A group of researchers led by Mohit N. Gilotra, M.D., assistant professor of orthopedics at the University of Maryland School of Medicine (UMSOM), will receive the 2018 Charles S. Neer Award from the American Shoulder and Elbow Surgeons (ASES).
Neer Award Goes to University of Maryland Surgeons
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Their groundbreaking work, a randomized controlled trial, demonstrated an effective method of potentially reducing the risk of serious infection after shoulder surgery. The award will be presented to the University of Maryland research team at the ASES Open Meeting/Specialty Day on March 10, 2018, in New Orleans.
Dr. Gilotra was the principal investigator and senior author; co-authors include R. Frank Henn III, M.D., associate professor of orthopedics at UMSOM, and S. Ashfaq Hasan, M.D., associate professor of orthopedics and chief of the elbow and shoulder program in the Department of Orthopaedics at UMSOM.
As the University of Maryland wrote in its November 30, 2017 news relase, “Propionibacterium acnes (P acnes), a gram-positive bacteria, is a commonly reported cause of delayed infection in shoulder surgery. Traditional skin preparations are ineffective in preventing these infections because they don’t penetrate deep enough into the skin to reach the source of the P acnes and have minimal to no effect on the bacteria.”
“In this randomized clinical trial with 80 patients, the researchers found that using benzoyl peroxide (BPO) is more effective at reducing P acnes bacteria on the shoulder than chlorhexidine gluconate (CHG), which may reduce the risk of intraoperative wound contamination and delayed post-operative infection.”
Dr. Gilotra told OTW, “Infection is a devastating complication after any surgery. P. acnes is a bacteria that causes most of the infections in shoulder surgery but it seemed like current skin preps were not effective. We set up our own lab to increase fidelity.”
“Benzoyl peroxide caused a much greater reduction in P. acnes bacteria compared to traditional chlorhexidine skin prep. We found that benzoyl peroxide is a low-cost safe adjunct as a preoperative skin prep to decrease the P. acnes skin burden prior to surgery. Future large (over 3,000 patients) clinical trials are necessary to show how effective it really is at decreasing surgical site infection.”
As for the Neer award, Dr. Gilotra told OTW, “It was a great honor and a testament to the hard work of the team and the importance of our findings.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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