30-day Surgical Site Infection Research Articles

541 Development and External Validation of the “Global Surgical-Site Infection” (GloSSI) Predictive Model in Adult Patients Undergoing Abdominal Surgery

Abstract Aim To develop a novel prognostic score to predict 30-day surgical-site infection (SSI) following gastrointestinal surgery, and externally validate in comparison to existing prognostic models. Method This was a secondary analysis of 3 independent prospective international cohort studies conducted on a global basis. This included adults undergoing gastrointestinal surgery. Model development was performed in the GlobalSurg-2 dataset (January-July 2016). The primary outcome was 30-day SSI, with two predictive techniques explored: penalised regression (LASSO) and machine learning (XGBOOST). Final model selection based on prognostic accuracy (Area Under the Curve [AUC], 95% confidence interval) and clinical utility. Novel and previous scores were externally validated in GlobalSurg-1 (July-November 2014), and GlobalSurg-3 (April-October 2018). Results 30,029 patients were eligible: 14,019 (SSI=12.3%) in the derivation cohort, and 8,464 (SSI=11.4%) and 7,546 (SSI=15.7%) in the validation cohorts (GlobalSurg-1 and GlobalSurg-3 respectively). The LASSO model was selected due to similar discrimination to XGBoost in the GlobalSurg-2 dataset (AUC: 0.738, 0.725-0.750 versus 0.737, 0.709-0.765), but greater explainability. The final GloSSI score included six variables: country income, ASA, diabetes, and operative contamination, approach, and duration. Discrimination remained good on external validation in GlobalSurg-1 (AUC: 0.730, 0.715-0.744), but moderate discrimination in GlobalSurg-3 (AUC: 0.606, 95% CI 0.588-0.623). Nonetheless, this demonstrated superior performance to external validation of all previous models evaluated within GlobalSurg or prior datasets. Conclusions The GloSSI score allowed accurate prediction of SSI with 6 simple variables routinely available at surgery across income settings. This can inform use of intraoperative and postoperative interventions to modify the risk of SSI and minimise associated harm.

Effects of povidone-iodine wound irrigation on surgical site infection in gastroenterological surgery: A randomized controlled trial

BackgroundThe irrigation efficacy of a povidone-iodine solution to prevent surgical site infection is still controversial. We assessed the irrigation effect with a povidone-iodine solution on the incidence of surgical site infection after gastroenterological surgery. MethodsThis study is a single-center, prospective, randomized, blinded-end point superiority trial for surgical wound irrigation. Patients undergoing gastroenterological surgery were randomly assigned in a 1:1 replacement ratio using computer-generated randomization. Patients were grouped according to their surgical wound treatment into the control group using the normal sterile saline and the povidone-iodine group using 10% povidone-iodine solution after the NS solution. The main finding was 30-day surgical site infections assessed in the full analysis set. ResultsFrom November 2020 to December 2022, 697 of 894 patients were eligible for the study, among which 347 were in the povidone-iodine group and 350 in the control group. Thirty-day surgical site infections occurred in 100 (14%) patients—54 (16%) in the povidone-iodine group and 46 (13%) in the control group (odds ratio, 1.229; 95% CI, 0.800–1.889; P = .406). Superficial incisional surgical site infections occurred in 30 (9%) and 15 (4%) patients, respectively (odds ratio, 2.154; 95% CI, 1.134–4.090; P = .026). Only 3 patients (1%) in the control group developed adverse skin reactions. ConclusionThis study examined the irrigation efficacy of povidone-iodine for surgical site infection prevention compared to control in gastroenterological surgery. Povidone-iodine wound irrigation has shown no additional beneficial effect on the occurrence of surgical site infections.

Identification of predictive factors for surgical site infections in gastrointestinal surgeries: A retrospective cross-sectional study in a resource-limited setting

Background Surgical site infection (SSI), albeit infrequent, drastically impacts the quality of care. This article endeavors to investigate the predictive factors of SSIs following surgical interventions that involve the gastrointestinal (GI) tract within a single institution in a resource-limited setting. Methods Over seven years from June 2015 to June 2022, patients who underwent GI surgery and developed SSI were retrospectively matched with an unaffected case-control cohort of patients. Standardized techniques for wound culture, laboratory evaluation of bacterial isolates, and antibiotic susceptibility tests were employed. Logistic regression analysis was utilized to investigate the predictive factors associated with 30-day postoperative SSI occurrence. Results A total of 525 patients who underwent GI surgical procedures were included, among whom, 86 (16.4%) developed SSI and the majority of SSIs were superficial (74.4%). Escherichia coli was the most commonly isolated bacterium (54.4%), and a high percentage of multidrug-resistant organisms were observed (63.8%). In multivariate Cox regression analysis, illiteracy (Odds ratio [OR]:40.31; 95% confidence interval [CI]: 9.54-170.26), smoking (OR: 21.15; 95% CI: 4.63-96.67), diabetes (OR: 5.07; 95% CI: 2.27-11.35), leukocytosis (OR: 2.62; 95% CI: 1.24-5.53), hypoalbuminemia (OR: 3.70; 95% CI: 1.35-10.16), contaminated and dirty wounds (OR: 6.51; 95% CI:1.62-26.09), longer operation duration (OR: 1.02; 95% CI: 1.01-1.03), emergency operations (OR: 12.58; 95% CI: 2.91-54.30), and extending antibiotic prophylaxis duration (OR: 3.01; 95% CI: 1.28-7.10) were the independent risk factors for SSI (all p < 0.05). Conclusions This study highlights significant predictors of SSI, including illiteracy, smoking, diabetes, leukocytosis, hypoalbuminemia, contaminated and dirty wounds, longer operative time, emergency operations, and extending antibiotic prophylaxis duration. Identifying these risk factors can help surgeons adopt appropriate measures to reduce postoperative SSI and improve the quality of surgical care, especially in a resource-limited setting with no obvious and strict policy for reducing SSI.

Impact of Pharmacist-Driven Penicillin Allergy De-Labeling Pilot Program in Preoperative Cardiothoracic and Spine Surgery Patients at Quaternary Hospital

Documented penicillin allergies are associated with an increased risk of surgical site infections (SSIs), and first-line antibiotics (e.g., cefazolin) are associated with a lower risk of SSIs. The goal of this study was to evaluate the effect of a pharmacist-driven penicillin allergy de-labeling pilot program on the use of preoperative cefazolin in selected surgery patients with documented penicillin allergies. This single-center, quasi-experimental study included adult patients with a charted penicillin allergy who underwent CT or spine surgery in 2021 (control group) or during the 6-month intervention pilot (October 2022–March 2023). In the intervention group, qualifying patients were interviewed via phone to assess allergy history. Qualified patients were de-labeled or referred to an allergist for outpatient skin testing and/or oral challenge. The primary outcome was the rate of cefazolin use preoperatively. Secondary outcomes included 30-day SSIs, Clostridioides difficile infection, acute kidney injury, readmission, and hospital length of stay. Of the intervention group, 57 (79.2%) patients completed the interview. Cefazolin was used preoperatively in 71.0% (152) of the control group versus 88.9% (64) of the intervention group (p < 0.002). There were no clinically significant differences in secondary outcomes. The pharmacist-driven penicillin allergy de-labeling pilot program in CT and spine surgery patients was associated with increased cefazolin use.

Postoperative Antibiotics, Outcomes, and Resource Use in Children With Gangrenous Appendicitis

Gangrenous, suppurative, and exudative (GSE) findings have been associated with increased surgical site infection (SSI) risk and resource use in children with nonperforated appendicitis. Establishing the role for postoperative antibiotics may have important implications for infection prevention and antimicrobial stewardship. To compare SSI rates in children with nonperforated appendicitis with GSE findings who did and did not receive postoperative antibiotics. This was a retrospective cohort study using American College of Surgeons' National Surgical Quality Improvement Program (NSQIP)-Pediatric Appendectomy Targeted data from 16 hospitals participating in a regional research consortium. NSQIP data were augmented with operative report and antibiotic use data obtained through supplemental medical record review. Children with nonperforated appendicitis with GSE findings who underwent appendectomy between July 1, 2015, and June 30, 2020, were identified using previously validated intraoperative criteria. Data were analyzed from October 2022 to July 2023. Continuation of antibiotics after appendectomy. Rate of 30-day postoperative SSI including both incisional and organ space infections. Complementary hospital and patient-level analyses were conducted to explore the association between postoperative antibiotic use and severity-adjusted outcomes. The hospital-level analysis explored the correlation between postoperative antibiotic use and observed to expected (O/E) SSI rate ratios after adjusting for differences in disease severity (presence of gangrene and postoperative length of stay) among hospital populations. In the patient-level analysis, propensity score matching was used to balance groups on disease severity, and outcomes were compared using mixed-effects logistic regression to adjust for hospital-level clustering. A total of 958 children (mean [SD] age, 10.7 [3.7] years; 567 male [59.2%]) were included in the hospital-level analysis, of which 573 (59.8%) received postoperative antibiotics. No correlation was found between hospital-level SSI O/E ratios and postoperative antibiotic use when analyzed by either overall rate of use (hospital median, 53.6%; range, 31.6%-100%; Spearman ρ = -0.10; P = .71) or by postoperative antibiotic duration (hospital median, 1 day; range, 0-7 days; Spearman ρ = -0.07; P = .79). In the propensity-matched patient-level analysis including 404 patients, children who received postoperative antibiotics had similar rates of SSI compared with children who did not receive postoperative antibiotics (3 of 202 [1.5%] vs 4 of 202 [2.0%]; odds ratio, 0.75; 95% CI, 0.16-3.39; P = .70). Use of postoperative antibiotics did not improve outcomes in children with nonperforated appendicitis with gangrenous, suppurative, or exudative findings.

Identification of predictive factors for surgical site infections in gastrointestinal surgeries: A retrospective cross-sectional study in a resource-limited setting

Background Surgical site infection (SSI), albeit infrequent, drastically impacts the quality of care. This article endeavors to investigate the predictive factors of SSIs following surgical interventions that involve the gastrointestinal (GI) tract within a single institution in a resource-limited setting. Methods Over seven years from June 2015 to June 2022, patients who underwent GI surgery and developed SSI were retrospectively matched with an unaffected case-control cohort of patients. Standardized techniques for wound culture, laboratory evaluation of bacterial isolates, and antibiotic susceptibility tests were employed. Logistic regression analysis was utilized to investigate the predictive factors associated with 30-day postoperative SSI occurrence. Results A total of 525 patients who underwent GI surgical procedures were included, among whom, 86 (16.4%) developed SSI and the majority of SSIs were superficial (74.4%). Escherichia coli was the most commonly isolated bacterium (54.4%), and a high percentage of multidrug-resistant organisms were observed (63.8%). In multivariate Cox regression analysis, illiteracy (Odds ratio [OR]:40.31; 95% confidence interval [CI]: 9.54-170.26), smoking (OR: 21.15; 95% CI: 4.63-96.67), diabetes (OR: 5.07; 95% CI: 2.27-11.35), leukocytosis (OR: 2.62; 95% CI: 1.24-5.53), hypoalbuminemia (OR: 3.70; 95% CI: 1.35-10.16), contaminated and dirty wounds (OR: 6.51; 95% CI:1.62-26.09), longer operation duration (OR: 1.02; 95% CI: 1.01-1.03), emergency operations (OR: 12.58; 95% CI: 2.91-54.30), and extending antibiotic prophylaxis duration (OR: 3.01; 95% CI: 1.28-7.10) were the independent risk factors for SSI (all p < 0.05). Conclusions This study highlights significant predictors of SSI, including illiteracy, smoking, diabetes, leukocytosis, hypoalbuminemia, contaminated and dirty wounds, longer operative time, emergency operations, and extending antibiotic prophylaxis duration. Identifying these risk factors can help surgeons adopt appropriate measures to reduce postoperative SSI and improve the quality of surgical care, especially in a resource-limited setting with no obvious and strict policy for reducing SSI.

Perioperative Risk Factors Predicting Hardware Exposure after Mandibulectomy and Reconstruction

Background and Hypothesis:Mandibulectomy is often required in the management of tumors, infection, or trauma of the head and neck. Reconstruction of the defect is accomplished via osteocutaneous free flaps and the use of titanium plates for fixation of the bone segments. Postoperative exposure of the mandibular hardware is an unfortunate outcome which results in significant quality of life detriment and often requires substantial revision surgery and reconstruction. We hypothesize that individuals with vasculopathic conditions and other circumstances that contribute to poor wound healing are more likely to experience hardware plate exposure following mandibular reconstruction.
 Methods:A single-institution, retrospective cohort study was performed on all adults undergoing mandibulectomy and osteocutaneous free flap reconstruction from 2010-2020. Demographics, patient history, surgical parameters, and follow-up data were collected. Comparisons and logistic regression were used to determine factors associated with postoperative hardware exposure.
 Results:The cohort consisted of 134 predominantly white (92.5%) male (65.7%) patients with mean age 58.4±13.0 years, 32 (23.9%) of whom had postoperative plate exposure. Between patients with and without exposure, there were no differences observed in demographics, substance use, surgical indications, or reconstructive techniques, neoadjuvant or adjuvant chemoradiation, nor 30-day major surgical site infection. The comorbidities of peripheral vascular disease, hypothyroidism, and immunosuppression were significantly more common in the plate exposure group. In multivariate logistic regression, peripheral vascular disease (OR [95%CI] = 18.8 [1.8-196.3]), hypothyroidism (OR [95%CI] – 3.5 [1.1-10.6]), and immunosuppression (OR [95%CI] =11.3 [2.4-54.1]) remained significant predictors of post-mandibulectomy hardware exposure.
 Conclusion and Potential Impact:Patients with pre-existing peripheral vascular disease, hypothyroidism, and/or immunosuppression have an increased risk of post-mandibulectomy hardware exposure. Understanding these risk factors can improve shared patient-surgeon decision making and counseling, as well as guide practitioners to focus on mitigating these comorbidities prior to surgery.

Antimicrobial stewardship program for gastrointestinal surgeries at a Vietnamese tertiary hospital.

Antimicrobial Stewardship Programs (ASP) have been applied widely in high-resource countries to prevent surgical site infections (SSI). Evidence favoring ASP interventions (ASPi) in gastrointestinal surgeries from low and middle-income countries has been limited, especially in antimicrobial prophylaxis. We aimed to investigate this gap at a Vietnamese tertiary hospital. We conducted a retrospective cohort study on patients undergoing clean-contaminated surgeries in 2015 who received standard of care (SoC) or SoC + ASPi. Primary outcome was 30-day SSI incidence. Secondary outcomes included length of stay (LoS) after surgery (days), cost of antibiotics, and cost of treatment (USD). Results were controlled for multiplicity and reported with treatment effect and 95% confidence interval (95%CI). A predictive model was built and cross-validated to detect patients at high risk of SSI. We included 395 patients for analysis (48.1% being female, mean age 49.4 years). Compared to patients receiving SoC, those with SoC + ASPi had a lower incidence of 30-day SSI (-8.8, 95%CI: -16.0 to -1.6, p = 0.042), shorter LoS after surgery (-1.1 days, 95%CI: -1.8 to -0.4, p = 0.004), and lower cost of antibiotics (-37.3 USD, 95%CI: -59.8 to -14.8, p = 0.012) and treatment (-191.1 USD, 95%CI: -348.4 to -33.8, p = 0.042). We estimated that by detecting patients at high risk of SSI with the predictive model and providing prophylactic measures, we could save 398120.7 USD per 1,000 cases of SSI. We found that ASPi were associated with a reduction in risks of SSI, hospital stays, and cost of antibiotics/treatment in a Vietnamese tertiary hospital.

Initiating versus delaying treatment-dose anticoagulation in suspected venous thromboembolism (VTE) in post-operative hip and knee arthroplasty patients: Outcomes and risks

BackgroundHip and knee arthroplasty is a risk factor for venous thromboembolism (VTE). Initiation of treatment-dose anticoagulation in the post-operative period in suspected cases prior to confirmed diagnosis involves balancing increased bleeding risk to VTE-associated morbidity. MethodsA single-centre retrospective cohort study was undertaken comparing outcomes of empirical treatment of suspected VTE in post-operative elective lower-limb arthroplasty patients as opposed to delaying treatment until diagnosis is confirmed. All patients undergoing ultrasonography (US) or CT-pulmonary-angiogram (CTPA) for suspected VTE following elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 05/05/17 and 19/07/21 were identified. Primary outcomes were surgical site infection (SSI), readmission, and other wound problems within 30-days of surgery. Results107 patients were included for analysis. 93 patients had suspected deep venous thrombosis (DVT), 21 had suspected pulmonary embolism (PE), and 7 were investigated for both DVT and PE. Empirical treatment-dose anticoagulation was initiated in 4 patients with suspected pulmonary embolism (PE) prior to CTPA, and 34 patients with suspected deep venous thrombosis (DVT) prior to US. No significant differences were noted in 30-day readmission rate ([DVT: 12 % vs 23 %, p = 0.41], [PE: 50 % vs 33 %, p = 1.00]), SSI rate ([DVT: 6 % vs 3 %, p = 1.00], [PE: 0 % vs 11 %, p = 1.00]) or other wound complication rate ([DVT: 3 % vs 3 %, p = 1.00), [PE 0 % vs 11 %, p = 1.00]) between empirically and non-empirically treated groups respectively. ConclusionEmpirical initiation of therapeutic anticoagulation in post-operative lower limb arthroplasty patients with suspected VTE appears to be safe practice prior to a definitive diagnosis.

Comparison of Early Complication Rates After High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Knee Osteoarthritis.

Although both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) can be utilized to treat unicompartmental osteoarthritis (OA) in select patients, the early complication rates between the 2 procedures are not well understood. Understanding of the complication profiles for both procedures would help clinicians counsel patients with unicompartmental knee OA who may be eligible for either treatment option. To compare the 30-day complication rates after HTO versus UKA for the treatment of knee OA using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Cohort study; Level of evidence, 3. NSQIP registries between 2006 and 2019 were queried using Current Procedural Terminology codes to identify patients undergoing HTO and UKA for knee OA. Patients >60 years of age were excluded. Patient demographics, preoperative comorbidities, and intraoperative data were collected. Postoperative 30-day complications, including venous thromboembolism (VTE), urinary tract infection (UTI), transfusion, surgical-site infection (SSI), and reoperations were recorded. Complication rates between treatment groups were compared using a multivariate logistic regression model adjusted for sex, age, body mass index, steroid use, respiratory status (smoking/dyspnea/chronic obstructive pulmonary disease), diabetes, and hypertension. A total of 156 patients treated with HTO and 4755 patients treated with UKA for knee OA were identified. Mean patient ages were 46 years for the HTO group and 53.4 years for the UKA group. Operative time was significantly longer in the HTO group versus the UKA group (112 minutes vs 90 minutes; P < .001). Multivariate analyses found no significant differences in VTE (1.3% vs 0.6%), UTI (0.6% vs 0.3%), transfusion (0.6% vs 0.2%), deep SSI (0.6% vs 0.1%), and reoperation (1.3% vs 1%) rates between HTO and UKA groups. The HTO group had a higher rate of superficial SSI compared with the UKA group (2.6% vs 0.6%; P = .006) (adjusted odds ratio, 4.2; 95% CI, 1.4-12.5; P = .01). There were no differences in 30-day VTE, UTI, transfusion, deep SSI, and reoperation rates for HTO versus UKA in the treatment of knee OA. HTO was associated with a higher rate of superficial SSI compared with UKA. These findings serve to guide clinicians in counseling patients regarding the early risks after HTO and UKA.

The iterative implementation of a comprehensive enhanced recovery after surgery protocol in all spinal surgery in Korea: a comparative analysis of clinical outcomes and medical costs between primary spinal tumors and degenerative spinal diseases.

Most studies on the enhanced recovery after surgery (ERAS) protocol in spine surgery have focused on patients with degenerative spinal diseases (DSDs), resulting in a lack of evidence for a comprehensive ERAS protocol applicable to patients with primary spine tumors (PSTs) and other spinal diseases. The authors had developed and gradually adopted components of the comprehensive ERAS protocol for all spine surgical procedures from 2003 to 2011, and then the current ERAS protocol was fully implemented in 2012. This study aimed to evaluate the impact and the applicability of the comprehensive ERAS protocol across all spine surgical procedures and to compare outcomes between the PST and DSD groups. Adult spine surgical procedures were conducted from 2003 to 2021 at the Seoul National University Hospital Spine Center and data were retrospectively reviewed. The author divided the study periods into the developing ERAS (2003-2011) and post-current ERAS (2012-2021) periods, and outcomes were compared between the two periods. Surgical procedures for metastatic cancer, infection, and trauma were excluded. Interrupted time series analysis (ITSA) was used to assess the impact of the ERAS protocol on medical costs and clinical outcomes, including length of stay (LOS) and rates of 30-day readmission, reoperation, and surgical site infection (SSI). Subgroup analyses were conducted on the PST and DSD groups in terms of LOS and medical costs. The study included 7143 surgical procedures, comprising 1494 for PSTs, 5340 for DSDs, and 309 for other spinal diseases. After ERAS protocol implementation, spine surgical procedures showed significant reductions in LOS and medical costs by 22% (p = 0.008) and 22% (p < 0.001), respectively. The DSD group demonstrated a 16% (p < 0.001) reduction in LOS, whereas the PST group achieved a 28% (p < 0.001) reduction, noting a more pronounced LOS reduction in PST surgical procedures (p = 0.003). Medical costs decreased by 23% (p < 0.001) in the DSD group and 12% (p = 0.054) in the PST group, with a larger cost reduction for DSD surgical procedures (p = 0.021). No statistically significant differences were found in the rates of 30-day readmission, reoperation, and SSI between the developing and post-current ERAS implementation periods (p = 0.65, p = 0.59, and p = 0.52, respectively). Comprehensive ERAS protocol implementation significantly reduced LOS and medical costs in all spine surgical procedures, while maintaining comparable 30-day readmission, reoperation, and SSI rates. These findings suggest that the ERAS protocol is equally applicable to all spine surgical procedures, with a more pronounced effect on reducing LOS in the PST group and on reducing medical costs in the DSD group.

SP3.8 Evaluation of remote surgical wound assessment in routine surgical practice: a mixed-methods pilot implementational study of a novel mobile digital intervention

Abstract Introduction Remote postoperative wound surveillance provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot remote digital postoperative wound surveillance and evaluate the readiness for implementation in routine practice. Methods A single-arm implementation study of remote postoperative wound surveillance in two tertiary care hospitals (clinicaltrials.gov: NCT05069103). Adults undergoing abdominal surgery received smartphone-delivered wound assessment for 30-days postoperatively (photographs and patient-reported SSI symptoms). Technology acceptance was assessed using 5-point Likert scales from the validated Telehealth Usability Questionnaire (TUQ) and summarised using means and 95% confidence intervals (CI). A mixed-methods approach was used with synthesis according to the WHO framework for monitoring and evaluating digital health interventions. Results 200 patients participated between July 2021 and April 2022, with 115 (57.5%) undergoing emergency procedures. The 30-day SSI rate was 16.5% (n=33/200), with 72.7% (n=24) diagnosed post-discharge. Usage of the intervention was 83.0% (n=166/200), with subsequently 74.1% (n=123/166) TUQ completion. Patient acceptance was high with regards to satisfaction (4.27, CI: 4.13-4.41) and usefulness (4.07, CI: 3.92-4.23). Communication was rated lowest (3.86, CI: 3.71-4.02), related to the desire for more frequent and personalised interactions with the surgical team. Nevertheless, the majority perceived improved quality (3.72, CI: 3.56-3.89) and efficiency (4.08, CI: 3.93-4.23) over routine postoperative care. Conclusion Remote postoperative wound surveillance successfully demonstrates readiness for implementation according to the WHO framework. Both patients and healthcare services can benefit from enhanced community support to ensure appropriate and timely management.

Wide Awake Trigger Finger Releases Performed in the United States: Trends in Volume, Operative Setting, and Reimbursement.

Trigger finger release (TFR) has traditionally been performed in outpatient operating rooms. More recently, TFR may be performed in the office setting to achieve greater efficiency and cost savings. The 2010-2020 Q2 PearlDiver M91Ortho data set was analyzed for cases of TFR. Exclusion criteria were age less than 18 years, <30 days of postoperative records, concomitant hand surgery, monitored anesthesia use, and inpatient surgery. Age, sex, and Elixhauser comorbidity index were recorded. Operating room and office procedures were matched 4:1 based on patient characteristics. Total and physician reimbursement for the day of surgery, as well as 30-day narcotics prescriptions, emergency department (ED) visits, and surgical site infections (SSI) were determined. Before matching, TFRs were found to be increasingly performed in the office (from 7.9% in 2010 to 14.6% in 2020). Matched cohorts consisted of 63,951 operating room and 15,992 office procedures. Office procedures had lower mean total reimbursements ($435 vs $752, P < 0.001), slightly lower mean physician reimbursements ($420 vs $460, P < 0.001), and lower rates of narcotic prescriptions (30.5% vs 50.5%, P < 0.001) and 30-day ED visits (2.2% vs 2.9%, P < 0.05). There was no difference in 30-day SSI (0.5% vs 0.6%, P = 0.374). In-office TFR is becoming increasingly prevalent. After matching, in-office TFRs were associated with lesser costs to the system, lower narcotic prescriptions, and fewer postoperative ED visits, without increased SSI. Although it is important to perform procedures in the best location for the patient, physician, and system, the current study supports the increased value offered by in-office TFR.

Association of Nicotine Cessation Time on the Incidence of Recurrent Incisional Hernia Repair and Postoperative Surgical Site Occurrences.

Nicotine products are believed to be associated with a higher incidence of incisional hernia (IH) recurrence and postoperative complications after IH repair. A retrospective analysis of the Abdominal Core Health Quality Collaborative (ACHQC) database was performed. Outcomes included risk of IH recurrence, 30-day surgical site infection (SSI), and 30-day surgical site occurrence (SSO). We included 14,663 patients. Nicotine users who quit within 1year of surgery had a 26% higher risk of IH recurrence compared to patients who quit more than a year before surgery or never users. Patients who quit using nicotine within 1year of surgery had a 54% higher odds of SSI compared to former nicotine users who quit more than a year before surgery. Former nicotine users with less than 1year of nicotine use cessation before surgery exhibited worse outcomes than those with more than a year of cessation or no prior use.

Surgeon volumes: preserving appropriate surgical outcomes in higher-risk patient populations undergoing abdominal wall reconstruction.

It is increasingly recognized that complex abdominal wall reconstruction (cAWR) necessitates specialized training. No studies have been conducted to assess whether a volume-outcomes relationship is present in cAWR. We sought to determine if outcomes for patients undergoing cAWR varied based on surgeon volume among participants in the Abdominal Core Health Quality Collaborative (ACHQC). All patients with ventral hernias undergoing elective cAWR with component separation (lateral component release) were selected from ACHQC database. Surgeons were ranked based on annual number of cAWR procedures performed and then grouped in tertiles. Patient characteristics, hernia risk factors, operative details, and 30-days outcomes were evaluated. A total of 9206 patients were identified, of which 310 (3.4%), 723 (7.9%) and 8173 (88.7%) cAWRs were performed by low (105 surgeons), medium (49) and high-volume (66) surgeons, respectively. Patients operated upon by high-volume surgeons tended to have more comorbidities and higher ASA class (72.5% of class ≥ III, vs 53.5%). Hernia characteristics demonstrated that high-volume surgeons more commonly operated on patients presenting with recurrent hernias (50.2% vs 42%), wider hernias (13.5cm vs 10.5cm), associated ostomies (13% vs 3.6%), and prior of surgical site infections (32% vs 26%, P = 0.035). High-volume surgeons more commonly performed posterior component separation procedures (92% vs 84%), utilized permanent mesh (92% vs 88%), and placed mesh in sublay position. In spite of operating on more advanced hernias, high-volume surgeons achieved comparable rates (all P > 0.4) of 30-day surgical site infections (SSI: 6.9% vs 7.1%) and surgical site occurrences requiring procedural intervention (SSO-PI: 8.9% vs 10%). High-volume surgeons maintain comparable outcomes following cAWR despite performing operations on patients with more comorbidities and advanced hernia disease. These findings should be integrated into the debates related to regionalizing abdominal wall reconstruction procedures among high-volume surgeons.

The impact of comorbidities on postoperative outcomes of ventral hernia repair: the patients' perspective.

Ventral hernia repair (VHR) outcomes can be adversely affected by modifiable patient co-morbidities, such as diabetes, obesity, and smoking. Although this concept is well accepted among surgeons, the extent to which patients understand the significance of their co-morbidities is unknown, and a few studies have sought to determine patient perspectives regarding the impact of their modifiable co-morbidities on their post-operative outcomes. We attempted to determine how accurately patients predict their surgical outcomes after VHR compared to a surgical risk calculator while considering their modifiable co-morbidities. This is a prospective, single-center, survey-based study evaluating patients' perceptions of how their modifiable risk factors affect outcomes after elective ventral hernia repair. Pre-operatively, after surgeon counseling, patients predicted the percentage of impact that they believed their modifiable co-morbidities (diabetes, obesity, and smoking) had on 30-day surgical site infections (SSI) and hospital readmissions. Their predictions were compared to the Outcomes Reporting App for CLinicians and Patient Engagement (ORACLE) surgical risk calculator. Results were analyzed using demographic information. 222 surveys were administered and 157 were included in the analysis after excluding for incomplete data. 21% had diabetes, 85% were either overweight with body mass index (BMI) 25-29.9 or obese (BMI ≥ 30), and 22% were smokers. The overall mean SSI rate was 10.8%, SSOPI rate was 12.7%, and 30-day readmission rate was 10.2%. ORACLE predictions correlated with observed SSI rates (OR 1.31, 95% CI 1.12-1.54, p < 0.001), but patient predictions did not (OR 1.00, 95% CI 0.98-1.03, p = 0.868). The correlation between patient predictions and ORACLE calculations was weak ([Formula: see text] = 0.17). Patient predictions were on average 10.1 ± 18.0% different than ORACLE, and 65% overestimated their SSI probability. Similarly, ORACLE predictions correlated with observed 30-day readmission rates (OR 1.10, 95% CI 1.00-1.21, p = 0.0459), but patient predictions did not (OR 1.00, 95% CI 0.975-1.03, p = 0.784). The correlation between patient predictions and ORACLE calculations for readmissions was weak ([Formula: see text] = 0.27). Patient predictions were on average 2.4 ± 14.6% different than ORACLE, and 56% underestimated their readmission probability. Additionally, a substantial proportion of the cohort believed that they had a 0% risk of SSI (28%) and a 0% risk of readmission (43%). Education, income and healthcare employment did not affect the accuracy of patient predictions. Despite surgeon counseling, patients do not accurately estimate their risks after VHR when compared to ORACLE. Most patients overestimate their SSI risk and underestimate their 30-day readmission risk. Furthermore, several patients believed that they had a 0% risk of SSI and readmission. These findings persisted regardless of level of education, income level, or healthcare employment. Additional attention should be directed toward setting expectations prior to surgery and using applications such as ORACLE to assist in this process.

Identification of predictive factors for surgical site infections in gastrointestinal surgeries: A retrospective cross-sectional study in a resource-limited setting

Background: Surgical site infection (SSI), albeit infrequent, drastically impact the quality of care. This article endeavors to investigate the predictive factors of SSIs following surgical interventions that involve the gastrointestinal (GI) tract within a single institution in a resource-limited setting. Methods: Over seven years from June 2015 to Oct 2022, patients who underwent GI surgery and developed SSI were retrospectively matched with an unaffected case-control cohort of patients. Standardized techniques for wound culture, laboratory evaluation of bacterial isolates, and antibiotic susceptibility tests were employed. Logistic regression analysis was utilized to investigate the predictive factors associated with 30-day postoperative SSI. Results: A total of 525 patients who underwent GI surgical procedures were included, among whom, 79 (15%) developed SSI. The majority of SSIs were superficial (67.10%), Escherichia coli was the most commonly isolated bacterium (54.4%), and a high percentage of multidrug-resistant organisms were observed (63.8%). In multivariate Cox regression analysis, illiteracy (Odds ratio [OR]:40.31; 95% confidence interval [CI]: 9.54-170.26), smoking (OR: 21.15; 95% CI: 4.63-96.67), diabetes (OR: 5.07; 95% CI: 2.27-11.35), leukocytosis (OR: 2.62; 95% CI: 1.24-5.53), hypoalbuminemia (OR: 3.70; 95% CI: 1.35-10.16), contaminated and dirty wounds (OR: 6.51; 95% CI:1.62-26.09), longer operative time (OR: 1.02; 95% CI: 1.01-1.03), emergency operations (OR: 12.58; 95% CI: 2.91-54.30), and extending antibiotic prophylaxis duration (OR: 3.01; 95% CI: 1.28-7.10) were the independent risk factors for SSI (all p &lt; 0.05). Conclusions: This study highlights significant predictors of SSI, including illiteracy, smoking, diabetes, leukocytosis, hypoalbuminemia, contaminated and dirty wounds, longer operative time, emergency operations, and extending antibiotic prophylaxis duration. Identifying these risk factors can help surgeons adopt appropriate measures to reduce postoperative SSI and improve the quality of surgical care, especially in a resource-limited setting with no obvious and strict policy for reducing SSI.

The Role of Admission Hyperglycaemia as a Risk Factor for Surgical Site Infection in Orthopaedic Trauma Patients

Introduction: Acute hyperglycemia following traumatic injury is common. Studies have shown that 20– 30% of trauma patients present following injury with blood glucose values ≥ 200 mg/dL, and that a majority of patients demonstrate values ≥ 150 mg/dL. The relationship between hyperglycemia and adverse outcomes, such as infectious complications, has been well described in the surgical literature. Post-traumatic hyperglycemia is less well-documented in orthopaedic trauma patients. Aim of the Study: The aim of this study was to evaluate the role of admission hyperglycaemia as a risk factor for surgical site infection in orthopaedic trauma patients. Methods: This was a retrospective observational study and was conducted in the Department of Orthopaedics Surgery of Brahmanbaria medical college Hospital, Brahmanbaria, Bangladesh during the period from October, 2020 to October, 2022. We included 130 patients who were admitted to orthopaedics surgery department. Result: Majority of our patients (41.54%) were aged 41-50 years and 65% patients were male compared to female (35%). The mean age was 45.69 ± 22.83 years. Majority (41.54%) of our patients had a preoperative American Society of Anesthesiologists (ASA) classification of II. Majority of patients 36.15% had type 1 open fracture. We found 45 patients with surgical site infection. Admission glucose more than 200 mg/dL was found higher (26.67%) in infected group. Among the hyperglycemic patients 36.36% were classified as ASA III &amp; the surgical site infection for 30 days was found 54.55%. Conclusion: We found that orthopaedic trauma patients without a history of diabetes showed a significant independent correlation between an admission BG value of ≥200 mg/dL and 30-day surgical site infection (SSI). Because of this, admission glucose readings in orthopaedic trauma patients may be a key indicator of the risk of infection.

Paradoxical Associations Exist Between BMI Category and Perioperative Complications Following Lower Extremity Arterial Bypass

Paradoxical Associations Exist Between BMI Category and Perioperative Complications Following Lower Extremity Arterial Bypass

O171 Evaluation of remote surgical wound assessment in routine surgical practice: a mixed-methods pilot implementational study of a novel mobile digital intervention

Abstract Introduction Remote postoperative wound surveillance provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot remote digital postoperative wound surveillance and evaluate the readiness for implementation in routine practice. Methods A single-arm implementational study of remote postoperative wound surveillance in two tertiary care hospitals (clinicaltrials.gov: NCT05069103). Adults undergoing abdominal surgery received smartphone-delivered wound assessment for 30-days postoperatively (photographs and patient-reported SSI symptoms). Technology acceptance was assessed using 5-point Likert scales from the validated Telehealth Usability Questionnaire (TUQ), and summarised using means and 95% confidence intervals (CI). A mixed-methods approach was used with synthesis according to the WHO framework for monitoring and evaluating digital health interventions. Results 200 patients participated between July 2021 and April 2022, with 115 (57.5%) undergoing emergency procedures. The 30-day SSI rate was 16.5% (n=33/200), with 72.7% (n=24) diagnosed post-discharge. Usage of the intervention was 83.0% (n=166/200), with subsequently 74.1% (n=123/166) TUQ completion. Patient acceptance was high with regards to satisfaction (4.27, CI: 4.13-4.41) and usefulness (4.07, CI: 3.92-4.23). Communication was rated lowest (3.86, CI: 3.71-4.02), related to the desire for more frequent and personalised interactions with the surgical team. Nevertheless, the majority perceived improved quality (3.72, CI: 3.56-3.89) and efficiency (4.08, CI: 3.93-4.23) over routine postoperative care. Conclusion Remote postoperative wound surveillance successfully demonstrates readiness for implementation according to the WHO framework. Both patients and healthcare services can benefit from enhanced community support to ensure appropriate and timely management.