AlOmran AK, Alosaimi N, Alshaikhi AA, Bakhurji OM, Alzahrani KJ, Salloot BZ, Alabduladhem TO, AlMulhim AI, Alumran A. Burden of routine orthopedic implant removal a single center retrospective study. World J Orthop 2024; 15(2): 139-146 [PMID: 38464354 DOI: 10.5312/wjo.v15.i2.139]
Corresponding Author of This Article
Ahmed I AlMulhim, MBBS, MD, Surgeon, Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, King Faisal Ibn Abdulaziz Road, Dammam 31441, Saudi Arabia. ahlmulhim@iau.edu.sa
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Feb 18, 2024; 15(2): 139-146 Published online Feb 18, 2024. doi: 10.5312/wjo.v15.i2.139
Burden of routine orthopedic implant removal a single center retrospective study
Ammar K AlOmran, Nader Alosaimi, Ahmed A Alshaikhi, Omar M Bakhurji, Khalid J Alzahrani, Basil Ziyad Salloot, Tamim Omar Alabduladhem, Ahmed I AlMulhim, Arwa Alumran
Ammar K AlOmran, Nader Alosaimi, Ahmed A Alshaikhi, Omar M Bakhurji, Khalid J Alzahrani, Basil Ziyad Salloot, Tamim Omar Alabduladhem, Ahmed I AlMulhim, Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
Arwa Alumran, Health Information Management and Technology Department, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
Author contributions: AlOmran AK, Alosaimi N contributed to the concept; Alshaikhi AA, Bakhurji OM contributed to design; Alzahrani KJ, Salloot BZ, Alabduladhem TO, AlMulhim AI contributed to study execution; AlOmran AK, Alosaimi N, Alshaikhi AA, Bakhurji OM, Alzahrani KJ, Salloot BZ, Alabduladhem TO, AlMulhim A contributed to manuscript writing and review; Alumran A contributed to statistical analysis.
Institutional review board statement: Ethical approval was obtained from the Institutional Review Board of Imam Abdulrahman bin Faisal University following the ethical requirements of the Declaration of Helsinki (IRB number: IRB-UGS-2022-01-396).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors have no conflict of interests.
Data sharing statement: Raw data and materials are available as needed.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ahmed I AlMulhim, MBBS, MD, Surgeon, Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, King Faisal Ibn Abdulaziz Road, Dammam 31441, Saudi Arabia. ahlmulhim@iau.edu.sa
Received: November 17, 2023 Peer-review started: November 17, 2023 First decision: December 7, 2023 Revised: December 18, 2023 Accepted: January 9, 2024 Article in press: January 9, 2024 Published online: February 18, 2024 Processing time: 81 Days and 7.1 Hours
Abstract
BACKGROUND
Open reduction and internal fixation represent prevalent orthopedic procedures, sparking ongoing discourse over whether to retain or remove asymptomatic implants. Achieving consensus on this matter is paramount for orthopedic surgeons. This study aims to quantify the impact of routine implant removal on patients and healthcare facilities. A retrospective analysis of implant removal cases from 2016 to 2022 at King Fahad Hospital of the University (KFHU) was conducted and subjected to statistical scrutiny. Among these cases, 44% necessitated hospitalization exceeding one day, while 56% required only a single day. Adults exhibited a 55% need for extended hospital stays, contrasting with 22.8% among the pediatric cohort. The complication rate was 6%, with all patients experiencing at least one complication. Notably, 34.1% required sick leave and 4.8% exceeded 14 d. General anesthesia was predominant (88%). Routine implant removal introduces unwarranted complications, particularly in adults, potentially prolonging hospitalization. This procedure strains hospital resources, tying up the operating room that could otherwise accommodate critical surgeries. Clearly defined institutional guidelines are imperative to regulate this practice.
AIM
To measure the burden of routine implant removal on the patients and hospital.
METHODS
This is a retrospective analysis study of 167 routine implant removal cases treated at KFHU, a tertiary hospital in Saudi Arabia. Data were collected in the orthopedic department at KFHU from February 2016 to August 2022, which includes routine asymptomatic implant removal cases across all age categories. Nonroutine indications such as infection, pain, implant failure, malunion, nonunion, restricted range of motion, and prominent hardware were excluded. Patients who had external fixators removed or joints replaced were also excluded.
RESULTS
Between February 2016 and August 2022, 360 implants were retrieved; however, only 167 of those who met the inclusion criteria were included in this study. The remaining implants were rejected due to exclusion criteria. Among the cases, 44% required more than one day in the hospital, whereas 56% required only one day. 55% of adults required more than one day of hospitalization, while 22.8% of pediatric patients required more than one day of inpatient care. The complication rate was 6%, with each patient experiencing at least one complication. Sick leave was required in 34.1% of cases, with 4.8% requiring more than 14 d. The most common type of anesthesia used in the surgeries was general anesthesia (88%), and the mean (SD) surgery duration was 77.1 (54.7) min.
CONCLUSION
Routine implant removal causes unnecessary complications, prolongs hospital stays, depletes resources and monopolizing operating rooms that could serve more critical procedures.
Core Tip: This retrospective study examines the implications of routine asymptomatic implant removal on both patients and healthcare institutions. The study reveals that such practices impose substantial financial and health-related challenges for both individuals and hospitals.
