intraoperative bleeding. I've opted for a water-cooled radiofrequency
probe to cauterize tissue and carefully control bleeding in real-time in
order to reduce the risk of post-op hemarthrosis from occurring.
5. Warming patients
Maintaining normothermia before, during and after procedures has been
shown to reduce the risk of post-op infection. Forced-air warming has
received unwanted attention in recent months as thousands of patients
have filed federal lawsuits claiming the technology disrupts clean laminar
airflow in the OR, causing airborne contaminants to infiltrate open surgical
wounds. Clinical research has not definitively identified forced-air warm-
ing as the root cause of deep wound infections during joint replacement
cases and the courts have so far agreed, but I think it's a reasonable pre-
caution to avoid using the devices during procedures performed on high-
consequence patients. I instead use a convective warming device that
warms patients with over-body blankets and under-body mattresses.
Body temperature's link to increased infection risk is more of a factor in
protracted surgeries. One of the best ways to maintain normothermia is to
get patients out of the OR as quickly as possible, and my direct anterior
hip replacements and total knees take less than less an hour to complete.
Widespread effort
A successful infection prevention program for outpatient total joints
demands collaboration among every member of the clinical team, from
surgeons to infection preventionists and anesthesia providers to surgical
nurses. Preventing SSIs in joint replacement patients requires dedicating
valuable time and allocating numerous resources, but the stakes are too
high and the payoff too great to ignore its importance.
OSM
3 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 9
Dr. Singer (ronsinger@mac.com) is an orthopedic surgeon affiliated with
OrthoCarolina in Charlotte, N.C.
