Clinical and radiological septic joint analysis of spontaneous sternoclavicular joint infections: achieving the best outcomes-a systems engineering approach.

Autor:	Pothini T; School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA., Wilmot CD; Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA., Waters JK; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Wait MA; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Reznik SI; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Jordan KG; Division of Chest Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Caire JT; Division of Chest Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Ashworth JM; Department of Health Systems Planning and Analytics, Parkland Hospital, Dallas, TX, USA., Cady LC; Department of Health Systems Planning and Analytics, University of Texas Southwestern Medical Center, Dallas, TX, USA., Lysikowski JR; Department of Health Systems Planning and Analytics, University of Texas Southwestern Medical Center, Dallas, TX, USA., Yen CF; Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA., Weinschenk RC; Department of Orthopedic Surgery, University of Texas Sokuthwestern Medical Center, Dallas, TX, USA., Samade R; Department of Orthopedic Surgery, University of Texas Sokuthwestern Medical Center, Dallas, TX, USA., Jessen ME; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Kusiak A; Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA., Kernstine KH; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2024 Mar 29; Vol. 65 (4).
DOI:	10.1093/ejcts/ezae128
Abstrakt:	Objectives: Spontaneous sternoclavicular joint infection (SSCJI) is a rare and poorly understood disease process. This study aims to identify factors guiding effective management strategies for SSCJI by using data mining. Methods: An Institutional Review Board-approved retrospective review of patients from 2 large hospitals (2010-2022) was conducted. SSCJI is defined as a joint infection without direct trauma or radiation, direct instrumentation or contiguous spread. An interdisciplinary team consisting of thoracic surgeons, radiologists, infectious disease specialists, orthopaedic surgeons, hospital information experts and systems engineers selected relevant variables. Small set data mining algorithms, utilizing systems engineering, were employed to assess the impact of variables on patient outcomes. Results: A total of 73 variables were chosen and 54 analysed against 11 different outcomes. Forty-seven patients [mean age 51 (22-82); 77% male] met criteria. Among them, 34 underwent early joint surgical resection (<14 days), 5 patients received delayed surgical intervention (>14 days) and 8 had antibiotic-only management. The antibiotic-only group had comparable outcomes. Indicators of poor outcomes were soft tissue fluid >4.5 cm, previous SSCJI, moderate/significant bony fragments, HgbA1c >13.9% and moderate/significant bony sclerosis. Conclusions: This study suggests that targeted antibiotic-only therapy should be considered initially for SSCJI cases while concurrently managing comorbidities. Patients displaying indicators of poor outcomes or no symptomatic improvement after antibiotic-only therapy should be considered for surgical joint resection. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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