Retrospective Audit of Prophylactic Use of Antibiotic-Containing Bone Cement for Primary Total Hip and Knee Arthroplasty in the Calgary Health Region
Bibliographic record
Abstract
ABSTRACT Background: Total hip and knee replacements are among the most common orthopedic procedures performed. Although the rate of deep infection after primary arthroplasty is relatively low, infection can lead to significant morbidity and both direct and indirect costs. Antibiotic-containing bone cement has therefore been used to prevent infections after joint replacement procedures, although there are no established guidelines for this practice. Objective: To determine the proportion of orthopedic surgeons in the Calgary Health Region who used antibioticcontaining bone cement as prophylactic therapy in conjunction with primary hip and knee arthroplasty, to identify which antibiotics were used and in what amounts, and to determine patient-related factors that might have influenced the use of such therapy. Methods: A descriptive, retrospective chart audit was conducted for procedures performed between March and May 2006. Data were collected for up to 4 hip and 4 knee arthroplasty procedures for each of 14 orthopedic surgeons. Results: Eleven (79%) of the 14 surgeons who performed the majority of primary arthroplasties used antibiotic-containing bone cement at premixed concentrations. Of the 109 patients whose charts were reviewed, 65 (60%) had received prophylactic therapy with an antibiotic-containing bone cement during the arthoplasty procedure. Patients with at least one immune-status risk factor were significantly more likely to receive this type of therapy than patients with no identified immune-status risk factors (p Conclusion: Orthopedic surgeons in the Calgary Health Region did not follow a standardized practice for the selection of antibiotic-containing bone cement as primary prophylaxis for hip and knee arthroplasty. Rather, practice appeared to be based on individual preference. The reasons for selection of particular products could not be determined from this study. RESUME Contexte : L’arthroplastie totale de la hanche et du genou sont parmi les chirurgies orthopediques les plus pratiquees. Bien que le taux d’infection profonde apres une arthroplastie primaire soit relativement faible dans la pratique d’aujourd’hui, l’infection peut entrainer une morbidite importante ainsi que des couts directs et indirects. Le ciment orthopedique additionne d’antibiotiques est utilise pour prevenir les infections secondaires a une arthroplastie, bien qu’il n’existe aucune ligne directrice definie sur son utilisation. Objectif : Determiner la proportion de chirurgiens orthopedistes du Calgary Health Region qui ont recours au ciment additionne d’antibiotiques a titre prophylactique dans le cadre d’une arthroplastie primaire de la hanche et du genou, dresser la liste des antibiotiques utilises et de leur dose, et etablir les facteurs lies aux patients qui pourraient influer sur le recours a ce traitement prophylactique. Methode : Un audit descriptif et retrospectif des dossiers medicaux a ete mene entre les mois de mars et mai 2006. Les donnees ont ete collectees sur un total d’au plus quatre arthroplasties de la hanche et quatre du genou pour chacun des 15 chirurgiens orthopedistes. Resultats : Onze (79 %) des 14 chirurgiens qui ont pratique la majorite des arthroplasties primaires ont eu recours a un ciment additionne d’antibiotiques a des concentrations premelangees. Des 109 patients dont les dossiers medicaux ont ete analyses, 65 (60 %) ont recu un traitement prophylactique au moyen de ciment additionne d’antibiotiques durant l’arthroplastie. Les patients qui presentaient au moins un facteur de risque immunitaire etaient significativement plus susceptibles de recevoir cette prophylaxie que ceux qui n’en presentaient pas (p Conclusion : Les chirurgiens orthopedistes du Calgary Health Region ne suivent pas de lignes directrices communes dans le choix du ciment additionne d’antibiotiques utilise comme traitement prophylactique primaire de l’arthroplastie de la hanche et du genou. Le choix semble plutot reposer sur les preferences individuelles. Il a ete impossible de cerner les raisons sous-tendant le choix d’un produit particulier.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".