This study aimed to identify risk factors for development of deep periprosthetic joint infection (PJI) in patients following surgical treatment of neck of femur fracture. This study identified a consecutive series of 2,822 (2,052 female, 73%) patients who underwent either hemiarthroplasty (n=1,825, 65%) or fixation (DHS) (n=997, 35%) for fractured neck of femur performed between January 2009 and June 2015 at our institution. Full patient demographics, co-morbidity and peri-operative complication data were determined. The majority of patients were either ASA 2 (n=663, 23%) or ASA 3 (n=1,521, 54%), mean age = 81.3 years (SD 10.3). All patients were followed up post-operatively by a dedicated surgical site infection (SSI) monitoring team in order to identify patients who developed a PJI within 1 year. A stepwise multivariable logistic regression model was used to identify patient and surgical factors associated with increased risk of infection. Predictors with a p-value of <0.20 in the univariate analysis were included in the multivariate analysis.Aim
Method
Arthroplasty requires an interdisciplinary multimodal approach with anaesthetists playing a key role; providing stable intra-operative conditions, allowing rapid patient recovery, optimising analgeisa and minimizing side-effects. The incidence of post-operative urinary retention (POUR) varies significantly in joint arthroplasty (10–84%). Current literature quotes lower doses of opioids have been shown to reduce POUR, however studies consistently show spinal opioids influence bladder function causing urinary retention. Existing literature fails to comment upon the rate of POUR following joint arthroplasty comparing intrathecal diamorphine against intrathecal local anaesthetic (ITLA) within a modern fast track arthroplasty system (FTA). A two-year (2009–11) retrospective analysis was conducted encompassing a multi-surgeon duel-centre review. Rates of POUR were compared when utilising ITLA and multimodal analgesia including local anaesthetic infiltration (LIA) (site A) against ITLA in combination with intrathecal diamorphine (site B) for joint arthroplasty under spinal analgesia. Outcomes were analysed using 30-day POUR rates coding data and cross-referenced against patient records. Information was collected on patient co-morbidity, age, gender, surgery duration and renal function. Patients were excluded for previous POUR, prostate pathology, postoperative PCA, and conversion to general anaesthetic.Background
Methods
