[Author]
Introduction
This literature review is intended to determine the effect of infection to the disability, mobility and psychological state of patients undergoing orthopedic surgery, comparing each in accordance to compliance or not of the surgical procedure to the Surgical Care Improvement Project (SCIP). Upon review however of the five available orthopedic surgical studies, there was no indication of any compliance or not to the SCIP protocol of the surgical procedures performed. The nearest mention of elements found in the protocol, such as anesthesia (SCIP-3) and postoperative blood glucose (SCIP-4) measurement, was found in Lin, Lin, Huang, Hsu, & Lin (2011). However its use had nothing to do with compliance of SCIP protocol; but as part of the experimental intervention tested in the study.
Moreover, not one of the five studies available mentioned any case of infection either as a central problem in the study or as a comorbidity that must be included in the study.
On the basis of the lack of pertinent information about SCIP protocol and postoperative infection cases in the available studies, this literature review shall be limited only to a review on the five studies in relation to disability, mobility and psychological state of patients undergoing orthopedic surgery.
Frie, Van Der Meulen & Black (2012) noted about 30% of patients undergoing knee and hip replacement surgery experienced complications. Hernia and varicose vein (VV) surgery showed about 25% in postoperative complications. The principal risk factor in such complications was co-morbidity such as urinary problems, bleeding, and wound problems. It is however not clear if the urinary and wound problems involved, entirely or in part, bacterial infection.
The study noted that any presence of three or more co-morbid conditions resulted to 40-50% higher rate of complications after hip or knee surgery, and about 75% higher for hernia and VV surgery. Wound problems following hip or knee replacement had been strongly associated with patient readmission for treatment or further surgery.
The use of task-oriented exercises and those designed to recover functional abilities and balance after hip replacement appeared to improve almost 50% of the patients in terms of physical function (Monticone, Ambrosini, Rocca, Lorenzon, Ferrante & Zatti, 2014). Open kinetic chain exercises used in the control group failed to provide as much improvement. The exercises performed in the experimental group also decreased pain intensity and improved the activities of daily life (ADL) significantly.
In a study (Hordam, Sabroe, Pedersen, Mejdahl & Soballe 2010) involving elderly patients with total hip replacement surgery, physical function improved in three months after surgery with nothing but telephone support and counseling from assigned nurses involved in the intervention group. But that improvement failed to continue under the same intervention in the next six months, or nine months from orthopedic surgery. It has no effect also in role physical and bodily pain.
With regards to the impacts on mobility, Schneppendahl et al (2011) noted the effectiveness of cemented bipolar hemiarthroplasty, an accepted choice of treatment in the elderly, in bringing back the majority (78.6%) of patients with femoral neck fracture to their original degree of mobility 91.3 months after surgery. It meant that patients were able to walk outside their home alone. The remaining 21.4% of the patients had significantly decreased mobility. Of the 91% of patients who need no walking device before their injury, at follow up, 65.5% had to increasingly use assisting devices.
Psychological effects of certain intervention methods were not consistently effective. Pre-training and post-training change in emotional role score was not statistically significant (Monticone, Ambrosini, Rocca, Lorenzon, Ferrante & Zatti, 2014).
Two interventions however proved effective in improving the psychological state of orthopedic patients after surgery. First, the use of music at a wave frequency of 8-13 Hz from the evening before surgery to the second day after surgery (a total of 84 hours) significantly lessened the degree of anxiety and pain of patients undergoing spinal surgery (Lin, Lin, Huang, Hsu, & Lin, 2011). The song used had 60-72 beats per minute, mimicking the normal heartbeat, of medium to low pitch and soft melodies.
Second, medications such as remifentanil and sevolurane significantly lowered blood indicators of pain, such as adrenocorticotropic hormone (ACTH), cortisol, antidiuretic homone (ADH), adrenaline (Ad), and noradrenaline (Nad), at a dose of 1.0 μg/kg/min (0.25 μg dose failed to provide such effect) (Shinoda, Murakami, Takamichi, Iizuka, Tanaka & Kuwasako, 2013). Blood glucose level (BGL) appeared to act as an indicator of pain level even under medication. A BGL of 118 mg/dL occurred at a dose of 0.25 μg/kg/min; and appeared at 92 mg/dL when the dose was 1.0 μg/kg/min.
References
Frie, K. G., Van Der Meulen, J. & Black N. (2012, June 14). Relationship between patients’
reports of complications and symptoms, disability and quality of life after surgery. British Journal of Surgery, 99, 1156-1163. Doi: 10.1002/bjs.8830
Hordam, B., Sabroe, S., Pedersen, P. U., Mejdahl, S. & Soballe, K. (2010). Nursing intervention
Lin, P. C., Lin, M. L., Huang, L. C., Hsu, H. C. & Lin, C. C. (2011). Music therapy for patients
receiving spine surgery. Journla of Clinical Nursing, 20, 960-968. Doi: 10.1111/j.1365.2702.2010.03452.x
Monticone, M., Ambrosini, E., Rocca, B., Lorenzon, C., Ferrante, S. & Zatti, G. (2014). Task-
oriented exercises and early full weight-bearing contribute to improving disability after total hip replacement: a randomized controlled trial. Clinical Rehabilitation, 28(7), 658-668. Doi: 10.1177/0269215513519342
Schneppendahl, J. et al (2011). Recovery after hip fractures: influence of bipolar
hemiarthroplasty on physical disability and social dependency in the elderly. Hip International, 21(06), 751-756. Doi: 10.5301/hip.2011.8824
Shinoda, T., Murakami, W., Takamichi, Y., Iizuka, H., Tanaka, M. & Kuwasako, Y. (2013).
Effect of remifentanil infusion rate on stress response in orthopedic surgery using a tourniquet application. BMC Anesthesiology, 13, 14.
