Frequency Of Surgical Site Infection Research Articles

Frequency of surgical site infection after single dose of preoperative antibiotics in children with uncomplicated acute appendicitis: a cross-sectional study

Background: Hyperaemic suppurative appendicitis, or uncomplicated appendicitis, often requires an appendectomy. Surgical Site Infection (SSI) is common post-surgery, and prophylactic studies show ceftriaxone and metronidazole effectively protect against most causative organisms. Methods: Ninety patients were included through non-probability convenience sampling. Acute appendicitis was diagnosed using the Alvarado score, with surgery for scores of 7 or higher. A single preoperative dose of ceftriaxone and metronidazole was administered. Follow-up visits included stitch removal on the seventh postoperative day and monitoring up to the tenth postoperative day using the Southampton criteria for wound infection. Results: Of the 90 patients, 64 (71.1%) were male and 26 (28.9%) were female. Fifty (55.6%) scored 7-8 on the Alvarado score, and 40 (44.4%) scored 9-10. Using the Southampton criteria, 5 (5.6%) developed grade I SSI. Infection rates showed no significant difference between male (3.1%) and female (11.5%) patients (p value >0.05) or by Alvarado score and symptom duration. No cases of SSI beyond grade II were observed. Conclusions: Administering a single preoperative antibiotic dose effectively minimizes surgical site infection in children with uncomplicated acute appendicitis, demonstrating clear management advantages.

Spectrum of Surgical Site Infection Pathogens in Chronic Infectious Spondylitis Requiring Revision Surgery: A 5-Year Cohort Study.

Background: Spectrum monitoring of the pathogen in spondylitis patients plays a key role in preventing infectious complications of spinal reconstructions in chronic spondylitis (CS) and in the treatment of surgical site infection (SSI). The aim of this study is to characterize the spectrum of SSI pathogens in CS requiring revision surgery. Methods: The primary cohort encompassed 569 surgical patients with infectious CS. In 99 patients (61 men and 38 women) requiring revision surgical interventions due to SSI, continuous microbiological monitoring of the pathogens was conducted. The average age of the patients was 63 ± 14 years. The vast majority of the patients underwent surgery on a set of multilevel (two or more spinal-motor segments) lesions. Lesions of the lumbar spine were more often noted, and lesions of the thoracic, thoracolumbar, and cervical spine sections were less often noted. This study included all patients operated on within the scope of revision spinal reconstructions in connection with the development of infection of the surgical area over the period from January 2018 to December 2022. Inclusion criteria were etiologically verified spondylitis, age of 18 years or older, and follow-up of 6 months or more. Results: The average rate of revision surgery due to SSI was 17.4%. Germ detection from the material of vertebral localization was noted in 48.3% and pathogen strains were isolated in urine in 60.8%, in decubital ulcers in 23.9%, and in hemoculture in 15.2% of all study patients. Aseptic, deep SSI was detected in 10.1%. Gram-positive, multidrug-resistant, and Gram-negative bacteria with extreme resistance prevailed in the microbiological landscape of late SSI, early, and delayed Gram-positive strains without drug resistance. Conclusions: Infectious etiology of spondylitis is associated with a significantly higher frequency of SSI. In the absence of a positive result from bacteriological examination of the vertebral localization material, it is advisable to conduct blood, decubital ulcer discharge, and urine sampling.

Differential diagnosis and treatment of nosocomial spinal infections in patients after open microdiscectomy (brief literature review)

Surgical site infections (SSI) occur in 0.7‒16.1 % of cases and are one of the most frequent nosocomial complications in spinal neurosurgery. The frequency of SSI after open microdiscectomies varies from 1.9 % to 5.5 % depending on several factors and requires clarification. The causative agents of spinal SSI are most often Staphylococcus aureus, S. epidermidis, methicillin-resistant S. aureus, less frequently anaerobic strains, and Mycobacterium tuberculosis.Symptoms of deep SSI caused by the most common Gram-positive and Gram-negative microflora are usually nonspecific and include fever, back pain, and limited movement. Anaerobic spondylodiscitis is characterized by long-lasting back pain, mainly without an increase in temperature, and a high frequency of epidural abscess formation. The most significant factors in the occurrence of SSI are surgical access, type and duration of surgical intervention, the number of levels operated on at once, the duration of hospitalization, the presence of diabetes, and the patient’s high body mass index. However, the importance of each of these and other factors in the development of SSI after surgical interventions for clinically manifest discogenic pathology continues to be studied. In several studies, open microdiscectomies were statistically significantly associated with a higher frequency of SSI formation. Posterior spondylodesis and implants in the spine increase the risk of SSI development. Prevention of SSI should include preoperative, intraoperative, and postoperative stages, compliance with which can contribute to reducing the risk of SSI. Treatment of purulent spondylodiscitis involves antibiotic therapy and long-term dynamic observation. Indications for surgical intervention are the effectiveness of antibiotic therapy, deterioration of neurological symptoms, and violation of the integrity of the vertebrae with the formation of instability. The issue of choosing the optimal access and volume of surgical intervention for postoperative spondylodiscitis is analyzed in many studies and, first of all, is determined by: localization, the nature of structural changes, the presence of accompanying abscesses, the degree of neurological deficit, the presence or absence of vertebral compression fractures and signs of spondylolisthesis.Postoperative SSI worsens patients’ quality of life and disease prognosis in patients with discogenic pathology. A clear understanding of the individual risk factors of SSI, timely diagnosis, and differentiated treatment can prevent the formation of these dangerous complications and minimize their manifestations.

Surgical Site Infection After Stoma Reversal: A Comparison Between Linear and Purse-String Closure.

Intestinal stomas are utilized for both benign and malignant conditions of the intestine to mitigate the risk of anastomotic leakage and re-exploration. However, stomas are associated with various complications, such as stoma necrosis, peri-stomal irritation, parastomal hernia, bleeding, bowel obstruction, and electrolyte abnormalities. Surgical site infection (SSI) is a significant source of morbidity following stoma reversal, leading to increased patient morbidity. The conventional method of stoma reversal involves closing the skin with non-absorbable sutures in a linear fashion, which is known as linear skin closure (LSC). Recently, a new method of skin closure using purse-string approximation (PSA) has been advocated, which allows healing by secondary intention. The rationale for this study is to compare the SSI associated with LSC and PSA after stoma reversal. This study aims to compare the frequency of SSI between LSC and PSA in stoma reversal. The study was conducted at the Department of General Surgery, Shifa International Hospitals Ltd. (SIH), Islamabad, Pakistan. The study is a randomized controlled clinical trial carried out between the 14th of March 2021 and the 22nd of November 2022. The sampling technique was non-probability consecutive random sampling. The sample size was calculated using the WHO sample size calculator by using the hypothesis test for two population proportions. The minimum sample size in each group was 40 patients. The total sample size was 80 patients. The overall frequency of SSIin all the patients was 18/80 (22.5%). The frequency of SSI in Group 1 (LSC) was 6/40 (15.0%), and in Group 2 (PSA), it was 12/40 (30.0%). The frequency of SSI in Group 2 (PSA) was twice as high as in Group 1 (LSC); however, the p-value was calculated to be 0.108. Therefore, this difference was statistically insignificant. While PSA has exhibited promise in reducing SSI rates and enhancing aesthetic outcomes and patient satisfaction, there is still enough data favoring LSC. Moreover, insufficient data is available for our population to make a definitive statement. Consequently, further research on this topic is warranted, preferably involving larger sample sizes and multicenter randomized controlled trials, to establish which technique is superior in SSI reduction.

The Outcome of Purse-string Versus Conventional Wound Closure Techniques in Patients Undergoing Stoma Reversal: A Randomized Controlled Trial

BackgroundPatients undergoing stoma reversal may experience surgical site infections and poor scarring. A purse-string closure approach may lower the incidence of surgical site infections due to its inherent ability to drain wound exudates. This study compared the frequency of surgical site infections and the cosmetic outlook of the scar among patients undergoing stoma reversal with linear and purse-string skin closure techniques. Setting and durationDepartment of Pediatric Surgery, University of Child Health Sciences Lahore with a duration of one year (June 2021 to June 2022). MethodsThis randomized controlled trial (TCTR20210417001) was conducted with IRB approval. A total of 124 patients undergoing stoma reversal were randomly assigned to two groups (62 in each): Group A received conventional linear skin closure, while Group B received purse-string wound closure. The study evaluated surgical site infection, cosmetic outcome, and length of stay. ResultsBoth groups had similar age, gender ratio, indication for surgery, and length of stay. The purse-string group had a significantly lower incidence of SSI (38.7 % vs. 14.5 %; p = 0.002) and better scar quality (Manchester scar scale showed 'good' scar quality in 63 % of patients vs. 22.6 % in the linear closure group, p-value <0.0001). ConclusionThe purse-string technique for skin closure resulted in fewer surgical site infections and improved scar appearance.

Association between methicillin-resistant Staphylococcus aureus nasal carriage and infection after pancreatic surgery.

Methicillin-resistant Staphylococcus aureus (MRSA) infections after pancreatectomy are relatively rare; however, they can be fatal when associated with pseudoaneurysms. For the past 12 years, we have been investigating nasal MRSA carriage by polymerase chain reaction testing, postoperatively in patients admitted to the intensive care units, to prevent nosocomial infections. Here, we investigated the relationship between MRSA nasal carriage and postoperative MRSA infection at the surgical site, following pancreatectomy. This single-center retrospective study analyzed 313 pancreatectomies (220 pancreaticoduodenectomies and 93 distal pancreatectomies), performed at our hospital between January 2011 and June 2022. The incidence of surgical site infection (SSI) and postoperative MRSA infection were compared between the nasal MRSA-positive and nasal MRSA-negative groups. MRSA nasal carriage was identified in 24 cases (7.6%), and the frequency of SSIs in the nasal MRSA-positive and MRSA-negative groups were 50% and 36.7%, respectively, with no significant difference (p = .273). However, the frequency of MRSA infection among the SSI cases was significantly higher in the nasal MRSA-positive group (16.7%) than in the nasal MRSA-negative group (1.7%) (p = .003). It should be noted that MRSA carriers have a significantly higher frequency of MRSA-positive SSIs.

Port Site Morbidities Following the Extraction of the Gallbladder from the Umbilical Port in Comparison to the Epigastric Port in Laparoscopic Cholecystectomy: A Double-Blinded, Randomized Controlled Trial.

Background Port site morbidities after laparoscopic cholecystectomy may be related to the port used for the extraction of the gallbladder. Prior randomized trials that tried to address the suitable port for gallbladder extraction showed mixed results favouring epigastric, whereas others favoured umbilical. Thus, the present study was conducted with the aim of finding a suitable port for gallbladder extraction after laparoscopic cholecystectomy. Methodology A total of 104 patients undergoing laparoscopic cholecystectomy were randomized to either the epigastric (Group 1) or umbilical (Group 2) port group for gallbladder extraction. Post-operative pain (by visual analogue scale (VAS)), the frequency of surgical site infection (SSI), and port site herniation were compared. Results Post-operative pain was lower in the umbilical port group in the initial 24 hours. The SSIs and port site herniation rates were lower in the umbilical port group; however, they were statistically not significant. Conclusion Less post-operative pain at the umbilical port may help with the early discharge of patients. In contrast to other studies, our trial had fewer infections and hernias in the umbilical port group.

Intraoperative Wound Irrigation for Prevention of Surgical Site Infections After Abdominal Surgery

Objectives: To compare the frequency of surgical site infections after abdominal surgery with and without intraoperative irrigation of the surgical wounds.&#x0D; Methodology: This randomized controlled trial was performed in general surgery department, PAF Hospital, Islamabad from 10th August 2022 to 9th May 2023. A total of 520 patients undergoing abdominal surgeries of any gender between the ages of 15–70 years were included. Patients were randomly divided in two groups on the basis of non-probability, consecutive sampling. The participants included in the group-A did not receive any intraoperative wound irrigation. The participants in the Group-B received intraoperative wound irrigation with antiseptic solution i.e., povidone-iodine in solution. Each patient was followed up respectively on 7th, 21st and 30th days postoperatively to observe surgical site infection. Chi square test was applied to compare SSI percentage between two groups. P-value of less than 0.05 was taken as significant.&#x0D; Results: Mean age was 39.87±6.93 years in group-A and 37.67±7.56 years in Group-B. Out of 520 patients, 344 (66.15%) were males and 176 (33.85%) were females. Surgical site infection after abdominal surgery without intraoperative irrigation was found to be 34 (13.08%) and surgical site infection after abdominal surgery with intraoperative irrigation was 12 (4.62%), hence statistically significant (p-value = 0.0007).&#x0D; Conclusion: This study concluded that intraoperative wound irrigation is effective to prevent the surgical site infections after abdominal surgery.

Rethinking Prophylaxis: Evaluating Surgical Site Infection Rates in Pediatric Orchidopexy without Prophylactic Antibiotics

Introduction: Undescended testes (UDT) is the most common congenital anomaly of the urogenital system in male newborns. Testicular descent into scrotum is necessary for normal spermatogenesis. The scrotal temperature is 2-7 degrees below body temperature. UDT are prone to impaired spermatogenesis, Surgical site infection (SSI) is a leading cause of postoperative morbidity and mortality. It is the third most common cause of hospital acquired infections. However injudicious use of antibiotics is responsible for increased costs, unwanted drug side effects like Clostridium difficile infection as well as the emergence of resistant strains and multidrug resistant infections. Objective: To determine the frequency of surgical site infection in pediatric patients undergoing orchidopexy without the administration of prophylactic antibiotics. Study Design: Descriptive Study Setting: Department of pediatrics, Lady Reading Hospital Peshawar. Duration of Study: From 08-July-2020 to 08-January-2021. Materials and Methods: In overall 126 respondents of undescended testis were selected in a consecutive manner OPD and subjected to orchidopexy. Follow up was done to detect the presence or absence or SSI. Results: The average age of the sample was 12.9+6.8 months. Mean weight of the included children was 12.8 4.9 kg and mean height was 73.1+ 13.5 cm. 50.8% Presented with right side undescended testis and 57.1% were in ASA class Mean operative time for orchidopexy was 44.4 10.3 minutes. SSI was recorded in 31 (24.6%) of children. Conclusion: Surgical site infection (SSI) is a significant concern in pediatric patients undergoing orchidopexy for unilateral undescended testis. Additional investigation is required to determine the factors that contribute to surgical site infections (SSI) in children and create successful measures for prevention. The use of prophylactic antibiotics should be carefully considered, considering the potential risks and benefits. Addressing SSI in this population is crucial for improving patient outcomes and reducing the burden of complications. Keywords: Orchidopexy, pediatrics, surgical site infection

Risk factors associated with surgical site infection in patients with musculoskeletal cancer

Background and objectives: surgical site infections (SSI) continue to be a major concern in orthopedic oncology and pose as great a challenge as cancer recurrence, despite the preventive potential of surgery. SSI can be avoided if evidence-based measures are taken. The objective was to assess the frequency of infections in oncological orthopedic surgeries and associated risk factors and inflammatory markers in a reference hospital in the state of Pernambuco. Methods: the frequency of SSI, the identification of isolated microorganisms, the risk factors and the profile of Th1 and Th2 inflammatory markers (IL-2, IL-4, IL-6, IL-10, TNF and IFN-Ƴ) in patients with musculoskeletal cancer were analyzed. Results: SSI were found in 9.1% of patients undergoing orthopedic surgery. Bivariate analysis revealed that a surgical team comprising more than five members (p=0.041) and the need for intraoperative transfusion (p=0.012) were correlated with a higher risk of SSI. The measurement of ultrasensitive C-reactive protein levels to assess the inflammatory response after SSI showed results that were superior to the reference values for each sample, ranging from &gt;5 to &gt;200mg/dl by the immunoturbidimetric method. Of the IL-2, INFγ and TNF (Th1) and IL-4, IL-6, IL-10 (Th2) levels, only interleukin 6 showed high levels, between 6.68 and 58.76 pg/mL. Conclusion: the study found that surgical team with five or more members and blood transfusion were factors associated with the development of SSI in orthopedic surgery in patients with musculoskeletal cancer. Among the inflammatory markers, interleukin 6 (IL-6) showed the highest correlation with the outcome.

Cefazolin vs Second-line Antibiotics for Surgical Site Infection Prevention After Total Joint Arthroplasty Among Patients With a Beta-lactam Allergy.

Cefazolin is a first-line agent for prevention of surgical site infections (SSIs) after total joint arthroplasty. Patients labeled allergic to beta-lactam antibiotics frequently receive clindamycin or vancomycin perioperatively due to the perceived risk of a hypersensitivity reaction after exposure to cefazolin. This single-system retrospective review included patients labeled allergic to penicillin or cephalosporin antibiotics who underwent a primary total hip and/or knee arthroplasty between January 2020 and July 2021. A detailed chart review was performed to compare the frequency of SSI within 90 days of surgery and interoperative hypersensitivity reactions (HSRs) between patients receiving cefazolin and patients receiving clindamycin and/or vancomycin. A total of 1128 hip and/or knee arthroplasties from 1047 patients were included in the analysis (cefazolin n = 809, clindamycin/vancomycin n = 319). More patients in the clindamycin and/or vancomycin group had a history of cephalosporin allergy and allergic reactions with immediate symptoms. There were fewer SSIs in the cefazolin group compared with the clindamycin and/or vancomycin group (0.9% vs 3.8%; P < .001) including fewer prosthetic joint infections (0.1% vs 1.9%). The frequency of interoperative HSRs was not different between groups (cefazolin = 0.2% vs clindamycin/vancomycin = 1.3%; P = .06). The use of cefazolin as a perioperative antibiotic for infection prophylaxis in total joint arthroplasty in patients labeled beta-lactam allergic is associated with decreased postoperative SSI without an increase in interoperative HSR.

Frequency of Surgical Site Infection in Mesh Repair for Inguinal Hernias

OBJECTIVES To determine the frequency of surgical site infection in mesh repair for inguinal hernias. METHODOLOGY This Descriptive observational study was carried out at the Surgical B unit of Hayatabad Medical Complex Peshawar from November 2021 to October 2022. A total of 179 patients were included in the study were given a single dose of antibiotics, i.e.1, gm Ceftriaxone, one hour before inguinal hernia mesh repair.RESULTS A total of 179 patients aged between 30-60 years with a mean age of 45 years were enrolled. There were 98(54.7%) male while 81(45.3%) females. The frequency of wound infection was noted in 23 (12.8%) patients following mesh repair for inguinal hernia. Out of 23, most of the patients, 10(43.5%) had Medical redness &amp; tenderness, 8(34.8%) patients had pus discharge from the wound side, and 5(21.7%) patients had wound site abscesses.CONCLUSION Surgical site infection after mesh repair was higher than the internationally reported incidence. Establishing a baseline SSI rate for inguinal hernia repairs offers a useful benchmark for future studies and surgical programs in these

Compare the Frequency of Surgical Site Infections Following Irrigation of Appendectomy Wounds with Sterile Saline Solution Vs Imipenem Solution

Objective: The purpose of this study was to compare the frequency of surgical site infection following appendectomy wound irrigation with imipenem solution versus ordinary saline solution. Study Design: Randomized/ Prospective study Place and Duration: This prospective randomized study was conducted at Department of Surgery, Jinnah International Hospital, Abbottabad and MTI Hayatabad Medical Complex Peshawar in the period from 01 July, 2022 to 31 December, 2022. Methods: Total 106 patients of acute appendicitis who underwent for appendectomy were included. After getting informed written consent detailed demographics of enrolled cases were recorded. Patients were categorized in two groups. Fifty-three cases of group I received imipenem solution at closure of wound and group II was irrigated with saline solution in fifty three cases. Patients were followed for surgical site infection and the development of deep abscesses after surgery. Results: In all there were majority 63 (59.4%) males and 43 (40.6%) females. Patients mean age in group I was 26.7±3.43 years and had mean BMI 22.15±11.23 kg/m2 while in group II mean age was 25.16±6.39 years with mean BMI 21.14±16.44 kg/m2. Frequency of catarrhal inflammation was 47 (88.7%) in group I and 44 (83.02%) in group II followed by perforated appendix and gangrenous appendix. Frequency of SSI in group I was lower found in 4 (7.5%) as compared to group II in 8 (15.1%) cases with p value &lt;0.005. There was no any significant difference observed in abscess formation among both groups Conclusion: In this study, we came to the conclusion that irrigation with imipenem solution can aid to lessen wound infection following appendectomy. It is simple to do and can lower medical expenses as well as patients' suffering from infections. Keywords: Wound irrigation with saline, Imipenem solution, Appendectomy wound infection

Impact of Antibiotic Prophylaxis on Surgical Site Infections in Cardiac Surgery.

(1) Background: Cephalosporins (CA) are the first-line antibiotic prophylaxis recommended to prevent surgical site infection (SSI) after cardiac surgery. The combination of vancomycin/gentamicin (VGA) might represent a good alternative, but few studies have evaluated its efficacy in SSI prevention. (2) Methods: A single-centre retrospective study was conducted over a 13-year period in all consecutive adult patients undergoing elective cardiac surgery. Patients were stratified according to the type of antibiotic prophylaxis. CA served as the first-line prophylaxis, and VGA was used as the second-line prophylaxis. The primary endpoint was SSI occurrence at 90 days, which was defined as the need for reoperation due to SSI. (3) Results: In total, 14,960 adult patients treated consecutively from 2006 to 2019 were included in this study, of whom 1774 (12%) received VGA and 540 (3.7%) developed SSI. VGA patients had higher severity with increased 90-day mortality. Nevertheless, the frequency of SSI was similar between CA and VGA patients. However, the microbiological aetiologies were different, with more Gram-negative bacteria noted in the VGA group. (4) Conclusions: VGA seems to be as effective as CA in preventing SSI.

Comparison of supratentorial meningioma resection outcomes by dural reconstruction technique.

Excision of intracranial meningiomas often requires resection or coagulation of the dura mater. The choice of dural closure technique is individualized and based on surgeon preference. The objective of this study was to determine outcomes following various dural closure techniques for supratentorial meningiomas. A retrospective, single-center cohort study was performed for patients who underwent excision of supratentorial meningiomas from 2000 to 2019. Outcomes including operative time, postoperative in-hospital complications, readmission, causes of readmission including surgical site infection, pseudomeningocele, need for shunt surgery, and imaging appearance of pseudomeningocele on long-term follow-up imaging were compared. Univariate and multivariable analyses were conducted. A total of 353 patients who had complete clinical and operative data available for review were included. Of these patients, 227 (64.3%) had nonsutured dural graft reconstruction and 126 (35.7%) had sutured dural repair, including primary closure, artificial dura, or pericranial graft. There was significant variability in using nonsutured dural reconstruction compared with sutured dural repair technique among surgeons (p < 0.001). Tumors with sagittal sinus involvement were more likely to undergo nonsutured closure (n = 79, 34.8%) than dural repair (n = 26, 20.6%) (p = 0.003). There were no other differences in preoperative imaging findings or WHO grade. Frequency of surgical site infection and pseudomeningocele, need for shunt surgery, and recurrence were similar between those undergoing nonsutured and those undergoing sutured dural repair. The mean operative time for the study cohort was 234.9 (SD 106.6) minutes. The nonsutured dural reconstruction group had a significantly shorter mean operative time (223.9 [SD 99.7] minutes) than the sutured dural repair group (254.5 [SD 115.8] minutes) (p = 0.015). In a multivariable linear regression analysis, after controlling for tumor size and sinus involvement, nonsutured dural graft reconstruction was associated with a 36.8-minute reduction (95% CI -60.3 to -13.2 minutes; p = 0.002) in operative time. Dural reconstruction using a nonsutured graft and sutured dural repair exhibit similar postoperative outcomes for patients undergoing resection for supratentorial meningiomas. Although sutured grafts may sometimes be necessary, nonsutured graft reconstruction for most supratentorial meningioma resections may suffice. The decreased operative time associated with nonsutured grafts may ultimately result in cost savings. These findings should be taken into consideration when selecting a dural reconstruction technique for supratentorial meningioma.

Single incision laparoscopic appendectomy with surgical-glove port is cost-effective and reliable in complicated acute appendicitis: A casecontrol multicenter study in Colombia

BackgroundThe single-port (SPL) and multi-port (MPL) laparoscopic approach are the gold standard of management of acute appendicitis, due to its multiple advantages over open surgery, mainly because of its direct effects on recovery, esthetics and costs of the procedure. However, in third-world countries, the laparoscopic approach is not yet fully reproducible due to the costs of the technique. The surgical-glove port single incision laparoscopic appendectomy (SGP-SILA) has been proposed as a viable option. However, it has never been studied in Colombia. ObjectiveTo evaluate the cost-effectiveness and reliability of SGP-SILA in the management of complicated acute appendicitis, compared to traditional MPL approach. Materials and methodsA retrospective case control study was carried out comparing patients undergoing laparoscopic appendectomy by SGP-SILA vs. MPL, evaluating operating costs associated with intraoperative and postoperative variables in two tertiary centers in Bogota, Colombia. The data were analyzed and expressed according to their nature and distribution. Results116 patients were included (SGP-SILA: 62 and MPL: 54). The median surgical time for SGP-SILA was 60 min vs. 39 min for MPL. SGP-SILA was shown to cause lower frequency of surgical site infection (4 vs. 8 patients; p = 0.047). It was found a significant correlation between Grade III surgical site infection and surgery time (p = 0.047) in the MPL group; also, with hospital stay (p < 0.001). Also, a lower risk of surgical site infection was found with the SGP-SILA technique (22% vs. 31%). SGP-SILA generated a reduction in both direct and indirect operating costs of approximately 10% (616 USD vs. 683 USD). ConclusionSGP-SILA and MPL are feasible and comparable procedures in the resolution of complicated acute appendicitis. SGP-SILA turns out to be more cost-effective compared to MPL, due to the use of more easily accessible instruments. This may be a reproducible technique in low- and middle-income countries.

On-Lay versus Sub-Lay Mesh Repair for Ventral Hernia: A Retrospective Cohort Study

Background: The most feared complication of hernia surgery is recurrence. There is no standard technique by which recurrence can be avoided. Objective: This study was conducted to test the hypothesis of whether the outcomes of sub-lay mesh are better than on-lay mesh repair for ventral hernias. Methods: This retrospective cohort study was conducted on patients who underwent open ventral hernia repair from 1st June 2016 - 31st April 2021. The primary outcome was recurrence and secondary outcomes were operative time, Surgical Site Infection (SSI) within 30 days, and seroma. Results: A total of 187 patients underwent ventral hernia repair and 69 were included in the study i.e. 35 in the sub-lay and 34 in the on-lay group. Both the groups were comparable for the baseline variables i.e. age, gender distribution, BMI, type of hernia, and content, with mean ± standard deviation age of 48.89 years ± 15.32 in the sub-lay and 52.7 ±12.3 in the on-lay group; however, the on-lay mesh was observed to be a preferred approach in patients with obesity or small defect &lt;5 cms. No statistically significant difference was observed between sub-lay and on-lay groups for recurrence (2.9% vs. 5.7%, p-value 0.51), SSI (8.6% vs. 2.9%, p-value: 0.31), Mesh infection (2.9% vs. 2.9% p-value: 0.74), duration of surgery (median: 120 vs. 121 minutes, p-value 0.36) and seroma formation (2.9% vs. 2.9%, p-value 0.74), respectively. Conclusion: This study demonstrates no significant differences between sub-lay vs. on-lay mesh placement in terms of recurrence, seroma formation, and operative time; however, with the slightly higher (statistically insignificant) frequency of SSI in the sub-lay group.

Risk of Surgical Site Infection Following Open and Laparoscopic Cholecystectomy

Objective: The purpose of this research was to assess the risk for infection at the surgical site following open vs. laparoscopic cholecystectomy. Study Design: Randomized control trial Place and Duration: Data was collected from different hospitals including Department of Surgery, Khyber Teaching Hospital and Jinnah International Hospital, Abbottabad in the period from March, 2022 to August, 2022. Methods: Total 94 patients of both genders had age 18-70 years were included. We have taken informed written consent from the included patients for detailed demographics. We equally divided cases in two groups. Group I received open cholecystectomy in 47 patients and 47 patients of group II received laparoscopic cholecystectomy. Post-operative frequency of surgical site infection was compared among both groups. SPSS 23.0 was used to analyze all data. Results: In 94 included cases, 63 (67.02%) were females and 31 (32.98%) were males. Patients mean age in group I was 32.3±13.44 years while in group II mean age was 35.7±16.37 years. Diabetes, depression, hypertension and liver disease were the comorbidities among both groups. Post-operative duration of hospital stay was lower in group II 1.9±6.32 days as compared to group I 4.5±1.19 days. We found that frequency of surgical site infection in group I was higher in 12 (25.5%) cases as compared to group II in 3 (6.4%) cases. Conclusion: In this study, we found that laparoscopic cholecystectomy resulted in a lower rate of infection at the surgical site compared to open cholecystectomy. Keywords: Surgical Site Infection, Open cholecystectomy, Laparoscopic cholecystectomy

1663. Risk-benefit assessment of cefazolin use for surgical site infection prevention among patients allergic to penicillins and cephalosporins

Abstract Background Prosthetic joint infection (PJI) is a devastating complication following knee and hip arthroplasty. Perioperative antibiotics are routinely used in an effort to decrease the risk of surgical site infections (SSI), including superficial skin infections and deep PJI. The American Academy of Orthopedic Surgeons recommend cefazolin as standard of care for SSI prophylaxis. However, non-beta-lactams are often used in patients labeled as allergic to penicillins or cephalosporins due to concern of increased hypersensitivity reactions (HSR). Methods This study examined the frequency of SSI and HSR after receipt of perioperative cefazolin compared to clindamycin and/or vancomycin (C/V) within adult patients labeled as allergic to penicillins or cephalosporins. Patients were included if they underwent primary total hip or knee replacement surgery between January 2020 and July 2021 within the University of Colorado Health system. The outcome of SSI was assessed up to 90 days after surgery. The outcome of HSR was assessed up to 60 minutes after the conclusion of surgery. Results The cohort included 1,128 patients (cefazolin, n=809; C/V, n=319). Baseline characteristics were similar between groups except the proportion of patients with a history of immediate allergy symptoms was greater in the C/V group (59.6%) compared to the cefazolin group (35.8%). The frequency of SSI was lower in the cefazolin group compared to the C/V group (0.9% vs. 3.8%, p &amp;lt; .01). The cefazolin group included 7 SSI, consisting of 6 superficial SSI and 1 deep PJI. The C/V group included 12 SSI, consisting of 6 superficial SSI and 6 deep PJI. HSR were not significantly different between patients receiving cefazolin vs. C/V (0.2% vs. 1.3%, p=.06). HSR in the cefazolin group consisted of skin involvement (n=1) and self-reported allergy in post-operative window (n=1). Both patients had a non-descript history of penicillin allergy. HSR in the C/V group consisted of skin involvement (n=2) and hemodynamic instability (n=2). Three of the four patients had a history of immediate cephalosporin allergy. Conclusion Among penicillin or cephalosporin allergic patients, the use of cefazolin was associated with a lower frequency of PJI without an increase in HSR during surgery. Disclosures All Authors: No reported disclosures.

988. Risk of surgical site infection and Clostridioides difficile infection after perioperative clindamycin in patients labeled penicillin and/or cephalosporin allergic

Abstract Background Perioperative antibiotics reduce surgical site infections after hip and knee arthroplasty. Clindamycin is routinely used as a perioperative antibiotic in patients with beta-lactam allergy labels instead of first-line antibiotics like cefazolin. The purpose of this study is to assess the risk of adverse outcomes associated with the use of clindamycin to prevent surgical site infections (SSI) after total joint arthroplasty. Methods This retrospective review included adult patients labeled as allergic to penicillin or cephalosporin antibiotics, who underwent a primary total hip and/or knee arthroplasty between January 2020 through July 2021, and received perioperative antibiotics. The outcomes of SSI and Clostridioides difficile infection (CDI) within 90 days was compared between patients receiving perioperative clindamycin vs. non-clindamycin antibiotics. Results A total of 1,121 surgical procedures in 1,047 patients were included. The frequency of SSI for the cohort was 1.6% and CDI was 0.4%. SSI occurred more frequently in the clindamycin group than in the non-clindamycin group (4.3% vs 0.7%, p&amp;lt; .01). The average duration from surgery to SSI was 22.7 ± 11.6 days in the clindamycin group and 24.8 ± 11.1 days in the non-clindamycin group. The frequency of CDI occurrence was greater in the clindamycin group than the non-clindamycin group (1.1% vs. 0.1%, p=.05). The average duration from surgery to CDI was 32.6 + 26.6 days in the clindamycin group and 4.6 days in the non-clindamycin group. Multivariable logistic regression identified clindamycin-containing perioperative antibiotic regimens (odds ratio (OR) 5.5) and opioid use prior to surgery (OR 8.7) as risk factors for 90-day surgical site infection. Staphylococcus aureus was the cultured pathogen in 9 of the 17 SSIs. Conclusion This study found a significantly higher frequency of SSI and CDI when clindamycin-based regimens are used perioperatively for primary hip and knee arthroplasty. These results are likely related to decreased activity of clindamycin against Staphylococcus aureus and greater alterations of the microbiome in comparison to beta-lactams. Disclosures All Authors: No reported disclosures.