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Robotic Knee Surgery Lowers Infection Rates
- 1. Research Study: Post-Surgical Infection and Recovery BY: TRISHA ESTES, JEREMIAH ROSENKRANCE, KRYSTAL KLEMEN OCTOBER 15, 2017
- 2. Components Introduction Research question Importance Current Knowledge Hypothesis Objectives Research Design Study Sample and Consent Interventions Method of Comparison
- 3. Components Results Outcome Findings and Evidence
- 4. Introduction The purpose if this study was to examine post-surgical infection rates between patients receiving robotic assisted surgery and patients receiving the conventional method (open surgery) for total knee arthroplasty and how it correlates to overall recovery.
- 5. PICO and Research Questions PICO Does the use of robotic assisted surgery decrease post-surgical infection rates in patients receiving total knee arthroplasty compared to the conventional (open) surgical method? Research Questions In patients receiving total knee arthroplasty, does the conventional surgical method increase the risk of post-surgical infection? In patients receiving total knee arthroplasty, what is the effect of robotic assisted surgery and open surgery on post-surgical infection rates and recovery time?
- 6. Hypothesis Hypothesis Patients of robotic assisted surgery are less likely to suffer from post- surgical infection and will achieve quicker recovery than patients receiving open surgical methods.
- 7. Research Study Objectives The study objective is to identify which type of procedure robotic or conventional, has better post surgical infection rates in regards to total knee arthroplasty?
- 8. Research Design Experimental Research Design Intervention- robotic assisted surgery versus conventional surgical approach Control- control group to receive conventional surgical method Randomization Participants randomly selected for control group or robotic approach group
- 9. Sample Population and Consent
- 10. Interventions
- 12. Results Shorter surgical duration decreases risk of post-surgical infection Robotic assisted surgery decreases infection risk Decreased joint manipulation Increased surgical precision Less surgical personnel in the OR Small surgical incision
- 13. Outcome Limitations Pre-existing conditions that may increase risk of infection Arthritis, obesity, increased BMI, diabetes Complications arising in surgery requiring lengthened surgical time Surgical protocol Amount of staff in OR Re-gloving during operative procedure
- 14. Findings and Evidence Conference held to review research results Evidence Results and evidence posted to surgical and operating room areas Hand washing technique reminders posted near sinks Education Nurse review infection prevention with patients prior to discharge Review signs and symptoms of infection with patients
- 15. Conclusion Robotic Assisted Surgery becoming Gold Standard Decreased risk of infection Decreased recovery time
- 16. References Polit, D., & Beck, C. (2018). Essentials of nursing research: appraising evidence for nursing practice (9th ed.) Philadelphia, PA: Wolters Kluwer. Renaud, A., Lavigne, M., & Vendittoli, P.-A. (2012). Periprosthetic joint infections at a teaching hospital in 1990-2007. Canadian Journal of Surgery, 55(6). http://dx.doi.org.proxy1.nwcu.edu/10.1503/cjs.033610 Van Der List, J., Chawla, H., & Pearle, A. (2016). Robotic-assisted knee arthroplasty: An overview. The American Journal of Orthopedics, 45(4). http://www.mdedge.com/amjorthopedics/article/108342/robotics/robotic-assisted-knee- arthroplasty-overview
Editor's Notes
- Surgical infections are a troubling factor that directly correlates to post-op recovery for patients. This research study is to determine if one surgical approach over another can decrease the risk of infections for patients to help increase overall recovery rate.
- Through the use of robotic-assisted surgical methods, patients will experience shortened surgical procedure time which results in decreased infection rates. The conventional surgical method requires more cutting and manipulation thus increasing the risk of infection as well as a longer surgical procedure time.
- The objective of this study is to determine if robotic assisted surgery results in decreased risk of infection in patients when compared to the conventional (open) surgical method. The information gathered from this research study can help facilitate interventions to ensure the risk of infection remains low through the pre-operative and recovery period. If robotic assisted surgery does in fact lessen the risk of infection and can be proven, this study could change the surgical procedures are performed in hospitals ensuring patients receive the highest level of care with as minimal risk as possible.
- “A true experiment or RCT is characterized by the following properties: Intervention—The experimenter does something to some participants by manipulating the independent variable. Control—The experimenter introduces controls into the study, including devising an approximation of a counterfactual—usually a control group that does not receive the intervention. Randomization—The experimenter assigns participants to a control or experimental condition on a random basis.” (Polit & Beck, p. 137) The research designed that will be used is the Experimental Design. The experiment is characterized by an intervention, control, and randomization. Intervention being using Robotic assisted surgery for total knee arthroplasty or using the conventional surgical methods and see what the outcomes are as far as post-surgical infection rates. The control group would receive the conventional surgical method, and the others the Robot assisted surgical method. Participants would be placed in the two groups at random as to prevent bias.
- According to a research study conducted by Peersman, Laskin, Davis, Peterson, and Richart (2005), “Patients without infections had surgery durations of 94 +/- 28 min. Patients with infection had durations of 127 +/- 45 min” (p.71). They found that the length of the surgery directly impacted the potential for post-surgical site infection. Through their research, Peersman et al. (2005), discovered that increased weight and BMI directly correlated with increased surgical time. “Recent studies have shown that robotic-assisted systems are superior to computer navigation systems with regard to less cutting time and less resection deviations… and shorter surgery time… and shorter hospital stay” (Van Der List, Chawla, & Pearle, 2016, p. 203). Robotic assisted surgery decreases the risk of infection by utilizing a shorter operation as well a more precise repair method resulting in less manipulation from a surgeon. We anticipate the results to indicate that robotic assisted surgical approach will reduce infection rates and also increase patient recovery as they will have a shorter operation as well as a more precise surgical repair. Patients will have a shorter recovery time of 6-8 weeks with the robotic method compared to up to 3 months with the conventional method. “Tighter control of intraoperative surgical variables… have been associated with improved survivorship and functional status” (Van Der List, Chawla, & Pearle, 2016, p. 207).
- Peersman et al. (2005) concluded that, “…the patient’s age and general health status are important factors in relation to complications” (p. 72). Age and pre-existing conditions can be correlated to the patient developing a post-op infection and the overall recovery of the patient. If the patient is older or deconditioned they may be more inclined to stay bed ridden immediately following surgery rather than improving recovery by being active sooner as well as slower healing for patients with diabetes. Another study conducted by Renaud, Lavigne, and Vendittoli (2012), reviewed surgical infection rates for total knee arthroplasty in patients receiving the conventional surgical method. They found that by changing their perioperative procedure, infection rate decreased by 44%. This involved double gloving and changing outer glove layer periodically throughout the surgical procedure, increasing the length of time high risk patients received antibiotic prophylaxis, and decreasing the number of staff in the operating room (Renaud, Lavigne, & Vendittoli, 2012).
- Findings will be posted on relevant floors and in surgery centers. A conference will be held to discuss the relevant findings of this study. So say the conventional method of surgery had a better post surgical infection rates. Signs would be posted where surgeons and nurses scrub in proper hand washing techniques as well as on the floor at the hospital in after care of these patients. If robotic assisted surgery had the better outcomes involving post surgical infection rates, these findings would be shared in hopes that other hospitals and surgery centers would move away from conventional methods. Nurses will be required to teach evidence based research to patients on how to further prevent infection after surgery.
- The conventional (open) surgical method has long since been deemed the “gold standard” for knee repair and replacement. However, with the production and use of the robotic surgical methods, surgeons and healthcare professionals around the world are looking towards a potential new gold standard procedure. The robotic-assisted surgical method is decreasing the length of surgical procedures and manipulation within the surgical incision resulting in decreased risk of infection. The robotic –assisted surgical approach is also more precise and decreasing recovery time immensely in post-operative knee patients. Ensuring patients receive antibiotic prophylaxis and through the use of robotic surgical methods, we can decrease surgical infections and give patients the best surgical outcome possible.