Difference In Wound Complications Research Articles

Long-Term Patency Between Brachiocephalic and Brachiobasilic Fistulas: A Single Institution Review

Dialysis access is a fundamental procedure performed by vascular surgeons. Commonly, upper extremity access is utilized via a brachiobasilic fistula (BBF) or brachiocephalic fistula (BCF). BCF is preferred due to ease compared to BBF without documented improved function. Few studies compare patency outcomes between BBF and BCF over time. Our goal was to evaluate the difference in outcomes between BBF and BCF. This is a retrospective review of patients with BCF or BBF between 2019-2022. Patients were split by procedure: BCF and BBF. Data collected included demographics, vein size, tunneled catheter, and previous access. Primary outcomes included primary patency (PP), primary assisted patency (PAP) and secondary patency (SP). Secondary outcomes included 30-day complications, access abandonment, interventions and mortality. Linear regression, Kaplan-Meier and log-rank test were performed. Our study had 184 patients, 109 (59%) with BCF and 75 (41%) with BBF. There were no differences in demographics except for BMI and vein size (BBF: 4 vs BCF: 3.6mm, p=0.020). There was no difference in PP at one year (41% vs 47%, p=0.547) or SP at two years (73% vs 84%, p=0.058) in BBF vs BCF. However, PAP was significantly greater in BCF (80% vs 67%, p=0.030) at one year. Secondary outcomes revealed no difference in wound complications (1% vs 0%, p=0.408), access abandonment (35% vs 28%, p=0.260), or number of interventions (1 vs 1, p=0.712) in BBF vs BCF. Mortality was significantly greater in the BBF patients (19% vs 6%, p=0.005). On adjusted analysis, BBF had 43 minutes longer operative time (p<0.001) and 22cc greater blood loss (p<0.0001). In this single center review comparing BBF and BCF, no difference was seen between BBF and BCF in terms of primary patency or secondary patency. Even with larger vein size, BBF did not confer a benefit in long term patency or access abandonment. Additionally, BBF did not confer decreased procedures to maintain patency and BBF had greater operative length and blood loss, as well as mortality. We believe this study demonstrates that for patients who must use an upper extremity location, when the cephalic vein is satisfactory, using the cephalic vein is preferred as it does not negatively impact long-term patency.

Smoking is not associated with wound complications in augmented urethroplasty: a NSQIP analysis.

To investigate if predictors of wound complications differed between patients undergoing excision and primary anastomosis urethroplasty (EPA) and augmented urethroplasty. The National Surgical Quality Improvement Program database from 2006 to 2018 was queried for male patients undergoing urethroplasty. Thirty-day wound complications were identified and categorized (superficial/deep/organ-space surgical site infections and dehiscence). Multivariable logistic regression was performed to determine risk factors associated with wound complications. Smoking history was defined as current smoker within the past year. Urethroplasty was performed in 2251 males, with 25.46% (n = 573) using a flap or graft. There was no significant difference in wound complications for patients undergoing augmented urethroplasty (n = 17, 2.97%) or EPA (n = 45, 2.68%) (p = 0.9). The augmented group had a higher BMI, longer operative time, and longer length of stay. On multivariable logistic regression, risk factors associated with wound complications for patients undergoing EPA were diabetes (OR 2.56, p = 0.03) and smoking (OR 2.32, p = 0.02). However, these factors were not associated with wound complications in patients undergoing augmented urethroplasty. Smoking and diabetes were associated with increased wound complications for men undergoing EPA, but not in patients undergoing augmented urethroplasty. Patients with comorbidities associated with worse wound healing may be more likely to have a wound complication when undergoing EPA.

Does Timing of Radiation Therapy Impact Wound Healing in Patients Undergoing Metastatic Spine Surgery?

The impact of radiation on wound healing after metastatic spine surgery remains an active area of research. In patients undergoing metastatic spine surgery, we sought to (1) assess the relationship between preoperative and/or postoperative radiation on wound complications, and (2) evaluate the relationship between the timing of postoperative radiation and wound complications. A single-center, retrospective, cohort study of patients undergoing metastatic spine surgery was conducted from 2010 to 2021. The primary exposure variable was the use/timing of radiation. Radiation included both external beam radiotherapy (EBRT) and stereotactic body radiotherapy (SBRT). Patients were trichotomized into the following groups: (1) preoperative radiation only, (2) postoperative radiation only, and (3) no radiation. The primary outcome variable was wound complications, which was defined as dehiscence requiring reoperation, infection requiring antibiotics, or infection requiring surgical debridement. Multivariable logistic/linear regression controlled for age, tumor size, primary organ of origin, and the presence of other organ metastases. A total of 207 patients underwent surgery for extradural spinal metastasis. Participants were divided into three groups: preoperative RT only (N = 29), postoperative RT only (N = 91), and no RT (N = 178). Patients who received postoperative RT only and no RT were significantly older than patients who received preoperative RT only (p = 0.009) and were less likely to be white (p < 0.001). No other significant differences were found in basic demographics, tumor characteristics, or intraoperative variables. Wound-related complications occurred in two (6.9%) patients with preoperative RT only, four patients (4.4%) in postoperative RT only, and 11 (6.2%) patients with no RT, with no significant difference among the three groups (p = 0.802). No significant difference was found in wound-related complications, reoperation, and time to wound complications between patients with preoperative RT only and no RT, and between postoperative RT only and no RT (p > 0.05). Among the postoperative-RT-only group, no difference in wound complications was seen between those receiving SBRT (5.6%) and EBRT (4.1%) (p > 0.999). However, patients who received preoperative RT only had a longer time to wound complications in comparison to those who received postoperative RT only (43.5 ± 6.3 vs. 19.7 ± 3.8, p = 0.004). Regarding timing of postoperative RT, the mean (SD) time to RT was 28.7 ± 10.0 days, with a median of 28.7 (21-38) days. No significant difference was found in time to postoperative RT between patients with and without wound complications (32.9 ± 12.3 vs. 29.0 ± 9.7 days, p = 0.391). In patients undergoing metastatic spine surgery, a history of previous RT or postoperative RT did not significantly affect wound complications. However, those with previous RT prior to surgery had a longer time to wound complications than patients undergoing postoperative RT only. Moreover, timing of RT had no impact on wound complications, indicating that earlier radiation may be safely employed to optimize tumor control without fear of compromising wound healing.

Effect of Various Ancillary Operating Room Techniques on Wound Healing Outcomes After Total Knee Arthroplasty.

The successful management of wound healing after total knee arthroplasty (TKA) depends on several aspects of ancillary intraoperative techniques and surgical variables. Many of these have been evaluated in a few recent reports. The prior reviews studied many aspects of wound healing and, for example, found lower risks of wound complications with barbed sutures compared with interrupted closure with non-barbed sutures, no differences in wound complications between adhesives, subcuticular sutures, staples, glue, or mesh adhesives for the closure of the skin layer, and that mesh adhesives may be associated with faster closing times compared to subcuticular sutures or staples in TKA. However, some topics that can be influenced by the surgeon were not covered in these previous reviews. Namely, the use of deep vein thrombosis (DVT) prophylaxis, tourniquet application, management of intraoperative drains, surgical approach selection, and patellar handling techniques can all potentially influence wound healing. Therefore, in this comprehensive systematic review of the literature, we focused on these five factors that may influence wound healing. Specifically, we evaluated: (1) the impact of different DVT prophylaxis methods on wound healing and infection rates; (2) the role of tourniquet application on wound closure and potential infection risks; (3) the effects of intraoperative drain usage on wound healing; (4) the influence of different surgical approaches on wound closure and postoperative infection rates; and (5) the effects of varying patellar handling strategies on wound healing and infection rates. A systematic search of electronic databases, including PubMed, Cochrane Library, Medline, and Embase, was conducted to identify studies assessing auxiliary surgical techniques and their impact on wound healing in total knee arthroplasty (TKA). Relevant terms like "knee," "arthroplasty," and "wound healing" refined the search, which included English language publications until May 1, 2023. Independent screening by two authors and a third mediator facilitated the selection process, with 24 studies meeting the criteria. Assessment of these studies involved evaluating their evidence level and methodological quality using the Modified Coleman Methodology Score (MCMS). A comparison was made on wound healing outcomes in TKA, which included evaluating methodological quality parameters like sample sizes, follow-up durations, and clinical effect measurements. Data synthesis for the studies provided a comprehensive summary, categorizing them by evidence level. There were seven reports on DVT prophylaxis that showed no statistically significant differences in wound complications among various treatment methods and medications in patients undergoing total knee arthroplasty (TKA), with wound complication rates ranging from 0.25 to 1%, except that aspirin appeared to have lower wound complications rates in three recent studies than other methods. There were five reports on tourniquet application that showed a generally increased rate of wound complications, but no increase in deep infections. The five reports on intraoperative drain use showed that while there is an increase in total blood loss in the group with drains, ranging from 568ml to 1,856ml, compared to 119ml to 535ml in the no-drain group, there are no significant differences in wound complications, infection rates, or other postoperative outcomes such as swelling, deep vein thrombosis, and range of motion between the drain and no-drain groups. There were three studies on surgical approaches revealing no differences in wound complication rates between the mini-subvastus and medial parapatellar incisions. Also, the surgical variables of patella eversion and anterior tibial translation were only studied in one report. The current literature highlights the importance of using aspirin when possible for DVT prophylaxis and the possibility that tourniquets may lead to increased superficial wound complications. Drains or surgical approach do not appear to lead to wound problems. Surgical variables, such as patella eversion and anterior tibial translation, need more study.

Effect of Various Ancillary Operating Room Techniques on Wound Healing Outcomes After Total Hip Arthroplasty.

The successful management of wound healing following total hip arthroplasty (THA) is multifaceted, relying on various intraoperative techniques and surgical variables. Recent reviews have evaluated many of these factors, including the comparison between mesh-adhesive dressings and other skin closure methods, the closing time of different suture techniques, and the four aspects of closure for THA (deep fascial layer; subdermal layer; intradermal layer). However, previous articles did not cover certain topics that can be directly influenced by the surgeon. Specifically, these include the use of deep vein thrombosis (DVT) prophylaxis, the management of intraoperative drains, and the selection of surgical approaches. Therefore, in this comprehensive systematic review of the literature, we have focused on three factors that may influence wound healing. We evaluated the following: (1) the impact of different DVT prophylaxis methods on wound healing and infection rates; (2) the effects of intraoperative drain use on wound healing; (3) the influence of various surgical approaches on wound closure, and postoperative infection rates. By concentrating on these areas, this review aims to provide a more complete understanding of the factors that contribute to successful wound management after THA. A systematic search of electronic databases, including PubMed, Cochrane Library, Medline, and Embase, was conducted to identify studies assessing surgical variables and techniques, specifically focusing on DVT prophylaxis, intraoperative drain use, and surgical approaches and their impact on wound healing in THA. Relevant terms like "hip," "arthroplasty," "wound healing," "DVT prophylaxis," and "surgical approaches" refined the search, which included English language publications until May 1, 2023. Independent screening by two authors and a third mediator facilitated the selection process, with 13 studies meeting the criteria. Assessment of these studies involved evaluating their evidence level and methodological quality using the Modified Coleman Methodology Score (MCMS). A comparison was made on wound healing outcomes in THA, specifically focusing on the three factors outlined in the introduction: (1) the impact of different DVT prophylaxis methods on wound healing and infection rates; (2) the effects of intraoperative drain use on wound healing; and (3) the influence of various surgical approaches on wound closure and postoperative infection rates. Data synthesis for the studies provided a comprehensive summary, categorizing them by evidence level, and aimed to contribute to a more complete understanding of the factors that influence successful wound management after THA. In studies examining DVT prophylaxis for total knee arthroplasties (TKA), three reports found that both rivaroxaban and enoxaparin had similar wound infection rates at 0.36%. However, one study segment suggested a slightly higher infection rate for rivaroxaban at 0.71% compared to enoxaparin's 0.49%. Despite this difference, it was not statistically significant (odds ratio [OR] 1.34, 95% confidence interval [CI] 0.46 to 3.86). In recent research, a low dose of aspirin has been observed to yield fewer wound complications when contrasted with other techniques. Five studies on intraoperative drain use revealed mixed outcomes. A total of five studies were identified that evaluated wound complications with drains following THA, comprising two randomized controlled trials (RCTs) and three observational cohort studies, with a combined sample size of 765. Among these, four studies specifically compared the use of closed suction drains to no drains. Half of these studies (two out of four) reported no significant differences in wound complications between the two groups, while the other half presented mixed findings. In surgical approach comparisons by Jin et al., meta-analysis between the direct anterior approach (DAA) and posterolateral approach (PLA) showed no significant difference in complications (OR 0.57, p=0.952). Two studies analyzed bikini incision DAA versus PLA or conventional DAA, indicating comparable outcomes with no significant differences in wound complications between the approaches and no major variations in healing, acute PJI, or dysesthesia when comparing bikini incision DAA to conventional DAA. Wound healing post THA is a complex process, influenced by various surgical techniques and intraoperative decisions. This systematic review meticulously examined three critical factors: the role of DVT prophylaxis, the implications of intraoperative drain usage, and the impact of different surgical approaches. Our analysis revealed that rivaroxaban and enoxaparin exhibit similar wound infection rates in THA. The decision to use intraoperative drains in the current literature indicates no definite advantage or disadvantage regarding wound problems with the use of closed-suction drainage in THA. In exploring surgical methodologies, the DAA and the PLA showed comparable complication rates. Yet, specific techniques within the DAA category demonstrated variations in delayed wound healing, particularly among obese patients. These findings emphasize the nuanced role of surgical choices in determining wound healing outcomes. As the field of THA continues to evolve, it becomes important for surgeons to be well-informed, ensuring optimal patient outcomes.

Time to Surgery Affects Wound Healing of Ankle Fractures

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures are very common. Most unstable ankle fractures require surgical intervention in order to obtain better clinical outcomes. However, there is still conflicting evidence about the implications of time to surgery on post- operative wound complications. Purpose of study: To investigate if early or delayed surgery results in difference in wound complications in patients who underwent surgical intervention for ankle fracture. Methods: A retrospective review of 238 ankle fracture cases treated with open reduction and internal fixation (ORIF) from October 28, 2016, through May 12, 2022 was completed at our institution. Patients were divided into 4 groups based on the time to surgery. In group 1, surgery was within a week. In group 2, surgery was in 2nd week. In group 3, surgery was in 3rd week. In group 4, surgery was after 3 weeks. Wound complications including minor wound complication and wound infection were investigated. The other factors including BMI, smoking, diabetes, etc. were investigated as well to avoid confounding bias. Since most of patients accepted surgery either in first 4 days (early surgery group) or between 10 to 20 days (delayed surgery group) in this series of patients. We also analyzed those two time points. Data was analyzed using STATA. Results: 238 patients with ankle fracture were analyzed. 36, 96, 71 and 35 patients were included in group 1, 2, 3 and 4 respectively. For BMI, smoking, and diabetes, no significant difference among 4 groups. The rate of minor wound complications in group 1, 2, 3 and 4 was 13.8%, 12.5%, 8.5% and 0%. The rate of wound infection in group 1, 2, 3 and 4 was 5.6%, 3.1%, 1.4% and 0%. For minor wound complication, there was significant decrease in group 4, as compared with group 1 and group 2 (p &lt; 0.05). Interestingly, in term of early vs delayed surgery, both infection rate (13.3% vs 2.8%) and minor wound complication rate (33.3% vs 10.8%) significantly decreased in the delayed surgery group (p &lt; 0.05). Conclusion: Delayed ORIF of ankle fracture resulted in decreased both minor wound complication rate and infection rate.

Poster 357: Tranexamic Acid in Foot and Ankle Surgery: A Systematic Review and Meta-analysis

Objectives: Tranexamic acid (TXA) use has become common in Orthopedic surgeries. Despite the growing number of publications related to its use, no recent systematic reviews have been published examining TXA use in foot and ankle surgery. The aim of this review article is to provide a summary of the current available literature regarding TXA use in foot and ankle surgery and to further the understanding of its safety and efficacy. Methods: This was a systematic review following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as outlined on the PRISMA checklist. Databases utilized included PubMed, Ovid, CINAHL, Clinical Key, Medline, and Embase, and the search was conducted through May 21, 2022. Key words used in the search included: “tranexamic acid,” “TXA,” “foot,” “ankle,” “calcaneal,” and “surgery.” The outcomes within the studies analyzed included measures of perioperative blood loss (intra-operative blood loss, 24-hour postoperative blood loss, blood loss from hour 24 to hour 48, postoperative hemoglobin (Hgb), and postoperative hematocrit (Hct)), as well as wound complications and vascular events. Wound complications and vascular events were defined as infection, hematoma formation, necrosis, dehiscence, DVT, PE, myocardial infarction (MI), acute coronary syndrome (ACS), cardiovascular event (CVA), limb ischemia (LI), gastrointestinal hemorrhage (GIH), nerve damage, and any other conditions specified as wound complications or vascular events within individual studies. The Cochrane Collaboration’s Risk of Bias 2 (RoB2) tool was used to assess the risk of bias in the studies included. The quality of the studies included was scored using a modified Coleman methodology score (MCMS). Primary treatment outcomes having data from three or more studies available were summarized in forest plots using RevMan 5.4.1 software (The Cochrane Collaboration, Copenhagen, Denmark). Random-Effects models were used to calculate mean differences with 95% confidence intervals for each outcome measure. Heterogeneity of studies was assessed using Tau2, Chi2, and I2 statistics. Statistical significance was set at α=0.05 for all comparisons. Results: The literature search produced 1125 papers. The full texts of 16 studies were assessed using inclusion and exclusion criteria and seven studies met preliminary inclusion criteria. Upon further inspection, five met full inclusion criteria for the meta-analysis. All groups receiving TXA had statistically significantly lower blood loss values at 24 hours. One study found a statistically significant increase in blood loss from 24-48 hours in their A group (TXA) versus non-TXA. Three study groups demonstrated statistically significantly higher values of postoperative hemoglobin in patients receiving TXA versus patients not receiving TXA. Three study groups demonstrated statistically significantly higher values of postoperative hematocrit in patients receiving TXA versus patients not receiving TXA. No studies found statistically significant differences in wound complications between TXA and non-TXA groups. Conclusions: Despite a growing amount of literature on the topic, there is still a paucity of literature published on TXA use in foot and ankle surgery. Additional literature is required to determine the best strategy for TXA use to optimize patient outcomes. Current literature suggests that foot and ankle surgery patients treated with TXA may have reduced 24-hour postoperative blood loss, increased postoperative hemoglobin and hematocrit when compared to similar patients not receiving TXA. The use of TXA in foot and ankle surgery did not lead to increased thromboembolic complications.

Wound complications in metastatic spine tumor patients with and without preoperative radiation.

Wound complications are a common adverse event following metastatic spine tumor surgery. Some patients with spinal metastases may first undergo radiation but eventually require spinal surgery because of either cord compression or instability. The authors compared wound complication rates in patients who had undergone surgery for metastatic disease and received preoperative radiation treatments, postoperative radiation, or no radiation. Records from patients treated at the University of California, San Francisco, for metastatic spine disease between 2005 and 2017 were retrospectively reviewed. Baseline characteristics were collected, including preoperative Karnofsky Performance Status (KPS), Spine Instability Neoplastic Score, total radiation dose, indication for surgery, diabetes status, time between radiation and surgery, use of perioperative chemotherapy or steroids, estimated blood loss, extent of fusion, and preoperative albumin level. Wound complication was defined as poor healing, dehiscence, or infection per the Centers for Disease Control and Prevention guidelines, within 6 months of surgery. One-way ANOVA was used to compare means across groups. Cumulative incidence analysis with competing risk methodology was used to adjust for risk of death during follow-up. Statistical analysis was performed using R software. Two hundred five patients with adequate medical records were identified. Seventy patients had received preoperative radiation, 74 had received postoperative radiation within 6 months after surgery, and 61 had received no radiation at the surgical site. Wound complication rates were similar across the 3 cohorts: 14.3% (n = 10) in the group with preoperative radiation, 10.8% (n = 8) in the group that received postoperative radiation, and 11.5% (n = 7) in the group with no radiation (p = 0.773). Competing risk analysis showed a higher cumulative incidence of wound complications for the preoperative cohort, though this difference was not significant (p = 0.46). Overall, 89 patients were treated with external beam radiation therapy (EBRT), whereas 55 received stereotactic body radiation therapy (SBRT). There was no significant difference in wound complications for patients treated with EBRT (11.2%, n = 10) versus SBRT (14.5%, n = 8; p = 0.825). KPS was the only factor correlated with wound complications on univariate analysis (p = 0.03). Wound complication rates did not differ across the 3 cohorts: patients treated with preoperative radiation, postoperative radiation within 6 months of surgery, or no radiation. The effect size was small for KPS and likely does not represent a clinically significant predictor of wound complications.

Donor BMI and Post-living Donor Liver Transplantation Outcomes: A Preliminary Report.

We studied 66 living donors and their recipients who underwent living donor liver transplant at our center between 2013 and 2020. BMI was divided into 3 categories (<25, 25-29.9, and ≥30 kg/m2). Magnetic resonance imaging-derived proton density fat fraction was used to quantify steatosis. Donor outcomes included length of stay (LOS), emergency department visits within 90 d, hospital readmissions within 90 d, and complication severity. Recipient outcomes included LOS and in-hospital mortality. The Student t test was used to compare normally distributed variables, and Kruskal-Wallis tests were used for nonparametric data. There was no difference in donor or recipient characteristics based on donor BMI. There was no significant difference in mean magnetic resonance imaging fat percentage among the 3 groups. Additionally, there was no difference in donor LOS (P = 0.058), emergency department visits (P = 0.64), and hospital readmissions (P = 0.66) across BMI category. Donor complications occurred in 30 patients. There was no difference in postdonation complications across BMI category (P = 0.19); however, there was a difference in wound complications, with the highest rate being seen in the highest BMI group (0% versus 16% versus 37%; P = 0.041). Finally, there was no difference in recipient LOS (P = 0.83) and recipient in-hospital mortality (P = 0.29) across BMI category. Selecting donors with BMI ≥30 kg/m2 can result in successful living donor liver transplantation; however, they are at risk for perioperative wound complications. Donor counseling and perioperative strategies to mitigate wound-related issues should be used when considering obese living donors.

An Outcomes-Focused Analysis of Laparoscopic and Open Surgery in a Nigerian Hospital.

The benefits of laparoscopic surgery such as swifter recovery and fewer wound complications, elude much of the developing world. Nigeria, a lower middle-income country, is the most populous sub-Saharan nation; an excellent model for studying the impact of laparoscopy in resource-constrained environments. The Department of Surgery at the Obafemi Awolowo University Teaching Hospital and the University of Utah's Center for Global Surgery present a study of laparoscopic surgery cases in sub-Saharan Africa. A retrospective chart review of 261 patients compared open and laparoscopic surgical outcomes for three common general surgery procedures: open versus laparoscopic cholecystectomy and appendectomy, and open laparotomy versus diagnostic laparoscopy for biopsy of intra-abdominal mass. The primary outcome was total length of stay (LOS); secondary outcomes included wound complications, analgesia and antibiotic use, time to oral intake, and patient charges. Total LOS for laparoscopic surgery was significantly shorter compared to analogous open procedures (4.7 vs 11.5 days). Postoperative LOS was also shorter (2.6 vs 8.2 days). There were no differences in wound complications. Median charges to patients were lower for laparoscopic versus open procedures ($184 vs $217 USD). The introduction of laparoscopy allows for significantly shorter LOS and equivalent wound complications in the context of a sub-Saharan teaching hospital. Concerns regarding higher costs of care for patients do not appear to be a significant issue. Further work is needed to evaluate costs to the hospital system as a whole, including procurement and maintenance of laparoscopic equipment.

Rates of Complications and Readmissions: In-Patient vs Outpatient ORIF of Calcaneus Fractures

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneus fractures are common injuries to the hindfoot. The safety of in-patient versus outpatient treatment in patients with calcaneus fractures remains unclear. The aim of the present study was to assess differences in wound complications and readmissions in operative calcaneus fractures treated with open reduction and internal fixation (ORIF) in an in- patient versus outpatient setting. Methods: Patients undergoing ORIF for calcaneus fractures from 2012 to 2020 were reviewed. Inclusion criteria were age greater than 18 years and an operative calcaneus fracture treated with the sinus tarsi approach (STA). Exclusion criteria consisted of a minimum of three months follow-up, open calcaneal fractures or fracture dislocations, inpatients with polytrauma, and patients without a preoperative computed tomography (CT) scan. A total of 113 patients met inclusion criteria with 24 (21%) managed inpatient and 89 (79%) managed as outpatient. The primary outcomes were deep infection defined as return to the operating room for debridement with positive cultures and readmissions. Secondary outcomes included implant related pain and unplanned return to the operating room. Results: Inpatients had a higher percentage of ASA classification 3&amp;4 patients (58.3% vs 29.2%, p=0.008). Outpatients had a longer delay in days between injury and definitive fixation (mean 8 (8.9 SD, 0-31 range) vs. 14 (12.4 SD, 0-91 range) days, p=0.009). There were no statistically significant differences in the incidence of deep infections (8.3% vs. 4.5%, p=.606), implant related pain (8.3% vs. 15.7%, p=.516), return to the operating room (16.7% vs. 15.7%, p=1.0) or readmissions (4.2% vs. 3.4%, p=1.0) between inpatient and outpatient groups including in binary logistic regression models (p&gt;.3 for all). In our retrospective study of patients undergoing operative repair of isolated calcaneus fractures with STA, there was no increased risk of wound complications or readmissions when calcaneus fractures were treated in an outpatient setting. Conclusion: In our retrospective study of patients undergoing operative repair of isolated calcaneus fractures with STA, there was no increased risk of wound complications or readmissions when calcaneus fractures were treated in an outpatient setting.

Comparison Between Closed Suction Drainage and No Drainage Following Total Ankle Arthroplasty.

The purpose of this study is to determine whether the use of closed suction drains after total ankle arthroplasty (TAA) is associated with lower wound complications in the first postoperative year as compared to no drain usage. A total of 324 TAA were reviewed and included for analysis. One hundred forty-four did not have a postoperative drain placed, whereas 180 did have a postoperative drain. Demographic data, including age, sex, tobacco or alcohol use, and various medical comorbidities, were obtained. Follow-up data were collected and reviewed at 2, 6, and 12 weeks; 6 months; and 1 year postoperatively for minor and major wound complications, as well as wound-related reoperations. At the 2-week mark, the use of a drain demonstrated a significant increase in wound complications. No significant difference in wound complications was found at each subsequent follow-up visit. Within the first postoperative year, a total of 46 patients (31.9%) without drains and 69 patients (38.3%) with drains had a wound complication. This was not statistically significant. Most wound complications were minor, and no significant difference in reoperation rates occurred between the 2 groups. A postoperative closed suction drain may increase wound complications in the first 2 weeks after TAA and should therefore be used with caution. Level III, retrospective comparative study.

No difference in wound complications with or without a post-operative pressure dressing: Our experience in 135 children undergoing mastoidectomy.

To assess the efficacy of avoiding mastoid pressure dressing (MPD) on children as a means of preventing discomfort and post-operative pain. A retrospective controlled study. All operations were carried out by experienced surgeons using standard techniques, whose custom, not the gravity of any individual case, dictated the use of MPD. Children who underwent mastoidectomy for inflammatory middle ear diseases at a tertiary centre from 2010 to 2021. Wound-related complications and Visual Analogue Scale (VAS) pain scores at discharge were compared between children who had an MPD applied following surgery and those who did not. One hundred thirty-five cases were included. The demographic characteristics of the patients and surgical techniques employed were similar for both groups. There were 91 patients in the MPD group and 44 in the non-mastoid dressing (NMPD) group. In the MPD group, five patients developed minor wound dehiscence, eight experienced surgical site infections (SSI), and one patient developed a keloid. In the NMPD group, one patient had an SSI, one patient suffered from a keloid scar, wound dehiscence was observed in one patient, and another one had a local hematoma. Therefore, there were no differences between the groups in relation to post-operative complications (p=.32). Despite these similitudes, the NMPD patients suffered less post-operative pain, as measured by the VAS (p=.02). This study shows that no significant benefit is derived from using an MPD after mastoidectomy in children. Surgeons should adhere to principles of appropriate haemostasis and wound closure to prevent post-operative wound complications. Our study supports the abandonment of routine MPD in children following mastoidectomy.

Myofascial Flap Closure Decreases Complications in Complex Surgery of the Craniocervical Junction in Ehlers-Danlos Patients.

Patients with Ehlers-Danlos syndrome (EDS) are at elevated risk for soft tissue complications when undergoing decompression with or without fusion of the craniocervical junction. We have previously shown that muscle flap closure can decrease reoperative rates. This study investigated whether myofascial flap closure improved clinical outcomes after simple or complex surgery of the craniocervical junction in EDS patients specifically. We performed a retrospective chart review of EDS patients who had undergone surgery for Chiari malformation at the Weill Cornell Medical Center between 2013 and 2020. Postoperative complications were recorded, including infection, wound dehiscence, seroma, hematoma, hardware removal, cerebrospinal fluid (CSF) leak, reoperation, and pseudomeningocele. Patients were stratified by type of closure and type of surgery. Fisher exact test was used for statistical comparison. Between 2013 and 2020, 62 EDS patients who had surgery of the cervicocranial junction were reviewed. Of these, 31 patients had complex surgery with myofascial flap closure and 22 had simple surgery with traditional closure. The mean age at the time of surgery was 21.3 years. There were no significant differences in wound complications or reoperation rates between the simple surgery and complex surgery groups. In addition, there were no significant differences in complications between complex surgery with flap closure and simple surgery with traditional closure. Our CSF cutaneous fistula rate was 0%, considerably lower than rates reported in the literature, and, in one case, a patient developed a postoperative pseudomeningocele secondary to a dural leak, but the myofascial flap closure prevented its progression. Patients with EDS undergoing surgery of the cervicocranial junction may benefit from myofascial flap closure. Flap closure reduced complications after complex surgery of the craniocervical junction to the level of simple surgery. Our CSF leak rate was exceptionally low and only one patient experienced pseudomeningocele. Myofascial flaps are safe to perform in the EDS cohort and prevented CSF cutaneous fistula formation.

Discharge Disposition and Clinical Outcomes After Spine Surgery.

Spinal decompression with or without fusion is one of the most commonly performed procedures in spine surgery. However, there is limited evidence on the effect of discharge environment on outcomes after surgery. The purpose of this study is to identify the effects of discharge disposition setting on clinical outcomes after spine surgery. Patients who underwent lumbar decompression, lumbar decompression and fusion, or posterior cervical decompression and fusion surgery were retrospectively identified. All clinical and demographic data were obtained from electronic health records. Surgical outcomes included wound complications, revision surgery, "30-day" readmission (0-30 d), and "90-day" readmission (31-90 d). Discharge disposition was stratified into home/self-care, acute inpatient rehabilitation, and subacute rehabilitation. Patient-reported outcome measures including VAS Back, VAS Leg, VAS Neck, VAS Arm, PCS-12 and MCS-12, ODI, and NDI were compared between patient discharge disposition settings using the Mann-Whitney U test. Pearson's chi-square analysis was used to assess for differences in wound complications, revision surgery, 30-day readmission, or 90-day readmission rates. Multivariate logistic regression incorporating age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI), and discharge disposition was used to determine independent predictors of wound complications. A total of 637 patients were included in the study. A significant difference (P = 0.03) was found in wound complication based on discharge disposition, with subacute disposition having the highest proportion of wound complications (6.1%) and home disposition having the lowest (1.5%). There were no significant differences in the rates of revision surgery, 30-day readmission, or 90-day readmission between groups. Subacute rehabilitation (odds ratio: 3.67, P = 0.047) and CCI (odds ratio 1.49, P = 0.01) were independent predictors of wound complications. Significant improvement in PROMs was seen across all postacute discharge dispositions. Baseline (P = 0.02) and postoperative (P = 0.02) ODI were significantly higher among patients discharged to an acute facility (49.4 and 32.0, respectively) compared to home (42.2 and 20.0) or subacute (47.4 and 28.4) environments. Subacute rehabilitation disposition and CCI are independent predictors of wound complications after spinal decompression surgery. Patients undergoing spine surgery have similar readmission and revision rates and experience similar clinical improvement across all postacute discharge dispositions.

Do Closed Suction Drains Affect Postoperative Wound Healing after Total Ankle Arthroplasty?

Category:Ankle Arthritis; AnkleIntroduction/Purpose:Although most studies demonstrate no clear benefit of closed suction drains after total joint arthroplasty of the hip, knee, and shoulder, there is no study that has specifically looked at ankle arthroplasty. Despite the paucity of information regarding the potential benefit or lack thereof with postoperative closed suction drains after total ankle arthroplasty, they are still utilized in practice. The purpose of this study is to determine whether or not the use of closed suction drains after total ankle arthroplasty have an affect on wound complications in the first postoperative year.Methods:Following a 3:1 match of patients with-drains to those without-drains, 78 patients with-drains and 28 without-drains were included for analysis. The drain group consisted of patients who had drains placed in the immediate postoperative period and removed prior to discharge from the hospital. The without-drains group acted as the control. Demographic data including age, sex, tobacco use, alcohol use, and medical comorbidities (diabetes, bleeding disorders, anemia, neuropathy, kidney disease, peripheral vascular disease, rheumatoid arthritis, history of leg ulcers or staphylococcus infection) were obtained. Follow-up data was collected and reviewed at 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperative, for minor and major wound complications, as well as wound-related re-operations.Results:At 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperative, there was no statistically significant difference in wound complications with or without the use of a drain. Within the first postoperative year, a total of 4 (14.3%) patients with- drains and 24 (30.8%) patients without-drains had a wound complication. This was not statistically significant (p=0.148). The majority of wound complications were minor. A single superficial infection and two reoperations for major wound complications were noted, all of which were in patients who had a drain placed. Age, sex, tobacco use, alcohol use, as well as a history of diabetes, bleeding disorders, neuropathy, kidney disease, peripheral vascular disease, rheumatoid arthritis, and history of leg ulcers or staphylococcus infection were similar between both groups. A history of anemia was significantly higher in the drain group, however this was not associated with an increased risk of postoperative wound complications.Conclusion:The use of a closed suction drain did not have an effect on postoperative wound complications in the first year after total ankle arthroplasty surgery. Based on the equivocal results in this study and that there is no clear consensus on the use of drains after total ankle arthroplasty surgery, the authors feel it is up to the individual surgeon to determine the necessity of use on a case-by-case basis.

Effect of Postoperative Immobilization Time on PROMIS Scores and Clinical Outcomes in Ankle Fracture Patients

Category:Ankle; TraumaIntroduction/Purpose:Ankle fractures are among the most common injuries that Orthopaedic Surgeons treat; yet, little guidance exists in postoperative protocols for ankle fractures concerning time of immobilization and weightbearing. Results from previous studies have been mixed; demonstrating improved outcomes, no difference in outcome, or poorer outcomes including increased wound complications in patients who are mobilized early. Here, we aim to investigate the association between early immobilization and patient reported outcomes. Our null hypothesis was that no difference in PROMIS scores would be identified in patients when comparing the effect of time of immobilization and time of weightbearing.Methods:A chart review identified ankle fractures that underwent surgical fixation between 2015 and 2020 at a level 1 trauma center and its associated facilities. One-hundred nineteen patients from 8 providers met inclusion criteria for our final analysis. Fifty patients were immobilized for <6 weeks and 69 patients were immobilized for at least 6 weeks. Our primary outcome measures included the PROMIS questionnaire, time of immobilization, and time to full weightbearing. Our secondary outcome measures included time to return to work, wound complications (infection, delayed healing), and complications associated with fracture fixation (loss of reduction, delayed union, reoperation, hardware failure). Repeated-measures ANOVAs were used to predict each of the PROMIS outcomes of anxiety, depression, physical function, and pain interference. Each model included the predictors of age, sex, race, BMI, payor, provider, time to radiographic union, time to return to work, time to full weightbearing, and early vs late immobilized groups.Results:There were no differences in PROMIS scores between mobilization groups and time to full weightbearing (p>0.05). Furthermore, there were no differences in wound complications nor complications associated with fracture fixation (p>0.05). Across our cohort, physical function scores were negatively impacted by higher BMI, increasing age and longer time to return to work/play (p<0.05). Our analysis further showed that depression, anxiety, pain interference and physical function levels improve as a function of time (p<0.05). African Americans showed more pain interference than other groups of patients (p<0.05). No difference in PROMIS scores were identified between treating providers (p>0.05).Conclusion:In this study, the null hypothesis was accepted. Data from our analysis shows no significant differences between the early and late mobilization and weightbearing groups in terms of PROMIS outcomes nor with wound complications and complications associated with fracture fixation. Our study does suggest that early mobilization after operative treatment of ankle fractures is safe and results in similar patient reported outcomes with no increased risk of complication. We did find that African American patients experienced more pain that other groups and we aim to further explore this topic to find potential modalities to address this disparity.

P117 INFLUENCE OF THE MESH FIXATION METHOD ON THE RESULTS OF OPEN INGUINAL HERNIA REPAIR

Abstract Aim Study of postoperative outcomes after Liechtenstein inguinal hernia repair using self-gripping mesh and polypropylene mesh with suture fixation. Material and Methods Medical records of 289 open inguinal hernia repairs were analyzed: 176 – with sutured polypropylene mesh and 113 – using self-gripping mesh. To assess the quality of life we have used EuraHS Qol and SF-36. Statistical analysis was performed using SPSS. Results There were no significant differences in wound complications (such as swelling, seroma, hematoma, orchitis) between these groups (p &amp;gt; 0,05). The duration of operation was significantly shorter with self-gripping mesh compared to sutured mesh (42,2 min. sd = 23,42 vs 58,5 min. sd = 16,70; p &amp;lt; 0.001). Pain on the first and 6th days after implantation self-gripping mesh was present significantly less frequently in comparison with sutured mesh (χ2 (1, N = 289) =7.925, p = 0.005 and χ2 (1, N = 289) =24.740, p &amp;lt; 0.001). NSAIDs intake time was less in self-gripping mesh group (3.01±1,07 vs 4.43±1,75 days; U = 11723, p &amp;lt; 0.001). We have found no significant differences in both groups for all quality-of-life indicators EuraHS (p = 0.234) and SF-36 (p = 0.190). Conclusions Self-gripping mesh has comparable outcomes with sutured polypropylene mesh regarding the frequency of wound complications and quality of life on long-term follow-up. However, self-gripping mesh is associated with reduced operation time, pain in the short-term postoperative period, and taking NSAIDs compared to sutured mesh.

Nutrition and Vitamin Deficiencies Are Common in Orthopaedic Trauma Patients.

Macro- and micronutrients play important roles in the biological wound-healing pathway. Although deficiencies may potentially affect orthopaedic trauma patient outcomes, data on nutritional deficiencies in orthopaedic trauma patients remain limited in the literature. The purpose of this study was to (1) evaluate the prevalence of macro- and micronutrient deficiencies in orthopaedic trauma patients with lower extremity fractures and (2) evaluate the impact of such deficiencies on surgical site complications. This retrospective study identified 867 patients with lower extremity fractures treated with surgical fixation from 2019 to 2020. Data recorded included albumin, prealbumin, protein, vitamins A/C/D, magnesium, phosphorus, transferrin and zinc, as well as wound complications. Nutritional deficiencies were found for prealbumin, albumin and transferrin at 50.5%, 23.4% and 48.5%, respectively. Furthermore, a high prevalence of micronutrient deficiencies (vitamin A, 35.4%; vitamin C, 54.4%; vitamin D, 75.4%; and zinc, 56.5%) was observed. We also recorded a statistically significant difference in wound complications in patients who were deficient in prealbumin (21.6% vs. 6.6%, p = 0.0142) and vitamin C (56.8% vs. 28.6%, p = 0.0236). Our study outlines the prevalence of nutritional deficiencies in an orthopaedic trauma population and identifies areas for possible targeted supplementation to decrease wound complications.

Similar infection rates in a new wound closure method following knee arthroplasty

Surgical site infections, defined as acute wound infections requiring surgical intervention within 90 days post-surgery, were retrospectively compared between a novel, zipper-like closure method (ZM) and staples in 682 patients (904 knees) and 772 patients (971 knees), respectively. The incidence of deep infections was 0.6% for staples and 0.2% for ZM (p = 0.169) and superficial infections was 0.1% for staples and 0.0% for ZM (p = 0.518). With no difference in wound complications, the ZM may be preferred since the two-week post-operative clinic visit required for wound check and staple removal was eliminated, thereby, decreasing clinic volume.