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Cumulative wisdom matters: Consensus has been reached for PJI management
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Health care in the United States continues to undergo rapid transformation. Although no one can claim to knowing the exact direction in which we are headed, one common theme appears to center around cost saving. There is no surprise to learn that “hospital-acquired infections” pose the greatest economic burden on the health care. As efforts to reduce cost unfold, numerous regulatory and non-regulatory protocols have emerged that “monitor” quality of care that hospitals and physicians provide. One of the commonly posited quality metrics relates to the incidence of infection after surgical procedures. So, even more than before, our mission to reduce surgical site infection and periprosthetic joint infection has gained importance.
At a recent meeting in Philadelphia, more than 300 leaders in musculoskeletal infection gathered to develop “best practice guidelines” related to management of periprosthetic joint infection. These delegates from 58 countries, and 130 societies and multiple specialties including orthopedic surgery, infectious disease, musculoskeletal pathology, microbiology, anesthesiology, dermatology, nuclear medicine, rheumatology, musculoskeletal radiology, veterinary surgery and numerous scientists, debated and voted on some of the most important questions that face us on a daily basis.
The consensus process that spanned more than 10 months with more than 23,000 communications between the delegates lead to the development of a 400-page document that addresses 207 questions. Strong consensus (>65% vote) was reached on all, except four questions. The information amassed as a result of this initiative is expected to provide a useful roadmap for practicing orthopedic surgeons around the world in their mission to reduce infection after orthopedic procedures and improve outcomes for our patients. We present some example questions that were debated and for which consensus was reached. The full document can be found on the website of numerous societies that were represented in the meeting such as the Musculoskeletal Infection Society (www.msis-na.com).
For more information:
Javad Parvizi, MD, FRCS, editor of Infection Watch, can be reached at the Rothman Institute, 925 Chestnut St., 5th Floor, Philadelphia, PA 19107; email: parvj@aol.com.
Disclosures: Gehrke is a consultant work for LINK, Zimmer and Biomet, and is a scientific board member for CD Diagnostics and Boehringer Ingelheim. Parvizi is a consultant to Zimmer, Smith & Nephew, 3M and Convatec.