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1.
Xi Yu Hong Wang Xin Duan Ming Liu Zhou Xiang 《Acta orthopaedica et traumatologica turcica》2018,52(4):299-307
Objective
The aim of this meta-analysis was to explore the difference between and compare intramedullary fixation (IF) and extramedullary fixation (EF) for unstable intertrochanteric fractures.Methods
We searched Pubmed database and Cochrane library following by including and excluding articles based from inception to December, 2016. All randomized controlled trials (RCTs) comparing IF and EF for unstable intertrochanteric fractures were assessed and selected by two researchers independently. Data were analyzed using Review Manager 5.1 version.Results
17 RCTs were enrolled in our meta-analysis comparing IF and EF and showed evidence that IF had lower rate of implant failure RR = 0.2695%CI 0.13–0.51, P < 0.0001 and re-operation (RR = 0.60, 95%CI 0.37–0.98, P = 0.04), while there was no statistical differences of cut-out, postoperative infections and other complications. Moreover, PPM scores verified that IF had better postoperative hip mobility recovery (MD = 0.87, 95%CI 0.08–1.66, P = 0.03).Conclusion
IF has lower incidence of failure of implant and reoperation and shows better postoperative functional recovery when treating adult unstable intertrochanteric fracture while the most postoperative complications were not statistically different from EF.Level of evidence
Level I, therapeutic study. 相似文献2.
Dong-Yeong Lee Young-Jin Park Hyun-Jung Kim Hyeong-Sik Ahn Sun-Chul Hwang Dong-Hee Kim 《Acta orthopaedica et traumatologica turcica》2018,52(2):101-108
Introduction
The aim of this study is to evaluate whether early (<8 h) surgical decompression is better in improving neurologic outcomes than late (≥8 h) surgical decompression for traumatic spinal cord injury (tSCI).Methods
The various electronic databases were used to detect relevant articles published up until May 2016 that compared the outcomes of early versus late surgery for tSCI. Data searching, extraction, analysis, and quality assessment were performed according to Cochrane Collaboration guidelines. The results are presented as relative ratio (RR) for binary outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CIs).Results
Seven studies were finally included in this meta-analysis. There were significant differences between the 2 groups in neurologic improvement (MD = 0.54, 95% CI = ?18.52 to ?7.02, P < 0.0001) and length of hospital stay (MD = ?12.77, 95% CI = 0.34–0.74, P < 0.00001). However, no significant differences were found between the 2 groups in perioperative complications (OR = 0.95, 95% CI = 0.35–2.61, P = 0.92).Conclusions
Early surgical decompression within 8 h after tSCI was beneficial in terms of neurologic improvement compared with late surgery. Early surgical decompression (within 8 h) is recommended for patients with tSCI.Level of evidence
Level III, therapeutic study. 相似文献3.
Susan M. Nedza Donald E. Fry Michael Pine Agnes M. Reband Pan Chen Gregory Pine 《American journal of surgery》2018,215(3):367-370
Background
Preoperative emergency department (ED) visits may reflect the patient's biliary disease, or may signal unstable comorbid conditions that have relevance following inpatient laparoscopic cholecystectomy (ILC) and outpatient laparoscopic cholecystectomy (OLC) in Medicare patients.Methods
We used the Medicare inpatient and outpatient Limited Datasets to identify elective laparoscopic cholecystectomy patients from 2011 to 2014. ED visits for 30-days before the surgical event were identified and correlated with the probability of patients returning to the ED in the 30-days following the procedure.Results
A total of 129,377 inpatient and 235,339 outpatient LCs were identified. A total of 20,021 (15.5%) of ILCs and 52,025 (22.1%) of OLCs had 30-day preoperative ED visits. ILCs with any 30-day ED visit preoperatively had an Odds Ratio (OR) that predicted a post-discharge ED visit of 1.85 (95% CI = 1.78–1.92; P < 0.0001). OLCs with any 30-day ED visit preoperatively had an OR for post-discharge ED visit of 1.50 (95% CI = 1.46–1.54; P < 0.0001).Conclusion
Preoperative ED visits predict postdischarge ED visits for laparoscopic cholecystectomy in Medicare patients. 相似文献4.
O. Tatli O. Bekar M. Imamoglu O. Gonenc Cekic A. Aygun U. Eryigit Y. Karaca A. Sahin S. Turkmen S. Turedi 《Transplantation proceedings》2017,49(8):1702-1707
Aim
To investigate the efficacy of cerebral oximetry (CO) as an auxiliary diagnostic tool in brain death (BD).Materials and Methods
This observational case-control study was performed on patients with suspected BD. Patients with diagnosis of BD confirmed by the brain death committee were enrolled as the BD group and other patients as the non-BD group. CO monitoring was performed at least 6 h, and cerebral tissue oxygen saturation (ScO2) parameters were compared.Results
Mean ScO2 level in the BD group was lower than non-brain-dead patients: mean difference for right lobe = 6.48 (95% confidence interval [CI] 0.08–12.88) and for left lobe = 6.09 (95% CI ?0.22–12.41). Maximum ScO2 values in the BD group were significantly lower than the non-BD group: mean difference for right lobe = 8.20 (95% CI 1.64–14.77) and for left lobe = 9.54 (95% CI 3.06–16.03). The area under the curve for right lobe maximum ScO2 was 0.69 (95% CI 0.55–0.81) and for left lobe was 0.72 (95% CI 0.58–0.84).Conclusion
Maximum ScO2 in brain-dead patients at CO monitoring is significantly low. However, this cannot be used to differentiate brain-dead and non-brain-dead patients. CO monitoring is therefore not an appropriate auxiliary diagnostic tool for confirming BD. 相似文献5.
J. Gołębiewska J. Solomina M.R. Kijek A. Kotukhov L. Basto K. Gołąb P.J. Bachul E. Konsur K. Ciepły N. Fillman L.-j. Wang C.C. Thomas L.H. Philipson M. Tibudan A. Krenc A. Dębska-Ślizień J. Fung P. Witkowski 《Transplantation proceedings》2017,49(10):2340-2346
Background
BETA-2 score using a single fasting blood sample was developed to estimate beta-cell function after islet transplantation (ITx) and was validated internally by a high ITx volume center (Edmonton). The goal was to validate BETA-2 externally, in our center.Methods
Areas under receiver operating characteristic curves (AUROCs) were obtained to see if beta score or BETA-2 would better detect insulin independence and glucose intolerance.Results
We analyzed values from 48 mixed meal tolerance tests (MMTTs) in 4 ITx recipients with a long-term follow-up to 140 months (LT group) and from 54 MMTTs in 13 short-term group patients (ST group). AUROC for no need for insulin support was 0.776 (95% confidence interval [CI] 0.539–1, P = .02) and 0.922 (95% CI 0.848–0.996, P < .001) for beta score and 0.79 (95% CI 0.596–0.983, P = .003) and 0.941 (95% CI 0.86–1, P < .001) for BETA-2, in LT and ST groups, respectively, and did not differ significantly. In LT group BETA-2 score ≥ 13.03 predicted no need for insulin supplementation with sensitivity of 98%, specificity of 50%, positive predictive value (PPV) of 93%, and negative predictive value (NPV) of 75%. In ST group the optimal cutoff was ≥13.63 with sensitivity of 92% and specificity, PPV, and NPV 82% to 95%. For the detection of glucose intolerance BETA-2 cutoffs were <19.43 in LT group and <17.23 in ST group with sensitivity > 76% and specificity, PPV, and NPV > 80% in both groups.Conclusion
BETA-2 score was successfully validated externally and is a practical tool allowing for frequent and reliable assessments of islet graft function based on a single fasting blood sample. 相似文献6.
Momotaro Kawai Atsushi Tanji Takayuki Nishijima Koichi Tateyama Yuhei Yoda Ai Iizuka Yusaku Kamata Tadahisa Urabe 《Journal of orthopaedic science》2018,23(6):987-991
Background
It remains unclear whether early surgical intervention can reduce mortality after surgery in hip fracture patients. The aim of this study was to investigate the association between time from injury to surgery and mortality rate within 90 days after hip fracture surgery.Methods
We retrospectively identified 1827 patients who underwent hip fracture surgery in a tertiary care center in Japan between April 2007 and March 2017. After applying exclusion criteria (patients with spontaneous fracture, multiple fractures, revision surgery, total hip arthroplasty, or a refusal to participate), 1734 patients were included. We extracted data concerning patients’ age, race, sex, operative procedure, American Society of Anesthesiologists (ASA) score, days from injury to surgery (injury-surgery days), and days from admission to surgery (admission-surgery days), which could affect 90-day mortality after surgery. Variables associated with 90-day mortality were determined using multivariate logistic regression analysis.Results
The 90-day postoperative mortality rate was 3.5% (60 of 1734). Multivariable analysis showed that injury-surgery days were not associated with 90-day mortality (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.80 to 1.05; P = 0.19), and that older age (OR, 1.06; 95% CI, 1.02 to 1.10; P = 0.005), male sex (OR, 3.62; 95% CI, 1.86 to 7.03; P < 0.001) and high ASA score (OR, 2.10; 95% CI, 1.06 to 4.18; P = 0.034) significantly increased 90-day mortality. In addition, admission-surgery days were not associated with 90-day mortality (OR, 0.95; 95% CI, 0.83 to 1.09; P = 0.45).Conclusion
Our results demonstrated that time from injury to surgery was not associated with mortality within 90 days after surgery after adjusting for age, sex, operative procedure, and ASA score. 相似文献7.
Yoshihiro Hagiwara Takuya Sekiguchi Yumi Sugawara Yutaka Yabe Masashi Koide Nobuyuki Itaya Shinichiro Yoshida Yasuhito Sogi Masahiro Tsuchiya Ichiro Tsuji Eiji Itoi 《Journal of orthopaedic science》2018,23(2):334-340
Background
The Great East Japan Earthquake (GEJE) and Tsunami devastated the northeastern coast of Japan on March 11, 2011. This study aimed to determine whether sociopsychological factors, such as sleep disturbance and psychological distress, influenced new-onset subjective knee pain in survivors during the post-disaster phase of the GEJE.Methods
From November 2012 to February 2013 (2 years after the GEJE) and from November 2013 to February 2014 (3 years after the GEJE), survivors (≥18 years) completed self-reported questionnaires. A total of 1470 survivors responded to the questionnaires and were included in this study. New-onset subjective knee pain was defined as knee pain by encircled response absent at 2 years but present at 3 years after the GEJE. Two years after the GEJE, ≥10/24 points on the Kessler Psychological Distress Scale, and ≥6/24 points on the Athens Insomnia Scale defined the presence of psychological distress and sleep disturbance, respectively. Multiple logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between new-onset subjective knee pain and psychological distress or sleep disturbance.Results
Among the participants, 10.9% (160/1470) reported experiencing new-onset subjective knee pain. Sleep disturbance was significantly associated with new-onset subjective knee pain (OR, 1.57, 95% CI, 1.08–2.29, P = 0.017); however, psychological distress was not (OR, 1.07, 95% CI, 0.65–1.78, P = 0.80).Conclusions
This is the first study to indicate an association between sleep disturbance and new-onset subjective knee pain among survivors of the GEJE. 247/300. 相似文献8.
G. Mattei A. Laghi S. Balduzzi M. Moscara C. Piemonte C. Reggianini M. Rigatelli S. Ferrari L. Pingani G.M. Galeazzi 《Transplantation proceedings》2017,49(9):2105-2109
Objective
The objective of this study was to identify possible biopsychosocial predictors of organizational complexity in patients referred to the consultant psychiatrist for assessment before liver transplantation.Methods
This was a case-control study. All psychiatric consultations performed before and after liver transplantation from January 1, 2008 to December 31, 2013 were included. Complexity was operationalized as “undergoing two or more psychiatric consultations”. Controls were defined as patients who were assessed only once by the consultant. Cases were represented by patients who underwent two or more consultations. Statistical analysis was performed with STATA 13.1, using logistic regressions.Results
In this study, 515 consultations were requested for 309 patients potentially eligible for liver transplantation. Controls were 209 (67.6%); cases were 100 (32.4%). Positive psychiatric history (odds ratio [OR] = 2.44; 95% confidence interval [CI], 1.43–4.16), viral or toxic (alcohol- or drug-related) liver disease (OR = 1.93; 95% CI, 1.09–3.42), use of psychotropic medications at the baseline (OR = 2.15; 95% CI, 1.14–4.07), and female gender (OR = 1.77; 95% CI, 1.01–3.11) were significantly associated with an increased probability of being cases.Conclusions
Positive psychiatric history, viral or toxic liver disease, use of psychotropic medications at the index referral, and female gender are possible biopsychosocial predictors of complexity in patients eligible for liver transplantation. 相似文献9.
Amandeep Ghuman Naomi Kasteel Ahmer A. Karimuddin Carl J. Brown Manoj J. Raval P. Terry Phang 《American journal of surgery》2018,215(5):949-952
Background
High urinary infection (UTI) rate (12%) for our rectal surgery prompted practice change to early catheter removal (postoperative day 2) and prophylactic tamsulosin. Here we report urinary retention (UR) and UTI after this change.Methods
Retrospective cohort study in male patients 50+ years undergoing elective colorectal surgery from July 2015 to July 2017. Multivariate regression was used to determine risk factors for urinary retention.Results
157 patients, 57 without and 100 with tamsulosin had UR 11.46% and UTI 5.13%. Of all potential risk factors, ileus (OR 5.50, 95% CI: 1.86–16.24) was an independent risk factor for urinary retention.Conclusions
Urinary retention of 11% after colorectal resection is within literature range and associated with post-operative ileus. Tamsulosin did not affect UR in our small study sample. Early catheter removal was associated with decreased UTI rate. 相似文献10.
Benjamin C. Jordan Joseph Brungardt Jared Reyes Stephen D. Helmer James M. Haan 《American journal of surgery》2018,215(1):48-52
Background
The specific contribution of dementia towards mortality in trauma patients is not well defined. The purpose of the study was to evaluate dementia as a predictor of mortality in trauma patients when compared to case-matched controls.Methods
A 5-year retrospective review was conducted of adult trauma patients with a diagnosis of dementia at an American College of Surgeons-verified level I trauma center. Patients with dementia were matched with non-dementia patients and compared on mortality, ICU length of stay, and hospital length of stay.Results
A total of 195 patients with dementia were matched to non-dementia controls. Comorbidities and complications (11.8% vs 12.4%) were comparable between both groups. Dementia patients spent fewer days on the ventilator (1 vs 4.5, P = 0.031). The length of ICU stay (2 days), hospital length of stay (3 days), and mortality (5.1%) were the same for both groups (P > 0.05).Conclusions
Dementia does not appear to increase the risk of mortality in trauma patients. Further studies should examine post-discharge outcomes in dementia patients. 相似文献11.
Francesco Muratori Filippo Frenos Leonardo Bettini Davide Matera Nicola Mondanelli Maurizio Scorianz Pierluigi Cuomo Guido Scoccianti Giovanni Beltrami Daniela Greto Lorenzo Livi Giacomo Baldi Giuliana Roselli Rodolfo Capanna Domenico Andrea Campanacci 《Journal of orthopaedic science》2018,23(6):1038-1044
Background and objectives
Liposarcoma (LPS) is a malignant mesenchymal tumor and the most common soft tissue sarcoma. Four different subtypes are described: well differentiated (WD) LPS or atypical lipomatous tumor (ALT), dedifferentiated (DD) LPS, myxoid LPS, and pleomorphic LPS (PLS). The objective of the study was to investigate prognostic factors and clinical outcome of liposarcoma.Methods
We retrospectively examined the clinico-pathological features of a series of 307 patients affected by Liposarcoma at a mean follow-up of 69 months (range 6–257). ALT/WD LPS were analyzed separately. The influence of site, size, type of presentation, grading, histotype and local recurrence on local and systemic control and survival was assessed.Results
The statistical analysis indicated that only surgical margins represented a significant prognostic factor for local recurrence in ALT/WD LPS (P = 0.0007) and other subtypes of LPS (P = 0.0055). In myxoid, PLS and DD LPS, significant prognostic factors for metastasis free survival (MFS) were surgical margins (P = 0.0009), size of the tumor (P = 0.0358), histology (P = 0.0117) and local recurrence (P = 0.0015). In multivariate analysis, surgical margins (0.0180), size (0.0432) and local recurrence (0.0288) correlated independently with MFS. Margins (P = 0.0315), local recurrence (P = 0.0482) and metastases (P < 0.0001) were prognostic factors for overall survival (OS).Conclusion
Marginal surgery can be an accepted treatment for ALT/WD LPS. In other liposarcoma subtypes (Myxoid, DD, PLS) wide or radical surgery is recommended as the margins significantly influence local recurrence-free survival (LRFS), metastasis-free survival (MFS) and overall survival (OS). Local recurrence and metastases were significant prognostic factors for OS. 相似文献12.
Laquanda T. Knowlin Laura Purcell Bruce A. Cairns Anthony G. Charles 《American journal of surgery》2018,215(6):1011-1015
Introduction
We sought to examine the impact of preexisting and new onset renal disease on burn injury mortality.Methods
Retrospective analysis of patients admitted to a regional burn center from 2002-2012 was performed. Variables analyzed included demographics, burn mechanism, inhalation injury status, and % TBSA. Poisson regression was performed to estimate risk of in-hospital burn mortality.Results
There were a total of 7640 patients over the study period. The adjusted 60-day risk of in-hospital mortality in patients with preexisting renal disease (PRD was 3 times higher compared to patients with no preexisting renal disease (IRR?=?3.22, 95% CI?=?1.26–8.25). The adjusted 60-day risk of mortality is 2 times higher for patients with new onset renal disease compared to those without (IRR?=?2.11, 95% CI?=?1.55–2.87).Conclusion
Preexisting and new onset renal disease results in a significantly higher risk of mortality following burn injury compared to patients without renal disease. Prevention of new onset renal injury and careful management of patients with preexisting renal disease to prevent exacerbation should be pursued. 相似文献13.
Jichao Yin Hongmou Zhao Guihua Zhuang Xiaojun Liang Xinglv Hu Yi Zhu Rongqiang Zhang Xiaochen Fan Yi Cao 《Journal of orthopaedic science》2018,23(3):552-556
Background
This cross-sectional study aims to investigate the flexible flatfoot (FFF) prevalence and related factors in school-aged children.Methods
A total of 1059 children aged 6–13 years were included. Dynamic footprints according to the FootScan system were collected from both feet. The relationship of FFF with age, gender, side, and body mass index (BMI) was investigated.Results
FFF percentage decreased from 39.5% at 6 years to 11.8% at 12 years and reached a plateau at 12–13 years. Overweight (OR 1.35, 95%CI 1.03–1.77, P = 0.03) and obese (OR 2.43, 95%CI 1.81–3.26, P＜0.01) showed a positive correlation with percentage of FFF children. No correlation was found between FFF prevalence and gender or side.Conclusions
FFF prevalence decreases with age and reaches a plateau at 12–13 years. Moreover, FFF prevalence is positively correlated with increased BMI and body height. 相似文献14.
Gorav Ailawadi Helena L. Chang Patrick T. O&#x;Gara Karen O&#x;Sullivan Y. Joseph Woo Joseph J. DeRose Michael K. Parides Vinod H. Thourani Sophie Robichaud A. Marc Gillinov Wendy C. Taddei-Peters Marissa A. Miller Louis P. Perrault Robert L. Smith Lyn Goldsmith Keith A. Horvath Kristen Doud Kim Baio Alexander Iribarne 《The Journal of thoracic and cardiovascular surgery》2017,153(6):1384-1391.e3
Rationale
Pneumonia remains the most common major infection after cardiac surgery despite numerous preventive measures.Objectives
To prospectively examine the timing, pathogens, and risk factors, including modifiable management practices, for postoperative pneumonia and estimate its impact on clinical outcomes.Methods
A total of 5158 adult cardiac surgery patients were enrolled prospectively in a cohort study across 10 centers. All infections were adjudicated by an independent committee. Competing risk models were used to assess the association of patient characteristics and management practices with pneumonia within 65 days of surgery. Mortality was assessed by Cox proportional hazards model and length of stay by a multistate model.Measurements and Main Results
The cumulative incidence of pneumonia was 2.4%, 33% of which occurred after discharge. Older age, lower hemoglobin level, chronic obstructive pulmonary disease, steroid use, operative time, and left ventricular assist device/heart transplant were risk factors. Ventilation time (24-48 vs ≤24 hours; hazard ratio [HR], 2.83; 95% confidence interval [95% CI], 1.72-4.66; >48 hours HR, 4.67; 95% CI, 2.70-8.08), nasogastric tubes (HR, 1.80; 95% CI, 1.10-2.94), and each unit of blood cells transfused (HR, 1.16; 95% CI, 1.08-1.26) increased the risk of pneumonia. Prophylactic use of second-generation cephalosporins (HR, 0.66; 95% CI, 0.45-0.97) and platelet transfusions (HR, 0.49, 95% CI, 0.30-0.79) were protective. Pneumonia was associated with a marked increase in mortality (HR, 8.89; 95% CI, 5.02-15.75) and longer length of stay of 13.55 ± 1.95 days (bootstrap 95% CI, 10.31-16.58).Conclusions
Pneumonia continues to impose a major impact on the health of patients after cardiac surgery. After we adjusted for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research. 相似文献15.
Donghai Li Xiaowei Xie Pengde Kang Bin Shen Fuxing Pei Changde Wang 《Journal of orthopaedic science》2017,22(6):1060-1065
Background
The purpose of this study was to evaluate the clinical results, survivorship and quick rehabilitation effects of modified surgery of percutaneously drilling and decompression through femoral head and neck fenestration combined with compacted autograft for early femoral head necrosis.Methods
We conducted a retrospective cohort study with 83 hips performed percutaneous decompression through femoral head and neck fenestration (Modified group) combined with autogenous bone grafting for early ONFH. For comparison, another 90 hips treated with conventional core decompression with bone grafting (Control group).Results
Median follow-up was 36 months (32–44 months). The length of incision, blood loss in operation, incision drainage, operation time and hospital stays in Modified group had better results than those in control group (P < 0.001). There were four cases in Modified group and five cases in control group had complications (P = 0.9). The VAS score and range of hip motion were better in Modified group during hospital stays summarily (P < 0.05). The average Harris score in modified group was higher than the control group at the first month (P = 0.005), while at other time of follow-up the two groups were with similar Harris scores (P > 0.05). There were 22 hips progressed to stage III in Modified group, while 23 hips progressed to stage III in control group (P = 0.89). The clinical success rate in Modified group were 86.7%, compared with that in control group (87.8%) ( P= 0.84).Conclusion
Percutaneous drilling and decompression through femoral head and neck fenestration combined with compacted autograft we reported showed an good surgical effect with a quick rehabilitation and had similar short-term effects compared with the conventional core decompression in treatment of early ONFH. 相似文献16.
Dirk van Osch Jan M. Dieleman Jeroen J. Bunge Diederik van Dijk Pieter A. Doevendans Willem J. Suyker Hendrik M. Nathoe 《The Journal of thoracic and cardiovascular surgery》2017,153(4):878-885.e1
Objective
The study aim was to investigate the long-term prognosis and risk factors of postpericardiotomy syndrome (PPS).Methods
We performed a single-center cohort study in 822 patients undergoing nonemergent valve surgery. Risk factors of PPS were evaluated using multivariable logistic regression analysis. We also compared the incidence of reoperation for tamponade at 1 year between patients with and without PPS. Main secondary outcomes were hospital stay and mortality.Results
Of the 822 patients, 119 (14.5%) developed PPS. A higher body mass index (odds ratio (OR) per point increase, 0.94; 95% confidence interval (CI), 0.89-0.99) was associated with a lower risk of PPS, whereas preoperative treatment for pulmonary disease without corticosteroids (OR, 2.55; 95% CI, 1.25-5.20) was associated with a higher risk of PPS. The incidence of reoperation for tamponade at 1 year in PPS versus no PPS was 20.9% versus 2.5% (OR, 15.49; 95% CI, 7.14-33.58). One-year mortality in PPS versus no PPS was 4.2% versus 5.5% (OR, 0.68; 95% CI, 0.22-2.08). Median hospital stay was 13 days (interquartile range, 9-18 days) versus 11 days (interquartile range, 8-15 days) (P = .001), respectively.Conclusions
Despite longer hospital stays and more short-term reoperations for tamponade, patients with PPS had an excellent 1-year prognosis. 相似文献17.
Hirokazu Shoji Toru Hirano Kei Watanabe Masayuki Ohashi Tatsuki Mizouchi Naoto Endo 《Journal of orthopaedic science》2018,23(3):449-454
Background
In spinal instrumentation surgeries, surgical site infection (SSI) is one of the complications to be avoided. However, spinal instrumentation surgeries have a higher rate of SSI than other clean orthopedic surgeries. The purpose of this study was to investigate the risk factors for SSI following spinal instrumentation surgeries and contribute to the prevention of SSIs by identifying high-risk patients.Methods
Records of 431 patients who underwent spinal instrumentation surgeries from 2011 to 2014 with a minimum follow-up period of 90 days were retrospectively reviewed. Associations of SSI with various preoperative, operative, and postoperative factors were statistically analyzed with univariate and stepwise multivariate logistic regression analysis.Results
Deep or superficial SSIs were observed in 15 patients (3.5%). Univariate analysis revealed significant association of SSI with diabetes mellitus (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.5–14.4; p = 0.012) and serum albumin ≤3.5 g/dl (OR 3.35, 95% CI 1.1–10.38, p = 0.012). The number of regular medications prescribed in patients with SSI (8.2 ± 5.4) was significantly more than that in patients without SSI (3.8 ± 4.4) (p = 0.001), and the cut-off value of the number of medications was 7, as derived from receiver operating characteristics analysis. Multivariate analysis revealed that the number of regular medications ≥7 was an independent risk factor significantly associated with SSIs (OR 7.3, 95% CI 2.3–24.0, p = 0.001).Conclusions
Our study demonstrated that an important risk factor for SSI after spinal instrumentation surgery was number of regular medications ≥7. Number of regular medications is a simple and valuable risk index for SSI, which reflects the influence of medications and comorbidities. 相似文献18.
Jie Wang Yandong Lu Yujie Cui Xuelei Wei Jie Sun 《Acta orthopaedica et traumatologica turcica》2018,52(5):334-342
Objective
The aim of this meta-analysis of randomized controlled trials (RCT) and retrospective cohort studies (CS) regarding the use of volar locking plate (VLP) and external fixation (EF) in distal radius fractures was to determine whether there was any evidence that one treatment was superior to the other.Methods
The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electrical databases (PubMed, EMBASE and the Cochrane library) were retrieved to find RCTs and CSs met the eligibility criteria. Two reviewers screened the studies, extracted the data and evaluated the methodological quality, and performed data analysis with RevMan 5.1. The publication bias was test by Stata 14.0. The Begg's and Egger's test were performed by Stata 14.0. The quality of evidence was graded according to the criteria of GRADE. We ultimately included ten RCTs and eleven CSs.Results
A total of 1590 subjects were reported. Publication bias was detected by funnel plot in RCTs. VLP could provide better results such as DASH scores (RCT: MD = ?6.12, 95%CI = ?12.07–0.17; CS: MD = ?6.43, 95%CI = ?12.53–0.3), ulnar variance (RCT: MD = ?0.81, 95%CI = ?1.25–0.37) and infection rate (RCT: RR = 0.25, 95%CI = 0.10–0.65; CS: RR = 0.15, 95%CI = 0.06–0.40). There were no significant differences for G-W scores, VAS and grip strength between the VLP group and EF group. There was significantly greater loss of volar tilt (P = 0.01) and radial inclination (P = 0.02) in patients receiving EF, basing on the CSs.Conclusions
VLP could provide better results, such as DASH scores, ulnar variance, volar tilt, radial inclination and infection rate. The use of VLP appear to be associated with better results of ROM (flexion, pronation, supination and radial deviation), radiographic parameters (volar tilt and radial inclination) and lower total complication rate and CRPS rate in CSs.Level of evidence
Level 1, Therapeutic study. 相似文献19.
Background
In kidney transplant recipients (KTRs) with hepatitis B virus (HBV) infection, immunosuppression may increase viral replication with increased risk for liver disease progression and HBV-related kidney diseases, factors that could adversely influence graft and patient outcomes. We aimed to analyze the impact of different phases of HBV infection on the outcomes in KTRs.Methods
Using the Organ Procurement and Transplant Network/United Network for Organ Sharing database, we selected adult KTRs from 2001 to 2011 who received peri-operative antibody induction followed by calcineurin inhibitor/mycophenolate mofetil maintenance with/without steroid. The cohort was divided into 4 groups, based on the presence/absence of hepatitis B surface antigen (HBsAg) and core antibody (HBcAb) at the time of transplantation: group 1: HBsAg+/HBcAb? (acute infection); group 2: HBsAg+/HBcAb+ (developing immune response); group 3; HBsAg?/HBcAb+ (resolving infection); and group 4: HBsAg?/HBcAb? (HBV-naive). Graft and patient survivals were compared among the groups in a multivariate Cox model.Results
Adjusted overall graft (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.90–1.10; P = .58) and patient (HR, 0.95; 95% CI, 0.83–1.09; P = .52) survival rates were similar between groups 1 and 2, with inferior death-censored graft survival in group 1 (HR, 0.83; 95% CI, 0.71–0.98; P = .02). Adjusted over all graft (HR, 1.0; 95% CI, 0.90–1.00; P = .46) and patient (HR, 1.03; 95% CI, 0.90–1.10; P = .10) survival rates were similar between groups 3 and 4, and death-censored graft survival trended inferior in group 3 (HR, 0.97; 95% CI, 0.90–1.00; P = .05).Conclusions
Our analysis supports a practice of delaying kidney transplantation in HBV-infected patients until they develop an immune response and preferably until the infection is cleared. 相似文献20.