Journal articles on the topic 'Total hip replacement Complications Risk assessment Statistical methods'
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Maciąg, Bartosz Michał, Krystian Żarnovsky, Olga Adamska, Grzegorz Jan Maciąg, Paweł Czuchaj, Marcin Łapiński, Maciej Świercz, Hanna Tsitko, and Artur Stolarczyk. "Posture stability and risk of fall test in the objective assessment of balance in patients with ectopic bone tissue after total hip replacement." Chirurgia Narządów Ruchu i Ortopedia Polska 87, no. 4 (December 20, 2022): 160–64. http://dx.doi.org/10.31139/chnriop.2022.87.4.4.
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Introduction. Total hip replacement is an operative treatment method for end-stage osteoarthritis, considered the most effective nowadays. One of the typical complications after the procedure is heterotopic ossification which may influence patient posture stability and increase the risk of falls. Aim. The study aimed to assess whether patients developing heterotopic ossifications after total hip replacement have a higher risk of falls in comparison to the matched-cohort group without them. Materials and methods. 46 out of 312 patients undergoing a total hip replacement in 2020 who developed heterotopic ossifications were observed. For these patients, a propensity score based on age, sex, and BMI was generated, and a matched-cohort control group consisting of 39 patients was selected. Each patient was operated on via an anterolateral approach, and an uncemented total hip prosthesis was implanted. Patients from both cohorts underwent postoperative radiological and biomechanical assessment and fulfilled WOMA C and Oxford questionnaires pre-and postoperatively. Statistical analyses of the results were performed. Results. There were statistically significant differences between cohorts in the postural stability test (4.9±1.1 vs 2.0±1.0 p<0.05), antero-posterior stability index (3.6±1.2 vs 1.6±0.9, p<0.05), medio-lateral stability index (3.0±1.3 vs 1.0±0.7, p<0.05) and risk of fall test (9.8±1.0 vs 7.8±1.0, p<0.05). No statistically significant differences were observed in the WOMA C and Oxford questionnaires. Conclusions. Our study proved that heterotopic ossifications, which appear in hip abductor muscles, could have an impact on balance and the risk of falls in patients after total hip replacement. In the elderly population, this can result in serious consequences such as a periprosthetic fracture or head trauma after total hip replacement.
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Bagherifard, Abolfazl, Kaveh Gharanizadeh, Mostafa Salehpour, Hamed Jafarpour, and Mani Mahmoudi. "Comparing Prophylactic Effect of Rivaroxaban and Enoxaparin on Thromboembolism After Total Hip or Knee Arthroplasty." Journal of Research in Orthopedic Science 7, no. 1 (February 1, 2020): 13–22. http://dx.doi.org/10.32598/jrosj.7.1.13.
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Background: Vascular thromboembolism is one of the major concerns of orthopedic surgeons after hip or knee replacement surgery. Although many thromboprophylactic drugs have been introduced, there is still no consensus over their efficacy and safety. Therefore, this study aimed to compare the efficacy and safety of oral rivaroxaban and aspirin administration and enoxaparin injections in patients undergoing knee or hip replacement. Objectives: Determination and comparison of the side effect and efficacy of Rivaroxaban and Enoxaparin after total hip or knee arthroplasty. Methods: A total of 231 patients undergoing knee or hip replacement surgery were included in the study. Of them, 31 patients were excluded due to missing the follow-up. Of the remaining 200 patients, 42 low-risk and 158 moderate- to high-risk patients were identified, according to Caprini risk assessment model. Then, they were divided into three groups: aspirin (42 patients), enoxaparin (78 patients), and rivaroxaban (80 patients). Severe hemorrhage (hemoglobin reduction of more than 2 g/dL or requiring blood transfusion) was assessed after the first dose of medication until discharge through daily hemoglobin testing. Frequency of other side effects such as wound complications (ecchymosis, hematoma, and wound infection) and gastrointestinal or skin problems was recorded and compared by daily examination during the hospital stay and then in the future visits to the clinic up to 6 months in each group. Follow up visits were performed at weeks 6, 12, and 24. Results: No cases of deep vein thrombosis or pulmonary thromboembolism were observed in any of the study groups. There was no significant difference between the two groups in the number of major bleeding cases (P=0.39). Ecchymosis around the wound was significantly higher in the rivaroxaban group than in the enoxaparin group (33.8% vs. 23%). However, this difference was not statistically significant (P=0.06). Conclusion: The efficacy and safety of rivaroxaban and enoxaparin drugs are comparable. Although ecchymosis was seen after using rivaroxaban rather than enoxaparin, rivaroxaban is orally administered and costs less for the patient and the health system. So, its use as a thromboprophylactic drug of choice following hip and knee arthroplasty surgery is still recommended.
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Levitan, Bennett, Zhong Yuan, Alexander GG Turpie, Richard J. Friedman, Martin Homering, Jesse A. Berlin, Scott D. Berkowitz, and Peter M. DiBattiste. "Quantitative Benefit–Risk Assessment of Rivaroxaban for the Prevention of Venous Thromboembolism." Blood 114, no. 22 (November 20, 2009): 169. http://dx.doi.org/10.1182/blood.v114.22.169.169.
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Abstract Abstract 169 Introduction: Venous thromboembolism (VTE) is a common complication after hip or knee replacement and is associated with significant morbidity and mortality. Anticoagulants reduce the risk of these complications, but can also result in increased bleeding, thus requiring an assessment of benefit–risk. Patients and Methods: To obtain more precise estimates of treatment effects on low frequency events, data were pooled from 4 phase 3 randomized clinical trials (RECORD1–4) of rivaroxaban vs enoxaparin regimens (or enoxaparin/placebo combination in 1 study) for the prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in total hip and knee replacement. Although the studies were designed to answer slightly different questions and differed in treatment duration and comparator dose, pooling was supported by similar study designs, identical endpoints, identical event ascertainment methods, and the same independent central blinded adjudication committees. Benefit–risk was assessed by comparing the excess number of outcome events for benefits vs that for harms (‘risks'), occurring over the treatment period. Excess number of events was defined as the number of events in a hypothetical population of 10,000 patients treated with enoxaparin minus the number of events in such a population treated with rivaroxaban. A positive value indicates that fewer events occur in the population treated with rivaroxaban. The analysis was undertaken for several clinically comparable pairs of composite benefit and harm outcomes: total VTE (any DVT, non-fatal PE, or death from any cause) vs major and clinically relevant non-major (CRNM) bleeding; major VTE (proximal DVT, non-fatal PE, or VTE-related death) vs major bleeding; and symptomatic VTE/all-cause mortality vs major bleeding. For each pair, pooled Mantel–Haenszel weighted risk differences were used to compute the excess number of benefit and harm events, and the difference between excess numbers of events was used to evaluate net clinical benefit (NCB; Table). In all calculations, benefits and risks were weighted equally. An additional assessment was performed using all treatment-emergent serious adverse events (SAEs) as reported by investigators. Results: Rixaroxaban is associated with statistically significantly fewer total VTE, major VTE, and symptomatic VTE/all-cause mortality events than enoxaparin, whereas enoxaparin is associated with a smaller number of different bleeding events, although no bleeding endpoints, other than the composite of major + CRNM bleeding, were statistically significantly different. In each pairwise comparison, the excess number of bleeding events is less than the excess number of VTE-related events by a factor ranging from 4 to 10 (Table). Enoxaparin was also associated with an excess of 194 treatment-emergent SAEs compared with rivaroxaban out of 10,000 patients. In all cases, there is a positive NCB for rivaroxaban vs enoxaparin with 95% confidence intervals (CIs) excluding 0, suggesting that the benefits of rivaroxaban exceed the risks when compared with enoxaparin. Conclusions: This quantitative benefit–risk approach provides a comparison of interventions in clinically relevant population terms. Using the net clinical benefit approach, for a variety of endpoints defining benefits and harms, the benefit–risk profile for rivaroxaban is consistently improved compared with enoxaparin for patients after elective hip and knee replacement. Disclosures: Levitan: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.: Employment, Equity Ownership. Yuan:Johnson & Johnson Pharmaceutical Research & Development, L.L.C.: Employment, Equity Ownership. Turpie:Johnson & Johnson Pharmaceutical Research & Development, L.L.C.: Consultancy; Bayer Schering Pharma AG: Consultancy, Speakers Bureau; sanofi-aventis: Consultancy; GSK: Consultancy; Astellas: Consultancy; Takeda: Consultancy; Portola: Consultancy. Friedman:Boehringer Ingelheim : Consultancy, Research Funding; Johnson & Johnson : Consultancy; Astellas US: Consultancy, Research Funding; Sanofi-Aventis: Consultancy. Homering:Bayer Schering Pharma AG: Employment. Berlin:Johnson & Johnson Pharmaceutical Research & Development, L.L.C.: Employment, Equity Ownership. Berkowitz:Bayer HealthCare Pharmaceuticals: Employment. DiBattiste:Johnson & Johnson Pharmaceutical Research & Development, L.L.C.: Employment.
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Patil, Pavankumar H., and Srinivas Pamarathi. "Assessment of clinical and functional outcomes following uncemented total hip arthroplasty in failed primary hemiarthroplasty." International Journal of Research in Orthopaedics 3, no. 3 (April 25, 2017): 551. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20171894.
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<p class="abstract"><strong>Background:</strong> Modern hip replacement has resulted in huge benefit for patients with arthritic hip disease, providing them with reduction of pain, return of function and consequently an improved quality of life. Evaluation of long term outcomes of an operative procedure is important to determine the durability of the procedures like uncemented total revision hip arthroplasty. In the present study, clinical and functional outcome and complications of uncemented total hip arthroplasty in failed primary hemiarthroplasty was assessed.</p><p class="abstract"><strong>Methods:</strong> Patients with failed primary hemiarthroplasty with Unipolar or Bipolar prosthesis (cemented and uncemented) due to aseptic loosening, protrusio causing groin pain, dislocation, breakage of implant leading to loss of function, periprosthetic fracture and acetabular osteolysis were included. During each visit, medical history was taken and physical examination was done. Range of movements (ROM) was recorded. The clinical and functional outcomes were evaluated by Harris Hip Score evaluation. Statistical analysis: Student’s paired t-test was used to find out the significance of difference between pre-operative and post-operative Harris Hip scores.<strong></strong></p><p class="abstract"><strong>Results:</strong> In 7 cases modular series was used for uncemented total hip arthroplasty, of which calcar replacement was done in 4 cases, and in one case constrained liner was placed. The maximum stem size used was 15mm and the minimum stem size 11mm. Stem size 11 was most frequently used. About 30% of the cases presented with pain postoperatively till the last follow-up, of which two cases reported mild pain with no effect on average activities and one case reported with moderate pain with some limitation of ordinary activity or work. The difference between the average pre-operative Harris Hip Score post-operative score was found to be highly significant (p=0.0001).</p><p><strong>Conclusions:</strong> This study has shown excellent results following the uncemented modular total hip arthroplasty in failed primary hemiarthroplasty in terms of pain relief, increased walking distance, and functional capabilities of the patients.</p>
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Glemba, K. A., A. E. Karateev, M. A. Makarov, S. A. Makarov, E. I. Bialik, S. I. Glukhova, and A. M. Lila. "Analysis of the factors determining the development of postoperative pain in patients after knee and hip replacement surgery." Modern Rheumatology Journal 15, no. 6 (December 13, 2021): 19–25. http://dx.doi.org/10.14412/1996-7012-2021-6-19-25.
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Chronic postoperative pain (POP) is a serious complication of total replacement (TR) of the knee (KJ) and hip (HJ) joints.Objective: to determine the factors associated with POP in patients after TR of KJ or HJ.Patients and methods. The study group consisted of 124 patients with knee osteoarthritis or hip osteoarthritis (age 63.6±9.9 years, 63% women and 37% men) who underwent TR of KJ or HJ. POP was defined as pain ≥40 mm on a numerical rating scale persistent for ≥3 months. Its presence was assessed after 3 and 6 months by telephone survey. Comparison of patients with POP and without it was carried out for a number of factors identified before surgery.Results and discussion. The incidence of POP was 27.4%. There was no difference in the incidence of POP in patients after TR of KJ or HJ: 28.1% and 26.9% (p=0.88). POP was statistically significantly associated with parameters such as higher body mass index (BMI); the intensity of pain at rest; general assessment of impairment; WOMAC index pain, stiffness and overall; severity of symptoms of neuropathic pain (PainDETECT); signs of depression and anxiety (HADS).The risk of POP was significantly higher (p<0.05) with BMI >30 kg/m2 (odds ratio, OR 2.755; 95% confidence interval, CI 1.053–7.206), rest pain ≥40 mm on a visual analog scale (OR 1.349; 95% CI 0.478–3.803), PainDETECT scores ≥13 (OR 3.598; 95% CI 1.048–12.36) and HADS depression ≥8 (OR 2.193; 95% CI 0.745–6.454), presence of ≥2 sources of pain (OR 6.996; 95% CI 2.358–20.756).Conclusion. It was found that the risk of POP after TR of KJ and HJ is higher in patients with overweight, severe preoperative pain, signs of neuropathic pain and depression, as well as in the presence of several sources of pain (except for the affected joint, that was replaced surgically).
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Nikolaus, Oliver B., Taylor Rowe, Bryan D. Springer, Thomas K. Fehring, and John R. Martin. "Can an outpatient risk assessment tool predict who needs postoperative haemoglobin monitoring?" Bone & Joint Journal 103-B, no. 1 (January 1, 2021): 65–70. http://dx.doi.org/10.1302/0301-620x.103b1.bjj-2019-1555.r3.
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Aims Recent improvements in surgical technique and perioperative blood management after total joint replacement (TJR) have decreased rates of transfusion. However, as many surgeons transition to outpatient TJR, obtaining routine postoperative blood tests becomes more challenging. Therefore, we sought to determine if a preoperative outpatient assessment tool that stratifies patients based on numerous medical comorbidities could predict who required postoperative haemoglobin (Hb) measurement. Methods We performed a prospective study of consecutive unilateral primary total knee arthroplasties (TKAs) and total hip arthroplasties (THAs) performed at a single institution. Prospectively collected data included preoperative and postoperative Hb levels, need for blood transfusion, length of hospital stay, and Outpatient Arthroplasty Risk Assessment (OARA) score. Results A total of 504 patients met inclusion criteria. Mean age at time of arthroplasty was 65.3 years (SD 10.2). Of the patients, 216 (42.9%) were THAs and 288 (57.1%) were TKAs. Six patients required a blood transfusion postoperatively (1.19%). Transfusion after surgery was associated with lower postoperative day 1 Hb (median of 8.5 (interquartile range (IQR) 7.9 to 8.6) vs 11.3 (IQR 10.4 to 12.2); p < 0.001), longer length of stay (1 day (IQR 1 to 1) vs 2 days (IQR 2 to 3); p < 0.001), higher OARA score (median of 60.0 (IQR 40 to 75) vs 5.0 (IQR 0-35); p = 0.001), and total hip arthroplasty (p < 0.001). All patients who received a transfusion had an OARA score > 34; however, this did not reach statistical significance as a screening threshold. Conclusion Risk of blood transfusion after primary TJR was uncommon in our series, with an incidence of 1.19%. Transfusion was associated with OARA scores > 60. The OARA score, not American Society of Anesthesiologists grade, reliably identified patients at risk for postoperative blood transfusion. Selective Hb monitoring may result in substantial cost savings in the era of cost containment. Cite this article: Bone Joint J 2021;103-B(1):65–70.
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Lampropoulou-Adamidou, Kalliopi, Theofilos S. Karachalios, and George Hartofilakidis. "Overestimation of the risk of revision with Kaplan-Meier presenting the long-term outcome of total hip replacement in older patients." HIP International 28, no. 3 (January 12, 2017): 246–53. http://dx.doi.org/10.5301/hipint.5000575.
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Introduction: The purpose of the present study was (i) to review the long-term outcome of cemented Charnley total hip replacements (THRs) performed by 1 surgeon (GH), 20 to 42 years ago, in patients ≥60 years, using both the Kaplan-Meier (KM) and the cumulative incidence (CI) methods, and (ii) to compare the estimations of the 2 statistical methods. Methods: We evaluated the outcome of 306 consecutive primary cemented THRs that were performed in 265 patients. The final clinical, radiographic assessment and satisfaction of living patients were also included. The survivorship was estimated with the use of KM and CI methods and the relative difference between their estimations was calculated. Results: Living patients’ final clinical results were significantly improved in comparison with respective preoperative ones, and all the acetabular and 91% of femoral components considered as well fixed. 95% of these patients reported satisfaction. The risk of revision at 25 years, with revision for aseptic loosening for 1 or both components as the endpoint, with 21 hips at risk, assessed with KM analysis was 6.9% and with CI approach was 3.9%. The relative difference between KM and CI estimations was increasing during follow-up, reaching up to 76.8% at 25 years. Conclusions: We concluded that fixation of implants with cement in older patients had satisfactory long-term results and can serve as a benchmark with which to compare newer fixation methods (hybrid and uncemented) and materials. However, KM method, in studies that include older population with long-term follow-up, may significantly overestimate the risk of revision and clinicians could consider using besides the cumulative incidence of competing risk method.
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Hah, Jennifer M., Yasamin Sharifzadeh, Bing M. Wang, Matthew J. Gillespie, Stuart B. Goodman, Sean C. Mackey, and Ian R. Carroll. "Factors Associated with Opioid Use in a Cohort of Patients Presenting for Surgery." Pain Research and Treatment 2015 (December 31, 2015): 1–8. http://dx.doi.org/10.1155/2015/829696.
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Objectives. Patients taking opioids prior to surgery experience prolonged postoperative opioid use, worse clinical outcomes, increased pain, and more postoperative complications. We aimed to compare preoperative opioid users to their opioid naïve counterparts to identify differences in baseline characteristics. Methods. 107 patients presenting for thoracotomy, total knee replacement, total hip replacement, radical mastectomy, and lumpectomy were investigated in a cross-sectional study to characterize the associations between measures of pain, substance use, abuse, addiction, sleep, and psychological measures (depressive symptoms, Posttraumatic Stress Disorder symptoms, somatic fear and anxiety, and fear of pain) with opioid use. Results. Every 9-point increase in the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) score was associated with 2.37 (95% CI 1.29–4.32) increased odds of preoperative opioid use (p=0.0005). The SOAPP-R score was also associated with 3.02 (95% CI 1.36–6.70) increased odds of illicit preoperative opioid use (p=0.007). Also, every 4-point increase in baseline pain at the future surgical site was associated with 2.85 (95% CI 1.12–7.27) increased odds of legitimate preoperative opioid use (p=0.03). Discussion. Patients presenting with preoperative opioid use have higher SOAPP-R scores potentially indicating an increased risk for opioid misuse after surgery. In addition, legitimate preoperative opioid use is associated with preexisting pain.
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Blinder, Morey A., Sarah Russel, and Mikala Barnes. "Prevalence of Symptomatic Avascular Necrosis and the Operative Treatment in Adult Patients with Sickle Cell Disease." Blood 124, no. 21 (December 6, 2014): 1379. http://dx.doi.org/10.1182/blood.v124.21.1379.1379.
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Abstract Introduction: Sickle cell disease (SCD) is complicated by widespread tissue and organ damage, including avascular necrosis (AVN) of the bones. Common sites of AVN include the shoulders and hips, which often causes severe pain and limited joint function, leading to surgical treatment. Although common, the prevalence of symptomatic AVN and optimal management for this disease has not been well defined. Furthermore, the overall effect of operative treatment on pain episodes requiring hospitalization is not known. The aim of this study is to retrospectively examine the prevalence of symptomatic AVN in adult SCD patients and assess the effects of surgical therapy. Methods: The Adult Hemoglobinopathy Resource Center at Washington University provides care for adult SCD patients throughout the St. Louis, Missouri metropolitan area. All patients have confirmed SCD (Hgb SS, Hgb SC, Hgb Sβ+, Hgb Sβ0, Hgb SC Harlem, Hgb SOther) and have been seen at least once since 2011 to be included in the study. Patients with new onset or worsening hip or shoulder pain underwent imaging studies and the presence or absence of radiographic evidence of AVN was used to determine the prevalence. The medical record was reviewed to identify patients with orthopedic procedures for AVN. The operative history of individuals with AVN was assessed and data from the post-operative hospital course was collected. The medical record was also reviewed to assess for subsequent hospitalizations and to determine whether the complications were directly related to the surgery or not. Medical record data was collected through June 2014. The surgical procedures were determined by the treating orthopedists and were not prospectively evaluated. Results: From October 2011 to June 2014, 324 patients have been evaluated. Of these patients, the mean age is 36 years (range 18-81); 180 are female (55.6%), and 144 are male (44.4%). The hemoglobinopathies include SS-205, SC-90, Sβ+-21, Sβ0-5, SC Harlem-2, and one unconfirmed genotype of SCD because of longstanding chronic transfusions. Out of the 324 patients, 94 (29%) had clinical and radiographic findings consistent with AVN of the hip(s) and 64 (19.8%) had findings consistent with AVN of the shoulder(s). No statistical difference was detected between genders (p >0.5) or among the genotypes, including between hemoglobin SS and SC (p>0.3). Forty-eight patients underwent 74 operations for AVN including 50 hip and 24 shoulder procedures. For the hip surgeries, these included 44 total hip arthroplasties, 2 hemiarthroplasties, 2 core decompressions and 2 other operative procedures. For the shoulder procedures, there were 11 total shoulder arthroplasties, 4 hemiarthroplasties, 8 core decompressions and 1 other operative treatment. All patients received pre-operative red cell transfusion support. The mean post-operative time in the hospital was 3.6 days (range <1-8) for hip surgery and 2.4 days (range <1-8) for shoulder surgery. Notably, there were thirteen re-hospitalizations within 30 days of surgery but these were all felt to be for pain syndromes not directly related to the surgical site. Fourteen patients were readmitted over the course of their care for joint-related complications resulting in 6 surgical revisions. Three had hemiarthroplasties converted to total arthroplasties, including both patients who originally received hip hemiarthroplasties. Both patients who underwent hip core decompressions later received total hip arthroplasties in those joints, and one patient of a shoulder core decompression also required total joint replacement. With three years of follow up, one patient underwent surgical removal of the prosthesis and insertion of an antibiotic spacer to treat a possible infection. Overall, patients who underwent surgical treatment for AVN had 2.4 hospitalizations per year for either joint related complications or other SCD related issues. Conclusion: SymptomaticAVN of hips and shoulders is a frequently occurring complication for patients with SCD. This data supports the role for joint replacement surgery as an effective treatment to improve joint function with a low risk of complications. However, hospitalizations for other complications of SCD, particularly sickle cell related pain, continue to occur and strategies for preventing AVN remain to be defined. Disclosures No relevant conflicts of interest to declare.
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Nain, Rose A., and Deena Clare Thomas. "Lipohypertrophy prevalence and its associated risk factors in insulin-treated patients with type 2 diabetes in North Borneo, Malaysia." Belitung Nursing Journal 8, no. 6 (December 27, 2022): 521–28. http://dx.doi.org/10.33546/bnj.2246.
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Background: Insulin-treated diabetes patients are at high risk of developing lipohypertrophy, which can negatively impact treatment outcomes. Early detection of lipohypertrophy is crucial to preventing blood glucose fluctuation. Unfortunately, this clinical issue is often overlooked by nurses, causing the development of vascular complications, which leads to an increase in the morbidity and mortality of the type 2 diabetes mellitus population. Objective: This study was conducted to identify lipohypertrophy prevalence and to establish the association between the presence of lipohypertrophy and its associated risk factors, including years on injection, total injection in a day, total insulin unit per day, often change needle, insulin injection site and move to a different area. Methods: This cross-sectional study included 128 patients with type 2 diabetes mellitus who received insulin therapy in an outpatient diabetic clinic. Questionnaires on socio-demographic and lipohypertrophy-associated risk factors were distributed among patients, and lipohypertrophy-assessment was done using a checklist. Descriptive statistics and Pearson Chi-square were used for statistical analysis. Results: The prevalence of lipohypertrophy was 51.6% (95% CI: 42.6, 60.5). Swelling on fatty tissue (46.1%) exhibited the highest percentage of lipohypertrophy features during the assessment. Pearson Chi-Square revealed a significant relationship between the presence of LH and BMI categories (χ2 = 10.059, df = 3, p = 0.018), duration of injection (χ2 = 15.001, df = 3, p = 0.002), frequency of needle replacement (χ2 = 9.525, df = 3, p = 0.023) and rotation of injection site (χ2 = 5.914, df = 1, p = 0.015). Conclusion: The high prevalence of lipohypertrophy indicates a need for a prevention strategy. Thus, nurses should play an important role in educating patients regarding the proper administration of insulin injections and performing a routine lipohypertrophy assessment and health education on the correct method of insulin injection.
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Bozhkova, Svetlana A., Vitaly N. Liventsov, Rashid M. Tikhilov, Carlo L. Romano, Aleksandr Yu Kochish, Dmitry V. Labutin, and Vasily A. Artyukh. "Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection." Traumatology and Orthopedics of Russia 28, no. 1 (January 15, 2022): 39–45. http://dx.doi.org/10.17816/2311-2905-1717.
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Background. Protein-energy malnutrition (PEM) is an established risk factor of postoperative complications in orthopedic disorders, including arthroplasty of the large joints.
The study aimed to evaluate PEM prevalence and its association with the early postoperative revision in patients with the difficult-to-treat (DTT) prosthetic joint infection (PJI) of the hip.
Methods. The retrospective study included 132 patients with chronic DTT PJI of the hip. The patients underwent orthopedic implant removal, radical debridement of the infected tissues, and resection arthroplasty with non-free transplantation of an axial vastus lateralis muscle flap (n = 57) or installation of an antimicrobial spacer (n = 75). DTT PJI was defined as an infection caused by rifampicin-resistant staphylococcal strains, ciprofloxacin-resistant gram-negative bacteria, fungi of the genus Candida, and their associations. The assessment of the patients protein-energy status included the evaluation of reference laboratory parameters, such as levels of hemoglobin, total protein, and albumin and number of lymphocytes. The degree of PEM was determined by the number of laboratory markers below the threshold values. The statistical comparison was performed using Fishers test. The odds ratio (OR, 95% confidence interval [CI]) was calculated to assess the risk of PJI recurrence. Differences were considered significant at p0.05.
Results. More than 70% of patients with chronic DTT PJI included in the study were diagnosed with preoperative PEM of varying degrees of severity. Hypoalbuminemia and decreased hemoglobin levels were diagnosed more often: 64.3% and 57.1% in the muscle flap plasty and 57.3% and 31.1% in the antimicrobial spacer group, respectively. In muscle plasty and antimicrobial spacer groups, a decrease in the values of three or more reference PEM markers was detected in 28.5% and 16.0% of patients, and this advanced impairment of the nutritional status increased the risk of early revision intervention by two (OR 2.0; CI 95% 0.478.56; p = 0.35) and six times (OR 6.11; 95% CI 1.0635.35; p0.04), respectively.
Conclusion. In general, the analysis of publications and results of our study show that PEM is associated with the development of surgical site infection and recurrence of PJI after revision surgery. A decrease in the values of three or more reference PEM markers is a significant predictor of repeated revisions after debridement surgery with the installation of an antimicrobial spacer. PEM complicates the postoperative course in patients with resection arthroplasty. Given the high incidence of PEM in patients with DTT PJI of the hip joint, further research is needed to develop methods for nutritional status correction and assessment of their effect on the outcomes of debridement surgery.
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Drelichman, Guillermo I., Nicolas Fernandez Escobar, Nora F. Basack, Maria S. Larroude, Gabriel Aguilar, Hugo Robledo, Leonardo J. Feldman, et al. "New Prognostic Factors in the Assessment of Bone Complications in Gaucher Disease. Report from the Argentinian Group for Diagnostic and Treatment for Gaucher Disease." Blood 124, no. 21 (December 6, 2014): 4116. http://dx.doi.org/10.1182/blood.v124.21.4116.4116.
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Abstract Objectives: the objectives of our study were to assess whether the current achievement of bone therapeutic goals (TG) correlate with the presence or absence of bone lesions (BL) and determine whether there are prognostic factors affecting response to enzyme replacement therapy (ERT) and the degree of bone involvement. Methods: 124 patients with Gaucher disease (GD) type 1 belonging to 45 centers in our country were studied. All studies were centralized in an imaging center and a central laboratory. Two points of evaluation were defined: 1) historical findings with data prior to diagnosis, diagnostic and data monitoring and 2) current findings with data obtained the day the following procedures were performed: total body resonance (TBR), volumetric resonance (VR), densitometry, complete blood count and chitotriosidase dosage. Five TG were evaluated according to the International Registration of Gaucher (ICGG). Results: with a median follow up of 15 years and a median treatment with ERT of 9.4, 105 patients (88%) achieved the five TG. Specifically bone TG were achieved by 90.3% of patients. However, this achievement was not correlated with the absence of BL as 87% of patients evaluated at day 0 showed different types of bone disease (BD) despite being in TRE. Reversible BL findings (infiltration and / or Erlenmeyer) and irreversible BL (infarcts and / or necrosis) increased from 71.8% at diagnosis versus 87% at study entry especially in relation to the appearance of acute BL (new) of osteonecrosis (24%). These discrepancies between the achievement of bone TG (90.3%), the presence of BD (87%) and the occurrence of acute BL (24%) show that the evaluation of the current bone TG is not accurate and it is necessary to evaluate more sensitive methods because it does not reflect the degree of bone involvement. We found four prognostic factors associated with the BD variable with statistical significance: ERT adherence, time between onset of symptoms and diagnosis, time between diagnosis and start of ERT and starting dose of ERT. Conclusions: these findings show that ERT "alone" can not maintain over time patients without chronic or acute BD or avoid the sequela. Several prognostic factors are associated with the likelihood that the patient is free of BD in the diagnosis and long-term monitoring. The findings at diagnosis of the following prognostic factors: late diagnosis (> 2 years) and a delay in treatment (> 2 years) were associated with a higher probability of irreversible BL. Findings in the monitoring of the following prognostic factors: good compliance to ERT, early initiation of ERT, early diagnosis and initial appropriate ERT dose at diagnosis according to risk level are associated with a greater likelihood of not presenting BD. According to this analysis we propose a new definition of bone TG and a new classification of prognostic groups (table 1). Table 1. New Prognostic Groups for BD in Gaucher Disease Prognostic Group Prognostic Factors Long - term consequences on Bone Group 1 (low risk of BD) ERT compliance > 90%Early diagnosis(< 2 years)Appropriate dose of ERT More likely not to present bone disease Group 2 (Intermediaterisk of BD) ERT compliance between > 80 and < 90%Delay in treatment(> 2 years) More likely to have reversible bone disease Group 3 (High risk of BD) ERT compliance between > 50 and < 80%More delay in treatment(> 2 years) More likely to have reversible and irreversible bone disease Group 4 (Very high Risk of BD) ERT compliance < 50%Low dose of ERT More likely to have reversible, irreversible and acute bone disease Disclosures Drelichman: Genzyme: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Fernandez Escobar:Genzyme: Research Funding, Speakers Bureau. Larroude:Genzyme: Honoraria. Aguilar:Genzyme: Honoraria.
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Amin, Nadia L., Sally Kinsey, Richard Feltbower, Ajay J. Vora, Nicholas Goulden, Rachel Wade, Chris Mitchell, Rachael Hough, Clare Rowntree, and Beki James. "Analysis of Long-Term Outcomes, Management and Prevalence of Osteonecrosis in UKALL 2003: 3.5% of Adolescents and Young Adults over 10 Years of Age with Acute Lymphoblastic Leukaemia Required Hip Replacement." Blood 126, no. 23 (December 3, 2015): 2083. http://dx.doi.org/10.1182/blood.v126.23.2083.2083.
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Abstract Introduction: As the majority of children and young people now survive acute lymphoblastic leukaemia (ALL), the challenge has shifted to minimising treatment related toxicity. Osteonecrosis is one of the most serious complications of treatment, and can result in significant long term morbidity. In UKALL2003, which recruited patients between Oct 1, 2003 and June 30, 2011, all patients received dexamethasone 6mg/m2 for 29 days during induction and again for 5 days each month during maintenance in combination with Vincristine. Standard and intermediate risk patients were randomised to 1 or 2 delayed intensifications, each of which contained dexamethasone 10mg/m2 for 14 days in an alternate week schedule. Aim: To report the prevalence, management and long term outcomes of patients who developed osteonecrosis among 3126 patients aged 1-24 years old entered into UKALL2003. Methods: Patients with reported bone toxicity were identified by the central trials unit, which also provided information regarding age, sex, ethnicity and treatment. A questionnaire for each patient was sent to the relevant primary treatment centres (n=40) requesting information on patient demographics, diagnosis, management and outcomes of patients with osteonecrosis. Each primary treatment centre was also asked for details of previously unreported patients known to have osteonecrosis. Statistical analysis was undertaken using Chi-squared tests to identify significant differences in the prevalence of osteonecrosis according to age, sex, ethnicity, and treatment. Percentages were calculated as simple percentages. Results: We received an 83% response rate from primary treatment centres. 153 patients (5%) were reported as having developed osteonecrosis at some point after the start of treatment for ALL (including relapse therapy or stem cell transplant if required (n=5)), of which 38 were previously unreported to the clinical trials unit. Age demonstrated the strongest association with risk of osteonecrosis (p=0.01). Of patients aged <10 years at diagnosis (n=2287), only 0.7% of patients developed osteonecrosis, compared with 16% of patients aged 10 to 15 years, and 15% of patients aged 16 years and over. 17% of those over the age of 18 years developed osteonecrosis. Only 11 of those affected were less than 10 years of age when symptoms began. There was no significant difference in prevalence by ethnic group (White/ British, South Asian, Black), sex or 1 versus 2 delayed intensifications (p=0.85, p=0.86 and p=0.38 respectively). Median time between onset of symptoms and diagnosis of osteonecrosis was 1 month, with 83% of patients diagnosed with MRI. The median time between diagnosis of ALL and onset of osteonecrosis symptoms was 14 months (range: minus 3 to 73 months). There were 438 areas of reported osteonecrosis in the 153 patients, with hips (157), knees (131), shoulders (61) and ankles (42) most commonly reported. Fractures were reported in 34 (22%) of patients who developed osteonecrosis. In the 153 patients with osteonecrosis, steroids were reported to have been discontinued in 93 (61%), bisphosphonates were given to 35 (23%), 10 of whom had also had fractures, 52 were given vitamin D (34%) and 64 (42%) required surgery. Hip replacements were required in 30 patients and of these, 29 were age >10 years at diagnosis of ALL (with a total of 839 patients aged >10 years in UKALL2003). There were 130 patients aged>18 years at diagnosis in UKALL2003, and of these, 4 required a hip replacement. With a median follow up of 70 months (range 27-124 months), 57 patients were reported to have no long term effects, 59 patients had minimal disability (able to carry out activities of daily living), 16 had significant disability, and 5 patients required a wheelchair at the time of response. 9 patients died from disease relapse, progression of ALL, sepsis or acute graft versus host disease. Outcome information was not available for a further 9 patients. Conclusion: This work highlights the impact of osteonecrosis as a cause of considerable morbidity for patients treated for ALL, with important implications for quality of life. Further, this work confirms that the greatest impact is on those aged over 10 years at diagnosis, with 1 in 30 patients in this group requiring hip replacement. Better strategies to monitor for and manage this condition are required to reduce the incidence, whilst maintaining overall and event free survival. Disclosures No relevant conflicts of interest to declare.
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Berezhna, A. V., S. D. Novikov, and T. O. Chumachenko. "MONITORING OF PERIPHERAL VENOUS CATHETERIZATION AT THE SURGICAL HOSPITAL." Eastern Ukrainian Medical Journal 8, no. 3 (2020): 314–23. http://dx.doi.org/10.21272/eumj.2020;8(3):314-323.
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Introduction. Peripheral venous catheters are widely used in medical practice to provide continuous venous access for therapeutic and diagnostic purposes. Peripheral vascular catheterization can be accompanied by infectious complications, including catheter-related bloodstream infections. An effective system of epidemiological surveillance and infection control of catheter-related bloodstream infections has not been developed at the state level in Ukraine; there is no proper monitoring for administration site and no registration of complications associated with the vascular catheterization. The purpose of this work was to assess the validity and propriety of the use of peripheral venous catheters in patients who receive inpatient treatment. Materials and methods: Between October 2019 and April 2020, 93 adult patients who were peripheral venous catheterized in a surgical hospital in Kharkiv were included in a prospective epidemiological study. The author's observation card was used for data collection for each patient daily. The catheter site was observed daily, and the following symptoms were entered into the card: flushed skin, swelling, discharge, and pain at the administration site at rest and on palpation. Interpretation of symptoms was conducted using the visual infusion phlebitis scale by A. Jackson. Statistical processing of data was carried out using descriptive statistics methods. To identify the relationship between the nominative values, Pearson's criterion χ2 was determined with P < 0.01. Research results: 51 women (54.8%) and 42 men (45.2%) aged 18 to 84 were enrolled. In total, patients spent 619 bed-days in the hospital, of which the proportion of days with vascular catheters equaled 90.8% (n = 562). The main indication for the catheterization procedure was multicomponent therapy or the use of incompatible medications (98.9% / n = 92). In total, 148 peripheral venous catheters were inserted in these patients. The number of vascular catheters per patient ranged 1 to 3. According to the data of daily monitoring of the administration site, the signs of inflammation were observed in 65.5% of cases (n = 97). The incidence of signs of inflammation at the administration site with the first catheterization was significantly higher (χ2 = 25.2804; p < 0.00001) than that with the second or third catheterization. The signs of local inflammation, which were more common in patients with vascular catheters, included flushed skin in the area of the catheter site (65.5% / n = 97), complaints of pain on palpation in the area of the catheter site (60.8% / n = 90) and swelling in the area of the catheter site (57.4% / n = 85). It was found that for more than half of the cases (55.4% / n = 82), the patients had symptoms of middle-stage phlebitis. It was also revealed that the most common reason for the removal of a peripheral venous catheter (n = 148) in the studied hospital were signs of local inflammation at the catheter site (61.5% / n = 91). However, in 16.9% of cases (n = 25), the occurrence of at least two signs of local inflammation at the catheter site, which indicated the initial stage of phlebitis and required to rearrange the catheter, was not the reason for immediate catheter removal. Conclusions: Health care workers make mistakes when working with peripheral venous catheters; in particular, there is no timely replacement of vascular catheters in the event of signs of infusion phlebitis. To reduce the risk of infectious complications of vascular catheterization at a health facility, the indications for insertion and removal of peripheral venous catheters and central venous catheters should be clearly defined, and standard operating procedures for ensuring vascular access and algorithms for managing patients with vascular catheters should be developed and implemented. Keywords intravascular catheter, prospective epidemiological study, assessment of the catheter insertion site, infusion phlebitis, catheter-related bloodstream infections, infection control.
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Mendolicchio, Grazia Loredana, Patrizia Marchese, Corrado Lodigiani, Anna Colombo, Matteo Ferrari, Marco Scardino, Guido Grappiolo, Lidia Rota, and Zaverio M. Ruggeri. "Variable Reduction Of Thrombus Formation In The Blood Of Patients Treated With Oral Factor Xa and Thrombin Inhibitors: Pathophysiologic and Therapeutic Implications." Blood 122, no. 21 (November 15, 2013): 1144. http://dx.doi.org/10.1182/blood.v122.21.1144.1144.
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Abstract Background Warfarin, an oral anti-vitamin K anticoagulant, effectively prevents venous thrombosis in patients at risk, but requires constant laboratory monitoring to maintain a therapeutic range and reduce bleeding complications. For many indications, oral inhibitors of coagulation factor (F) Xa and thrombin (FIIa) have proven at least as effective as warfarin with comparable risk of bleeding complications, but with the advantage of administration in a fixed dose without laboratory monitoring. Although rare, thrombosis may still occur in treated patients and bleeding remains a potentially serious complication. Aims The assumption that an equal dose of an anticoagulant drug can achieve a comparable antithrombotic effect in different patients implies that an appropriate test of efficacy should yield results within a relatively narrow range of values. Thus, we measured the volume of platelet aggregates and fibrin deposited onto thrombogenic surfaces exposed to flowing blood to compare the antithrombotic effect of rivaroxaban (Riv), a FXa inhibitor, and dabigatran (Dab), a thrombin inhibitor, with that of warfarin (Warf) in patients undergoing total knee or hip replacement and treated to prevent deep vein thrombosis. Methods Blood containing 0.011 M trisodium citrate was recalcified with 5 mM CaCl2 and perfused at the wall shear rate of 300 and 1500 s-1 over a surface coated with fibrillar collagen type I, or at 300 s-1 over recombinant tissue factor (TF). Platelet aggregates and fibrin were detected in situ through distinct fluorochromes and the respective volumes were measured from stacks of confocal optical sections. We tested 12 normal controls, 12 patients treated with Warf (INR between 1.94 and 2.90), 10 patients treated with Riv and 10 with Dab between 8 and 16 days from the initiation of therapy. Statistical analysis was performed using one-way analysis of variance. Results On the collagen surface at the lower shear rate of 300 s-1, the blood of Warf patients yielded an average volume of deposited fibrin significantly lower not only of control (P<0.001) but also Riv and Dab patients (P<0.01); the latter two were not different from control. All 12 Warf samples, but only 5/10 Riv and 4/10 Dab, were below the lower limit of normal values. In contrast, at the higher shear rate of 1500 s-1 the average fibrin volume was significantly lower than control in Warf (P<0.001) as well as Riv and Dab (P<0.01) blood. Notably, at both lower and higher shear rate the average volume of platelet aggregates was not decreased in Warf, Riv or Dab blood; rather, the tendency was to increased. On the TF surface, stable thrombus formation in flowing blood could only be assessed at the lower shear rate of 300 s-1, since even the reactivity of normal samples was negligible at 1500 s-1; thus we focused on blood from Riv and Dab treated patients who showed only an insignificant reduction of fibrin formation at 300 s-1 on the collagen surface. In contrast, thrombus volume in the blood of Riv and Dab treated patients was decreased on the TF surface under the same flow conditions. In the case of Dab, the average volume of both platelet aggregates and fibrin was significantly lower (P<0.01) than in control blood; with Riv, fibrin volume was also significantly reduced (p<0.01), but that of platelet aggregates was not. Of note, the volume of fibrin formed in Dab samples was only one third of that in Riv samples. Summary/Conclusions The significance of findings obtained with a test of thrombus formation in ex vivo flowing blood and the potential value for interpreting the evidence provided by clinical trials remain to be established prospectively. This notwithstanding, it is apparent that different agents have different anticoagulant effects, and those administered in a “one fits all” dose and without laboratory monitoring lead to a greater inter-individual variability of results. The influence of the thrombogenic surface on the ex vivo anticoagulant potency of drugs with distinct coagulation targets suggests that treating or preventing different thrombotic disorders may require a selective choice among therapeutic agents targeting specific coagulation pathways and physiologic inhibitors. Disclosures: No relevant conflicts of interest to declare.
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Farhat, Hadi. "The Role of Color Doppler Ultrasonography in the Prevention of Thromboembolic Disease after Total Hip Replacement." International Journal of Pharmaceutical and Bio-Medical Science 02, no. 07 (July 2, 2022). http://dx.doi.org/10.47191/ijpbms/v2-i7-02.
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Orthopedic and trauma surgery carries a high risk of deep vein thrombosis (DVT) in the lower limbs and acute pulmonary embolism (APE). In traumatology, the greatest risk is in hip fractures of the proximal extremity of the femur, especially those of the neck, and intertrochanteric fractures. In orthopedics the risk of thromboembolic complications (TEC) is particularly high in hip and knee surgery, especially in prosthetic replacement, as general factors are associated with local factors such as trauma to vessels and / or blood stasis which further aggravate the perioperative imbalance of the coagulation system. In particular, hip replacement surgery is the one that shows a higher frequency of DVT (especially affecting the proximal large vessels), and of TEC, so much so that pulmonary embolism is one of the main causes of death after this intervention. In this paper, we review the different instruments used for the diagnosis of DVT such as phlebography, radiolabeled fibrinogen collection test, impedance, plethysmography, ultrasound, nuclear magnetic resonance and computed tomography. We also discuss the different prophylaxis methods for DVT and subsequent PE prevention. Then, we performed an experimental study on 420 patient’s operated on for total hip replacement at the 1st Orthopedic Clinic of the University of Florence and other private clinics in the period between 1994-1996. These are 286 first cemented implants, 36 first hybrid implants, 38 first cementless implants and 60 hip replacement reviews. This study showed the importance of color doppler ultrasonography in the prevention of DVT in hip replacement patients and subsequent APE prophylaxis. Significant relationship was found between APE and the protocole used to follow up with the patients (Pvalue 0.0007). Patients in group 2 in which only clinical control (no preoperative color doppler ultrasonography assessment) was performed have higher risk for APE To Occur Than patients in group 1 to whom pre and post-operative color doppler ultrasonography was routinely applied.
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Бережняк, В., А. Момот, and И. Меркулов. "COMPARATIVE ASSESSMENT OF EFFECTIVENESS OF THROMBOPROPHYLAXIS BY NOVEL ORAL ANTICOAGULANTS AT TOTAL HIP REPLACEMENT." Тромбоз, гемостаз и реология, no. 3(71) (August 22, 2017). http://dx.doi.org/10.25555/thr.2017.3.0792.
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Введение. Венозные тромбозы и тромбоэмболия легочной артерии относятся к числу наиболее распространенных, социально и экономически значимых видов патологии человека. Высокий удельный вес причин венозных тромбоэмболических осложнений принадлежит такому виду высокотехнологичной помощи как эндопротезирование крупных суставов. Цель работы. Сравнительное изучение динамики ряда проявлений тромботической готовности на фоне приема новых оральных антикоагулянтов (НОАК). Материалы и методы. Проведен сравнительный анализ тромботической готовности у 195 пациентов после тотального эндопротезирования тазобедренного сустава на фоне приема НОАК — ривароксабана (73 больных) или дабигатрана этексилата (122 больных). С этой целью использовались интегральные методы исследования системы гемостаза (тест генерации тромбина и тромбоэластометрия), а также определение маркеров внутрисосудистого свертывания крови — комплекса тромбин-антитромбин (ТАТ) и Д-димеров. Результаты. Не выявлено различий между группами больных ни по числу эпизодов венозного тромбоза, ни по срокам его возникновения и локализации. Также не обнаружено заметной разницы параметров гемостаза в период приема НОАК. Однако в отдаленный период (через 1 и 3 месяца после операции) в случаях применения дабигатрана этексилата зафиксирован синдром «отмены» («rebound effect»), что проявилось в сравнительно большей интенсивности генерации тромбина в плазме крови, более высоком уровне комплекса ТАТ и большей плотности фибринового сгустка (по показателю MCF при тромбоэластометрии). Заключение. Полагаем, что выявленная закономерность должна учитываться при выборе антикоагулянта для тромбопрофилактики у ортопедических пациентов, имеющих дополнительные постоянные или длительно действующие факторы тромбогенного риска. Introduction. Venous thromboses and pulmonary embolism are the most common, socially and economically significant types of human pathology. At endoprosthesis replacement of large joints venous thromboembolic complications often develop. Aim. A comparative study of thrombotic readiness manifestations under new oral anticoagulants (NOACs) administration. Materials and methods. A comparative analysis of thrombotic readiness was performed in 195 patients after total hip replacement under NOACs administration — rivaroxaban (73 patients) or dabigatran etexilate (122 patients). For this purpose integral methods were used to study hemostatic system (thrombin generation test and thromboelastometry) as well as determination of intravascular coagulation markers — thrombin-antithrombin (TAT) complex and D-dimers. Results. No diff erences were found between compared groups of patients either in number of episodes of venous thrombosis or in time of its onset and localization. Also there was no noticeable diff erence in hemostatic parameters during the period of NOACs administration. However in the long-term period (at 1 and 3 months after surgery) in cases of dabigatran etexilate usage «rebound effect» was fixed that manifested by a relatively higher intensity of thrombin generation in blood plasma, higher level of TAT complex and higher density of fibrin clot (according to MCF parameter in thromboelastometry). Conclusion. We consider that the revealed regularity should be taken into account in choosing anticoagulant for thromboprophylaxis at orthopedic patients who have permanent or long-acting thrombogenic risk factors.
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Keller, K., L. Hobohm, S. Barco, I. Schmidtmann, T. Munzel, M. Engelhardt, L. Eckhard, S. Konstantinides, and P. Drees. "Venous thromboembolism in patients hospitalized for knee and hip joint replacement surgery." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.3567.
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Abstract Background Venous thromboembolism (VTE) is a frequent acute cardiovascular disease, leading to significant morbidity and mortality worldwide. Major trauma, surgery, immobilisation and joint replacements are major provoking factors for VTE. In particular, patients undergoing knee and hip joint replacement surgery are at high risk of developing VTE perioperatively, even in the era of established pharmacological thromboprophylaxis. Without thromboprophylaxis, as many as 20–60% of patients may develop perioperative VTE. Purpose As recent studies indicate an increasing number of total knee and hip replacement surgeries in European countries and the United States, aims of our study were to investigate a) total burden and temporal trends of VTE complications following knee (KJR) and hip joint replacement (HJR) in Germany 2005–2016 and to identify b) predictors of VTE during hospitalization. Methods In an analysis of the nationwide German inpatient sample, we included all hospitalized patients with elective primary KJR and HJR in Germany between 2005 and 2016 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2016, own calculations). We analyzed temporal trends of surgical procedure, mortality, and VTE, and identified predictors of VTE. Results A total of 1,804,496 hospitalized patients underwent KJR (65.1% women, 53.4% aged ≥70 years) and 1,885,839 received HJR (59.1% women, 51.4% ≥70 years). VTE was documented in 23,297 (1.3% of total) KJR patients and in 11,554 HJR patients (0.6%). The number of primary KJR (129,832 in 2005 to 167,881 in 2016 [β-(slope)-estimate 1978 per year; 95% CI 1951 to 2004, P<0.001]) and primary HJR (145,223 in 2005 to 171,421 in 2016 [β-estimate 1818 per year; 95% CI 1083 to 2553, P<0.001]) increased during this twelve-year period. In-hospital VTE decreased from 1.9% to 0.9% (β-estimate −0.77 [95% CI: −0.81 to −0.72], P<0.001) after KJR and from 0.9% to 0.5% (β-estimate −0.71 (95% CI: −0.77 to −0.65), P<0.001) after HJR. In parallel, in-hospital death rate dropped from 0.14% (184 deaths) to 0.09% (146 deaths) (β-estimate −0.44 [95% CI: −0.59 to −0.30], P<0.001) after KJR and from 0.33% to 0.29% (β-estimate −0.11 (95% CI: −0.20 to −0.02), P=0.018) after HJR. Infections during hospitalization were associated with a higher VTE risk. VTE events were associated with in-hospital death in KJR (OR 20.86 [95% CI: 18.78–23.15], P<0.001) and HJR (OR 15.19 [95% CI: 14.19–16.86], P<0.001) independently from age, sex and comorbidities. Conclusions While total numbers of KJR and HJR interventions increased in Germany between 2005 and 2016, the rate of VTE decreased substantially. VTE complications were associated with 15-to 21-fold increase of in-hospital case-fatality rate. Perioperative infections increased the risk for VTE substantially. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503), institutional grant for the Center for Thrombosis and Hemostasis. The authors are responsible for the contents of this publication.
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Grammatico-Guillon, Leslie, Katiuska Miliani, Linda Banaei-Bouchareb, Agnès Solomiac, Jessica Sambour, Laetitia May-Michelangeli, and Pascal Astagneau. "A computerized indicator for surgical site infection (SSI) assessment after total hip or total knee replacement: The French ISO-ORTHO indicator." Infection Control & Hospital Epidemiology, September 9, 2021, 1–8. http://dx.doi.org/10.1017/ice.2021.371.
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Abstract Objective: The French National Authority for Health (HAS), with a multidisciplinary working group, developed an indicator ‘ISO-ORTHO’ to assess surgical site infections (SSIs) after total hip arthroplasty or total knee arthroplasty (THA/TKA) based on the hospital discharge database. We present the ISO-ORTHO indicator designed for SSI automated detection and its relevance for quality improvement and hospital benchmarks. Methods: The algorithm is based on a combination of International Statistical Classification of Diseases, Tenth Revision (ICD-10) and procedure codes of the hospital stay. The target population was selected among adult patients who had a THA or TKA between January 1, 2017, and September 30, 2017. Patients at very high risk of SSI and/or with SSI not related to hospital care were excluded. We searched databases for SSIs up to 3 months after THA/TKA. The standardized infection ratio (SIR) of observed versus expected SSIs was calculated (logistic regression) and displayed as funnel plot with 2 and 3 standard deviations (SD) after adjustment for 13 factors known to increase SSI risk. Results: In total, 790 hospitals and 139,926 THA/TKA stays were assessed; 1,253 SSI were detected in the 473 included hospitals (incidence, 0.9%: 1.0% for THA, 0.80% for TKA). The SSI rate was significantly higher in males (1.2%), in patients with previous osteo-articular infection (4.4%), and those with cancer (2.3%), obesity, or diabetes. Most hospitals (89.9%) were within 2 SD; however, 12 hospitals were classified as outliers at more than +3 SD (1.6% of facilities), and 59 hospitals (7.9%) were outliers between +2 SD and +3 SD. Conclusion: ISO-ORTHO is a relevant indicator for automated surveillance; it can provide hospitals a metric for SSI assessment that may contribute to improving patient outcomes.
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Simonsson, Johan, Erik Bülow, Karin Svensson Malchau, Fredrik Nyberg, Urban Berg, and Ola Rolfson. "Worse patient-reported outcomes and higher risk of reoperation and adverse events after total hip replacement in patients with opioid use in the year before surgery: a Swedish register-based study on 80,483 patients." Acta Orthopaedica, January 3, 2022, 190–97. http://dx.doi.org/10.2340/17453674.2021.1021.
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Background and purpose — Recent studies indicate that preoperative use of opioids could be associated with higher rates of complications and worse patient-reported outcomes (PROs) after orthopedic surgery. We investigated the prevalence of preoperative opioid use and analyzed its influence on risk of revision, adverse events (AE), and PROs in patients with total hip replacement (THR). Patients and methods — This observational study included 80,483 patients operated on in 2008–2016 with THRs due to osteoarthritis. Data was obtained from the Swedish Hip Arthroplasty Register, Statistics Sweden’s sociodemographic registers, the Swedish National Patient Register, and the Prescribed Drug Register. We focused on patients with ≥ 4 opioid prescriptions filled 1 year prior to THR. To control for confounding, we used propensity scores to weight subjects in our analyses. Logistic and linear regression was used for outcome variables with adjustments for sociodemographic variables and comorbidities. Results — Patients with ≥ 4 opioid prescriptions in the year before THR (n = 14,720 [18%]) had a higher risk of revision within 2 years (1.8% vs. 1.1% OR 1.4, 95% CI 1.3–1.6) and AE within 90 days (9.4% vs. 6.4% OR 1.2, 95% CI 1.2–1.3) compared with patients without opioid treatment in the preoperative period. Patients with ≥ 4 opioid prescriptions rated 5 points worse on a 0–100 scale of Pain VisualAnalogue Scale (VAS) and 9 points worse on a generalhealth (EQ) VAS 1 year postoperatively. Interpretation — Having ≥ 4 opioid prescriptions filled in the year before surgery is associated with a higher risk of revision, adverse events, and worse PROs after THR. Consequently, preoperative opioid treatment should be addressed in the clinical assessment of patients eligible for THR.
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Wong, Jean, Helen R. Doherty, Mandeep Singh, Stephen Choi, Naveed Siddiqui, David Lam, Nishanthi Liyanage, George Tomlinson, and Frances Chung. "The prevention of delirium in elderly surgical patients with obstructive sleep apnea (PODESA): a randomized controlled trial." BMC Anesthesiology 22, no. 1 (September 14, 2022). http://dx.doi.org/10.1186/s12871-022-01831-1.
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Abstract Background Obstructive sleep apnea (OSA) is associated with neurocognitive impairment – a known risk factor for postoperative delirium. However, it is unclear whether OSA increases the risk of postoperative delirium and whether treatment is protective. The objectives of this study were to identify OSA with a home sleep apnea test (HSAT) and to determine whether auto-titrating positive airway pressure (APAP) reduces postoperative delirium in older adults with newly diagnosed OSA undergoing elective hip or knee arthroplasty. Methods We conducted a multi-centre, randomized controlled trial at three academic hospitals in Canada. Research ethics board approval was obtained from the participating sites and informed consent was obtained from participants. Inclusion criteria were patients who were $$\ge 6$$ ≥ 6 0 years and scheduled for elective hip or knee replacement. Patients with a STOP-Bang score of ≥ 3 had a HSAT. Patients were defined as having OSA if the apnea–hypopnea index was ≥ 10/h. These patients were randomized 1:1 to either: 1) APAP for 72 h postoperatively or until discharge, or 2) routine care after surgery. The primary outcome was postoperative delirium, assessed twice daily with the Confusion Assessment Method for 72 h or until discharge or by chart review. The secondary outcome measures included length of stay, and perioperative complications occurring within 30 days after surgery. Results Of 549 recruited patients, 474 completed a HSAT. A total of 234 patients with newly diagnosed OSA were randomized. The mean age was 68.2 (6.2) years and 58.6% were male. Analysis was performed on 220 patients. In total, 2.7% (6/220) patients developed delirium after surgery: 4.4% (5/114) patients in the routine care group, and 0.9% (1/106) patients in the treatment group (P = 0.21). The mean length of stay for the APAP vs. the routine care group was 2.9 (2.9) days vs. 3.5 (4.5) days (P = 0.24). On postoperative night 1, 53.5% of patients used APAP for 4 h/night or more, this decreased to 43.5% on night 2, and 24.6% on night 3. There was no difference in intraoperative and postoperative complications between the two groups. Conclusions We had an unexpectedly low rate of postoperative delirium thus we were unable to determine if postoperative delirium was reduced in older adults with newly diagnosed OSA receiving APAP vs. those who did not receive APAP after elective knee or hip arthroplasty. Trial registration This trial was retrospectively registered in clinicaltrials.gov NCT02954224 on 03/11/2016.
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Lee, Nathan J., Andrei F. Joaquim, Venkat Boddapati, Justin Mathew, Paul Park, Jun S. Kim, Zeeshan M. Sardar, Ronald A. Lehman, and K. Daniel Riew. "Revision Anterior Cervical Disc Arthroplasty: A National Analysis of the Associated Indications, Procedures, and Postoperative Outcomes." Global Spine Journal, January 19, 2021, 219256822097914. http://dx.doi.org/10.1177/2192568220979140.
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Study Design: Retrospective study. Objective: To examine the associated indications, procedures, and postoperative outcomes after revision ACDA. Methods: We utilized a national database to identify adult(≥18 years) patients who underwent either a primary ACDA or removal of ACDA over a 10-year period(2008-2017). An in-depth assessment of the reasons for revision surgery and the subsequent procedures performed after the removal of ACDA was done by using both Current Procedural Terminology(CPT) and International Statistical Classification of Diseases (ICD-9,10) coding. Results: From 2008 to 2017, a total of 3,350 elective, primary ACDA cases were performed. During this time, 69 patients had a revision surgery requiring the removal of ACDA. The most common reasons for revision surgery included cervical spondylosis(59.4%) and mechanical complications(27.5%). After removal of ACDA, common procedures performed included anterior cervical fusion with or without decompression(69.6%), combined anterior/posterior fusion/decompression (11.6%), and replacement of ACDA (7.2%). The indications for surgery did not vary significantly among the different procedures performed (p = 0.318). Patients requiring revision surgery for mechanical complications or those who underwent a combined surgical approach were at significantly higher risk for subsequent short-term complications (p<0.05). Conclusion: Over a 10-year period, the rate of revision surgery for ACDA was low (2.1%). Nearly 90% of revision cases were due to either cervical spondylosis or mechanical complications. These indications for surgery did not vary significantly among the different procedures performed. These findings will be important during the shared-decision making process for patients undergoing primary or revision ACDA.
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Wei, Dongmei, Vannina González Marrachelli, Jesus D. Melgarejo, Chia-Te Liao, Stefan Janssens, Peter Verhamme, Thomas Vanassche, et al. "Lipoprotein profiles of fat distribution and its association with insulin sensitivity." Frontiers in Endocrinology 13 (October 25, 2022). http://dx.doi.org/10.3389/fendo.2022.978745.
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BackgroundFat deposition is associated with adverse outcomes. Waist-to-hip (WHR) ratio is a simple feasible index to assess fat distribution. Lipoprotein particle composition in relation to WHR and to what extent their association is mediated by insulin sensitivity are less investigated.MethodsIn 504 randomly recruited Flemish (mean age: 48.9 years; women: 51.6%), we analyzed the lipoprotein particle constitutions using nuclear magnetic resonance spectroscopy. WHR obesity described a WHR of ≥ 0.85 for women or 0.9 for men. Insulin sensitivity was evaluated by the homeostasis model assessment-estimated insulin resistance (HOMA-IR). SCORE-2 risk algorithm was applied to estimate 10-year cardiovascular risk. Statistical methods included multivariable-adjusted linear regression analysis, logistic regression analysis, and mediation analysis.ResultsThe prevalence of WHR obesity was 54.6%, approximately 3 times of BMI-determined obesity (19.1%). Individuals with WHR obesity had significantly higher metabolic complications, such as hypertension (57.1%), dyslipidemia (61.8%), and insulin resistance (14.2%). WHR and WHR obesity were positively associated with total very-low-density lipoprotein (VLDL) particle concentration, remnant cholesterol, and triglycerides, but were negatively associated with VLDL particle size (P ≤ 0.027), independent of body mass index and other covariates. WHR was inversely associated with total high-density lipoprotein (HDL) particle concentration, whereas WHR obesity was inversely associated with HDL cholesterol (P ≤ 0.039). Neither WHR nor WHR obesity was associated with the concentration of total low-density lipoprotein (LDL) particles, LDL particle size, and LDL cholesterol (P ≥ 0.089). In the mediation analysis, insulin sensitivity significantly mediated the effect of WHR on total VLDL particle concentration (mediation percentage: 37.0%), remnant cholesterol (47.7%), and HDL cholesterol (41.1%). Individuals with WHR obesity were at increased cardiovascular risk, regardless of LDL cholesterol (P ≤0.028). In WHR obesity, higher total VLDL particle concent36ration and remnant cholesterol, and lower HDL cholesterol were associated with an increased cardiovascular risk (P≤ 0.002).ConclusionsUpper-body fat deposition was independently associated with an unfavorable lipoprotein profile, and insulin sensitivity significantly mediated this association. LDL cholesterol might underestimate lipid abnormality for people with upper-body obesity and lowering VLDL particles and remnant cholesterol might potentially reduce the residual cardiovascular risk.
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Cano, A., C. Diago, R. Domingo, M. Niebla, J. Marginet, JM Tolosana, and S. Perez. "Efficacy of the hypothermic compression bandage in the surgical wound of cardiac devices." European Journal of Cardiovascular Nursing 20, Supplement_1 (July 1, 2021). http://dx.doi.org/10.1093/eurjcn/zvab060.149.
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Abstract Funding Acknowledgements Type of funding sources: None. Introduction Pocket hematoma is one of the most frequent complications (10%) of the cardiac devices implant. To reduce the risk of bleeding, once the wound is sutured and isolated with a sterile dressing, the nurse performs a compression bandage over the area of the generator pocket. The choice of the type of bandage on the wound of the generator pocket is the responsibility of the nurse and there are several methods that vary according to the center. The vasocontrictive property of ice is known but its applicability is not demonstrated in these types of wounds. Objective Evaluate the efficacy of the hypothermic compression bandage versus conventional compression bandage, for the prevention of surgical wound post cardiac device implant hematoma in chronic oral anticoagulant and / or platelet antiaggregant treatment. Methodology This is a randomized prospective study. The protocol was accepted by ethical committee. The team of nurses from the arrhythmia laboratory recruited 310 patients (sample size with statistical calculation) who were going to undergo an implant or replacement of a pacemaker or internal defibrillator. Those patients who were under treatment with oral anticoagulant and/or platelet antiaggregants were selected. Through a list of random numbers two therapeutic branches were created: the intervention group was applied a compressive bandage with ice and the usual group lacked the conventional compressive bandage. Both bandages placed just at the end of wound closure and for 6 hours post-implant. Skin status was stratified between healthy, ecchymosis, mild hematoma and severe hematoma. The assessment of the state of the skin was performed by a blinded nurse, in the control of the wound at 7 days post intervention. The primary endpoint was the appearance of hematoma. The secundary endpoint was the appearance of severe hematoma, defined as bleeding with vital commitment that required drainage or rehospitalization. Results 310 patients participated in the study. 156 patients were randomized to the intervention group and 153 to usual care. The mean age of the sample was 73.77 ± 10.68 years and 74.8% were men. There were no significant differences between the intervention and usual care groups on any baseline demographic or clinical characteristics. A total of 13 patients presented hematoma and 36 patients presented ecchymosis. In the intervention group, 5.88% (n = 18) of ecchymosis and 1.3% (n = 4) of mild hematoma were observed. In the usual care group, 5.88% (n = 18) of ecchymosis and 2.9% (n = 9) of mild hematoma were observed. No patient in neither groups had severe hematoma. No significant differences were observed between the two types of bandage in any of the 3 levels of hematomas. There were also no significant differences between hematoma and the type of platelet antiaggregants or oral anticoagulant. Conclusion After this study it is observed that there is no difference between applying a compression bandage with or without cold.