Deep Space Surgical Site Infections Research Articles

Evaluation of the Efficacy of Magnetic Resonance Imaging for Feminizing Gender Affirmation Genital Surgery: A Novel Approach.

Background Gender dysphoria is treated with gender affirmation surgery (GAS) for assigned male at birth (AMAB) individuals. This study aimed to evaluate the postoperative anatomical changes in AMAB individuals who underwent GAS using magnetic resonance imaging (MRI) and to compare it with cis-females, thereby assessing the efficacy of the surgical technique in achieving pelvic anatomy similar to cis-females. Methodology This was a prospective observational study done in a tertiary care hospital. AMAB individuals who underwent gender affirmation genital surgery using single-stage solely penile skin inversion vaginoplasty were included after informed consent and approval by the Institutional Human Ethics Committee. Patients with complications such as deep space surgical site infection (SSI) and neo-vaginal prolapse were excluded. All the study participants were advised a vaginal self-dilatation regimen, reviewed three months after the surgery, and subjected to an MRI of the pelvis with a vaginal tutor. Parameters such as neo-vaginal depth, alpha (α) angle, rectovaginal thickness, and remnant of corpora cavernosa were measured and compared with cis-female parameters measured from images in the archives from the Department of Radiology. Result A total of 21 patients were included in the study, with a mean age of 27±4.7. Between the study group and cis-females, no significant difference was seen in vaginal depth, and cis-females had significantly higher values in other parameters. There was a significant difference between the subgroups, i.e., defaulters and non-defaulters in soft tissue parameters such as vaginal depth (p=0.001), αangle (p=0.002), and rectovaginal thickness (p=0.002) with the non-defaulter patients having higher values. Conclusion Single-stage penile skin inversion vaginoplasty is capable of producing anatomical parameters, importantly neo-vaginal depth, which is fairly comparable with cis-female, as evident in the non-defaulter subgroup patients. Proper compliance with the vaginal dilatation regimen plays a significant role in the maintenance of soft tissue pelvic anatomical parameters.

Machine Learning Model for Assessment of Risk Factors and Postoperative Day for Superficial vs Deep/Organ-Space Surgical Site Infections.

Background. Deep and organ space surgical site infections (SSI) require more intensive treatment, may result in more severe clinical disease and may have different risk factors when compared to superficial SSIs. Machine learning (ML) algorithms provide the opportunity to analyze multiple factors to predict of the type and time of development of SSI. Therefore, we developed a ML model to predict type and postoperative week of SSI. Methodology. A case-control study was conducted among patients who developed a SSI after undergoing general surgery procedures at a tertiary care hospital between 2019 to 2020. Patients were followed for 30 days. Six ML algorithms were trained as predictors of type of infection (superficial vs deep/organ space) and time of infection, and tested using area under the receiver operating characteristic curve (AUC-ROC). Results. Data for 113 patients with SSIs was available. Of these 62 (54.8%) had superficial and 51 had (45.2%) deep/organ space infections. Compared with other ML algorithms, the XG boost univariate model had highest AUC-ROC (.84) for prediction of type of SSI and Stochastic gradient boosting univariate, logistic regression univariate, XG boost univariate, and random forest classification univariate model had the highest AUC-ROC (.74) for prediction of week of infection. Conclusions. ML models offer reasonable accuracy in prediction of superficial vs deep SSI and time of developing infection. Follow-up duration and allocation of treatment strategies can be informed by ML predictions.

Outcomes of Exploratory Laparotomy and Abdominal Infections Among Combat Casualties

BackgroundAbdominal injuries historically account for 13% of battlefield surgical procedures. We examined the occurrence of exploratory laparotomies and subsequent abdominal surgical site infections (SSIs) among combat casualties. MethodsMilitary personnel injured during deployment (2009-2014) were included if they required a laparotomy for combat-related trauma and were evacuated to Landstuhl Regional Medical Center, Germany, before being transferred to participating US military hospitals. ResultsOf 4304 combat casualties, 341 (7.9%) underwent laparotomy. Including re-explorations, 1053 laparotomies (median, 2; interquartile range, 1-3; range, 1-28) were performed with 58% occurring within the combat zone. Forty-nine (14.4%) patients had abdominal SSIs (four with multiple SSIs): 27 (7.9%) with deep space SSIs, 14 (4.1%) with a deep incisional SSI, and 12 (3.5%) a superficial incisional SSI. Patients with abdominal SSIs had larger volume of blood transfusions (median, 24 versus 14 units), more laparotomies (median, 4 versus 2), and more hollow viscus injuries (74% versus 45%) than patients without abdominal SSIs. Abdominal closure occurred after 10 d for 12% of the patients with SSI versus 2% of patients without SSI. Mesh adjuncts were used to achieve fascial closure in 20.4% and 2.1% of patients with and without SSI, respectively. Survival was 98% and 96% in patients with and without SSIs, respectively. ConclusionsLess than 10% of combat casualties in the modern era required abdominal exploration and most were severely injured with hollow viscus injuries and required massive transfusions. Despite the extensive contamination from battlefield injuries, the SSI proportion is consistent with civilian rates and survival was high.

The association between illicit drug use and infectious complications among trauma patients

Management of patients with traumatic injury is a complex endeavor requiring a concerted effort of multi-organ stabilization and prevention of septic shock. Given that traumatic injury is frequently mediated by illicit drug use, which has previously been associated with immune suppression, it is hypothesized that infectious complications may occur more prevalently in this patient population. In this study, we evaluate the incidence of infectious complications in trauma patients who screened positive for illicit drug abuse. The national trauma databank was queried for all patients who underwent laboratory evaluation for drug use between 2002 and 2009 and between 2013 and 2014. Patient demographics, clinical outcomes (injury severity score [ISS], intensive care unit length of stay [ILOS], hospital length of stay [HLOS], mortality, risk-adjusted ILOS [rILOS] or HLOS [rHLOS]) and infectious complications (pneumonia, superficial surgical site infection, organ space infection, deep space surgical site infection and urinary tract infection) were attained. Out of 5,564,821 incidents, 525,052 admissions met the inclusion criteria. Patients were 41 ± 19 years of age and 72% were male. Patients positive for drug use were 1.1-fold more likely to develop pneumonia, 1.2-fold more likely to develop superficial site infection, and 1.3-fold more likely to develop organ space infection. No statistically significant variations in ILOS, HLOS, rILOS, rHLOS or mortality were noted. Traumatic patients who screen positive for illicit drug use are more likely to develop infectious complications. Therefore, vigilance and appropriate preventative measures should be considered in this unique group of patients.

Feeding jejunostomy during Whipple is associated with increased morbidity

BackgroundPlacement of a feeding jejunostomy tube (FJ) is often performed during pancreaticoduodenectomy (PD). Few studies, however, have sought to determine whether such placement affects postoperative outcomes after PD. Materials and methodsThis is a retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database to determine the 30-d-postoperative mortality rate, major complication rate, and overall complication rate of jejunostomy tube placement at the time of PD. Univariate and multivariate comparison of postoperative outcomes between patients with and without FJ placement during PD was performed on a total of 4930 patients. ResultsThirty-day-postoperative mortality did not differ between the two groups (4.0% for patients with FJ versus 2.7% without, P = 0.13), whereas overall morbidity (43.3% with FJ versus 34.6% without, P < 0.0001) and serious morbidity (29.5% with FJ versus 22.8% without, P < 0.0001) were significantly higher in patients undergoing FJ placement during PD. The specific complications that occurred more frequently in FJ patients than patients without FJ included deep space surgical site infection, pneumonia, unplanned reintubation, acute renal failure, and sepsis. ConclusionAlthough FJ placement during PD is considered to be routine at many institutions, our analysis of data from NSQIP suggest that FJ placement may be associated with increased postoperative morbidity.

Predicting Adverse Outcomes After Complex Cancer Surgery

Predicting Adverse Outcomes After Complex Cancer Surgery