Difference In Postoperative Infection Rates Research Articles

Immediate plate fixation of open tibial plafond fractures does not elevate risk of infection.

To determine if immediate plate fixation of open tibial plafond fractures has a negative effect on soft tissue complications and increases the risk of deep infection. This was a single-institution retrospective cohort study performed at level-1 trauma center. All patients with open OTA/AO 43C plafond fractures treated over 20-year period with follow-up until fracture union or development of deep infection. Ninety-nine of 333 identified patents met the inclusion criteria. The intervention was operative treatment of open tibial plafond fractures. The main outcome measurements were return to operating room for deep infection, nonunion, and below knee amputation. The overall rate of complications was 52%. Gender, body mass index, tobacco use, diabetes, ASA classification, time to OR from injury, wound location, and associated fibula fracture were not associated with deep infection. There was a significant difference in Gustilo-Anderson fracture grade among infected versus non-infected (P = 0.04). There was no significant difference in postoperative infection rates between patients treated with external fixation, external fixation and limited plate fixation, and plate fixation alone during initial surgery (P = 0.64). It is well established that open pilon fractures have a high incidence for postoperative infection and development of complications such as nonunion. As these injuries have poor clinical outcomes, any additional measures to prevent infection and soft tissue complications should be utilized. In appropriately selected cases, both immediate plate fixation and immediate limited plate fixation with external fixation at the time of I&D do not appear to elevate risk of deep infection. Therapeutic Level III.

Limited Efficacy of Empiric Antibiotics for Pediatric Facial Fractures

Controversies exist regarding the role of perioperative antibiotic use in pediatric craniomaxillofacial fracture repair. This study aims to identify factors associated with antibiotic prescribing patterns and measures the association between antibiotic exposure and postoperative infections. In this retrospective cohort study, TriNetX, a research database, was used to gather data on patients under 18years of age who underwent repair of facial fractures. The records were obtained from 2003 to 2021. Current Procedural Terminology codes for facial fracture procedures were used to identify patients. Antibiotic use, defined as a binary categorical variable of whether or not patients received perioperative antibiotics. The secondary predictor variable was timing ofantibiotic administration, categorized by pre, intra, and postoperative administration. Postoperative infection, determined by International Classification of Diseases, 9th and 10th Revision codes within patient charts. Covariates included demographic variables such as age, sex, race, ethnicity, geographic location, and fracture characteristics, such as number of fractures and location of fracture. χ2 analyses were used for categorical variables and two sample t tests for quantitative variables. Multivariable logistic regression was used to evaluate patient infection and antibiotic use with adjustment for covariates. P-values were 2-tailed and statistical significance was defined as P<.05. This cohort included 5,413 patients of which 70.4% were male, 74.4% identified as white, and 83.3% identified as non-Hispanic or Latino. There were no differences in postoperative infections in patients who received antibiotics compared to those who did not (0.9 vs 0.5%, respectively, P=.12). Nevertheless, antibiotic prescriptions have increased over the years. After controlling for relevant covariates, antibiotic use did not decrease the odds of infection (adjusted odds ratio 1.1, 95% CI 0.53 to 2.34, P=.79). There was a significant association between the timing of antibiotic use and infection (P=.044), with increased odds of infection when antibiotics were given postoperatively (adjusted odds ratio 3.8, 95% CI 1.2 to 12.07, P=.023). While antibiotic prescriptions have increased over the years, this study demonstrates there is no difference in postoperative infection rates for pediatric patients prescribed antibiotics and those where were not.

Preoperative Epidural Steroid Injection Does Not Increase Infection Risk Following Posterior Cervical Surgery.

Retrospective cohort study. The purpose of this study was to characterize infection risk of preoperative epidural steroid injection (ESI) in patients undergoing posterior cervical surgery. ESI is a helpful tool for alleviating pain and is often used as a diagnostic tool prior to cervical surgery. However, a recent small-scale study found that ESI prior to cervical fusion was associated with an increased risk of postoperative infection. Patients from 2010-2020 with cervical myelopathy, spondylosis, and radiculopathy who underwent posterior cervical procedure including laminectomy, laminoforaminotomy, fusion, or laminoplasty were queried from the PearlDiver database. Patients who underwent revision or fusion above C2 or who had a diagnosis of neoplasm, trauma, or pre-existing infection were excluded. Patients were divided on whether they received an ESI within 30 days prior to the procedure and subsequently matched by age, gender, and preoperative comorbidities. Chi-squared analysis was used to calculate risk of postoperative infection within 90 days. Logistic regression controlling for age, sex, ECI, and operated levels was conducted within the unmatched population to assess infection risk for injected patients across procedure subgroups. Overall, 299417 patients were identified with 3897 having received a preoperative ESI and 295520 who did not. Matching resulted in 975 in the injected group and 1,929 in the control group. There was no significant difference in postoperative infection rate in those who received an ESI within 30 days preoperatively and those who did not (3.28% vs. 3.78%, OR=0.86, 95% CI: 0.57-1.32, P=0.494). Logistic regression accounting for age, gender, ECI, and levels operated demonstrated that injection did not significantly increase infection risk in any of the procedure subgroups. The present study found no association between preoperative ESI within 30 days prior to surgery and postoperative infection in patients undergoing posterior cervical surgery.

Preliminary Analysis of Contamination in Liver Preservation Solution and Prophylaxis for Post-transplant Infection

Objective To discuss the preservation solution (PS) contamination and initial experience of liver transplantation from organ donation by citizens after death and initial experience. Methods The 78 liver transplant recipients were divided into positive group and negative group based on the finding of the culture of PS. The positive group received the sequential therapy of antibiotics with ertapenem and imipenem for one week, and the negative group stopped using imipenem. The situation of PS contamination and infection after liver transplantation and prognosis during the follow-up 3 months of the recipients were analyzed. Results PS culture positive rate was 41.03%, and 33 strains of pathogens were isolated. The most common pathogenic bacteria were gram-negative bacilli (9 strains, 27.27%) and <i>coagulase –negative staphylococci</i> (9 strains, 27.27%). The infection rate after liver transplantation was 31.25% and 13.04%, respectively, in positive group and negative group (χ²=3.837, <i>P</i>=0.048). The most frequent infection sites were lower respiratory tract (5 cases, 31.25%), abdominal cavity (5 cases, 31.25%) and surgical incision (4 cases, 25.00%). There was no significant difference in postoperative infection rate among patients with different CTP, MELD and surgical methods (<i>P</i>>0.05). One case (1.28%) was infected with the same pathogenic bacteria as PS contamination 3 weeks after liver transplantation, and died of multiple organ failure. There was no significantly difference in the acute rejection rate (1,3.13% and 2, 4.35%) and mortality (2,6.25% and 5,10.87%) between the two groups (<i>P</i>>0.05). Conclusion Contamination of the PS is frequent in liver transplantation, and it is the risk factor for postoperative infection of recipients. Early targeted antimicrobial treatment against pathogens cultured from PS play a positive role in reducing the contamination-associated infection rate after liver transplantation.

Outcomes following use of a standard antibiotic protocol in the management of maxillofacial trauma patients

PurposeTo evaluate the effectiveness of a standard antibiotic regimen protocol in the management of maxillofacial trauma patients. Materials and methodsThe study sample included patients with at least one facial fracture and managed by either closed (CR/MMF) or open reduction (ORIF) by the Oral and Maxillofacial Surgery service. A standardized antibiotic administration protocol based on type of treatment performed and timing of surgical intervention was used in the management of all patients. The primary predictor variable was antibiotic usage. The primary outcome measured was postoperative surgical site infection. Bivariate analysis was performed to assess the association between antibiotic exposure and postoperative surgical site infection. A p value of less than or equal to .05 was deemed to be significant. ResultsThe study sample comprised of 392 patients (102 midface and 290 mandible fractures). The mean age of the study group was 35 years and 89% of the patients were male. Postoperative infection was encountered in 18 patients (all with compound mandible fractures). The infection rates were 3.6% after CR/MMF and 8.7% after ORIF. No patient with midface fractures developed an infection. Chi-square test showed no statistically significant difference in postoperative infection rate in mandible fractures treated either by CR/MMF (p = 0.91) or ORIF (p = 0.94). ConclusionsUse of this antibiotic administration protocol limits antibiotic usage and standardizes their administration in the management of maxillofacial trauma without increasing the rate of postoperative surgical site infections.

The Effect of Povidone-Iodine Lavage in Preventing Infection After Total Hip and Knee Arthroplasties: Systematic Review and Meta-Analysis

BackgroundDilute povidone-iodine (PI) lavage, a simple disinfection method, could reduce postoperative infection risk. However, there is no clinical consensus regarding its efficacy in total joint arthroplasties (TJAs). This systematic review and meta-analysis evaluated PI lavage’s efficacy in preventing infection after TJA. MethodsMEDLINE, Embase, and the Cochrane Library were systematically searched for studies published before November 22, 2019, that compared postoperative infection rates in patients who underwent TJA with or without PI lavage before wound closure. Subgroup analyses were designed to identify the differences in infection site (overall or deep), type of surgery (total hip arthroplasty or total knee arthroplasty), time until diagnosis of infection (3 or 12 months postoperatively), and primary/aseptic revision arthroplasties. ResultsWe included 7 studies with 31,213 TJA cases, comprising 8861 patients who received PI lavage and 22,352 who did not. Pooled odds ratio for overall infection rate for the PI and non-PI lavage groups was 0.67 (95% confidence interval, 0.38-1.19, P = .17) and for the deep infection rate was 0.90 (95% confidence interval, 0.27-2.98, P = .86). Subgroup analyses revealed no differences in postoperative infection rates between the PI and non-PI lavage groups in terms of total hip arthroplasty and total knee arthroplasty, diagnosis of infection at 3 and 12 months postoperatively, or primary and aseptic revision arthroplasties. ConclusionWe detected no differences in the overall postoperative infection rates between the PI and non-PI lavage groups before wound closure in TJA including all studies in the subgroup analyses.

Postoperative Oral Antibiotics in Outpatient Foot and Ankle Surgery: Are We Affecting Postoperative Infections or Wound Healing Complications?

Category:InfectionIntroduction/Purpose:Postoperative infections after foot and ankle surgery can cause devastating outcomes for patients. Studies of postoperative infection rates in outpatient foot and ankle surgery range from 0.5-6.5%, with increasing numbers found in diabetic patient populations. The use of perioperative antibiotics in the prevention of postoperative infection in outpatient surgery is a topic that has often been discussed yet there remains considerable controversy. The authors hypothesize that there is no difference in postoperative infection rate or wound healing complications in patients who received postoperative oral antibiotics versus those that did not. Additionally, the authors sought to identify patient characteristics associated with postoperative infections or wound complications.Methods:Retrospective chart review of 649 elective outpatient foot and/or ankle surgery cases over a 2-year period performed by two fellowship trained foot and ankle surgeons at an academic medical center ambulatory surgical unit. All cases were included with at least one follow-up visit and no evidence of chronic wounds or infection. Those cases that did not have adequate follow up or if postoperative antibiotic treatment could not be determined were subsequently excluded. Analysis evaluated patients that received postoperative oral antibiotics (PAB) and those that did not receive postoperative oral antibiotics (NAB) to identify whether a difference in infection rate or wound healing complication were present. Patient demographics, medical comorbidities, BMI, smoking status, and tourniquet time were analyzed to identify contributing factors or comorbidities that may be more prevalent in those that developed postoperative infections in the PAB and NAB groups.Results:633 operative cases were included in the study. The average age of patients in the PAB group and NAB group was equal (age 45 ± 17). The number of infections in PAB was 6, while the number of infections in NAB was 10 (3% vs. 2%, p = 0.60). The number of deep versus superficial infections and wound complications between the two groups was not statistically significant. Patients that developed infections versus those that did not were older (average age 55 vs. 45, p = 0.02), demonstrated a higher prevalence of hypertension (44% vs. 17%, p = 0.01), and a history of neoplasm (19% vs. 2%, p < 0.01). No significant difference was found between groups based on BMI, diabetes, tourniquet time, or smoking status.Conclusion:There are limited studies published on the efficacy of routine postoperative antibiotics in outpatient foot and ankle surgery, despite a majority of surgeons (75%) reporting using postoperative antibiotics.2 The present study suggests there is no benefit to prescribing postoperative oral antibiotics in an outpatient surgery setting. Additionally, older patients, patients with hypertension, and patients with a history of neoplasm made up a larger percentage of patients in the postoperative infection group. BMI, diabetes, tourniquet time and smoking status did not have a significant difference in postoperative infections between the PAB group and NAB group.

A retrospective analysis of the use of intravenous dexamethasone for postoperative nausea and vomiting in total joint replacement

BackgroundMultimodal perioperative pain-management protocols have contributed to the success of elective total joint replacement in orthopedic surgery. General or neuraxial anesthesia for arthroplasty is accompanied by complications such as pruritis, nausea, and vomiting. Dexamethasone has been demonstrated to be a safe perioperative antiemetic. This study evaluates the benefit of low-dose intravenous dexamethasone used in the perioperative period to prevent postoperative nausea and vomiting.MethodsTwo scheduled doses of 8 mg of dexamethasone 12 hours apart after total hip arthroplasty or total knee arthroplasty were given to a dexamethasone group (n = 492) and were retrospectively compared with a no-dexamethasone group (n = 364) based on the use of antiemetics in the postoperative period. Frequency of antiemetic use in both groups was compared using a zero-inflated fixed-model Poisson distribution. Additional analysis included need for opioid analgesic, administration of diphenhydramine, and postoperative infection rates at 30 and 90 days.ResultsThe dexamethasone group was found to have a significant reduction in need for the rescue antiemetic ondansetron (P = .00194). There was an associated reduction in length of stay for the treatment group (mean 1.83 days) relative to the control group (mean 2.17 days) (P < .001). There was no significant difference in postoperative infection rates at 30 or 90 days after arthroplasty.ConclusionsDexamethasone is a safe adjunct to perioperative protocol that may reduce nausea, thus improving patient satisfaction. There is an associated reduction in length of stay that may reduce cost of hospitalization.

Severe LVAD-related infections requiring surgical treatment: Incidence, predictors, effect on survival, and impact of device selection.

Left ventricular assist devices (LVADs) are being used more frequently for treating refractory, advanced heart failure. However, infection remains a frequent complication. In this study, we analyzed the incidence of severe infections in LVAD recipients to determine its impact on survival. From May 2009 through March 2016, 437 patients with advanced heart failure underwent implantation of a continuous-flow LVAD (n = 314, HeartMate II LVAD [Abbott Laboratories, Abbott Park, IL]; n = 123 HeartWare HVAD [Medtronic, Minneapolis, MN]). We analyzed the rate of severe device infection requiring surgical intervention or involving sepsis and the impact of severe infection on outcomes in patients on long-term LVAD support. Infection occurred in 244 patients (HeartMate II, n = 186; HVAD, n = 58); severe infections developed in 160 patients (HeartMate II, n = 119; HVAD, n = 41). HeartMate II recipients had 344 severe infection events (0.63 events per patient-year [EPPY]), whereas HeartWare recipients had 89 severe infection events (0.42 EPPY; P = 0.047). HeartMate II recipients had a higher incidence of pump infections (P < 0.001). Severe infections did not significantly affect survival (P = 0.42). Although HeartMate II patients had a significantly higher incidence of pump infections requiring surgical treatment, survival was not adversely affected. The difference in postoperative infection rates may be an important factor in device type selection.

Thursday, September 27, 2018 8:30 AM–9:30 AM Best Papers: 106. Do preoperative epidural steroid injections increase the risk of infection after lumbar spine surgery?

BACKGROUND CONTEXT Lumbar radiculopathy occurs in up to 5% of the population accounting for significant morbidity. Lumbar epidural corticosteroid injections (ESI) may provide diagnostic and therapeutic benefit in the nonoperative management of radiculopathy. However, concern exists regarding whether preoperative ESI's might predispose surgical patients to an increased risk of postoperative infection. PURPOSE To determine an association and temporal relationship between preoperative ESI and postoperative infection in a large population of patients undergoing lumbar surgery. STUDY DESIGN/SETTING Retrospective review of all patients who underwent elective lumbar surgery for radiculopathy or stenosis at a single institution between 2000 and 2017 with at least 90 days follow-up. PATIENT SAMPLE All patients who underwent lumbar surgery were identified in our institutional database by ICD and CPT code. Those who underwent preoperative lumbar ESI were also identified by CPT code. Patients were categorized as no ESI, preoperative ESI less than 30 days, 30-90 days, and greater than 90 days before surgery. Pre- and postoperative clinical data was available in a single electronic medical record. OUTCOME MEASURES The primary outcome measure was postoperative infection requiring reoperation within 90 days of index procedure. Postoperative infections were identified by ICD code and confirmed by operative report for each patient. METHODS Of the patients who underwent lumbar spine surgery, those who received preoperative lumbar ESI were identified. Postoperative infection rates were determined by ICD code and operative report. All demographic information including age, sex, body mass index (BMI) and Charlson Comorbidity Index (CCI) was determined. Comparison and regression analysis was used to determine an association between preoperative ESI exposure, demographics, comorbidities, and postoperative infection. RESULTS A total of 15,011 patients who underwent elective lumbar surgery were included. Of these, 197 (1.3%) were diagnosed with postoperative infection. Of the identified patients, 595 had lumbar ESI within 30 days of surgery, 1709 within 30-90 days of surgery, and 2036 greater than 90 days before surgery. Overall, there was a marginally higher rate of infection among the cohort of patients who had a preoperative ESI that did not reach statistical significance (1.54% vs. 1.22%, p=.118). Among the temporal subgroups, there was no significant difference in postoperative infection rates between those patients who had ESI within 30 days of surgery (12/595, 2.0%, p=.089) or those who had ESI 30-90 days before surgery (15/1709, 0.9%, p=.23) compared to those with no preoperative ESI (130/10541, 1.2%). Those patients who underwent ESI greater than 90 days before surgery had a higher rate of infection (40/2036, 2.0%) compared to those with no ESI (p=.007). Sub analysis of those patients who underwent ESI greater than 90 days before surgery demonstrated that patients with a postoperative infection had a higher BMI (p CONCLUSIONS This retrospective single institution review of over 15,000 patients undergoing lumbar spine surgery demonstrated that increased body mass index and Charlson Comorbidity Index are stronger predictors of postoperative infection after lumbar spine surgery than having received a preoperative ESI. Although the data did not demonstrate a temporal relationship between preoperative lumbar epidural steroid injection and risk of postoperative infection, there was a trend toward a higher infection rate among all patients who underwent preoperative ESI when compared with those who did not. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Should we bury K-wires after metacarpal and phalangeal fracture osteosynthesis?

BackgroundBurying Kirschner wires (K-wires) under the skin after metacarpal and phalangeal fracture osteosynthesis may reduce risk of infection, but it might also complicate later removal. Purpose/aim of studyTo examine infection and reoperation rates after metacarpal and phalangeal fracture osteosynthesis with buried versus exposed K-wires. Materials and methodsMetacarpal and phalangeal fractures treated with K-wire osteosynthesis at our institution from 1st of January, 2009 to 1st of February, 2015 were identified retrospectively. The final study population included 444 patients, 331 with metacarpal, 109 phalangeal and 4 with mixed fractures. Surgical and patient records were examined 90 days postoperatively. Findings/results337 patients (75.9%) were treated with buried K-wires and 107 patients (24.1%) with exposed (non-buried) K-wires. 14 patients (4.1%) treated with buried K-wires presented with postoperative infection, opposed to 7 patients (6,5%) treated with non-buried K-wires (p = 0.311). None of the postoperative infections caused re-operation. Only one case of deep/severe infection was recorded in a patient treated with buried K-wires requiring intravenous antibiotic treatment. In 58 of 337 patients (17.2%) treated with buried K-wires, removal was not possible in the outpatient clinic and required readmission for removal in the operation theatre. All exposed K-wires could be removed in the out-patient clinic without re-operation. ConclusionsWe found no difference in postoperative infection rate between metacarpal and phalangeal fracture osteosynthesis with buried versus exposed K-wires. However, the high readmission and reoperation rate (17.2%) after burying K-wires should call for reconsideration of surgical strategies.

Optimal Timing of Preoperative Skin Preparation with Povidone-Iodine for Spine Surgery: A Prospective, Randomized Controlled Study.

Study DesignA prospective, randomized, controlled study.PurposeThe objective of this study was to evaluate the effectiveness of two techniques of skin preparation with povidone-iodine.Overview of LiteraturePreoperative skin preparation is important for preventing surgical site infection by reducing the bacteria in the surgical area. Povidone-iodine is a commonly used agent for preoperative skin preparation, and further decrease in surgical site infections can be expected by understanding how to apply it more effectively.MethodsEighty-nine spine surgery patients were randomly allocated to two groups. In group A, povidone-iodine was applied to the surgical site just before starting the operation; in group B, povidone-iodine was applied several minutes prior to starting the operation and was allowed to dry. We collected samples from the wound edge before suturing, and we compared the rates of positive culture between the two groups.ResultsThe rate of positive culture was 30.2% (13 out of 43 patients) in group A, and 6.5% (3 out of 46 patients) in group B. This indicates that there was a significant difference in postoperative infection rates between group A and group B.ConclusionsBecause bacteria on the skin appeared significantly reduced by allowing povidone-iodine to dry for several minutes prior to surgery, we recommend this approach to reduce the incidence of postoperative infections.

Comparative evaluation of short-term versus long-term post-operative antibiotic prophylaxis after mandibular fractures

Background: No consensus is present among the clinicians regarding the use of post-operative antibiotics after the open reduction and internal fixation. This study evaluates the efficacy of short-term (48 hrs) versus long-term (5 days) post-operative antibiotics in preventing infection rates after the open reduction and internal fixation in mandible fractures. Methods: A total of 80 patients of dentate mandibular fractures were divided randomly in 2 groups; Group 1 received post-operative intravenous antibiotics (amoxicillin+clavulanate 1.2 g+ metronidazole 0.5 g/100 cc) TDS for 48 hrs post-operatively Group 2 received same course for 5 post-operative days and patient were monitored for the signs of infection according to the centers for disease control and prevention criteria, rise in white blood cells counts and C-reactive protein (CRP) levels. Side effects were recorded in both groups. Results: Out of 39 patients in Group 1 two patients showed rise in CRP levels and single patient developed abscess, whereas in Group 2 wound dehiscence was noted in 2 patients and both had prolonged rise in CRP levels at the 5th day. Conclusions: No significant difference in post-operative infection rates was seen between two groups which suggests short-term post-operative antibiotic treatment is equally efficacious as long-term treatment.

Effects of the Sangvia blood collection system on patients undergoing elective hip surgery.

We have conducted a randomized controlled study where 164 patients were randomized to receive autologous salvaged blood collected by Sangvia™ Blood Salvage System or allogeneic red cell concentrates if transfusion was indicated by clinical judgement. The study was powered to detect if transfusion of autologous blood reduced the occurrence of postoperative infections. We found no statistical significant difference in postoperative infection rate between the groups, but this may be due to the fact that postoperative infections were diagnosed in only five patients. Increased C-reactive protein concentrations slightly above level of significance indicate that autologous blood transfusions stimulate the patient's immune system. However, there was no indication of increased transfusion reaction rate, including febrile reactions, in the autologous group. Transfusion of autologous blood did not reduce the use of allogeneic red cell concentrates. The mean use of allogeneic red cell concentrates was 0.93 units (both groups combined), indicating that the transfusion policy may have been too liberal. There was a highly significant inverse correlation between pre-operative haemoglobin concentration and transfusion of allogeneic blood. In a patient population with a low frequency of postoperative infection, a larger study is needed to clarify if autologous salvaged blood protects against postoperative infections.

Prophylactic Postoperative Antibiotics for Enucleation and Evisceration

To investigate the necessity and usefulness of prophylactic postoperative antibiotics in patients undergoing enucleation or ocular evisceration. A retrospective, multicenter, comparative case series was designed. After obtaining Institutional Review Board authorization, a medical records' review was conducted. Demographics, indication for surgery, surgical technique, postoperative antibiotic dosing, and postoperative course were evaluated. Records were grouped according to antibiotic protocols, and presence or absence of postoperative wound infection (orbital cellulitis) was recorded. Rates of postoperative infection were analyzed statistically. Between 1996 and 2011, 666 evisceration or enucleation surgeries were conducted at 4 institutions. Six hundred forty-eight records were available for analysis, of which 4 were excluded due to insufficient follow-up data. All the remaining 644 patients received a single, perioperative, intravenous dose of antibiotics. Five hundred seventy-eight patients (90%) received an orbital implant, while 66 (10%) did not. Three hundred eighty-one patients (59%) received postoperative antibiotics, and 263 patients (41%) did not. Two cases were identified with signs suggestive of infection, but no culture-positive infections were found, and no patient was admitted to the hospital for management. Of the 2 suspicious cases, 1 was found in the group that received postoperative antibiotics (group 1) and 1 in the group that did not receive postoperative antibiotics (group 2). No statistically significant difference in postoperative infection rate was noted between the 2 groups (p=0.52). While patients with infectious indications for surgery were more likely to receive postoperative antibiotics (p<0.001), there was no statistically significant difference in rates of infection among patients with infectious indications for surgery based on receiving or not receiving postoperative antibiotics (p=0.79), and no patients with infectious indications for surgery not receiving postoperative antibiotics developed a postoperative infection. This study demonstrates the clinical safety of withholding postoperative prophylactic antibiotics in orbital surgery even when implanting alloplastic material in a sterile field. Furthermore, Centers for Disease Control and Prevention guidelines mandate cessation of postoperative antibiotics within 24 hours of surgery. Surgeons are cautioned not to generalize these results to nonsterile surgery such as sinonasal or nasolacrimal surgery.

Open reduction and internal fixation of acute intra-articular displaced calcaneal fractures: A retrospective analysis of surgical timing and infection rates

The choice of surgical timing in open reduction for calcaneal fractures has been proposed to be associated with soft-tissue complications and infection. This study analysed the correlation between surgical timing and postoperative infection rates. We performed a retrospective single-surgeon single-facility study (Kaohsiung Medical University Hospital, KMUH) between January 2006 and January 2010. Fifty patients with 53 close intra-articular calcaneal fractures were included. They received open reduction and internal fixation via the extensile lateral L-shaped approach. We assessed the duration between heel trauma and operation from the medical records and sorted our patients into early (within 3 days), intermediate (from 3 to 10 days) and delayed (over 10 days) surgical groups. The mean follow-up period was 13 months. Only one of the 50 patients, a 74-year-old female with diabetes mellitus, developed deep infection requiring hardware removal and serial debridement. Overall, we did not find a statistical difference in postoperative infection rates in the different timing groups. Our conclusion is that in experienced hands, surgical timing may not affect postoperative infection rates in calcaneal fracture among strictly selected patients who do not have potential risk factors for wound complication. Therefore, early operation may be helpful to these patients.

The cost of post-operative shed blood salvage after total knee arthroplasty: an analysis of 1,093 consecutive procedures.

Requirements for allogeneic red cell transfusion after total knee arthroplasty are still high (20-50%), and salvage and reinfusion of unwashed, filtered post-operative shed blood is an established method for reducing transfusion requirements following this operation. We performed a cost analysis to ascertain whether this alternative is likely to be cost-effective. Data from 1,093 consecutive primary total knee arthroplasties, managed with (reinfusion group, n=763) or without reinfusion of unwashed salvaged blood (control group, n=330), were retrospectively reviewed. The costs of low-vacuum drains, shed blood collection canisters (Bellovac ABT, Wellspect HealthCare and ConstaVac CBC II, Stryker), shed blood reinfusion, acquisition and transfusion of allogeneic red cell concentrate, haemoglobin measurements, and prolonged length of hospital stay were used for the blood management cost analysis. Patients in the reinfusion group received 152±64 mL of red blood cells from postoperatively salvaged blood, without clinically relevant incidents, and showed a lower allogeneic transfusion rate (24.5% vs. 8.5%, for the control and reinfusion groups, respectively; p =0.001). There were no differences in post-operative infection rates. Patients receiving allogeneic transfusions stayed in hospital longer (+1.9 days [95% CI: 1.2 to 2.6]). As reinfusion of unwashed salvaged blood reduced the allogeneic transfusion rate, both reinfusion systems may provide net savings in different cost scenarios (€ 4.6 to € 106/patient for Bellovac ABT, and € -51.9 to € 49.9/patient for ConstaVac CBCII). Return of unwashed salvaged blood after total knee arthroplasty seems to save costs in patients with pre-operative haemoglobin between 12 and 15 g/dL. It is not cost-saving in patients with a pre-operative haemoglobin >15 g/dL, whereas in those with a pre-operative haemoglobin <12 g/dL, although cost-saving, its efficacy could be increased by associating some other blood-saving method.

Randomized Controlled Trial of the Effectiveness of Chlorhexidine Showers Before Elective Plastic Surgical Procedures

This randomized controlled trial was designed to assess the effect of preoperative chlorhexidine showers on skin colonization and postoperative infection rates associated with plastic surgical procedures involving the trunk. Chlorhexidine showers were effective in reducing skin colonization with coagulase-negative staphylococci and yeasts, but there was no difference in postoperative infection rates.

Risk for postoperative infection after transfusion of white blood cell–filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty

This study was designed to obtain data on the incidence of postoperative infection in patients undergoing elective orthopedic surgery and receiving white blood cell (WBC)-filtered blood components prepared according to current standards. A total of 308 consecutive orthopedic patients who opted for preoperative autologous blood donation (PAD) for primary unilateral hip and knee replacement surgery were enrolled in a prospective observational study of the incidence of postoperative infection. Patients with contraindications for PAD or with any infectious disease were not included in the study. To identify probably confounding factors, differences between patient groups were analyzed first. Identified factors, which differed between groups, and variables describing blood supply were further tested in uni- and multivariate logistic regression analysis for their independent influence on development of postoperative infection. Infection rates were compared on the basis of actual transfusion groups. Of the 308 study patients, 101 were not transfused, 85 received their PAD, 100 received allogeneic WBC-filtered red blood cells (RBCs), and 22 were given autologous RBCs and additionally allogeneic WBC-filtered RBCs. Overall the infection rate was 6.82 percent (21/308). Infection rates varied significantly between transfusion groups (no transfusion, 6.9%; autologous RBCs, 1.2%; allogeneic WBC-filtered RBCs, 12.0%; both transfusion types, 4.6%; p = 0.03). Allogeneic recipients showed significantly more infections compared to autologous recipients (p = 0.0053). Multivariate regression analysis confirmed transfusion of allogeneic WBC-filtered RBCs as an independent variable predicting postoperative infection (odds ratio, 23.65; confidence interval, 1.3-422.1; p = 0.01). Differences in postoperative infection rates between allogeneic and autologous recipients are still observable, although universal WBC filtration has been introduced into clinical practice.

Safety and efficacy of unmodified whole blood vs. buffy coat‐depleted red cell concentrates in autologous transfusion of elective orthopaedic surgery patients

Storing autologous blood as whole blood (WB) has been proposed for increasing the cost-effectiveness of preoperative autologous blood donation programmes. However, experimental data suggest that autologous leucocytes might lead to immunomodulation similar to the effect attributed to allogeneic leucocytes. In a retrospective analysis, the postoperative outcome of 120 patients undergoing elective orthopaedic surgery and having donated up to two units of autologous WB (AWB) was compared with that of a control group of 52 patients, whose autologous donation had been processed into buffy coat-depleted red cell concentrates (RCC). At least one autologous unit, but no allogeneic units, had been transfused in all analysed patients. Donation schemes were equally efficacious in both groups. There was no significant difference in postoperative infection rates between the two groups. Overall rates were 7.7% in the RCC group and 8.3% in the WB group. Surgical, thromboembolic and other recorded complications, length of postoperative hospital stay and days of the use of antibiotics were also not significantly different between the two groups. The results of this study suggest that transfusion of up to two units of unmodified AWB is as efficacious as the transfusion of autologous RCC and does not negatively influence the postoperative outcome in elective orthopaedic surgery.