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Will Administering Antibiotics 'Late' Reduce Your SSIs?
TIME CHANGE Each patient received an IV infusion of cefuroxime either "early," in the anesthesia room, or "late," in the OR. The SSI rate was 4.9% in the early group, and 5.3% in the late group.

Will narrowing the window for administering pre-operative antibiotics decrease the likelihood of a patient developing a surgical site infection? Not according to a newly published study conducted by Swiss researchers.

A randomized trial of general surgery adult inpatients at 2 Swiss hospitals attempted to determine the precise optimum timing administration of surgical antimicrobial prophylaxis. Whether the antibiotics were given at about 60 minutes before surgery or at less than 30 minutes, the hospitals showed almost no difference in overall SSIs.

Between Feb. 21, 2013, and Aug. 3, 2015, 5,580 patients received pre-operative antibiotic treatment — specifically, a 1.5g intravenous infusion of cefuroxime (combined with 500mg of metronidazole in colorectal surgery) — either "early," in the anesthesia room, or "late," in the OR. Of those, 5,175 patients were analyzed: 2,589 in the early group; and 2,586 in the late group. The median administration time was 42 minutes before incision in the early group and 16 minutes before incision in the late group.

The overall SSI rate was 5.1% (234 of 4,596) — 4.9% in the early group, and 5.3% in the late group — and the length-of-stay duration and 30-day mortality rates were also similar between the 2 groups. The follow-up rate was 100% (5,175 of 5,175 patients), and the outpatient 30-day follow-up rate was 88.8% (4,596 of 5,175).

Bill Donahue

Sham Knee Arthroscopy as Effective as Real Surgery?
REAL PROGRESS Patients who had "placebo surgeries" improved just as much as those who had actual surgeries.

Patients rarely benefit from knee arthroscopy, according to a new study that calls into question the effectiveness of the most common orthopedic surgery performed on patients with degenerative knee disease.

At 24 months post-op, researchers evaluated 146 patients with degenerative medial meniscal tears but no evidence of knee osteoarthritis who underwent either arthroscopic partial meniscectomy (APM) or so-called sham surgery. Patients who had sham surgeries improved just as much as patients who underwent actual arthroscopies, reported Finnish researchers in Annals of the Rheumatic Diseases.

All 146 study participants had suspected meniscus tears that were later verified by MRI and knee arthroscopy, but 76 were given sham surgeries in which surgeons only simulated APMs, mimicking the sounds and sensations of surgery.

All patients had the same post-op care protocol, and all were evaluated 2 years later by an independent orthopedic surgeon who didn't know which were which, and who evaluated them for pain, range of motion, stability and other criteria.

The results "support the evolving consensus that degenerative meniscus tear represents an (early) sign of knee osteoarthritis, rather than a clinical entity on its own," say the authors. As such, they say, caution is warranted when "referring patients with knee pain and suspicion of a degenerative meniscal tear to MRI examination or APM, even after a failed attempt at conservative treatment."

Knee arthroscopy is performed 2 millions time per year worldwide, most often in middle-aged and older patients with knee symptoms and degenerative knee disease.

Jim Burger

Opioids and Orthopedics Don't Mix
ALTERNATIVE THERAPY Patients should limit their use of opioids before knee replacement surgery.

Orthopedic surgeons need to consider opioid-sparing ways to manage their patients' joint discomfort before and after surgery, according to a pair of newly released studies. One show the pre-op use of opioids negatively impacts the pain patients experience after surgery. The other suggests that overprescribing the powerful painkillers to manage post-op pain could be contributing to the opioid crisis that's gripping the nation. A quick summary of both studies:

  • Patients who use opioids to manage chronic joint discomfort before knee replacement surgery are less likely to experience adequate pain relief after their procedures, according to research published in the Journal of Bone and Joint Surgery. Investigators at Brigham and Women's Hospital in Boston, Mass., reviewed the case outcomes of 156 patients who underwent total knee replacement. According to the study, 23% of the patients filled at least 1 opioid prescription before surgery. Patients who used opioids before surgery experienced about 9% less pain reduction in the 6 months following surgery than patients who did not use opioids.

    The researchers say surgeons need to consider the long-term consequences of opioid use and discuss the potential impact of using the painkillers to control osteoarthritis pain with patients who are considering undergoing total knee replacement within 2 years.

  • Most opioids prescribed following orthopedic procedures go unused, notes research published in the Journal of Pain. The study's authors, who presented their findings at the annual meeting of the American Pain Society, say 96% of 93 patients who underwent orthopedic procedures received at least 1 opioid prescription, with a majority of the products containing immediate release oxycodone. After a month, approximately two-thirds of the patients had completed the opioids therapy.

    Although the average patient used half of the 80 pills they were prescribed, three-fourths of the patients said they received "excellent" or "good" pain control. In addition, most of the patients kept the prescribed pills in an unlocked location, were unaware of the proper way to dispose of unused pills and, in fact, did not get rid of the excess medications. The findings highlight the importance of personalizing opioid prescriptions to individual patients in order to reduce the oversupply of the addictive painkillers in communities across America.

Daniel Cook

InstaPoll: Do You Make Visitors Sign In?

Do you require the person(s) who accompanies the patient to your facility to sign the visitor log? Tell us in this week's InstaPoll.

Nearly two-thirds (65%) of the 298 respondents to last week's InstaPoll require both a monitoring RN and a circulating RN for nurse-monitored sedation cases. AORN recommends that there be 2 perioperative RNs assigned to care for the patient if the patient is receiving moderate sedation — one to administer sedation and monitor the patient, and one to perform the circulating role. The results:

How many RNs work local anesthetic cases?

  • 2 (1 circulating and 1 monitoring) 66%
  • 1 22%

Dan O'Connor

News & Notes
  • Joint Commission updates advisory on sterilization and high-level disinfection The Joint Commission has issued an advisory on safety actions to address the growing problem of improperly sterilized or high-level disinfected equipment. A checklist of recommended actions to help surgical facilities protect patients from the transmission of disease and bacterial agents includes competency and training, evidence-based guidelines and quality monitoring, among others.
  • Guidance on ransomware attacks available ECRI Institute has published free guidance to help hospitals identify and protect against ransomware attacks. The article includes a list of what ECRI calls "immediate do's and don'ts for quickly responding to emerging threats."
  • Enhanced recovery after surgery Twenty hospitals within the Kaiser Permanente health system that implemented the enhanced recovery after surgery (ERAS) program for patients who underwent elective colorectal resection or emergency hip fracture repair realized shorter hospital stays and fewer post-op complications, according to research published in JAMA Surgery. The ERAS program focuses on enhancing patients' perioperative pain management, mobility, nutrition and engagement.