status Exam (MMSE) and the NEECHAM Confusion Tool were used to collect data. Chart reviews provided additional data. Patients were assessed preoperatively to obtain baseline assessment and screen out patients with preexisting confusion. Assessments were then done once in the morning and once in the evening for 5 days following surgery. Main research classifications Delirium, sundowning, sundown syndrome. Findings The MMSE and NEECHAM were found to be highly correlated: Morning NEECHAM vs morning MMSE (Correlation Coefficient = .6515; p = .000), evening NEECHAM vs evening MMSE (Correlation Coefficient = .8301; p = .000). A test of repeated measures was used to examine the data. The Within factor was time, the Between factor was age, and the interaction effect was age by time of day. Dependent variables were total NEECHAM scores and total MMSE scores, in addition to total scores of these tests' subsections. An alpha level of .05 was used for all statistical tests. Age had a significant main effect on the NEECHAM (F = 7.44; p = .001) and MMSE (F = 6.04; p = .004). Time did not have a significant effect on either the MMSE (F = .00; p = .953) or the NEECHAM (F = .43; p = .513). There was no statistically significant interaction between age and time of day (NEECHAM, F = .97, p = .384 and MMSE (F = .19, p = .826). No subjects were assessed as demented per the MMSE. Only 12 episodes of acute confusion were noted using the NEECHAM. Conclusion Patients in this population rarely, if ever, became confused. The older the individual, the more likely he/she was to have confusion. Time of day was neither significant in development of delirium nor on mental status assessment scores in this population. Implications for nursing research Current research literature notes that 10% to 50% of elderly postoperative patients experience delirium. Patients who have had femoral neck fractures can experience delirium three times more than patients having nonorthopaedic surgery. This study found that delirium in hip surgery patients is rare. A study of the more subtle components of delirium such as attention and memory might reveal less obvious changes in mental status following surgery. Type of orthopaedic surgery also might impact incidence of delirium. A comparative study between elderly total knee and total hip replacement patients would be interesting. Studying patients who have emergency hip surgery related to fracture in comparison to patients having elective hip surgery for degenerative conditions might identify other etiologies for delirium following hip surgery. Fatigue rather than time of day might be studied to observe whether it has a significant impact on mental status or delirium scores.

Postoperative Mental Status In Elderly Hip Surgery Patients

To determine if elderly patients undergoing hip surgery became delirious postoperatively and, if so, whether age and/or time of day were related to delirium. Repeated measures. A convenience sample of 70 hip surgery patients 60 years of age and older at a large Midwestern teaching hospital were studied. Patients were excluded who were unconscious, unable to hear, see, and/or verbally communicate in English. Patients were also excluded who had a known history of dementia, Alzheimer's dementia, addiction to alcohol and/or sedative hypnotics, functional psychosis, or any other psychiatric diagnosis. Of the 70 patients, 37 were female and 33 were male. Mean age of the patients was 72.9 years (S.D. = 8.13). Patients were placed into one of three groups: Group 1--age 60 to 69 years (n = 25); Group 2--age 70 to 79 years (n = 25); or Group 3--80 years and older (n = 20). The most common procedure for all groups was total hip replacement (n = 48). Data were collected primarily by both objective and subjective assessment of the patients. Both the Folstein's Mini Mental Status Exam (MMSE) and the NEECHAM Confusion Tool were used to collect data. Chart reviews provided additional data. Patients were assessed preoperatively to obtain baseline assessment and screen out patients with preexisting confusion. Assessments were then done once in the morning and once in the evening for 5 days following surgery. Delirium, sundowning, sundown syndrome. The MMSE and NEECHAM were found to be highly correlated: Morning NEECHAM vs morning MMSE (Correlation Coefficient = .6515; p = .000), evening NEECHAM vs evening MMSE (Correlation Coefficient = .8301; p = .000). A test of repeated measures was used to examine the data. The Within factor was time, the Between factor was age, and the interaction effect was age by time of day. Dependent variables were total NEECHAM scores and total MMSE scores, in addition to total scores of these tests' subsections. An alpha level of .05 was used for all statistical tests. Age had a significant main effect on the NEECHAM (F = 7.44; p = .001) and MMSE (F = 6.04; p = .004). Time did not have a significant effect on either the MMSE (F = .00; p = .953) or the NEECHAM (F = .43; p = .513). There was no statistically significant interaction between age and time of day (NEECHAM, F = .97, p = .384 and MMSE (F = .19, p = .826). No subjects were assessed as demented per the MMSE. Only 12 episodes of acute confusion were noted using the NEECHAM. Patients in this population rarely, if ever, became confused. The older the individual, the more likely he/she was to have confusion. Time of day was neither significant in development of delirium nor on mental status assessment scores in this population. Current research literature notes that 10% to 50% of elderly postoperative patients experience delirium. Patients who have had femoral neck fractures can experience delirium three times more than patients having nonorthopaedic surgery. This study found that delirium in hip surgery patients is rare. A study of the more subtle components of delirium such as attention and memory might reveal less obvious changes in mental status following surgery. Type of orthopaedic surgery also might impact incidence of delirium. A comparative study between elderly total knee and total hip replacement patients would be interesting. Studying patients who have emergency hip surgery related to fracture in comparison to patients having elective hip surgery for degenerative conditions might identify other etiologies for delirium following hip surgery. Fatigue rather than time of day might be studied to observe whether it has a significant impact on mental status or delirium scores.