40. Surgical Site Infection in Spinal Metastasis - Risk Factor and Countermeasure

A retrospective review (phase 1) and prospective clinical study (phase 2). To identify independent risk factors for surgical site infection (SSI) and to evaluate the positive effect of prostaglandin E1 (PGE1) to decrease the risk of SSI in patients with spinal metastasis. Surgery for spinal metastasis is associated with an increased risk of SSI. Although previous reports have evaluated risk factors of SSI for spinal metastasis, most of the studies lack multivariate analysis. A recent study demonstrated the utility of PGE1 in decreasing wound complications in patients with prior irradiation. The role of PGE1 in surgery for spinal metastasis has not been previously evaluated. One hundred ten patients with spinal metastasis were retrospectively reviewed (phase 1). Risk factors for SSI were analyzed using logistic regression. Phase 2 was a prospective clinical trial investigating the utility of PGE1 at reducing the rate of SSI. Ninety-four patients with spinal metastasis were treated at our institute. The infection rate and risk factors identified in phase 1 and 2 were compared. The rate of SSI during phase 1 was 7.1%. Independent risk factors identified by multivariate logistic regression were diabetes, and preoperative irradiation. The rate of SSI for patients who had irradiation before surgery was 32%, whereas the rate for patients without irradiation was 1.1%. This difference was statistically significant. The rate of SSI in phase 2 was 3.1%. In phase 2 patients who received preoperative irradiation, the rate of SSI was 4.5%. The difference between phase 1 and phase 2 was statistically significant. This study identified diabetes and preoperative irradiation to be independent risk factors for SSI in patients with spinal metastasis. PGE1 administration was found to significantly decrease the incidence of SSI in patients with spinal metastasis who underwent preoperative irradiation.

308. Surgical site infection after lumbar fusion surgery: risk factors and the preventive new technology

The risk factors for surgical site infection (SSI) after HPB surgery are poorly defined. This meta-analysis aimed to quantify the SSI rates and risk factors for SSI after pancreas and liver resection. The PUBMED, MEDLINE and EMBASE databases were systematically searched using the PRISMA framework. The primary outcome measure was pooled SSI rates. The secondary outcome measure was risk factor profile determination for SSI. The overall rate of SSI after pancreatic and liver resection was 25.1 and 10.4%, respectively (p < 0.001). 32% of pancreaticoduodenectomies developed SSI vs 23% after distal pancreatectomy (p < 0.001). The rate of incisional SSI in the pancreatic group was 9% and organ/space SSI 16.5%. Biliary resection during liver surgery was a risk factor for SSI (25.0 vs 15.7%, p = 0.002). After liver resection, the incisional SSI rate was 7.6% and the organ space SSI rate was 10.2%. Pancreas-specific SSI risk factors were pre-operative biliary drainage (p < 0.001), chemotherapy (p < 0.001) and radiotherapy (p = 0.007). Liver-specific SSI risk factors were smoking (p = 0.046), low albumin (p < 0.001) and significant blood loss (p < 0.001). The rate of organ/space SSI in patients with POPF was 47.7% and in patients without POPF 7.3% (p < 0.001). Organ/space SSI rate was 43% in patients with bile leak and 10% in those without (p < 0.001). The risk factors for SSI following pancreatic and liver resections are distinct from each other, with higher SSI rates after pancreatic resection. Pancreaticoduodenectomy has increased risk of SSI compared to distal pancreatectomy. Similarly, biliary resections during liver surgery increase the rates of SSI.

The specific risk factors for surgical site infection (SSI) in orthopaedic oncology patients undergoing endoprosthetic reconstruction have not previously been evaluated in a large prospective cohort. In the current study, we aimed to define patient- and procedure-specific risk factors for SSI in patients who underwent surgical excision and endoprosthetic reconstruction for lower-extremity bone or soft-tissue tumors using the prospectively collected data of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. PARITY was a multicenter, blinded, randomized controlled trial with a parallel 2-arm design that aimed to determine the effect of a long duration (5 days) versus short duration (24 hours) of postoperative prophylactic antibiotics on the rate of SSI in patients undergoing surgical excision and endoprosthetic reconstruction of the femur or tibia. In this secondary analysis of the PARITY data, a multivariate Cox proportional hazards regression model was constructed to explore predictors of SSI within 1 year postoperatively. A total of 96 (15.9%) of the 604 patients experienced an SSI. Of the 23 variables analyzed in the univariate analysis, 4 variables achieved significance: preoperative diagnosis, operative time, volume of muscle excised, and hospital length of stay (LOS). However, only hospital LOS was found to be independently predictive of SSI in the multivariate regression analysis (hazard ratio per day = 1.03; 95% confidence interval = 1.01 to 1.05; p < 0.001). An omnibus test of model coefficients demonstrated that the model showed significant improvement over the null model (χ2 = 78.04; p < 0.001). No multicollinearity was found. This secondary analysis of the PARITY study data found that the only independent risk factor for SSI on multivariate analysis was hospital LOS. It may therefore be reasonable for clinicians to consider streamlined discharge plans for orthopaedic oncology patients to potentially reduce the risk of SSI. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

It is generally believed that the accompanying conditions in patients with inflammatory bowel disease (IBD) are associated with a high incidence of surgical site infection (SSI), and sometimes these patients are classified as compromised hosts without definitive clinical evidence. The aim of this study was to clarify the impact of IBD on the occurrence and features of SSI in patients with clean-contaminated wounds. We conducted prospective SSI surveillance of 580 patients with clean-contaminated wounds who underwent surgery between March 2006 and December 2007 using the National Nosocomial Infection Surveillance system. Multivariate analyses using stepwise logistic regression were performed to determine risk factors for SSI. A total of 562 patients with clean-contaminated wounds who underwent surgery for IBD [ulcerative colitis (UC), n = 173; Crohn's disease (CD), n = 122] or colorectal cancer [(CA), n = 267] were identified for evaluation. SSI was observed in 12.6% of all patients and there was no significant difference in infection rate by type of disease (UC, 14.5%; CD, 13.9%; CA, 10.9%). Multivariate logistic regression analysis yielded an ASA score > or =3 [odds ratio (OR) = 2.04; 95% confidence interval (CI) = 1.06-3.93] and rectal surgery (OR = 2.35; 95% CI = 1.28-4.31) as independent risk factors for SSI. IBD surgery was not an independent risk factor for overall SSI (OR = 1.62; 95% CI = 0.94-2.80). However, there was a significant difference in the incidence of incisional SSI [IBD, 11.9% (UC, 12.7%; CD, 10.7%); CA, 4.9%, p = 0.003]. In the analysis of rectal surgery, the incidence of incisional SSI was 5.3% in CA patients, 12.0% in UC patients, and 26.3% in CD patients. In contrast to overall SSI data, IBD surgery was found to be an independent risk factor for incisional SSI (OR = 2.59; 95% CI = 1.34-5.03). In patients of surgery restricted to clean-contaminated wounds, IBD was shown to be an independent risk factor for incisional SSI. With the use of proper operative procedures and techniques, the incidence of organ/space SSI should not be high in patients who undergo an uncomplicated IBD surgical procedure.

Surgical site infection (SSI) is the most common complication following surgical procedures. The aim of this study was to determine the incidence and associated risk factors of SSI in orthopedic patients admitted in a tertiary care center. Data were collected which focused on demographic details, lifestyle factors, diagnosis, surgical procedure, duration of surgery, prophylactic antibiotics, postoperative antibiotics and comorbidity obtained from the patients hospital records. Univariate analysis and multinomial logistic regression tests were performed to identify independent risk factors for orthopedic incisional SSIs. The overall rate of SSI was 2.1%. Univariate analysis showed diabetes, smoking and duration of hospital stay to be significantly associated with patients in whom SSI developed than in uninfected control patients. Independent risk factors for SSI that were identified by multinomial logistic regression were diabetes (OR 3.953) and smoking (OR 38.319). Diabetes and smoking were independent risk factors for SSIs. Therefore, it is recommended to tightly regulate blood glucose levels and stop smoking to reduce the SSIs.

The specific risk factors for surgical site infection (SSI) in orthopaedic oncology patients undergoing endoprosthetic reconstruction have not previously been evaluated in a large prospective cohort. The current study aims to define patient and procedure-specific risk factors for SSI in patients undergoing surgical excision and endoprosthetic reconstruction of the lower extremity for oncologic indications using the prospectively collected data of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. PARITY was a multicenter, blinded, parallel two-arm design randomized controlled trial that aimed to determine the effect of long (5 days) vs. short duration (24 hours) postoperative prophylactic antibiotics on the rate of SSI in patients undergoing surgical excision of the femur or tibia. The primary analysis of the PARITY study of 604 eligible patients was published in the Journal of the American Medical Association (Oncology) on January 6, 2022. In this secondary analysis of the PARITY data, a multivariate Cox proportional hazards regression model was constructed to explore predictors of SSI within one year postoperatively. Based on the outcomes of the univariate analysis and theoretical relationships, the following variables were selected for inclusion in the regression model: age, sex, tumor location (femur vs. tibia) and type (primary bone vs. soft tissue sarcoma invading bone vs. oligometastatic bone disease), soft tissue mass, preoperative neutropenia, neoadjuvant chemotherapy, operative time, total muscle excised, intraoperative vancomycin powder use, silver coated prosthesis, prosthesis betadine soak, arthroplasty helmet use, operative laminar flow, postoperative suction drain, urinary catheter, postoperative negative pressure wound therapy, hospital length of stay (LOS) and adjuvant chemotherapy. The results of the model are presented with hazards ratios (HR) and 95% confidence intervals (CI). A total of 96 of 604 patients (15.9%) experienced an SSI. Of the 22 variables analysed in the univariate analysis, four variables achieved statistical significance: tumor type, operative time, volume of muscle excised and hospital LOS. However, only hospital LOS was found to be independently predictive of SSI in the multivariate regression analysis (HR = 1.03, 95% CI = [1.01–1.05], P = 0.001). An omnibus test of model coefficients demonstrated that the model showed significant improvement over the null model (χ2 = 76.6, P 0.7 as a cut off for exclusion. This secondary analysis of the PARITY study data found that among the potential risk factors for SSI following endoprosthetic reconstruction of the lower extremity, the only independent risk factor on multivariate analysis was hospital LOS. It therefore may be reasonable for clinicians to consider streamlined discharge plans for orthopaedic oncology patients to potentially reduce the risk for SSI.

A retrospective study. The purpose of this study was to identify the independent risk factors for postoperative surgical site infection (SSI) after posterior lumbar spinal surgery based on the perioperative factors analysis. SSI is one of the most common complications after spinal surgery. Previous studies have identified different risk factors for postoperative SSI after lumbar spinal surgery. However, most of the studies were focused on the patient and procedure-related factors. Few studies reported the correlation between laboratory tests and postoperative SSI. A retrospective study was carried out in a single institution. Patients who underwent posterior lumbar spinal surgery between January 2010 and August 2016 were included in this study. All patients' medical records were reviewed and patients with postoperative SSI were identified. Perioperative variables were included to determine the risk factors for SSI by univariate and multivariate regression analysis. A total of 2715 patients undergoing posterior lumbar spinal surgery were included in this study. Of these patients, 64 (2.4%) were detected with postoperative SSI, including 46 men and 18 women. Diabetes mellitus (P = 0.026), low preoperative serum level of calcium (P = 0.009), low preoperative and postoperative albumin (P = 0.025 and 0.035), high preoperative serum glucose (P = 0.029), multiple fusion segments (P < 0.001), increased surgical time and estimated blood loss (P = 0.023 and 0.005), decreased postoperative hemoglobin (P = 0.008), and prolonged drainage duration (P = 0.016) were found to be the independent risk factors for SSI. Multilevel fusion and a history of diabetes mellitus were the two strongest risk factors (odds ratio = 2.329 and 2.227) for SSI. Based on a large population analysis, previous reported risk factors for SSI were confirmed in this study while some new independent risk factors were identified significantly associated with SSI following lumbar spinal surgery, including preoperative low serum level of calcium, decreased preoperative and postoperative albumin, and decreased postoperative hemoglobin. 4.

This study aimed to investigate the risk factors for surgical site infection (SSI) after percutaneous kyphoplasty (PKP) and evaluate the application value of the preoperative C-reactive protein (CRP)-to-albumin ratio (CAR) in predicting SSI. This study retrospectively enrolled 329 patients with thoracolumbar compression fractures who underwent PKP in the Affiliated Hospital of Qingdao University from January 2019 to June 2024. The demographic information, surgery-related data and laboratory examination results of the patients were collected. According to these results, the patients were divided into SSI and non-SSI groups, and the results were compared and analyzed. The receiver operating characteristic curve was used to determine the optimal cutoff value of preoperative CAR for predicting SSI, and binary logistic regression analysis was employed to evaluate the predictive value of CAR for SSI. The risk factors of SSI in the thoracolumbar subgroup were further explored. The study enrolled a total of 329 patients, and SSI occurred in 29 (8.81%). The optimal cut-off value of CAR was 0.1213, and the area under the curve was 0.808 (P < 0. 001). The results showed that SSI rates were related to the surgical site, and the SSI rate in the lumbar spine was higher than that in the thoracic spine. The SSI group had a longer surgical duration and more operated segments. The levels of preoperative CRP, CAR, procalcitonin and erythrocyte sedimentation rate (ESR) were higher; however, serum albumin levels were lower. More patients had CAR ≥0.1213 (75.86% vs 25.33%) and white blood cell (WBC) >10*109 (27.59% vs 10.00%). In addition, no significant differences were found by the other demographic data and laboratory examinations between the two groups. In the binary logistic regression analysis, preoperative CAR was an independent risk factor for post-PKP SSI, and the SSI risk increased by 7.464 times in patients with CAR ≥0.1213. The number of operated segments, surgical duration, and ESR were also independent risk factors for SSI, whereas serum albumin is a protective factor. Preoperative CAR is an effective predictor of post-PKP SSI, which can be used for clinical prevention and reduction of SSI risk.

This study aimed to identify the risk factors of surgical site infection (SSI) in elective colorectal resection and the strategy for prevention of SSI in modern era of colorectal surgery. The practice of colorectal surgery has undergone remarkable evolution recently because of application of laparoscopic resection. This could affect SSI in colorectal patients. An updated investigation of SSI under current practice of colorectal surgery would provide valuable information. This was a prospective study of SSI on 1011 patients, who had elective colorectal resection in a university teaching hospital, during January 2002 to December 2006. Standard definition and postoperation follow-up of SSI were adopted through collaboration between surgeons and wound surveillance program of Infection Control Unit. Risk factors of SSI were evaluated. Logistic regression was used to perform multivariate analysis and decide independent risk factors of SSI. The overall rate of incisional SSI and organ/space SSI was 4.8% and 1.7%, respectively. Rate of incisional SSI in open and laparoscopic colorectal resection was 5.7% and 2.7%, respectively. Anastomotic leakage was the only factor that predicted organ/space SSI (P < 0.01). Independent risk factors of incisional SSI included blood transfusion [P = 0.047; odds ratio (OR) = 2.43; 95% confidence interval (CI): 1.0-5.9], anastomotic leakage (P < 0.01; OR = 6.5; 95% CI: 2.3-18.6), and open colorectal resection (P = 0.037; OR = 2.36; 95% CI: 1.1-5.3). In current practice of colorectal surgery, operative factors are more important than patient factors for SSI. Good surgical technique to reduce anastomotic leakage and reduce blood transfusion has paramount importance in SSI prevention. Laparoscopic surgery was associated with reduction of rate of SSI by more than 50% when compared with open surgery and would have a strong impact on the prevention of surgical infection.

Surgical Site Infection (SSI) is one of the common postoperative complications after gastric cancer surgery. Previous studies have explored the risk factors (such as age, diabetes, anaemia and ASA score) for SSI in patients with gastric cancer. However, there are large differences in the research results, and the correlation coefficients of different research results are quite different. We aim to investigate the risk factors of surgical site infection in patients with gastric cancer. We queried four English databases (PubMed, Embase, Web of Science and the Cochrane Library) and four Chinese databases (China National Knowledge Infrastructure, Chinese Biological Medicine Database, Wanfang Database and Chinese Scientific Journal Database (VIP Database)) to identify published literature related to risk factors for surgical site infection in patients with gastric cancer. Rev Man 5.4 and Stata 15.0 were used in this meta-analysis. A total of 15 articles (n = 6206) were included in this analysis. The following risk factors were found to be significantly associated with surgical site infection in gastric cancer: male (OR = 1.28, 95% CI [1.06, 1.55]), age >60 (OR = 2.75, 95% CI [1.65, 4.57]), smoking (OR = 1.99, 95% CI [1.46, 2.73]), diabetes (OR = 2.03, 95% CI [1.59, 2.61]), anaemia (OR = 4.72, 95% CI [1.66, 13.40]), preoperative obstruction (OR = 3.07, 95% CI [1.80, 5.23]), TNM ≥ III (OR = 2.05, 95% CI [1.56, 2.70]), hypoproteinemia (OR = 3.05, 95% CI [2.08, 4.49]), operation time ≥3 h (OR = 8.33, 95% CI [3.81, 18.20]), laparotomy (OR = 2.18, 95% CI [1.61, 2.94]) and blood transfusion (OR = 1.44, 95% CI [1.01, 2.06]). This meta-analysis showed that male, age >60, smoking, diabetes, anaemia, preoperative obstruction, TNM ≥ III, hypoproteinemia, operation time ≥3 h, open surgery and blood transfusion were the risk factors for SSI in patients with gastric cancer.

Liaison: Anthony T Tokarski BS Leaders: David Blaha MD (US), Michael A. Mont MD (US), Parag Sancheti MS, DNB, MCh (International) Delegates: Lyssette Cardona MD, MPH, MHA, AAHIVS, FIDSA, Gilberto Lara Cotacio MD, Mark Froimson MD, Bhaveen Kapadia MD, James Kuderna MD, PhD, Juan Carlos Lopez MD, Wadih Y Matar MD, MSc, FRCSC, Joseph McCarthy MD, Rhidian Morgan-Jones MB BCh, FRCS, Michael Patzakis MD, Ran Schwarzkopf MD, Gholam Hossain Shahcheraghi MD, Xifu Shang MD, Petri Virolainen MD, PhD, Montri D. Wongworawat MD, Adolph Yates Jr, MD

The rates of surgical site infections (SSI) continue to be reported with great variability, even for the same operation, from different geographical areas. Hence, a hospital-based surveillance of SSI can help in designing effective preventive strategies. This study was done to assess the risk factors, characteristics, and incidence of SSI in patients undergoing emergency gastrointestinal surgery. The study was a case series analysis, enrolling all consecutive patients undergoing emergency gastrointestinal surgery. The patients were examined daily for SSI using ASEPSIS score and during the post-operative period up to 30 days. For patients with SSI, wound swab was taken for culture and sensitivity. Patient and operative characteristics were analyzed for identifying risk factors, and the bacteriological profile and sensitivity pattern of intra-abdominal specimens were analyzed and compared with microbiological profile of SSI. A total of 100 patients were studied. The incidence of SSI was 33%. Age (44.33 ± 18.277 vs. 39.43 ± 16.158; p 0.015) and pre-operative blood transfusion (61.1 vs. 38.9; p 0.012) were found to be significant risk factors for SSI. On multivariate analysis, blood transfusion (p 0.027) and the duration of operation (p 0.005) were found to be independent risk factors. In cases where the isolated organisms were Escherichia coli, Enterococcus faecalis, and Klebsiella pneumoniae, concordance was noted between the intra-abdominal pathogens and the organisms isolated from the SSI. Risk factors for SSI in patients undergoing emergency abdominal surgeries include increasing age, pre-operative blood transfusion, prolonged operating time, intra-operative blood loss, and operative procedures involving bowel resection. Concordance exists between intra-abdominal and SSI pathogens.

There were few articles reviewed prognostic factors of surgical site infection (SSI) in patients with spinal metastases following surgery. The purpose of the present study was to systematically: (1) investigate the incidence rates of SSI following spinal metastases surgery; (2) identify the factors which were independently associated with postoperative wound infection. One hundred sixty-seven consecutive adult patients with spinal metastases and underwent surgical treatment were retrospectively enrolled from January 2011 to February 2022. Demographic data, disease and operation-related indicators were extracted and analyzed. Univariate and multivariate logistic analysis model were performed respectively to determine independent risk factors of SSI. 17 cases infection were collected in this study. The overall incidence of SSI after surgery of spinal metastases patients was 10.2%. Univariate regression analysis showed that age (P = .028), preoperative ALB level (P = .024), operation time (P = .041), intraoperative blood loss (P = .030), Karnofsky Performance Status score (P = .000), body mass index (P = .013), American Society of Anesthesiologists > 2 (P = .010), Tobacco consumption (P = .035), and number of spinal levels involved in surgical procedure (P = .007) were associated with wound infection. Finally, the multivariate logistic model demonstrated that body mass index (P = .043; OR = 1.038), preoperative ALB level (P = .018; OR = 1.124), and number of spinal levels (P = .003; OR = 1.753) were associated with SSI occurrence. Surgery on multiple vertebral levels for spinal metastases significantly increases the risk of SSI and weight management, nutritional support and palliative surgery have the positive significance in reducing wound complications. Orthopedist should focus on identifying such high-risk patients and decrease the incidence of wound infection by formulating comprehensive and multi-disciplinary care strategy.

BackgroundPatellar fractures are a common knee injury among elderly patients, with a high risk of developing surgical site infections (SSI) postoperatively, which severely affects patient prognosis and quality of life. Elderly patients are more susceptible to SSI due to various factors such as decreased immune function and chronic diseases. Therefore, identifying the risk factors for SSI is of great clinical significance for prevention.ObjectiveThis study aims to analyze the risk factors for postoperative SSI in elderly patients with patellar fractures, providing a basis for developing more effective clinical prevention and treatment strategies.MethodsThis retrospective study collected data from 856 elderly patients who underwent patellar fracture surgery at Baoding First Central Hospital between January 2017 and December 2023. Patients were divided into SSI and non-SSI groups based on the occurrence of SSI, and their demographic data, comorbidities, and laboratory results were analyzed. Logistic regression was used to identify independent risk factors for SSI, and ROC curve analysis was conducted to determine the optimal cutoff point for predictive indicators.ResultsThe incidence of SSI was found to be 2.1%. Univariate analysis showed that BMI, surgical delay, diabetes, hematocrit (HCT), and albumin (ALB) were significantly associated with SSI. Logistic regression analysis further confirmed that BMI (p = 0.043), surgical delay (p = 0.000), HCT (p = 0.038), ALB (p = 0.015), and diabetes (p = 0.022) were independent risk factors for SSI. ROC curve analysis indicated that the optimal cutoff points for BMI, HCT, and ALB were 25.39 kg/m2, 35.62%, and 39.3 g/L, respectively, with an AUC of 0.794 for the combined predictive indicators.ConclusionHigh BMI, surgical delay, diabetes, low HCT, and low ALB are independent risk factors for postoperative SSI in elderly patients with patellar fractures. Preoperative management targeting these high-risk factors, such as optimizing patient weight, controlling diabetes, and improving nutritional status, can effectively reduce the incidence of SSI and improve postoperative outcomes. Future multicenter studies may further validate these findings and provide additional prevention strategies.