Anthony M. DiGioia III, MD

The American Academy of Orthopaedic Surgeons released an information statement reinforcing the need to take prophylactic antibiotics when having dental work or other invasive procedures.  This recommendation comes from the fact that deep infections of total joint replacements are very costly, both financially and emotionally for the patient due to the need for extensive revision surgery and staged treatment. Patients often do not have normal use of the infected joint until the revision process and surgery is completed, which can be 3-6 months and in some cases longer.  Revision surgery due to infection affects both the patient's quality of life as well as can be a significant financial burden due to time off work.  

Due to the disastrous consequences of infection in a total joint replacement, it is highly recommended to take prophylactic antibiotics.  "It is likely that bacteremia associated with acute infections in the oral cavity, skin, respiratory, gastrointestinal, and urogenital systems and/or other sites can and do cause late implant infections.  Patients with total joint replacements who are having invasive procedures are at an increased risk of hematogenous seeding of their prosthesis."  Therefore, the American Academy of Orthopaedic Surgeons recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia.  Invasive procedures include dental cleaning, Orthopaedic, vascular, gastrointestinal, head and neck, obstetric and gynecological, and genitourinary procedures.  The first dose must be given at least 60 minutes before the procedure so that an effective dose is present in the tissues before the procedure begins.  Antibiotic prophylaxis is recommended in most patients, but must be examined on a case-by-case basis.

A population-based case-control study performed revealed that family history of dvt is a risk factor for a first dvt.  Blood samples and information about family history and environmental triggers were collected from 1,605 patients with a first dvt and 2,159 control subjects, 31.5% of patients and 17.3% of the controls reported having one or more first-degree relatives with a history of dvt.  A positive family history increased the risk of dvt more than 2-fold, and up to 4-fold when one or more relatives was affected.  

The risk also increased when a family history of dvt was also present with other genetic or environmental risk factors.  For those with a family history, a genetic, and an environmental risk factor, the risk of dvt was increased 64- fold compared to those without risk factors or a family history.  Overall, it is important to pay attention to a patient's family history of dvt, as it may be beneficial in risk assessment for patients who are undergoing surgery.  Patients who have a family of dvt and are in a hypercoaguable state from surgery, may benefit from extra prophylaxis in the prevention of dvt.

Did you know that October is PFCC Awareness Month?

 

Patient and Family Centered Care (PFCC) Awareness Month is an international awareness-building campaign that occurs every October to commemorate the progress that has been made toward making PFCC a reality and to build momentum for further progress through education and collaboration.

 

Hospitals and health care organizations around the world are encouraged to celebrate by empowering patients, strengthening their patient and family centered care practices, and publicly proclaiming to their patients and communities their commitments to PFCC.

 

The staff at Renaissance Orthopaedics and The Orthopaedic Program at Magee-Womens Hospital of UPMC, under the leadership of Dr. Tony DiGioia, have implemented many PFCC measures for patients needing orthopaedic care.  Dr. DiGioia designed the PFCC Orthopaedic Program to make the surgical process as easy and pain-free as possible for patients and their families.  The orthopaedic staff understand patients' and families' needs from the beginning of the process to the end.  They use a team approach with the patient (and the patient's chosen coach) as team members.  This builds a sense of community and allows the team to focus on the patient's wellness.  PFCC methods start with the initial appointment through pre-op testing and teaching to pre-surgery discharge planning, surgery, pain management, physical therapy and discharge. 

 

The in-patient hospital unit was designed to promote a healing environment.  PFCC hospitals are organized, not cluttered.  The unit is clean and quiet.  It provides comfort to patients and families in a friendly, open, welcoming environment.  Most patients in The Orthopaedic Program at Magee are able to stay in private rooms with wireless internet access.  Café-style room service is available 24 hours each day.  There is even a state-of-the-art gym and fitness area on the unit floor.  Family and friends are able to visit with patients in the Family Room.  The Family Room is a combination kitchen/living room with rocking chairs, couches, a big screen TV, a fully stocked refrigerator, internet kiosk and a massage chair.

 

The results show that PFCC works!  Renaissance Orthopaedics and The Orthopaedic Program's patients stay in the hospital one to three days (with an average of approximately two and a third days).  Ninety-five percent of patients are discharged directly to their homes.  Press Ganey scores place Dr. Digioia's group in the 99^th percentile nationally.  These are the highest Press Ganey scores in the region!  Patients agree:  After a month, 90 percent reported decreased pain from pre-op, 90 percent resumed "normal" activity, 90 percent reported good to excellent outcomes, and 99 percent would recommend The PFCC Orthopaedic Program to friends and family!

 

Dr. DiGioia also chairs workshops to teach PFCC methods to other health care providers.  In partnership with the Innovation Center at Magee-Womens Hospital of UPMC, the AMD3 Foundation sponsors the PFCC Workshop Series, which is geared toward all caregivers from support staff, nurses, doctors, and, in fact, any person who has the potential to impact a patient's care experience.

 

The next PFCC Workshop Series event will be the VisionQuest Workshop, A Journey to Transform the Patient and Family Experience Begins Here...One Step at a Time, which will be held on Friday, Nov. 13.  To find out more information about this workshop or to register, please visit www.patientandfamilycenteredcare.org.

 

To learn more about the PFCC methodology, please visit www.patientandfamilycenteredcare.org.