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Bacterial colonization of surgical helmets, a prophylactic aspirin regimen for venous thromboembolism (VTE), and the value of virtual visits in pediatric orthopedics were examined in several studies at the American Academy of Orthopaedic Surgeons meeting.

Pathogens and Surgical Helmets

Nearly three-fourths of a sample of surgical helmets and surgeons' foreheads swabbed after a day's worth of hip and knee replacement surgeries showed major levels of pathogens, according to a prospective, observational study.

Emanuele Chisari, MD, of the Rothman Orthopedic Institute in Philadelphia, and colleagues reported that "73.8% of the samples taken from helmets isolated pathogen(s) at all timepoints, and 100% were positive for a pathogen at one point during the day. Some 82% of helmets demonstrated an increase in colony forming units on culture over the course of the day. In total, 64% of helmets grew bacterial species from corresponding skin samples of the helmet user that were not present at the start of the day."

The most common pathogens were skin bacteria such as C. acnes (n=56/84 samples), Staphylococcus capitis (32/84), and Staphylococcus epidermidis (31/84). Researchers also turned up "significant pathogens of orthopedic interest" such as coagulase negative staph (10/84), Enterococcus species (9/84), Enterobacter species (8/84), Staphylococcus aureus (5/84), and Staphylococcus hominis (5/84).

The findings suggest "a dynamic transfer between the skin of the helmet user and the surgical helmet," used during total joint arthroplasty, the authors stated.

Surgical helmets are normally not sterilized, "mostly because it would be too expensive and is probably not necessary," Chisari said. However, an antiseptic cleaning protocol for surgical helmets is probably a good idea and would have a small cost, he added.

The study did not examine if these organisms, which commonly cause orthopedic infection, led to any adverse events, "but definitely we would love to have a low biomass of them in the OR [operating room]," Chisari told MedPage Today.

Post-THA Aspirin for VTE

Aspirin for postoperative anticoagulation was non-inferior to non-aspirin anticoagulants in total hip arthroplasty (THA), according to Gurpreet Singh, MD, of Northwest Permanente Physicians and Surgeons in Hillsboro, Oregon, and colleagues.

They tracked 35,142 primary THA patients for 90 days (2009-2019) in a joint registry, 41.9% of whom used post-op aspirin for VTE prophylaxis. In propensity score-weighted models, they found that aspirin use demonstrated non-inferiority to non-aspirin anticoagulants in VTE rates (OR 0.73, 95% CI 0.52-1.02, 0.97 one-sided upper bound).

They also reported that aspirin use was linked with a lower likelihood for deep infection (OR 0.56, 95% CI 0.38-0.83), readmission (OR 0.62, 95% CI=0.55-0.71), and bleeding (OR 0.49, 95% CI=0.29-0.83) versus non-aspirin anticoagulants. However, no difference was observed for wound complications or mortality, the authors stated.

In an analysis of 2,920 patients at high risk of VTE, the researchers noted that aspirin use was associated with a lower likelihood for deep infection (OR 0.26, 95% CI 0.08-0.82), readmission (OR 0.41, 95% CI 0.28-0.59), and bleeding (OR 0.23, 95% CI 0.06-0.82) versus non-aspirin anticoagulants.

While "In patients considered higher risk for VTE, aspirin use was associated with fewer complications without increasing the likelihood of VTE in comparison to potent anticoagulation...non-inferiority for VTE in this high-risk population was not demonstrated," Singh's group cautioned.

Virtual Visits for the Win

Virtual visits offered similar satisfaction to in-person visits across multiple domains for pediatric orthopedic patients, according to a survey-based study.

Ahmed Emara, MD, of the Cleveland Clinic, and colleagues surveyed parents or guardians of 1,686 patients, the majority with nontraumatic complaints Of those, 86.6% had in-office and 13.4% had virtual visits. The study was done in 2020 (post-pandemic), and asked about the quality of their interactions.

The authors said that >85% of respondents in both groups reported "good/excellent" satisfaction rates. Virtual visits were associated with higher odds of patients reporting "good/excellent satisfaction" with the ease of scheduling (booking) an appointment (odds ratio 4.72, 95% CI 1.46-15.21, P=0.009). Other findings were:

• 89% reported "good/excellent" satisfaction with ease of talking to the provider over a video connection
• 86% reported "good/excellent" satisfaction with adequacy of the video connection throughout the visit
• 90% reported "good/excellent" adequacy of audio connection throughout the visit
• 77% reported overall satisfaction with the virtual visit relative to in-office visits

However, the authors found lower odds of reporting "good/excellent" satisfaction with the ability to schedule the visit at a particularly convenient time (OR 0.1, 95% CI 0.08-0.18, P<0.001) and with providers' explanation of their condition in a virtual setting (OR 0.4, 95% CI 0.17-0.91, P=0.03) versus in-office visits.

And for the "likelihood of you recommending our practice to others," 88.6% of those who did a virtual visit said "good/excellent" versus 97.5% of those who did an in-person visit (P<0.001). But both groups had similar levels of "good/excellent" responses (97.3% vs 96.1%) to the "likelihood of your recommending this care provider to others" (P=0.566).

"Providers are encouraged to invest time and provide educational material to explain patients' conditions to overcome potential limitations," the authors wrote. " Additionally, allowing more flexibility with visit scheduling and increasing available virtual time slots may increase overall satisfaction with virtual encounters."