Single-anesthetic bilateral total hip arthroplasty (THA) has had a historically high perioperative complication profile. However, a matched cohort study by Houdek et al. in the January 4, 2017 edition of JBJS comparing single-anesthetic versus staged bilateral THA over four years found no significant differences between the two procedures in terms of:
- Risks of revision, reoperation, or complications (including DVT/PE, dislocation, periprosthetic fracture, and infection; see graph, where blue line represents single-anesthetic and red line indicates staged)
- Perioperative mortality
- Discharge to home versus rehab
The single-anesthetic group (94 patients, 188 hips) experienced shorter total operating room time and hospital length of stay than the matched cohort, and consequently the single-anesthetic approach lowered the relative total cost of care by 27%.
While the Mayo Clinic authors concede the potential for selection bias in this study (e.g., there was no standardized protocol for determining eligibility for inclusion in either group), they say that they currently consider single-anesthetic bilateral THA for patients with bilateral coxarthrosis who are <70 years of age, relatively healthy, and/or have bilateral hip contractures that would make rehabilitation difficult.
In a study in the February Journal of Hand Surgery, nearly a third of all people who sustained a cat bite to the hand ended up hospitalized for treatment of a serious infection. Among those hospitalized, the average length of stay was 3.2 days, mostly for surgical procedures, including irrigation and debridement, and administration of appropriate antibiotics.
One major risk factor for hospitalization was a bite located over a joint/tendon sheath, rather than one located over soft tissue. Study co-author Brian Carlsen of the Mayo Clinic explained further in an interview with USA Today: “When the cat bites the hand, the joints and tendons are protected with fluid and there is no circulation, so bacteria can grow like crazy.” The most common pathogen isolated in cultures was Pasturella multocida, which the study authors described as “one of the most aggressive pathogens isolated from the saliva of 70% to 90% of cats.”
The authors conclude that “there should be a low threshold for aggressive treatment” in patients who present with a cat bite to the hand along with lymphangitis, erythema, and swelling. Or, as Dr. Carlsen told USA Today (with tongue presumably in cheek): “Rule of thumb–go see a doctor if a cat bites your hand.”