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Infection after mini-open rotator cuff repair
Mauricio F Herrera1, Greg Bauer, Fletcher Reynolds
1New York Orthopaedic Hospital, New York Presbyterian Medical Center, New York, NY 10032, USA.
Abstract:
A consecutive case series from 2 institutions of patients with postoperative wound infections after mini-open rotator cuff repair was reviewed. Between 1991 and 2000, 360 patients underwent mini-open rotator cuff repair after arthroscopic subacromial decompression. Seven patients had postoperative infection develop (1.9%). All patients were men, with a mean age of 55 years (range, 40-64 years). Treatment included serial irrigation and debridement, long-term intravenous antibiotics, and revision rotator cuff repair. Mean follow-up after definitive treatment was 32 months (range, 12-57 months). Propionibacter acnes was present in 6 of 7 patients (86%) with infections. The initial rotator cuff repair was disrupted in 4 shoulders and intact in 3. A revision rotator cuff repair was performed at the final irrigation and debridement in all 4 shoulders. Results were 100% satisfactory. The mean American Shoulder and Elbow Surgeons pain score improved from 7 (range, 6-9) preoperatively to 1 (range, 0-2). The mean final score was 95. Because these infections were noted to occur only in arthroscopically assisted rotator cuff repairs, a second preparation and draping were introduced as routine protocol. No postoperative infections have occurred in the ensuing 200 mini-open rotator cuff repairs.
Insights
Postoperative wound infections after mini-open rotator cuff repair occurred in 1.9% of patients. Implementing a second sterile preparation and draping protocol eliminated subsequent infections in 200 cases.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
Background:
- Mini-open rotator cuff repair is a common orthopedic procedure.
- Postoperative wound infections can complicate rotator cuff repair outcomes.
Purpose of the Study:
- To investigate the incidence and management of postoperative wound infections following mini-open rotator cuff repair.
- To evaluate the effectiveness of enhanced sterile protocols in preventing surgical site infections.
Main Methods:
- A retrospective case series of 360 patients undergoing mini-open rotator cuff repair between 1991 and 2000.
- Analysis of infection cases, treatment strategies, and patient outcomes.
- Introduction of a second sterile preparation and draping protocol after initial observations.
Main Results:
- Seven patients (1.9%) developed postoperative wound infections, predominantly caused by Propionibacterium acnes.
- Infected patients required serial irrigation, debridement, antibiotics, and often revision rotator cuff repair.
- Following the implementation of a dual sterile draping protocol, no further infections occurred in 200 subsequent cases.
Conclusions:
- Postoperative wound infections after mini-open rotator cuff repair are infrequent but serious complications.
- Enhanced sterile techniques, specifically a second preparation and draping, appear highly effective in preventing surgical site infections.
- This protocol change significantly improved patient safety and surgical outcomes.
