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Li Z, Xu X, Zhuang Z, Lu J, Gao F, Jiang Q. Impact of spinal Anaesthesia versus general Anaesthesia on the incidence of surgical site infections after knee or hip arthroplasty: A meta-analysis. Int Wound J 2024; 21:e14369. [PMID: 37649253 PMCID: PMC10781890 DOI: 10.1111/iwj.14369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023] Open
Abstract
Postoperative Surgical Site Infections (SSIs) pose significant challenges to recovery after joint arthroplasty. This systematic review and meta-analysis aim to compare the incidence of SSIs after knee or hip arthroplasty under Spinal Anaesthesia (SA) versus general anaesthesia (GA). We conducted the systematic review and meta-analysis following the PRISMA guidelines, analysing data from 15 studies selected from PubMed, Embase, Web of Science, and Cochrane Library up to May 16, 2023. The analysis included studies comparing SSIs incidence in patients aged 18 years and above who underwent knee or hip arthroplasty under SA or GA. Quality assessment was performed using the Cochrane Collaboration's risk of bias tool. The effect size was calculated using random or fixed-effects models based on the observed heterogeneity. We assessed the heterogeneity between studies and conducted a sensitivity analysis. Of 1651 initially identified studies, 15 articles encompassing 353 169 patients were included in the final analysis. A total of 156 405 patients were under SA, while 196 764 received GA. The studies demonstrated substantial heterogeneity (p = 0.007, I2 = 53.7%), resulting in a random-effects model being employed. Patients receiving SA showed a 23% lower likelihood of developing SSIs postoperatively compared to GA patients (OR: 0.77, 95% CI: 0.70-0.86, p < 0.001). Sub-group analysis further confirmed these findings regardless of the type of joint arthroplasty. This meta-analysis indicated a significantly lower incidence of SSIs following knee or hip arthroplasty under SA compared to GA. Despite observed heterogeneity, the results underscore the potential benefit of SA over GA in orthopaedic surgeries to reduce the risk of SSIs.
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Affiliation(s)
- Zhizhuo Li
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Xingquan Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Zaikai Zhuang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Jun Lu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Fuqiang Gao
- Department of OrthopedicsPeking University China‐Japan Friendship School of Clinical MedicineBeijingChina
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
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Gupta A, Shin J, Oliver D, Vives M, Lin S. Incidence and risk factors for surgical site infection (SSI) after primary hip hemiarthroplasty: an analysis of the ACS-NSQIP hip fracture procedure targeted database. ARTHROPLASTY (LONDON, ENGLAND) 2023; 5:1. [PMID: 36593517 PMCID: PMC9808930 DOI: 10.1186/s42836-022-00155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/16/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Primary hip hemiarthroplasty (HHA) is frequently utilized to treat geriatric hip fractures, which are associated with significantly higher morbidity and mortality. While not particularly common, surgical site infection (SSI) is a major complication that frequently requires revision surgery in a frail population. The objective of this study was to determine the incidence of and risk factors for SSI after HHA in hip fracture patients. MATERIALS AND METHODS This retrospective cohort study was performed using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Geriatric patients (65+) who underwent HHA for non-pathologic, traumatic hip fractures between 2016-2017 were included. Demographic variables, comorbidities, operative variables, and complications were compared between "SSI" and "non-SSI" groups. Multivariate regression identified independent risk factors for postoperative SSI. Significance was set at P = 0.05. RESULTS A total of 6169 patients were included. The overall incidence of SSI was 1.3%. SSI was significantly associated with body mass index (BMI), preoperative functional status, congestive heart failure, chronic corticosteroid use, intraoperative time, sepsis, wound dehiscence, readmission within 30-days, and reoperation. On multivariate analysis, chronic steroid use (OR: 2.30, 95% CI: 1.13-4.70), BMI ≥ 35 kg/m2 (OR: 3.59, 95% CI: 1.57-8.18), and intraoperative time ≥120 mins (OR: 2.15, 95% CI: 1.08-4.27) were found to be independent risk factors. CONCLUSIONS Postoperative SSI is a serious complication that is responsible for prolonged hospital stays, increased mortality, and greater healthcare costs. Here, we identified multiple risk factors for SSI after primary HHA in the US elderly population.
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Affiliation(s)
- Arjun Gupta
- grid.430387.b0000 0004 1936 8796Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ 07103 USA
| | - John Shin
- grid.430387.b0000 0004 1936 8796Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ 07103 USA
| | - Dylan Oliver
- grid.430387.b0000 0004 1936 8796Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ 07103 USA
| | - Michael Vives
- grid.430387.b0000 0004 1936 8796Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ 07103 USA
| | - Sheldon Lin
- grid.430387.b0000 0004 1936 8796Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ 07103 USA
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Quan J, Chen X, Tang X, Liu X, Li J, Yi B, Li P, Lu K, Gu J. Effects of General Anesthesia on Changes of Serum Hepatitis B Virus-DNA Levels in Infected Patients Underwent Non-Hepatobiliary Minimally Invasive Surgery: A Pilot Observational Study. Infect Drug Resist 2022; 15:6631-6640. [DOI: 10.2147/idr.s379350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022] Open
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Fukuda T, Imai S, Simoda S, Nakdera M, Horiguchi H. Comparison of peripheral nerve block with local infiltration analgesia regarding walking ability after total knee replacement: A retrospective, propensity-score matched-pair cohort study. J Orthop Surg (Hong Kong) 2021; 28:2309499020931656. [PMID: 32564654 DOI: 10.1177/2309499020931656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE It is unclear whether perioperative analgesic techniques affect the functional outcome of total knee replacement (TKR). We investigated the effects of peripheral nerve block (PNB) and local infiltration (LI) on walking ability after TKR. METHODS The medical records of 7143 patients who underwent TKR using general anesthesia with PNB or LI techniques were reviewed. Factors affecting independence and/or improvement of walking after surgery were investigated using multivariate regression analysis. To adjust for baseline differences and minimize selection bias for the chosen analgesic technique, patients were matched by propensity scores. RESULTS The multivariate regression analysis showed that PNB was associated with independence and/or improvement of walking. Of the 7143 patients, 2755 (39%) received PNB analgesia and 4388 (61%) LI analgesia. After the propensity score matching, the analgesic types were not associated with walking ability. Independence reflected by the total score of daily living activities was higher in the PNB group than in the LI group. The PNB group started rehabilitation later but performed rehabilitation for longer in the initial period than the LI group. Consumption levels of fentanyl, pentazocine, and antiemetics were lower in the PNB group than in the LI group. The PNB group had fewer hypertensive episodes during surgery than the LI group. There was no significant difference in total hospitalization costs between the two groups. CONCLUSIONS No significant difference in postoperative walking ability was found between PNB and LI groups. However, PNB offered some advantages over LI. Future detailed investigations to improve TKR surgery are needed.
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Affiliation(s)
- Taeko Fukuda
- Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Kasumigaura Medical Center Hospital (Tsuchiura Center for Medical Education and Training), National Hospital Organization, Tsuchiura, Japan
| | - Shinobu Imai
- Department of Clinical Data Management and Research, National Hospital Organization Headquarters, Tokyo, Japan.,Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Shunji Simoda
- Department of Clinical Data Management and Research, National Hospital Organization Headquarters, Tokyo, Japan
| | - Masaya Nakdera
- Department of Clinical Data Management and Research, National Hospital Organization Headquarters, Tokyo, Japan
| | - Hiromasa Horiguchi
- Department of Clinical Data Management and Research, National Hospital Organization Headquarters, Tokyo, Japan
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Patel AH, Ross BJ, Ofa SA, Flick TR, Sanchez FL, Sherman WF. The Impact of Femoral Nerve Anesthesia on Short-Term Clinical Outcomes and Opioid Claims After Total Knee Arthroplasty. Arthroplast Today 2020; 6:1016-1021.e9. [PMID: 33385044 PMCID: PMC7772446 DOI: 10.1016/j.artd.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 02/03/2023] Open
Abstract
Background The impact of femoral nerve blocks (FNBs) during primary total knee arthroplasty (TKA) on clinical outcomes and pain management remains unclear. The present research investigates the impact that continuous and single-shot FNBs during TKA have on postoperative opioid claims and short-term clinical outcomes. Methods An administrative claims database was queried to identify patients who underwent primary TKA with a continuous FNB, single-shot FNB, or no FNB. More than 300,000 patients were analyzed from the database. Rates of opioid claims were compared via achi-square analysis. Incidence of postoperative complications was compared with multivariable logistic regression. Results Patients receiving a FNB had a significantly higher risk of falls both at 6 months (odds ratio [OR], 1.30) and 1 year postoperatively (OR, 1.25), as well as readmissions within 90 days (OR, 1.18) compared with patients without FNBs. The FNB cohort exhibited a higher risk of deep vein thrombosis (OR, 1.57), myocardial infarction (OR, 1.79), and cerebrovascular accident (OR, 1.20) during the inpatient stay. Relative to single-shot FNBs, continuous FNBs were associated with a higher risk of readmissions within 90 days and systemic complications, although the risk varied by age, sex, and Charlson Comorbidity Index score. More patients without FNBs filed opioid claims within 1 year postoperatively, but the average total morphine milligram equivalents prescribed was comparable to patients who received FNBs. Conclusions FNBs during TKA place patients at a significantly higher risk of falls, readmissions, and systemic complications in the short term. The risk of readmission and systemic complications was higher for continuous FNBs. More patients without FNBs filed opioid claims postoperatively than patients who received FNBs.
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Affiliation(s)
- Akshar H Patel
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Bailey J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sione A Ofa
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Travis R Flick
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Fernando L Sanchez
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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A Comparison of Neuraxial and General Anesthesia for Thirty-Day Postoperative Outcomes in United States Veterans Undergoing Total Knee Arthroplasty. J Arthroplasty 2020; 35:3138-3144. [PMID: 32641270 DOI: 10.1016/j.arth.2020.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/26/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of this study is to investigate which anesthetic technique is superior on 30-day outcomes after primary total knee arthroplasty (TKA) in United States veteran patients. To our knowledge, this is the first account from the Veterans Health Administration comparing the effects of different anesthesia modalities in patients undergoing TKA. METHODS The Veterans Affairs Surgical Quality Improvement Program database was utilized to analyze patients undergoing primary TKA during the period of 2008-2015. Subjects were divided into 2 cohorts based on the method of surgical anesthesia used: general anesthesia or neuraxial anesthesia. Propensity score matching was utilized to avoid possible selection bias between the 2 cohorts when assessing patient demographics and comorbidities. The 2 groups were analyzed for 30-day postoperative complications, using multivariable logistic regression techniques to evaluate independent associations between anesthetic method and postoperative outcomes. RESULTS All Veterans Affairs patients undergoing primary TKA under general anesthesia (n = 32,363) and neuraxial anesthesia (n = 14,395) within the study period were included in this study. Following propensity score matching, multivariable analysis revealed significantly lower risks of cardiovascular (adjusted odds ratio [AOR] 0.74, 95% confidence interval [CI] 0.6-0.88, P < .001), respiratory (AOR 0.75, 95% CI 0.57-0.97, P = .03), and renal complications (AOR 0.62, 95% CI 0.4-0.9, P = .01) in patients receiving neuraxial anesthesia compared to those receiving general anesthesia. Neuraxial anesthesia was also associated with reduced hospital stay and lower odds of prolonged hospitalization (AOR 0.85, 95% CI 0.8-0.9, P < .001). CONCLUSION Veteran patients undergoing TKA under neuraxial anesthesia had reduced postoperative complications and decreased hospitalization stay compared to patients undergoing general anesthesia.
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Della Polla G, Bianco A, Mazzea S, Napolitano F, Angelillo IF. Preoperative Antibiotic Prophylaxis in Elective Minor Surgical Procedures among Adults in Southern Italy. Antibiotics (Basel) 2020; 9:antibiotics9100713. [PMID: 33081002 PMCID: PMC7603198 DOI: 10.3390/antibiotics9100713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
Little is known regarding the factors associated with surgical antibiotic prophylaxis (SAP) compliance in elective minor surgery. The purposes of this cross-sectional study were to identify the frequency of inappropriate SAP administration and to understand the characteristics associated with such inappropriateness in a sample of elective minor surgical procedures. The study was performed between May and July 2019 among a random sample of patients aged 18 years and older in seven public hospitals randomly selected in the Campania and Calabria Regions of Italy. Globally, only 45% of SAP approaches were deemed completely in accordance with the evidence-based guidelines. Patients with an ordinary admission, those who underwent local anesthesia, those receiving plastic and reconstructive and ophthalmology surgery, and those who had not received a prosthetic implant were more likely to receive an appropriate SAP approach; those receiving obstetrics, gynecological, and urological surgical procedures were less likely than those who underwent abdominal, vascular, and breast surgery. The course of antibiotic prophylaxis was not consistent with the guidelines in 48.5% procedures with one or more reasons for inappropriateness. Appropriate time of the SAP administration was more frequently observed in patients who were older, those with a Charlson comorbidity index of 0, those who did not receive a prosthetic implant, and those receiving plastic and reconstructive surgery; it was less likely in patients receiving obstetrics, gynecological, and urological surgeries compared with those who underwent abdominal, vascular, and breast surgery. Aspects of SAP that need to be improved are molecule choice, time of administration, and specific surgical procedures. Hospital managers should involve surgeons and anesthesiologists in initiatives tailored to optimize SAP prescribing.
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Affiliation(s)
- Giorgia Della Polla
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, 5 80138 Naples, Italy; (G.D.P.); (F.N.)
| | - Aida Bianco
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Via Tommaso Campanella, 115 88100 Catanzaro, Italy; (A.B.); (S.M.)
| | - Silvia Mazzea
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Via Tommaso Campanella, 115 88100 Catanzaro, Italy; (A.B.); (S.M.)
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, 5 80138 Naples, Italy; (G.D.P.); (F.N.)
| | - Italo Francesco Angelillo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, 5 80138 Naples, Italy; (G.D.P.); (F.N.)
- Correspondence: ; Tel.: +39-081-566-7717
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Scholten R, Leijtens B, Hannink G, Kamphuis ET, Somford MP, van Susante JLC. General anesthesia might be associated with early periprosthetic joint infection: an observational study of 3,909 arthroplasties. Acta Orthop 2019; 90:554-558. [PMID: 31339401 PMCID: PMC6844397 DOI: 10.1080/17453674.2019.1644069] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Periprosthetic joint infection (PJI) remains a devastating complication following total knee or total hip arthroplasty (TKA/THA). Nowadays, many studies focus on preventive strategies regarding PJI; however, the potential role of anesthesia in the development of PJI remains unclear.Patients and methods - All consecutive patients undergoing elective primary unilateral TKA or THA from January 2014 through December 2017 were included. Exclusion criteria included femoral fractures as the indication for surgery and previously performed osteosynthesis or hardware removal on the affected joint. Age, sex, BMI, ASA classification, type of arthroplasty surgery, type of anesthesia, duration of surgery, smoking status, and intraoperative hypothermia were recorded. Propensity score-matched univariable logistic regression analysis was used to control for allocation bias.Results - 3,909 procedures consisting of 54% THAs and 46% TKAs were available for analysis. 42% arthroplasties were performed under general anesthesia and 58% under spinal anesthesia. Early PJIs were observed in 1.7% of the general anesthesia group and in 0.8% in the spinal anesthesia group. The multivariable logistic regression model demonstrated an odds ratio for PJI of 2.0 (95% CI 1.0-3.7) after general anesthesia relative to the propensity score-matched patients who received spinal anesthesia.Interpretation - These results suggest a potential association between general anesthesia and early PJI. Future research using large-scale data is required to further elucidate this clinically relevant association.
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Affiliation(s)
- Ruben Scholten
- Rijnstate Ziekenhuis, Department of Orthopedics, Arnhem;
| | - Borg Leijtens
- Rijnstate Ziekenhuis, Department of Orthopedics, Arnhem;
| | - Gerjon Hannink
- Radboud University Medical Center, Department of Operating Rooms, Nijmegen;
| | - Ed T Kamphuis
- Rijnstate Ziekenhuis, Department of Anesthesiology, Arnhem, the Netherlands
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Wang L, Xu X, Cao JG, Liu J. Negative pressure wound therapy in total hip and knee arthroplasty: a meta-analysis. J Comp Eff Res 2019; 8:791-797. [PMID: 31397173 DOI: 10.2217/cer-2019-0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aim: To assess the efficiency and safety of negative pressure wound therapy (NPWT) in the total hip and knee arthroplasty, we conducted a meta-analysis from randomized controlled trials. Methods: Potential academic articles were identified from the Cochrane Library, PubMed, Embase, Springer and ScienceDirect. Secondary sources were identified from the references of the included literature. RevMan 5.1 was used to analyze the pooled data. Results: Six randomized controlled trials met the inclusion criteria. Meta-analysis showed more superficial surgical site infection and blisters in patients with total knee arthroplasty. There were no significant differences between two groups in total infection and total complications. Conclusion: NPWT decreased the incidence of superficial surgical site infection. More blisters were noticed in patients with NPWT after total knee arthroplasty.
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Affiliation(s)
- Lei Wang
- Department of Joint Surgery, Tianjin Hospital, Tianjin, 300211, PR China
| | - Xin Xu
- Department of Imaging, Tianjin Hospital of ITCWM, Nankai Hospital, Tianjin, 300100, PR China
| | - Jian-gang Cao
- Department of Sport Medicine, Tianjin Hospital, Tianjin, 300211, PR China
| | - Jun Liu
- Department of Joint Surgery, Tianjin Hospital, Tianjin, 300211, PR China
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Abdelaziz H, Citak M, Fleischman A, Gavrankapetanović I, Inaba Y, Makar G, Memtsoudis SG, Soffin EM. General Assembly, Prevention, Operating Room - Anesthesia Matters: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S93-S95. [PMID: 30348581 DOI: 10.1016/j.arth.2018.09.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Xu C, Guo H, Qu P, Fu J, Kuo FC, Chen JY. Preoperatively elevated serum inflammatory markers increase the risk of periprosthetic joint infection following total knee arthroplasty in patients with osteoarthritis. Ther Clin Risk Manag 2018; 14:1719-1724. [PMID: 30271156 PMCID: PMC6147535 DOI: 10.2147/tcrm.s175854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The purpose of this study was to evaluate the prevalence of preoperatively elevated serum inflammatory markers and to determine its association with periprosthetic joint infection (PJI) in patients with osteoarthritis (OA) undergoing total knee arthroplasty (TKA). Methods From January 2010 to May 2014, we retrospectively reviewed 3,376 consecutive patients who were scheduled for unilateral TKA due to OA. Patients with inflammatory arthritis, posttraumatic arthritis, previous knee surgery, simultaneous surgery or arthroplasty, and comorbidity with autoimmune disease, hepatitis, renal disease, respiratory tract infections, urinary tract infection, and malignancy were excluded. One hundred and forty patients with preoperatively elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) were enrolled. The control group was matched by age, sex, body mass index, and year of index surgery in 1:1 ratio. All patients were followed for a minimum of 1 year or until the occurrence of PJI. PJI was defined based on the criteria in the International Consensus Meeting. A multivariate Cox proportional hazards model was utilized to calculate the HR and 95% CI. Results The prevalence of preoperatively elevated inflammatory markers was 4.1%. The rate of PJI was significantly higher in the both elevated ESR and CRP groups (12.5%, 4/32) compared with both normal group (1.4%, 2/140) and either high group (0.9%, 1/108) (P<0.001). Patients with preoperative elevated ESR and CRP had a significant risk of PJI compared to those with normal serum inflammatory markers (HR: 15.8, 95% CI: 2.57–96.7, P=0.003) after adjusting confounding factors. The cumulative rate for PJI was 6.3% (95% CI: 0%–14.27%) at 1 year and 16.5% (95% CI: 0%–30.66%) at 5 years for both high ESR and CRP groups, which was significantly higher than other 2 groups (P=0.0002). Conclusion Although the prevalence of preoperatively elevated ESR and CRP is low, routine examination of ESR and CRP preoperatively might be necessary to prevent subsequent PJI in patients with OA following TKA.
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Affiliation(s)
- Chi Xu
- Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, China,
| | - Heng Guo
- Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, China,
| | - Pengfei Qu
- Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, China,
| | - Jun Fu
- Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, China,
| | - Feng-Chih Kuo
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan,
| | - Ji-Ying Chen
- Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, China,
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Elkassabany NM, Memtsoudis SG, Mariano ER. What Can Regional Anesthesiology and Acute Pain Medicine Learn from "Big Data"? Anesthesiol Clin 2018; 36:467-478. [PMID: 30092941 DOI: 10.1016/j.anclin.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Demonstrating value added to patients' experience through regional anesthesiology and acute pain medicine is critical. Evidence supporting improved outcomes can be derived from prospective studies or retrospective cohort studies. Population-based studies relying on existing clinical and administrative databases are helpful when an outcome is rare and detecting a change would require studying large numbers of patients. This article discusses the effect of regional anesthesiology and acute pain medicine interventions on mortality and morbidity, infection rate, cancer recurrence, inpatient falls, local anesthetic systemic toxicity, persistent postsurgical pain, and health care costs.
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Affiliation(s)
- Nabil M Elkassabany
- Sections of Orthopedic and Regional Anesthesiology, Department of Anesthesiology and Critical Care, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104, USA.
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Weill Cornell Medical College, Hospital for Special Surgery, 535 East 70th street, New York, NY 10021, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Stanford University School of Medicine, 3801 Miranda Avenue, Palo Alto, CA 94304, USA
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Surgical masks as source of bacterial contamination during operative procedures. J Orthop Translat 2018; 14:57-62. [PMID: 30035033 PMCID: PMC6037910 DOI: 10.1016/j.jot.2018.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 01/30/2023] Open
Abstract
Background Surgical masks (SMs) are used to reduce bacterial shedding from the mouth, nose and face. This study aimed to investigate whether SMs may be a potential source of bacterial shedding leading to an increased risk of surgical site infection. Methods Bacterial contamination of the SMs was tested by making an impression of the external surface of the mask on sterile culture media immediately. We investigated the difference in bacterial counts between the SMs worn by surgeons and those placed unused in the operating room (OR), and the bacterial count variation with indicated wearing time. Moreover, the difference in bacterial counts on the external surface between the first and second layers of double-layered SMs was also assessed. Results The bacterial count on the surface of SMs increased with extended operating times; significant difference was found between the 4- to 6-hour and 0-hour groups (p < 0.05). When we analysed the bacterial counts from the same surgeon, a significant increase was noted in the 2-hours group. Moreover, the bacterial counts were significantly higher among the surgeons than the OR. Additionally, the bacterial count of the external surface of the second mask was significantly higher than that of the first one. Conclusions The source of bacterial contamination in SMs was the body surface of the surgeons rather than the OR environment. Moreover, we recommend that surgeons should change the mask after each operation, especially those beyond 2 hours. Double-layered SMs or those with excellent filtration function may also be a better alternative. The translational potential of this article This study provides strong evidence for the identification that SMs as source of bacterial contamination during operative procedures, which should be a cause for alarm and attention in the prevention of surgical site infection in clinical practice.
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Frisch NB, Darrith B, Hansen DC, Wells A, Sanders S, Berger RA. Single-dose lidocaine spinal anesthesia in hip and knee arthroplasty. Arthroplast Today 2018; 4:236-239. [PMID: 29896560 PMCID: PMC5994870 DOI: 10.1016/j.artd.2018.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/25/2022] Open
Abstract
Background With the increasing interest in fast recovery and outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used for many years in spinal anesthesia. However, lidocaine spinal anesthesia has been reported to have a risk of transient neurologic symptoms (TNSs). The purpose of this study is to determine the safety and efficacy of single-dose lidocaine spinal anesthesia in the setting of outpatient joint arthroplasty. Methods We performed a prospective study on 50 patients who received lidocaine spinal anesthesia in the setting of outpatient hip and knee arthroplasty. All patients received a single-shot spinal injection, with 2% isobaric lidocaine along with titrated propofol sedation. We evaluated demographic data, length of motor blockage, time to ambulation, time to discharge readiness, patient-reported symptoms of TNS. Results Of the 50 patients studied, 11 had total hip arthroplasty, 33 total knee arthroplasty, 5 unicompartmental knee arthroplasty, and 1 underwent isolated polyethylene liner exchange in a total knee arthroplasty. The average total duration of motor blockade was 2.89 hours (range 1.73-5.17, standard deviation 0.65). Average time from postanesthesia care unit to return of motor function was 0.58 hours (range 0-1.5, standard deviation 0.48). None of the patients reported TNS. Conclusions Isobaric lidocaine spinal anesthesia appears to be a safe and effective regimen for outpatient hip and knee arthroplasty. All patients were discharged on the day of surgery with isobaric lidocaine spinal injection. There were no reports of TNSs.
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Affiliation(s)
- Nicholas B Frisch
- Ascension Crittenton Hospital, DeClaire LaMacchia Orthopaedic Institute, Rochester Hills, MI, USA
| | - Brian Darrith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Adrienne Wells
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sheila Sanders
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Richard A Berger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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16
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Sellbrandt I, Brattwall M, Jildenstål P, Warrén Stomberg M, Jakobsson J. The choice between surgical scrubbing and sterile covering before or after induction of anaesthesia: A prospective study. F1000Res 2017; 6:1019. [PMID: 28868139 PMCID: PMC5553078 DOI: 10.12688/f1000research.11965.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 11/20/2022] Open
Abstract
Background : Day surgery is increasing, and safe and effective logistics are sought. One part of the in-theatre logistics commonly discussed is whether surgical scrub and sterile covering should be done before or after induction of anaesthesia. The aim of the present study was to compare the impact of surgical scrub and sterile covering before vs. after the induction of anaesthesia in male patients scheduled for open hernia repair. Methods : This is a prospective randomised study. Sixty ASA 1-3 patients scheduled for open hernia repair were randomised to surgical scrub and sterile covering before or after induction of anaesthesia; group "awake" and "anaesthetised". Need for vasoactive medication during anaesthesia was primary study objective. Duration of anaesthesia and surgery, theatre time, recovery room stay and time to discharge, patients and theatre nurses experiences and willingness to have the same logistics on further potential surgeries, by a questionnaire provided before discharge was also assessed. Results : The duration of anaesthesia was shorter and doses of propofol and remifentanil were reduced by 10 and 13%, respectively, in the awake group. We found still no difference in the need for vasoactive medication during anaesthesia Time in recovery area was significantly reduced in the awake group 39 (SD 15) vs. 48 SD 16) (p<0.05), but time to discharge was not different. There was further no difference in the patients' assessment of quality of care, and only one patient in the awake group would prefer to be anaesthetised on a future procedure. All nurses found pre-anaesthesia scrubbing acceptable as routine. Conclusion : Surgical scrub and sterile covering before the induction of anaesthesia can be done safely and without jeopardising patients' quality of care and possibly improve perioperative logistics. Further studies are warranted assessing impact of awake scrubbing and sterile covering on quality and efficacy of perioperative care.
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Affiliation(s)
- Irene Sellbrandt
- Department of Anaesthesia, Capio Lundby Hospital, Gothenburg, 417 17, Sweden
| | - Metha Brattwall
- Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Mölndal, 413 45, Sweden
| | - Pether Jildenstål
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Health and Care Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, 413 46, Sweden
| | - Margareta Warrén Stomberg
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Health and Care Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, 413 46, Sweden
| | - Jan Jakobsson
- Department of Anaesthesia, Institution for Clinical Science, Karolinska Institutet at Danderyds University Hospital, Stockholm, 182 88, Sweden
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17
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Elsharydah A, Embabi AS, Minhajuddin A, Joshi GP. Racial Disparity in the Perioperative Care for Patients Undergoing Total Knee and Hip Arthroplasty: A Retrospective Propensity-Matched Cohort Study. J Racial Ethn Health Disparities 2017; 5:632-637. [DOI: 10.1007/s40615-017-0409-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/17/2017] [Accepted: 07/04/2017] [Indexed: 11/29/2022]
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Park YB, Chae WS, Park SH, Yu JS, Lee SG, Yim SJ. Comparison of Short-Term Complications of General and Spinal Anesthesia for Primary Unilateral Total Knee Arthroplasty. Knee Surg Relat Res 2017; 29:96-103. [PMID: 28545173 PMCID: PMC5450584 DOI: 10.5792/ksrr.16.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/23/2016] [Accepted: 06/12/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose To compare the occurrences of perioperative complications of two anesthetic techniques (general anesthesia [GA] and spinal anesthesia [SA] in patients undergoing primary unilateral total knee arthroplasty (TKA). Materials and Methods Patients who underwent unilateral primary TKA due to osteoarthritis from January 2005 to January 2014 were retrospectively reviewed. They were divided into two groups: GA (n=490) and SA (n=746). The operation duration, length of perioperative stay in the operation room and occurrences of adverse events in postoperative 30 days (mean, 29.7±3.1 days) were compared. Before multivariate linear or logistic regression analysis, different baseline characteristics were adjusted in the statistical models. Results There were significant intergroup differences in mean age (GA, 68.4±7.2 years; SA, 70.7±7.5 years; p<0.001) and mCCI (GA, 3±1.4; SA, 3.2±1.5; p<0.001). The GA group required longer preoperative room time (+9.4 minutes; p<0.001), postoperative room time (+12.7 minutes; p<0.001), and postoperative hospital stay (+2.5 days; p=0.001) and had more surgical site infections (5 [1%] vs. 0 [0%]; p=0.005) and blood transfusion (205 [41.8%] vs. 262 [35.1%]; p=0.01). No differences in operative duration and other adverse events were identified. Conclusions We should cautiously consider that GA may be associated with slightly increased preoperative and postoperative room times, postoperative hospital stay, transfusion and surgical site infection rates in primary unilateral TKA.
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Affiliation(s)
- Yong Bok Park
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Won Seok Chae
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sin Hyung Park
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji Soo Yu
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sun Geun Lee
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Soo Jae Yim
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Zhou Y, Cao S, Li L, Narava M, Fu Q, Qian Q. Is soft tissue repair a right choice to avoid early dislocation after THA in posterior approach? BMC Surg 2017; 17:60. [PMID: 28525999 PMCID: PMC5438560 DOI: 10.1186/s12893-017-0212-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Dislocation is the second most common complication after total hip arthroplasty (THA). The effectiveness of soft tissue repair to reduce dislocation rate is still debated and thus a meta-analysis was conducted. Methods A systematic search in PubMed, Embase, and Cochrane databases was conducted for this meta-analysis. Inclusion criteria: clinical comparative trials on the use of soft tissue repair including rotators and capsule repair in primary THA. The main data outcome were the incidences of early hip dislocation after primary THA. HSS score, incidence of other complications was also included in the outcomes. Results A total of 4816 cases were included for the analysis from ten studies (3 RCTs/7 Retrospective trials). Overall, the soft tissue repair group showed a significant lower early dislocation rate and higher HSS score compared to the no repair group; but no significant difference was observed between the two groups in regards to the early dislocation rate in RCT studies only. The capsule repair group showed a significant lower early dislocation rate than no capsule repair group while no significant difference was observed between the rotators repair group and no rotators repair group. In all included studies, 4 greater trochanter fractures, 2 sciatic nerve palsies and 1 infection were reported in soft tissue repair group while no cases were observed in the no repair group. Conclusions The efficacy of soft tissue repair is positive but still not conclusive to reduce the early dislocation rate after primary THA while soft tissue repair may bring more other complications. Capsule repair seems more effective than rotators repair only.
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Affiliation(s)
- Yiqin Zhou
- Joint Surgery and Sports Medicine Department, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Shiqi Cao
- Joint Surgery and Sports Medicine Department, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Lintao Li
- Joint Surgery and Sports Medicine Department, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.,Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | | | - Qiwei Fu
- Joint Surgery and Sports Medicine Department, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
| | - Qirong Qian
- Joint Surgery and Sports Medicine Department, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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Complications After Continuous Posterior Lumbar Plexus Blockade for Total Hip Arthroplasty. Reg Anesth Pain Med 2017; 42:446-450. [DOI: 10.1097/aap.0000000000000589] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty. Reg Anesth Pain Med 2017; 42:683-697. [DOI: 10.1097/aap.0000000000000673] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Does Anesthetic Technique Influence the Incidence of Surgical Site Infection in Total Joint Arthroplasty? Reg Anesth Pain Med 2016; 41:553-4. [PMID: 27547898 DOI: 10.1097/aap.0000000000000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Impact of Neuraxial Versus General Anesthesia on the Incidence of Postoperative Surgical Site Infections Following Knee or Hip Arthroplasty. Reg Anesth Pain Med 2016; 41:555-63. [DOI: 10.1097/aap.0000000000000437] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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