Predicting success of a Debridement, Antibiotics and Implant Retention (DAIR) procedure for Periprosthetic Joint Infection (PJI) remains a challenge. A failed DAIR might adversely affect the outcome of any future revision surgery for PJI. Hence, the ability to identify and optimise factors predictive of DAIR success would help target the procedure to the appropriate patient cohort and avoid unnecessary surgery for patients where a DAIR is unlikely to eradicate infection. A retrospective review of our prospective Bone Infection Group database was performed to identify all patients who underwent a DAIR of their hip or knee arthroplasty. Diagnosis of PJI was confirmed using the Musculoskeletal Infection Society (MSIS) 2013 and the European Bone and Joint Infection Society (EBJIS) 2021 classification systems. DAIR surgery was grouped into “successful” or “unsuccessful” outcomes as per the MSIS working group outcome-reporting tool.Aim
Method
Commissioning for quality and innovation (CQUIN) guidelines specify that diaphyseal fractures of the tibia should be treated within 24 hours of admission. We aimed to identify our compliance at a Major Trauma Centre. Restrospective analysis of all tibia fractures over 12 months. Fractures that were not diaphyseal nor open were excluded. Time of presentation, x-ray, arrival to ward and arrival in theatre were analysed against CQUIN guidelines. 43 fractures, 18 (42%) arrived in theatre for operative management within 24 hours. 15 (35%) were managed operatively in the subsequent 24 hours and 10 (23%) were managed after 48 hours. Average time to theatre was 38 hrs 37 mins (SD 29hrs 42mins). It took on average 51mins (SD 43 mins) for a patient to have an xray and 3 hrs 53 mins (SD 1hr 47mins) to arrive on the ward, and average 3 hrs 2 mins (SD 1hr 43mins) between xray and the ward. 42% of patients are making CQUIN standards for closed tibial shaft fractures. There are logistical and resource factors contributing towards this as well as clinical issues. To address this there needs to be an agreed multidisciplinary pathway developed to ensure compliance with CQUIN standards.
