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- Title
Lack of level I evidence on how to prevent infection after elective shoulder surgery.
- Authors
Eck, Carola F.; Neumann, Julie A.; Limpisvasti, Orr; Adams, Christopher R.
- Abstract
<bold>Purpose: </bold>Infection is a concern after all orthopedic procedures, including shoulder surgery. This systematic review of literature aimed to determine risk factors for infection as well as the availability and effectiveness of measures utilized to prevent infection after elective shoulder surgery.<bold>Methods: </bold>An electronic database search was performed using MEDLINE (1950-October 2017), EMBASE (1980-October 2017), CINAHL (1982-October 2017), and the Cochrane database to identify studies reporting a risk factor or preventive measure for infection after shoulder surgery.<bold>Results: </bold>Fifty-one studies were eligible for inclusion. Risk factors identified for infection were male sex, the presence of hair, receiving an intra-articular cortisone injection within the 3 months prior to surgery, smoking, obesity, and several comorbidities. The only preventive measure with level I evidence was for the use of chlorhexidine wipes for cleansing the skin in the days prior to surgery and for the use of ChloraPrep or DuraPrep over povodine and iodine to prep the skin at the time of surgery. Level II-IV evidence was found for other infection prevention methods such as intravenous antibiotic prophylaxis.<bold>Conclusion: </bold>There are many risk factors associated with developing an infection after elective shoulder surgery. Many preventive measures have been described which may decrease the risk of infection; however, most lack a high level evidence to support them. The findings of this systematic review are clinically relevant as it has been shown that infection after shoulder surgery results in poor patient-reported outcomes and pose a significant financial burden. As surgeons the goal should be to prevent infections to avoid the morbidity for patients and the increased cost for society.<bold>Level Of Evidence: </bold>IV systematic review of literature.
- Subjects
INFECTION prevention; SHOULDER surgery; PREVENTION of surgical complications; ELECTIVE surgery; MEDLINE; INFECTION risk factors; POVIDONE-iodine; CHLORHEXIDINE; BACTERICIDES; PREVENTION of communicable diseases; IODINE; ORTHOPEDIC surgery; PROPANOLS; SEX distribution; SYSTEMATIC reviews; COMORBIDITY; ANTIBIOTIC prophylaxis; THERAPEUTICS
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2018, Vol 26, Issue 8, p2465
- ISSN
0942-2056
- Publication type
journal article
- DOI
10.1007/s00167-018-4832-7