University of Iowa Carver College of Medicine, Iowa City, IA.
University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, IA.
Iowa Orthop J. 2020;40(1):147-151.
We conducted a retrospective review of geriatric hip fractures at our institution evaluating how a change in practice to 2-octyl cyanoacrylate adhesive (Dermabond®) with polyester mesh (Prineo®) and elimination of the 2-week follow-up visit impacts quality and efficiency of care after hip fracture. Our aim was to determine the impact of simplified wound closure and extended clinical follow-up on the number of outpatient calls to nurses and wound complications.
Patients included in this assessment were aged ≥65 years who underwent surgical fixation or hip replacement for proximal femur fracture during a one-year period preceding and following the implementation of Prineo® usage in wound closure (January 1 2017 to December 31, 2018). Information on demographics, comorbidities, nutritional screening, discharge location, wound complications, follow-up rates, and number of call-ins to the on-call nursing line within 6 weeks of surgery were collected via chart review. Cohort demographics and categorical outcomes were compared using Chi Square analysis and Wilcoxon Rank Sum test for continuous variables. The relationships between demographics, wound closure, fracture characteristics, and postoperative SSI was modeled with logistic regression.
A total of 208 (n = 110 pre-practice change) patients were included in this analysis. No differences in age, sex, comorbidity rates, or race were identified between groups at baseline (p >.05). Outcomes analysis of Discharge Disposition, Length of Hospital Stay, SSI, 30 Day Mortality and Readmission found no significant differences between groups. Utilization of the nursing call service did not vary between groups within 6-weeks of surgery (p >.05).
The findings from this study underscore the utility of this closure system in hip fracture wound care and are in concurrence with other studies of Prineo® system that found no significant increase in wound complications up to 6 weeks after surgery.
The benefits of this surgical site closure system include the elimination of a 2-week follow-up and consequential reduction in unnecessary visits. Future analysis is needed to assess more long-term follow-up, determine the cost savings impact of this practice, potential SSI reduction, and assess its application in other surgical settings..
我们对我院的老年髋部骨折进行了回顾性研究，评估了将 2-辛基氰基丙烯酸酯胶粘剂（Dermabond®）与聚酯网（Prineo®）的使用方法改变以及取消术后 2 周随访对髋部骨折后护理质量和效率的影响。我们的目的是确定简化伤口闭合和延长临床随访对护士门诊电话次数和伤口并发症的影响。
本评估纳入年龄≥65 岁，在使用 Prineo®进行伤口闭合的一年期间（2017 年 1 月 1 日至 2018 年 12 月 31 日），接受股骨近端骨折手术固定或髋关节置换的患者。通过病历回顾收集患者的人口统计学、合并症、营养筛查、出院地点、伤口并发症、随访率以及术后 6 周内拨打值班护士热线的次数等信息。使用卡方分析和 Wilcoxon 秩和检验比较队列的人口统计学和分类结局，使用逻辑回归模型分析人口统计学、伤口闭合、骨折特征和术后手术部位感染之间的关系。
共纳入 208 例（110 例为实践改变前）患者进行分析。两组患者在年龄、性别、合并症发生率和种族方面无差异（p>0.05）。两组患者的出院去向、住院时间、手术部位感染、30 天死亡率和再入院率无差异。两组患者术后 6 周内的护士电话服务利用情况无差异（p>0.05）。
本研究结果强调了该闭合系统在髋部骨折伤口护理中的实用性，与其他 Prineo®系统研究结果一致，即术后 6 周内伤口并发症无显著增加。
该手术部位闭合系统的优点包括消除了 2 周随访以及随之而来的不必要的就诊次数。需要进一步分析以评估更长期的随访、确定该实践的成本节约影响、潜在的手术部位感染减少以及评估其在其他手术环境中的应用。
