human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Deep and superficial sternal wound infections ( DSWI & SWI ) following cardiac surgery increase morbidity , mortality and cost . Autologous platelet rich plasma ( PRP ) derived from the patient ’s own blood has been used in other surgical setting s to promote successful wound healing . The goal of this study was to analyze the addition of PRP using a rapid point of care bedside system to st and ard wound care in all patients undergoing sternotomy for cardiac surgical procedures . Methods Over a 7 year period , 2000 patients undergoing open cardiac operations requiring sternotomy were enrolled . One thous and patients received st and ard of care sternal closure . The other 1000 patients received st and ard of care sternal closure plus PRP applied to the sternum at the time of closure . The outcomes related to wound healing , infection , readmissions , and costs were analyzed . Results In the 2000 patients , there were more ventricular assist device implants/heart transplants and emergency operations in the PRP group ; otherwise there were no significant differences . The use of PRP reduced the incidence of DSWI from 2.0 to 0.6 % , SWI from 8.0 to 2.0 % , and the readmission rate from 4.0 to 0.8 % . The use of PRP reduced the costs associated with the development of deep and superficial wound complications from $ 1,256,960 to $ 593,791 . Conclusions The use of PRP decreases the incidence and costs of sternal wound complications following cardiac surgery . The routine use of platelet rich plasma should be considered for all patients undergoing sternotomy for cardiac surgical procedures .Trial registration Clinical trials.gov ( NCT00130377 ) for the data registry BACKGROUND This investigation used age as a continuous variable to estimate implant survival and the risk of complications . METHODS Prospect ively collected data were used to analyze 5494 consecutive shoulder arthroplasties performed from 1970 to 2012 . Patients were a mean age of 67 years . The association between the age at the index procedure and the risk for each outcome was assessed using Cox regression and smoothing spline analysis . RESULTS Older age was associated with a decreased risk of revision surgery , revision for mechanical failure , and reoperation but with a higher risk for thromboembolic events . Reoperation rates also decreased in a linear fashion with older ages ( P < .001 ) . The risk of revision surgery decreased in a linear fashion between the ages of 40 and 85 , with a 3 % decreased risk of revision per 1-year increase in age ( P < .01 ) . This association held true in a multivariate model and when specific procedures were separated out . Compared with patients aged < 50 years , patients aged from 50 to 65 years ( P < .001 ) and those > 65 years ( P < .001 ) have decreased risks of revision surgery . The risk of a revision surgery in a patient aged > 50 years was significantly decreased ( ~13 % reduction in risk for each year ; P < .001 ) . There was a subtle association between older age and decreased rates of infection ( P = .01 ) . CONCLUSIONS There is a strong association between older age and decreased rates of revision surgery and reoperation after shoulder arthroplasty , with a striking association with decreased rates of mechanical failure . These are important considerations when counseling younger patients regarding their risks BACKGROUND Anatomic total shoulder arthroplasty ( TSA ) and reverse total shoulder arthroplasty ( RTSA ) are increasingly common procedures employed to treat arthritic conditions . Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff , concerns about RTSA persist because of variable complication rates and outcomes . METHODS This is a prospect i ve , case-control study comparing outcomes and complications after TSA and RTSA . The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy . Average clinical follow-up was more than 2 years in both groups . Major complications included infection , periprosthetic fracture , instability , glenoid loosening , and need for revision surgery . Patient outcome measures included the American Shoulder and Elbow Surgeons score , pain visual analog scale score , and goniometer-measured range of motion . Plain radiographs were review ed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA . RESULTS At 2 years , there were no differences in rate of major complications  ( TSA , 15 % ; RTSA , 13 % ; P = .808 ) or revision surgeries  ( TSA , 11 % ; RTSA , 9 % ) . Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups . TSA patients had greater external rotation than RTSA patients did ( 53 ° vs 38 ° ; P = .001 ) . Otherwise , forward flexion , abduction , and internal rotation were comparable in range of motion . CONCLUSIONS TSA and RTSA  have similar complication rates , need for revision , patient-reported outcomes , and range of motion at 2 years of follow-up . The use of side-by-side cohorts in this study allows st and ardized comparison between these 2 shoulder arthroplasty procedures HYPOTHESIS Deep infection after shoulder surgery is a rare but devastating problem . This study tested the hypothesis that the home application of a 2 % chlorhexidine gluconate cloth before shoulder surgery would be more efficacious than a st and ard shower of soap and water at decreasing the preoperative cutaneous levels of pathogenic bacteria on the shoulder . MATERIAL S AND METHODS This r and omized , prospect i ve study evaluated 100 consecutive patients undergoing shoulder surgery . Patients were r and omly assigned to use 2 % chlorhexidine gluconate-impregnated cloths ( treatment group ) or to shower with soap and water before surgery ( control group ) . Cutaneous cultures were taken from the patients ' shoulders in the preoperative holding area . Patients were monitored for 2 months postoperatively for clinical signs of infection . RESULTS In the treatment group vs the control group , the overall positive culture rate was 66 % vs 94 % ( P = .0008 ) , and the positive culture rate for coagulase-negative Staphylococcus was 30 % vs 70 % ( P = .0001 ) . The positive culture rate for Propionibacterium acnes was 46 % in the treatment group vs 58 % in the control group ( P = .32 ) . No infections occurred in any patients at a minimum of 2-months after surgery . DISCUSSION The use of the 2 % chlorhexidine cloth was effective at decreasing overall bacterial culture rates before shoulder surgery and was particularly effective at decreasing the quantity of coagulase-negative Staphylococcus , a known causative agent of postoperative shoulder infections . CONCLUSION Use of chlorhexidine impregnated cloths prior to shoulder surgery may be a useful adjunct to presently used infection prevention strategies Background Few studies have analyzed the association between elevated BMI and complications after total shoulder arthroplasty ( TSA ) . Previous studies have not consistently arrived at the same conclusion regarding whether obesity is associated with a greater number of postoperative complications . We used a national surgical data base to compare the 30-day complication profile and hospitalization outcomes after primary TSA among patients in different BMI categories . Questions / purpose sWe asked : ( 1 ) Is obesity associated with an increased risk of complications within 30 days of primary TSA ? ( 2 ) Is obesity associated with increased operative time ? Methods The American College of Surgeons National Surgical Quality Improvement Program ® data base for 2006 to 2012 was queried to identify all patients who underwent a primary TSA for osteoarthritis of the shoulder . The ACS-NSQIP ® data base was selected for this study as it is a nationally representative data base that provides prospect ively collected perioperative data and a comprehensive patient medical profile . Exclusion criteria included revision TSA , infection , tumor , or fracture . We analyzed 4796 patients who underwent a primary TSA for osteoarthritis of the shoulder . Patients who underwent a TSA  were divided in four BMI categories : normal ( 18.5–25 kg/m2 ) , overweight ( 25–30 kg/m2 ) , obesity Class 1 ( 30–35 kg/m2 ) , and obesity Class 2 or greater ( > 35 kg/m2 ) . Perioperative hospitalization data and 30-day postoperative complications were compared among different BMI classes . Differences in patient demographics , preoperative laboratory values , and preexisting patient comorbidities also were analyzed among different BMI groups , and multivariate analysis was used to adjust for any potential confounding variables . Results There was no association between BMI and 30-day complications after surgery ( normal as reference , overweight group relative risk : 0.57 [ 95 % CI , 0.30–1.06 ] , p = 0.076 ; obesity Class 1 relative risk : 0.52 [ 95 % CI , 0.26–1.03 ] , p = 0.061 ; obesity Class 2 or greater relative risk : 0.54 [ 95 % CI , 0.25–1.17 ] , p = 0.117 ) . However , greater BMI was associated with longer surgical times ( for normal BMI control group : 110 minutes , SD , 42 minutes ; overweight group : 115 minutes , SD , 46 minutes , mean difference to control : 5 minutes [ 95 % CI , −1 to 10 minutes ] , p = 0.096 ; obesity Class 1 : 120 minutes , SD , 43 minutes , mean difference : 10 minutes [ 95 % CI , 5–15 minutes ] , p < 0.001 ; obesity Class 2 or greater : 122 minutes , SD , 45 minutes , mean difference : 12 minutes [ 95 % CI , 6–18 minutes ] , p < 0.001 ) . Conclusions Although the surgical time increased for patients with greater BMI , the 30-day complications and perioperative hospitalization data after TSA were not different in patients with increased BMI levels . Obesity alone should not be a contraindication for TSA , and obese patients can expect similar incidences of postoperative complications . The preoperative medical optimization plan should be consistent with that of patients who are not obese who undergo TSA.Level of Evidence Level III , therapeutic study PURPOSE To document the skin colonization and deep tissue inoculation rates associated with  arthroscopic shoulder surgery  and how these rates differ with procedural and demographic factors . METHODS We prospect ively recruited outpatient shoulder arthroscopy patients who agreed to participate and met the inclusion criteria from February 2013 to May 2014 . All patients received routine antibiotic prophylaxis intravenously . Initial cultures were obtained before the skin preparation by swabbing the skin at the 3 st and ard portal sites : posterior , anterosuperior , and anterolateral . The skin preparation used 4 % chlorhexidine scrub and 2 % chlorhexidine gluconate/70 % isopropyl alcohol paint applied to the entire shoulder . After completion of the arthroscopic procedure , a second culture was obtained through a cannula at the surgical site . All cultures were plated for 21 days using Brucella medium . RESULTS We enrolled 51 patients over a 15-month period . Cultures showed a 72.5 % Propionibacterium acnes superficial colonization rate : 46.1 % of female and 81.6 % of male patients ( P = .027 ) . We identified a deep culture-positive inoculation rate of 19.6 % , all with positive P acnes skin colonization . No correlation could be made concerning diagnosis , procedure , suture anchor use , age , or sex . CONCLUSIONS The rate of skin colonization with P acnes is high at arthroscopic portals , especially in men . Despite st and ard skin preparation and prophylactic antibiotics , the rate of deep tissue inoculation with P acnes in shoulder arthroscopy is much higher than the rate of infection reported in the literature . CLINICAL RELEVANCE Shoulder arthroscopy introduces a significant amount of P acnes into the deep tissues BACKGROUND Although diabetes has been associated with increased perioperative morbidity and mortality after hip and knee arthroplasty , its impact on early postoperative outcomes after shoulder replacement remains relatively unexplored . The purpose of the study was to determine the association of diabetes with in-hospital death , complications , length of stay , non-homebound disposition , and cost in patients undergoing shoulder arthroplasty . METHODS By use of the Nationwide Inpatient Sample data base for the year 2011 , an estimated 66,485 patients having undergone shoulder arthroplasty were identified and separated into groups with ( 21 % ) and without ( 79 % ) diabetes mellitus . Comparisons of specific outcome measures between diabetic and nondiabetic cohorts were performed by bivariate and multivariable analyses with logistic regression modeling . RESULTS Diabetes mellitus was independently associated with in-hospital death , a number of perioperative complications , prolonged hospital stay , and increased non-homebound disposition after shoulder arthroplasty . The presence of diabetes was not associated with increased hospital cost . CONCLUSION Patients with preexisting diabetes are at higher 
    Output:
    
agent
Conclusion There are many risk factors associated with developing an infection after elective shoulder surgery .
The findings of this systematic review are clinical ly relevant as it has been shown that infection after shoulder surgery results in poor patient-reported outcomes and pose a significant financial burden .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Deep and superficial sternal wound infections ( DSWI & SWI ) following cardiac surgery increase morbidity , mortality and cost . Autologous platelet rich plasma ( PRP ) derived from the patient ’s own blood has been used in other surgical setting s to promote successful wound healing . The goal of this study was to analyze the addition of PRP using a rapid point of care bedside system to st and ard wound care in all patients undergoing sternotomy for cardiac surgical procedures . Methods Over a 7 year period , 2000 patients undergoing open cardiac operations requiring sternotomy were enrolled . One thous and patients received st and ard of care sternal closure . The other 1000 patients received st and ard of care sternal closure plus PRP applied to the sternum at the time of closure . The outcomes related to wound healing , infection , readmissions , and costs were analyzed . Results In the 2000 patients , there were more ventricular assist device implants/heart transplants and emergency operations in the PRP group ; otherwise there were no significant differences . The use of PRP reduced the incidence of DSWI from 2.0 to 0.6 % , SWI from 8.0 to 2.0 % , and the readmission rate from 4.0 to 0.8 % . The use of PRP reduced the costs associated with the development of deep and superficial wound complications from $ 1,256,960 to $ 593,791 . Conclusions The use of PRP decreases the incidence and costs of sternal wound complications following cardiac surgery . The routine use of platelet rich plasma should be considered for all patients undergoing sternotomy for cardiac surgical procedures .Trial registration Clinical trials.gov ( NCT00130377 ) for the data registry BACKGROUND This investigation used age as a continuous variable to estimate implant survival and the risk of complications . METHODS Prospect ively collected data were used to analyze 5494 consecutive shoulder arthroplasties performed from 1970 to 2012 . Patients were a mean age of 67 years . The association between the age at the index procedure and the risk for each outcome was assessed using Cox regression and smoothing spline analysis . RESULTS Older age was associated with a decreased risk of revision surgery , revision for mechanical failure , and reoperation but with a higher risk for thromboembolic events . Reoperation rates also decreased in a linear fashion with older ages ( P < .001 ) . The risk of revision surgery decreased in a linear fashion between the ages of 40 and 85 , with a 3 % decreased risk of revision per 1-year increase in age ( P < .01 ) . This association held true in a multivariate model and when specific procedures were separated out . Compared with patients aged < 50 years , patients aged from 50 to 65 years ( P < .001 ) and those > 65 years ( P < .001 ) have decreased risks of revision surgery . The risk of a revision surgery in a patient aged > 50 years was significantly decreased ( ~13 % reduction in risk for each year ; P < .001 ) . There was a subtle association between older age and decreased rates of infection ( P = .01 ) . CONCLUSIONS There is a strong association between older age and decreased rates of revision surgery and reoperation after shoulder arthroplasty , with a striking association with decreased rates of mechanical failure . These are important considerations when counseling younger patients regarding their risks BACKGROUND Anatomic total shoulder arthroplasty ( TSA ) and reverse total shoulder arthroplasty ( RTSA ) are increasingly common procedures employed to treat arthritic conditions . Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff , concerns about RTSA persist because of variable complication rates and outcomes . METHODS This is a prospect i ve , case-control study comparing outcomes and complications after TSA and RTSA . The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy . Average clinical follow-up was more than 2 years in both groups . Major complications included infection , periprosthetic fracture , instability , glenoid loosening , and need for revision surgery . Patient outcome measures included the American Shoulder and Elbow Surgeons score , pain visual analog scale score , and goniometer-measured range of motion . Plain radiographs were review ed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA . RESULTS At 2 years , there were no differences in rate of major complications  ( TSA , 15 % ; RTSA , 13 % ; P = .808 ) or revision surgeries  ( TSA , 11 % ; RTSA , 9 % ) . Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups . TSA patients had greater external rotation than RTSA patients did ( 53 ° vs 38 ° ; P = .001 ) . Otherwise , forward flexion , abduction , and internal rotation were comparable in range of motion . CONCLUSIONS TSA and RTSA  have similar complication rates , need for revision , patient-reported outcomes , and range of motion at 2 years of follow-up . The use of side-by-side cohorts in this study allows st and ardized comparison between these 2 shoulder arthroplasty procedures HYPOTHESIS Deep infection after shoulder surgery is a rare but devastating problem . This study tested the hypothesis that the home application of a 2 % chlorhexidine gluconate cloth before shoulder surgery would be more efficacious than a st and ard shower of soap and water at decreasing the preoperative cutaneous levels of pathogenic bacteria on the shoulder . MATERIAL S AND METHODS This r and omized , prospect i ve study evaluated 100 consecutive patients undergoing shoulder surgery . Patients were r and omly assigned to use 2 % chlorhexidine gluconate-impregnated cloths ( treatment group ) or to shower with soap and water before surgery ( control group ) . Cutaneous cultures were taken from the patients ' shoulders in the preoperative holding area . Patients were monitored for 2 months postoperatively for clinical signs of infection . RESULTS In the treatment group vs the control group , the overall positive culture rate was 66 % vs 94 % ( P = .0008 ) , and the positive culture rate for coagulase-negative Staphylococcus was 30 % vs 70 % ( P = .0001 ) . The positive culture rate for Propionibacterium acnes was 46 % in the treatment group vs 58 % in the control group ( P = .32 ) . No infections occurred in any patients at a minimum of 2-months after surgery . DISCUSSION The use of the 2 % chlorhexidine cloth was effective at decreasing overall bacterial culture rates before shoulder surgery and was particularly effective at decreasing the quantity of coagulase-negative Staphylococcus , a known causative agent of postoperative shoulder infections . CONCLUSION Use of chlorhexidine impregnated cloths prior to shoulder surgery may be a useful adjunct to presently used infection prevention strategies Background Few studies have analyzed the association between elevated BMI and complications after total shoulder arthroplasty ( TSA ) . Previous studies have not consistently arrived at the same conclusion regarding whether obesity is associated with a greater number of postoperative complications . We used a national surgical data base to compare the 30-day complication profile and hospitalization outcomes after primary TSA among patients in different BMI categories . Questions / purpose sWe asked : ( 1 ) Is obesity associated with an increased risk of complications within 30 days of primary TSA ? ( 2 ) Is obesity associated with increased operative time ? Methods The American College of Surgeons National Surgical Quality Improvement Program ® data base for 2006 to 2012 was queried to identify all patients who underwent a primary TSA for osteoarthritis of the shoulder . The ACS-NSQIP ® data base was selected for this study as it is a nationally representative data base that provides prospect ively collected perioperative data and a comprehensive patient medical profile . Exclusion criteria included revision TSA , infection , tumor , or fracture . We analyzed 4796 patients who underwent a primary TSA for osteoarthritis of the shoulder . Patients who underwent a TSA  were divided in four BMI categories : normal ( 18.5–25 kg/m2 ) , overweight ( 25–30 kg/m2 ) , obesity Class 1 ( 30–35 kg/m2 ) , and obesity Class 2 or greater ( > 35 kg/m2 ) . Perioperative hospitalization data and 30-day postoperative complications were compared among different BMI classes . Differences in patient demographics , preoperative laboratory values , and preexisting patient comorbidities also were analyzed among different BMI groups , and multivariate analysis was used to adjust for any potential confounding variables . Results There was no association between BMI and 30-day complications after surgery ( normal as reference , overweight group relative risk : 0.57 [ 95 % CI , 0.30–1.06 ] , p = 0.076 ; obesity Class 1 relative risk : 0.52 [ 95 % CI , 0.26–1.03 ] , p = 0.061 ; obesity Class 2 or greater relative risk : 0.54 [ 95 % CI , 0.25–1.17 ] , p = 0.117 ) . However , greater BMI was associated with longer surgical times ( for normal BMI control group : 110 minutes , SD , 42 minutes ; overweight group : 115 minutes , SD , 46 minutes , mean difference to control : 5 minutes [ 95 % CI , −1 to 10 minutes ] , p = 0.096 ; obesity Class 1 : 120 minutes , SD , 43 minutes , mean difference : 10 minutes [ 95 % CI , 5–15 minutes ] , p < 0.001 ; obesity Class 2 or greater : 122 minutes , SD , 45 minutes , mean difference : 12 minutes [ 95 % CI , 6–18 minutes ] , p < 0.001 ) . Conclusions Although the surgical time increased for patients with greater BMI , the 30-day complications and perioperative hospitalization data after TSA were not different in patients with increased BMI levels . Obesity alone should not be a contraindication for TSA , and obese patients can expect similar incidences of postoperative complications . The preoperative medical optimization plan should be consistent with that of patients who are not obese who undergo TSA.Level of Evidence Level III , therapeutic study PURPOSE To document the skin colonization and deep tissue inoculation rates associated with  arthroscopic shoulder surgery  and how these rates differ with procedural and demographic factors . METHODS We prospect ively recruited outpatient shoulder arthroscopy patients who agreed to participate and met the inclusion criteria from February 2013 to May 2014 . All patients received routine antibiotic prophylaxis intravenously . Initial cultures were obtained before the skin preparation by swabbing the skin at the 3 st and ard portal sites : posterior , anterosuperior , and anterolateral . The skin preparation used 4 % chlorhexidine scrub and 2 % chlorhexidine gluconate/70 % isopropyl alcohol paint applied to the entire shoulder . After completion of the arthroscopic procedure , a second culture was obtained through a cannula at the surgical site . All cultures were plated for 21 days using Brucella medium . RESULTS We enrolled 51 patients over a 15-month period . Cultures showed a 72.5 % Propionibacterium acnes superficial colonization rate : 46.1 % of female and 81.6 % of male patients ( P = .027 ) . We identified a deep culture-positive inoculation rate of 19.6 % , all with positive P acnes skin colonization . No correlation could be made concerning diagnosis , procedure , suture anchor use , age , or sex . CONCLUSIONS The rate of skin colonization with P acnes is high at arthroscopic portals , especially in men . Despite st and ard skin preparation and prophylactic antibiotics , the rate of deep tissue inoculation with P acnes in shoulder arthroscopy is much higher than the rate of infection reported in the literature . CLINICAL RELEVANCE Shoulder arthroscopy introduces a significant amount of P acnes into the deep tissues BACKGROUND Although diabetes has been associated with increased perioperative morbidity and mortality after hip and knee arthroplasty , its impact on early postoperative outcomes after shoulder replacement remains relatively unexplored . The purpose of the study was to determine the association of diabetes with in-hospital death , complications , length of stay , non-homebound disposition , and cost in patients undergoing shoulder arthroplasty . METHODS By use of the Nationwide Inpatient Sample data base for the year 2011 , an estimated 66,485 patients having undergone shoulder arthroplasty were identified and separated into groups with ( 21 % ) and without ( 79 % ) diabetes mellitus . Comparisons of specific outcome measures between diabetic and nondiabetic cohorts were performed by bivariate and multivariable analyses with logistic regression modeling . RESULTS Diabetes mellitus was independently associated with in-hospital death , a number of perioperative complications , prolonged hospital stay , and increased non-homebound disposition after shoulder arthroplasty . The presence of diabetes was not associated with increased hospital cost . CONCLUSION Patients with preexisting diabetes are at higher 
    Output:
    