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One- vs 2-Stage Bursectomy for Septic Olecranon and Prepatellar Bursitis: A Prospective Randomized Trial
Ilker Uçkay1, Elodie von Dach2, Cédric Perez3
1Orthopaedic Surgery Service, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Service of Infectious Diseases, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Infection Control Program, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
The one-stage bursectomy approach for septic bursitis is safe, effective, and cost-saving compared to the two-stage method. This surgical technique reduces hospital stay and nurses workload, making it a preferred option for patients.
Area of Science:
- Orthopedics
- Infectious Diseases
- Surgical Innovation
Background:
- Septic bursitis is a common condition requiring prompt treatment.
- Surgical intervention, specifically bursectomy, is often necessary for moderate to severe cases.
- The optimal surgical approach for septic bursitis remains a subject of investigation.
Purpose of the Study:
- To compare the efficacy and cost-effectiveness of one-stage versus two-stage bursectomy for hospitalized patients with septic bursitis.
- To assess treatment failure rates, complications, length of hospital stay, and resource utilization for each surgical approach.
Main Methods:
- A randomized controlled trial involving 164 hospitalized patients with septic bursitis (elbow or patella).
- Patients were randomized to either a one-stage or two-stage bursectomy.
- All patients received 7 days of postsurgical oral antibiotic therapy.
Main Results:
- Treatment failure rates were similar between the one-stage (10%) and two-stage (16%) groups (P=.23).
- The one-stage approach showed significantly better outcomes for elbow bursitis, with lower wound dehiscence rates (P=.03).
- One-stage bursectomy resulted in shorter hospital stays, reduced nurses' workload, and lower total costs compared to the two-stage approach (all P<.01).
Conclusions:
- For hospitalized adults with septic bursitis, one-stage bursectomy with primary closure and antibiotic therapy is a safe and effective treatment.
- The one-stage approach is more resource-efficient, leading to significant cost savings.
- A two-stage approach may increase the risk of wound dehiscence in olecranon bursitis.
