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Journal articles on the topic 'Surgical wound infections Risk assessment Statistical methods'

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Published: 10 December 2022
Last updated: 29 January 2023

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1

Parizh, David, Enrico Ascher, Syed Ali Raza Rizvi, Anil Hingorani, Michael Amaturo, and Eric Johnson. "Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery." Vascular 26, no. 1 (July 14, 2017): 47–53. http://dx.doi.org/10.1177/1708538117719155.

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Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures. Summary background data: In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p < 0.005). Conclusions Preventative measures, in the form of a standardized protocol, to decrease surgical site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.
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Raymond, Lendelle, Eris Cani, Cosmina Zeana, William Lois, and Tae Park. "719. Clinical Outcomes of Single versus Double Anaerobic Coverage for Intra-abdominal Infections." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S410. http://dx.doi.org/10.1093/ofid/ofaa439.911.

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Abstract Background Double anaerobic coverage (DAC) is often used for intra-abdominal infections (IAIs) post-operatively. The primary objective of the study was evaluating length of hospital stay (LOS), in-hospital post-operative complications, and re-admission within 30 days of discharge due to post-operative complications in patients who received piperacillin/tazobactam plus metronidazole versus piperacillin/tazobactam for IAIs post-operatively. The secondary objective was comparing in-hospital mortality and hospital-acquired Clostridioides difficile infections (CDI) between the two groups. Methods This was a retrospective, cohort study including adults with surgically managed IAIs at an urban community hospital between January 1, 2016 and June 30, 2019. The following data were collected: age, sex, body mass index, comorbidities, Charlson Comorbidity Index (CCI), 5-day post-operative body temperature, American Society of Anesthesiologists (ASA) pre-operative assessment score, surgical wound classification, and IAI diagnosis. Multivariate analysis and aggregate resampling of the sampling distribution were conducted. An alpha of &lt; 0.05 was considered statistically significant. Results Out of 163 patients, 96 patients received piperacillin/tazobactam plus metronidazole and 67 patients received piperacillin/tazobactam. The patients who received DAC were sicker with higher CCI (p=0.021) and 5-day post-operative body temperature (p=0.013). They were also at a higher risk for surgical site infections (p=0.002). Double anaerobic coverage was more often used for acute cholecystitis (p=0.0001) and gastrointestinal perforations (&lt; 0.0001). After adjusting for these variables, DAC was associated with longer LOS (median 9 days vs. 4 days, p&lt; 0.0001) and in-hospital post-operative complications (23% vs. 9%, p&lt; 0.0001). There were more re-admissions within 30 days of discharge due to post-operative complications in the single anaerobic coverage group (4% vs. 1%, p=&lt; 0.0001). In-hospital mortality (4% vs. 0%) and hospital-acquired CDI (1% vs. 0%) were only observed in DAC group. Conclusion Double anaerobic coverage was associated with no clinical benefit in surgically managed IAIs and in some cases may produce worse outcomes. Disclosures All Authors: No reported disclosures
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Garde, Hector, Marco Ciappara, Isabel Galante, Manuel Fuentes Ferrer, Angel Gómez, Jesus Blazquez, and Jesus Moreno. "Radical Cystectomy in Octogenarian Patients: A Difficult Decision to Take." Urologia Internationalis 94, no. 4 (2015): 390–93. http://dx.doi.org/10.1159/000371556.

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Introduction: The increasing life expectancy and the proportion of octogenarians make radical cystectomy (RC) more frequent in octogenarian patients with muscle invasive bladder cancer. Objective: To analyze overall survival and complications in our series. Material and Methods: Descriptive analysis of patients older than 80 years undergoing RC between 2000 and 2012. Surgical risk (American Society of Anesthesiologists scale, ASA), hospital stay, complications (Clavien-Dindo classification) and types of urinary diversion were evaluated. Variables were expressed in mean or medians. Overall survival was analyzed using the Kaplan-Meier method. Univariate overall survival analysis was performed using the univariate Cox regression model. The null hypothesis was rejected by a type I error <0.05. Statistical analyses were performed using SPSS 15.0 (SPSS Inc., Chicago, Ill., USA). Results: Thirty-three patients were included. Their mean age was 81.9 ± 1.8 years. There were 24 males (72.7%). The surgical risk was identified as follows: ASA II in 9 patients (27.3%), ASA III in 23 (69.7%) and ASA IV in 1 (3%). Concerning urinary diversion, 19 patients (57.6%) underwent ureteroileostomy and 14 (42.4%) bilateral cutaneous ureterostomy. Average hospital length of stay was 19 days (14-30). TNM stage was T0 in 1 patient (3%), T1 in 4 (12.1%), T2 in 11 (33.3%), T3 in 13 (39.4%), T4 in 4 (12.1%), Nx in 9 (12%), N0 in 13 (39.4%), N1 in 3 (9.1%), and N2 in 5 (15.2%). The most frequent complications were pneumonia in 6 patients (18.2%) and surgical wound infection in 6 (18.2%). Lymphadenectomy did not involve a significant increase in complications. Six patients (18.2%) died in the immediate postoperative period, 5 of whom from respiratory complications. The mean survival of the rest of the series was 24 months (range 15.1-32.8). Conclusions: Overall assessment of the patient is essential and not only the chronological age. RC is a valid option despite chronological age. In the postoperative period, there is a higher risk of complications but not higher mortality due to surgical complications.
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Akın, Merve, Serdar Topaloğlu, Hakan Özel, Fatih M. Avşar, Tezcan Akın, Erdal Polat, Erdem Karabulut, and Süleyman Hengirmen. "Awareness and wound assesment decrease surgical site infections." Turkish Journal of Surgery 37, no. 2 (June 1, 2021): 133–41. http://dx.doi.org/10.47717/turkjsurg.2021.5059.

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Objective: Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine prac- ticality of SSI risk assessment methods (SENIC and NNIS) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure and evaluation of the contribution of wound assesment to the reduction of wound infection. Material and Methods: Patients were followed with a prospective data chart through four year. Correlation of SENIC and NNIS together with ASEPSIS were performed. Results: During the study period, 275 SSI occurred. SSIs were determined within the 21 days-period after operations. Correlation between SENIC with ASEPSIS (rs= 0.41, p< 0.001) was found better than that for NNIS with ASEPSIS (rs= 0.37, p< 0.001). Type of operation (emergency vs. elective), body mass index, operation class and American Society of Anesthesiologists scores were found independently predictive factors for SSI. The forth year SSI rate was found to be significantly lower than the other years (p< 0.001). Conclusion: This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS method. In addi- tion, surgical wound assesment and awarness of the wound infection rates, have decreased the SSI rates over the years.
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Hall, Jennifer, Laura Abbott, Kathrina Prelack, and Jonathan Friedstat. "12 Effective Treatment of Malnourished Pediatric Burn Patients." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S11. http://dx.doi.org/10.1093/jbcr/iraa024.016.

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Abstract Introduction Pediatric burn patients are at high nutritional risk given disease burden and its impact on body reserves. As part of our global mission, we care for children who arrive late after their injury, often with malnutrition. In our experience, these patients have greater susceptibility to infection, poor wound healing, and longer lengths of stay. In accordance, we implemented strategies to improve outcomes in this population including a sustained period of nutritional optimization prior to surgery. The purpose of this study was to describe the frequency of malnutrition in our hospital and to compare clinical outcomes between malnourished (MN) and well-nourished patients (WN) using this approach. Methods An IRB approved retrospective review of pediatric burn patients at our institution from 2010–2018 who received nutritional support (enteral and/or parenteral nutrition) for at least five days was conducted. Data collection included general demographics, anthropometrics, nutritional intake, nutrition related labs, and clinical outcome variables such as length of stay (LOS), and days to wound closure. Using a case-control design, malnourished patients were matched (by age and burn size) to their well-nourished counterparts. Differences in nutritional status and clinical outcome were compared by student’s t test. Results A total of 174 patients, 7.02 ± 5.19 years of age with 39.18 ± 18.31% total body surface area (TBSA) burns were included in the study. Thirty percent of all patients classified as malnourished based upon body mass index (BMI) or weight/length z-scores, visual assessment and/or reported weight loss. On admission, malnourished patients had significantly lower BMI z scores (MN -2.5 vs. WN 0.8, p&lt; 0.0001). Despite significant differences in days post burn admission (MN 97.9 days, WN 17.7 days, p=0.028); there was no statistical difference in days to 95% wound closure (MN 39.4, WN 38.2 days, p=0.85) or LOS (MN 56.5, WN 52.5 days p=0.63) between the two groups. Average intake of malnourished patients over the first four weeks of admission ranged between 92–116% of calorie goal and 96–109% protein goal.Nutrition related lab value averages for MN patients improved over the four week time frame, Prealbumin (mg/dl) (week one 9.6, week four 17.75), C-reactive protein (mg/L) (week one 92.3, week four 71.91), and Albumin (g/dl) (week one 2.64, week four 3.32). Conclusions Despite arriving significantly malnourished, our pediatric burn patients had similar outcomes to their well-nourished counterparts in terms of LOS and 95% wound closure. This can be attributed to prompt identification of those patients at risk, and use of refeeding and nutritional rehabilitation protocols prior to surgical intervention. Applicability of Research to Practice Effective protocols for the management of malnourished pediatric burn patients can negate the impact of malnutrition on clinical outcomes.
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Akhter, Farkhunda, Maliha Khawar, Tooba Hamid, and Moazzam Ali. "SURGICAL SITE INFECTIONS (SSI)." Professional Medical Journal 23, no. 11 (November 10, 2016): 1328–33. http://dx.doi.org/10.29309/tpmj/2016.23.11.1756.

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Objectives: The objective of this study is to determine the frequency ofpost-caesarean SSI and determine the frequency of factors leading to post-caesarean SSI.Study design: Descriptive case series. Setting and duration: Department of Obstetrics &Gynaecology, District Headquarters Teaching hospital, Rawalpindi from June 2015 to Nov2015. Materials and methods: Through non-probability consecutive sampling, 180 patientswho have undergone caesarean section who fulfilled the inclusion criteria were enrolled in thestudy. The data was collected manually on a formatted proforma. All patients suspected ofhaving SSI within 30 days of CS were identified for any pre-operative factors leading to theirSSI. Suspected SSI was confirmed by Culture testing of wound swabs, prior to commencementof an antibiotic treatment or as soon as the diagnosis was suspected. Data was analyzed usingSPSS version 20. Results: Of the 180 patients, 8 suffered from SSI (4.4%). The average agefor the patients was 25.42±3.68 years. The operations were elective in 38.9% of the cases and61.1% were urgent. On data analysis, Diabetes, Anaemia and emergency CS were significantlyassociated with SSI with a p-value less than 0.05. Conclusion: SSI continues to be a significantpost-operative complication. A thorough assessment of risk factors that predispose to SSI andtheir prevention may help in reduction of SSI rates. We recommend that above mentionedfactors to be taken into consideration before planning obstetrical surgeries. Prevention of theseinfections should be a clinical and public health priority.
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Malashenko, A. A., K. A. Krasnov, and O. A. Krasnov. "Surgical risk assessment in Hiv-infected patients treated within the penitentiary system of Kemerovo region." Fundamental and Clinical Medicine 6, no. 4 (December 28, 2021): 113–21. http://dx.doi.org/10.23946/2500-0764-2021-6-4-113-121.

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Aim. To assess the surgical risk in HIV-infected patients who received the surgical treatment within the penitentiary system of Kemerovo Region.Materials and Methods. We retrospectively analysed the physical status and the extent of surgical risk in 296 HIV-infected patients who underwent elective (n = 201) or emergency (n = 95) surgery in Hospital №1 (Kemerovo) from 2015 to 2018. Physical status was assessed according to American Society of Anesthesiologists (ASA) Physical Status Classification System. Surgical risk was scored according to Moscow Scientific Society of Anesthesiologists and Critical Care.Results. The majority of patients had 3 (48.4 and 36.3% in emergency and elective patients, respectively) or 4a (30.5 and 45.8% in emergency and elective patients, respectively) stages of HIV infection. Opportunistic infections were diagnosed in 49.3% of patients and were always accompanied by superficial mycoses. Physical status of most patients (47.4% and 63.7% in emergency and elective patients, respectively) corresponded to ASA physical status class 3. Emergency patients mainly had surgical risk class 3 (n = 50, 52.6%) while elective patients often had surgical risk class 2 (n = 106, 52.7%). The prevalence of postoperative complications, most often impaired wound healing, was 9.8%.Conclusion. More than 80% of HIV-infected patients who underwent surgical interventions within the penitentiary system of Kuzbass were at III or IV stages of HIV infection, entailing a high frequency of opportunistic diseases such as superficial mycoses and dictating the need to include antifungal treatment into the surgical treatment. Impaired wound healing was the most frequent postoperative complication.
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Chirdchim, Watcharin, Preecha Wanichsetakul, and Jayanton Patumanond. "Aesthetic Outcomes of Intra-Umbilical Incision vs Infra-Umbilical Incision in Postpartum Tubal Sterilization: A Randomized Controlled Trial." Ramathibodi Medical Journal 42, no. 1 (March 18, 2019): 1–9. http://dx.doi.org/10.33165/rmj.2019.42.1.109492.

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Background: An incision inside the umbilicus is popular used in single port surgery intra-umbilical skin incision surgeries have been proven efficient and safe. When compared to infra-umbilical skin incisions, an incision wound was invisible after the operation. Why not use intra-umbilical skin incision in postpartum tubal sterilization. Objective: To compare aesthetic scores of an incision wound, surgical time and complications in postpartum sterilization under infra-umbilical and intra-umbilical skin incision. Methods: This was a randomized controlled trial conducted in Prapokkhlo Hospital, Chanthaburi, Thailand. Patients (n = 58) with informed consents were randomly assigned to one of the two skin incision techniques for postpartum sterilization (n = 29 for each arm). Surgical times were recorded. Both the patients and an independent physician made wound aesthetic assessments one week after the operation using the Patient and Observer Scar Assessment Scores (POSAS), which compares the wound to the nearby skin. T tests and exact probability statistical tests were used for statistical analysis. Results: The surgeon’s POSAS scores in intra-umbilical incisions were significantly closer to normal skin than those in infra-umbilical incisions (6.8 ± 1.5 vs 12.5 ± 5.0; P < .001). A similar finding was observed for patient POSAS scores (6.5 ± 1.2 vs 15.4 ± 5.0; P < .001). The operation times were also shorter (9.1 ± 2.8 vs 11.8 ± 4.7 minutes; P = .009). Neither intra-abdominal injuries nor wound infections were observed. Conclusions: Postpartum sterilization using intra-umbilical skin incision was more efficient in regard to aesthetic concerns and operation time.
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Rodriguez, (Ret ). Carlos J., Anuradha Ganesan, Faraz Shaikh, M. Leigh Carson, William Bradley, Tyler E. Warkentien, and David R. Tribble. "Combat-Related Invasive Fungal Wound Infections." Military Medicine 187, Supplement_2 (May 1, 2022): 34–41. http://dx.doi.org/10.1093/milmed/usab074.

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ABSTRACT Introduction During Operation Enduring Freedom in Afghanistan, an outbreak of combat-related invasive fungal wound infections (IFIs) emerged among casualties with dismounted blast trauma and became a priority issue for the Military Health System. Methods In 2011, the Trauma Infectious Disease Outcomes Study (TIDOS) team led the Department of Defense IFI outbreak investigation to describe characteristics of IFIs among combat casualties and provide recommendations related to management of the disease. To support the outbreak investigation, existing IFI definitions and classifications utilized for immunocompromised patients were modified for use in epidemiologic research in a trauma population. Following the conclusion of the outbreak investigation, multiple retrospective analyses using a population of 77 IFI patients (injured during June 2009 to August 2011) were conducted to evaluate IFI epidemiology, wound microbiology, and diagnostics to support refinement of Joint Trauma System (JTS) clinical practice guidelines. Following cessation of combat operations in Afghanistan, the TIDOS database was comprehensively reviewed to identify patients with laboratory evidence of a fungal infection and refine the IFI classification scheme to incorporate timing of laboratory fungal evidence and include categories that denote a high or low level of suspicion for IFI. The refined IFI classification scheme was utilized in a large-scale epidemiologic assessment of casualties injured over a 5.5-year period. Results Among 720 combat casualties admitted to participating hospitals (2009-2014) who had histopathology and/or wound cultures collected, 94 (13%) met criteria for an IFI and 61 (8%) were classified as high suspicion of IFI. Risk factors for development of combat-related IFIs include sustaining a dismounted blast injury, experiencing a traumatic transfemoral amputation, and requiring resuscitation with large-volume (&gt;20 units) blood transfusions. Moreover, TIDOS analyses demonstrated the adverse impact of IFIs on wound healing, particularly with order Mucorales. A polymerase chain reaction (PCR)-based assay to identify filamentous fungi and support earlier IFI diagnosis was also assessed using archived formalin-fixed, paraffin-embedded tissue specimens. Although the PCR-based assay had high specificity (99%), there was low sensitivity (63%); however, sensitivity improved to 83% in tissues collected from sites with angioinvasion. Data obtained from the initial IFI outbreak investigation (37 IFI patients) and subsequent TIDOS analyses (77 IFI patients) supported development and refinement of a JTS clinical practice guideline for the management of IFIs in war wounds. Furthermore, a local clinical practice guideline to screen for early tissue-based evidence of IFIs among blast casualties at the Landstuhl Regional Medical Center was critically evaluated through a TIDOS investigation, providing additional clinical practice support. Through a collaboration with the Uniformed Services University Surgical Critical Care Initiative, findings from TIDOS analyses were used to support development of a clinical decision support tool to facilitate early risk stratification. Conclusions Combat-related IFIs are a highly morbid complication following severe blast trauma and remain a threat for future modern warfare. Our findings have supported JTS clinical recommendations, refined IFI classification, and confirmed the utility of PCR-based assays as a complement to histopathology and/or culture to promote early diagnosis. Analyses underway or planned will add to the knowledge base of IFI epidemiology, diagnostics, prevention, and management.
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Mueller, Kyle B., Matthew D’Antuono, Nirali Patel, Gnel Pivazyan, Edward F. Aulisi, Karen K. Evans, and M. Nathan Nair. "Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on the Development of Surgical Site Infection after Spinal Surgery: A Prospective Observational Study." Neurosurgery 88, no. 5 (February 20, 2021): E445—E451. http://dx.doi.org/10.1093/neuros/nyab040.

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Abstract BACKGROUND Use of a closed-incisional negative pressure therapy (ci-NPT) dressing is an emerging strategy to reduce surgical site infections (SSIs) in spine surgery that lacks robust data. OBJECTIVE To determine the impact of a ci-NPT, as compared with a standard dressing, on the development of SSIs after spine surgery. METHODS This was a prospective observational study over a 2-yr period. Indications for surgery included degenerative disease, deformity, malignancy, and trauma. Exclusion criteria included anterior and lateral approaches to the spine, intraoperative durotomy, or use of minimally invasive techniques. SSIs up to 60 d following surgery were recorded. RESULTS A total of 274 patients were included. SSI rate was significantly lower with ci-NPT dressing (n = 118) as compared with the standard dressing (n = 156) (3.4 vs 10.9%, P = .02). There was no statistical difference in infection rate for decompression alone procedures (4.2 vs 9.1%, P = .63), but there was a statistically significant reduction with the use of a negative-pressure dressing in cases that required instrumentation (3.2 vs 11.4%, P = .03). Patients at higher risk (instrumentation, deformity, and malignancy) had less SSIs with the use of ci-NPT, although this did not reach statistical significance. There were no complications in either group. CONCLUSION SSI rates were significantly reduced with a ci-NPT dressing vs a standard dressing in patients who underwent spinal surgery. The higher cost of a ci-NPT dressing might be justified with instrumented cases, as well as with certain high-risk patient populations undergoing spine surgery, given the serious consequences of an infection.
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M. Maaty, Aliaa, Amr H. Yehia, Mohamed M. Abdelaleem, and Mohammed A. Abd El-Fattah. "Subcutaneous Antibiotic Irrigation to Prevent Wound Infection in Obese Patients Undergoing Cesarean Section." Women Health Care and Issues 4, no. 3 (May 12, 2021): 01–05. http://dx.doi.org/10.31579/2642-9756/060.

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Background: Surgical site infections (SSIs) pose considerable morbidity and account for up to 20% of all nosocomial infections in surgical patients Aim of the Work: to determine the efficacy & safety of irrigation of subcutaneous tissue by Gentamicin for caesarean section Incision in reducing the risk of post-caesarean wound complications among obese women compared with placebo. Patients and Methods: This prospective randomized clinical trial study was conducted on total 132 obese patients who underwent elective cesarean section at Ain Shams University Maternity hospitals. This study was conducted on obese women undergoing caesarean section at Ain Shams University Maternity Hospital with the following inclusion and exclusion criteria. Patients were distributed randomly into 2 groups using a computer based program: Group (A) N = 66: CS with Irrigation of subcutaneous tissue by placebo (200 ml of saline 0.9 %). Group (B) N = 66: CS with irrigation of subcutaneous tissue by Gentamicin solution ( 1mg/kg gentamicin in 200 ml of saline 0.9%). Results: The results of this study revealed that the rate of SSI was less in gentamycin (3%) (n=2/66) than control group (4.5%) (n=3/66) with no statistical significance between them . postoperative hospital stay and readmission rate due to SSI for the gentamycin group were also shorter but not statistically different in compared to the control group. Applying local gentamycin antibiotic irrigation during wound closure after cesarean section in obese patients is not recommended. NO role of local gentamycin irrigation in subcutaneous tissue in prevention of wound surgical site infection. Conclusion: as evident from the current study, In obese women undergoing elective CS , wound irrigation with Gentamicin is not superior to wound irrigation with placebo (saline 0.9) regarding efficacy & safety.
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Abd El-Hay, Ahmed Mohamed. "Effect of Amh in Patients with Polycystic Ovarian Syndrome on Pregnancy Rate in Icsi Cycle." Women Health Care and Issues 4, no. 4 (May 17, 2021): 01–05. http://dx.doi.org/10.31579/2642-9756/068.

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Background: Surgical site infections (SSIs) pose considerable morbidity and account for up to 20% of all nosocomial infections in surgical patients Aim of the Work: to determine the efficacy & safety of irrigation of subcutaneous tissue by Gentamicin for caesarean section Incision in reducing the risk of post-caesarean wound complications among obese women compared with placebo. Patients and Methods: This prospective randomized clinical trial study was conducted on total 132 obese patients who underwent elective cesarean section at Ain Shams University Maternity hospitals. This study was conducted on obese women undergoing caesarean section at Ain Shams University Maternity Hospital with the following inclusion and exclusion criteria. Patients were distributed randomly into 2 groups using a computer based program: Group (A) N = 66: CS with Irrigation of subcutaneous tissue by placebo (200 ml of saline 0.9 %). Group (B) N = 66: CS with irrigation of subcutaneous tissue by Gentamicin solution (1mg/kg gentamicin in 200 ml of saline 0.9%). Results: The results of this study revealed that the rate of SSI was less in gentamycin (3%) (n=2/66) than control group (4.5%) (n=3/66) with no statistical significance between them. Postoperative hospital stay and readmission rate due to SSI for the gentamycin group were also shorter but not statistically different in compared to the control group. Applying local gentamycin antibiotic irrigation during wound closure after cesarean section in obese patients is not recommended. NO role of local gentamycin irrigation in subcutaneous tissue in prevention of wound surgical site infection. Conclusion: as evident from the current study, in obese women undergoing elective CS, wound irrigation with Gentamicin is not superior to wound irrigation with placebo (saline 0.9) regarding efficacy & safety.
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Wang, Jennifer, Zyg Chapman, Emma Cole, Satomi Koide, Eldon Mah, Simon Overstall, and Dean Trotter. "Use of Closed Incision Negative Pressure Therapy (ciNPT) in Breast Reconstruction Abdominal Free Flap Donor Sites." Journal of Clinical Medicine 10, no. 21 (November 5, 2021): 5176. http://dx.doi.org/10.3390/jcm10215176.

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Background: Closed incision negative pressure therapy (ciNPT) may reduce the rate of wound complications and promote healing of the incisional site. We report our experience with this dressing in breast reconstruction patients with abdominal free flap donor sites. Methods: A retrospective cohort study was conducted of all patients who underwent breast reconstruction using abdominal free flaps (DIEP, MS-TRAM) at a single institution (Royal Melbourne Hospital, Victoria) between 2016 and 2021. Results: 126 female patients (mean age: 50 ± 10 years) were analysed, with 41 and 85 patients in the ciNPT (Prevena) and non-ciNPT (Comfeel) groups, respectively. There were reduced wound complications in almost all outcomes measured in the ciNPT group compared with the non-ciNPT group; however, none reached statistical significance. The ciNPT group demonstrated a lower prevalence of surgical site infections (9.8% vs. 11.8%), wound dehiscence (4.9% vs. 12.9%), wound necrosis (0% vs. 2.4%), and major complication requiring readmission (2.4% vs. 7.1%). Conclusion: The use of ciNPT for abdominal donor sites in breast reconstruction patients with risk factors for poor wound healing may reduce wound complications compared with standard adhesive dressings; however, large scale, randomised controlled trials are needed to confirm these observations. Investigation of the impact of ciNPT patients in comparison with conventional dressings, in cohorts with equivocal risk profiles, remains a focus for future research.
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Varon, David E., Kristo Nuutila, Laura E. Cooper, Javier Chapa, Franklin Valdera, Sean E. Christy, Robert J. Christy, Rodney K. Chan, and Anders H. Carlsson. "615 Evaluation of Topical Off-The-Shelf Therapies to Improve Burn Wound Healing During Prolonged Field Care." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S147—S148. http://dx.doi.org/10.1093/jbcr/irac012.243.

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Abstract Introduction Burns are common injuries in the battlefield. Given austere environments, prolonged field care (PFC) is often necessary. Delays in surgical debridement create a risk of infection and deranged healing for burn patients. As such, this study attempts to identify the best commercially available off-the-shelf (OTS) dressings with field-deployable potential. Methods Deep-partial thickness burns (1" diameter) were created on the dorsum of 3 anesthetized pigs utilizing a thermocoupled burn device at 100°C for 15s. Non-surgical debridement was done 1-h post-burn creation and either an OTS dressing or standard-of-care (SOC) treatment (Silver Sulfadiazine) was applied to the wound in order to simulate a PFC environment. OTS dressings were randomized and included irradiated sterile human skin allograft (ISHSA), alloplastic absorbable skin substitute (AASS), and synthetic polyurethane dermal matrix (SPDM). Wounds were serially assessed on post-burn days 3, 7, 14, 21, and 28. Assessments were conducted using a combination of photographs, histology, and quantitative bacteriology. Endpoints included burn wound progression, re-epithelialization, wound contraction, scar elevation index (SEI), and colony forming units (CFU). Results No statistically significant differences in burn wound progression were seen on days 3 and 7 for the ISHSA or SPDM and the SOC. The differences between the AASS and the SOC were statistically significant on both days (p≤0.05). Day 21 re-epithelialization results for the ISHSA, AASS, SPDM and SOC treated wounds were 30%, 85%, 95%, and 78% re-epithelialized, respectively. The difference between the AASS and the SOC was statistically significant (p≤0.05). Results showed that by day 28, wound contraction for the ISHSA, AASS, SPDM and SOC treated wounds were 65%, 80%, 82%, and 78%, respectively. No statistically significant differences in wound contraction were seen for any of the OTS dressings and the SOC. SEI showed no statistically significant difference in scar hypertrophy between the OTS dressings and the SOC on day 28. CFU results showed no statistically significant differences between the OTS dressings and the SOC on days 3 and 7. Conclusions Three OTS dressings were compared to the SOC for use in the PFC setting. Generally, all the dressings performed well when compared to the SOC in terms of burn wound progression, re-epithelialization, wound contraction, SEI, and CFU. Although significant differences in burn progression and re-epithelialization for burns treated with AASS were seen. In the future, we hope to continue to discover and test various OTS dressings to determine their appropriateness for use in the PFC setting.
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Wahyuningrum, Ari Damayanti. "PERBANDINGAN METODE SIRKUMSISI MODERN (KLAMP DAN LEM) TERHADAP PROSES PENYEMBUHAN LUKA PASCA SIRKUMSISI PADA ANAK." Jurnal Ilmiah Kesehatan Media Husada 9, no. 2 (November 24, 2020): 82–87. http://dx.doi.org/10.33475/jikmh.v9i2.236.

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Circumcision is a minor surgical procedure permormed as a modification of part the body by making an incision in the prepurtium of a part of the body by making incision in the prepurtium. The prepurtium that has not been circumcised has bacterial colonies which are risk factor for urinary tract infections. The insidence rate of urinary tract infections in Indonesia in infants who have not been circumcised under 1 year is 35% and children over 1 year are 22% of 200 children. The tecnology that eveloved in circumcision from the conventional methode of suture has shifted to the modern method of seamless circumcision. This study aims to compare the clamp and glue methods to the wound healing process after circumcision in chlidren. The research method was cohort with comparative statistical analysis of Pvalue 0.000<0.05 so there is a significant difference between the result of the klamp method ang glue in the healing process. Where the wound healing process in the glue method is much faster than the klamp method because it is more optimal in the hemostasis and inflammation phase because there are no foreign object namely the klamp. Keywords: Modern circumcision, Klamp, Glue, Wound Healing.
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Koyagura, Balakondaiah, Harsha Kumar Koramutla, Bijju Ravindran, and Jithendra Kandati. "Surgical site infections in orthopaedic surgeries: incidence and risk factors at tertiary care hospital of South India." International Journal of Research in Orthopaedics 4, no. 4 (June 23, 2018): 551. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20182598.

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<p class="abstract"><strong>Background:</strong> Health care associated infections (HAI) are infections that patients acquire while receiving medical care and are one of the most adverse events during health care delivery. Among the HAI surgical site infections [SSI] ranks the second among surgery patients. The present study aims to identify the risk factors, incidence and also to set the strategies required to prevent the development of SSI in orthopaedic surgeries primarily.</p><p class="abstract"><strong>Methods:</strong> A one year prospective study was conducted with a follow up of cases for one year post surgery in orthopaedic department. Cases that had undergone surgery were followed for development of SSI with a detailed demographic history, risk factor details after ethical committee approval. The data was analyzed using Statistical Package Social Sciences software 16 package (Chicago, USA).<strong></strong></p><p class="abstract"><strong>Results:</strong> The incidence of SSI was 6.5% with males 61% and females 39% with mean age of 34.12±8.01 years. In our present significant statistical correlation was observed with SSI and associated risk factors which include, Increased age, BMI &gt;25, administration of prophylactic antibiotic’s, multiple fractures (&gt;2 in number), contaminated wound, presence of drain at surgical site and blood transfusion. Methicillin resistant <em>Staphylococcus aureus</em> was the most common isolated pathogen (48.4%).</p><p class="abstract"><strong>Conclusions:</strong> The occurrence of SSI was higher in orthopaedic surgery than general surgeries. So our study clearly indicates that increased age, increased duration of surgery, increased hospitalization post-surgery, placement of drain at surgical site and blood transfusion are significant risk factors in development of SSI in orthopaedic surgeries.</p>
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Yadav, Gulab Dhar, Ashish Varshney, and Adiveeth Deb. "A Prospective Study of the Clinical Profile of Pilonidal Sinus Disease at a Tertiary Care Centre in North India - Comparison of Limberg Flap Closure and Z-Plasty in Treatment." Journal of Evidence Based Medicine and Healthcare 8, no. 28 (July 12, 2021): 2532–37. http://dx.doi.org/10.18410/jebmh/2021/468.

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BACKGROUND Sacrococcygeal pilonidal sinus disease is defined as a hair-filled cavity in the subcutaneous fat of the natal cleft (postsacral intergluteal region). This study was done to investigate the prevalence, clinical presentation, body mass index (BMI) as a risk factor; and complications of Limberg flap and Z-plasty, for the reconstruction of defects after excision of sacrococcygeal pilonidal sinus in terms of the incidence of seroma, wound infection, wound dehiscence, flap necrosis, recurrence, duration of hospital stay and time taken for complete wound healing after the procedure. METHODS This was a prospective study done on 50 patients from January 2018 to October 2020 at a tertiary care hospital in 15 to 50 years of age group presenting with pilonidal sinus disease. Statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. Significance was assessed at 5 %. RESULTS The mean age of presentation was 25 years with chief complains of swelling, discharge and pain, the mean BMI was 24.39 kg/m2 . Anaerobic infection is more common in the sinus (40 %), and among aerobic organisms, Staphylococcus was the most common organism (19 %). In Limberg flap closure, only one 1 developed wound infection and this same patient had partial wound dehiscence, while in Zplasty group, 3 developed seroma, 2 wound infections and 2 partial flap ischemia. CONCLUSIONS The goals of management of pilonidal sinus diseases include conservative management along with definitive surgical treatment of the disease. Pilonidal abscess is managed by incision and drainage and is followed by definitive treatment, later on. Flap procedures are effective ways to treat the disease, of which Limberg flap is the most reliable flap with minimum complications, lesser hospital stay and faster wound healing. KEYWORDS Pilonidal Sinus, Limberg Flap, Z-Plasty
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Zide, Jacob R., Farzam Farahani, Joel Rodriguez, Dane K. Wukich, and Anthony Riccio. "Obesity Increases Risk for Surgical Site Infections and Wound Dehiscence after Pediatric Foot Surgery: A Retrospective Cohort Review using the NSQIP-Pediatric Database." Foot & Ankle Orthopaedics 7, no. 1 (January 2022): 2473011421S0051. http://dx.doi.org/10.1177/2473011421s00516.

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Category: Other Introduction/Purpose: Both the incidence of childhood obesity and the number of obese children undergoing surgical procedures are increasing in pediatrics. As such, pediatric orthopaedic surgeons will likely encounter obese patients more frequently in their practice and a better understanding of the unique risks associated with obesity is valuable to maximize patient safety. The purpose of this study is, therefore, to retrospectively evaluate the relationship between obesity and post-operative outcomes in pediatric orthopaedic surgery patients across multiple institutions using a large national database. Methods: Pediatric patients who had undergone foot surgery were retrospectively identified by cross-referencing reconstructive foot-specific CPT codes with ICD-9/ICD-10 diagnosis codes using the American College of Surgeons 2012-2017 Pediatric National Surgical Quality Improvement (ACS-NSQIP-Pediatric) database. Patients were stratified into normal weight and obese cohorts based upon Center for Disease Control BMI-to-age growth charts. Patient demographics, comorbidities, intra-operative, and post- operative factors were compared between these two cohorts via univariate analysis with false discovery rate adjustment. Multivariable logistic regression models were then generated to assess for obesity as an independent predictor of post-operative complications. Results: Of the 3,924 patients identified, 1,063 (27.1%) were obese. Obese patients were more often male (64.7% vs 58.7%; p=0.001) and taller (56.3in vs 51.3in; p<0.001) than normal weight patients. There were no differences in pre-operative comorbidities between the two cohorts. Obese patients had a higher overall post-operative complication rate compared to normal weight patients (3.01% vs 1.32%; p=0.001). There was a significantly higher rate of wound dehiscence in obese patients (1.41% vs 0.59%; p=0.039) as well as a higher surgical site infection (SSI) rate that trended towards, but did not reach, statistical significance (1.32% vs. 0.59%; p=0.061). No differences were noted in unplanned readmissions (1.03% vs 0.9%; p=0.968) or unplanned reoperations (1.03% vs. 0.45%; p=0.175) within 30 days of surgery between the two groups. In multivariate analysis, obesity was found to be an independent predictor of both wound dehiscence (adjusted OR=2.16; 95%CI=1.05-4.50; p=0.037) and SSI (adjusted OR=3.03; 95%CI=1.39-6.61; p=0.005). Conclusion: Obese children undergoing foot surgery had higher overall complication rates than normal weight patients. Obese children undergoing foot surgery may be at higher risk for wound complications and surgical site infections than those of normal weight. This information may be useful in assessing and discussing surgical risks with patients and their families.
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Narulita, Lisa, Suharjono, Kuntaman, and Mohammad Akram. "Analysis of the use of antibiotics profile and factors of surgical site infections study on digestive and oncology surgeries." Journal of Basic and Clinical Physiology and Pharmacology 32, no. 4 (June 25, 2021): 693–700. http://dx.doi.org/10.1515/jbcpp-2020-0453.

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Abstract Objectives The incision method operation with a high risk of infection in a clean and clean-contaminated operation requires the use of prophylactic antibiotics to minimize the risk of infection. This study was designed to analyze the effectiveness of prophylactic antibiotics in patients with digestive and oncology surgeries. Methods The statistical method used was chi-square to determine the risk factors for infection at surgical site infections (SSI) in patients with digestive and oncology surgeries. This study had received ethical approval from the Ethics Committee of Dr. H. Slamet Martodirdjo Hospital, Pamekasan. Results There were 67 patients consisted of 48 digestive surgeries (71.6%) and 19 oncology surgeries (28.4%). The criteria of observation on day 30 showed that as 1 (1.5%) SSI patient experienced purulence, inflammation, and erythema around the surgical wound so an analysis of p>0.05 was carried out so that there was no association with the incidence of SSI during hospitalization, but other factors originating from the patient, such as a lack of personal hygiene at home and lack of nutritious food intake was measured in temperature, pulse, respiration, and white blood cells examination before surgery and 24 h after surgery, all within normal ranges. The qualitative analysis of prophylactic antibiotics using the Gyssen method showed that 31 (46.3%) rationales needed an improvement process. Conclusions The widely used prophylactic antibiotics, namely cefazolin and cefuroxime are recommended antibiotics used in incision surgery and rationale used.
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Medvedev, V. L., A. M. Opolsky, and M. I. Kogan. "Risk factors of complications after plastics of vesico-vaginal fistulas with a preoperative application of autoplasma, enriched with platelets." Experimental and Сlinical Urology 13, no. 4 (October 30, 2020): 106–13. http://dx.doi.org/10.29188/2222-8543-2020-13-4-106-113.

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Introduction. Vesicovaginal fistula, or VVF, is one of the most urgent and sociomedically significant problems in modern urology. As of today, more than three million women suffer from VVF worldwide. Purpose of the study. To evaluate the risk factors for complications in a group of patients with VVF operated with the preliminary use of platelet-rich plasm, or PRP. Materials and methods. Study included 22 patients who underwent surgical closure of VVF in period from 2011 to 2018 with the preliminary preparation of PRP tissues. A total of 22 patients were divided into two groups: the 1st group included 14 patients who had no complications, while the 2nd group included eight women with developed complications. Results. Statistically significant differences in the assessment of clinical characteristics of patients in the two groups were observed for the following indicators: duration of hospitalization (p<0.01), duration of bladder drainage (p<0.01). Urinary tract infection, or UTI, was identified more often in the group with complications (p<0.05). Presence of hypertension (p<0.05), pain syndrome (p<0.05), macrohematuria (p<0.05). Statistically significant differences in the assessment of characteristics of vesicovaginal fistula of patients in the two groups were observed for four indicators: distance between the fistula and the internal urethral orifice (p<0.05), the largest diameter of the fistula (p<0.05), the stage of сicatrization (p<0.05), the diameter of the fistula before surgical treatment (p<0.01). Conclusion. Results of the study dictate the need for an operating surgeon to carefully select the timing and volume of surgical treatment, taking into account many factors mentioned above. Patients should be made aware in detail of possible complications that might arise following VVF fistuloplasty and the reasons for their development in order to adequately prepare for surgical treatment, compensate for concomitant diseases, optimize tissues and blood vessels for better healing of the postoperative wound.
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Yabrodi, Mouhammad, Jeremy L. Hermann, John W. Brown, Mark D. Rodefeld, Mark W. Turrentine, and Christopher W. Mastropietro. "Minimization of Surgical Site Infections in Patients With Delayed Sternal Closure After Pediatric Cardiac Surgery." World Journal for Pediatric and Congenital Heart Surgery 10, no. 4 (July 2019): 400–406. http://dx.doi.org/10.1177/2150135119846040.

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Background: Delayed sternal closure (DSC) following pediatric cardiac surgery is commonly implemented at many centers. Infectious complications occur in 18.7% of these patients based on recent multicenter data. We aimed to describe our experience with DSC, hypothesizing that our practices surrounding the implementation and maintenance of the open sternum during DSC minimize the risk of infectious complications. Methods: We reviewed patients less than 365 days who underwent DSC between 2012 and 2016 at our institution. Infectious complications as defined by the Society of Thoracic Surgeons Congenital Heart Surgery Database were recorded. Patients with and without infectious complications were compared using Wilcoxon rank sum tests or Fisher exact tests as appropriate. Results: We identified 165 patients less than 365 days old who underwent DSC, 135 (82%) of whom had their skin closed over their open sternum. Median duration of open sternum was 3 days (range: 1-32 days). Infectious complications occurred in 15 (9.1%) patients—13 developed clinical sepsis with positive blood cultures, one patient developed ventilator-associated pneumonia, and one patient developed wound infection (0.6%). No cases of mediastinitis occurred. No statistical differences in characteristics between patients with and without infectious complications could be identified. Conclusion: Infectious complications after DSC at our institution were notably less than reported in recent literature, primarily due to minimization of surgical site infections. Practices described in the article, including closing skin over the open sternum whenever possible, could potentially aid other institutions aiming to reduce infectious complications associated with DSC.
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Kestle, John R. W., Jay Riva-Cambrin, John C. Wellons, Abhaya V. Kulkarni, William E. Whitehead, Marion L. Walker, W. Jerry Oakes, et al. "A standardized protocol to reduce cerebrospinal fluid shunt infection: The Hydrocephalus Clinical Research Network Quality Improvement Initiative." Journal of Neurosurgery: Pediatrics 8, no. 1 (July 2011): 22–29. http://dx.doi.org/10.3171/2011.4.peds10551.

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Object Quality improvement techniques are being implemented in many areas of medicine. In an effort to reduce the ventriculoperitoneal shunt infection rate, a standardized protocol was developed and implemented at 4 centers of the Hydrocephalus Clinical Research Network (HCRN). Methods The protocol was developed sequentially by HCRN members using the current literature and prior institutional experience until consensus was obtained. The protocol was prospectively applied at each HCRN center to all children undergoing a shunt insertion or revision procedure. Infections were defined on the basis of CSF, wound, or pseudocyst cultures; wound breakdown; abdominal pseudocyst; or positive blood cultures in the presence of a ventriculoatrial shunt. Procedures and infections were measured before and after protocol implementation. Results Twenty-one surgeons at 4 centers performed 1571 procedures between June 1, 2007, and February 28, 2009. The minimum follow-up was 6 months. The Network infection rate decreased from 8.8% prior to the protocol to 5.7% while using the protocol (p = 0.0028, absolute risk reduction 3.15%, relative risk reduction 36%). Three of 4 centers lowered their infection rate. Shunt surgery after external ventricular drainage (with or without prior infection) had the highest infection rate. Overall protocol compliance was 74.5% and improved over the course of the observation period. Based on logistic regression analysis, the use of BioGlide catheters (odds ratio [OR] 1.91, 95% CI 1.19–3.05; p = 0.007) and the use of antiseptic cream by any members of the surgical team (instead of a formal surgical scrub by all members of the surgical team; OR 4.53, 95% CI 1.43–14.41; p = 0.01) were associated with an increased risk of infection. Conclusions The standardized protocol for shunt surgery significantly reduced shunt infection across the HCRN. Overall protocol compliance was good. The protocol has established a common baseline within the Network, which will facilitate assessment of new treatments. Identification of factors associated with infection will allow further protocol refinement in the future.
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Chapin, B. F., S. E. Delacroix, S. H. Culp, G. Gonzalez, and C. G. Wood. "Postoperative complications from cytoreductive nephrectomy after neoadjuvant targeted therapy for metastatic renal cell carcinoma." Journal of Clinical Oncology 29, no. 7_suppl (March 1, 2011): 300. http://dx.doi.org/10.1200/jco.2011.29.7_suppl.300.

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300 Background: Neoadjuvant treatment of metastatic renal cell carcinoma (RCC) with targeted systemic therapies is under investigation. Postoperative complications that occurred after cytoreductive nephrectomy (CRN) preceded by neoadjuvant systemic therapy were assessed. Methods: A retrospective review of all patients with clinical evidence of metastasis that underwent CRN was performed. Of 683 surgical patients with metastatic disease, 67 had received preoperative targeted therapy. Preoperative, operative, and postoperative characteristics were evaluated for each patient. Surgical complications were assessed using the modified Clavien system. A multivariate was sued to determine preoperative variables in an attempt to predict surgical complications within 1 year of CRN. Results: Complications occurred in 64% (43/67) of patients within 365 days of CRN. Clavien grade ≥ 3 complications occurred in 30% (20/67) patients. The most common occurrences were superficial wound dehiscence (25%), and wound infection (15%). On univariate analysis there were no statistically significant differences between groups in regards to age, race, gender, smoking history, follow-up, Charlson comorbidity index, MSKCC risk groups, or time from cessation of targeted therapy to surgery. Significant predictors of complications included BMI ≥ 30 (p=0.007), EBL (p=0.019), matted nodes (p=0.043), and surgical approach (p=0.001). Clinical T-stage and N-stage (p=0.068, p=0.073) approached significance. On multivariate analysis Charlson comorbidity index ≥ 8(OR 5.2, 95% CI 1.23, 21.99) and clinical N-stage (OR 5.11, 95%CI 1.21, 21.66) were significant predictors of postoperative complications. Conclusions: In this series of patients treated with neoadjuvant targeted therapy, a majority of patients experienced a postoperative complication after CRN. A Charlson comorbidity index ≥ 8 or clinical node positivity predicted for an increased risk of postoperative complications. The use of neoadjuvant systemic targeted therapy prior to CRN is investigational and adequate assessment of operative morbidity is needed prior to wide spread adoption. No significant financial relationships to disclose.
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K.S., Sriranjani, and Rajeshwara K.V. "A Comparative Study of the Incidence and Severity of Surgical Site Infection Following Emergency and Elective Abdominal Surgeries." Journal of Evolution of Medical and Dental Sciences 10, no. 7 (February 15, 2021): 404–8. http://dx.doi.org/10.14260/jemds/2021/90.

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BACKGROUND Surgical site infections (SSI) represent a significant hurdle in the recovery and return to normalcy of patients. When considering abdominal surgeries in particular, SSI and its complications have been identified as one of the most important causes for postoperative morbidity. Treatment of SSI’s ideally begins with prevention and this can be done with the identification of risk factors. This allows for appropriate stratification and institution of steps to safeguard the patient against the development of SSI in the pre-surgical period. The objectives of the study were to compare the incidence, severity and microbiological profile of surgical site infections following emergency and elective abdominal surgeries. METHODS This study was a prospective observational study, conducted from December 2017 to May 2019 at Father Muller Medical College Hospital, Mangalore, among patients who underwent laparotomy (regardless of indication) in either an elective or emergency setting. Patients who had SSI were then stratified using the ASEPSIS wound scoring system and the Southampton wound assessment scale. The type of SSI was further documented in each patient. Other parameters such as duration of stay in the hospital, microbiological profile, interventions performed etc. were also recorded in the study. RESULTS 150 patients were enrolled in the study (84 female and 66 male), 23 patients (incidence of 15.33 %) developed an SSI (7 elective cases and 16 emergency cases), whereas 127 did not. Of the organisms cultured, the most common was found to be coagulase negative staphylococcus (CoNS, 7 cases) followed by E. coli (4 cases). CONCLUSIONS The following factors were found to significantly contribute to the development of SSI - nature of the surgery, i.e. elective vs. emergency (P-value 0.040), class of wound (Pvalue 0.001), underlying malignancy (P-value 0.030) and a concomitant urinary tract infection (UTI) (P-value 0.045). The following factors were not found to contribute to the development of a SSI - sex of the patient (P-value 0.108), age of the patient (Pvalue 0.699), presence of diabetes mellitus (DM) (P-value 0.816), chronic kidney disease (CKD) (P-value 0.904) and acute respiratory infection (ARI) (P-value 0.909).
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Wach, Johannes, Claudia Goetz, Kasra Shareghi, Torben Scholz, Volker Heßelmann, Ann-Kathrin Mager, Joachim Gottschalk, Hartmut Vatter, and Paul Kremer. "Dual-Use Intraoperative MRI in Glioblastoma Surgery: Results of Resection, Histopathologic Assessment, and Surgical Site Infections." Journal of Neurological Surgery Part A: Central European Neurosurgery 80, no. 06 (July 4, 2019): 413–22. http://dx.doi.org/10.1055/s-0039-1692975.

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Abstract Background To achieve maximal resection in glioblastoma (GBM) surgery, intraoperative imaging is important. An intraoperative magnetic resonance imaging (iMRI) suite used for both diagnostic and intraoperative imaging is considered being a reasonable concept for modern hospital management. It is still discussed if the dual use increases the risk of surgical site infections (SSI). This article assesses the rate of gross total resection (GTR), extent of resection (EOR), and histopathology after iMRI-guided resections in patients with GBM. The rate of surgical site infections (SSIs) is evaluated. Methods In all, 79 patients with GBM were operated on with iMRI. Additional resection was performed if iMRI depicted contrast enhancing tissue suggestive of residual tumor. GTR and EOR were determined by segmentation and volumetric analysis of the MR images. SSIs and the role of intravenous only or intravenous plus intrathecal antibiotics were evaluated. Statistical analysis was performed to detect the sensitivity, specificity, positive predictive value, and negative predictive value of iMRI-guided extended resections. Pearson's two-tailed chi-square test was performed to evaluate the rates of GTR and variables associated with SSI. Results GTR was achieved in 59 patients (74.68%). Rate of GTR was 35.44% before iMRI and additional resections (p < 0.0001). Mean EOR was 96.27%. Positive predictive value for tumor cells in the additionally resected tissue was 88.6%, negative predictive value was 100%, sensitivity was 100%, and specificity was 70. 6%. Rate of SSIs was 5.06% (n = 4). Two superficial SSIs, one subdural empyema and one cerebritis, were seen. SSI rates with parenteral only and additional intrathecal antibiotics were 0% and 8%, respectively (p = 0.133). Conclusion Increase of extent of tumor resection using iMRI is evident. SSI rate is within the normal range of neurosurgical procedures. A dual-use iMRI suite is a safe concept.
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Sandy-Hodgetts, Kylie, Richard Parsons, Richard Norman, Mark W. Fear, Fiona M. Wood, and Scott W. White. "Effectiveness of negative pressure wound therapy in the prevention of surgical wound complications in the cesarean section at-risk population: a parallel group randomised multicentre trial—the CYGNUS protocol." BMJ Open 10, no. 10 (October 2020): e035727. http://dx.doi.org/10.1136/bmjopen-2019-035727.

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IntroductionCaesarean delivery is steadily becoming one of the more common surgical procedures in Australia with over 100 000 caesarean sections performed each year. Over the last 10 years in Australia, the caesarean section rate has increased from 28% in 2003 to 33% in 2013. On the international stage, the Australian caesarean delivery rates are higher than the average for the Organisation for Economic Co-operation and Development, Australia ranked as 8 out of 33 and is second to the USA. Postoperative surgical site infections (SSIs) and wound complications are the most common and costly event following a caesarean section. Globally, complication rates following a caesarean delivery vary from 4.9% to 9.8%. Complications such as infection and wound breakdown affect the postpartum mother’s health and well-being, and contribute to healthcare costs for clinical management that often spans the acute, community and primary healthcare settings. Published level one studies using advanced wound dressings in the identified ‘at-risk’ population prior to surgery for prophylactic intervention are yet to be forthcoming.Methods and analysisA parallel group randomised control trial of 448 patients will be conducted across two metropolitan hospitals in Perth, Western Australia, which provide obstetric and midwifery services. We will recruit pregnant women in the last trimester, prior to their admission into the healthcare facility for delivery of their child. We will use a computer-generated block sequence to randomise the 448 participants to either the interventional (negative pressure wound therapy (NPWT) dressing, n=224) or comparator arm (non-NPWT dressing, n=224). The primary outcome measure is the occurrence of surgical wound dehiscence (SSWD) or SSI. The Centres for Disease Control reporting definition of either superficial or deep infection at 30 days will be used as the outcome measure definition. SWD will be classified as per the World Union of Wound Healing Societies grading system (grade I–IV). We will assess recruitment rate, and adherence to intervention and follow-up. We will assess the potential effectiveness of NPWT in the prevention of postpartum surgical wound complications at three time points during the study; postoperative days 5, 14 and 30, after which the participant will be closed out of the trial. We will use statistical methods to determine efficacy, and risk stratification will be conducted to determine the SWD risk profile of the participant. Follow-up at day 30 will assess superficial and deep infection, and wound dehiscence (grade I–IV) and the core outcome data set for wound complications. This study will collect health-related quality of life (European Quality of Life 5-Dimensions 5-Level Scale), mortality and late complications such as further surgery with a cost analysis conducted. The primary analysis will be by intention-to-treat. This clinical trial protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and the Consolidated Standards of Reporting Trials guidelines.Ethics and disseminationEthics approval was obtained through St John of God Health Care (HREC1409), Western Australia Department of Health King Edward Memorial Hospital (HREC3111). Study findings will be published in peer-reviewed journals and presented at international conferences. We used the SPIRIT checklist when writing our study protocol.Trial registration numberAustralian and New Zealand Clinical Trials Registry (ACTRN12618002006224p).
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Magyar, Matthew, Allyson Shephard, Pat Bedard, Ken Tang, Gyaandeo Maharajh, and Nisha Thampi. "Getting to the Heart of the Matter: Epidemiology of Surgical Site Infections Following Open Heart Surgery in Children." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s239—s240. http://dx.doi.org/10.1017/ice.2020.796.

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Background: Surgical site infections (SSIs) following open heart surgery involving cardiopulmonary bypass (CPB) among pediatric patients are healthcare-associated infections associated with significant morbidity and mortality. At a pediatric acute-care facility, an increase in SSI incidence prompted an epidemiologic review. We describe the incidence of cardiac SSIs at our hospital; we identified risk factors and areas of practice variation to inform improvement initiatives. Methods: SSI cases following CPB at our hospital have been identified through routine surveillance using NHSN definitions since January 2016. An increase in cases was noted in mid-2018, prompting a common cause analysis with stakeholders across the preoperative, intraoperative, and postoperative care continuum. Areas of practice variability were identified, and an epidemiologic review was performed to determine risk factors among cases compared to noncases between January 2016 and August 2018. The rate of SSIs and 95% confidence intervals were estimated, and univariate logistic regressions were fitted to estimate unadjusted odds ratios (ORs) for the association between each of the predetermined preoperative, intraoperative, and postoperative factors and developing an SSI. Results: Overall, 139 patients underwent surgery involving CPB between January 1, 2016, and August 31, 2018. Preoperative bathing was infrequently documented (9% among cases vs 5% among noncases; P = .56). Operating room observations identified frequent door openings and equipment crowding. Moreover, 11 patients (7.9%) developed a cardiac SSI, with 6 (14.3%) occurring in the first 8 months of 2018 (P = .067). There were no predominant pathogens; 3 of 11 cases were associated with methicillin-susceptible Staphylococcus aureus. Also, 9 cases were classified as deep incisional or organ-space SSI. Each hour increase in total CPB duration was associated with a 63% increase in odds of developing an SSI (OR, 1.626; 95% CI, 1.041–2.539). Each additional day of intubation (OR, 2.400; 95% CI, 1.203–4.788) and peritoneal dialysis (OR, 1.767; 95% CI, 1.070–2.919) during the first 3 days postoperatively were also associated with increased SSI risk. Postoperative documentation of wound assessment occurred in 60% of patients, with no difference between cases and noncases (55% vs 67%; P = .42). Conclusions: Using a mixed-methods approach, preoperative bathing, increased operating room traffic, and postoperative care around wounds and invasive devices were identified as areas of improvement toward safer surgical care. Although no unique organism or process explained the increased rate, determining risk factors and areas of practice variability through stakeholder engagement provided insight into opportunities to prevent SSIs.Funding: NoneDisclosures: None
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Abreu, Milena Reis, Larissa Paiva, Tamires Costa Mendes, Barbara Cristiny Maia, Ana Luiza Rodrigues, cia Moreira, Victor de Souza, Braulio Couto, and Carlos Starling. "Risk Factors for Surgical Site Infection After Orthopedic Trauma Surgery: A Two-Year Prospective Multicenter Analysis." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s377—s378. http://dx.doi.org/10.1017/ice.2020.1010.

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Background: Trauma is defined by the NHSN as “blunt or penetrating traumatic injury.” Therefore, if the surgery was performed because of a recent fall, for example, then it is a trauma surgery. Here, we investigated which preoperative and operative parameters are associated with surgical site infection (SSI) after orthopedic trauma surgery. Objective: We aimed to answer 3 main questions: What is the risk of wound infection for patients undergoing trauma surgery? What are the main etiologic agents of SSI after trauma surgery? And what are the risk factors associated with SSI after trauma surgery? Methods: This prospective multicenter cohort study included 2,035 patients undergoing trauma surgery between July 2016 and June 2018 in 4 hospitals in Belo Horizonte, Brazil. Outcome variables were SSI, hospital mortality, and length of hospital stay. The following preoperative and operative parameters were evaluated: age, length of hospital stay before surgery, duration of surgery, number of professionals at surgery, number of hospital admissions, surgical wound classification, American Society of Anesthesiologists (ASA) preoperative assessment score, type of surgery (elective, emergency), general anesthesia (yes, no), trauma surgery (yes, no), and the 3-point prediction Nosocomial Infections Surveillance (NNIS) risk index. Results: The overall estimated SSI risk was 2.8% (95% CI, 2.0%–3.6%). Hospital mortality risk after trauma surgery was 3.4% (95% CI, 2.8%–4.4%). Hospital length of stay parameters in noninfected patients were as follows: mean, 8 days; median, 3 days; SD, 12 days. Hospital length of stay parameters in infected patients were mean, 30 days; median, 23 days; with SD, 31 days. The parameters for hospital stay in infected patients were mean, 10 days; median, 3 days, and SD, 15.9 (P < .001). Trauma orthopedic surgery lasting >2 hours was associated with approximately twice the risk (RR, 2.2) of developing an SSI compared to ≤2 hours of surgery: 27 of 739 (3.7%) versus 21 of 1,290 (1.6%), respectively, (P = .005) (Fig. 1). The NNIS risk index predicts the risk of SSI after trauma surgery (P = .003): 13 of 737 SSIs (1.8%) had an NNIS risk index of 0; 20 of 736 SSIs (2.7%) had an NNIS risk index of 1; 8 of 211 SSIs (3.8%) had an NNIS risk index of 2; and 2 of 11 SSIs (18.2%) had an NNIS risk index of 3 (Fig. 2). Conclusions: We identified intrinsic risk factors for SSI after orthopedic trauma surgery. The identification of the actual SSI incidence after trauma surgery in developing country hospitals and associated risk factors may support actions to minimize the complications caused by SSI.Funding: NoneDisclosures: None
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Cintean, Raffael, Alexander Eickhoff, Carlos Pankratz, Beatrice Strauss, Florian Gebhard, and Konrad Schütze. "Radial vs. Dorsal Approach for Elastic Stable Internal Nailing in Pediatric Radius Fractures—A 10 Year Review." Journal of Clinical Medicine 11, no. 15 (July 31, 2022): 4478. http://dx.doi.org/10.3390/jcm11154478.

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Background: Forearm fractures are one of the most common fractures in children. Over the last years, a tendency towards surgical treatment was seen, especially closed reduction and internal fixation with elastic stable internal nailing (ESIN). Despite an overall low complication rate being described, a risk of intraoperative complications remains. Material and Methods: A total of 237 patients (mean age 8.3 ± 3.4 (1–16) years) with forearm or radius fractures treated with ESIN between 2010 and 2020 were included in the study. The retrospective review of 245 focused on fracture pattern, pre- and postoperative fracture angulation, intra- and postoperative complications, and surgical approach for nail implant. The fracture pattern and pre- and postoperative angulation were measured radiographically. Complications such as ruptures of the extensor pollicis longus (EPL) tendon and sensibility disorders of the superficial radial nerve were further analyzed. Results: In 201 cases (82%), we performed a dorsal approach; 44 fractures (17.9%) were treated with a radial approach. In total, we found 25 (10%) surgery-related complications, of which 21 (8.6%) needed further surgical treatment. In total, we had 14 EPL ruptures (5.7%), 4 sensibility disorders of the superficial radial nerve (1.6%), 2 refractures after implant removal (0.8%), 2 superficial wound infections (0.8%), and 1 child with limited range of motion after surgery (0.4%). No statistical significance between pre- and postoperative angulation correlated to fracture patterns or diameter of the elastic nail was seen. As expected, there was a significant improvement of postoperative angulation. Using radial approach in distal radial fractures showed a lower rate of surgical related complications, 2.3% of which need further surgical treatment as well as better postoperative angulations compared to the dorsal approach (8.5%). Conclusion: Especially due to the low risk of damaging the EPL tendon, the radial approach showed a lower complication rate which needed further surgical treatment. The risk of lesions of the superficial radial nerve remains.
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Bäck, Caroline, Mads Hornum, Morten Buus Jørgensen, Ulver Spangsberg Lorenzen, Peter Skov Olsen, and Christian H. Møller. "One-year mortality increases four-fold in frail patients undergoing cardiac surgery." European Journal of Cardio-Thoracic Surgery 59, no. 1 (September 15, 2020): 192–98. http://dx.doi.org/10.1093/ejcts/ezaa259.

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Abstract OBJECTIVES An increased focus on biological age, ‘frailty’, is important in an ageing population including those undergoing cardiac surgery. None of the existing surgery risk scores European System for Cardiac Operative Risk Evaluation II or Society of Thoracic Surgeons score incorporates frailty. Therefore, there is a need for an additional risk score model including frailty and not simply the chronological age. The aim of this study was to evaluate the impact of frailty assessment on 1-year mortality and morbidity for patients undergoing cardiac surgery. METHODS A total of 604 patients aged ≥65 years undergoing non-acute cardiac surgery were included in this single-centre prospective observational study. We compared 1-year mortality and morbidity in frail versus non-frail patients. The Comprehensive Assessment of Frailty (CAF) score was used: This is a score of 1–35 determined via minor physical tests. A CAF score ≥11 indicates frailty. RESULTS The median age was 73 years and 79% were men. Twenty-five percent were deemed frail. Frail patients had four-fold, odds ratios 4.63, 95% confidence interval (CI) 2.21–9.69; P &lt; 0.001 increased 1-year mortality and increased risk of postoperative complications, i.e. surgical wound infections and prolonged hospital length of stay. A univariable Cox proportional hazards regression showed that an increased CAF score was a risk factor of mortality at any time after undergoing cardiac surgery (hazards ratios 1.11, 95% CI 1.07–1.14; P &lt; 0.001). CONCLUSIONS CAF score identified frail patients undergoing cardiac surgery and was a good predictor of 1-year mortality. Clinical trial registration number NCT02992587.
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Uçkay, Ilker, Vinoth Yogarasa, Felix W. A. Waibel, Annette Seiler-Bänziger, Maja Kuhn, Margrit Sahli, Martin C. Berli, Benjamin A. Lipsky, and Madlaina Schöni. "Nutritional Interventions May Improve Outcomes of Patients Operated on for Diabetic Foot Infections: A Single-Center Case-Control Study." Journal of Diabetes Research 2022 (August 5, 2022): 1–6. http://dx.doi.org/10.1155/2022/9546144.

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Aim. While a patient’s nutritional status is known to generally have a role in postoperative wound healing, there is little information on its role as therapy in the multifaceted problem of diabetic foot infections (DFIs). Methods. We assessed this issue by conducting a retrospective case-control cohort study using a multivariate Cox regression model. The nutrition status of the DFI patients was assessed by professional nutritionists, who also orchestrated the nutritional intervention (counselling, composition of the intrahospital food) during hospitalization. Results. Among 1,013 DFI episodes in 586 patients (median age 67 years; 882 with osteomyelitis), 191 (19%) received a professional assessment of their nutrition accompanied by between 1 and 6 nutritional interventions. DFI cases who had professional nutritionists’ interventions had a significantly shorter hospital stay, had shorter antibiotic therapies, and tended to fewer surgical debridements. By multivariate analysis, episodes with low Nutritional Risk Status- (NRS-) Scores 1-3 were associated with significantly lower failure rates after therapy for DFI (Cox regression analysis; hazard ratio 0.2, 95% confidence interval 0.1-0.7). Conclusions. In this retrospective cohort study, DFI episodes with low NRS-Score were associated with lower rates of clinical failure after DFI treatment, while nutritional interventions improved the outcome of DFI. We need prospective interventional trials for this treatment, and these are underway.
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Navalkele, Bhagyashri, Amar Krishna, George McKelvey, Samuel Perov, Kunal Sood, Youssef Dakallah, and Teena Chopra. "Recent Respiratory Tract Infection and Additional Surgeries Increase Risk for Surgical Site Infection in Total Joint Arthroplasty: A Retrospective Analysis of 2255 Patients." Open Forum Infectious Diseases 4, suppl_1 (2017): S101—S102. http://dx.doi.org/10.1093/ofid/ofx163.087.

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Abstract Background Surgical site infections (SSI) are one of the most common healthcare-associated infections contributing to high economic burden. Around 658,000 total joint arthroplasties (TJA) are performed annually in the Unites States, estimated 0.9–2.5% develop surgical site infection. Despite following prevention guidelines, SSI continues to occur. The aim of our study was to identify perioperative risk factors for SSI in patients undergoing TJA. Methods A retrospective cohort study was performed of patients at the Detroit Medical Center from 2011 to 2015. All adult patients undergoing primary or revision total knee or hip joint arthroplasty were included. Patients were divided into SSI (prosthetic joint infections) and non-SSI group. Baseline characteristics and perioperative variables influencing SSI were assessed. Statistical analysis was performed using SAS software. Continuous variables were compared using Wilcoxon–Rank-sum test and categorical variables using Fischer’s exact test. Results Among 2255 included patients, 1203 had knee arthroplasties (53%), 1052 had hip arthroplasties (47%) and SSI occurred in 46 patients (2%). Overall, mean age was 58.81 ± 11 years; 64% were females, 57% were African American, and 41% were smokers. Diabetes did not increase risk for SSI (37% with SSI vs. 26% without SSI; P = 0.09). Administration of general anesthesia, American Society of Anesthesiologists score of ≥2, the presence of hypothermia and hyperglycemia did not statistically increase the risk for SSI. Patients with recent respiratory tract infection in previous 30 days prior to surgery were more likely to develop infection compared with patients without recent infection (20% vs. 6.6%, OR 3.42; 95% confidence interval 1.62–7.22, P = 0.0034). Any additional surgery within 90 days of arthroplasty increased risk for infection (22% vs. 11%, P = 0.03). Among the 46 SSIs, knee surgeries experienced more infections than hip surgeries (67% vs. 33%, P = 0.07). Conclusion In this study, recent respiratory tract infection in 30 days prior to surgery and additional surgeries within 90 days after arthroplasty increased risk for SSI. Careful preoperative assessment and sufficient time to postoperative recovery is essential to reduce SSI. Further multicenter studies are needed to validate our findings. Disclosures All authors: No reported disclosures.
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Junqueira, Beatriz Lasmar Portilho, Bairbre Connolly, Oussama Abla, George A. Tomlinson, and Joao Guilherme Pires Vieira Amaral. "Port-A-Catheter Infection Rate and Associated Risk Factors in Children Diagnosed with Acute Lymphoblastic Leukemia." Blood 114, no. 22 (November 20, 2009): 987. http://dx.doi.org/10.1182/blood.v114.22.987.987.

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Abstract Abstract 987 Poster Board I-9 Background: Port-a-catheters are commonly used as vascular access device in children with Acute Lymphoblastic Leukemia (ALL) requiring long-term chemotherapy. Literature suggests that surgical procedures should not be performed in patients with very low neutrophil counts. Neutropenia, however, is very common in patients with ALL putting them at increased risk for infection and impaired wound healing. Objectives: 1) To determine if severe neutropenia, defined as neutrophil count < 500/mm3, on the day of port-a-catheter insertion is a risk factor for catheter-associated infection in children with ALL; 2) To evaluate the incidence of catheter-associated infection and wound dehiscence; 3) To assess other potential risk factors for infection, such as ALL risk category, dexamethasone use during induction therapy and nutritional status at the time of port-a-catheter insertion. Methods: This was a retrospective study conducted in children newly diagnosed with ALL (January 2005 to August 2008) who had a port-a-catheter inserted to assess catheter-associated infections and dehiscence. Demographic data, clinical characteristics, port-a-catheter insertion data and complications post-procedure were reviewed. The post-procedure complications were classified as early (≤ 30 days) or late (> 30 days). The end of catheter follow-up was March, 2009. The nutritional status was evaluated using albumin and total protein levels as well as the BMI-for-age z-score or weight-for-age z-score. Statistical analysis included descriptive and inferential statistics (Chi-squared test, Wilcoxon rank sum test and Kaplan-Meier survival curve). Results: 192 port-a-catheters were inserted in 179 patients with ALL in this 3.5 year time period. Most patients were started on chemotherapy 3 days prior to catheter insertion. A total of 43 catheter-associated infections (22.39%) were diagnosed and the infection rate was 0.35/1000 catheter-days. Children with severe neutropenia on the day of insertion (n=99) had a catheter-associated infection rate of 15.15%; whereas, non-severe neutropenic (≥ 500 cells/mm3) children (n=93) had a rate of 24.73%. This difference was not statistically significant (p=0.137). Out of 192 port-a-catheters, 12 (6.25%) had to be removed due to infection. The most common organisms to cause catheter removal were Coagulase Negative Staphylococcus and Staphylococcus aureus. Patients with high risk precursor B and T cell ALL had a statistically significant higher incidence of late catheter-associated infections (p=0.024) than standard risk ALL. Gender (p=0.863), use of dexamethasone during induction (p=0.201), low BMI-for-age z-score or weight-for-age z-score (p=0.659), low albumin (p=0.530), low total protein (p=0.759) and fever pre-procedure (p=0.339) were not risk factors for infection. Patients who had an early catheter-associated infection did not have a greater chance of having a late infection (p=0.813). Out of 9 wound dehiscences (4.68%), 5 presented also with a local infection. The catheter infection-free survival rate at 1 year was 88.6%, at 2 years was 86.7% and at 3 years was 83.9% (see Graph). Conclusion: This study shows that severe neutropenia on the day of port-a-catheter insertion does not increase the incidence of catheter-associated infection in children with ALL. In contrast, high risk ALL (precursor B and T cell) is a risk factor for late catheter-associated infections. Disclosures: No relevant conflicts of interest to declare.
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Seow, Dexter, Hugo A. Ubillus, Mohammad T. Azam, Matthew B. Weiss, Arianna L. Gianakos, Youichi Yasui, Christopher J. Pearce, and John G. Kennedy. "Treatment of Acute Achilles Tendon Ruptures: A Systematic Review of Overlapping Meta-Analyses." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0092. http://dx.doi.org/10.1177/2473011421s00927.

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Category: Ankle Introduction/Purpose: Acute Achilles tendon rupture (AATR) is a common injury of an incidence rate of up to 31 per 100,000 per year. The current meta-analyses on the treatment of AATR have conflicted data that may, in part, be due to the differences in their methodologies. The aim of this study is to systematically review and present the current meta-analyses for the treatment of AATR. The outcomes of this study can provide clinicians with a clear overview of the current literature to help decide on the optimal treatment for patients. Methods: Two independent reviewers searched PubMed and Embase on March 17, 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Assessment of evidence was two-fold: level of evidence (LoE) and quality of evidence (QoE). LoE was evaluated using published criteria by The Journal of Bone and Joint Surgery and the QoE by the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) scale. Pooled complication rates were highlighted for significance in favor of 1 group or no significance. Statistical analysis was performed using a statistical software package (R version 3.5.1; R Foundation for Statistical Computing, Vienna, Austria). Descriptive statistics were calculated for each study and statistical parameters analyzed. Continuous variables were reported as mean +- standard deviation and categorical variables were reported as frequencies with percentages. P-values < 0.05 was considered statistically significant. Results: 21 meta-analyses were included in the study. Re-rupture rates ranged between 2.3% to 5.0% for open repair/MIS and 3.9% to 13% for conservative treatment (p < 0.05). Re-rupture rates were reported in 3 of 4 meta-analyses that ranged between 2.3% to 7.8% for conservative treatment earlier rehabilitation and 5.0% to 12.2% for conservative treatment later rehabilitation. Re-rupture rates were 2.5% for open repair earlier rehabilitation and 3.8% for open repair later rehabilitation. When comparing surgical techniques, re-rupture rates ranged between 1.4% to 3.1% for percutaneous repair/MIS and 2.2% to 2.7% for open repair. Infection rates ranged between 2.8% to 5.0% for open repair/MIS and 0% to 0.02% for conservative treatment. The majority of meta-analyses (3 of 5) significantly favored by effect size, open repair/MIS for total infection rates (p < 0.05). Conclusion: The results of this study demonstrate that operative repair reduced the rate of re-rupture when compared to conservative treatment. There is currently conflicting information on whether early functional rehabilitation reduces the difference between the two treatments. Operative treatment has been shown to have a higher rate of wound complications, although the rates of deep wound infections remains to be determined. Percutaneous repair resulted in similar re-rupture rates when compared to open surgery but for the rates of other complications including wound infections, this was diminished. Further meta- analyses which compare all cohorts are needed to ascertain best evidence.
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Raslan, Rasha, Michelle Elizabeth Doll, Heather Albert, Hirsh Shah, Kaila Cooper, Emily Godbout, Michael Stevens, and Gonzalo Bearman. "Staphylococcal Decolonization to Prevent Surgical Site Infection: Is There a Role in colorectal surgery?" Infection Control & Hospital Epidemiology 41, S1 (October 2020): s497. http://dx.doi.org/10.1017/ice.2020.1175.

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Background: Colorectal surgery is associated with a high risk of surgical site infections (SSIs), with an incidence ranging from 16.9% to 20%, and SSIs are associated with significant morbidity and mortality, prolonged length of hospitalization, and increased health care costs. Staphylococcal decolonization is an attempt to alter the microbiome to prevent staphylococcal and other skin flora from accessing the surgical site, and This practice effectively reduces SSIs in orthopedic, neurologic, and cardiac surgeries. A staphylococcal decolonization protocol was enacted in colorectal surgeries at our institution beginning in October 2016. We compared patient outcomes between patients who did and did not undergo preoperative staphylococcal decolonization. Methods: All patients undergoing nonemergent NHSN-defined colorectal procedures from July 2015 until June 2019 at a tertiary-care medical center were included in this retrospective study. Staphylococcal decolonization was performed using chlorhexidine 2% body wash solution, mupirocin nasal ointment, and chlorhexidine 0.12% oral rinse all twice daily for 5 days prior to surgery. All SSIs were defined by NSHN criteria. The primary outcome was SSI, and secondary outcomes were superficial wound infection (SIP) and organ-space infection (IAB). Predictive variables included decolonization status (yes or no), age, gender, body mass index, procedure duration, American Society of Anesthesiologists (ASA) score, diabetes, smoking, and surgical oncology service. Surgical antimicrobial prophylaxis with cefazolin and metronidazole OR cefoxitin, and chlorhexidine skin preparation were standard throughout the study period. Univariate analysis was performed using a χ2 or t test. Multivariable logistic regression was performed to control for all clinically important variables above. All statistical analyses were done using SAS version 9.4 software (Cary, NC). Results: In total, 1,139 patients underwent nonemergent colorectal surgery from July 2015 to June 2019. There were 74 SSIs: 42 IABs and 32 SIPs. Decolonization was performed in 332 of 1,139 cases (29%). There was no difference in overall SSIs between those decolonized and not decolonized (P = .50). However, SIPs were reduced in the group receiving decolonization: 1.2% (4 of 332) versus 3.5% (28 of 807) (P = .04. When controlling for known SSI risk factors, those not receiving decolonization remained at increased risk of SIPs (OR, 3.79; 95% CI, 1.14–12.61; P = .03. Conclusions: Staphylococcal decolonization may prevent a subset of SSIs in patients undergoing colorectal surgery.Funding: NoneDisclosures: Michelle Doll reports a research Grant from Molnlycke Healthcare.
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Prats-Uribe, Albert, Spyros Kolovos, Klara Berencsi, Andrew Carr, Andrew Judge, Alan Silman, Nigel Arden, et al. "Unicompartmental compared with total knee replacement for patients with multimorbidities: a cohort study using propensity score stratification and inverse probability weighting." Health Technology Assessment 25, no. 66 (November 2021): 1–126. http://dx.doi.org/10.3310/hta25660.

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Background Although routine NHS data potentially include all patients, confounding limits their use for causal inference. Methods to minimise confounding in observational studies of implantable devices are required to enable the evaluation of patients with severe systemic morbidity who are excluded from many randomised controlled trials. Objectives Stage 1 – replicate the Total or Partial Knee Arthroplasty Trial (TOPKAT), a surgical randomised controlled trial comparing unicompartmental knee replacement with total knee replacement using propensity score and instrumental variable methods. Stage 2 – compare the risk benefits and cost-effectiveness of unicompartmental knee replacement with total knee replacement surgery in patients with severe systemic morbidity who would have been ineligible for TOPKAT using the validated methods from stage 1. Design This was a cohort study. Setting Data were obtained from the National Joint Registry database and linked to hospital inpatient (Hospital Episode Statistics) and patient-reported outcome data. Participants Stage 1 – people undergoing unicompartmental knee replacement surgery or total knee replacement surgery who met the TOPKAT eligibility criteria. Stage 2 – participants with an American Society of Anesthesiologists grade of ≥ 3. Intervention The patients were exposed to either unicompartmental knee replacement surgery or total knee replacement surgery. Main outcome measures The primary outcome measure was the postoperative Oxford Knee Score. The secondary outcome measures were 90-day postoperative complications (venous thromboembolism, myocardial infarction and prosthetic joint infection) and 5-year revision risk and mortality. The main outcome measures for the health economic analysis were health-related quality of life (EuroQol-5 Dimensions) and NHS hospital costs. Results In stage 1, propensity score stratification and inverse probability weighting replicated the results of TOPKAT. Propensity score adjustment, propensity score matching and instrumental variables did not. Stage 2 included 2256 unicompartmental knee replacement patients and 57,682 total knee replacement patients who had severe comorbidities, of whom 145 and 23,344 had linked Oxford Knee Scores, respectively. A statistically significant but clinically irrelevant difference favouring unicompartmental knee replacement was observed, with a mean postoperative Oxford Knee Score difference of < 2 points using propensity score stratification; no significant difference was observed using inverse probability weighting. Unicompartmental knee replacement more than halved the risk of venous thromboembolism [relative risk 0.33 (95% confidence interval 0.15 to 0.74) using propensity score stratification; relative risk 0.39 (95% confidence interval 0.16 to 0.96) using inverse probability weighting]. Unicompartmental knee replacement was not associated with myocardial infarction or prosthetic joint infection using either method. In the long term, unicompartmental knee replacement had double the revision risk of total knee replacement [hazard ratio 2.70 (95% confidence interval 2.15 to 3.38) using propensity score stratification; hazard ratio 2.60 (95% confidence interval 1.94 to 3.47) using inverse probability weighting], but half of the mortality [hazard ratio 0.52 (95% confidence interval 0.36 to 0.74) using propensity score stratification; insignificant effect using inverse probability weighting]. Unicompartmental knee replacement had lower costs and higher quality-adjusted life-year gains than total knee replacement for stage 2 participants. Limitations Although some propensity score methods successfully replicated TOPKAT, unresolved confounding may have affected stage 2. Missing Oxford Knee Scores may have led to information bias. Conclusions Propensity score stratification and inverse probability weighting successfully replicated TOPKAT, implying that some (but not all) propensity score methods can be used to evaluate surgical innovations and implantable medical devices using routine NHS data. Unicompartmental knee replacement was safer and more cost-effective than total knee replacement for patients with severe comorbidity and should be considered the first option for suitable patients. Future work Further research is required to understand the performance of propensity score methods for evaluating surgical innovations and implantable devices. Trial registration This trial is registered as EUPAS17435. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 66. See the NIHR Journals Library website for further project information.
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Miller, Aspen, Nathan Hendrickson, John Davison, Erin Wilson, Ruth Grossman, Natalie Glass, and Michael Willey. "Amino Acid Supplementation Is Associated with Reduced Mortality and Complications Following Acute Fracture Fixation: Results of a Prospective, Randomized Controlled Trial." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1134. http://dx.doi.org/10.1093/cdn/nzaa055_019.

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Abstract Objectives Acute musculoskeletal trauma patients experience immobilization and under-nutrition resulting in catabolic skeletal muscle wasting and compromised wound healing. We conducted a prospective RCT to assess the effect of supplementation with conditionally essential amino acids (CEAA) on postoperative outcomes in patients with acute orthopedic trauma. We hypothesized that supplementation with CEAA would decrease postoperative complications. Methods Adults with operative pelvis or long bone fractures, excluding distal radius fractures, were prospectively enrolled in this single-blinded RCT. Patients were assigned by stratified by injury severity and randomized to standard preoperative nutrition (control) or standard nutrition with oral supplement containing CEAA for two weeks after surgery (CEAA). Subjects with minimum 6-months follow up were included in this analysis. Postoperative complication rates were analyzed with X,2 using intention-to-treat analysis. Results 243 patients met inclusion criteria (Control: 117, CEAA: 126). Median supplement compliance in CEAA patients was 84% of 28 prescribed CEAA servings with no reported supplement-related adverse events. 7 of 117 patients within the control group died during follow up vs. 1 of 126 in CEAA group (P = 0.031). Total complication rate was 55% control patients and 41% CEAA patients (P = 0.040). Surgical site infection (SSI) rates were 24% in control vs. 14% in CEAA (P = 0.055). Medical complication rates were 35% in control vs. 23% in CEAA (P = 0.039). Nonunion rates were 3% in control vs. 5% in CEAA (P = 0.751). Conclusions Patients receiving CEAA supplementation following acute fracture fixation had significantly lower mortality, overall complications, and medical complications. There was a trend toward decreased surgical site infections among patients receiving CEAA, although this did not reach statistical significance. Postoperative oral supplementation with CEAA is a low-cost, low-risk intervention associated with reductions in postoperative mortality and complications. Further work is warranted to improve preoperative risk stratification and further define which individuals receive greatest benefit from this intervention. Funding Sources American Academy of Orthopaedic Surgeons, Board of Specialty Societies Quality and Patient Safety Action Fund.
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Fu, Kai-Ming G., Justin S. Smith, David W. Polly, Christopher P. Ames, Sigurd H. Berven, Joseph H. Perra, Richard E. McCarthy, D. Raymond Knapp, and Christopher I. Shaffrey. "Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery." Journal of Neurosurgery: Spine 14, no. 4 (April 2011): 470–74. http://dx.doi.org/10.3171/2010.12.spine10486.

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Object Patients with varied medical comorbidities often present with spinal pathology for which operative intervention is potentially indicated, but few studies have examined risk stratification in determining morbidity and mortality rates associated with the operative treatment of spinal disorders. This study provides an analysis of morbidity and mortality data associated with 22,857 cases reported in the multicenter, multisurgeon Scoliosis Research Society Morbidity and Mortality database stratified by American Society of Anesthesiologists (ASA) physical status classification, a commonly used system to describe preoperative physical status and to predict operative morbidity. Methods The Scoliosis Research Society Morbidity and Mortality database was queried for the year 2007, the year in which ASA data were collected. Inclusion criterion was a reported ASA grade. Cases were categorized by operation type and disease process. Details on the surgical approach and type of instrumentation were recorded. Major perioperative complications and deaths were evaluated. Two large subgroups—patients with adult degenerative lumbar disease and patients with major deformity—were also analyzed separately. Statistical analyses were performed with the chi-square test. Results The population studied comprised 22,857 patients. Spinal disease included degenerative disease (9409 cases), scoliosis (6782 cases), spondylolisthesis (2144 cases), trauma (1314 cases), kyphosis (831 cases), and other (2377 cases). The overall complication rate was 8.4%. Complication rates for ASA Grades 1 through 5 were 5.4%, 9.0%, 14.4%, 20.3%, and 50.0%, respectively (p = 0.001). In patients undergoing surgery for degenerative lumbar diseases and major adult deformity, similarly increasing rates of morbidity were found in higher-grade patients. The mortality rate was also higher in higher-grade patients. The incidence of major complications, including wound infections, hematomas, respiratory problems, and thromboembolic events, was also greater in patients with higher ASA grades. Conclusions Patients with higher ASA grades undergoing spinal surgery had significantly higher rates of morbidity than those with lower ASA grades. Given the common application of the ASA system to surgical patients, this grade may prove helpful for surgical decision making and preoperative counseling with regard to risks of morbidity and mortality.
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Roberts, Derek J., Sudhir K. Nagpal, Henry T. Stelfox, Tim Brandys, Vicente Corrales-Medina, Luc Dubois, and Daniel I. McIsaac. "Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysis." JMIR Research Protocols 10, no. 9 (September 16, 2021): e28759. http://dx.doi.org/10.2196/28759.

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Background Surgical site infections (SSIs) are common, costly, and associated with increased morbidity and potential mortality after lower limb revascularization surgery (ie, arterial bypass, endarterectomy, and patch angioplasty). Identifying evidence-informed risk factors for SSI in patients undergoing these surgeries is therefore important. Objective The aim of this study is to conduct a systematic review and meta-analysis of prognostic studies to identify, synthesize, and determine the certainty in the cumulative evidence associated with reported risk factors for early and delayed SSI after lower limb revascularization surgery in adults with peripheral artery disease. Methods We will search MEDLINE, Embase, the seven databases in Evidence-Based Medicine Reviews, review articles identified during the search, and included article bibliographies. We will include studies of adults (aged ≥18 years) with peripheral artery disease that report odds ratios, risk ratios, or hazard ratios adjusted for the presence of other risk factors or confounding variables and relating the potential risk factor of interest to the development of SSI after lower limb revascularization surgery. We will exclude studies that did not adjust for confounding, exclusively examined certain high-risk patient cohorts, or included >20% of patients who underwent surgery for indications other than peripheral artery disease. The primary outcomes will be early (in-hospital or ≤30 days) SSI and Szilagyi grade I (cellulitis involving the wound), grade II (infection involving subcutaneous tissue), and grade III (infection involving the vascular graft) SSI. Two investigators will independently extract data and evaluate the study risk of bias using the Quality in Prognosis Studies tool. Adjusted risk factor estimates with similar definitions will be pooled using DerSimonian and Laird random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. Finally, we will use the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to determine certainty in the estimates of association between reported risk factors and the development of SSI. Results The protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews). We will execute the peer-reviewed search strategy on June 30, 2021, and then complete the review of titles and abstracts and full-text articles by July 30, 2021, and September 15, 2021, respectively. We will complete the full-text study data extraction and risk of bias assessment by November 15, 2021. We anticipate that we will be able to submit the manuscript for peer review by January 30, 2022. Conclusions This study will identify, synthesize, and determine the certainty in the cumulative evidence associated with risk factors for early and delayed SSI after lower limb revascularization surgery in patients with peripheral artery disease. The results will be used to inform practice, clinical practice statements and guidelines, and subsequent research. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021242557; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242557 International Registered Report Identifier (IRRID) PRR1-10.2196/28759
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Berezhna, A. V., S. D. Novikov, and T. O. Chumachenko. "MONITORING OF PERIPHERAL VENOUS CATHETERIZATION AT THE SURGICAL HOSPITAL." Eastern Ukrainian Medical Journal 8, no. 3 (2020): 314–23. http://dx.doi.org/10.21272/eumj.2020;8(3):314-323.

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Introduction. Peripheral venous catheters are widely used in medical practice to provide continuous venous access for therapeutic and diagnostic purposes. Peripheral vascular catheterization can be accompanied by infectious complications, including catheter-related bloodstream infections. An effective system of epidemiological surveillance and infection control of catheter-related bloodstream infections has not been developed at the state level in Ukraine; there is no proper monitoring for administration site and no registration of complications associated with the vascular catheterization. The purpose of this work was to assess the validity and propriety of the use of peripheral venous catheters in patients who receive inpatient treatment. Materials and methods: Between October 2019 and April 2020, 93 adult patients who were peripheral venous catheterized in a surgical hospital in Kharkiv were included in a prospective epidemiological study. The author's observation card was used for data collection for each patient daily. The catheter site was observed daily, and the following symptoms were entered into the card: flushed skin, swelling, discharge, and pain at the administration site at rest and on palpation. Interpretation of symptoms was conducted using the visual infusion phlebitis scale by A. Jackson. Statistical processing of data was carried out using descriptive statistics methods. To identify the relationship between the nominative values, Pearson's criterion χ2 was determined with P < 0.01. Research results: 51 women (54.8%) and 42 men (45.2%) aged 18 to 84 were enrolled. In total, patients spent 619 bed-days in the hospital, of which the proportion of days with vascular catheters equaled 90.8% (n = 562). The main indication for the catheterization procedure was multicomponent therapy or the use of incompatible medications (98.9% / n = 92). In total, 148 peripheral venous catheters were inserted in these patients. The number of vascular catheters per patient ranged 1 to 3. According to the data of daily monitoring of the administration site, the signs of inflammation were observed in 65.5% of cases (n = 97). The incidence of signs of inflammation at the administration site with the first catheterization was significantly higher (χ2 = 25.2804; p < 0.00001) than that with the second or third catheterization. The signs of local inflammation, which were more common in patients with vascular catheters, included flushed skin in the area of the catheter site (65.5% / n = 97), complaints of pain on palpation in the area of the catheter site (60.8% / n = 90) and swelling in the area of the catheter site (57.4% / n = 85). It was found that for more than half of the cases (55.4% / n = 82), the patients had symptoms of middle-stage phlebitis. It was also revealed that the most common reason for the removal of a peripheral venous catheter (n = 148) in the studied hospital were signs of local inflammation at the catheter site (61.5% / n = 91). However, in 16.9% of cases (n = 25), the occurrence of at least two signs of local inflammation at the catheter site, which indicated the initial stage of phlebitis and required to rearrange the catheter, was not the reason for immediate catheter removal. Conclusions: Health care workers make mistakes when working with peripheral venous catheters; in particular, there is no timely replacement of vascular catheters in the event of signs of infusion phlebitis. To reduce the risk of infectious complications of vascular catheterization at a health facility, the indications for insertion and removal of peripheral venous catheters and central venous catheters should be clearly defined, and standard operating procedures for ensuring vascular access and algorithms for managing patients with vascular catheters should be developed and implemented. Keywords intravascular catheter, prospective epidemiological study, assessment of the catheter insertion site, infusion phlebitis, catheter-related bloodstream infections, infection control.
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Banks, Michael C., Pooja S. Yesantharao, Lisa C. Smith, Emily h. Werthman, Carrie A. Cox, Vidhi Javia, and Julie Caffrey. "586 Patient Satisfaction for the Use of DVPRS in the Assessment of Pain in the Burn and Surgical ICU." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S144—S145. http://dx.doi.org/10.1093/jbcr/irab032.236.

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Abstract Introduction The assessment and treatment of pain has become increasingly important in light of the opioid epidemic. Inadequately managed pain can lead to increased risk of psychiatric illness. The numeric rating scale (NRS) is used in most ICUs and only assesses pain intensity. Although it is reliable, valid, and user-friendly, other publications have criticized this one-dimensional pain assessment tools as offering little information about the impact of the pain on the patient’s life. The defense and veterans pain rating scale (DVPRS) is a multi-dimensional tool designed to assess the patient’s pain intensity as well as how the pain interferes with the patient’s general activity, sleep, mood and stress. Studies have shown that it has good validity and reliability in the inpatient and outpatient military population with neuropathic and non-neuropathic pain. The DVPRS has not been evaluated in critical care patients. Thus, this study comparatively investigated ICU patients’ satisfaction with the DVPRS versus the NRS. Methods This was a prospective pilot study performed from September 2018 to July 2019 in a 10 bed burn intensive care unit (BICU) and 10 bed surgical intensive care unit (SICU) at a university teaching hospital. This was an IRB approved study. All enrolled patients were older than 18 years of age and were CAM-ICU negative. The participating staff members were educated on the use of the scales prior to the start of the study. Routine treatment of pain was not altered by the study. Pain was assessed by staff nurses randomly assigned to use the NRS or DVPRS tool. The selected tool was used on admission, during wound care and every 4 hours or upon patient need. The patients completed satisfaction surveys on the day of discharge. Results 42 patients participated and 32 completed the study. 18 patients were in the DVPRS arm and 14 were in the NRS arm. Our primary outcome was patient satisfaction, ranked on a scale from 0–10, where 0 was the lowest score and 10 was the highest. Overall, patients in the DVPRS cohort had higher median satisfaction scores (median score: 10, interquartile range: 8–10) than the NRS cohort (median score: 8, interquartile range 7–9), though this difference did not reach statistical significance (p=0.16). However, DVPRS patients were significantly more likely to be “completely satisfied” than NRS patients (55.6% in DVPRS patients versus 21.4% in NRS patients; p=0.04). Furthermore, upon multivariate logistic analysis adjusting for age, gender, and ICU using the NRS pain scale conferred lower odds of complete satisfaction with pain management (odds ratio: 0.19, p=0.04). Conclusions Our study showed that ICU patients preferred the DVPRS over the NRS. The DVPRS appeared to be as effective as the NRS in pain relief and gave providers more information about patients’ pain.
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Conner, Janet, and Joan Ivaska. "Direct Data Mining from the Electronic Medical Record to Assess and Improve Compliance With Infection Prevention Bundles." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s32—s33. http://dx.doi.org/10.1017/ice.2020.511.

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Background: Bundles have been proven to reduce the risk of healthcare-associated infections and to provide for rapid recognition and response for the best outcome in patients with sepsis. Each element alone does not provide the statistical significance that all elements together allow. Providing near real-time compliance with bundle measures to clinical staff can drive performance improvement with the bundle during the patient’s hospital stay, resulting in improved clinical care and prevention of infection. Methods: In 2019, 3 clinical initiatives were chartered that applied evidence-based bundles for early identification and treatment of sepsis, prevention of healthcare-associated pneumonia (HAP), and prevention of surgical site infection. The bundle included the following elements: assessment of sepsis, measurement of lactic acid, collection of blood culture, timely administration of antibiotics. The HAP bundle included the following elements: assessment of aspiration risk, elevation of the head of the bed, oral care twice daily and preoperatively, and incentive spirometry postoperatively. And the SSI bundle included the following elements: preoperative CHG bath, appropriate preoperative antibiotic, perioperative glucose control, and perioperative temperature control. A multidisciplinary team developed and implemented dashboards that extracted bundle elements from the electronic medical record (EMR) nightly. Bundle compliance was calculated at the individual element level as well as the aggregate. Bundle failure data were available at the patient level as well as in aggregate by care location and provider, allowing for real-time feedback to staff and creation of improvement plans. An unanticipated benefit was the identification and correction of charting inconsistencies. Results: Collection, aggregation, and analysis of bundle compliance data were displayed in a system dashboard, and data were refreshed nightly. This approach allowed us to display overall bundle compliance at the facility and system level, including a heat map showing each facility’s compliance with the bundle and each associated element. Utilization of an EMR dashboard allowed for performance review on 100% of eligible patients rather than a sample, as occurs with manual review and abstraction processes. Routine review of performance via the dashboards with frontline staff, clinical leaders, medical staff, and executives has resulted in month-by- month improvement in bundle compliance. Conclusions: Direct data mining, data aggregation and analysis, followed by direct feedback to frontline staff, has resulted in steady improvement in overall bundle compliance, compliance with individual bundle components, and standardization of charting in the EMR. This approach has ultimately resulted in better outcomes for sepsis patients, reduction in healthcare-associated pneumonia, and reduction in surgical site infections.Funding: NoneDisclosures: None
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Anisimov, A. Yu, A. I. Andreev, R. A. Ibragimov, A. A. Аnisimov, and I. A. Kalimullin. "Clinical and Anatomical Substantiation of Access to the Splenic and Left Renal Veins in the Operation of Distal Splenorenal Anastomosis." Russian Sklifosovsky Journal "Emergency Medical Care" 10, no. 2 (August 24, 2021): 293–302. http://dx.doi.org/10.23934/2223-9022-2021-10-2-293-302.

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Aim of study. Development in an anatomical experiment of a technique for operative access to the splenic and left renal veins during distal splenorenal bypass surgery with justification of the possibility of its successful application in clinical conditions.Material and methods. In the conditions of an anatomical experiment on 40 unfixed corpses of adults of both genders, objective volumetric and spatial indicators in surgical wounds were studied in two variants of exposure of retroperitoneal space vessels, as the first stage of distal splenorenal anastomosis. In clinical conditions in 40 patients with portal hypertension of various genesis, during the operation of distal splenorenal anastomosis, the wide exposure of the anterior surface of the pancreas, spleen, left renal veins and most of their branches was performed using the original method of partial left — sided medial visceral rotation, followed by an objective assessment of the volume-spatial parameters of access. Measurements were performed using a medical goniometer in relation to the mobilized areas of the left renal and splenic veins. Statistical processing of the study results was carried out using the method of variation statistics. To identify statistically significant differences, the Student’s t-test was used for disjoint samples.Results. An original method of operative access to the splenic and left renal veins was developed during the operation of distal splenorenal bypass by lifting the internal organs of the left flank of the abdominal cavity from the posterior abdominal wall and diverting them to the right. In the anatomical experiment in the original method of partial left-sided medial visceral rotation, all indicators were better (depth of the wound is less and the angles of operative activity and the inclination of the axis of operative activity — larger) than with a classic approach of intraoperative intraperitoneal access via transverse incision in the mesentery of the transverse colon. Despite the various variants of vascular architectonics and various anthropometric indicators of patients, there were no any forced refusal of distal splenorenal bypass surgery or unintentional damage to both the vessels themselves and the pancreas, specific complications associated with the implementation of the proposed operative approach to the vessels of the left retroperitoneal space, including damage to the spleen and ischemia of the descending colon, in any of 40 clinical cases.Conclusion. The suggested option of operative access to the splenic, left renal veins and their branches at the first stage of performing distal splenorenal anastomosis in patients with portal hypertension of various genesis provides convenient spatial relations in the operating wound; creates comfortable conditions for performing the main surgical technique — applying vascular anastomosis; has a minimal risk of developing specific complications associated with the approach to the vessels of the left retroperitoneal space.
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Naderi, Mandana, Kimberly Welker, Tina Pourshams-Manzouri, Vanthida Huang, and Amy Buros. "227. Evaluation of Empiric Vancomycin Utilization at 72 Hours Post Admission: is De-escalation of Vancomycin Appropriate?" Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S114—S115. http://dx.doi.org/10.1093/ofid/ofaa439.271.

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Abstract Background At both of our institutions in 2018, the average vancomycin days of therapy per 1,000 patient days was 112. The purpose of this study was to examine a 72-hour time-out as an effective de-escalation tool by evaluating the indication and clinical appropriateness of the continuation of empiric vancomycin therapy. Methods A retrospective chart review was performed from January 2018 to October 2018 at two community hospitals. Patients &gt; 18 years who received at least 3 days of empiric vancomycin therapy were included. Patients were excluded if immunocompromised, pregnant, on hemodialysis, received vancomycin for surgical prophylaxis, or expired within 72 hours of vancomycin initiation. Criteria for appropriate continuation of vancomycin at 3 days: positive culture for methicillin-resistant Staphylococcus aureus (MRSA), presence of infection with or without defined sources with systemic signs of infection (i.e. white blood cells &gt;12,000 cells/L or &lt; 5,000 cells/L and/or elevated temperature ≥ 37.5°C), or pending wound/sputum cultures after vancomycin initiation. Results A total of 160 adult patients initiated on vancomycin were analyzed; 118 of 160 (74%) met appropriate criteria. The most common indications for vancomycin were: skin and soft tissue infections (SSTI) 82 patients (51%); pneumonia 37 patients (23%); and positive blood culture 20 patients (13%). Risk factors for MRSA were similar between both groups. Forty-four (28%) patients had cultures pending and 23 patients (14%) had a known non-MRSA pathogen at time of assessment. American Indian race (OR 3.01 (1.21, 7.53) p-value= 0.0174) and SSTI indication (OR 2.87 (1.24, 6.80) p-value= 0.0147) were associated with not meeting appropriate criteria. Conclusion Approximately 25% of patients receiving empiric vancomycin therapy did not meet clinical criteria for continuation beyond 72 hours. The indication most commonly associated with continued vancomycin utilization was SSTI. These results identified indications in which empiric vancomycin prescribing can be optimized, and a 72-hour antibiotic time-out may be warranted as a stewardship intervention. Timely culture obtainment and intervention when another pathogen is identified are possible strategies to ensure success of 72-hour time-out. Disclosures All Authors: No reported disclosures
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Beam, Joel W. "Topical Silver for Infected Wounds." Journal of Athletic Training 44, no. 5 (September 1, 2009): 531–33. http://dx.doi.org/10.4085/1062-6050-44.5.531.

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Abstract Reference/Citation: Vermeulen H, van Hattem JM, Storm-Versloot MN, Ubbink DT. Topical silver for treating infected wounds. Cochrane Database Syst Rev. 2007(1);CD005486. Clinical Question: What is the clinical evidence base for silver dressings in the management of contaminated and infected acute and chronic wounds? Data Sources: Investigations were identified by Cochrane Wounds Group Specialized Register (2006), CENTRAL (2006), MEDLINE (2002–2006), EMBASE (2002–2006), CINAHL (2002–2006), and digital dissertations (2006) searches. Product manufacturers were contacted to identify additional eligible studies. The search terms included wound infection, surgical wound infection, ulcer, wound healing, and silver. Study Selection: Each study fulfilled the following criteria: (1) The study was a randomized controlled trial of human participants that compared dressings containing silver with any dressings without silver, dressings with other antiseptics, or dressings with different dosages of silver. (2) The participants were aged 18 years and older with contaminated and infected open wounds of any cause. (3) The study had to evaluate the effectiveness of the dressings using an objective measure of healing. No language or publication status restrictions were imposed, and participants could be recruited in any care setting. Studies were excluded if the wounds were ostomies (surgically formed passages). Data Extraction: Study quality assessment was conducted independently by 3 authors using the Dutch Institute for Health Care Improvement and Dutch Cochrane Centre protocols. Characteristics of the study, participants, interventions, and outcome measures were extracted by one author and verified by a second using a standard form. The principal outcome measure was healing (time to complete healing, rate of change in wound area and volume, number and proportion of wounds healed within trial period). Secondary measures were adverse events (eg, pain, maceration, erythema), dressing leakage, and wound odor. Based on the unique comparisons in the studies, a meta-analysis was not conducted. As a result, summary estimates of treatment effect were calculated for each outcome comparison. RevMan software (version 4.2; Cochrane Centre, Oxford, United Kingdom) was used for statistical analysis. Main Results: Specific search criteria identified 31 studies for review, of which 3 met the inclusion and exclusion criteria. Lack of randomization and absence of wound infections excluded the majority of studies from the review. In the 3 studies selected, silver-containing dressings were compared with nonsilver dressings and dressings with other antimicrobials. One group used a silver-containing foam dressing and a nonsilver foam dressing; another group used a silver-containing alginate and a nonsilver alginate; and a third group used a silver-containing foam and various dressings (nonsilver foams, alginates, hydrocolloids, and gauze and other antimicrobial dressings). Sample sizes ranged between 99 and 619 participants. Most of the wounds in the included studies were pressure, diabetic, and venous leg ulcers. Wound infection was subjectively defined by 1 group as the presence of 2 or more signs and symptoms (eg, continuous pain, erythema, heat, or moderate to high levels of exudate) and by the other 2 groups as signs of critical colonization (eg, delayed healing, increased pain and exudate levels, discoloration, and odor). The primary measure in the included studies was healing outcome. The 3 groups used various assessments of healing, including relative and absolute reduction in wound area and number of wounds healed during the trial period. The trial period in each study was 4 weeks. In the 3 trials, the authors randomized the participants to the treatment groups. Examining healing, one group (129 participants) compared Contreet silver foam (Coloplast A/S, Humlebaek, Denmark) with Allevyn foam (Smith & Nephew, St-Laurent, Quebec, Canada). The authors reported no differences for rates of complete healing (risk difference [RD] = 0.00, 95% confidence interval [CI] = −0.09, 0.09) and median wound area reduction (weighted mean difference [WMD] = −0.30 cm2, 95% CI = −2.92, 2.35). However, Contreet was favored over Allevyn (P = .034) for median relative reduction in wound area (WMD = −15.70 cm2, 95% CI = −29.5, −1.90). One group (99 participants) compared Silvercel silver alginate (Johnson & Johnson Wound Management, Somerville, NJ) with Algosteril alginate (Johnson & Johnson Wound Management). The authors found no differences in rates of complete healing (RD = 0.00, 95% CI = −0.06, 0.05), mean absolute (WMD = 4.50 cm2, 95% CI = −0.93, 9.93) and relative wound area reduction (WMD = −0.30 cm2, 95% CI = −17.08, 16.48), or healing rate per day (week 1 to 4) (WMD = 0.16 cm2, 95% CI = −0.03, 0.35). One group (619 participants) compared Contreet with various dressings (nonsilver foams, alginates, hydrocolloids, and gauze and other antimicrobial dressings). For median relative wound area reduction, the authors noted a superiority of Contreet over the various dressings (P = .0019). Examining secondary outcomes, 2 groups used subjective analysis to compare adverse reactions among the dressings. One group reported no difference between Contreet (in satellite ulcers, deterioration of periwound tissue) and Allevyn (in satellite ulcers, maceration, eczema) (RD = 0.02, 95% CI = −0.07, 0.12), and one group found no difference between Silvercel (in pain during dressing change, eczema, periwound erythema, maceration) and Algosteril (in pain during dressing change, eczema, erythema) (RD = −0.01, 95% CI = −0.12, 0.11). Two groups subjectively assessed leakage among silver and nonsilver dressings. The data from one group demonstrated superiority of Contreet over Allevyn (P = .002; RD = −0.30, 95% CI = −0.47, −0.13), and one group found Contreet better than various dressings (eg, nonsilver foams, alginates, hydrocolloids, and gauze, and other antimicrobial dressings) (P = .0005; RD = −0.11, 95% CI = −0.18, −0.05). Using a subjective 4-point scale, one group compared silver and nonsilver dressings and reported a difference favoring Contreet over Allevyn in terms of wound odor (P = .030; RD = −0.19, 95% CI = −0.36, −0.03). Conclusions: Overall, this review provides no clear evidence to support the use of silver-containing foam and alginate dressings in the management of infected chronic wounds for up to 4 weeks. However, the use of silver foam dressings resulted in a greater reduction in wound size and more effective control of leakage and odor than did use of nonsilver dressings. Randomized controlled trials using standardized outcome measures and longer follow-up periods are needed to determine the most appropriate dressing for contaminated and infected acute and chronic wounds.
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Kapolas, Christopher, Jane Kosirog-Glowacki, Kathryn L. Barney, Linda Advincula, Leonard M. Klein, Jacob D. Bitran, Shams Bufalino, and Tulio E. Rodriguez. "Risk Factors for the Development of Cardiac Arrhythmias during Hematopoietic Stem Cell Transplantation." Blood 132, Supplement 1 (November 29, 2018): 3387. http://dx.doi.org/10.1182/blood-2018-99-120189.

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Abstract Background: Approximately 9% to 27% of patients undergoing hematopoietic stem cell transplantation (HSCT) develop a cardiac arrhythmia (CA).[1] This complication correlates with longer length of stays, higher probability of ICU admission, and higher mortality compared to patients who do not develop CA. Moreover, post-transplant CA is associated with greater risk of death within a year of HSCT. Identification of predictive risk factors for CA in patients undergoing HSCT has been elusive. Traditional risk factors like male gender, smoking, hypertension, diabetes, hypercholesterolemia, or established coronary artery disease, have not been found to be predictive of pre or post-transplant CA in HSCT patients. Echocardiogram may help identifying patients at risk of post-surgical arrhythmias but this has not been the case in HSCT.[2] MUGA scan has not been able to identify patients at risk for developing cardiac events during HSCT either.[3] In view of the detrimental consequences associated with CA during HSCT and the lack of reliable predictive risk factors, we decided to analyze and identify potential risk factors for CA in patients transplanted at our institution. Objective: This study aims to determine risk factors for the development of CA in patients undergoing HSCT. Methodology: A retrospective analysis of 138 consecutive patients undergoing HSCT at our institution between January 1st, 2015 and December 31st, 2017 was performed. One patient was excluded due to lack of baseline EKG. Data from patients ≥ 18 y/o who underwent autologous or allogeneic HSCT was analyzed. Variables analyzed included: age, gender, ethnicity, prior HSCT, diagnosis, type of transplant (autologous vs allogeneic), prior anthracycline exposure, diabetes mellitus, chronic kidney disease, hypertension, coronary artery disease, congestive heart failure, hyperlipidemia, previous arrhythmias, amyloidosis, documented STEMI or NSTEMI, home medications continued during HSCT, prior cardiovascular procedures, left ventricular ejection fraction prior to HSCT, baseline QTc prior to HSCT, stem cell dose, conditioning regimen, graft-versus-host disease prophylaxis, number of prior acute kidney injuries using RIFLE criteria, documented infections, electrolyte abnormalities, and hemoglobin < 7.0 g/dL. Statistical Methods: The Statistical Analysis Software (SAS) System program V9.0 was used for analysis. To compare potential risk factors of categorized data by patients with a documented arrhythmia and patients without a documented arrhythmia, a univariate comparison was performed using chi-square or Fisher's Exact test. Variables that were collected and demonstrated, as per-patient means, were analyzed using a multivariable T Test linear regression. A difference in incidence of arrhythmias between variables with a P-value of < 0.05 were statistically significant. Results: 31 patients (23%) developed CA during their HSCT. The most common type was atrial fibrillation (n= 13; 42%). The incidence of CA was greater in patients with a diagnosis of Non-Hodgkin's Lymphoma (17/31; 54.8%) vs (7/106; 6.6%); (p < 0.001) and QTc greater than 500 msec at any time during transplantation (8/31; 25.8%) vs (6/106; 5.6%) (p= 0.0011). All other risk factors did not have an association with an increased risk of CA during HSCT. Mean length of hospital stay, incidence of ICU admission, and number of in-hospital deaths were not statistically different between groups. Conclusion: Our data suggests that a diagnosis of Non-Hodgkin's Lymphoma or QTc prolongation ≥ 500 msec at any time during HSCT may be risk factors for CA during HSCT. Our study has the limitation of being a single institution analysis however, most patients (70%) in this analysis were prospectively placed on cardiac telemetry making our assessment of the incidence of CA during HSCT reliably accurate. Prospective interventional studies are warrant. [1] Tonorezos, Emilys S; Stillwell, Elizabth E; Calloway, James J., et al., Bone Marrow Transplant. 2015 Sep; 50(9): 1212-1216. [2] Osranek M, Fatema K, Qaddoura F, et al. Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery: a prospective study. J Am Coll Cardiol. 2006;48(4):779-786. [3] Garcia I., Rodriguez T.E., Davis S., et al.; The Necessity of MUGA Scans to Detect Risks for Cardiac Toxicity in Patients Considered for Bone Marrow Transplantation. Tandem IBMTR/ASBMT Meeting; Orlando, FL 2002. Disclosures No relevant conflicts of interest to declare.
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Araujo, Maria Gala Santini, Nelly Carrasco, Pablo Sotelano, Ana Cecilia Parise, Leonardo Conti, and Daniel Villena. "Evans Osteotomy with Locked Plate with Wedge Block for Stage IIB Flat Foot." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0003. http://dx.doi.org/10.1177/2473011417s000353.

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Category: Hindfoot Introduction/Purpose: Elongation of the lateral column is indicated only in patients who have a flexible deformity Stage 2B of flat foot. The Evans osteotomy is performed 1.5 or 2 cm from the cuboideal calcaneal joint, and in many publications is maintained by different kind of devices. Our hypothesis is that Evans osteotomy, with blocked plates with a wedge block, without the use of bone graft, maintain the correction obtained at one year after surgery. The primary objective was to evaluate the radiological results at the postoperative year of the osteotomy Secondary objectives were to evaluate the persistence of the correction obtained between the 3 months and the year of the postoperative period and to evaluate the functional outcomes with AOFAS score. Methods: We studied a total of 12 patients, 14 feet. with stage 2 B flat foot, in all cases surgery was performed by the same specialist between March of 2011 and March of 2014 in the Service of foot and ankle of our institution. Inclusion criteria were: patients with type 2B flat foot, submitted to external column elongation, with plates blocked with a 6 to 10 mm wedge block, without the use of bone grafting, minimum follow-up of 1 year. Exclusion criteria: revision of previous surgery, another type of material used for elongation of the external column, neurological sequelae. The study was performed retrospectively through clinical records database, data collection and measurements were performed by 2 second-year Foot and ankle fellow trained in the same institution. Statistical analysis was performed with the T-student test. Results: A total of 12 patients / 14 feet were evaluated during the study period, with a diagnosis of flatfoot type 2B. The average age was 57 years (32-65 years), 11 (78.5%) were female. No statistically significant difference was observed in any of the radiographic variables measured, at 3 months and at 12 months postoperatively. The preoperative AOFAS score, was 54 points. At the first year was 93 points. Consolidation was achieved at 3 months in all cases. The complications found were 2 superficial infections and 1 wound dehiscence. As a late complication, there was only 1 case of cuboidal calcaneal osteoarthritis that did not require surgical resolution. Conclusion: Evans osteotomy for elongation of the external column provides a reproducible and reliable method to restore the normal functional stability of the midfoot and hindfoot. According to the results obtained in our work, we can conclude that the blocked plates with a wedge lock manage to preserve the corrections obtained with the Evans osteotomy in patients with type IIB flat foot. There is no need of autograft with the consequent risk of comorbidities produced by a second approach to the grafting as well as the complications that could happen with the use of allografts.
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Januleviciene, Ingrida. "Ophthalmology and mathematics: crossroad or scientific interface?" Modeling and Artificial Intelligence in Ophthalmology 1, no. 2 (December 15, 2016): 5–9. http://dx.doi.org/10.35119/maio.v1i2.39.

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The progress of science is discontinuous. However, accepting the dynamic nature of science, most of us have experienced the point of research crossroads when it was hard to choose the correct path. In 1962 Thomas Samuel Kuhn published his controversial book The Structure of Scientific Revolutions introducing the term “paradigm shift” raising the idea that progress isn't a continuous accumulation, but rather a revolutionary process where brand new ideas are adopted and old ideas are abandoned. Without trying to accept or argue philosphical aspects, today we experience a rapidly growing amount of research in ophthalmology. The goal of the current evidence-based approach in medicine is to optimize everyday clinical practice based on comprehensive research. However, results coming from the basic sciences sometimes may not be directly applicableto an individual patient. The latest developments, scientific achievements and research in ophthalmology steer to the exciting new perspective based on a multidisciplinary approach. Bringing together scientists whose expertise encompasses ophthalmology, physiology, mathematics, physics and engineering and who explore different aspects of the same problems empowering to make scientific progress. Can ophthalmologists think mathematically? Is it possible to provide a quantitative representation of the biophysical processes in the eye? Application of objective scientific methods and subjective perspectives can open up a wide range of educational and professional opportunities leading to a better understanding of the pathogenesis and the natural course of the disease, progression and new ways of treatment. Introducing the 2nd issue of Journal for Modeling in Ophthalmology, we hope the reader will enjoy both clinical and theoretical insights on glaucoma in short papers that followed the International Congress on Advanced Technologies and Treatments for Glaucoma (ICATTG15) held in Milan (Italy), October 29-31, 2015 (http://www.icatto.com/archive/icattg2015/). Normal tension glaucoma is a particularly difficult type of glaucoma both in terms of diagnosis and treatment. M. Iester pointed out that different types of glaucoma exist and are probably based on the presence of different risk factors. The cut-off value of 21 mmHg is not used anymore to differentiate healthy subjects from glaucoma patients. The paper by L. Quaranta et al analyses the rationale for IOP measurements throughout the 24-hour cycle. IOP is not a static number; rather, it exhibits time-dependent variations that can reach up to 6 mmHg over a 24-hour period in healthy eyes, and even more in eyes with glaucoma2-5. Regarding 24-hour IOP characteristics, only IOP peak was correlated to visual field progression, while 24-hour IOP fluctuation was not an independent risk factor6. Indeed, 24-hour mean, peak and fluctuation were all associated and a strong correlation was found between mean and peak IOP, and between fluctuation and peak IOP. Mean IOP is a strong predictor of glaucomatous damage. A desired therapeutic target is therefore a uniform reduction of IOP throughout the 24 hours. A reliable method of continuous IOP measurement would be desirable, making 24-hour IOP phasing easier and opening new pathways for research. Interestingly, the papers by M. Szopos M et al and A. Mauri et al lead to new perspectives of mathematical modeling of aqueous humor flow and intraocular pressure towards individualized glaucoma management. M. Szopos et al aimed to provide both a qualitative description and a quantitative assessment of how variations in aqueous humor flow parameters influence IOP and the outcome of IOP lowering medications. They developed a mathematical model that described the steady state value of IOP as the result of the balance between aqueous humor production and drainage and performing stochastic simulations to assess the influence of different factors on the IOP distribution in ocular normotensive and ocular hypertensive subjects and also on the IOP reduction following medications. This model may help identify patient specific factors that influence the efficacy of IOP lowering medications and aid the development of novel, effective, and individualized therapeutic approaches to glaucoma management. A. Mauri et al. theoretically analyzed new aspects of electro-fluid dynamics of aqueous humor production. The connection between HCO3, Na+ and topical medications in the regulation of aqueous humor production is still controversial and difficult to study experimentally by trying to isolate the role of a single electrolyte in regulating aqueous humor production. The use of a mathematical model appeared to be a promising approach to help unravel such a connection through simulation and comparison of different predicted scenarios. Groups of authors from Indianapolis and Milan universities contributed to glaucoma progression analysis. K. Hutchins et al paper on clinical evaluation of baseline characteristics predictive of structural and functional progression in open angle glaucoma patients with different demographic characteristics aimed to examine ocular blood flow parameters that may predict structural and functional disease progression in open angle glaucoma patients of different diabetic status, gender, ethnicity, and body mass index. D. Messenio et al. evaluated the variations of IOP, morphometric papillary characteristics, perimetric indices and electrophysiological parameters before and after topical IOP lowering therapy in patients with suspect normal tension glaucoma. They showed that electrophysiological tests could provide a more sensitive measure of retinal ganglion cell integrity and help distinguish between suspect normal-pressure glaucoma patients before perimetric alterations are evident and normal subjects with apparent larger disc cupping. Over the past decades, color Doppler imaging (CDI) has gained popularity as a reliable tool to measure blood flow in a variety of vascular beds throughout the body. The use of CDI to measure blood flow parameters in retrobulbar vessels has become very common. L. Carichino et al introduced a computer-aided identification of novel ophthalmic artery waveform parameters. The computed-aided analysis of ophthalmic artery velocity waveforms obtained via CDI were able to distinguish arterial waveform parameters values between healthy subjects and glaucoma patients, as well as between gender. Authors foresee further studies investigating the potential to predict severity and progression of glaucoma. An interesting contribution by S. Cassani et al on theoretical predictions of metabolic flow regulation in the retina aims to better understand the regulating mechanisms in health and disease. This study used a theoretical model to investigate the response of retinal blood flow to changes in tissue oxygen demand. The increase in blood flow predicted by the model due to an increase in oxygen demand was not in the same proportion as the change in blood flow observed with the same decrease in oxygen demand, suggesting that vascular regulatory mechanisms may respond differently to different levels of oxygen demand. Several studies have suggested an association between vascular factors and glaucoma7-11. Several epidemiological studies demonstrated the influence of ocular perfusion pressure on the prevalence, incidence and progression of glaucoma12. Ocular perfusion pressure refers to the pressure available to drive blood through the intraocular vasculature, with the degree of perfusion being influenced by the resistance to flow, which is a function of the vessel caliber or the vessel tone 13. While it seems a very complex parameter, A. Guglielmi et al utilized statistical techniques and analysis to show that it is the joint effect of IOP, ocular perfusion pressure and blood pressure, or, more precisely, of all the covariates in the selected logistic model, that determines the probability of disease, rather than the value of an individual covariate. Importantly, the main statistical interest should be the prediction of disease probabilities for new patients entering the study, presenting specific values of the covariates included in the model, rather than the estimated individual effect of a single predictor. It has been shown that glaucoma, proliferative vitreoretinopathy, posterior capsule opacification, diabetic retinopathy, age-related macular degeneration, pterygium and keratoconus have been associated with modulation of Transforming Growth Factor beta (TGF-β) protein expression14-20. Therapeutic intervention targeting TGF-β2 protein expression may have multifold effects on relevant intraocular tissues such as trabecular meshwork (cell invasion/migration), retina (scarring and wound-healing processes) and/or optic nerve head (neuroprotection), and warrant further evaluation in patients suffering advanced glaucoma and undergoing trabeculectomy. Hasenbach K et al. used a murine model of glaucoma filtration surgery to evaluate the effect of intraocular ISTH0036 administration. They showed that treatment with ISTH0036 resulted in prolonged bleb survival and decreased scarring (downregulation of collagen 1 and 3 fibers) in a murine glaucoma filtration surgery model. Initial results rose a strong rationale that patients with glaucoma or other ocular diseases may benefit from treatment with TGF-β2 antisense oligonucleotides. D.Paulaviciute-Baikstiene et al. performed a prospective 12 month study aiming to find the correlation between anterior segment OCT and functional outcomes of trabeculectomy by describing morphological features of successful and limited success filtering blebs. The detection of early postoperative scarring and the continuing development of surgical measures to reduce this risk represent a major challenge of filtering surgery. Authors suggest that larger internal fluid filled cavity, total bleb height, bigger bleb wall thickness and multiform bleb wall reflectivity are good indicators of successful bleb function. The 2nd Issue of the Journal for Modeling in Ophthalmology uniquely combines and balances clinical and mathematical aspects in the study of glaucoma and we believe that both ophthalmologists and modeling experts will find in it interesting aspects and new information on glaucoma and its risk factors. Enjoy your reading!
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49

Leung, P., E. Lester, A. G. Doumouras, A. G. Doumouras, F. Saleh, S. Bennett, C. Fulton, et al. "2015 Canadian Surgery Forum02 The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks03 The association of change in body mass index and health-related quality of life in severely obese patients04 Inpatient cost of bariatric surgery within a regionalized centre of excellence system05 Regional variations in the public delivery of bariatric surgery: an evaluation of the centre of excellence model06 The effect of distance on short-term outcomes after bariatric surgery07 The role of preoperative upper endoscopy in bariatric surgery: a systematic review08 Outcomes of a dedicated bariatric revision surgery clinic10 Quality of follow-up: a systematic review of the research in bariatric surgery14 Bariatric surgery improves weight loss and cardiovascular disease compared with medical management alone: an Alberta multi-institutional early outcomes study16 Diabetic control after laparoscopic gastric bypass and sleeve gastrectomy: a short-term prospective study17 Knowledge and perception of bariatric surgery among primary care physicians: a survey of family doctors in Ontario19 Is early discharge of patients post laparoscopic sleeve gastrectomy safe?22 A comparison of outcomes between bariatric centres of excellence within Ontario02 Closure methods for laparotomy incisions: a cochrane review03 Closing the audit cycle: Are we consenting correctly now?05 Regional variation in the use of surgery in Ontario06 Quitting general surgery residency: attitudes and factors in Canada07 Nipple-sparing mastectomy: utility of intraoperative frozen section analysis of retroareolar tissue08 Withdrawn09 Reliable assessment of operative performance10 Video assessment as a method of assessing surgical competence: the difference in video-rating skills after 4 years of residency11 Burnout among academic surgeons13 Increased health services use by severely obese patients undergoing emergency surgery: a retrospective cohort study14 Novel models for advanced laparoscopic suturing: taking it to the next level16 Pectoral nerve block in breast and axillary surgery17 Predictors for positive resection margins in gastric adenocarcinoma: a population-based analysis18 Predictors of malignancy in thyroid nodules19 Safety and efficacy of POEM for treatment of achalasia: a systematic review of the literature20 Informed consent for surgery21 Meconium ileus: 20 years of experience22 Paraesophageal hernia repair in the elderly: outcomes in a 10-year retrospective study23 The changing face of breast cancer: younger age and aggressive disease in Filipino Canadians24 A systematic review of intraoperative blood loss estimation methods for major noncardiac surgery: a 50-year perspective25 The AVATAR trial: applying vacuum to accomplish reduced wound infections in laparoscopic pediatric surgery27 Indications for use of damage control surgery in civilian trauma patients: a content analysis and expert appropriateness rating study28 Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: a content analysis and expert appropriateness rating study29 The impact of health care contact and invasive procedures on Staphylococcus aureus bacteremia: a 5-year retrospective cohort study30 Acute care surgery — positive impact on gallstone pancreatitis31 Safety and efficacy of a step-up approach to management of severe, refractory Clostridium difficile infection32 Clinical and operative outcome of patients with acute cholecystitis who are treated initially with image-guided cholecystostomy34 Assessment of preoperative carbohydrate loading and blood glucose concentration in patients with diabetes35 Impact of pre-emptive lidocaine infiltration at trocar sites (PLITS) and intraoperative ketorolac administration on postoperative pain and narcotics consumption after endocholecystectomy: a randomized-controlled trial36 Expert intraoperative judgment and decision-making: defining the cognitive competencies for safe laparoscopic cholecystectomy37 Teaching clinical anatomy to postgraduate surgical trainees38 Investigating the role of TNFR1 in gastric adenocarcinoma peritoneal metastasis39 Selective outcome reporting and publication biases in surgical randomized controlled trials40 Definitive percutaneous management of symptomatic cholelithiasis41 Peer-based coaching: an innovative method to teach faculty an advanced laparoscopic technique42 Improving teaching and learning in the operating room: Does the surgical procedure feedback rubric support learning?43 Withdrawn44 Mislabelling study designs as case–control in surgical literature45 Measured resting energy expenditure in patients with open abdomens: preliminary data of a prospective pilot study46 Open abdomen management and primary abdominal closure in a surgical abdominal sepsis cohort: a retrospective review47 The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: a systematic review49 Program directors and trainees attitudes toward the introduction of multi-source feedback as part of surgical residents’ formative assessment process at the University of Calgary: a qualitative study50 Outcomes associated with alternate blunt cerebrovascular injury detection strategies in major trauma patients: a systematic review and meta-analysis51 Assessing the effect of preoperative nutrition on the surgical recovery of elderly patients53 Why is the percentage of medical students selecting a general surgery career different between Canadian medical schools?54 Colorectal cancer patient perspectives of preoperative repeat endoscopy: a qualitative study55 Staphylococcus aureus bacteremia in a pediatric population: a retrospective study in a tertiary-care referral centre56 The impact of postoperative complications on the recovery of elderly surgical patients57 Withdrawn58 The economics of recovery after pancreatic surgery: detailed cost minimization analysis of a postoperative clinical pathway for patients undergoing pancreaticoduodenectomy59 2015 CJS Editor’s Choice Award Recipient: Achalasia-specific quality of life after pneumatic dilation and laparoscopic Heller myotomy with partial fundoplication: a randomized clinical trial60 NSAID use is associated with an increased risk of anastomotic leak after colorectal surgery: results of a frequentist and Bayesian meta-analysis61 Miracles for babies with abnormal lungs: the story of miR-10a and lung development62 Investigating hospital readmissions and unplanned ED visits following general surgical procedures at a tertiary care centre63 Remote FLS testing: ready for prime time64 Contrast blush (CB) significance on computed tomography (CT) and correlation with noninterventional management (NIM) failure for blunt splenic injury (BSI) in children65 Bridging the gap on the surgical ward: enhancing resident–nurse communication through a CUSP pilot project66 A prospective interim analysis of microbiological gene expression profile of Staphyloccocus aureus bacteremia and its clinical implications67 Outcomes of selective nonoperative management of civilian abdominal gunshot wounds: a systematic review and meta-analysis68 Does rater training improve the reliability of surgical skill assessments? A randomized control trial69 Parallel or divergent? The evolution of emergency general surgery service delivery at 3 Canadian teaching hospitals70 Surgeon satisfaction in the era of dedicated emergency general surgery services: a multicentre study74 Withdrawn76 Timing of cholecystectomy after gallstone pancreatitis: Are we meeting the standards?77 Management of traumatic occult hemothorax, a survey of trauma providers in Canada78 Withdrawn01 Extent of lymph node involvement after esophagectomy with extended lymphadenectomy for esophageal adenocarcinoma predicts recurrence: a large North American cohort study02 A randomized comparison of electronic versus handwritten daily notes in thoracic surgery03 Is tissue still the issue? Lobectomy for suspected lung nodules without preoperative or intraoperative confirmation of malignancy04 Incidence of pulmonary embolism and deep vein thrombosis following major lung resection: a prospective multicentre incidence study05 Venous thromboembolism (VTE) prophylaxis in thoracic surgery: a Canadian national delphi consensus survey06 Preoperative chemoradiation therapy v. chemotherapy in patients undergoing modified en bloc esophagectomy for locally advanced esohageal adenocarcinoma: Does radiation add value?07 Comparative outcomes following tracheal resection for benign versus malignant conditions08 Combined clinical staging for resectable lung cancer: clinicopathological correlations and the role of brain MRI10 A retrospective cohort evaluation of non–small cell lung cancer recurrence detection11 Health-related quality of life measure distinguishes between low and high T stages in esophageal cancer12 Transition from multiport to single-port anatomic lung resection is feasible13 Survival rates in patients with N3 esophageal adenocarcinoma treated with neoadjuvant chemotherapy and esophagectomy with en-bloc lymphadenectomy14 Impact of a dedicated outpatient clinic on the management of malignant pleural effusions16 Has the quality of reporting of randomized controlled trials in thoracic surgery improved?17 Clinical features distinguishing malignant from benign esophageal diagnoses in patients referred to an esophageal diagnostic assessment program18 Concordance with invasive mediastinal staging guidelines19 Current lung-protective ventilation strategies may not be protective during one-lung ventilation surgery20 National practice variation in pneumonectomy perioperative care — results from a survey of the Canadian Association of Thoracic Surgeons21 Outcomes after multimodal treatment of esophagogastric neuroendocrine carcinoma: Is there a role for resection?22 Clinical results of treatment for isolated axillary and plantar hyperhidrosis: a single centre experience23 The role of pneumonectomy after neoadjuvant chemotherapy for N2 non–small cell lung cancer24 Time delays in the management of non–small cell lung cancer: a comparison between high-volume designated and low-volume community hospitals25 Regionalization and outcomes of lung cancer surgery in Ontario, Canada26 Robotic pulmonary resection for lung cancer: the first Canadian series01 The effect of early postoperative nonsteroidal anti-inflammatory drugs on pancreatic fistula following pancreaticoduodenectomy02 Laparoscopic ultrasound still has a role in the staging of pancreatic cancer: a systematic review of the literature03 Impact of portal vein embolization on morbidity and mortality of major liver resection in patients with colorectal metastases: experience of a small single tertiary care centre04 A decision model and cost analysis of intraoperative cell salvage during hepatic resection05 The impact of portal pedicle clamping on survival from colorectal liver metastases in the contemporary era of liver resection: a matched cohort study06 Clinical and pathological features of intraductal papillary neoplasms of the biliary tract and gallbladder07 International practice patterns among ALPPS surgeons: Do we need a consensus?08 Omental flaps to protect pancreaticojejunostomy in pancreatoduodenectomy11 Preoperative diagnostic angiogram and endovascular aortic stent placement for appleby resection candidates: a novel surgical technique in the management of locally advanced pancreatic cancer12 Recurrence following initial hepatectomy for colorectal liver metastases: a multi-institutional analysis of patterns, prognostic factors and impact on survival13 The influence of the multidisciplinary cancer conference era on the management of colorectal liver metastases14 Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy15 How does simultaneous resection of colorectal liver metastases impact chemotherapy administration?16 Preoperative liver volumetry for surgical planning: a systematic review and evaluation of current modalities17 Surgical planning of hepatic metastasectomy using radiologist performed intraoperative ultrasound21 Surgical resection and perioperative chemotherapy for colorectal cancer liver metastases: a population-based study22 Management and outcome of colorectal cancer (CRC) liver metastases in the elderly: a population-based study23 Outcomes following repeat hepatic resection for recurrent metastatic colorectal cancer: a population-based study24 A clinical pathway after pancreaticoduodenectomy standardizes postoperative care and may decrease postoperative complications25 Significance of regional lymph node involvement in patients undergoing liver resection and lymphadenectomy for colorectal cancer metastases26 NSAID use and risk of postoperative pancreatic fistulas following pancreaticoduodenectomy: a retrospective cohort study27 Minimally invasive HPB surgery in Canada: What are we doing and do we want to do more?28 2015 CJS Editor’s Choice Award Recipient: Predictors of actual survival in resected pancreatic adenocarcinoma: a population-level analysis29 Predictors of receipt of adjuvant therapy following pancreatic adenocarcinoma resection: a population-based analysis30 Effect of surgical wait time on oncological outcomes in periampullary cancer31 Does surgical assist expertise affect resectability in periampullary malignancies?32 The impact of tranexamic acid on fibrinolytic activity during major liver resection33 Colorectal cancer with synchronous hepatic metastases: a national survey of opinions on treatment sequencing and multidisciplinary cooperation34 Outcomes associated with a matched series of patients undergoing sequential resections of colorectal cancer and hepatic metastases compared with synchronous surgical therapy of the primary and hepatic metastases35 The impact of anesthetic inhalational agent on short-term outcomes after liver resection38 The impact of perioperative blood transfusions on posthepatectomy short-term outcomes: an analysis from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)39 Associations between pancreatic cancer quality indicators and outcomes in Nova Scotia40 Developing a national quality agenda in hepato-pancreato-biliary surgery: key priority areas for study02 Withdrawn03 Histological features and clinical implications of polypropylene degradation04 A rare case of primary hernia of the perineum05 Migration of polypropylene mesh in the development of late complications06 Laparoscopic hernia repair — Has this procedure run its course?07 Mesh materials used for hernia repair: Why do they shrink?08 The role of pure tissue repairs in a tailored concept for inguinal hernia repair09 Recurrent inguinal hernias a persistent problem in hernia surgery: analysis of 14 640 recurrent cases in the German hernia database, Herniamed10 Open circular intra-abdominal ventral herniorrhaphy: a new technique in ventral hernia repair01 Misrepresentation or “spin” is common in robotic colorectal surgical studies02 Postoperative pelvic sepsis rates following complete pathologic response to neoadjuvant therapy in rectal cancer03 Understanding the complexities of shared decision-making in cancer: a qualitative study of the perspectives of patients undergoing colorectal surgery04 Impact of hospital volume on quality indices for rectal cancer surgery in British Columbia, Canada07 The effect of laparoscopy on inpatient cost after elective colectomy for colon cancer08 Predictors of variation in neighbourhood access to laparoscopic colectomy for colon cancer09 Predictors of 30-day readmission after elective colectomy for colon cancer10 Neutrophil-to-lymphocyte ratio predicts major perioperative complications in patients with colorectal cancer12 Sessile serrated adenoma (SSA) detection-predictive factors13 Diverticular abscess managed with long-term definitive nonoperative intent is safe14 Long-term outcomes of conservative management following successful nonoperative treatment of acute diverticulitis with abscess: a systematic review15 Incidence of ischemic colitis after abdominal aortic aneurysm repair: results from the national surgical quality improvement program database16 Sigmoid colectomy for acute diverticulitis in immunosuppressed v. immunocompetent patients: outcomes from the ACS-NSQIP database17 A cross-sectional survey of health and quality of life of patients awaiting colorectal surgery in Canada19 Self-expanding metal stents versus emergent surgery in acute malignant large bowel obstruction20 Combined laparoscopic and TAMIS LAR in a morbidly obese patient after open right hepatectomy21 Safety and feasibility of laparoscopic rectal cancer resection in morbidly obese patients22 Factors associated with morbidity following sacral neurostimulation for fecal incontinence: beware of the high risk groups23 Hyperglycemia increases surgical site infections following colorectal resections for malignancy in a standardized patient cohort24 Implementing an enhanced recovery program after colorectal surgery in elderly patients: Is it feasible?25 From laparoscopic-assisted to total laparoscopic right colectomy with intracorporeal anastomosis: Is the shift in technique justified?26 Surgical site infection rates following implementation of a “colorectal closure bundle” in elective colorectal surgeries27 Quality of life and anorectal function of rectal cancer patients in long-term recovery28 Combined laparoscopic/transanal endoscopic microsurgery approach to radical resection for rectal tumours29 Transanal endoscopic microsurgery resection of rectal neuroendocrine tumours: a single centre Canadian experience30 Abdominoperineal reconstruction with a myocutaneous flap32 Comparison of robotic and laparoscopic colorectal surgery with respect to 30-day perioperative morbidity33 Definitive management of fistula-in-ano using draining setons35 Oncologic outcomes following complete pathologic response to neoadjuvant therapy in rectal cancer36 Laparoscopic total mesorectal excision in obese patients with rectal cancer: What is the oncological impact?38 Improving the enhanced recovery programs in laparoscopic colectomy: liposomal bupivacaine may not be the answer39 Fistulae related to colonic diverticular disease: a single institution experience41 Laparoscopic colectomy for malignancy provides similar pathologic outcomes and improved survival outcomes compared with open approaches42 MRI utilization and completeness of reporting in rectal cancer: a population-based study43 Supporting quality assurance initiatives for rectal cancer: Is the CAP protocol enough?44 Accuracy and predictive ability of preoperative MRI for rectal adenocarcinoma: room for improvement47 A population-based study of colorectal cancer in patients ≤ 40: Does the extent of resection affect outcomes?48 Transanal minimally invasive surgery (TAMIS) for rectal neoplasms01 The impact of blood transfusion on perioperative outcomes following resection of gastric cancer: an analysis of the ACS-NSQIP02 Association of wait time to surgical management with overall survival in Ontarians with melanoma04 General surgeons’ attitudes toward breast reconstruction in the province of Quebec06 Neoadjuvant chemotherapy for breast cancer: Is practice changing? A population-based review of current surgical trends07 Robotic versus laparoscopic versus open gastrectomy for gastric adenocarcinoma15 Influence of preoperative MRI on the surgical management of breast cancer patients17 Adverse events related to lymph node dissection for cutaneous melanoma: a systematic review and meta-analysis19 Regional variations in survival, case volume and intraoperative margin assessment in resected gastric cancer20 Comparison of clinical and economic outcomes between robotic, laparoscopic and open rectal cancer surgery: early experience at a tertiary care centre21 Outcomes and clinicopathologic features of patients with Angiosarcoma of the breast23 Postmastectomy radiation: Should subtype factor in to the decision?24 Omission of axillary staging in elderly patients with early stage breast cancer impacts regional control but not survival: a systematic review and meta-analysis25 Objective pathological assessment of CRCLM by MALDI26 Identification of predictive tumour markers in breast cancer tissue — a pilot study research plan27 Reframing women’s risk: counselling on contralateral prophylactic mastectomy in non–high risk women with early breast cancer28 Withdrawn30 Comparison of different methods of immediate breast reconstructions for breast cancer patients: Is “single stage” really better?32 Is lymph node ratio a more accurate prognostic factor in stage III colon cancer than standard nodal staging?33 Costs associated with reoperation in the setting of attempted breast-conserving surgery: a decision analysis34 Polo-like kinase 4 (Plk4) activates Cdc42, stimulates cell invasion and enhances cancer progression in vivo35 Negative predictive value of preoperative abdominal CT in determining gastric cancer resectability on a population level36 2015 CJS Editor’s Choice Award Recipient: (18)F-fluoroazomycin arabinoside positron emission tomography (FAZA-PET) imaging predicts response to chemoradiation and evofosfamide (TH-302) in a preclinical xenograft model of rectal cancer37 Impact of a regional guideline on the surgical treatment of the axilla in patients with breast cancer: a population-based study39 Recent trends in port-site metastasis following laparoscopic resection of gallbladder cancer: a systematic review40 Real-time electromagnetic navigation for breast tumour resection: pilot study on palpable tumours41 Neoadjuvant imatinib for primary gastrointestinal stromal tumour (GIST): mutational status and timing of resection42 Adherence to osteoporosis screening guidelines in seniors with breast cancer treated with anti-estrogen therapy: a population-based study43 Automated robot interventions for enhanced clinical outcomes in breast biopsy44 Preoperative pregabalin or gabapentin for postoperative acute and chronic pain among patients undergoing breast cancer surgery: a systematic review and meta-analysis of randomized controlled trials46 Uptake and impact of synoptic reporting on breast cancer operative reports in a community care setting47 Withdrawn." Canadian Journal of Surgery 58, no. 4 Suppl 2 (August 2015): S169—S238. http://dx.doi.org/10.1503/cjs.008615.

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50

Sinsinwar, Dr Dhan Singh, and Dr Ravi Gupta. "LOWER SEGMENT CESARIAN SECTION SURGICAL SITE INFECTION: RISK FACTOR AND MICROBIAL ETIOLOGY." International Journal of Medical and Biomedical Studies 3, no. 2 (February 27, 2019). http://dx.doi.org/10.32553/ijmbs.v3i2.608.

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Abstract:
INTRODUCTION: Lower Segment Cesarean Section (LSCS) delivery is a major obstetrical surgical procedure to save the lives of mothers and foetus. Surgical site infections (SSI) are the most common reason about 20% to be unplanned admitted after discharging of the patient to their home. Various risk factors in SSI following LSCS has been identified which includes subcutaneous hematoma, subcutaneous hematoma, tobacco use in pregnancy, incision length > 16.6 cm , body mass index >30 or 35 kg/m2, prolonged second stage (compared with first stage) , no antibiotic prophylaxis, duration of labour >12 h , premature rupture of membranes , gestational diabetes, previous cesarean delivery and emergency delivery. MATERIAL AND METHODS: A total of 646 patients were included in the study of which 27 were diagnosed as SSI. Risk factor for SSI was divided into three categories: 1) host-related factors, 2) pregnancy and intrapartum-related factors, and 3) procedure-related factors. Purulent discharge was obtained from the surgical incision site 48 hours postoperatively with sterile disposable swabs. Blood sample for blood culture was collected when the possibility of septicemia or bacteremia as suggested by the presence of fever, shock, or other signs and symptoms of sepsis associated with the surgical wound. The bacterial isolates obtained were identified as per standard identification procedures in time microbiology laboratory. Antibiotic susceptibility of the organisms done as per protocol. RESULTS: A total of 646 patients were included in the study of which 94 (14.55%) were diagnosed as SSI. mean age of patients who underwent LSCS was 24± 4.57 years. Of the 646 patients in 18 - 20 years 125 (19.3%),21-25 years 304 (47.1%), 26-30 years 189 (29.3%) and in > 30 years age group 28 (4.3%) cases were observed, of the total 94 SSI cases 11 (8.8%) were in the age group if 18 - 20 years, 39 (12.8%) were in the age group of 21-25 years, 32 (16.9%) were in 26-30 years age group and 12 (42.9%) were in the > 30 years age group. Acinetobacter spies was the commonest isolate 29(30.9%) followed by staphylococcus aureus 22 (23.4%), Escherichia coli 21 (22.3%) and Klebsiellapneumoniae. premature rupture of membrane (PROM), antibiotics given earlier than 2 hours and increased duration of stay in the hospital were found to be statistically significant. It was interpreted that PROM > 24 hrs is likely to increase the chances of infection. As the duration of hospital stay increases by 1 day, the chances of infection increase. CONCLUSION: Identification, management and proper assessment of risk factors are necessary to in reduction of SSI rates. Premature rupture of membrane (PROM), antibiotics given earlier than 2 hours, BMI >25 and increased duration of stay in the hospital were associated with increased SSI rate.
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