Organ Space Research Articles

Safety and efficacy of a kaolin-impregnated hemostatic gauze in cardiac surgery: A randomized trial

ObjectiveA kaolin-based nonresorbable hemostatic gauze, QuikClot Control+, has demonstrated effective hemostasis and safety when used for severe/life-threatening (grade 3/4) internal organ space bleeding. We evaluated the efficacy and safety of this gauze for mild to moderate (grade 1-2) bleeding in cardiac surgery compared with control gauze. MethodsThis was a randomized, controlled, single-blinded study of patients who underwent cardiac surgery between June 2020 and September 2021 across 7 sites with 231 subjects randomized 2:1 to QuikClot Control+ or control. The primary efficacy end point was hemostasis rate (ie, subjects achieving grade 0 bleed) through up to 10 minutes of bleeding site application, assessed using a semiquantitative validated bleeding severity scale tool. The secondary efficacy end point was the proportion of subjects achieving hemostasis at 5 and 10 minutes. Adverse events, assessed up to 30 days postsurgery, were compared between arms. ResultsThe predominant procedure was coronary artery bypass grafting, and 69.7% and 29.4% were sternal edge and surgical site (suture line)/other bleeds, respectively. Of the QuikClot Control+ subjects, 121 of 153 (79.1%) achieved hemostasis within 5 minutes, compared with 45 of 78 (58.4%) controls (P < .001). At 10 minutes, 137 of 153 patients (89.8%) achieved hemostasis compared with 52 of 78 controls (68.4%) (P < .001). At 5 and 10 minutes, hemostasis was achieved in 20.7% and 21.4% more QuikClot Control+ subjects, respectively, compared with controls (P < .001). There were no significant differences in safety or adverse events between treatment arms. ConclusionsQuikClot Control+ demonstrated superior performance in achieving hemostasis for mild to moderate cardiac surgery bleeding compared with control gauze. The proportion of subjects achieving hemostasis was more than 20% higher in QuikClot Control+ subjects at both timepoints compared with controls, with no significant difference in safety outcomes.

Evaluation of Perioperative Factors Contributing to Organ Space Surgical Site Infection After Minimally Invasive Hysterectomy [ID: 1374862

INTRODUCTION: Postoperative organ space surgical site infection (oSSI), commonly referred to as pelvic abscess, is a clinically impactful complication after hysterectomy. Although more common in open hysterectomies, oSSIs occur in minimally invasive hysterectomy (MIH), contributing to morbidity. In the current study, we evaluate perioperative factors contributing to development of oSSIs in patients undergoing MIH. METHODS: From 2016 to 2022, a multicenter retrospective analysis of patients undergoing MIH was conducted. Patient characteristics, preexisting conditions, surgical history, intraoperative factors, and type of MIH were evaluated to determine factors contributing to the development of oSSI. RESULTS: One thousand one hundred eighty-nine patients underwent MIH. 28 patient (2.4%) developed oSSI. There was no difference in age or body mass index between groups (P&gt;.05) and no difference in the incidence of oSSI based on type of MIH (P=.832). Patients with endometriosis were more likely to develop oSSI (4.9% versus 2.0%, P=.045, odds ratio [OR] 2.49, 95% CI 1.98–6.25). A diagnosis of cancer did not affect oSSI (3.9% versus 2.1%, P=.162, OR 1.90, 95% CI 0.76–4.78). History of diabetes, hypertension, cesarean delivery, prior laparoscopy, prior laparotomy, smoking, or obesity did not affect the incidence of oSSI (P&lt;.05). Patients developing oSSI had a greater mean intraoperative estimated blood loss (EBL) (233.55 cc versus 94.3 cc, P&lt;.001), greater mean length of stay (LOS) (2.4 versus 0.9 days, P&lt;.001), higher incidence of post-operative ileus (15.8% versus 0.7%, P&lt;.001) and blood transfusion (34.6% versus 1.0%, P&lt;.001). CONCLUSION: Development of oSSI is associated with preexisting endometriosis and greater intraoperative EBL. Development of oSSI was associated with greater LOS, postoperative ileus, and blood transfusions. Attention to hemostasis may reduce rates of oSSI.

Epidemiology of postoperative spinal wound infection in the Middle East and North Africa (MENA) region

BackgroundDespite the extensive literature on postoperative spinal wound infection, yet to our knowledge, there is no previous study containing combined data from several sites in the Middle East and North Africa (MENA) region. This study aimed to estimate the incidence of surgical site infection (SSI) following spine surgeries, its associated factors, and management. MethodsIn a retrospective cohort study, medical records of all patients ≥18 years of age who underwent spine surgery at 6 tertiary referral centers in the MENA region between January 2014 to December 2019 (n=5,872) were examined to collect data on the following: (1) Patient's characteristics, (2) Disease characteristics, (3) Spine surgery approach, and (4) Characteristics of Postoperative SSI. The determinants of postoperative SSI were identified using logistic regression analysis. Receiver operating characteristic (ROC) curve was applied to identify the cut-off of the length of stay in the hospital postoperatively till the infection is likely to occur. Significance was set at p<.05. ResultsThe overall incidence of SSI was 4.2% (95% CI: 3.72–4.77), in the form of deep (46.4%), superficial (43.1%), dehiscence (9.3%), and organ space (1.2%) infections. After adjusting for all possible confounders, significant predictors of postoperative SSI were; diabetes (OR=2.12, p<.001), smoking (OR=1.66, p=.002), revision surgery (OR=2.20, p<.001), open surgery (OR=2.73, p<.001), perioperative blood transfusion (OR=1.45, p=.033), ASA class III(OR=2.08, p=.002), and ≥4 days length of stay "LOS" (OR= 1.71, p=.001). A cut-off of 4 days was the optimum LOS above which postoperative SSI is more likely to occur, with 0.70 sensitivity, 0.47 specificity, and 0.61 area under the curve. ConclusionsThis is the first study that highlighted the incidence of postoperative SSI in spine surgery in the MENA region. Incidence figures are comparable to figures in different areas of the world. Identifying predictors of SSI might help high‑risk patients benefit from more intensive wound management.

Machine Learning Model for Assessment of Risk Factors and Postoperative Day for Superficial vs Deep/Organ-Space Surgical Site Infections.

Background. Deep and organ space surgical site infections (SSI) require more intensive treatment, may result in more severe clinical disease and may have different risk factors when compared to superficial SSIs. Machine learning (ML) algorithms provide the opportunity to analyze multiple factors to predict of the type and time of development of SSI. Therefore, we developed a ML model to predict type and postoperative week of SSI. Methodology. A case-control study was conducted among patients who developed a SSI after undergoing general surgery procedures at a tertiary care hospital between 2019 to 2020. Patients were followed for 30 days. Six ML algorithms were trained as predictors of type of infection (superficial vs deep/organ space) and time of infection, and tested using area under the receiver operating characteristic curve (AUC-ROC). Results. Data for 113 patients with SSIs was available. Of these 62 (54.8%) had superficial and 51 had (45.2%) deep/organ space infections. Compared with other ML algorithms, the XG boost univariate model had highest AUC-ROC (.84) for prediction of type of SSI and Stochastic gradient boosting univariate, logistic regression univariate, XG boost univariate, and random forest classification univariate model had the highest AUC-ROC (.74) for prediction of week of infection. Conclusions. ML models offer reasonable accuracy in prediction of superficial vs deep SSI and time of developing infection. Follow-up duration and allocation of treatment strategies can be informed by ML predictions.

Risks of Immunosuppressive Therapy in Patients Undergoing Open Reduction Internal Fixation for Ankle Fractures

Chronic steroid and immunosuppressant use have been shown to increase the risk for postoperative complications in orthopedic surgery. Further understanding of the risks of immunosuppression is necessary to aid in risk stratification and patient counseling. However, these risks have not yet been explored in ankle fracture patients. Thus, the purpose of this study is to determine whether patients taking immunosuppressives are at an increased risk for morbidity and mortality following open reduction and internal fixation (ORIF) of ankle fractures. Patients undergoing operative treatment for ankle fractures from 2006 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients were categorized based on their use of immunosuppressive medications. Postoperative outcomes assessed included superficial surgical site infections, deep surgical site infections, organ space infections, wound dehiscence, pneumonia, unplanned intubation, pulmonary embolism, urinary tract infection, renal failure, blood transfusion requirement, deep vein thrombosis, sepsis, cardiac arrest, extended length of hospital stay, readmission, reoperation, and mortality. Univariate and multivariate analyses were performed. In total, 10,331 patients underwent operative treatment for ankle fracture. Total 10,153 patients (98.3%) were not taking immunosuppressants and 178 (1.7%) were taking these medications. In multivariate analysis, patients taking immunosuppressants were at increased risk of pulmonary embolism (odds ratio [OR] 4.382; p=.041) and hospital readmission (OR 2.131; p=.021). Use of immunosuppressive medications is an independent risk factor for pulmonary embolism and readmission following ORIF for ankle fractures. Notably, no association with wound complications, infections, or sepsis was identified.

Knee Arthrodesis: An Analysis of Surgical Risk Factors and Complications Using a National Database.

Knee arthrodesis is predominantly a salvage procedure. In present time, knee arthrodesis is mostly considered for cases of unreconstructable failed total knee arthroplasty after prosthetic joint infection or trauma. Knee arthrodesis has shown better functional outcomes than amputation for these patients but has a high complication rate. The purpose of this study was to characterize the acute surgical risk profile of patients undergoing a knee arthrodesis for any indication. The American College of Surgeons National Surgical Quality Improvement Program database was queried to determine 30-day outcomes after knee arthrodesis between 2005 and 2020. Demographics, clinical risk factors, and postoperative events were analyzed, along with reoperation and readmission rates. A total of 203 patients that underwent a knee arthrodesis were identified. Forty-eight percent of patients had at least 1 complication. The most common complication was acute surgical blood loss anemia requiring a blood transfusion (38.4%), followed by organ space surgical site infection (4.9%), superficial surgical site infection (2.5%), and deep vein thrombosis (2.5%). Smoking was associated with higher rates of reoperation and readmission (odds ratio 9, P < .01, and odds ratio 6, P < .05). Overall, knee arthrodesis is a salvage procedure that has a high rate of early postoperative complications and is most often performed in patients at higher risk. Early reoperation is strongly associated with a poor preoperative functional status. Smoking places patients at higher risk of early complications.

MP60-05 INFECTIOUS COMPLICATION AFTER RADICAL CYSTECTOMY: TIMING AND OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP60-05 INFECTIOUS COMPLICATION AFTER RADICAL CYSTECTOMY: TIMING AND OUTCOMES Young Son, Mark Quiring, Benjamin Fink, Virgil Demario, Scott Serpico, Thomas Mueller, and Gordon Brown Young SonYoung Son More articles by this author , Mark QuiringMark Quiring More articles by this author , Benjamin FinkBenjamin Fink More articles by this author , Virgil DemarioVirgil Demario More articles by this author , Scott SerpicoScott Serpico More articles by this author , Thomas MuellerThomas Mueller More articles by this author , and Gordon BrownGordon Brown More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) with urinary diversion is the primary treatment option for muscle invasive bladder cancer (MIBC) and select patients for non-muscle invasive bladder cancer (NMIBC). Surgical and non-surgical Infection after RC is a devastating complication. Postoperative infection has been shown to increase admission to ICU, increase length of hospital stay, increased readmission and double the mortality rate. We aim to add to the literature of the characteristics, timing, and predilection of infection after RC. METHODS: The ACS NSQIP is a health insurance portability and accountability act (HIPAA) compliant data file containing patient cases from 706 participating hospital institutions. This retrospective study focused on radical cystectomy cases in the NSQIP data set for bladder cancer. Patients with missing data or had multiple infections were excluded. The patients were then subgrouped to surgical site infection (SSI), wound disruption, UTI, and sepsis (sepsis and septic shock). RESULTS: Among the 3955 patients, the rate of SSI, UTI, wound disruption, sepsis/septic shock was 11.9%, 8.1%, 2.1%, and 10.0% (Table). The average days from operation until infectious complications were 15.1 days for organ space SSI, 14.57 days for deep SSI, 14.2 days for superficial SSI, 14.9 days for UTI, 12.2 days for wound disruption, and 13.8 days for sepsis (figure). Multivariable analysis for all infections identified diabetes as an independent variable associated with SSI (p=0.003), UTI (p=0.039), and sepsis/septic shock (p<0.001). Prior pelvic radiation was associated with SSI (p=0.001) and sepsis/septic shock (p=0.012). Furthermore, all infectious etiologies were associated with readmission on multivariable regression. CONCLUSIONS: Infection after radical cystectomy can be an often a serious complication. We identified that the timing of wound disruption to occur earliest while organ space SSI was identified late. Diabetes was associated with all the infectious complications while prior radiation was associated with SSI and sepsis. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e844 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Young Son More articles by this author Mark Quiring More articles by this author Benjamin Fink More articles by this author Virgil Demario More articles by this author Scott Serpico More articles by this author Thomas Mueller More articles by this author Gordon Brown More articles by this author Expand All Advertisement PDF downloadLoading ...

Were surgical outcomes for acute appendicitis impacted by the COVID-19 pandemic?

BackgroundThe COVID-19 pandemic disrupted healthcare systems throughout the world. We examine whether appendectomy outcomes in 2020 and 2021 were affected by the pandemic.MethodsWe conducted a retrospective cohort study of 30-day appendectomy outcomes using the ACS-NSQIP database from 2019 through 2021. Logistic regression and linear regression analyses were performed to create models of post-operative outcomes.ResultsThere were no associations between the time period of surgery and death, readmission, reoperation, deep incisional SSI, organ space SSI, sepsis, septic shock, rate of complicated appendicitis, failure to wean from the ventilator, or days from admission to operation. During the first 21 months of the pandemic (April 2020 through December 2021), there was a decreased length of hospital stay (p = 0.016), increased operative time (p < 0.001), and increased likelihood of laparoscopic versus open surgery (p < 0.001) in compared to 2019.ConclusionsThere were minimal differences in emergent appendectomy outcomes during the first 21 months of the pandemic when compared to 2019. Surgical systems in the US successfully adapted to the challenges presented by the COVID-19 pandemic.

Outcomes and Resource Utilization Associated with Use of Routine Pre-Discharge White Blood Cell Count for Clinical Decision-Making in Children with Complicated Appendicitis: A Multicenter Hospital-Level Analysis

BackgroundThe objective was to explore the hospital-level relationship between routine pre-discharge WBC utilization (RPD-WBC) and outcomes in children with complicated appendicitis. MethodsMulticenter analysis of NSQIP-Pediatric data from 14 consortium hospitals augmented with RPD-WBC data. WBC were considered routine if obtained within one day of discharge in children who did not develop an organ space infection (OSI) or fever during the index admission. Hospital-level observed-to-expected ratios (O/E) for 30-day outcomes (antibiotic days, imaging utilization, healthcare days, and OSI) were calculated after adjusting for appendicitis severity and patient characteristics. Spearman correlation was used to explore the relationship between hospital-level RPD-WBC utilization and O/E's for each outcome. Results1528 children were included. Significant variation was found across hospitals in RPD-WBC use (range: 0.7–100%; p < 0.01) and all outcomes (mean antibiotic days: 9.9 [O/E range: 0.56–1.44, p < 0.01]; imaging: 21.9% [O/E range: 0.40–2.75, p < 0.01]; mean healthcare visit days: 5.7 [O/E 0.74–1.27, p < 0.01]); OSI: 14.1% [O/E range: 0.43–3.64, p < 0.01]). No correlation was found between RPD-WBC use and antibiotic days (r = +0.14, p = 0.64), imaging (r = −0.07, p = 0.82), healthcare days (r = +0.35, p = 0.23) or OSI (r = −0.13, p = 0.65). ConclusionsIncreased RPD-WBC utilization in pediatric complicated appendicitis did not correlate with improved outcomes or resource utilization at the hospital level. Level of EvidenceIII. Type of StudyClinical Research

Adverse postoperative outcomes associated with perioperative blood transfusion in gynecologic oncology surgery

ObjectiveTo examine the incidence of perioperative blood transfusion and association with 30 day postoperative outcomes in gynecologic cancer surgery.MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was...

Cardiac Tamponade in Idiopathic Capillary Leak Syndrome: Philippines’ First

Background: Clarkson’s disease, more known as idiopathic systemic capillary leak syndrome (SCLS) is a rare condition characterized by hypotensive episodes due to capillary hyperpermeability, which may be manifested by fluid accumulation in any organ or potential space, causing range of complications: respiratory failure (from pulmonary edema or pleural effusion), mesenteric hypoperfusion (from hepatic congestion and severe intestinal edema), compartment syndrome and rhabdomyolysis, and even shock from hypovolemia or cardiac tamponade. Very few cases of cardiac tamponade have been reported and certainly a serious and life-threatening complication. Case Summary: A 44-year-old female, reported to have intermittent episodes of angioedema aggravated by menstruation and infection, came in due to persistent hypotension. Patient presented with flu-like symptoms and tested positive for COVID – 19 infection. Initial laboratories revealed hemoconcentration, slightly elevated creatinine and hypoalbuminemia. Electrolytes and urinalysis were normal. 2D echocardiography showed large pericardial effusion with right atrial and ventricular collapse suggestive of cardiac tamponade, hence patient underwent emergency pericardial windowing. Initial chest X-ray was normal but repeat study showed pleural effusion on the 4th day of admission which was drained surgically. Additional diagnostic tests revealed negative for hepatitis, Mycoplasmal and Epstein-Barr virus. Direct and indirect Coomb’s test were also negative and Lupus panel was unremarkable. Serum free light chain panel showed suspicious for low level monotypic serum free lambda light chains (based only on the free light ratio). Immunopathology results showed no overt evidence of monoclonal bands. Protein electrophoresis pattern showed decreased albumin fraction and increased alpha, beta, and gamma fractions. C1 inhibitor was slightly elevated while serum tryptase was within normal values. Patient was managed as a case of idiopathic systemic capillary leak syndrome or Clarkson’s disease. Aside from judicious fluid resuscitation and vasopressors assist Methylprednisolone pulse therapy (MPPT) and intravenous immunoglobulin (IVIg) were administered. Patient was discharged with tapering doses of oral steroids and scheduled monthly IV immunoglobulin infusion. Conclusion: Cardiac tamponade, an uncommon yet severe and life-threatening complication of systemic capillary leak syndrome (SCLS) or Clarkson’s disease, requires immediate intervention. While the exact cause remains unclear, research suggests that during acute SCLS episodes and hyperinflammatory states, fluid accumulation in the pericardial space can impede ventricular filling, leading to hemodynamic compromise.

A clinical study on surgical site infections after craniotomy at a tertiary care hospital

Background: Patients with craniotomy procedure might have serious complication like surgical site infection (SSI) with the incidence rate of &gt;9.0%. Certain factors such as multiple operations, cerebrospinal fluid leak, use of corticosteroids, altered sensorium, and diabetes may increase the risk of SSI. It is important to prevent the incidence of SSIs to reduce mortality and morbidity of the patients undergoing craniotomy due to various indications. Aims and Objectives: The present study intends to clinically evaluate the SSI in post-craniotomy and to study general characteristics of patients who are suffering with SSI after craniotomy. Materials and Methods: The present study is prospective observational study of conducted on patients with SSI after craniotomy surgery. A complete history of patient and surgery-related information was collected. The data were analyzed using descriptive statistics. Results: A total of 25 patients with SSI after craniotomy surgery were included in the study. The mean age of the patient was 53 years with male predominance (56). Out of 25 cases, nine patients were obese, 19 patients had a habit of smoking, and 13 patients were suffering from comorbid conditions. The majority of the patients (12 patients) were having intensive care unit stay of 8–14 days. The most common bacteria causing SSIs is found to be Staphylococcus aureus in organ space infections. Conclusion: From the present study, it can be concluded that even though risk statistical significance can be ruled out, it is important to consider the certain risk factors preoperatively to provide proper health-care facility.

Incidence, predictors, and 30-day outcomes of Clostridioides difficile infection in patients undergoing cystectomy: A national database analysis

Clostridioides difficile infection (CDI) is the second most common health care acquired infection (HAI) and the most common gastrointestinal HAI, with an estimated 365,200 cases reported by the center for disease control in 2017. CDI continues to remain a major cause of inpatient admission and utilization of health care resources. This study aimed to determine the true incidence, risk factors, and outcomes of CDI in patients undergoing cystectomy. We conducted an analysis of patients undergoing cystectomy between 2015 and 2017 using the American college of surgeon National Surgical Quality Improvement Program to study the incidence, risk factors, and 30 day postsurgical outcomes associated with CDI following cystectomy. Developed by the American College of Surgery, this is a nationally validated, risk adjusted, and outcomes based program designed to determine and improve the quality of surgical and postsurgical care. The incidence of CDI following cystectomy was 3.6% in our patient cohort. About 18.8% of patients developed CDI following hospital discharge. None elective surgeries and complete cystectomy procedures had a higher rate of CDI. About 48.4% of patients with CDI had a preceding postoperative infection. Postoperative organ space infections, postoperative renal failure, postoperative sepsis, and septic shock were independently associated with the development of CDI, (all P < 0.05). Patients who developed postoperative CDI during hospitalization had lengthier hospital admissions than those who did not develop a CDI and had a higher risk of deep venous thrombosis formation. A sizable number of patients experience CDIs after cystectomy procedures in the USA, and CDI development is associated with an increase in length of stay and unplanned readmissions. Interventions and initiatives are needed to reduce this burden of disease.

Impact of Frailty Upon Surgical Decision-Making for Left-Sided Colon Cancer.

Background: Frailty is characterized by reduced physiologic reserve, and for patients with colon cancer, frailty is associated with increased morbidity after resection. One commonly cited reason for performing an end colostomy vs a primary anastomosis in left-sided colon cancer is the belief that frail patients do not have the physiologic reserve to withstand the morbidity associated with an anastomotic leak. We explored the impact of frailty on the type of operation performed in patients with left-sided colon cancer. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program for patients with colon cancer who underwent a left-sided colectomy from 2016 to 2018. Patients were categorized using the modified 5-item frailty index. Multivariate regression was used to identify independent predictors of complications and type of operation performed. Results: Of 17,461 patients, 20.7% were considered frail. Frail patients received an end colostomy more often than nonfrail patients (11.3% vs 9.6%, P=0.01). On multivariate analysis, frailty was a significant predictor for total medical complications (odds ratio [OR] 1.45, 95% CI 1.29-1.63) and readmission (OR 1.53, 95% CI 1.32-1.77) but was not independently associated with organ space surgical site infections or reoperation. Frailty was independently associated with receiving an end colostomy vs a primary anastomosis (OR 1.23, 95% CI 1.06-1.44), but an end colostomy did not decrease the risk of reoperation or organ space surgical site infections. Conclusion: Frail patients with left-sided colon cancer are more likely to receive an end colostomy, but an end colostomy does not lower the risk of reoperation or organ space surgical site infections. Based on these results, frailty alone should not prompt the decision to perform an end colostomy, but further studies are needed to guide surgical decision-making in this understudied population.

Did the National Ban on Bacitracin Irrigation Affect Infection Rates in Implant-Based Breast Reconstruction? An Analysis of a National Database

IntroductionThe current standard of practice in implant-based breast reconstruction is irrigation of the mastectomy pocket with antimicrobial solution before implant placement. Prior to being banned and formally recalled in January 2020, bacitracin was a very commonly utilized antibiotic. This study characterizes the effects of the national bacitracin ban on implant-based breast reconstruction infection rates by using a nationwide database to compare complication rates before and after bacitracin was banned. Materials and MethodsThe American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried retrospectively for all patients who underwent implant-based breast reconstruction before the bacitracin ban (2012-2019) and afterwards (2020). Demographics, comorbidities, and complications were collected. Univariate analysis and multivariate analysis were conducted to determine if there were significant changes in wound complications, local wound infections, and systemic infections between the 2 case-control matched cohorts. ResultsA total of 37,126 patients were in the pre-ban cohort and 6333 patients were in the post-ban cohort. Before matching, there were significant differences in race distribution, BMI, ASA class, inpatient vs. outpatient status, preoperative smoking, and preoperative diabetes mellitus (all P < .05). After case-control matching, there were 6313 patients in each cohort. Univariate analysis revealed differences in postoperative superficial and organ space surgical site infection, wound complications/infections, all cause complications, and reoperations (all P < .05). Multivariate analysis showed that patients who underwent breast reconstruction before the ban had decreased odds of having wound infections, related infections, all cause complications, and reoperations (all P < .05). ConclusionThis study provides a macroscopic view into the effects of the formal injectable bacitracin ban on breast reconstruction outcomes. Patients who underwent implant-based breast reconstruction after the ban of injectable bacitracin had higher odds of developing wound infections, related infections, and reoperations. More study into suitable alternatives to injectable bacitracin for surgical site antimicrobial irrigation is warranted.

Reusing personal protective equipment (PPE) did not increase surgical site infection in trauma surgical patients during the COVID-19 pandemic: A retrospective cohort study in Michigan Trauma Centers

BackgroundReuse of personal protective equipment (PPE), masks more specifically, during the COVID-19 pandemic was common. The primary objective of this study was to compare pre-pandemic surgical site infection (SSI) rates prior to reuse of PPE, to pandemic SSI rates after reuse of PPE in trauma surgical patients. MethodsA retrospective cohort analysis collected from the Michigan Trauma Quality Improvement Program database was performed. The pre-COVID cohort was from March 1, 2019 to December 31, 2019 and post-COVID cohort was March 1, 2020 to December 31,2020. Descriptive statistics were used to assess differences between variables in each cohort. ResultsNearly half (49.8%) of our cohort (n = 48,987) was in the post-COVID group. There was no significant difference in frequency of operative intervention between groups (p > .05). There was no significant increase (p > .05) between pre- and post-COVID cohorts for superficial, deep, or organ space SSI when reuse of masks was common. ConclusionReuse of PPE did not lead to an increase in SSI in surgical patients. These findings are consistent with previous studies, but the first to be described in the trauma surgical patient population. Studies such as this may help inform further discussion regarding PPE usage as we continue to emerge from the current pandemic with the continuous threat of future pandemics.

Oral antibiotics and organ space infection after appendectomy and intravenous antibiotics therapy for complicated appendicitis in children.

There is little consensus regarding management after appendectomy for complicated appendicitis in children. Recent literature suggests that patients may be safely discharged without oral antibiotics after adequate intravenous antibiotics therapy. We conducted a nationwide retrospective cohort study comparing the proportion of postoperative organ space infection between patients discharged with and without oral antibiotics after appendectomy followed by intravenous antibiotics therapy for complicated appendicitis. Using the Diagnosis Procedure Combination database, we identified patients between 3 and 18 years of age who had undergone appendectomy for complicated appendicitis between July 2010 and March 2018. Propensity score matched analyses were performed to compare outcomes between the groups with and without oral antibiotics. The primary outcome was readmission due to organ space infection within 60 days of discharge and the secondary outcome was 60-day readmission due to any reason. Additionally, we conducted a stabilized inversed probability of treatment weighting analysis as a sensitivity analysis. We identified 13,100 eligible patients who had received oral antibiotics (n=3,501) and who had not (n=9,599). Propensity score matching created 2,769 pairs. Readmissions due to organ space infection were 3.4% and 5.2% in the non-users and users of oral antibiotics, respectively (P=0.007). The oral antibiotics users also had a significantly higher proportion of readmission due to any reason than the non-users (5.5% vs 7.4%, P=0.004). The sensitivity analyses demonstrated consistent results. Among children who had undergone appendectomy for complicated appendicitis, oral antibiotics following discharge after adequate intravenous antibiotics therapy may increase organ space infection.

Concurrent major hepatic resection with primary colorectal cancer increases risk of organ space infections.

Patients with colorectal cancer frequently present with liver metastases requiring either concurrent colon and liver resection or staged resection for curative therapy. The goal of this study is to determine if synchronous resection increases risk of perioperative adverse outcomes such as surgical site infections (SSIs). We conducted a cross-sectional retrospective analysis of the targeted hepatectomy NSQIP database from 2015 to 2019. The primary outcome was surgical site infections stratified into superficial, deep, organ space, and wound dehiscence. We performed univariate followed by a multivariate logistic regression to determine if there were higher odds of SSIs in patients undergoing hepatic resection concurrently with primary colorectal resection. Additionally, we performed stratified analyses by size of hepatic resections (partial, total left, total right, and trisegmentectomy). Of the 7,445 patients included in the study, 431(5.8%) underwent synchronous resection and 7,014 metachronous resection. On average, synchronous resections prolonged surgery by 62min. There was no difference in superficial and deep SSIs between the groups; however, there was a significant difference in organ space SSIs. Patients undergoing synchronous resection had 1.51 times the odds of developing an organ space SSI (OR 1.51, 95%CI 1.10, 2.17, p = 0.04) compared to patients with metachronous resection on multivariate analysis. Patients undergoing a total right hepatectomy concurrently with a colorectal resection had 2.30 times the odds of developing an organ space SSI (OR 2.30, 95%CI 1.20, 6.86, p = 0.010). Prior studies demonstrated that synchronous resections are safe in properly selected patients with no difference in long-term outcomes. Few studies have explored immediate perioperative outcomes between the two approaches. After controlling for confounders, we demonstrate that synchronous resection with major hepatic surgery increases the risk of organ space SSIs. Future studies should elucidate the precise source of organ space SSIs in order to decrease the risk of this adverse outcome.

Prevalence of Surgical Site infections among Surgical operated patients in Zewditu Memorial Hospital. Addis Ababa Ethiopia December 2020.

Background: Surgical site infections are the most common kinds of hospital-acquired infections. It's a common complication that can cause serious morbidity and mortality after surgery. It is also the major cause of extended hospital stays, accounting for up to 20% of hospital expenses. Methods and materials: A random sample of 144 surgical patients was analyzed utilizing a hospital-based retrospective cross-sectional study technique from January 1 to December 31, 2019. The information was acquired using a World Health Organization-developed modified standardized checklist for surgery safety and the national surveillance network for nosocomial infections. A rigorous random sampling strategy was used to choose study participants. Descriptive statistics such as frequency and percentage were used to describe the data. Result: A total of 13 of the 144 patients who were operated on had surgical site infections (9.02 percent). Elective surgical cases made up 102 (71%) of the total, while emergency surgical cases comprised 42 (29%). Preventive antibiotics were administered to the remaining 99 (69%) research participants, with 73 (73%) receiving ceftriaxone, 3% receiving ampicillin, and 23 (24%) receiving a combination of ceftriaxone and metronidazole. There were 13 cases of surgical site infections in all (9.02 percent). Six (46%) were superficial surgical site infections, four (31%) were deep surgical site infections, and three (23%) were organ space surgical site infections. 11 (84%) patients were treated with IV antibiotics and wound treatment, 1 (8%) cases with wound debridement, and the remaining 1 (8%) cases with laparotomy, antibiotics, and wound management. Conclusion: In this study area, surgical site infection is infrequent. The bulk of the population is made up of women. The use of prophylactic antibiotics and the age of the patients were both variables in the development of surgical site infections

Comparison of Robotic and Laparoscopic Colectomies Using the 2019 ACS NSQIP Database.

Robot-assisted laparoscopic surgeries (RLSs) have become increasingly common in the past decade alongside conventional laparoscopic surgeries (CLSs). In general, RLSs have been reported to be superior to CLSs; therefore, we compared both methods among patients undergoing an elective colectomy for differences in perioperative factors and postoperative complications. A retrospective analysis was conducted using the 2019 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. We stratified 5879 patients into two cohorts according to their preoperative diagnosis of either colon cancer or chronic diverticulitis. Patients within each group were further stratified by operative approach. Of the 5879 patients, 3210 colon cancer and 2669 chronic diverticulitis patients underwent an elective colectomy. There were no differences in length of stay and time from operation to discharge between RLSs and CLSs. RLSs, however, had significantly longer operation times (minutes; colon cancer: RLS 242.9 ± 91.0 vs CLS 177.4 ± 78.2, P < 0.001; chronic diverticulitis: RLS 226.2 ± 87.4 vs CLS 181.7 ± 74.4, P < 0.001). Among all of the colon cancer patients, RLS had higher rates of unplanned return to the operating room (P = 0.028) and organ space surgical site infection (P = 0.035). Among chronic diverticulitis patients, RLS was associated with higher rates of postoperative sepsis, anastomotic leak, organ space surgical site infection, and unplanned readmission (all P < 0.05). CLS may be the more efficient operative technique because it was associated with a shorter average operation time and fewer postoperative complications. This paradigm, however, may change as the robotic technology develops and surgeons become more experienced with RLS.