Difference In Wound Complications Research Articles

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 > 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 < 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 < 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 < 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.

22. Robotic assisted vs conventional posterior lumbar fusion: An analysis of 90-day complications and readmissions

<h3>BACKGROUND CONTEXT</h3> Although robotic-assisted spinal fusion is gaining traction in the United States, little is known whether the robotic assistance during pedicle screw placement is associated with lower complication rates following elective posterior lumbar fusions. <h3>PURPOSE</h3> The purpose of this study was to assess whether robotic-assistance in elective posterior lumbar fusions is associated with a difference in the rates of 90-day medical and surgical complications. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of administrative claims data. <h3>PATIENT SAMPLE</h3> This was a retrospective review of insurance claims from an all-payer dataset, Symphony Integrated DataVerse (IDV). The Symphony IDV was queried using International Classification of Diseases 10th Edition (ICD-10) procedure codes to identify patients undergoing elective posterior lumbar fusions for degenerative spine pathologies between 2015 and 2018. Patients undergoing cervical fusions, thoracic fusions and/or fusions for deformity, malignancy and trauma were excluded from the study. Patients undergoing concurrent anterior fixation and/or combined fusions were also removed from the study. ICD-10 procedure codes (8E0W4CZ, 8E0W0CZ, 8E0W3CZ) were used to identify patients undergoing a robotic-assisted spinal fusion. <h3>OUTCOME MEASURES</h3> Ninety-day medical and surgical complications. <h3>METHODS</h3> Multivariate logistic regression analyses were used to assess whether undergoing a robotic-assisted fusion (vs conventional fusion) was associated with differences in wound complications, medical complications, pseudarthrosis, revision surgery and readmissions within 90 days of surgery (adjusting for age, gender, region, comorbidity burden, use of interbody, payor/plan type, length of fusion [1-level vs greater than 1 level]). <h3>RESULTS</h3> Following application of inclusion/exclusion criteria, a total of 39,387 patients undergoing elective posterior lumbar fusions were included in the cohort, out of which 245 (0.6%) underwent a robotic-assisted fusion. Multivariate analysis showed that robotic-assisted fusion (vs conventional fusion) was not associated with significant differences in 90-day rates of pseudarthrosis (p=0.945), wound complications (p=0.299), urinary tract infections (p=0.648), acute myocardial infarctions (p=0.209), acute renal failure (p=0.461), pneumonia (p=0.214), stroke (p=0.917), deep venous thrombosis (p=0.562), pulmonary embolism (p=0.401), revision fusion (p=0.862), readmissions (p=0.985). <h3>CONCLUSIONS</h3> Using a cohort of nearly 40,000 patients undergoing posterior lumbar fusion, our findings show that patients who underwent a robotic-assisted fusion had similar rates of surgical and medical complications, as compared to those who underwent a conventional fusion. Further studies using more granular prospective data that collects information on patient-reported outcomes, is warranted to better understand the future role of robots in spine surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Robotic-Assisted Versus Conventional Posterior Lumbar Fusion—An Analysis of 90-Day Complications and Readmissions

To evaluate medical and surgical complication rates between robotic-assisted versus conventional elective posterior lumbar fusions. The Symphony Integrated DataVerse was queried using International Classification of Diseases, 10th Edition, Clinical Modification procedure codes to identify patients undergoing elective posterior lumbar fusions for degenerative spine pathologies between 2015 and 2018. International Classification of Diseases, 10th Edition, Clinical Modification procedure codes (8E0W4CZ, 8E0W0CZ, 8E0W3CZ) were used to identify patients undergoing a robotic-assisted spinal fusion. Outcome measures were 90-day medical and surgical complications, 1-year pseudarthrosis, and 1-year revision surgery rates. Multivariate logistic regression analyses were used to assess whether undergoing a robotic-assisted fusion (vs. conventional fusion) was associated with differences in wound complications, medical complications, pseudarthrosis, revision surgery, and readmissions within 90 days of surgery. A total of 39,387 patients undergoing elective posterior lumbar fusions were included in the cohort-of whom 245 (0.62%) patients underwent a robotic-assisted fusion. Multivariate analysis showed that robotic-assisted fusion (vs. conventional fusion) was not associated with significant differences in 90-day rates of wound complications (P= 0.299), urinary tract infections (P= 0.648), acute myocardial infarctions (P= 0.209), acute renal failure (P=0.461), pneumonia (P= 0.214), stroke (P= 0.917), deep venous thrombosis (P= 0.562), pulmonary embolism (P=0.401), and readmissions (P= 0.985). In addition, there were no significant differences in the 1-year rates of revision fusions (P= 0.316) and pseudarthrosis (P= 0.695). Patients who underwent a robotic-assisted fusion had similar rates of surgical and medical complications compared with those who underwent a conventional fusion. Further studies are warranted to better understand the future role of robots in spine surgery.

Antibiotic use during repair of obstetrical anal sphincter injury: a quality improvement initiative.

To evaluate the effects of a quality improvement initiative regarding the administration of antibiotics at the time of obstetric anal sphincter injury (OASIS) repair. At University of Michigan-a tertiary care center in Ann Arbor, MI, USA, we implemented a quality improvement intervention aimed at administering a single dose of broad-spectrum antibiotics at the time of OASIS repair. Best practice recommendations and reminders were presented to the department. Cefazolin plus metronidazole or clindamycin plus gentamycin were the recommended antibiotics. The effects of this intervention were assessed based on a chart review of deliveries between January 4, 2014 and February 13, 2019, which included patient data both pre-initiative and post-initiative to compare the prevalence of antibiotic use at the time of OASIS repair. Recommended antibiotic use increased from 0.3% (1/372) pre-initiative to 75.7% (106/140) post-initiative (P<0.001), and any antibiotic use increased from 6.5% (24/372) to 82.9% (116/140, P<0.001). The proportion of cases complicated by wound infection/breakdown decreased by 55% after the quality improvement intervention (3.2% pre-intervention vs 1.4% post-intervention, P=0.22). Following a departmental quality improvement intervention aimed at increasing antibiotic administration at the time of OASIS repair, antibiotic use increased 13-fold. Although underpowered to detect a significant difference in wound complications, our study showed a clinically meaningful decrease in wound infection/breakdown with antibiotic administration.

How Does Octyl-2-Cyanoacrylate Tissue Adhesive Compare With Prolene Sutures in Cleft Lip Repair?

Comparative evidence of the usefulness of octyl-2-cyanoacrylate tissue adhesive in cleft lip epidermal skin closure especially in Africans is still lacking. This study aimed to compare the outcome of wound healing after the use of Dermabond tissue adhesive and 5/0 Prolene sutures in cleft lip repair. This was a prospective randomized controlled clinical study. The sampled population was patients undergoing cleft lip repair at a tertiary health facility in Lagos, Nigeria. Study patients were randomly allocated to either group A (Dermabond) or group B (suture). The predictor variable was the type of material used in skin closure; the primary outcome variable was the esthetics of the resulting scar, and secondary outcome variables were wound healing complications. Assessment of the 3-month postoperative wound scar was performed using the cosmetic visual analog scale (CVAS) and the Hollander Wound Evaluation scale (HWES). Calculated sample size was 14 participants per group. Descriptive and comparative statistics were computed, and the P value was set at <0.05. Analysis of result included 38 participants. Median age was 4months and 52.6% were women. Two cases (5.3%) of wound healing complications were recorded (1 in each group). Blinded evaluation of the 3-month postoperative photographs yielded a mean CVAS score of 86.0 (±11.2) and HWES score of 5.0 (±0.9) for group A and a mean CVAS score of 76.5 (±14.5) and HWES score of 4.5 (±1.1) for group B. There was no statistically significant difference between these 2 groups based on the CVAS (P=.052) and HWES (P=.152). The results of this study suggest Dermabond offers a comparable cosmetic outcome as 5/0 Prolene suture in epidermal closure of cleft lip. There was no statistically significant difference in wound complications and wound cosmetic scores between the 2 groups.

Early drain removal does not increase the rate of surgical site infections following an open transversus abdominis release.

Intraoperative drain placement during an open transversus abdominis release (TAR) is common practice. However, evidence detailing the optimal timing of drain removal is lacking. Surgical dogma teaches that drains should remain in place until output is minimal. This practice increases the risk of drain-associated complications (infection, pain, and skin irritation) and prolongs the burden of surgical drain maintenance. The objective of this study is to review infectious outcomes following TAR with early or late drain removal. Patients who underwent an open bilateral TAR from 1/2018 to 1/2020 were eligible for the study. Prior to 2019, one of the two intraoperative drains was left in place at discharge. In 2019, clinical practice shifted to remove both drains at hospital discharge irrespective of output. The rate of infectious morbidity was compared between the two cohorts. A total of 184 patients were included: 89 late and 95 early drain removal. No differences in wound complications existed between the two cohorts: surgical site occurrence (SSO): 21.3% vs. 18.9% (p = 0.68); surgical site infection (SSI): 14.6% vs. 10.5% (p = 0.40); abscess: 8.9% vs. 4.2% (p = 0.20); seroma: 6.7% vs. 10.5% (p = 0.36); cellulitis: 14.6% vs. 8.4% (p = 0.19%); or SSO requiring procedural intervention (SSOPI): 5.6% vs. 5.2% (p = 0.92). Rates of antibiotic prescription and 30-day readmission were also similar (p = 0.69 and p = 0.89). Early removal of abdominal wall surgical drains at discharge irrespective of drain output does not increase the prevalence of infectious morbidity following TAR. It is likely safe to remove all drains at discharge regardless of drain output.

A comparative study of Lumbar Decompression and Fusion with Internal Fixation versus Simple Decompression in elderly patients with two-segment Lumbar Spinal Stenosis.

Objective:To investigate and compare the effect of decompression and fusion with internal fixation vs. simple decompression in the treatment of elderly patients with two-segment lumbar spinal stenosis (LSS) in perioperative and postoperative follow-up periods.Methods:Twenty-eight elderly patients with two-segment LSS admitted in Baoding First Hospital between Mar. 2017 and Jan. 2018 were retrospectively analyzed. Fifteen patients who underwent simple decompression were included in the simple decompression group, and 13 who underwent decompression and fusion with internal fixation were included in the decompression-fixation group. The general data and perioperative conditions including wound complications, operation time, blood loss, and VAS (legs) and JOA score were analyzed and compared between the two groups.Results:There was no significant difference in postoperative leg pain (VAS) between the two groups, and a statistically significant difference in JOA score was found between the two groups one month after the operation. The operation time, length of stay, and blood loss in the decompression-fixation group were significantly different from those in the simple decompression group and no significant difference in wound complications was observed between the two groups.Conclusion:There is no significant difference in leg pain relief in elderly patients with two-segment LSS when treated with decompression and fusion with internal fixation or simple decompression. Simple decompression is associated with less intraoperative injuries, better postoperative functional recovery, and reduced hospital stay.

Utility of Routine Preoperative Laboratory Testing for Low-Risk Patients in Ambulatory Gynecologic Surgery

Study Objective To evaluate the utility of routine preoperative laboratory testing in low-risk patients undergoing ambulatory gynecologic surgery. Design The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried for low-risk patients who underwent elective, ambulatory gynecologic surgery from 2015-2018. Setting The ACS NSQIP database is a validated, risk-adjusted surgical outcomes database that prospectively collects data from participating institutions nationally. Patients or Participants Low-risk patients selected for inclusion in this study were defined as being American Society of Anesthesiologists (ASA) class 1 or 2. This included 19,885 patients. Interventions Patient characteristics, comorbidities, and NSQIP-defined complications were compared between those with and without preoperative laboratory testing. Preoperative laboratory testing was defined as chemistry, hematology, coagulation, or liver function studies obtained within 30 days preoperatively. Measurements and Main Results Of 19,885 patients studied, 14,258 (71.8%) received preoperative laboratory testing, with at least one abnormal test identified in 4,053 (28.4%) patients. There was no statistically significant difference in overall postoperative complication rate when comparing patients who received preoperative laboratory testing with those who did not (2.5% vs. 2.2%, p=0.30). Additionally, there was no statistically significant difference in wound complications (1.0% vs. 1.0% p=0.78), major complications (1.0% vs. 0.8% p=0.11), unplanned return to the operating room (0.1% vs. 0.2%, p=0.40), unplanned readmission (0.7% vs. 0.5% p=0.10), or overall morbidity (2.1% vs. 1.9% p=0.38). Chi-squared analyses were performed to compare categorical variables. Continuous variables were compared using unpaired t-tests. Conclusion Preoperative laboratory testing continues to be performed in the majority of low-risk patients undergoing ambulatory gynecologic surgery despite evidence and guidelines that do not recommend this practice. However, there was no difference in surgical outcomes between patients who did and did not receive preoperative laboratory testing. Postoperative complications are infrequent in this patient population. These results suggest that preoperative laboratory testing should be used more judiciously in low-risk patients undergoing ambulatory gynecologic surgery. To evaluate the utility of routine preoperative laboratory testing in low-risk patients undergoing ambulatory gynecologic surgery. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried for low-risk patients who underwent elective, ambulatory gynecologic surgery from 2015-2018. The ACS NSQIP database is a validated, risk-adjusted surgical outcomes database that prospectively collects data from participating institutions nationally. Low-risk patients selected for inclusion in this study were defined as being American Society of Anesthesiologists (ASA) class 1 or 2. This included 19,885 patients. Patient characteristics, comorbidities, and NSQIP-defined complications were compared between those with and without preoperative laboratory testing. Preoperative laboratory testing was defined as chemistry, hematology, coagulation, or liver function studies obtained within 30 days preoperatively. Of 19,885 patients studied, 14,258 (71.8%) received preoperative laboratory testing, with at least one abnormal test identified in 4,053 (28.4%) patients. There was no statistically significant difference in overall postoperative complication rate when comparing patients who received preoperative laboratory testing with those who did not (2.5% vs. 2.2%, p=0.30). Additionally, there was no statistically significant difference in wound complications (1.0% vs. 1.0% p=0.78), major complications (1.0% vs. 0.8% p=0.11), unplanned return to the operating room (0.1% vs. 0.2%, p=0.40), unplanned readmission (0.7% vs. 0.5% p=0.10), or overall morbidity (2.1% vs. 1.9% p=0.38). Chi-squared analyses were performed to compare categorical variables. Continuous variables were compared using unpaired t-tests. Preoperative laboratory testing continues to be performed in the majority of low-risk patients undergoing ambulatory gynecologic surgery despite evidence and guidelines that do not recommend this practice. However, there was no difference in surgical outcomes between patients who did and did not receive preoperative laboratory testing. Postoperative complications are infrequent in this patient population. These results suggest that preoperative laboratory testing should be used more judiciously in low-risk patients undergoing ambulatory gynecologic surgery.

Profile vs Tubular Plate in Unimalleolar or Bimalleolar Fractures: is There a Real Difference in Wound complications?

Category:Ankle; TraumaIntroduction/Purpose:The aim of our study is to compare two types of plates, one third tubular plate and LCP distal fibula plate, evaluating the clinical outcome and the skin complications associated with their use.Methods:We collected the data of 122 consecutive unimalleolar or bimalleolar fractures treated by internal fixation for a closed, displaced distal closed fibular fracture. Exclusion criteria were: 1) open ankle fractures,2) trimalleolar fractures, 3) previous ankle fractures 4) severe venous insufficiency, 5) ankleosteoarthritis previous to surgery, 6) associated ankle dislocation. After this selection, 93 patients were included in our study and assigned in two groups, based on using of different implant: in group A48 patients were treated with one-third tubular and in group B 45 patients were treated with LCP distalfibula plate. There were no significant differences in the baseline characteristics. Patients received the same surgical procedure and the same post-operative care, then they were radiologically evaluated at1-3-12 months and clinical examination was made at 24 (range 15-36) months using AOFAS clinical rating system. All data were evaluated using chi-square test.Results:At the final 24-month follow-up a comparison between the two groups showed no statistical significant differences in reduction accuracy and bone union ratio at radiological examination. The wound complications rate of the overall study group was 7.6%. There were no statistical differences in the rate of wound complications between the two groups. There were no differences between both group in percentage of hardware removal at follow-up (overall 5.4%). In the group A occurred 1 deep infection, 2 superficial infection, no wound dehiscence; in group B occured 1 deep infection, 1 superficial infection and 2 wound dehiscence. There were no statistical differences in the rate of wound complications between the two groups (p=0.70; Fisher exact test).Conclusion:Our study has shown no difference in radiographic bone union rate, no significant differences in terms of clinical outcomes, in time of bone reduction and wound complication rate between the LCP distalfibula plate and conventional one-third tubular plate. RCT or metanalasys are in this case useful to improve scientific evidence and give more information for the correct surgical treatment of ankle fractures.

Tranexamic Acid Use in Foot and Ankle Surgery.

Background:There is a potential role for tranexamic acid (TXA) use in foot and ankle procedures; however, the benefits of this intervention have not been fully elucidated. The purpose of this study was to explore the safety, outcomes, and medical complication profile of the use of intravenous TXA in patients undergoing foot and ankle surgery.Methods:A prospective study with retrospective review of 241 patients undergoing elective and traumatic foot and ankle procedures was performed. One gram of intravenous (IV) TXA was administered prior to incision. Patients were followed and evaluated for medical comorbidities, intraoperative blood loss, wound complication, superficial and deep infections, hematoma formation, medical complications, 30-day hospital readmission rate, and return visits to the emergency department or urgent care setting prior to first postoperative visit. Descriptive statistics were used for subgroup analysis. Mean postoperative follow-up was 4.5 months.Results:Estimated blood loss in all cases was less than 20 mL. There was 1 case of superficial cellulitis (1/241, 0.4%), 1 deep infection after Achilles tendon repair (1/241, 0.4%), 4 cases of delayed wound healing (4/241, 1.6%), 1 instance of deep vein thrombosis (1/241, 0.4%), and 2 cases of postoperative pulmonary embolism (2/241, 0.8%). There were no instances of postoperative hematoma formation. There were no additional recorded thromboembolic events. There were no adverse drug reactions. There were no 30-day hospital readmissions or return visits to the emergency department or urgent care setting before the first postoperative visit. In a subgroup analysis, there was no significant difference in wound complications or infections between nondiabetics and diabetics (P > .05) and traumatic and nontraumatic cases (P > .05).Conclusions:The use of IV TXA in foot and ankle surgeries was associated with low risk of wound complications, infections, hematoma formation, thromboembolic events, and overall complication rates with minimal side effect profile. Perioperative tranexamic acid use may prove to be beneficial in foot and ankle surgery patients but especially in higher-risk patients such as those with diabetes, trauma, and those that are immunocompromised.Level of Evidence:Level IV, case series.

Skin closure following abdominal wall reconstruction: three-layer skin suture versus staples

Skin closure following abdominal wall reconstruction (AWR) has received little attention, even though these patients have demonstrated insufficient wound healing. This study assessed the postoperative wound-related complications and patient-reported outcomes after skin closure using single- or triple layer closure following AWR. This was a retrospective study at a University Hospital from 2016 to 2018. Patients were grouped into a single-layer cohort (SLC) and a triple-layer cohort (TLC). Skin incisions closed with either technique were compared. Postoperative complications were registered from chart review (SLC: n = 48, TLC: n = 40). Patient reported-outcomes were assessed through the Patient Scar Assessment Questionnaire (PSAQ) and the Hernia Related Quality of Life survey. A total of 51 patients were included (SLC: n = 26, TLC: n = 25). There was no difference in wound complications after single- or triple-layer skin closure; seroma (SLC: 16.7% vs. TLC: 15%, p = 1.00), surgical site infection (SLC: 4.2% vs. TLC: 7.5%, p = .834), hematoma (SLC: 6.2% vs. TLC: 2.5%, p = .744) and wound rupture (SLC: 2.1% vs. TLC: 2.5%, p = 1.00). Patients who had incisions closed using single-layer closure were more satisfied; PSAQ satisfaction with scar symptoms (SLC: 6.7 points (IQR 0.0–18.3) vs. TLC: 26.7 points (IQR 0.0–33.3), p = .039) and scar aesthetics (SLC 25.9 points (IQR 18.5–33.3) vs. TLC: 37.0 (IQR 29.6–44.4), p = .013). There was no difference in 30-day wound complications after either skin closure technique. The results favoured the single-layer closure technique regarding the cosmetic outcome. Abbreviations: AWR: abdominal wall reconstruction; SLC: single-layer cohort; TLC: triple-layer cohort; PSAQ: patient scar assessment questionnaire; IH: incisional hernia; QOL: quality of life; BMI: body mass index; HerQLes: hernia-related quality of life; ASA: American Society of Anesthesiologists; SSO: surgical site occurence; SSI: surgical site infection; LOS: length of stay; RCT: randomized controlled trial.

259. Hospital mark-up and outcomes following lumbar fusions: moving towards the era of transparency in prices

BACKGROUND CONTEXT Even though charges levied by hospitals for provision of surgical services has broad financial implications on insurance contracts, pricing is not subject to regulation. As a result, hospital mark-ups (1/charge-to-cost ratio (CCR)) are known to vary significantly across the nation. While hospital administrators argue that higher hospital mark ups are reflective of high-quality care, no study have evaluated the impact of undergoing surgery in high markup hospitals on 90-day outcomes following lumbar fusions. PURPOSE To evaluate whether hospitals with higher mark-up ratios for lumbar fusions is associated with improved/better outcomes. STUDY DESIGN/SETTING Retrospective review of 100% Medicare Standard Analytical Files (SAF100) database. PATIENT SAMPLE The 2014 100% Medicare Standard Analytical Files (SAF100) was queried using DRG code 469 (SPINAL FUSION EXCEPT CERVICAL W/O MCC) to identify patients undergoing lumbar fusions. Hospital mark-up of facilities was calculated using a previously validated formula: (1/CCR). Hospital were divided into three groups – 1) low mark-up (0-2.99), 2) medium mark-up (3.00-5.49) and 3) high mark-up (>5.49). OUTCOME MEASURES Ninety-day complications and readmissions. METHODS Multivariate logistic regression analyses were used to assess for differences in 90-day outcomes between high, medium and low markup hospitals, while controlling for age, gender, region, Elixhauser Comorbidity Index, diagnosis (fracture or degenerative lumbar pathology), approach (anterior or posterior), type of fusion (primary vs revision), extent of fusion (1-3 level or 4-8 level), use of interbody, BMP, neuromonitoring, concurrent laminectomy or discectomy, hospital bed size, teaching status, hospital location (urban or rural), ownership (government, proprietary or voluntary), and whether hospital was a high volume facility (≥ 70 cases/year). A p-value of less than 0.025 was considered significant, due to comparison being carried out between three groups. RESULTS A total of 75,707 patients undergoing surgery in 1,365 hospitals were included – out of which 17,466 (23.1%) received surgery in high mark-up hospitals (N=341), 36,888 (48.7%) received surgery in medium mark-up hospital (N=805) and 21,353 (28.2%) received surgery in low mark-up hospitals (N=341). Following adjustment for baseline demographics, hospital-level factors and clinical characteristics, undergoing surgery at high mark-up hospital (vs low mark-up hospital) was not associated with significant differences in wound complications (p=0.935), sepsis (p=0.139), revision fusion (p=0.139), acute renal failure (p=0.098), myocardial infarction (p=0.774), deep venous thrombosis (p=0.046), pulmonary embolism (p=0.442), and urinary tract infections (p=0.739). High mark-up hospitals, vs low mark-up hospitals, had slightly lower odds of pneumonia (OR 0.76 [95% CI 0.64-0.92]; p=0.004) and readmissions (0.91 [95% CI 0.84-0.98]; p=0.012). Similarly, no significant differences in outcomes were noted between medium mark-up hospitals (vs low mark-up hospitals), with the exception of slightly lower odds of urinary tract infections (p=0.009). CONCLUSIONS Based on the findings of the study, it appears that hospital markup is not largely correlated with the quality of surgical care following lumbar fusions. Moving forward, price transparency in billings will be essential for controlling the ever-increasing cost burden associated with spinal fusions. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

103. Discharge to subacute rehabilitation is a predictor of wound complications after spine surgery

BACKGROUND CONTEXT A significant number of patients are discharged to inpatient care facilities after various procedures in spine surgery. However, data are limited regarding the relationship between nonhome disposition and postdischarge surgical outcomes. PURPOSE The aim of this study was to evaluate differences in wound complications and readmission among discharge settings in patients undergoing elective spine surgery for degenerative cervical and lumbar disease (radiculopathy and/or myelopathy). STUDY DESIGN/SETTING This study is a retrospective analysis of prospectively collected data from a single, high-volume academic medical center. PATIENT SAMPLE Patients undergoing one- to three-level lumbar decompression, one- to three-level lumbar decompression and fusion, or posterior cervical decompression and fusion were retrospectively identified. OUTCOME MEASURES The outcomes of interest in this study were wound complications (surgical site infections, wound dehiscence), revision surgery, 30-day readmission, and 90-day readmission. METHODS Patient characteristics, including age, gender, body mass index (BMI), Charlson Comorbidity Index (CCI), and discharge setting (home, acute rehabilitation, subacute rehabilitation) were collected. Patients were stratified into those discharged to home/self-care (home), those discharged to inpatient rehabilitation (acute), and those discharged to skilled nursing or long-term rehabilitation (subacute). A multivariate logistic regression model was developed to identify variables associated with wound complications. RESULTS A total of 623 patients were included in the final analysis, with 480 patients in the Home group, 72 patients in the Acute group, and 80 patients in the Subacute group. Acute and Subacute patients had a higher mean age compared to the Home group (p CONCLUSIONS Our results suggest that discharge to subacute rehabilitation may be associated with an increased risk of wound complications in patients’ status post elective cervical or lumbar surgery. Moreover, our analysis further supports previous reports establishing an association between increased postoperative wound complications and obesity. Patients across all groups utilized a similar amount of resources in terms of readmissions and revision surgery. Surgeons should understand the need for appropriate risk stratification, and when clinically possible and safe, design pathways aimed at home discharge to reduce the occurrence of postoperative wound complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Seasonal effect on the incidence of post-operative wound complications after trauma-related surgery of the foot, ankle and lower leg

IntroductionPost-operative wound complications remain among the most common complications of orthopedic (trauma) surgery. Recently, studies have suggested environmental factors such as season to be of influence on wound complications. Patients operated in summer are reported to have more wound complications, compared to other seasons. The aim of this study was to identify if “seasonality” was a significant predictor for wound complications in this cohort of trauma-related foot/ankle procedures.Materials and methodsThis retrospective cohort study included all patients undergoing trauma-related surgery (e.g. fracture fixation, arthrodesis, implant removal) of the foot, ankle or lower leg. Procedures were performed at a Level 1 Trauma Center between September 2015 until March 2019. Potential risk factors/confounders were identified using univariate analysis. Procedures were divided into two groups: (1) performed in summer (June, July or August), (2) other seasons (September–May). The number of surgical wound complications (FRIs, SSIs or wound dehiscence) was compared between the two groups, corrected for confounders, using multivariate regression.ResultsA total of 599 procedures were included, mostly performed in the hindfoot (47.6%). Patients were on average 46 years old, and mostly male (60.8%). The total number of wound complications was 43 (7.2%). Age, alcohol abuse, open fracture and no tourniquet use were independent predicting factors. No difference in wound complications was found between summer and other seasons, neither in univariate analysis [4 (3.2%) vs 39 (8.2%), p = 0.086] nor when corrected for predicting factors as confounders (p = 0.096).ConclusionsNo seasonality could be identified in the rate of wound complications after trauma surgery of the lower leg, ankle and foot in this cohort. This lack of effect might result from the temperate climate of this cohort. Larger temperature and precipitation differences may influence wound complications to a larger extent. However, previous studies suggesting seasonality in wound complications might also be based on coincidence.

Clinical Application of CT Navigation in treatment of Lumbar Spondylolisthesis with Minimally Invasive Surgery - Transforaminal Lumbar Interbody Fusion.

Objective:To explore the clinical effect of the application of CT navigation in the treatment of lumbar spondylolisthesis with minimally invasive surgery - transforaminal lumbar interbody fusion (MIS-TLIF).Methods:A retrospective study was conducted on 30 patients with lumbar spondylolisthesis who were continuously treated in linyi central hospital from May 2018 to March 2019.The patients were divided into two groups,15 patients treated with MIS-TLIF with the aid of CT navigation during the operation were included into an observation group. Another 15 patients were treated with open transforaminal lumbar interbody fusion as the control group. The baseline information, including gender, age and course of disease, perioperative period and imaging conditions, and VAS and ODI scores of patients in the two groups were collected and analyzed.Results:Fifteen patients were included into the observation group, including 9 male and 6 female patients with an average age of 52.60 ± 6.31 and a course of disease of 16.33 ± 6.00 months. The other 15 patients were included into the observation group, including seven male and eight female patients with an average age of 52.87 ± 7.38 and a course of disease of 19.13 ± 9.89 months. The difference in the gender, age and course of disease between the two groups had no statistical significance (P > 0.05). However, the difference in the duration of operation and intraoperative blood loss between the two groups had statistical significance (P< 0.05). There were no statistically significant differences in wound complications, neurological complications, preoperative slippage rate, postoperative slippage rate, slippage reduction rate and screw placement accuracy (P > 0.05). VAS scores of the two groups were statistically significant from six months after surgery (P < 0.01). There was no significant difference in ODI between the two groups at any time point (P >, 0.05). VAS and ODI scores were improved at each time point compared with those before surgery.Conclusion:The minimally invasive transforaminal lumbar fusion performed with the aid of CT navigation during the operation shortens the duration of operation and the amount of bleeding, reduces the back pain, is beneficial to the early postoperative functional exercise, and speeds up the postoperative recovery.

Dilute Betadine Lavage Reduces the Risk of Acute Postoperative Periprosthetic Joint Infection in Aseptic Revision Total Knee and Hip Arthroplasty: A Randomized Controlled Trial

BackgroundThe purpose of this randomized, controlled trial is to determine whether dilute betadine lavage compared to normal saline lavage reduces the rate of acute postoperative periprosthetic joint infection (PJI) in aseptic revision total knee (TKA) and hip arthroplasty (THA). MethodsA total of 478 patients undergoing aseptic revision TKA and THA were randomized to receive a 3-minute dilute betadine lavage (0.35%) or normal saline lavage before surgical wound closure. Fifteen patients were excluded following randomization (3.1%) and six were lost to follow-up (1.3%), leaving 457 patients available for study. Of them, 234 patients (153 knees, 81 hips) received normal saline lavage and 223 (144 knees, 79 hips) received dilute betadine lavage. The primary outcome was PJI within 90 days of surgery with a secondary assessment of 90-day wound complications. A priori power analysis determined that 285 patients per group were needed to detect a reduction in the rate of PJI from 5% to 1% with 80% power and alpha of 0.05. ResultsThere were eight infections in the saline group and 1 in the betadine group (3.4% vs 0.4%, P = .038). There was no difference in wound complications between groups (1.3% vs 0%, P = .248). There were no differences in any baseline demographics or type of revision procedure between groups, suggesting appropriate randomization. ConclusionDilute betadine lavage before surgical wound closure in aseptic revision TKA and THA appears to be a simple, safe, and effective measure to reduce the risk of acute postoperative PJI. Level of EvidenceLevel I.

Use of an Accelerated Discharge Pathway in Patients With Severe Cerebral Palsy Undergoing Posterior Spinal Fusion for Neuromuscular Scoliosis

BackgroundImplementation of a coordinated multidisciplinary postoperative pathway has been shown to reduce length of stay after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis. This study sought to compare the outcomes of nonambulatory cerebral palsy (CP) patients treated with PSF and cared for using an accelerated discharge (AD) pathway with those using a more traditional discharge (TD) pathway. MethodsA total of 74 patients with Gross Motor Function Classification System (GMFCS) class 4/5 CP undergoing PSF were reviewed. Thirty consecutive patients were cared for using a TD pathway, and 44 patients were subsequently treated using an AD pathway. The cohorts were then evaluated for postoperative complications and length of stay. ResultsLength of stay (LOS) was 19% shorter in patients managed with the AD pathway (AD 4.0 days [95% CI 2.5-5.5] vs. TD 4.9 days [95% CI 3.5-6.3], p = .01). There was no difference between groups with respect to age at surgery, GMFCS class, preoperative curve magnitude, pelvic obliquity, kyphosis, postoperative curve correction, fusion to the pelvis, or length of fusion between groups. Length of stay remained significantly shorter in the AD group by 0.9 days when controlling for estimated blood loss (EBL) and length of surgery. Complication rates trended lower in the AD group (33% AD vs. 52% TD, p = .12), including pulmonary complications (21% AD vs. 38% TD, p = .13). There was no significant difference in wound complications, return to the operating room, or medical readmissions between groups. ConclusionsAdoption of a standardized postoperative pathway reduced LOS by 19% in nonambulatory CP patients. Overall, complications, including pulmonary, trended lower in the AD group. Early discharge appears to be possible in this challenging patient population. Although the AD pathway may not be appropriate for all patients, the utility of the AD pathway in optimizing care for more routine PSF for this patient subset appears to be worthwhile. Level of EvidenceLevel III, therapeutic.

Hypoalbuminemia Predicts Increased Readmission and Emergency Department Visits After Lower Extremity Bypass.

Preoperative hypoalbuminemia is associated with poor outcomes across many surgical fields. However, the effects on outcomes after lower extremity bypass (LEB), particularly over the 90-day global surgical period, are unclear. Our goal was to analyze the effect of hypoalbuminemia within 90 days after LE bypass. We performed a single-center retrospective review of all infrainguinal LEBs from 2007 to 2017. Patients were categorized into 3 preoperative albumin groups: severe hypoalbuminemia (SH; albumin ≤2.8g/dL), mild-moderate hypoalbuminemia (MH; albumin >2.8-3.5g/dL), and normal albumin (albumin >3.5g/dL). Patient and procedural details were recorded. Outcomes analyzed included wound infection, myocardial infarction (MI), pulmonary complications, early graft occlusion (≤30 days), mortality, and emergency department (ED) presentation and readmissions within 30 and 90 days. Multivariable analysis was performed. We identified 313 patients undergoing LEB-45 (14.4%) with SH, 133 (42.5%) with MH, and 135 (43.1%) with normal albumin. Overall, the mean age was 65.7 years, and 63.3% were male. The SH group more frequently had tissue loss, diabetes, hypertension, end-stage renal disease, preoperative hematocrit <30%, and patients admitted preoperatively (all P < .05). There were no significant differences in wound complications, MI, pulmonary complications, early graft occlusion, 30-day or 90-day mortality, and 30-day ED presentation. Severe hypoalbuminemia compared to MH and normal albumin, respectively, had significantly higher rates of 30-day readmission (40% vs 30.8% vs 17.8%, P = .005), 90-day ED presentation (55.6% vs 33.8% vs 29.6%, P = .006), and 90-day readmission (66.7% vs 48.9% vs 35.6%, P = .001). Multivariable analysis showed that SH was independently associated with 90-day ED presentation (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.23-6.36, P = .014) and 90-day readmission (OR: 2.63, 95% CI: 1.21-5.71, P = .015). Our study suggests that patients with SH undergoing LEB had similar perioperative complication rates compared to normal albumin and MH groups, and SH was independently associated with 90-day ED presentation and readmission. Further studies are needed to assess other factors associated with ED visits and readmission.