Wound closure and follow-up after total knee arthroplasty - Do they affect the rate of antibiotic prescription?
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ therapeutic use
Arthroplasty, Replacement, Knee
Body Mass Index
Child
Drug Prescriptions
/ statistics & numerical data
Female
Follow-Up Studies
Humans
Male
Middle Aged
New Zealand
Risk Factors
Surgical Stapling
Surgical Wound Infection
/ drug therapy
Sutures
Young Adult
Antibiotics
Follow-up
Knee arthroplasty
Journal
The Knee
ISSN: 1873-5800
Titre abrégé: Knee
Pays: Netherlands
ID NLM: 9430798
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
23
05
2018
revised:
21
01
2019
accepted:
27
01
2019
pubmed:
25
3
2019
medline:
24
10
2019
entrez:
25
3
2019
Statut:
ppublish
Résumé
This study aimed to evaluate risk factors for oral antibiotic prescription in the first six weeks after primary TKA, particularly whether the wound closure method (staples or sutures) and two-week follow-up clinician (surgeon or general practitioner (GP)) altered antibiotic use. Four thousand eight hundred forty-six TKAs from January 2013 to December 2016 at three tertiary hospitals in Auckland, New Zealand were analysed by manual review of patient electronic records and a national prescription database. Surgeon preference dictates the method of wound closure and whether wound review is followed up by the operating surgeon or by the patient's GP. Univariate and multivariate analysis was carried out to identify significant patient and surgical risk factors for oral antibiotic prescribing. Oral antibiotics were prescribed in 24% of patients following primary TKA. Twenty-six percent of patients closed with staples were prescribed oral antibiotics versus 19% with sutures (adjusted OR = 1.4, p < 0.004). Excluding re-presentations and readmissions, GPs prescribed oral antibiotics in 22% of patients compared to seven percent of patients seen by surgeons (adjusted OR = 2.8, p < 0.001). Other risk factors for antibiotic prescription included increasing age, BMI and ASA score. Oral antibiotic prescribing rates are higher if the wound was closed with staples and if a GP performed the two-week follow-up. Improved communication between surgeons and GPs are required to ensure adequate follow-up following TKA and appropriate oral antibiotic use.
Sections du résumé
BACKGROUND
BACKGROUND
This study aimed to evaluate risk factors for oral antibiotic prescription in the first six weeks after primary TKA, particularly whether the wound closure method (staples or sutures) and two-week follow-up clinician (surgeon or general practitioner (GP)) altered antibiotic use.
METHODS
METHODS
Four thousand eight hundred forty-six TKAs from January 2013 to December 2016 at three tertiary hospitals in Auckland, New Zealand were analysed by manual review of patient electronic records and a national prescription database. Surgeon preference dictates the method of wound closure and whether wound review is followed up by the operating surgeon or by the patient's GP. Univariate and multivariate analysis was carried out to identify significant patient and surgical risk factors for oral antibiotic prescribing.
RESULTS
RESULTS
Oral antibiotics were prescribed in 24% of patients following primary TKA. Twenty-six percent of patients closed with staples were prescribed oral antibiotics versus 19% with sutures (adjusted OR = 1.4, p < 0.004). Excluding re-presentations and readmissions, GPs prescribed oral antibiotics in 22% of patients compared to seven percent of patients seen by surgeons (adjusted OR = 2.8, p < 0.001). Other risk factors for antibiotic prescription included increasing age, BMI and ASA score.
CONCLUSION
CONCLUSIONS
Oral antibiotic prescribing rates are higher if the wound was closed with staples and if a GP performed the two-week follow-up. Improved communication between surgeons and GPs are required to ensure adequate follow-up following TKA and appropriate oral antibiotic use.
Identifiants
pubmed: 30904322
pii: S0968-0160(18)30342-9
doi: 10.1016/j.knee.2019.01.017
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
700-707Informations de copyright
Copyright © 2019. Published by Elsevier B.V.