Higher Wound Infection Rate Research Articles

Intraoperative Temperature Monitoring with Zero Heat Flux Technology (3M SpotOn Sensor) in Comparison with Tympanic and Oesophageal Temperature and Hypotermia Risk Factors: An Observational Study.

ObjectiveInadvertent hypothermia (body temperature below 35°C) is a common and avoidable challenge during surgery under anaesthesia. It is related to coagulation (clotting) disorders, an increase in blood loss, and a higher rate of wound infection. One of the methods for non-invasive monitoring of the core body temperature is the 3M SpotOn zero heat flux method. In this approach, sensors placed at the frontal region of the patient measure the skin temperature by creating an isothermic channel. The study aimed to determine the risk factors for hypothermia and compare the 3M SpotOn zero heat flux method with the tympanic membrane (eardrum) and oesophageal (food pipe) temperature measurement methods.DesignObservational.Data sourcesThe patients’ data were collected, including age, gender, weight, BMI, other illnesses, smoking history, type of anaesthesia, duration of surgery, operating room temperature, pulse rate, blood pressure, blood loss, and transfusions. Body temperature was measured by the tympanic membrane method before and after surgery, oesophageal method during surgery, and SpotOn measurements throughout all three periods were recorded.Eligibility criteriaInclusion criteria was: adult patients, both genders, who had undergone major abdominal cancer surgery at the trialists’ institution, in whom the SpotOn zero heat flux, tympanic membrane, and oesophageal temperature measurement methods had all been used. Participant exclusion criteria was the absence of recorded data.ResultsIn this study, inadvertent intraoperative hypothermia incidence was 38.1% in the recovery room. Although gender, presence of comorbidities, history of smoking, administration of epidural anaesthesia, and requirement of blood transfusion [red blood cells (RBCs) and fresh frozen plasma (FFP)] did not affect hypothermia significantly during admission to the recovery room, prewarming the patient throughout the operation prevented the occurrence of hypothermia significantly (p=0.004). Additionally, as the American Society of Anaesthesiologists (ASA) physical status score worsened, the rate of hypothermia increased significantly (Frequency: 1st degree, 29.4%; 2nd degree, 47.5%; 3rd degree, 66.7%; X2Slope- p=0.047).ConclusionThe most significant risk factor was found to be not prewarming the patient as a strict procedure, and as the ASA physical status score worsened, the rate of hypothermia increased significantly. Besides, the SpotOn method provided temperature measurements as good as the oesophageal temperature measurements. Clinical Trial registration: ISRCTN 14027708.

40 Wildfire Burn Victims: A Unique Population

Abstract Introduction In the past ten years, wildfires have burned an average of 6.8 million acres annually. The frequency of wildfires is expected to increase with climate change. Wildfire burn victims have not been previously well characterized in the literature. As we prepare for more wildfires it is necessary to target populations at risk for sustaining burns with prevention efforts and to prepare hospital systems to meet these patients’ needs. Methods A retrospective review of patients admitted to a burn center between 2016 and 2019 was performed. Patients who were admitted after sustaining a burn attributable to wildfires were identified from the burn center database. Controls were matched to wildfire burn patients by age, gender and total body surface area of burn. The primary outcome was mortality. Secondary outcomes included number of operations, length of stay (LOS), intensive care unit (ICU) LOS, development of wound infections and pneumonia, wound culture microbiology. Results A total of 16 patients who had sustained burns in wildfires were identified and matched with 32 controls. There was no difference in mortality (19% wildfire vs. 9% non, p=0.386), LOS (18 days wildfire vs. 15 days non-wildfire, p=0.406), ICU LOS (17 days wildfire vs. 11 days non-wildfire, p=0.991) and number of skin grafts (1 wildfire vs. 0.5 non-wildfire, p=0.519). Patients who had sustained burns in a wildfire trended towards higher rates of pneumonia (31% wildfire vs. 13% non-wildfire, p=0.117), and higher rates of wound infection (31% wildfire vs. 19% non-wildfire, p=0.361). On evaluation of wound cultures for the 5 wildfire patients and the 7 non-wildfire patients who developed wound infections, more patients who sustained burns in wildfires had gram positive bacteria cultured from their wounds (100% wildfire vs. 29% non-wildfire, p=0.027). Patients who had sustained burns in wildfires trended towards increased likelihood of readmission (23% wildfire vs. 3% non-wildfire, p=0.080). Conclusions Patients who sustain burns in wildfires are likely at increased risk of readmission, of developing pneumonia and of developing gram-positive wound infections. Interventions for these patients should focus on pneumonia prevention and assistance with wound care after discharge.

Timing of orchidopexy and its relationship to postoperative testicular atrophy: results from the ORCHESTRA study.

BackgroundIn 2011 a consensus statement from the British Association of Paediatric Urologists recommended lowering the age at orchidopexy to under 1 year. There are concerns that a younger age at operation may increase postoperative testicular atrophy. The ORCHESTRA study aimed to establish the current age at orchidopexy in a multicentre, international audit and to see whether testicular atrophy was affected by age at operation.MethodsThe study was undertaken over a 3-month period in 28 centres in boys undergoing orchidopexy for unilateral, palpable undescended testes. Data collection was done using a standardized, predetermined protocol. The primary outcome was postoperative testicular atrophy. Secondary outcomes were wound infections, reoperations, and unplanned hospital stays related to anaesthetic events.ResultsA total of 417 patients were included, of whom only 48 (11.5 per cent) underwent orchidopexy before 1 year of age. There was no difference in anaesthetic complications in boys aged less than 1 year versus older patients: 0 of 48 (0 per cent) versus 6 of 369 (1.6 per cent) (P = 0.999). Complete follow-up was available for 331 patients (79.4 per cent). There was no difference in atrophy rate between those aged less than 1 year and older boys: 1 of 37 (3 per cent) versus 9 of 294 (3.1 per cent) (P = 0.999). Reoperation rates were 0 of 37 (0 per cent) and 7 of 294 (2.4 per cent) respectively (P = 1.000). There were more wound infections in boys under 1 year of age: 4 of 37 (11 per cent) versus 7 of 294 (2.4 per cent) (P = 0.025).ConclusionOnly 11.5 per cent of boys underwent surgery before the age of 1 year. There was no increased risk of postoperative testicular atrophy with early surgery, although there was a higher rate of wound infection. Further study is required to demonstrate that early orchidopexy is not inferior to orchidopexy undertaken in boys aged over 1 year.

Pattern of surgical site infection in contaminated and infected wounds and corelation with introperative bacterial growth

Surgical Site Infections (SSIs), previously called post operative wound infections, result from bacterial contamination during or after a surgical procedure.Surgical site infections are the third most common hospital associated infection, accounting for 14-16% of all infections in hospitalized patients. Aims and objectives are to establish the pattern of wound infection in terms of aerobic organisms after contaminated and infected surgical procedures. 50 patients having emergency or elective traumatic or non-traumatic abdominal operations who fulfil the criteria of infected and contaminated wounds are included in the study. Patients to be studied were selected in random basis. The incidence of wound infection is 31.57% in contaminated surgical procedures and 29.03% in infec-ted surgical procedure. Operation in emergency set up results in an increased risk of wound infection. Patients with positive intra operative bacteriology runs a higher risk of developing wound infection. The commonest organism isolated from intra operative swab cultures were E. coli followed by Klebsiella in both infected and contaminated procedures. Presence of polymicrobial flora in intraoperative swab culture is associated with hig-her rate of wound infection.

Timing to achieve the best recurrence-free survival after neoadjuvant chemoradiotherapy in locally advanced rectal cancer: experience in a large-volume center in China.

To identify the optimal interval from the end of neoadjuvant chemoradiotherapy to surgery (CRT-surgery interval) based on long-term oncological outcome of locally advanced rectal cancer (LARC). Retrospective data analysis is reported from patients diagnosed with cT3 or T4 or TxN+ rectal cancer who underwent neoadjuvant treatment and curative-intent surgery between January 2010 and December 2018. With a priority focus on the effect of interval on oncological prognosis, we used recurrence-free survival (RFS) as the primary endpoint to determine the best cutoff point of time intervals. Then, the short-term and long-term outcomes of patients from longer and shorter interval groups were compared. Data from 910 patients were analyzed, with 185 patients who achieved pCR (20.3%). The trend for increased rates of pCR for groups with a prolonged time interval was not observed (P = 0.808). X-tile determined a cutoff value of 10.5 weeks, and the population was divided into longer (> 10 weeks) and shorter (≤ 10 weeks) interval groups. The shorter interval was associated with a higher wound infection rate (4.7% vs. 1.1%, P = 0.031), but other postoperative complications did not differ between the groups. The 5-year RFS rate was significantly higher in patients in a longer group than those in the shorter weeks group (86.8% vs. 77.8%, P = 0.016). The 5-year OS rates between groups were similar (84.1% vs. 82.5%, P = 0.257). Local recurrence and lung metastases rates were higher in shorter interval group than those of longer group (local recurrence rate: 1.7% vs. 5.1%, P = 0.049; lung metastases rate: 5.7% vs. 10.7%, P = 0.047). Cox multivariate regression analysis confirmed the CRT-surgery interval (HR = 0.599, P = 0.045) to be an independent prognostic factor of RFS. This study is the first, to the best of our knowledge, to define the optimal CRT-surgery interval based on RFS as the primary endpoint. Prolonging the waiting period to 10 weeks after the completion of CRT with additional chemotherapy cycles during the interval period might be a promising option to improve oncological survival in LARC patients treated with CRT and TME without compromising the surgical safety. Further randomized controlled trials investigating this are warranted to prove a clearly causality.

Bacterobilia in Biliary Surgery: Risk Factors

Introduction: Procedures over the biliary tree are controversial prior biliary surgery and may contribute to bacterobilia which can also lead to higher rate of wound infections. We aim to analyze our population of patients under biliary surgery and the risk factors leading to bacterobilia. Methods: Retrospective study from 2014 to 2019. Surgeries involving biliary tree were included. Prior biliary procedures and personal risk factors were analyzed. Univariate analysis using Student t test, Fisher and chi2; relative risk was measured and multivariate logistic regression was performed. Statistical significance level set at 0,05. Results: Out of 86 biliary surgeries bacterobilia was documented in 45; 40 had some kind of biliary procedure prior final surgery (p=0,001), with a relative risk of 5,66 (CI 95% 1,8-17,3). When type of procedure was analyzed, percutaneous drainage showed no difference but ERCP had higher rate of bacterobilia (RR 3,14, CI95% 1,29-7,58). When previous cholangitis was developed bacterobilia was also higher (RR 2,53, CI 95% 1,04-6,1); but when patients were operated while receiving antibiotic treatment the rate of bacterobilia was lower (p=0,05). Age, sex, BMI, alcoholism, smoking, diabetes, inmunosupressive treatment, level of bilirubin, hemoglobin or albumin showed no difference. The presence of bacterobilia was not associated to higher rates of wound infection or other postoperative complications. In multivariate analysis only being operated under antibiotic treatment showed statistical significance (p= 0,041). Conclusion: Instrumentation of the biliary tree prior surgery should be performed in selective patients. Surgery during antibiotic treatment is feasible and reduces the risk of bacterobilia.

Does the time from symptom onset to surgery affect the outcomes of patients with acute appendicitis? A prospective cohort study of 255 patients.

The objective of this study was to evaluate the impact of operative timing on outcomes of acute appendicitis. This study examined adult patients who had presented to the hospital with acute appendicitis and had undergone appendectomy from December 2017 to February 2019. Time delay and outcomes of perforated and non-perforated appendicitis were compared. Patients were classified into five groups based on the period from symptom onset to operation: group 1, <24 hours; group 2, ≥24 and <48 hours; group 3, ≥48 and <72 hours; group 4, ≥72 and <96 hours; and group 5, ≥96 hours. The five groups were compared, with risk of perforation assessed in particular. A total of 255 patients were included in the analysis. Symptom duration, operative time, and length of postoperative hospital stay (P< .001) were significantly longer in the perforated group (n=49) than in the non-perforated group (n=206). The perforated group also had a higher conversion rate to open procedures (P= .002) and a higher rate of wound infection (P= .034). Group 1 had 53 patients, group 2 had 95 patients, group 3 had 57 patients, group 4 had 32 patients, and group 5 had 18 patients. The incidence of appendiceal perforation and median operative time progressively increased along with symptom duration in the five groups. In multivariate analyses, independent risk factors for appendiceal perforation were male gender (odds ratio=2.33, 95% confidence interval [CI]: 1.07-5.08) and symptom duration ≥48 hours (relative to ≥24 and <48 hours) (odds ratio=4.64, 95%CI: 1.76-12.27). Patients with symptom duration ≥72 hours had a significantly longer operative time than those with symptom duration ≥48 and <72 hours (β=21.38, 95%CI: 5.66-37.11, P= .008). The risk of perforation increased significantly 48 hours after the onset of appendicitis. Symptoms duration ≥72 hours was associated with a longer operative time.

Linear versus Circular Stapler for Gastrojejunal Anastomosis in Laparoscopic Roux-En-Y Gastric Bypass: An Analysis of 211 Cases.

Purpose Although laparoscopic Roux-en-Y gastric bypass (LRYGB) is a frequently performed bariatric procedure, there is still no consensus on its technical implementation. Methods 211 patients treated with LRYGB in a single institution between March 2011 and October 2016 were analyzed retrospectively. A subgroup analysis for the linear (LSA) versus circular stapler technique (CSA) for gastrojejunal anastomosis (GJA) was performed to evaluate complications and outcomes. Results 128 (60.6%) patients received GJA with CSA and 83 (39.4%) with LSA. Average weight loss one year after surgery, respectively, BMI after one year of follow-up (kg/m2), showed no significant difference. Median surgery time was significantly shorter in the LSA group. If the procedure was performed with CSA, significantly more wound infections occurred. Conclusions Both the circular and the linear stapler techniques for gastrojejunal anastomosis in laparoscopic Roux-en-Y gastric bypass are safe methods with comparable outcomes. A disadvantage of CSA is the significantly higher rate of wound infections, a circumstance which requires increased attention.

The feasibility and safety of early ileostomy reversal: a systematic review and meta-analysis.

Recent evidence supports the safety of early reversal of a temporary stoma, within 14 days of construction. The aim of this systematic review and meta-analysis was to evaluate the post-operative morbidity and overall feasibility of early stoma reversal. Medline and Cochrane databases were searched for studies up to June 2019 that investigated the outcomes of early stoma reversal (EC, defined as closure ≤14 days from the index operation) versus late stoma reversal (LC, ≥8 weeks from the index operation). Meta-analysis was performed on the respective rates of post-operative morbidity, anastomotic leak, wound infection, bleeding, sepsis, small bowel obstruction and ileus. Nine studies were included (667 patients analysed). Meta-analysis showed no significant difference in the post-operative morbidity rate, anastomotic leak rate, rates of small bowel obstruction, bleeding and ileus between EC and LC. However, the wound infection rate was significantly higher after EC than LC; relative difference 0.10 (95% confidence interval 0.00-0.19, P = 0.047). The stoma-related complication rate was significantly higher after LC than EC; relative difference -0.28 (95% confidence interval -0.45 to -0.11, P = 0.001). The concept of early stoma reversal is appealing, and this meta-analysis confirms the safety of early stoma closure with an associated reduction in stoma-related complications despite higher wound infection rates. However, the results need to be interpreted with caution due to the heterogeneity of the studies included, especially in respect of the definition of complications that were used. Further well-designed prospective studies are required prior to confident adoption of early stoma closure into clinical practice.

Non-cross-linked biological mesh in complex abdominal wall hernia: a cohort study

PurposeComplex abdominal wall hernia repair (CAWHR) is a challenging procedure. Mesh prosthesis is indicated, but the use of synthetic mesh in a contaminated area may add to overall morbidity. Biological meshes may provide a solution, but little is known about long-term results. The aim of our study was to evaluate clinical efficacy and patient satisfaction following Strattice™ (PADM) placement.MethodsIn this cohort study, all patients operated for CAWHR with PADM in three large community hospitals in Germany were included. Patients underwent abdominal examination, an ultrasound was performed, and patients completed quality-of-life questionnaires. The study was registered in ClinicalTrials.gov under Identifier NCT02168231.ResultsTwenty-seven patients were assessed (14 male, age 67.5 years, follow-up 42.4 months). The most frequent postoperative complication was wound infection (39.1%). In no case, the PADM had to be removed. Four patients had passed away. During outpatient clinic visit, six out of 23 patients (26.1%) had a recurrence of hernia, one patient had undergone reoperation. Five patients (21.7%) had bulging of the abdominal wall. Quality-of-life questionnaires revealed that patients judged their scar with a median 3.5 out of 10 points (0 = best) and judged their restrictions during daily activities with a median of 0 out of 10.0 (0 = no restriction).ConclusionsDespite a high rate of wound infection, no biological mesh had to be removed. In some cases, therefore, the biological meshes provided a safe way out of desperate clinical situations. Both the recurrence rate and the amount of bulging are high (failure rate 47.8%). The reported quality of life is good after repair of these complex hernias.

Erratum: Obesity Is Associated with Significant Morbidity after Multiligament Knee Surgery.

The objective was to report the effect of obesity, utilizing a body mass index (BMI) threshold of 35 kg/m2, on outcomes and complications of multiple ligament knee injury (MLKI). It was hypothesized that obese patients would have longer intraoperative times and hospital length of stay, greater estimated blood loss, and higher rates of wound infection requiring irrigation and debridement (ID p = 0.0001) and higher rates of concomitant lateral meniscus injury (48.0 vs. 25.3%; p = 0.04). Among patients undergoing single-staged surgery, obese patients had significantly longer duration of surgery (219.8 vs. 178.6 minutes; p = 0.02) and more wound infections requiring ID p = 0.03). In contrast, nonobese patients had higher rates of arthrofibrosis requiring manipulation under anesthesia and/or arthrolysis (25.3 vs. 0%; p = 0.003). Obese patients undergoing surgery of an MLKI have longer operative times, greater rates of wound infection requiring I&D, and lower rates of arthrofibrosis. Surgeons may consider these results when counseling patients on their postoperative course and risk for complications. Future research might focus on strategies to reduce complication rates in obese patients with MLKI. This is a Level III, retrospective comparative study.

Cardiac surgery outcomes in patients with antecedent kidney, liver, and pancreas transplantation: a meta-analysis.

Cardiovascular events are among the most common causes of late death in the transplant recipient (Tx) population. Moreover, major cardiac surgical procedures are more challenging and risky due to immunosuppression and the potential impact on the transplanted organ's functional capacity. We aimed to assess open cardiac surgery safety in abdominal solid organ transplant recipients, comparing the postoperative outcomes with those of nontransplant (N-Tx) patients. Electronic databases of PubMed, EMBASE, and SCOPUS were searched. The endpoints were: overall rate of infectious complications (wound infection, septicemia, pneumonia), cardiovascular and renal events (stroke, cardiac tamponade, acute kidney failure), 30-days, 5-years, and 10-years mortality post-cardiac surgery interventions in patients with and without prior solid organ transplantation. This meta-analysis included five studies. Higher rates of wound infection (Tx vs. N-Tx: OR: 2.03, 95% CI: 1.54 to 2.67, I2 = 0%), septicemia (OR: 3.91, 95% CI: 1.40 to 10.92, I2 = 0%), cardiac tamponade (OR: 1.83, 95% CI: 1.28 to 2.62, I2 = 0%) and kidney failure (OR: 1.70, 95 %CI: 1.44 to 2.02, I2 = 89%) in transplant recipients were reported. No significant differences in pneumonia occurrence (OR: 0.95, 95% CI: 0.71 to 1.27, I2 = 0%) stroke (OR: 0.89, 95% CI: 0.54 to 1.48, I2 = 78%) and 30-day mortality (OR: 1.92, 95% CI: 0.97 to 3.80, I2 = 0%) were observed. Surprisingly, 5-years (OR: 3.74, 95% CI: 2.54 to 5.49, I2 = 0%) and 10-years mortality rates were significantly lower in the N-Tx group (OR: 3.32, 95% CI: 2.35 to 4.69, I2 = 0%). Our study reveals that open cardiac surgery in transplant recipients is associated with worse postoperative outcomes and higher long-term mortality rates.

Outcomes of inflammatory bowel disease surgery in obese versus non-obese patients: a meta-analysis.

Obesity is considered a risk factor for many chronic diseases and obese patients are often considered higher risk surgical candidates. The aim of this meta-analysis was to evaluate the outcomes of obese (body mass index ≥ 30kg/m2) versus non-obese patients undergoing surgery for inflammatory bowel disease (IBD). PubMed, Scopus, and Embase libraries were searched up to March 2019 for studies comparing outcomes of obese with non-obese patients undergoing surgery for IBD. A meta-analysis was conducted using Review Manager software to create forest plots and calculate odds ratios and mean differences. Four thousand three hundred and eleven patients from five observational studies were included. Obese patients were older at the time of surgery and more likely to have diabetes. Obese patients had longer operative times (MD 23.28, 95% CI 14.63-31.93, p < 0.001), higher intra-operative blood loss (MD 45.32, 95% CI 5.89-84.76, p = 0.02), longer length of stay (MD 0.90, 95% CI 0.60-1.20, p < 0.001), higher wound infection rates (OR 1.76, 95% CI 1.39-2.23, p < 0.001), and higher total postoperative complication rates (OR 1.33, 95% CI 1.04-1.70, p = 0.02). Obesity is associated with significantly worse outcomes following IBD-specific surgery, including longer operative times, greater blood loss, longer length of stay, higher wound infection rates, and higher total postoperative complication rates. Clinicians should be mindful of these increased risks when counselling patients and consider weight reduction strategies where possible.

Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants.

Background Gastrostomy placement in children is one of the most frequently performed pediatric surgical procedures and laparoscopic-assisted gastrostomy (LAG) is the preferred technique. Wound infection after LAG has become a significant concern due to the emergence of antibiotic resistance. The aim of this study was to describe the frequency of wound infection after LAG in children younger than 2 years of age and to identify the associated risk factors and the bacterial species involved. Methods Information about wound infection, results from bacterial cultures, and type of antibiotic treatment used within 30 postoperative days after LAG were compiled for infants who underwent LAG from 2010 to 2017. A retrospective chart review was performed. Data was compiled from charts and from an electronic database containing prospectively collected data. A multivariate logistic analysis was used to explore potential risk factors. Preoperative antibiotic prophylaxis and postoperative local wound care were conducted according to standard procedures. Results The 141 included infants underwent surgery at a median age of 10 months (range: 1–24). Thirty-eight (27%) patients had a clinically determined wound infection, bacteria were cultured from 26/38 (69%), and 30/38 (79%) received antibiotic treatment. The median interval from surgery to detection of a clinical wound infection was 14 days (range: 4–30). The most common microbes discovered were skin bacteria Staphylococcus aureus or Streptococcus pyogenes , but respiratory and intestinal bacteria were also found. Multivariate logistic regression analysis revealed no independent risk factors for infection such as age, gender, or underlying diagnosis. Conclusion Infants have a high rate of postoperative clinical wound infection after LAG despite the use of preoperative antibiotic prophylaxis and intense local wound care. Gender, age at operation, and previous diagnoses were not found to be independent risk factors for wound infection.

Broad variation in prosthetic conduit use for femoral-popliteal bypass is not justified on the basis of contemporary outcomes favoring autologous great saphenous vein

BackgroundSingle-segment great saphenous vein (GSV) has been the preferred conduit for femoral-popliteal (FP) bypass, particularly for a popliteal artery target below the knee. Yet, controversy persists surrounding whether prosthetic conduit can yield comparable outcomes to GSV for FP bypass to either the above-knee (AK) or below-knee (BK) popliteal artery. We sought to analyze national variation in conduit use and to compare contemporary outcomes in FP bypass. MethodsA retrospective review of elective FP bypass in the Vascular Quality Initiative database using single-segment GSV or polytetrafluoroethylene (PTFE) from 2003 to 2018 was performed. Variation in conduit use was examined on a regional and center level. Characteristics of the patients and operative factors were compared. Effects of conduit on 1-year outcomes were assessed using Kaplan-Meier and multivariable Cox regression analyses. ResultsOf 7430 FP bypasses performed in the Vascular Quality Initiative, 3930 (53%) used GSV and 3500 (47%) used PTFE. Conduit use differed for AK-popliteal bypass (38% GSV and 62% PTFE) and BK-popliteal bypass (67% GSV and 33% PTFE). PTFE use was inversely correlated with preoperative vein mapping among centers (ρ = −0.55; P < .001). This inverse correlation was stronger for AK-popliteal bypasses (ρ = −0.61; P < .0001) than for BK-popliteal bypasses (ρ = −0.34; P = .0004). Overall, patients undergoing FP bypass with PTFE were more likely to be older and to have multiple medical comorbidities. Operative outcomes were similar between groups, although FP bypass with GSV incurred higher rates of wound infection (P < .001) and reoperation for bleeding, thrombosis, or revision (P < .01). At 1-year follow-up, GSV patients had higher graft occlusion-free survival (83% vs 78%; P < .001) and amputation-free survival (87% vs 82%; P < .001). These differences were observed for both AK-popliteal and BK-popliteal artery subgroups. On multivariable analyses stratified by bypass target, PTFE use was independently associated with increased risk of graft occlusion (AK-popliteal: hazard ratio [HR], 1.4 [P = .002]; BK-popliteal: HR, 1.3 [P = .02]) and amputation (AK-popliteal: HR, 1.4 [P = .006]; BK-popliteal: HR, 1.6 [P < .001]) at both target levels. ConclusionsPTFE is frequently used in FP bypass, representing two-thirds of AK-popliteal FP bypasses and one-third of BK-popliteal FP bypasses. However, PTFE use varies widely among centers. GSV was associated with higher rates of wound infection and reoperation and PTFE was associated with inferior 1-year outcomes independent of target artery level. GSV should be used for FP bypass whenever it is clinically feasible. Decreasing variation in prosthetic conduit use may be a useful quality improvement metric.

Role of Mechanical Bowel Preparation and Perioperative Antibiotics in Pediatric Pull-Through Procedures

BackgroundThere are no clear guidelines for the use of mechanical bowel preparation and postoperative antibiotics in children undergoing elective colorectal pull-through surgery. The objective of this study was to determine whether preoperative bowel preparation administration or duration of postoperative antibiotics impacted the rate of complications after elective pediatric pull-through surgery. Materials and methodsPatients aged <18 y who underwent a pull-through procedure between 2011 and 2017 were retrospectively identified. Patient data included diagnosis, procedure, administration of mechanical bowel preparation, and duration of perioperative intravenous (IV) antibiotics. Outcomes of interest included surgical site infections and anastomotic complications. ResultsA total of 180 patients met inclusion criteria, of which 47.2% received mechanical bowel preparation. The combined rate of infectious and anastomotic complications was 12.2%. There was no significant difference in combined complication rate among those receiving bowel preparation compared with those who did not (14.1% versus 10.5%, P = 0.46). Administration of bowel preparation in the perineal anoplasty subgroup was associated with higher rates of wound infection (33.3% versus 3.3%, P = 0.05). One hundred five patients (58.3%) received perioperative IV antibiotics for ≤24 h. This group had similar rates of complications (13.3%) compared with those receiving IV antibiotics for longer than 24 h (11.6%, P = 0.74). ConclusionsAlthough mechanical bowel preparation did not affect the overall complication rate for pull-through procedures, it was associated with more wound infections in those undergoing perineal anoplasty. Duration of postoperative IV antibiotics was not significantly associated with the rate of wound and anastomotic complications.

Outcomes of Open Versus Minimally Invasive Ivor-Lewis Esophagectomy for Cancer: A Propensity-Score Matched Analysis of NSQIP Database.

We conducted this analysis to compare the outcomes of open transthoracic esophagectomy (OTTE) and minimally invasive transthoracic esophagectomy (MITTE) when performed for oncologic indications. The NSQIP esophagectomy-targeted database during 2-year period was used. Only patients who underwent elective TTE for oncologic indications were included. Patients were matched per a propensity score for the likelihood of receiving OTTE versus MITTE. Overall, 2098 esophagectomies were reported; 576 met the inclusion criteria. A total of 161 purely OTTE patients were matched 1:1 with patients who received purely MITTE. OTTE was associated with higher reported rates of abdominal and mediastinal lymphadenectomies (LAD) (26.7% vs. 3.1% and 38.5% vs. 16.1%, respectively; p < 0.001) and had shorter mean operative time (329 vs. 414min; p < 0.001). However, OTTE patients had higher rates of wound infection (7.5% vs. 1.9%), longer median hospitalization (10 vs. 8days), more non-home discharges (18.0 vs. 8.1%), and a tendency toward higher rates of postoperative transfusion (13.0% vs. 6.8%; p = 0.092). The overall complications rate was higher in OTTE (46.0% vs. 33.5%; p = 0.028). No difference was noted in the rates of anastomotic leak, negative margins, reoperation, readmission, or mortality. Laparoscopic versus robotic approaches were uniformly comparable, except for higher rates of reported abdominal LAD in laparoscopic and higher rates of reported mediastinal LAD in robotic approach. MITTE is comparable to OTTE for oncologic indications in immediate postoperative outcomes. A concern is raised regarding the oncologic outcome given the lower reported rates of lymphadenectomies. Comparison of long-term outcomes is essential to address this concern.

Obesity Is Associated with Significant Morbidity after Multiligament Knee Surgery.

The objective was to report the effect of obesity, utilizing a body mass index (BMI) threshold of 35 kg/m2, on outcomes and complications of multiple ligament knee injury (MLKI). It was hypothesized that obese patients would have longer intraoperative times and hospital length of stay, greater estimated blood loss, and higher rates of wound infection requiring irrigation and debridement (I&D) and revision ligament surgery. A retrospective review was performed on 143 individuals who underwent surgery for an MLKI between 2011 and 2018 at a single academic center. Patients were included if there was a plan for potential surgical repair/reconstruction of two or more ligaments. Patients with prior surgery to the affected knee or intra-articular fracture requiring reduction and fixation were excluded. Comparisons between obese and nonobese patients were made using two-sample t-test and either chi-square or Fisher's exact test for continuous and categorical variables, respectively. Significance was set at p < 0.05. Of 108 patients meeting inclusion criteria, 83 had BMI < 35 kg/m2 and 25 had BMI ≥ 35 kg/m2. Obese patients sustained higher rates of MLKI due to ultralow velocity mechanisms (28.0 vs. 1.2%; p = 0.0001) and higher rates of concomitant lateral meniscus injury (48.0 vs. 25.3%; p = 0.04). Among patients undergoing single-staged surgery, obese patients had significantly longer duration of surgery (219.8 vs. 178.6 minutes; p = 0.02) and more wound infections requiring I&D (20.0 vs. 4.8%; p = 0.03). In contrast, nonobese patients had higher rates of arthrofibrosis requiring manipulation under anesthesia and/or arthrolysis (25.3 vs. 0%; p = 0.003). Obese patients undergoing surgery of an MLKI have longer operative times, greater rates of wound infection requiring I&D, and lower rates of arthrofibrosis. Surgeons may consider these results when counseling patients on their postoperative course and risk for complications. Future research might focus on strategies to reduce complication rates in obese patients with MLKI. This is a Level III, retrospective comparative study.

Postoperative Supine Position Increases the Risk of Infection After Spinal Surgery by Posterior Approach

Spine surgeries performed via the posterior approach have a higher infection rate. Several theories have been proposed, including poor hygienic condition of bed sheets and traumatized muscle associated with supine position promoting circulatory impairment. We investigated the influence of supine position on the rate of deep wound infection after spine surgery by the posterior approach. A total of 106 patients were randomly divided into 2 groups: lateral decubitus only versus dorsal and lateral decubitus. Patient follow-up after hospital discharge was performed at 30, 60, 180, and 360 days. Deep wound infection was diagnosed according to U.S. Centers for Disease Control and Prevention criteria. Patient sample was mainly composed of patients with neoplastic disease and patients with trauma. Postoperative wound infection developed in 12 cases (11.3%), and Streptococcus aureus was the most common pathogen. Incidence of postsurgical deep wound infection was significantly greater in the control group (P= 0.004). Supine position was significantly correlated with higher rates of wound infection among patients who underwent spine surgery by the posterior approach. Avoidance of supine position may represent a modifiable risk factor to diminish postoperative spine infection rates.

Female Gender is not a Risk Factor for Early Mortality after Coronary Artery Bypass Grafting.

Background:The female gender is considered as a risk factor for morbidity and mortality after coronary artery bypass grafting (CABG).Aim:In this analysis, we assessed the impact of female gender on early outcome after CABG.Study Design:This is a retrospective analysis of data from our center situated in South India.Statistical Analysis:Patients were categorized according to gender and potential differences in pre-operative and post-operative factors were explored. Significant risk factors were then built in a multivariate model to account for differences in predicting gender influence on surgical outcome.Methods:773 consecutive patients underwent first time CABG between January 2015 and December 2016. 96.77% of cases were performed using off-pump technique. 132 (17.07%) patients were females. These patients formed the study group.Results:The in-house/ 30-day mortality in females was similar to that of males (3.03% vs. 3.12%, p value 0.957). Mediastinitis developed more commonly in females (5.35% vs. 1.30%; p value 0.004) compared to males. There were more re-admissions to hospital for female patients (21.37% in females vs. 10.14% in males, p value <0.001). In multivariate analysis using logistic regression; there was a significant association between age (OR 1.08), chronic obstructive airway disease (OR 4.315), and use of therapeutic antibiotics (OR 6.299), IABP usage (OR 11.18) and renal failure requiring dialysis (OR 28.939) with mortality.Conclusions:Early mortality in females was similar to that of males. Females were associated with higher rate of wound infection and readmission to hospital.