Clinical features of cochlear implantation in Japan and factors affecting postoperative infection.

Assessment of risk factors associated with the use of perioperative allogeneic blood transfusion and the effect of transfusion on infectious complications after ileal pouch-anal anastomosis (IPAA). All patients included had IPAA with ileostomy. They were divided into two groups: transfused (TRAN); nontransfused (NON). Data included age, gender, preoperative anemia (Hgb <9 l g/dl), operative blood loss, transfusion volume, incidence of postoperative infectious or anastomotic complications, and length of stay (LOS). The 1,202 patients eligible for the study were divided into: TRAN = 240 patients and NON = 962 patients. The patient age, sex, and preoperative steroid use were similar in both groups. Significantly, more patients in the TRAN group were anemic preoperatively (32 vs 11%; p<0.05) and the preoperative Hgb level was significantly lower in the TRAN (12.07; p<0.05 vs 13.34 g/dl). Transfusion was required more frequently in anemic patients (p<0.001). The overall infection rate was significantly higher in the TRAN (48.75 vs 11.22%, p<0.001), Anastomotic separation (10.83 vs 3.32%, TRAN and NON, respectively; p<0.001) and fistula formation percentage (20.8 vs 4.46%, TRAN and NON, respectively; p<0.001) was significantly higher in the TRAN group. Pelvic sepsis also occurred more frequent in TRAN (22.9 vs 4.2%, TRAN and NON, respectively; p<0.001). The incidence of any infectious complication at any site was higher in anemic patients irrespective of transfusion status (18.2 vs 2.8%, p<0.05). Transfusion was the only significant independent risk factor for postoperative infections. LOS was adversely affected by an infectious complication (9 vs 7 days, p<0.001). Preoperative anemia is a significant risk factor for perioperative transfusion with significant increase in postoperative infectious complications and anastomotic complications after IPAA. Strategies to correct preoperative anemia, refine indications for transfusion, and define the use of blood salvage techniques may be helpful in decreasing this risk.

This was a retrospective study. The main objective of this study was to investigate (1) whether pediatric patients with cerebral palsy (CP) have higher rates of postoperative infectious complications after spinal fusion and (2) risk factors for postoperative infections. Prior studies have shown that patients with CP undergo corrective spine surgery more often than the general population, yet typically have worse postoperative outcomes. Further investigation is needed to improve our understanding of the perioperative factors that place children with CP at greater risk of postoperative infectious complications. The 2019 "American College of Surgeons National Surgical Quality Improvement Program" Pediatric database was used for patient data. The univariable analysis compared the prevalence of preoperative comorbidities and perioperative factors between children with and without CP. Multivariable logistic regression modeling was used to ascertain independent risk factors for postoperative infectious complications. A total of 4445 patients were included in the study; 606 (13.63%) patients had CP and 3839 (86.37%) did not. Patients with CP were more likely to have several notable preoperative comorbidities, and the rate of developing any infectious complication was more than 7 times greater in the CP cohort than in the control cohort (14.36% vs 1.88%; P <0.001). Multivariable analysis revealed CP [odds ratio (OR): 3.55, CI: 2.25-5.60; P <0.001], American Society of Anesthesiologists class 3 or higher (OR: 2.10, CI: 1.29-3.42; P = 0.003), and hematologic disorders (OR: 2.01, CI: 1.06-3.83; P = 0.033) to be independent risk factors for increased postoperative infectious complications. CP is an independent risk factor for the development of 30-day postoperative infectious complications in pediatric patients. In addition, the American Society of Anesthesiologists class 3 or higher and hematologic disorders were risk factors for postoperative infections after spinal fusion surgery.

BackgroundIn patients undergoing surgical resection for gastric cancer, postoperative complications—in particular, postoperative infections—remain an important problem and can result in delayed recovery and increased postoperative mortality.ObjectiveTo investigate the association between perioperative anesthesia management and postoperative infectious complications in patients undergoing resection for gastric cancer.DesignRetrospective cohort study.SettingA single-center study performed from April 1, 2015, to June 30, 2018, at Peking University Cancer Hospital.PatientsPatients who underwent resection for gastric cancer.Main Outcome MeasuresDemographic information, perioperative data (including anesthesia-related data, surgery-related data, and cancer diagnosis), and information on postoperative recovery were recorded. The primary outcome was incidence of postoperative infection; the secondary outcome was length of hospital stay. The associations between perioperative factors and postoperative infectious complications were analyzed using multivariable logistic regression models and the classification tree method.ResultsA total of 880 patients were included in the study; of these, 111 (12.6%) had postoperative infectious complications during hospitalization, including 78 surgical site infections and 62 remote infections. After correction for confounding factors on logistic multivariable analysis, perioperative use of glucocorticoids was associated with a lower incidence of postoperative infection (hazard ratio 0.968, 95% confidence interval 0.939 to 0.997, P=0.029), and intraoperative systolic blood pressure <90 mmHg for >10 min was associated with a higher incidence of postoperative infection (hazard ratio 2.112, 95% confidence interval 1.174 to 3.801, P=0.013). In addition, older age, preoperative hypoproteinemia, and total gastrectomy were identified as independent predictors of postoperative infection.ConclusionFor patients with gastric cancer, perioperative use of glucocorticoids and avoiding intraoperative hypotension may decrease the incidence of postoperative infectious complications.

BackgroundLaparoscopic cholecystectomy (LC) is one of the most common surgeries in laparoscopic surgery. Although, it is believed that LC has low-risk for post-operative infectious complications, the use of a prophylactic antibiotic is still controversial in elective LC.ObjectiveTo determine the impact of prophylactic antibiotics on postoperative infection complications in elective laparoscopic cholecystectomy.MethodsIn this double-blind, placebo-controlled, randomized, clinical trial, patients who were candidates for elective LC, from March 2012 to 2015, in four hospitals in Babol, Iran, were studied. Patients were allocated randomly to two groups, i.e., group C: Cefazolin (n = 182) and group P: placebo (n = 247). Group C received 1 g of Cefazolin 30 minutes before anesthesia and and then, six and 12 hours after anesthesia. Group P patients received 10 ml of isotonic sodium chloride solution. Age, gender, type of gallbladder diseases (stone, polyp, or hydrops), the length of post-operative hospitalization, frequency of gallbladder rupture, the duration of surgery, and the kinds of complications associated with infections were collected for each patient in the two groups. The data were analyzed by IBM-SPSS version 20, using the t-test and the chi-squared test, and a p-value < 0.05 was considered as significant.ResultsThere were no significant differences between the two groups in terms of gender (C versus P: 18 (9.9%) male versus 22 (9%); p = 0.74), age (C versus P: 43.75 + 13.30 years versus 40.91 + 13.05; p = 0.20), and duration of surgery (C versus P: 34.97 ± 8.25 min versus 34.11 ± 8.39; p = 0.71). There were no significant differences between the two groups in the incidences of post-operative infection (C versus P: 3 (1.7%) versus 5 (2%); p = 0.99) and rupture of the gallbladder (C versus P: 14 (7.8%) versus 17 (6.8%); p = 0.85). No other post-operative systemic infectious complications (e.g., sepsis, pneumonia, or urinary tract infection) were found in either group.ConclusionFor patients who underwent laparoscopic cholecystectomy (LC), prophylactic antibiotics had no important role in the prevention of infections; so these antibiotics apparently are not necessary in treatment, and they are not recommended for patients with laparoscopic cholecystectomy as low-risk selective antibiotics.Trial registrationThe trial was registered at the Iranian Clinical Trial Registry (http://www.irct.ir) with the IRCT identification number IRCT2013070413865N1.FundingThis research was supported financially by the Research Council of Babol University of Medical Sciences.

Infectious complications of cardiac surgery are often severe and life threatening. Statins having both immunomodulatory and anti-inflammatory effects were intuitively thought to influence the development of postsurgical infections. We sought to systematically examine whether any association exists between statin use and risk of infectious complications in patients undergoing cardiac surgery. We searched Ovid MEDLINE, Ovid EMBASE, Thomson Scientific Web of Science, and Elsevier Scopus from inception through February 2011 for comparative studies examining the association between statin use and risk of postoperative infections in patients undergoing cardiac surgery. We contacted a study's author for missing information. We conducted a random-effects meta-analysis of individual studies' odds ratios (adjusted for potential confounders). We identified 6 cohort studies for inclusion, 3 of which were conducted in Canada and 3 of which were conducted in the United States. Four were single-center studies, and 2 were population based. Exposure ascertainment was based on a review of admission medication list or prescription databases. Infectious outcomes were heterogeneous and included surgical site infections within 30 days, serious infections (sepsis), or any other postoperative infection. Statin use in the preoperative period was associated with a trend toward reduction in the incidence of postoperative infections in patients who underwent cardiac surgery (odds ratio, 0.81 [95% confidence interval, 0.64-1.01]; [Formula: see text]; [Formula: see text]). Heterogeneity was explained by country effect. Studies performed in Canada showed weaker associations than studies performed in the United States. This difference could not be attributed to study quality alone. We did not find good evidence to support an association between statin use and postoperative infectious complications. However, the trend toward statistical significance for this association indicates that further investigation is warranted.

This study focused on the impact of post-operative infection on patient outcome after resection with curative intent for colorectal cancer. Postoperative surgical and medical complications have been implicated as a negative predictor of long-term outcome in various malignancies. We studied a population of 1083 patients who underwent resection with curative intent for colorectal cancer. These patients were divided into 2 groups based on the occurrence (65 patients, 6%) or absence (1018 patients, 94%) of postoperative complications due to infection. We investigated the demographic and clinicopathological features of each patient with and without postoperative infectious complications, as well as the impact of postoperative infection on long-term survival. Results showed that patients with postoperative infectious complications had diabetes mellitus more frequently and also had urgent surgery compared to those without infectious complications. In addition, patients with postoperative infectious complications had a significantly more unfavorable outcome compared with those without postoperative infection in cancer-specific, but not overall survival. Multivariate analysis demonstrated that age, rectal cancer and tumor stage correlated with overall survival, but not postoperative infectious complications. However, postoperative infections, as well as gender, were associated with the length of time until the patient succumbed from the recurrence of colorectal cancer after resection for curative intent. Thus, postoperative infectious complications are predictors of adverse clinical outcome in patients with colorectal cancer. However, further immunological study is necessary to confirm the biological significance of these findings.

Purpose: To evaluate the efficacy of 1-day treatment of antimicrobial prophylaxis by analysis of the incidence and risk factors for postoperative infectious complications such as bacteriuria and urinary tract infection in the transurethral enucleation and resection of the prostate (TUERP). Materials and Methods: A retrospective review of 78 patients who underwent TUERP was performed. Of 78 patients, 32 patients received antibiotics less than 1 day (group A). The other 46 patients received antibiotics for more than 2 days (group B). All patients had urinalysis and urine culture preoperatively, on the day of removal, at 1-2 weeks and 3-4 weeks after discharge. The incidence and the risk factors for postoperative infectious complication were investigated. Results: The incidence of infectious complications after TUERP was not statistically significant between group A and group B (18.8% vs. 15.2%, p=0.680). Multivariate analysis documented only two independent risk factors of postoperative infectious complications: preoperative catheterization (OR, 4.189; 95% CI, 1.071-16.382; p=0.040) and diabetes mellitus (DM) (OR, 5.589; 95% CI, 1.469-21.256; p=0.012). Comparative analysis performed in subgroups with two risk factors also showed no difference in the incidence of infectious complication regardless of antibiotic duration. Conclusions: No significant difference in the incidence of postoperative infectious complications was observed between two groups. Therefore, it seems reasonable to prescribe prophylactic antibiotics less than 1 day for reducing postoperative infectious complications after TUERP. Preoperative urethral catheterization and DM were identified as significant risk factors for postoperative infectious complications and preventive management directed against the risk factors preoperatively is recommended.

To discover the incidence of postoperative surgical site infections in non-immunocompromised pediatric patients with an absolute neutrophil count (ANC) < or = 1,000 preoperatively. Office and hospital charts of consecutive patients with preoperative ANC < or = 1,000 undergoing elective surgery over a three-year period were reviewed for evidence of postoperative surgical site infection. Six of 200 patients with preoperative ANCs < or = 1,000 developed a postoperative surgical site infection, an infection rate of 3.0%. One of 35 patients with preoperative ANCs < or = 500 developed a surgical site infection. The mean ANC of the study population was 800 (range 200 to 1,000); the mean ANC of the group with postoperative infection likewise was 800 (range 500 to 1,000). There was a postoperative surgical site infection rate of 3.0% in non-immunocompromised children who had a preoperative ANC < or = 1,000, similar to the overall surgical site infection rate in children. Cancellation of elective procedures in non-immunocompromised children with ANC < or = 1,000 is not warranted on the grounds of concern about postoperative infection.

BACKGROUNDAcute appendicitis is common among pediatric patients, and postoperative infections and complications are significant factors that affect recovery. As a “forward-looking” nursing model, anticipatory care may reduce the incidence of postoperative wound infections and complications.AIMTo explore the effects of anticipatory care on the management of postoperative infections and complications in pediatric patients diagnosed with acute appendicitis.METHODSThis prospective randomized controlled study included data from 78 pediatric patients who underwent acute appendicitis surgery at Shijiazhuang Sixth Hospital (Hebei Province, China) between February 2021 and March 2024. Patients were divided into two groups: The intervention and control groups (n = 39 each) were based on a random numbers table method. Both groups received routine postoperative nursing care, whereas the intervention group received additional anticipatory care. Statistical analyses were performed using independent sample t-tests, χ2 tests, analysis of variance, and rank-sum tests.RESULTSPostoperative pain scores and hospital length of stay were significantly lower in the intervention group than those in the control group (P < 0.05 and P < 0.001, respectively). Postoperative wound infection and overall complication rates were significantly lower in the intervention group than those in the control group (5.13% vs 23.08%, P < 0.001; 15.38% vs 46.15%, P < 0.001, respectively). Furthermore, parental satisfaction scores were significantly higher in the intervention group than those in the control group (P < 0.05). Logistic regression identified high C-reactive protein level as a risk factor for postoperative infections and complications, whereas proactive (i.e. anticipatory) nursing intervention was a protective factor.CONCLUSIONThis study provided a scientific basis for the implementation of anticipatory care in the postoperative management of pediatric patients experiencing acute appendicitis.

Introduction Postoperative infections, including surgical site infections (SSIs), pneumonia, bloodstream infections (BSIs), and urinary tract infections (UTIs), remain among the most frequent and impactful complications following surgery. They contribute substantially to patient morbidity, length of stay, and healthcare costs, despite improvements in surgical techniques and perioperative care. In Europe alone, healthcare-associated infections are estimated to cause over 90,000 deaths annually and impose a burden of more than 500 DALYs per 100,000 population [1]. Despite the adoption of ERAS protocols and prophylactic antibiotics, the incidence of postoperative infections has plateaued in many settings, suggesting the need for adjunctive strategies beyond standard perioperative care. In this context, perioperative nutrition has emerged as a potentially modifiable factor capable of influencing immune responses, gut microbiota, and systemic inflammation. Immunonutrition (enriched with arginine, omega-3 fatty acids, nucleotides), probiotics, synbiotics, and protein supplementation are currently being investigated for their ability to prevent infectious complications and improve surgical outcomes [2,3]. However, the literature is fragmented and results are often inconsistent across interventions and populations [4-7]. Objectives This study aimed to systematically evaluate the efficacy of perioperative nutritional supplementation in reducing postoperative infectious complications in adult surgical patients. The focus on infection stems from its clinical burden and its potential sensitivity to immune-modulating strategies. Secondary outcomes included specific infection types (SSIs, BSIs, UTIs, and pneumonia) and hospital length of stay (LOS), selected for their relevance to patient recovery and healthcare system impact. These outcomes were selected to capture both the direct impact of infections and their broader consequences on patient recovery and resource utilization. Methods A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD42024575184) [8]. PubMed, Scopus, Cochrane Library, and Google Scholar were searched without restrictions on date or language. Eligible studies included adult surgical patients receiving perioperative nutritional interventions (immunonutrition, probiotics, synbiotics, protein supplementation) compared to standard care or placebo. The research question was structured using the PICO framework to ensure structured and clinically meaningful comparisons. Both randomized controlled trials (RCTs) and observational studies were included. The primary outcome was the incidence of infectious complications. Meta-analyses were performed using STATA SE 19, with pooled odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity was assessed via the I² statistic, and a random- or fixed-effects model was applied accordingly. The methodological quality of included studies was assessed using NIH tools, with most RCTs classified as low or moderate risk of bias, and observational studies showing greater variability [9]. Risk of bias was independently assessed by multiple reviewers, and disagreements were resolved by consensus, ensuring rigorous evaluation. Results Thirty-nine studies (27 RCTs and 12 observational) met the inclusion criteria. Immunonutrition was the most consistently effective intervention, significantly reducing the overall incidence of infectious complications in both RCTs (OR = 0.36; 95% CI: 0.21–0.62) and observational studies (OR = 0.32; 95% CI: 0.17–0.61). The protective effect was particularly evident with oral administration and in patients aged ≤65 years. Probiotics showed a borderline protective effect overall, while synbiotics appeared more effective in younger patients and when administered orally. Protein supplementation was evaluated in too few studies to allow for pooled analysis of the primary outcome. Regarding secondary outcomes, a general trend of benefit was observed across most interventions, though with variability in effect size and consistency. Immunonutrition and protein supplementation were associated with reduced SSIs. Probiotics showed favorable effects on UTIs and pneumonia. Synbiotics were linked to a shorter LOS, though heterogeneity and limited data warrant cautious interpretation. The quality of evidence varied, with most RCTs showing low or moderate risk of bias. These findings, although promising, should be interpreted with caution due to limited data in some subgroups and moderate heterogeneity in certain analyses. Conclusions Perioperative nutritional supplementation, particularly immunonutrition, represents a promising and evidence-based strategy to reduce postoperative infectious complications. Secondary benefits on SSIs, UTIs, pneumonia, and LOS support the broader integration of nutritional protocols into surgical care. Immunonutrition showed the most consistent results, while probiotics were effective for UTIs and pneumonia. Synbiotics significantly reduced LOS, though limited data and heterogeneity warrant caution. The strength of evidence depends on study volume and quality; thus, interventions like immunonutrition for SSIs should be prioritized, while others—such as protein supplementation for non-SSI outcomes—require further evaluation. Clarifying differential impacts across surgical specialties and standardizing formulations, timing, and administration routes will be crucial for tailored and effective implementation.

Objective To investigate the risk factors of postoperative abdominal infection in patients with cholelithiasis (CL) and its nursing intervention, so as to provide some guidance for clinic. Methods A total of 421 patients with CL, treated by surgery from January 2012 to December 2014, were selected by cluster sampling method. Among them, 78 CL patients with postoperative abdominal infection were enrolled in the study. The distribution of pathogens and risk factors such as physical factors in patients or iatrogenic factors were investigated. Besides, a pertinent nursing intervention was carried out pre-operation and post-operation in order to prevent or improve the infection in CL patients. Results A total of 89 bacterial strains were isolated, including 53 Gram-negative (59.55%) , 36 Gram-positive (40.45%) and 1 fungal strain (1.12%) . The top five strains are Escherichia coli 28 (31.46%) , Enterococcus faecalis 19 (21.35%) , Pseudomonas aeruginosa 14 (15.73%) , Klebsiella pneumonia 9 (10.11%) and E. faecium 9 (10.11%) , respectively. The results showed that the factors including the age of patients, complicating with other diseases, damage operation, drainage tubes, classes of postoperative antibiotics, etc. had significant impact on the incidence of postoperative abdominal infection in CL patients (P<0.05) . Conclusions Many risk factors involve in postoperative abdominal infection of patients with CL. Some effective nursing interventions should be applied to reduce the incidence of postoperative infection and improve postoperative complications in patients. Key words: Gallstones; Infection; Risk factors; Nursing care

Few reports have reported the long-term outcome of esophageal cancer patients suffering from postoperative infectious complications. Here, we investigated the impact of postoperative infectious complications in patients who had undergone curative resection for esophageal cancer. The study population comprised 97 patients who underwent radical resection for esophageal cancer with curative intent between 2001 and 2008. Postoperative infectious complications were defined as surgical site infections and pneumonia. We compared clinical features, tumor histology, recurrence, and overall survival between patients with postoperative infections and those who did not. Of the 97 patients studied, 37 had postoperative infectious complications. The disease-free and overall survival rates of the entire cohort did not significantly differ between patients with and without postoperative infectious complications. Univariate analysis revealed that among patients with stage III esophageal cancer, those with postoperative infectious complications demonstrated significantly shorter disease-free survival than those without. Multivariate analysis demonstrated that postoperative infectious complications were independent prognostic indicators for disease-free survival of stage III esophageal cancer patients. Our findings suggest that postoperative infectious complications in stage III esophageal cancer patients have a negative impact on disease-free survival.

Sarcopenia has been linked to an increased risk of postoperative complications and poor prognosis in patients undergoing major surgery for urological cancer. The sarcopenia index has emerged as a potential marker of muscle mass. This study investigated the relationship between the sarcopenia index and the occurrence of postoperative infections in patients undergoing major urological surgery. A total of 416 patients who underwent radical cystectomy, prostatectomy, nephrectomy, partial nephrectomy, or nephroureterectomy between April 2023 and May 2024 were retrospectively analyzed. The sarcopenia index was determined using the following formula: [(serum creatinine/serum cystatin C) × 100]. An optimal threshold for the sarcopenia index was established by using receiver operating characteristic curve analysis. The primary endpoint was the incidence of postoperative infectious complications, including pneumonia, urinary tract infections, and surgical site infections. We also examined the incidence of urinary tract infection and total postoperative complications in the sub-analyses. Of the 416 included patients, 172 (41%) had a sarcopenia index below the determined threshold. Postoperative infectious complications were more in patients with lower sarcopenia index values than in those with higher values (11 vs. 3%, P = 0.0014). However, no significant association was found in the sub-analyses. Multivariate analysis identified a reduced sarcopenia index and contaminated surgical wounds (primarily from radical cystectomy) as independent predictors of postoperative infections. Patients undergoing major urological cancer surgery with a lower sarcopenia index are at an elevated risk of developing postoperative infectious complications. The sarcopenia index may help clinicians predict postoperative infections and improve perioperative management.

P61. Allogenic transfusion increases the risk for postoperative infectious complications in children undergoing spinal fusion

Objectives:To evaluate the effect of preoperative statin therapy on the incidence of postoperative infection.Methods:This systematic review of the literature was carried out in August 2015. Studies were retrieved via PubMed, Embase, and the Cochrane Library (1980 to 2015), and the reference files were limited to English-language articles. We used a standardized protocol, and a meta-analysis was performed for data abstraction.Results:Five studies comprising 1,362 patients qualified for the analysis. The incidence of postoperative infections in the statin group (1.1%) was not significantly lower than that in the placebo group (2.4%), with a risk ratio (RR) of 0.56 (95% confidence interval [CI] 0.24-1.33, p=0.19). Patients of 3 studies underwent cardiac surgery. The aggregated results of these studies failed to show significant differences in postoperative infection when a fixed effects model was used (RR: 0.39; 95% CI: 0.08-1.97, p=0.26].Conclusions:We failed to find sufficient evidence to support the association between statin use and postoperative infectious complications. The absence of any evidence for a beneficial effect in available randomized trials reduces the likelihood of a causal effect as reported in observational studies.