Independent Risk Factors For Surgical Site Infection Research Articles

184. Surgical site infection in thoracolumbar fractures: Incidence and risk factors in a series of 11,401 patients

<h3>BACKGROUND CONTEXT</h3> Surgical site infection (SSI) is relatively uncommon following elective spine surgery with reported rates ranging from 0.5-5%. Published reports have suggested a higher SSI rate in nonelective spine surgery such as spinal trauma though there is a paucity of large database studies examining this issue. <h3>PURPOSE</h3> The purpose of this study is to investigate the incidence and risk factors of SSI in patients undergoing spinal surgery for thoracic and lumbar fractures in a large administrative database. <h3>STUDY DESIGN/SETTING</h3> Retrospective. <h3>METHODS</h3> Patients undergoing spinal surgery for thoracic and lumbar fractures between 2015-2020 were identified in the PearlDiver Mariner Patient Claims Database (PearlDiver Technologies, Colorado Springs, CO, USA) using ICD-10 codes. Clinical data was collected based on ICD-10 codes. Collected data included gender, age, diabetes, smoking status, obesity, Elixhauser comorbidity index (ECI) and SSI. Patients were excluded who had another surgery either 14 days before or 21 days after the index spinal surgery. Univariate analysis was used to assess the association of potential risk factors and SSI. Multivariate analysis was used to identify independent risk factors of SSI. <h3>RESULTS</h3> Of 10,769 patients undergoing spinal surgery for thoracic and lumbar fractures, 9,848 met inclusion criteria and 921 were excluded. Of these, 736 patients developed SSI (7.5%). Risk factors significantly associated with SSI in univariate analysis included diabetes (OR 1.55; 95% CI 1.33-1.81; P=1.43e-8), obesity (OR 1.41; 95% CI 1.30-1.54; P=3.36e-13), increased age (P=0.00015) and ECI (P=2.2e-16). On multivariate analysis, obesity and ECI were independently associated with SSI (P=1.2e-4 and P=2.23e-10 respectively). <h3>CONCLUSIONS</h3> Nonelective spinal surgery for thoracic and lumbar fractures is associated with a 7.5% risk of surgical site infection. Obesity and ECI are independent predictors of SSI in this patient population. By establishing the rate of SSI in a large, nationwide database this study gives providers a broad overview of the risk of SSI in this population and may also help counsel patients regarding risk. Limitations of the study include its retrospective nature and its dependency on accurate ICD-10 database coding. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

124. Risk factors, biomarkers and microorganism data for surgical site infections after posterior spinal fusion: a modern series of 3,965 patients

<h3>BACKGROUND CONTEXT</h3> Surgical site infection (SSI) after posterior spinal fusion (PSF) is an uncommon but morbid complication. Microorganism and biomarker data are often excluded from large-scale studies on SSI after PSF. <h3>PURPOSE</h3> Identify independent risk factors for SSI after PSF and characterize the role of biomarker data on modern management. <h3>STUDY DESIGN/SETTING</h3> Retrospective chart review at an urban, academic tertiary referral center. <h3>PATIENT SAMPLE</h3> We identified all patients who underwent PSF at our institution between 2000 and 2015, for a total of 3,965 consecutive patients. <h3>OUTCOME MEASURES</h3> Surgical site infection, 30-day readmission, reoperation, antimicrobial culture results. <h3>METHODS</h3> We identified all patients who underwent PSF at our institution between 2000 and 2015, and collected demographic, clinical and biomarker data. We performed multivariable regression, time-to-event analysis, and receiver operating characteristic analyses to identify factors associated with SSI and SSI management decisions. <h3>RESULTS</h3> Among 3,965 patients, 191 patients (4.8%) developed SSI. A significantly greater proportion of infections were gram positive (61.8%, p <0.001). Time-to-infection was shorter for gram-negative infections. Comorbid disease burden, staged procedures, and more levels fused are consistent predictors of adverse outcomes, including readmission, reoperation, infection and prolonged antibiotic therapy. Leukocytosis was absent in 41% of SSI patients. A C-reactive protein (CRP) threshold of 3.9 mg/L was 68.2% sensitive and 64.7% specific for identifying patients who underwent wound washout (AUROC=0.72, p <0.001). An erythrocyte sedimentation rate (ESR) threshold of 42 mm/hour was 74.4% sensitive and 64.7% specific (AUROC=0.72, p=0.001). For predicting prolonged antibiotic use, a threshold CRP peak of 15.7 mg/L was 66.7% sensitive and 74.7% specific (AUROC=0.69, p=0.011). An ESR threshold of 70 mm/hour was 86.7% sensitive and 65.4% specific (AUROC=0.70, p=0.002). <h3>CONCLUSIONS</h3> Comorbid disease burden, staged procedures and more levels fused are risk factors for adverse outcomes, including readmission, reoperation, infection and prolonged antibiotic therapy. The timing and risk factors for infection vary by bacterial peptidoglycan class. Leukocytosis can be mild with SSI, and inflammatory biomarkers are only moderately accurate in predicting clinical decisions. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Risk Factors for Postoperative Complications Following Aesthetic Breast Surgery: A Retrospective Cohort Study of 4973 Patients in China.

The popularity of aesthetic breast surgery in China results in greater demand for assessing risk factors for complications and mortality. To determine the incidence and independent risk factors for postoperative complications following aesthetic breast surgery in China. A retrospective cohort study on 4973 patients who had aesthetic breast surgery between 2012 and 2021 was performed. Postoperative complications include minor complications (incision healing impaired, hematoma, or fat liquefaction) and surgical site infection (SSI), which were recorded within 30 days after surgery. The follow-up time was expanded to 1year only after prosthesis implantation procedures. Potential risk factors including age, weight, length of hospital stay, operation time, volume resection, incision location, and other clinical profile information were evaluated. Among 4973 patients who underwent aesthetic breast surgery, the minor complication rate was 0.54%, and SSI was 0.68%. Augmentation with prosthesis implantation had the highest SSI rate (4.23%), which was significantly associated with increasing age (relative risk [RR] 1.12; P < 0.01) and periareolar incision (RR 5.87, P < 0.01). After augmentation with autologous fat transplantation, postoperative antibiotic use (RR 6.65, P < 0.01) was an independent risk factor for SSI. After adjusting for weight, volume resection over 1500 g (RR 14.7, P < 0.01) was an independent risk factor for SSI of reduction-mastopexy surgery. The complication rate of reduction mammaplasty (1.01%) and gynecomastia correction was lower (0.75%), and there was no record of complication in mastopexy procedures (n = 161). The incidence of postoperative complications following aesthetic breast surgery is low. Risk factors for complications mainly include increasing age, perioperative antibiotic use, periareolar incision, and extensive volume resection. Much more attention should be focused on those high-risk patients in clinical practice to decrease breast infection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of Ventilator-Associated Pneumonia and Surgical Site Infection between Two Methods of Tracheostomy.

Objective To compare the incidence of ventilator-associated pneumonia (VAP) and surgical site infection (SSI) between percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST). Methods Data on 487 patients undergoing tracheostomy between 1st January 2014 and 30th September 2020 were reviewed. Patients were divided according to the surgical techniques. Clinical characteristics and postoperative care were compared to explore the risk factors for SSI and VAP. All tracheostomies were performed by intensivists who had completed at least ten tracheostomies. ST was performed using standard techniques. PDT was performed according to a modification technique described by Ciaglia. All procedures were performed at the bedside in the ICU. Results Of all, 344 patients (70.6%) were men and 143 (29.4%) were women, and the mean age was 56 years (standard derivation [SD] 12 years). Two hundred and sixty-six patients (54.6%) received PDT, and 221 (45.4%) received SY. Patients in the PDT group had a significantly lower rate of SSI (3.4% vs. 8.5%, P = 0.01) compared with the ST group. Multivariate analysis revealed that comorbidities (P = 0.003), surgical type (P = 0.01), and cluster nursing (P < 0.001) were independent risk factors for SSI; age (P = 0.005), comorbidities (P < 0.001), smoking (P = 0.008), and cluster nursing (P = 0.01) were independent risk factors for VAP. Conclusion PDT significantly reduces the risk of SSI. Proper care should be administrated in patients with one or more risk factors of SSI or VAP to prevent the occurrence of complications.

Preoperative hemoglobin A1c and perioperative blood glucose in patients with diabetes mellitus undergoing spinal cord stimulation surgery: A literature review of surgical site infection risk.

The aim of our study was to review the surgical literature regarding the relationship between hemoglobin A1c (HbA1c), diagnosis of diabetes mellitus (DM), and risk of postoperative surgical site infection (SSI). A librarian-assisted literature search was performed with two goals: (1) identify surgical publications related to SSI and HbA1c values, and (2) identify publications reporting infection risk with DM in spinal cord stimulation (SCS), intrathecal drug delivery systems (IDDS), and cardiovascular implantable electronic device (CIED) implantation surgeries. Published guidelines on perioperative management of DM are reviewed. We identified 30 studies reporting SSI and HbA1c values. The literature review indicated that for many surgical procedures, elevated HbA1c is not correlated to rate of SSI. We identified 16 studies reporting infection rates within DM cohorts following SCS, IDDS, and CIED implantation surgeries. The data reviewed did not indicate DM as an independent risk factor for SSI. Preoperative HbA1c levels in patients with a history of DM is not a singularly sufficient tool to estimate risk of perioperative infection in SCS implantation surgery. Published guidelines on perioperative management of DM do not suggest a specific HbA1c above which surgery should be delayed; intentional perioperative glycemic control is recommended.

Association between the duration of antibiotic prophylaxis and surgical site infection after orthognathic surgery in Japan

PurposeThis study aimed to evaluate the risk factors for surgical site infection (SSI) after orthognathic surgery, focusing on the duration of prophylactic antibiotic administration in Japan. Study DesignThe study included 181 patients who underwent orthognathic surgery at the Department of Oral and Maxillofacial Surgery of Yamagata University Hospital between 2012 and 2021. The clinical parameters of SSI were retrospectively investigated using patient charts. Logistic regression analysis was used to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) for risk factors for SSI after orthognathic surgery. ResultsNineteen patients (10.5%) were complicated with SSI. Male sex (OR, 3.638; 95% CI, 1.316–10.058) and an antibiotic prophylaxis duration ≤3 days (OR, 12.718; 95% CI, 1.639–98.673) were independent risk factors for SSI after orthognathic surgery. ConclusionExtended-term antibiotic prophylaxis was more effective for prevention of SSI after orthognathic surgery than short-term in this study.

Risk factors of wound infection after lung transplantation: a narrative review.

Background and ObjectiveThe incidence of incision infection after lung transplantation is prominently high which affect the prognosis. Summarizing the risk factors related to incision infection after lung transplantation contribute to the control of incision infection by pre-controlling the risk factors. The objective is to summarize risk factors related to wound infection after lung transplantation.MethodsPubMed was used to research the literature relating to the risk factors to incision infection after lung transplantation through 1990 to 2022. The retrieval strategy were Medical Subject Heading (MeSH) terms combined entry terms. Two researchers conducted the literature retrieval independently. Two researchers independently evaluate the quality of the literature and summarize the indicators.Key Content and FindingsA total of 98 researches were collected from PubMed and 8 articles described the related risk factors of incision infection after lung transplantation. All of the 8 articles were retrospective studies, of which 4 articles were grouped by the delayed chest closure (DCC) execution and the other 4 articles were grouped by the surgical site infection (SSI) occurred. Two articles performed multivariate regression analysis to determine the independent risk factors of SSI after lung transplantation and the other 6 articles compared the SSI rate in different patients population. The integrated results showed that bronchoalveolar lavages (BALs), smoking status, body mass index (BMI), diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation.ConclusionsBALs, smoking status, BMI, diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation.

Impact of gender on surgical site infections in abdominal surgery: A multi-center study

Abstract Objective Male sex is controversially discussed as a risk factor for surgical site infections (SSI). The aim of the present study was to evaluate the impact of gender on SSI in abdominal surgery under elimination of relevant confounders. Methods Clinicopathological data of 6603 patients undergoing abdominal surgery from a multi-center prospective database of four Swiss hospitals including patients between 2015 and 2018 were assessed. Patients were stratified according to postoperative SSI and risk factors for SSI were assessed using univariate and multivariate analysis. Results In 649 of 6603 patients SSI was reported (9.8%). SSI was significantly associated with increased risk of reoperation (22.7% vs. 3.4%, p &amp;lt;0.001), higher mortality rate (4.6% vs. 0.9%, p &amp;lt;0.001) and higher rate of length of hospital stay &amp;gt; 75th percentile (57.0% vs. 17.9%, p &amp;lt;0.001). In univariate analysis male sex was a significant risk factor for SSI (p = 0.01). In multivariate analysis including multiple confounders’ such as comorbidities and perioperative factors there was no association between male sex and risk of SSI (OR 1.1 [CI 0.8–1.4]). BMI &amp;gt;= 30 kg/m2 (OR 1.8 [CI 1.3–2.3]), duration of surgery &amp;gt; 75th percentile (OR 2.3 [1.8–2.9]), high contamination level (OR 1.3 [1.0–1.6]), laparotomy (OR 1.3 [1.0–1.7]), previous laparotomy (OR 1.4 [1.1–1.7]), blood transfusion (OR 1.7 [1.2–2.4]), cancer (OR 1.3 [1.0–1.8]), malnutrition (OR 2.5 [1.8–3.4]) were independent risk factors for SSI in multivariate analysis. Conclusion Under elimination of relevant confounders there is no significant correlation between gender and risk of SSI after abdominal surgery. Independent risk factors for SSI as BMI &amp;gt;= 30 kg/m2, duration of surgery &amp;gt; 75th percentile, high contamination level, surgical approach or malnutrition should be considered during treatment.

WITHDRAWN: Incidence and outcome of surgical site infections in thoracic-organ transplant recipients registered in the Swiss Transplant Cohort Study

<h2>Abstract</h2><h3>Background</h3> Transplant-related surgical site infections (SSI) pose a relevant threat for heart (HTx) and lung transplant recipients (LuTx). Considering the paucity of data, we analyzed HTx and LuTx within the Swiss Transplant Cohort Study (STCS). <h3>Methods</h3> The STCS dataset was used to identify adult HTx and LuTx with a follow-up of at least 90 days post-transplant between 2008 and 2020. Risk factors for SSIs were investigated with logistic regression. Cox proportional hazard models, one model starting from transplantation with 365 days follow-up and one model starting 90 days post-transplant with unrestricted follow-up, were applied to address the impact of SSIs on patient and graft survival. <h3>Results</h3> Of 356 HTx 31 (8.7%) and of 450 LuTx 21 (4.7%) individuals experienced SSIs. In both HTx and LuTx, the majority of SSIs were caused by bacteria, most frequently coagulase-negative staphylococci and <i>Enterococcus</i> spp.. In HTx, diabetes mellitus (multivariable OR 2.4, 95%CI 1.02-5.8, <i>P</i>=0.04) and maintenance immunosuppression without calcineurin or mTOR inhibitor in the first week post-transplant (multivariable OR 3.9, 95%CI 1.3-11.4, <i>P</i>=0.01) were independent risk factors for SSIs. In multivariable Cox proportional hazard models, SSIs were associated with reduced patient and graft survival in LuTx (365-day model: HR 5.0, 95%CI 1.9-13.0; <i>P</i>=0.009; 90-day baseline model: HR 2.2, 95%CI 1.2-4.1, <i>P</i>=0.02), whilst we did not detect an association in HTx. <h3>Conclusions</h3> Gram-positive bacteria predominated in SSIs after both HTx and LuTx. LuTx with SSI had impaired failure-free survival as compared to those without SSI.

Risk factors of postoperative surgical site infection in colon cancer based on a single center database

Objective: To explore the incidence and risk factors of postoperative surgical site infection (SSI) after colon cancer surgery. Methods: A retrospective case-control study was performed. Patients diagnosed with colon cancer who underwent radical surgery between January 2016 and May 2021 were included, and demographic characteristics, comorbidities, laboratory tests, surgical data and postoperative complications were extracted from the specialized prospective database at Department of General Surgery, Peking Union Medical College Hospital. Case exclusion criteria: (1) simultaneously multiple primary colon cancer; (2) segmental resection, subtotal colectomy, or total colectomy; (3) patients undergoing colostomy/ileostomy during the operation or in the state of colostomy/ileostomy before the operation; (4) patients receiving natural orifice specimen extraction surgery or transvaginal colon surgery; (5) patients with the history of colectomy; (6) emergency operation due to intestinal obstruction, perforation and acute bleeding; (7) intestinal diversion operation; (8) benign lesions confirmed by postoperative pathology; (9) patients not following the colorectal clinical pathway of our department for intestinal preparation and antibiotic application. Univariate analysis and multivariate analysis were used to determine the risk factors of SSI after colon cancer surgery. Results: A total of 1291 patients were enrolled in the study. 94.3% (1217/1291) of cases received laparoscopic surgery. The incidence of overall SSI was 5.3% (69/1291). According to tumor location, the incidence of SSI in the right colon, transverse colon, left colon and sigmoid colon was 8.6% (40/465), 5.2% (11/213), 7.1% (7/98) and 2.1% (11/515) respectively. According to resection range, the incidence of SSI after right hemicolectomy, transverse colectomy, left hemicolectomy and sigmoid colectomy was 8.2% (48/588), 4.5% (2/44), 4.8% (8 /167) and 2.2% (11/492) respectively. Univariate analysis showed that preoperative BUN≥7.14 mmol/L, tumor site, resection range, intestinal anastomotic approach, postoperative diarrhea, anastomotic leakage, postoperative pneumonia, and anastomotic technique were related to SSI (all P<0.05). Multivariate analysis revealed that anastomotic leakage (OR=22.074, 95%CI: 6.172-78.953, P<0.001), pneumonia (OR=4.100, 95%CI: 1.546-10.869, P=0.005), intracorporeal anastomosis (OR=5.288, 95%CI: 2.919-9.577,P<0.001) were independent risk factors of SSI. Subgroup analysis showed that in right hemicolectomy, the incidence of SSI in intracorporeal anastomosis was 19.8% (32/162), which was significantly higher than that in extracorporeal anastomosis (3.8%, 16/426, χ(2)=40.064, P<0.001). In transverse colectomy [5.0% (2/40) vs. 0, χ(2)=0.210, P=1.000], left hemicolectomy [5.4% (8/148) vs. 0, χ(2)=1.079, P=0.599] and sigmoid colectomy [2.1% (10/482) vs. 10.0% (1/10), χ(2)=2.815, P=0.204], no significant differences of SSI incidence were found between intracorporeal anastomosis and extracorporeal anastomosis (all P>0.05). Conclusions: The incidence of SSI increases with the resection range from sigmoid colectomy to right hemicolectomy. Intracorporeal anastomosis and postoperative anastomotic leakage are independent risk factors of SSI. Attentions should be paid to the possibility of postoperative pneumonia and actively effective treatment measures should be carried out.

Surgical site infection following minimally invasive lobectomy: Is robotic surgery superior?

BackgroundSurgical site infection (SSI) in thoracic surgery remains a significant cause of morbidity and prolonged hospitalization. Minimally invasive surgery (MIS) has significantly reduced the risk of SSI. We intended to compare whether there was difference between video‐assisted thoracic surgery (VATS) and robotic‐assisted thoracic surgery (RATS) in SSI and highlight possible factors influencing SSI in lobectomy.MethodsThis retrospective study analyzed patients who underwent minimally invasive lobectomy from January 2018 to December 2019. All patients' clinical characteristics and surgery‐related information which may be related to the likelihood of SSI were recorded.ResultsA total of 1231 patients' records were reviewed with 806 VATS and 425 RATS. SSI was classified as deep or superficial SSI. Eighty‐six (7.0%) patients were found to develop an SSI with 62 patients having deep infections and 24 had superficial infection. No statistical difference in the incidence rate and category of SSI was observed between patients undergoing VATS and RATS.ConclusionsThere was no difference in the incidence of SSI between VATS and RATS lobectomy. Male gender, heavy smoking, uncontrolled diabetes mellitus, body mass index (BMI) > 27.9, more blood loss, and the higher National Healthcare Safety Network (NHSN) risk index score (1 or 2) were the independent risk factors of SSI following minimally invasive lobectomy, while male gender, uncontrolled diabetes mellitus, BMI > 27.9, more blood loss and the higher NHSN risk index score (1 or 2) were the main predictors of deep SSI.

Identifying the Risk Factors Associated with Surgical Site Infection Following Cesarean Section in Adolescent Mothers

This study aimed to determine the modifiable risk factors associated with surgical site infection (SSI) after cesarean section in adolescent pregnant patients. Retrospective case-control study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Pregnant adolescents (≤ 19 years) who underwent cesarean section at our institution between January 2014 and March 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: To determine the modifiable and nonmodifiable risk factors associated with SSI following cesarean section in adolescents. The diagnosis of SSI was made according to the criteria defined by the Centers for Disease Control and Prevention (CDC). SSI was diagnosed in 62 (2.9%) of 2105 adolescent mothers who underwent cesarean section. Univariate and multivariate analyses confirmed that body mass index (BMI) (OR=2.35; 95% CI, 1.3-4.78), induction of labor (OR=1.9; 95% CI, 1.2-3.71), and preoperative hemoglobin values less than 10g/dl (OR=2.1; 95% CI, 1.2-4.46) were risk factors for SSI in adolescent mothers. Patient- and operation-related risk factors did not reach the level of statistical significance. BMI, labor induction, and antenatal anemia were independent risk factors for SSI in adolescents. Among these, BMI and anemia were modifiable patient-related risk factors. Addressing obesity in adolescents and treating prenatal anemia could be the first steps toward preventing SSI.

Factors associated with neonatal surgical site infection after abdominal surgery.

To assess the risk factors for surgical site infections (SSIs) post-abdominal surgery in neonates. A retrospective, single-center cohort study was conducted using patient data from 2009 to 2018. Patient characteristics and several variables were analyzed to identify independent risk factors for SSI. SSI occurred in 39/406 procedures (9.6%). Univariate analysis showed that the incidence of SSI was significantly higher in patients who had undergone multiple surgical procedures (P = 0.032), prolonged operations (P = 0.016), long-term hospitalization (P < 0.001), long-term antibiotic administration (P < 0.001), with methicillin-resistant Staphylococcus aureus (MRSA) colonization (P = 0.044), contaminated/dirty wounds (P < 0.001), and American Society of Anesthesiologists physical status of 3 or 4 (P = 0.021). Multivariate analysis identified prolonged operations [odds ratio (OR): 2.91 (1.21-8.01)] and contaminated/dirty wounds [OR: 5.42 (2.41-12.1)] as independent risk factors. Patients with SSI had a higher incidence of MRSA colonization (27.8% vs. 14.8%, P = 0.044), longer antibiotic administration (24days vs. 8days, P = 0.049), and longer hospitalization times (98days vs. 43days, P = 0.007) than those without SSIs. Long operations exceeding 100min and surgical procedures with contaminated/dirty wounds are independent risk factors for neonatal SSIs after abdominal surgery. SSIs were related to MRSA colonization during hospitalization, long-term antibiotic administration, and long-term hospitalization.

“Prospective study evaluating incidence of surgical site infection in thyroidectomy: Is antibiotic prophylaxis required?

Objective: Occurrence of surgical site infection (SSI) is considered a rare occurrence in patients undergoing thyroidectomy. International guidelines do not recommend usage of antimicrobial prophylaxis (AP) for thyroid surgery and this study is aimed at finding whether such guidelines hold ground in a developing country like India. Study design: This prospective comparative study included 293 patients who underwent thyroidectomy at a single institution. Setting: The study was conducted in a tertiary referral hospital (Amrita institute of medical sciences, Kochi, Kerala, India) between 2017 - 2019. Methods: One group undergoing thyroidectomy received AP and other did not. Incidence of SSI was assessed in all patients during in-patient stay, 10th day and 30th day. Details of the data collected includes patient’s age, gender, co-morbidity, nutritional status, operative and drain duration, length of stay in the hospital. Results: Out of 293 patients, five cases of SSI were diagnosed in the group without AP (Four – superficial SSI and one - deep incisional SSI) and zero cases in the group with AP. Our study revealed an infection rate of 1.7 % in thyroid surgery. Comparing incidence of SSI in patients with and without AP, there was no statistically significant difference (p=0.152). In multivariate analysis, type 2 Diabetes Mellitus (p=0.016) and overweight/obesity (p=0.045) were identified as independent risk factors for SSI. Conclusion: Our results were found to be in synchronization with international guidelines and concluded that AP is not a necessary pre-operative preparation for all patients undergoing thyroidectomy but in a developing country like India multiple factors could predispose patients to SSI resulting in significant strain on the hospital and the patients’ financial resources. Patients with Type 2 Diabetes Mellitus and overweight/obese patients may be considered as high-risk patients in whom selective use of antimicrobial prophylaxis may be beneficial.

Incidence and risk factors associated with surgical site infection after surgically treated hip fractures in older adults: a retrospective cohort study.

Surgical site infection (SSI) is one of the most common complications in the traumatic orthopedics field, but remains not adequately studied after hip fractures. This study aims to investigate the incidence and risk factors associated with SSI after surgically treated hip fractures in older adults. A retrospective cohort study including 2932 older adult patients (1416 with femoral neck fracture and 1516 with intertrochanteric fracture) surgically treated from Jan 2015 to Dec 2019 due to hip fractures was performed. Their data on demographics, injury-related data, surgery-related data, and preoperative laboratory test results were collected from hospitalization medical records. Univariate analyses were used to compare between the patients with and without SSI, and multivariate logistic regression analyses were used to identify the risk factors. A total of 89 patients developed SSI, with an accumulated incidence rate of 3.04% (95%CI 2.41-3.66). Staphylococcus aureus was the most common source of infection. In univariate analysis, 11 items were found to be significant in femoral neck fractures and 5 items were found to be significant in intertrochanteric fracture. In the multivariable logistic regression model, cerebrovascular disease (OR 2.17, 95%CI 1.14-4.15) and hematocrit (HCT) (< Lower limit) (OR 3.46, 95%CI 1.13-10.56) were independent risk factors for SSI in femoral neck fracture. Heart disease (OR 2.13, 95%CI 1.18-3.85) was a risk factor for SSI, while LDH (> 250 U/L) (OR 0.44, 95%CI 0.20-0.95) was a protective factor for SSI in intertrochanteric fracture. We observed 89 cases (3.04%) of SSI in 2932 older adult patients with hip fractures in this study. Cerebrovascular disease and lower HCT were two independent risk factors for SSI in femoral neck fracture, whereas heart disease was a risk factor and LDH was a protective factor for SSI in intertrochanteric fracture. Targeted preoperative management, such as predicting the probability of SSI and taking appropriate measures accordingly is essential and highly regarded. Future multicentric studies with more patients evaluated are expected to better address the risk factors for SSI in older hip fracture patients.

The Effect of Preoperative Oral Antibiotics in the Prevention of Surgical Site Infection after Laparoscopic Colorectal Cancer Surgery: A Propensity Score Matching Study.

Objectives: Recent findings suggest that the combination of mechanical bowel preparation (MBP) and preoperative oral antibiotics (OA) decreases the risk of surgical site infection (SSI) in colorectal surgery; however, this remains controversial. The present study examined the efficacy of OA plus MBP in laparoscopic colorectal cancer (CRC) surgery using propensity score matching (PSM). Methods: A total of 1080 patients with CRC underwent MBP followed by laparoscopic surgery between 2007 and 2019. OA was administered to all patients with CRC who underwent colectomy from 2018. PSM was performed to compare the effects of OA plus MBP (OA) versus MBP only (non-OA) on the rate of superficial SSI. Results: Overall, 128 patients received OA. Significant differences were observed in age, the American Society of Anesthesiologists performance status (ASA-PS), liver disease, and preoperative serum albumin (Alb) between the OA and non-OA groups. The enrolled patients were matched using PSM into two groups based on the following factors: sex, age, body mass index, ASA-PS, diabetes mellitus, liver disease, Alb, and tumor location, which resulted in the disappearance of significant differences. A univariate analysis showed that blood loss of 100 g or more, non-OA, and preoperative chemotherapy or radiation correlated with SSI (p = 0.021, 0.010, 0.038). A multivariate analysis of these three variables identified blood loss of 100 g or more and non-OA as independent risk factors for SSI (hazard ratio (HR): 3.238, p = 0.031; HR: 2.547, p = 0.033). Conclusions: The present study revealed that OA plus MBP markedly reduced SSI rate. OA with MBP needs to be adopted in laparoscopic CRC surgery.

Predictors of surgical site infection and pneumonia following oral cavity tumor surgery.

To identify risk factors for surgical site infection (SSI) and pneumonia following oral cavity tumor surgery. Retrospective chart review of a consecutive series of patients undergoing oral cavity resection. Several clinicopathologic variables were tested for their association with SSI and pneumonia. Three hundred and forty-four cases in 330 patients were included. Incidence of SSI and pneumonia was 67 (19.5%) and 38 (11%), respectively. On multivariate analysis, marginal mandibulectomy and segmental mandibulectomy were independent risk factors for SSI, whereas time under anesthesia (TUA) was an independent risk factor for pneumonia. Receiver operating characteristic curve identified 390 min as the cutoff above which pneumonia was predicted with a high degree of accuracy. In oral cavity resections, mandibulectomy predisposes to SSI. Further, prolonged TUA (>390 min) is a powerful predictor for pneumonia. As it is a modifiable risk factor, reduction in TUA might correspondingly lower the incidence of postoperative pneumonia.

Incidence and Risk Factors for Surgical Site Infection Following Coronary Artery Bypass Graft Procedures

Background: Deep and organ-space surgical site infections (SSIs) are serious complications of coronary artery bypass graft (CABG) procedures. It is unclear whether the use of bilateral versus single internal mammary artery (BIMA vs SIMA) and surgical approach to internal mammary artery (IMA) harvest (pedicled vs skeletonized) are independent risk factors for SSI. The use of BIMA grafting redirects blood flow away from the sternum to the heart and may increase SSI risk due to lower tissue perfusion. A skeletonized approach to graft harvest, wherein the IMA is dissected free of surrounding tissue to preserve collateral sternal blood flow, may decrease SSI risk as compared to a pedicled approach in which the IMA is mobilized within a tissue pedicle. We describe the incidence and potential risk factors for post-CABG SSI in an academic tertiary-care center performing ~500 IMA procedures annually. Methods: Data were abstracted on adult patients who underwent a CABG procedure using at least 1 IMA graft between July 2017 and June 2020. Additional data on potential risk factors for SSI were obtained electronically from hospital data marts and the Division of Cardiac Surgery database, including demographics, comorbidities, number of arterial grafts, surgical approach, surgeon, and discharge location. Using standard NHSN definitions, infection control practitioners identified post-CABG deep and organ-space SSIs. Patient and procedure characteristics were evaluated as potential risk factors for deep and organ-space SSI using the Fisher exact test. Results: Of 1,591 CABG procedures performed during the study period, 1,244 (78.2%) were performed using a SIMA technique and 347 (21.8%) were performed using a BIMA technique. The overall post-CABG SSI incidence was 1.2 per 100 procedures, with 1.0 SSIs per 100 SIMA procedures and 1.7 SSIs per 100 BIMA procedures. Table 1 demonstrates an increase over time in proportion of CABG procedures performed using SIMA and skeletonized IMA grafts. We also observed a decrease in overall SSI incidence over this period. See Table 2 for univariate predictors of post-CABG SSI. Conclusions: Female sex, BMI ≥40, age ≥75 years, diabetes, and discharge to a rehabilitation setting were associated with development of post-CABG SSI. Although the overall incidence of deep and organ-space SSI in our cohort was very low, making it difficult to draw conclusions about potentially modifiable risk factors, an increase in the use of SIMA and skeletonized grafts appears to be accompanied by a decrease in SSI incidence. More data from our institution and others are needed to determine the significance of this trend.Funding: NoDisclosures: None

Surgical Site Infections Are Associated With Higher Blood Loss and Open Access in General Thoracic Practice

Background: Surgical site infections (SSIs) are the most costly and second most frequent healthcare-associated infections in the Western world. They are responsible for higher postoperative mortality and morbidity rates and longer hospital stays. The aim of this study is to analyze which factors are associated with SSI in a modern general thoracic practice.Methods: Data were collected from our department's quality database. Consecutive patients operated between January 2014 and December 2018 were included in this retrospective study.Results: A total of 2430 procedures were included. SSIs were reported in 37 cases (1.5%). The majority of operations were video-assisted (64.6%). We observed a shift toward video-assisted thoracic surgery in the subgroup of anatomical resections during the study period (2014: 26.7%, 2018: 69.3%). The multivariate regression analysis showed that blood loss >100 ml (p = 0.029, HR 2.70) and open surgery (p = 0.032, HR 2.37) are independent risk factors for SSI. The latter was higher in open surgery than in video-assisted thoracic procedures (p < 0.001). In the subgroup of anatomical resection, we found the same correlation (p = 0.043). SSIs are also associated with significantly longer mean hospital stays (17.7 vs. 7.8 days, p < 0.001).Conclusion: As SSIs represent higher postoperative morbidity and costs, efforts should be made to maintain their rate as low as possible. In terms of prevention of SSIs, video-assisted thoracic surgery should be favored over open surgery whenever possible.

Prevalence and risk factors of surgical site infection after closed isolated patella fracture surgery: A prospective cohort study.

Surgical site infection (SSI) after patella fracture surgery could be devastating and challenging. There is no large sample size study to investigate the prevalence and risk factors of it. The purpose of this study was to address this clinical issue. A total of 820 patients who underwent patella fracture surgery between October 2014 and December 2018, were included. Demographic data, fracture type, injury mechanism, pre-operative stay, surgery-related variables, and pre-operative laboratory indexes were obtained from a prospective database. The optimum cutoff value of surgery duration was detected by receiver operating characteristic analysis. Univariate analysis and multivariate analysis were performed to determine the risk factors. A total of 17 patients developed SSI after patella fracture surgery, indicating a prevalence of 2.1%, with 11 cases (1.3%) for superficial infection and six cases (0.8%) for deep infection. After adjustment of multiple variables, current smoking, (OR, 18.6, CI, 3.5-99.0); albumin < 35g/L, (OR, 7.4, CI, 1.1-52.3); diabetes mellitus, (OR, 8.8, CI, 1.3-59.4) and surgery duration > 79.5minutes, (OR, 13.2, CI, 1.5-117.3) were identified to be independent risk factors of SSI after patella fracture surgery (p < 0.05). The prevalence of SSI in patients with closed isolated patella fracture was 2.1%, with 1.3% for superficial and 0.8% for deep infection. We recommend individualized risk stratification and targeted interventions for patients with risk factors (current smoking, albumin < 35g/L, diabetes mellitus, and surgery duration > 79.5minutes).