Sigurdardottir Maria, Sigurdsson Martin Ingi, Vias Rafael Daniel, Olafsson Yngvi, Gunnarsdottir Ingibjorg, Sigurdsson Emil L, Karason Sigurbergur
Department of Anaesthesia and Intensive Care, Landspitali - The National University Hospital of Iceland, Reykjavik; Faculty of Medicine, University of Iceland, Reykjavik.
Department of Mathematics, Faculty of Physical Sciences, University of Iceland, Reykjavik.
Acta Orthop. 2024 Jul 17;95:392-400. doi: 10.2340/17453674.2024.41012.
The aim of our study was to investigate change in modifiable risk factors following preoperative optimization and whether risk of superficial surgical site infection (SSI) after total joint arthroplasty (TJA) could be reduced.
This is a prospective study of implementation of a preoperative optimization pathway for patients waiting for primary TJA. Information regarding the intervention arm was collected from January 2019 to January 2021, first at decision for operation and then at preoperative assessment 1 week prior to operation. The control arm was included between August 2018 and September 2020 after receiving conventional preoperative preparation and information gathered at preoperative assessment. Follow up occurred 6 weeks postoperatively for both groups. The primary outcome was postoperative superficial SSI.
The optimization effort resulted in improvement of weight, anemia, HbA1c, vitamin D, and patient engagement. At preoperative assessment the baseline characteristics of the 2 groups were similar except that the intervention group had substantially more comorbidities. Regarding superficial SSI, association was found with BMI ≥ 30 and HbA1c ≥ 42 mmol/mol in the control group but not in the intervention group. When corrected for differences in ASA classification (reflecting comorbidities), age, and sex, being in the intervention group was associated with lower odds of occurrence of superficial SSI compared with the control group (OR 0.64, 95% confidence interval 0.42-0.97).
We showed that preoperative optimization in a structured cooperation between hospital and primary care was associated with a reduced risk of superficial SSI.
我们研究的目的是调查术前优化后可改变的风险因素的变化，以及全关节置换术（TJA）后浅表手术部位感染（SSI）的风险是否能够降低。
这是一项针对等待初次TJA患者的术前优化路径实施情况的前瞻性研究。关于干预组的信息收集于2019年1月至2021年1月，首先在决定手术时收集，然后在术前1周进行术前评估时收集。对照组纳入时间为2018年8月至2020年9月，这些患者接受了常规术前准备，并在术前评估时收集信息。两组均在术后6周进行随访。主要结局是术后浅表SSI。
优化措施使体重、贫血、糖化血红蛋白、维生素D以及患者参与度得到改善。在术前评估时，两组的基线特征相似，只是干预组的合并症更多。关于浅表SSI，在对照组中发现与BMI≥30和糖化血红蛋白≥42 mmol/mol有关，而在干预组中未发现。在校正了美国麻醉医师协会（ASA）分级（反映合并症）、年龄和性别差异后，与对照组相比，干预组发生浅表SSI的几率较低（比值比0.64，95%置信区间0.42 - 0.97）。
我们表明，医院与初级保健机构之间进行结构化合作的术前优化与浅表SSI风险降低相关。
