Early Postoperative Wound Infection Research Articles

Single-level posterior cervical foraminotomy associated with increased incidence of early postoperative wound infection rates relative to anterior cervical discectomy with fusion and cervical disc arthroplasty.

To date, there are no studies comparing perioperative outcomes of cervical radiculopathy patients managed by anterior cervical discectomy with fusion (ACDF), cervical disc arthroplasty (CDA), or posterior cervical foraminotomy (PCF). To assess if there were differences in perioperative outcomes between cervical radiculopathy patients who can be appropriately treated with ACDF, CDA, or PCF. Patients diagnosed with cervical radiculopathy who underwent a single-level ACDF, CDA, or PCF between 2012 and 2019 were retrospectively identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using current procedural terminology (CPT) codes. Patients were subsequently stratified into those who underwent ACDF, CDA, or PCF, and propensity score-matched to adjust for differences in patient demographics/characteristics. Differences were assessed in terms of operative time, healthcare utilization metrics (reoperations, readmissions, lengths-of-stay), as well as medical and surgical complications. A total of 18,614 cervical radiculopathy patients undergoing surgery were identified (ACDF: n=15,862; CDA: n=1,731; PCF: n=1,021). After 1:1 propensity score matching (n=535 each), there were no differences in characteristics in patients undergoing ACDF, CDA, or PCF (P>0.05). PCF patients had statistically higher rates of reoperation (2.1%) than ACDF (0.4%), CDA (0.6%) patients (P=0.010). PCF patients also experienced higher rates of superficial infection (P=0.001), and deep infection (P=0.007), relative to ACDF and CDA patients. There were no other significant differences in medical/surgical complications between the ACDF, CDA, or PCF patients. Cervical radiculopathy patients undergoing PCF are associated with higher rates of perioperative infection and overall reoperation than ACDF or CDA. Further research is required to elucidate the mechanism behind this association.

Surgical Outcomes and Predictive Factors of Medial Toe Excision for Polysyndactyly of the Fifth Toe.

We aimed to report surgical outcomes and analyze prognostic factors of medial toe excision for polysyndactyly of the fifth toe. We reviewed the details of 139 consecutive patients who underwent surgery for postaxial polydactyly of the foot from 2009 to 2018. Among these, 83 patients (90 feet) with polysyndactyly of the fifth toe, treated by medial toe excision (between the duplicated toes) and reconstruction of the fourth web space using a dorsal rectangular flap, were included. The toe alignment and stability were restored by chondroplasty and soft tissue balancing without an osteotomy. A full-thickness skin graft was performed in 52 feet. The mean age at surgery was 27.1 ± 17.5 months and the mean duration of follow-up was 42.8 ± 24.9 months. At the last follow-up, a relatively small size of the reconstructed toe was observed in 19 feet (19/90, 21.1%). Proximal duplication level (metatarsal or proximal phalanx type) and preoperative hypoplasia of the remaining toe were related to the small postoperative size. Valgus deformity of the remaining toe was observed in 2 feet (2/90, 2.2%). We observed 17 cases with delayed healing or early postoperative wound infection. Among these, 7 cases (7/90, 7.8%) showed postoperative thickening or advancement of the web, which was not observed in cases without wound problems. No cases had functional disturbance or pain. The overall surgical outcomes were satisfactory without an osteotomy. Patients with a proximal duplication level or preoperative hypoplasia of the remaining toe should be informed of its possible small size postoperatively. Level IV, retrospective case series.

A study to evaluate the pattern of microorganisms causing early post-operative wound infection in patients undergoing orthopaedic surgery with implant for closed fracture or disease in medical college and hospital, Kolkata

<p class="Default"><strong>Background:</strong> For all orthopaedic surgical procedures with implant, infection at the operative site has always been recognized as a potential complication. The present study was done to evaluate the pattern of causative microorganisms in post-operative infection after orthopaedic surgery with implant in Medical College and Hospital, Kolkata.</p><p><strong>Methods: </strong>This study was Institution based cross-sectional observational case study. Patients population were selected from the patients, who were admitted or came for follow up in the Department of Orthopaedics, who had undergone surgery with implant for close fracture and disease and developed early (<3 months) post-operative wound infection The samples were collected and were sent to the Department of Microbiology, Medical College & Hospital, Kolkata for isolation and identification of the microorganisms and their antimicrobial susceptibility were done.<strong></strong></p><p><strong>Results:</strong> Maximum infections were detected and wound swabs were sent for culture in 2<sup>nd</sup> week of surgery followed by 3rd week. Only 10% (8 cases) had infection beyond 8 weeks. Plates with screws were used in 37 cases (46%) and nails in 15 cases (19%). It was been seen that infection in case of hip prosthesis were significant that is 8% (6 cases) which included four cases of hemiarthroplasty and two cases of total hip arthroplasty.</p><p><strong>Conclusions:</strong> The data suggests that there is preponderance of Gram- negative infections in operated orthopaedic patients, but <em>Staphylococcus aureus </em>predominates the infectious agents as the sole pathogen. <em>Klebsiella </em>species<em> </em>and <em>pseudomonas </em>species<em> </em>are second and third most common pathogens respectively.</p>

Does human immunodeficiency virus status affect early wound healing in open surgically stabilised tibial fractures?

We compared early post-operative rates of wound infection in HIV-positive and -negative patients presenting with open tibial fractures managed with surgical fixation. The wounds of 84 patients (85 fractures), 28 of whom were HIV positive and 56 were HIV negative, were assessed for signs of infection using the ASEPIS wound score. There were 19 women and 65 men with a mean age of 34.8 years. A total of 57 fractures (17 HIV-positive, 40 HIV-negative) treated with external fixation were also assessed using the Checkett score for pin-site infection. The remaining 28 fractures were treated with internal fixation. No significant difference in early post-operative wound infection between the two groups of patients was found (10.7% (n = 3) vs 19.6% (n = 11); relative risk (RR) 0.55 (95% confidence interval (CI) 0.17 to 1.8); p = 0.32). There was also no significant difference in pin-site infection rates (17.6% (n = 3) vs 12.5% (n = 5); RR 1.62 (95% CI 0.44 to 6.07); p = 0.47). The study does not support the hypothesis that HIV significantly increases the rate of early wound or pin-site infection in open tibial fractures. We would therefore suggest that a patient's HIV status should not alter the management of open tibial fractures in patients who have a CD4 count > 350 cells/μl.

The posterior two-portal approach for reconstruction of scapula fractures: Results of 39 patients

The purpose of this study was to describe the so-called posterior two-portal approach to the scapula in detail and to investigate the clinical outcome of patients with displaced glenoid and scapular neck fractures who were surgically treated using this approach. From February 1992 to August 2008, 39 patients (30 men and nine women; mean age: 53 years) with scapular fractures underwent surgical fixation at our institution. Thirty-three patients had glenoid fractures and six had unstable scapular neck fractures. All patients were treated via the two-portal approach. The reduction was evaluated radiographically, and the clinical results were analysed using the Constant score. The mean follow-up period was 78 months (range: 6–168). In 24 of the 33 glenoid fractures, the reduction was anatomical. The mean Constant score was 82.3 (range: 35–100) points. In one case, an early postoperative wound infection was cured by local revision, and one patient developed posttraumatic osteoarthritis of the acromioclavicular joint after 2 years. Only one patient developed specific glenohumeral degeneration after non-anatomical reduction. The posterior two-portal approach allows for a good visualisation of the posterior scapular neck and the glenoid area, facilitating the reduction and safe internal fixation of dislocated scapular neck and glenoid fractures.

Early Post-Operative Wound Infection in Austin Moore Hemiarthroplasty in Enugu, Nigeria

Background: Early post operative wound infection is usually seen within four weeks of orthopaedic operations 1.Use of foreign implants, operating on the elderly, the obese, diabetic or patients with other chronic diseases increase the risk further 2.This study reveals the incidence of early infection and associated factors among patients who had Austin Moore hemiarthroplasty [AMH] in our centre over a ten year period Method: Hospital records of 46 out of 59 patients who had AMH at the National Orthopaedic Hospital, Enugu between 1995 and 2004 (10yr periods) were reviewed retrospectively. 13 patients with incomplete records were excluded. Results: The patients\' ages ranged from 26 to 99yrs with 67yrs as the mean age. There was slight female preponderance. Majority of our patients presented late [76%]. Only 2 patients presented within 24hrs of injury. 89.1% of our patients had femoral neck fracture as indication for hemiarthroplasty, with trivial falls at home and RTA as the leading causes of injury (54.3% and 32% respectively). Most of the patients had co-morbid medical conditions with hypertension predominating [76%]. Eight patients were diabetic 6 of who were also hypertensives. 87% of the patients were transfused. Wound infection was the commonest complication (26.1%). The most common infecting organism was coliform bacteria [33%,] others included staphylococcus aureus, proteus sp, klebsiela sp and pseudomonas sp. All the patients had prophylactic as well as presumptive antibiotic treatment. 43.5% of patients had ceftriaxone and metronidazole. This combination is both the commonest and most effective against infection. Use of gentamicin was uncommon. Majority of the infection was superficial (74.4%) and were treated with antibiotics and wound dressing. Those with deep infection had incision and drainage or removal of the prosthesis in addition. Keywords: Early postoperative wound infection; Austin Moore hemiarthroplasty, Elderly patients.Nigerian Journal of Orthopaedics and Trauma Vol. 7 (1) 2008 pp. 1-2

Role of preoperative nutritional assessment on early postoperative wound infection

Role of preoperative nutritional assessment on early postoperative wound infection

Paravesical Abscess as an Unusual Late Complication of Inguinal Hernia Repair in Children

We analyzed pitfalls in the etiology, diagnosis and treatment of pediatric patients who had a paravesical abscess (PVA) resulting from previous inguinal hernia repair. We retrospectively reviewed the records of 6 children undergoing operation for PVA related to previous inguinal hernia repair between 1994 and 2002. All patients were male and 1.5 to 8 years old. The location of PVA was the right side of the bladder in 4 patients and the left side in 2. History showed that only 2 cases were complicated by early postoperative wound infection. Four patients were hospitalized with a relapse of symptoms following antibiotic treatment for possible urinary tract infection. The interval between initial inguinal hernia repair and the diagnosis of PVA was 6 to 48 months. Five patients had from recurrent lower urinary tract symptoms, 2 had ipsilateral groin discomfort and 1 had lower abdominal discomfort. There were swelling and tenderness at palpation of the ipsilateral groin in 5 patients not present at previous examinations. Only 1 patient had fever and leukocytosis. Urinalysis showed microscopic hematuria in all patients, of whom 2 had also leukocyturia. All patients had negative urine cultures. Ultrasound and computerized tomography findings suggested features of abscess formation at the paravesical space with concomitant focal thickening of the adjacent bladder wall. At surgery when entering the abscess cavity, thick pus and granulation tissues were débrided. Transfixing silk sutures were found to be secured to the adjacent bladder wall in 2 patients and in the area of the internal ring in 4. They were removed. The adjacent bladder walls needed no additional intervention. Biopsy specimens revealed only chronic inflammatory components. Antibiotics were continued for a mean of 7 days. Weekly ultrasound was performed to evaluate bladder wall thickening, which resolved completely within 3 to 5 weeks. Followup was 5 months to 6 years and no recurrence was noted. In children presenting with lower urinary tract symptoms (early period) plus findings of soft tissue infection at the ipsilateral inguinal region (late period) after inguinal hernia repair clinicians should be aware of the possibility of PVA as a primary problem to avoid insufficient treatment because its definitive treatment is removal of the infected suture material.

Endocarditis Involving a Left Ventricular Apicoaortic Valve-Bearing Conduit

Fatal infectious endocarditis involving a left ventricular apicoaortic valve-bearing conduit occurred in a 20-year-old man. Risk factors included early postoperative wound infection, broad spectrum suppressive antibiotic administration, and inadequate dental prophylaxis against infectious indocarditis. Palliative therapy included intravenous antibiotic administration and removal of the conduit. Lessons learned are discussed.

Postoperative wound infection after implant and removal of osteosynthetic material.

Osteosynthetic material was implanted and removal in 972 consecutive operations in the upper and lower extremity. Early post-operative wound infection developed significantly more often after osteosynthesis than after removal of the implant; neither sex nor age influenced significantly the frequency of wound infection. The latter was higher when insertion or removal of material was performed in the lower extremity than in the upper extremity. The hip and ankle regions were involved most often. Staph. aureus and Staph. albus predominated among the Gram-positive infections; gram-negative infections, however, occurred remarkably frequently, E. coli being the most common organism isolated. To decimate exogenous and endogenous contamination of the wounds during operation, aseptic and antiseptic measures should be reinforced. In operation in a region proven to carry a higher post-operative infectious risk, i.e. the hip and ankle, it is suggested that antibiotics should be administered at the time of osteosynthesis.