Dijkman C, Thomas A R, van Boekel L, Oost I Koenraadt-Van, van Geenen R C I
Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.
Foundation for Orthopaedic Research, Care and Education, Amphia Hospital, Breda, The Netherlands.
Arch Orthop Trauma Surg. 2024 Dec 16;145(1):56. doi: 10.1007/s00402-024-05658-y.
Wound drainage after total knee or hip arthroplasty is a relatively frequent complication. It results in delayed mobilization, prolonged hospital stay, increased costs and is associated with an increased risk of infection. In this study, tissue adhesive was administered as an adjunct to skin closure with staples.
From February 2017, in a cohort of 1000 consecutive patients receiving primary total hip, total knee (TKA) or unicondylar knee arthroplasty, tissue adhesive was administered after skin closure with staples. Patients were prospectively analyzed for increased duration of hospital admission due to wound drainage. This cohort was compared to a consecutive cohort of 1000 patients before February 2017, treated with the same perioperative protocol, except for administration of tissue adhesive for skin closure. Difference in number of patients requiring prolonged hospital stay due to wound drainage was assessed between the two cohorts. Besides, costs of tissue adhesive were compared to change in hospital admission costs to assess the cost-effectiveness.
The number of patients requiring prolonged hospital admission due to wound drainage was significantly reduced in the study group compared to the group not treated with tissue adhesive (39/990 patients vs. 68/961 patients, p = 0.002). The mean number of extra days of hospital admission due to wound drainage was also significantly lower in the tissue adhesive cohort (0.06 vs. 0.13 days). The mean number of extra days in hospital only proved to be significant in the TKA cohort. Total money saved by preventing prolonged hospital admission in general cohort amounted €19,610.
This study proves that tissue adhesive as an adjunct to staples for wound closure after total knee arthroplasty reduces wound drainage and is cost effective. Besides, this could potentially lead to lower rates of periprosthetic joint infection. Therefore, the use of tissue adhesive in total knee arthroplasty would be recommended.
全膝关节或全髋关节置换术后伤口引流是一种较为常见的并发症。它会导致活动延迟、住院时间延长、费用增加，并且感染风险也会升高。在本研究中，组织粘合剂作为皮肤缝合钉闭合皮肤的辅助手段使用。
从2017年2月起，在1000例连续接受初次全髋关节、全膝关节（TKA）或单髁膝关节置换术的患者队列中，在使用缝合钉闭合皮肤后应用组织粘合剂。对患者因伤口引流导致住院时间延长的情况进行前瞻性分析。将该队列与2017年2月之前的1000例连续患者队列进行比较，除了皮肤闭合使用组织粘合剂外，两组患者的围手术期方案相同。评估两组队列中因伤口引流需要延长住院时间的患者数量差异。此外，比较组织粘合剂的成本与住院费用的变化，以评估成本效益。
与未使用组织粘合剂治疗的组相比，研究组中因伤口引流需要延长住院时间的患者数量显著减少（990例患者中有39例 vs. 961例患者中有68例，p = 0.002）。组织粘合剂队列中因伤口引流导致的平均额外住院天数也显著更低（0.06天 vs. 0.13天）。仅在TKA队列中，平均额外住院天数被证明具有统计学意义。在总体队列中，通过防止延长住院时间总共节省了19,610欧元。
本研究证明，在全膝关节置换术后，组织粘合剂作为缝合钉闭合伤口的辅助手段可减少伤口引流且具有成本效益。此外，这可能会降低假体周围关节感染的发生率。因此，建议在全膝关节置换术中使用组织粘合剂。
