TIMING FROM ADMISSION TO DEBRIDEMENT, ANTIBIOTIC, AND IMPLANT RETENTION (DAIR) AFFECTS TREATMENT SUCCESS IN TOTAL KNEE ARTHROPLASTY PROSTHETIC JOINT INFECTION
Notice bibliographique
Résumé
Prosthetic joint infection (PJI) represents a devastating complication associated with increased patient morbidity, mortality and a decreased quality of life. DAIR is an attractive treatment option in patients presenting with acute PJI due to its reduced morbidity, cost and technical ease of the procedure. Time from hospital admission to surgery is a factor known to be associated with outcomes for several orthopaedic procedures, notably in the care of hip fractures. Little is known, however, with regards to whether time from admission to DAIR affects outcomes. As such, we developed a study to assess the association of factors associated with failure of DAIR in total knee arthroplasty (TKA). This is a retrospective, consecutive series from a single academic, tertiary referral centre specializing in the treatment of PJI. A search of our institutional PJI registry was conducted between 2008 and 2021 for patients having undergone DAIR following TKA at a minimum 2-year follow-up. Baseline patient and surgical characteristics were collected. The primary outcome assessed was reoperation for recalcitrant PJI. Secondary outcomes assessed were: 90-day readmission, 90- day and 1- year mortality, Post-operative complications, and use of chronic suppressive antibiotic therapy. Multivariate regression analysis was performed to determine the effect of variables on outcomes and reported as odds ratios (OR) and confidence intervals (CI) with p < 0 .05 considered statistically significant. A total of 121 patients satisfied final inclusion criteria for this study, consisting of 89 primary TKAs and 22 revision TKAs. Mean age at time of DAIR was 67.8 + 11 years. Multivariate regression analysis of our primary outcome demonstrated that time from admission to DAIR > 48 hours was associated with a substantial increase in risk for reoperation for PJI (OR: 8.7, CI95% 1.5-51.1, p = 0.017). Post-operative complications were positively associated with DAIR >48 hours from admission (OR: 47.7, CI95% 2.7 – 827.1, p = 0.008). 90-day readmission was associated with lower preoperative Hb (OR: 1.04, CI95% 1.01 – 1.07, p = 0.014). Similarly, 1-year all-cause mortality was associated with lower preoperative Hb (OR: 1.06, CI95% 0.99 – 1.14, p = 0.082). The results of this study suggest that the timing of hospital admission to DAIR has both a significant impact on reoperation for recalcitrant PJI and one-year mortality risk. Akin to the treatment of hip fractures, care should be provided within 48 hours of admission to reduce treatment failure and mortality. In lieu of these findings, surgeons should advocate for rapid OR access when performing DAIR in the treatment of TKA PJI. Further research is required to delineate more specific time cut-offs in DAIR for TKA PJI.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».