Postoperative Infection Research Articles

Antibiotic use in cesarean procedures in developing countries: current practices and improvements

Cesarean delivery, a common surgical procedure worldwide, is associated with a significantly increased risk of postoperative infections compared to vaginal births. This risk is notably higher in developing countries due to varying practices in antibiotic prophylaxis and differences in healthcare settings. This study aims to evaluate the current practices and potential improvements in antibiotic use in cesarean sections within these regions. Our analysis revealed that cesarean sections are performed at an increased rate in developing countries, with infection rates ranging from 10% to 40%, primarily due to inconsistent and often inadequate antibiotic prophylaxis. The most common postoperative infections include endometritis, wound infections, and urinary tract infections, largely influenced by factors such as the timing of antibiotic administration, the choice of antibiotic, and the presence of risk factors like prolonged labor and membrane rupture. The standard practice in many developing countries involves the administration of antibiotics post-cord clamping, which has been challenged by recent studies suggesting that preoperative administration can significantly reduce infection rates without adverse effects on neonatal outcomes. A shift towards a single dose of broad-spectrum antibiotics such as cephalosporins administered 30-60 minutes before incision is recommended based on our findings. This approach aligns with the successful reduction of infectious morbidity observed in developed countries and supports the need for standardized guidelines. Furthermore, our study underscores the importance of healthcare provider education and the establishment of clear protocols for antibiotic prophylaxis in cesarean sections. By adopting these improvements, developing countries can achieve a significant reduction in maternal morbidity and contribute to safer childbirth practices.

A novel online calculator based on inflammation-related endotypes and clinical features to predict postoperative pulmonary infection in patients with cervical spinal cord injury

BackgroundPostoperative pulmonary infection (POI) of patients with cervical spinal cord injury (CSCI) is highly heterogeneous, while the potential endotypes and related risk factors remain unclear. MethodsA retrospective collection of 290 CSCI patients was conducted from January 2010 to July 2024 using 1:1 propensity score matching to compare POI (n = 145) and non-POI (n = 145) groups. We generated laboratory examination data from admission patients and identified endotypes using unsupervised consensus clustering and machine learning. CSCI patients were randomly assigned to the training set (n = 203) and internal validation set (n = 87). A separate cohort comprising 245 CSCI patients were used for external validation. Independent predictors for POI were identified using univariate and multivariate logistic regression. A nomogram and an online calculator were developed and validated, both internally and externally. ResultsTwo inflammation-related endotypes were identified: high inflammation endotype (endotype C1) and low inflammation endotype (endotype C2). Eight predictors for POI were identified (including age, operation duration, number of surgical segments, time between injury and surgery, preoperative steroid pulse, American Spinal Injury Association (ASIA) grade, smoking history, and inflammation-related endotype). A nomogram integrating the risk factors showed excellent discrimination in the training set (AUC, 0.976; 95% CI 0.956–0.996), internal validation set (AUC, 0.993; 95% CI 0.981–1.000), and external validation set (AUC, 0.799; 95%CI 0.744–0.854). Calibration curves demonstrated excellent fit, and decision curves highlighted its favorable clinical value. An online calculator (https://tjspine.shinyapps.io/dynnomapp/) was constructed to improve the convenience and efficiency of our prediction model. ConclusionsWe identified inflammation-related endotype and constructed a web-based calculator for predicting POI in patients with CSCI, exhibiting excellent clinical utility.

Comparison of Early Versus Late Debridement Outcomes in the Management of Open Distal Radius Fractures

The optimal timing for surgical treatment of open distal radius fractures remains an area of debate. The purpose of this study was to examine the outcomes of open distal radius fractures treated surgically before or after 24 hours. A multicenter retrospective review was performed on all open distal radius fractures treated over 11 years. Patient demographics, injury mechanism, and initial treatment were recorded. Fracture severity was graded by the Gustilo-Anderson classification. Comparisons were made between those treated surgically within and after 24 hours. Outcomes examined included infection, revision surgery, osteomyelitis, and nonunion. A total of 230 cases met the inclusion criteria. The cohorts of early and delayed surgical intervention were similar with regard to preoperative demographics. The most common mechanism of injury was motor vehicle accident. Approximately 40% of cases were graded as type I, 40% as type II, and 20% as type III. Mean time to debridement in the group treated after 24 hours was 5 days. A mean postoperative follow-up of greater than 6 months was obtained in both cohorts. Similar outcomes were found between cohorts with respect to postoperative infection, revision surgery, osteomyelitis, and nonunion. Similar outcomes with regards to infection, revision, osteomyelitis, and nonunion were found between open distal radius fractures treated emergently versus those managed in a delayed fashion. Patient- and injury-specific factors are important in dictating care. Prognostic IIB.

Complications and revision rates after total shoulder arthroplasty are similar between patients with and without diabetes mellitus.

There is wide variability in the conclusions of studies examining the effects of diabetes mellitus (DM) on outcomes of shoulder arthroplasty (SA). The objective of this study was to determine if there are differences in complication profiles between patients with DM and those without undergoing anatomic and reverse total SA. A retrospective review of patients undergoing SA in a single center from January 2014 to December 2019 was performed. Patients were then stratified into two cohorts, patients with controlled DM (mean hemoglobin A1C < 7%) and those without. Outcomes analyzed included intraoperative complications, postoperative complications, and revision surgery rates. Emergency department (ED) visits and hospital readmissions within 30 days were also recorded. A total of 595 patients underwent SA. No significant difference was found between the diabetes (n = 151) and control group (n = 444) with regard to length of stay (P = .168), complications (P = .286), infection rate (P = .977), 30-day ED visits (P = .789), and readmissions (P = .230). The average time to revision was 26.8 months in the diabetes group and 26.6 months in the control group (P = .989). Following SA patients with controlled DM showed no increased risk of postoperative infection, ED visitation,hospital readmission, and revision surgery rate when compared to non-diabetics. Level III-retrospective cohort.

Evidence-Based Critical Assessment of the Success Rate of Dental Implants in Smokers: An Umbrella Systematic Review.

The aim of this umbrella systematic review is to evaluate the success rate and osseointegration of dental implants in patients with a smoking habit. Electronic database searches of PubMed/Medline, Google Scholar, ScienceDirect, Cochrane Library, and EBSCOhost were done from 2006 until August 2024, using medical subject headings (MeSH) terms. Systematic reviews and meta-analyses (SRMAs) investigating the association between smoking and the rate of success of dental implants based on dental implant failure, marginal bone loss, survival, and peri-implant parameters were deemed eligible. The Assessment of Multiple Systematic Reviews Tool 2 (AMSTAR 2) was used to assess the quality of the included SRMAs. Seventeen systematic reviews have been included. In the reviews, 10 studies included meta-analyses (MAs) that evaluated implant failure rate and marginal bone loss. According to the AMSTAR 2 checklist, one review was scored "high," seven reviews were scored "moderate," seven reviews were scored "low," and two reviews were scored "critically low" quality. The strength of evidence suggests a low level of success and high rate of failure of osseointegration of dental implants in smokers. However, the influence of smoking on the rate of dental implant failure seems to be associated with various factors such as peri-implant inflammatory markers, post-operative infections, etc. Inherently, the conclusion of this review is based on a limited number of systematic reviews.

Outcomes of Traditional Excisional Management of Breast Cysts with Ultrasonographical Guidance

Background: Surgery for breast cysts may be necessary for symptom relief or to rule out malignancy. Compared to palpation alone, ultrasound guidance provides better accuracy and outcomes. Objectives: This study aimed to assess the efficacy of conventional excisional therapy of breast cysts under ultrasonographic supervision. Ultrasound-guided excision allows precise localization of the lesion, potentially leading to better results than palpation-guided methods. Methodology: A prospective study was conducted from January 2023 to May 2024 on 40 patients undergoing excisional management of benign breast cysts. Patients were divided into two groups: Group A (n=20) underwent ultrasound-guided excision, while Group B (n=20) had palpation-guided excision. Outcomes measured included recurrence rates, cosmetic satisfaction, and post-operative complications. Statistical analysis was performed using SPSS version 28.0, employing independent t-tests for continuous variables and chi-square tests for categorical data. p ≤0.05 was considered statistically significant. Results: The recurrence rate was 5% in the ultrasound-guided group, compared to 20% in the palpation-guided group (p = 0.03). Cosmetic satisfaction was significantly higher in the ultrasound-guided group, with 85% reporting good to excellent outcomes, compared to 55% in the palpation group (p = 0.02). Post-operative complications, including hematoma and infection, were lower in the ultrasound-guided group. Conclusion: Ultrasound-guided excision of breast cysts is less invasive, with increased accuracy, lower recurrence, and improved cosmetic outcomes compared to palpation-guided excision. It should be considered the first-line treatment for benign breast cyst excision.

Outcomes of Abductor Repair Using Mesh Augmentation in Oncologic Proximal Femur Replacement.

We reviewed 18 (mean age 64 years; 8 female: 10 male) consecutive patients undergoing PFR with Marlex mesh augmentation between 2018 and 2023 at a single institution. The most common indication was metastatic disease (n = 13). The mean follow-up in the 14 surviving patients was 27 months (range 12-34). All patients were ambulatory at final follow-up. There were no post-operative dislocations, infections, or wound issues. At the final follow-up, the mean total MSTS score was 77%. Mesh augmentation of PFRs allowed for adequate soft tissue tensioning and muscular attachment to the body of the implant. In our series, this technique was durable, with no dislocations and no mesh-related complications. In summary, mesh augmentation of PFRs may be considered during reconstruction for oncologic indications.

Tolerability and Outcomes for Treatment of Older Myxoid Liposarcoma Population.

Myxoid liposarcoma predominantly affects young and middle-aged individuals, and little is known regarding treatment tolerability and outcomes in older patients. This study aims to better understand this older patient population. This single institution retrospective study included patients aged 70 years and older with localized (non-metastatic) myxoid liposarcoma. Sixteen patients were included. The median age was 75 years, and 9 (56%) were female. Fourteen (88%) were extremity tumors and two (12%) were trunk. The median tumor size was 10.4 cm (range, 3.6 to 28 cm). Five (31%) tumors had a round cell component. All patients had surgery. Fourteen (88%) had perioperative radiation, and three (19%) had perioperative chemotherapy. One patient had postoperative infection, and one patient had neutropenic fever from preoperative chemotherapy. The median follow up from surgery was 6.3 years. Eight (50%) patients died from MLPS. The median relapse-free survival and overall survival were 34 months and 75 months, respectively. Most older patients with localized MLPS received perioperative radiation therapy with surgery, and few serious toxicities were reported. Even with treatment, half of the patients relapsed.

Incidence of infection rate for shunt implantation: the zero % rate is always a myth

IntroductionPaediatric CSF shunt infection rate remains a well-known complication that is not only responsible of potentially severe sequels for patients but also for economical expenses. In that study, we questioned if it is possible to attain the zero percent rate of infection that should be the goal of every paediatric neurosurgeon.MethodsWe report our series of patients treated with a CSF device from January the first 2016 to December 31 2018.ResultsIn all 147 patients treated for hydrocephalus, the follow-up was of at least of 2 years from the implantation. Antibiotic-coated tubes were always used with a differential pressure valve system. A total of 172 surgical procedures were performed for 147 patients. In the follow-up time period, 4 patients presented a post-operative infection (2.3%). Two infections appeared early after the surgical procedure one after 24 h and the other after 6 days; the other two infections were diagnosed after 53 days and the other after 66 days. The germs responsible of the infections were a Staphylococcus capitals, an Escherichia coli, a Klebsiella pneumonia, and a Staphylococcus aureus.ConclusionsShunts will always be implanted especially in new-borns and for particular aetiologies of hydrocephalus. To reduce the rate of infection, the best thing to do is to adopt adapted protocols. Our low incidence of infection rate for shunts represent a long history to research preventive factors that helped us to improve our results during the time.

Positive Cutibacterium acnes Intervertebral Discs Are Not Associated with Subsidence Following Anterior Cervical Discectomy and Fusion at 3 or 6 Months.

Background/Objectives:Cutibacterium acnes (C. acnes), formerly known as Propionibacterium acnes (P. acnes), is an anaerobic, low-virulent bacterium that has been associated with postoperative infections of the shoulder, knee, and cervical spine. Recent studies have highlighted an association between C. acnes and the development of degenerative disc disease (DDD). The aim of this study is to ascertain whether C. acnes increases the risk of subsidence following anterior cervical discectomy and fusion (ACDF). Methods: After IRB approval, consecutive patients undergoing elective ACDF for DDD from 2017 to 2018 were enrolled in this prospective cohort study. Intervertebral disc samples were taken at each affected level and cultured. A total of 66 patients with radiographic follow-ups were included in the final analysis. The extent of subsidence and cervical lordosis was determined immediately postoperatively and at the 3- and 6-month follow-ups. Results: No significant difference in subsidence was observed at 3 months (p = 0.07) or 6 months (p = 0.11) between culture-positive and -negative cohorts. Additionally, there was no significant difference detected in the change in cervical lordosis observed at 3 months (p = 0.16) or 6 months (p = 0.27) between culture-positive and -negative cohorts. For the most inferiorly fused segment, there was a significant difference in subsidence observed at 3 months (1.5 mm, 95% CI: 0.2-2.7 mm, p = 0.02) but not at 6 months (p = 0.17). Conclusions: Intervertebral discs with a positive C. acnes culture were not associated with greater levels of subsidence at 3 or 6 months following ACDF for DDD. Further research is necessary to endorse these results and to gauge the clinical significance of C. acnes infection.

Is Total Joint Arthroplasty an Effective and Safe Option for Psoriatic Arthritis Patients? A Scoping Review.

Recent advancements in the treatment of psoriatic arthritis (PsA) have improved patient outcomes, but many still experience disease progression, potentially leading to joint replacement surgery. In this scoping review, we examine the relationship between PsA and orthopedic surgery, focusing on the risks and temporal trends of total hip arthroplasty (THA) and total knee arthroplasty (TKA), the prevalence of postoperative complications, and the effectiveness of these procedures in PsA. The included studies suggest that PsA patients have an overall higher risk of undergoing THA and TKA compared to the general population, but with temporal trends showing a decreased risk for patients diagnosed in recent years. Acute complications, such as renal failure, stroke, and postoperative infections, may be more common in PsA patients than in those with osteoarthritis after THA and TKA. No significant differences were found in pain, function, or satisfaction between PsA, skin psoriasis, and osteoarthritis patients after THA. A key conclusion from our review is the need to strengthen the collaboration between rheumatologists and orthopedic surgeons, as interdisciplinary evaluation is crucial for improving the outcomes of PsA patients undergoing orthopedic surgery.

Comprehensive analysis of risk factors for postoperative wound infection following open reduction and internal fixation of Rib fractures

BackgroundPostoperative wound infections (PWIs) significantly impact patient outcomes following open reduction and internal fixation (ORIF) of rib fractures. Identifying and understanding risk factors associated with these infections are crucial for improving surgical outcomes and patient care.MethodsThis retrospective study, conducted from January 2020 to October 2023 at our institution, aimed to analyze the risk factors for PWIs in patients undergoing ORIF for rib fractures. A total of 150 patients were included, with 50 in the infected group and 100 in the non-infected control group, matched for demographic and clinical characteristics. Data on variables such as intraoperative blood loss, hospital stay duration, body mass index (BMI), operation time, presence of anemia, drainage time, diabetes mellitus status, smoking habits, and age were collected. Statistical analysis involved univariate and multivariate logistic regression using SPSS software (Version 27.0), with p-values < 0.05 considered statistically significant.ResultsUnivariate analysis revealed no significant association between intraoperative blood loss or hospital stay duration and PWIs. However, operation time ≥ 5 h, anemia, drainage time ≥ 7 days, diabetes mellitus, smoking, and age ≥ 60 years were significantly associated with higher PWI rates. Multivariate logistic regression confirmed these factors as independent predictors of PWIs, with operation time and diabetes mellitus showing particularly strong associations.ConclusionsProlonged operation time, anemia, extended drainage, diabetes mellitus, smoking, and advanced age significantly increase the risk of PWIs following ORIF for rib fractures. Early identification and targeted management of these risk factors are essential to reduce the incidence of infections and improve postoperative outcomes.

A Meta-Analysis Examining the Effect of Perioperative Biologic Disease-Modifying Anti-Rheumatic Medications on Postoperative Wound Complications in Various Orthopedic Surgeries.

This meta-analysis was designed to compare the risk of postoperative wound complications in various orthopedic surgeries (OSs) affected by the perioperative use of biologic disease-modifying anti-rheumatic drugs (bDMARDs). The odds ratio (OR) and mean difference (MD), with 95% confidence intervals (CIs), were calculated using dichotomous or continuous random or fixed-effect models, based on the meta-analysis data. This study incorporated 14 investigations conducted between 2005 and 2023, encompassing a total population of 19,021 individuals undergoing diverse OSs. Participants who continued their bDMARDs exhibited a substantially higher incidence of postoperative surgical site infections (OR, 1.39; 95% CI, 1.12-1.72, p = 0.002) compared to those who withheld bDMARDs. However, the study did not find any statistically significant difference between the continuation or withholding of bDMARDs regarding delayed wound healing (OR, 2.02; 95% CI, 1.00-4.06, p = 0.05) or disease flares (OR, 0.59; 95% CI, 0.28-1.25, p = 0.17). The results show that patients who continued their bDMARDs had a notably higher incidence of postoperative surgical site infections. However, no significant differences were observed in delayed wound healing or disease flares when compared to those who withheld bDMARDs. It is important to acknowledge the limitations of this analysis, such as the relatively small number of participants and the limited number of studies available for certain comparisons, which may impact the validity of the findings.

Exploring the antimicrobial potential of Leukocyte- and Platelet-Rich Fibrin - an in vitro study.

This study investigates the antimicrobial properties of leukocyte- and platelet-rich fibrin (L-PRF) against Enterococcus faecalis (ATCC 29212), Pseudomonas aeruginosa (ATCC 27853), and Candida albicans (ATCC 90028). Infections can hinder wound healing posing challenges. L-PRF's potential for regeneration and antimicrobial action has been studied. Considering the increasing concern about antibiotic resistance, assessing the antimicrobial properties of L-PRF provides valuable insights into its potential as a therapeutic agent in postoperative infections. Twenty volunteers were enrolled in the study, following ethical guidelines, and obtaining informed consent. Blood samples were collected and L-PRF was prepared. Microbial suspensions were prepared, and susceptibility testing was performed using the Kirby-Bauer agar diffusion method. The study revealed significant heterogeneity in the susceptibility to L-PRF. All L-PRF membrane samples exhibited antimicrobial activity against P. aeruginosa, with inhibition zones of 13 mm ± 3.85 SD. Enterococcus faecalis displayed inhibition diameter of 7.25 mm ± 5.15 SD. Candida albicans susceptibility to L-PRF varied among samples, with both inhibitory and non-inhibitory results. Results showed varying degrees of antimicrobial activity, particularly against P. aeruginosa, and highlight the complexity of the L-PRF-microorganism interaction. Further investigations are needed to elucidate the clinical implications and optimize the use of L-PRF.

Indications and outcomes for locoregional perforator propeller flaps in head and neck reconstruction: Topographical approach in 83 patients

BackgroundLocal perforator flaps have been used in head and neck for coverage of relatively small defects. In this study, we aimed to present our results using a wide spectrum of locoregional flaps in perforator propeller fashion in reconstruction of moderate-to-large sized soft tissue defects of the head and neck. Patients and MethodsFrom August 2012 to June 2023, a total of 83 patients with moderate to large-sized soft tissue defects of the head and neck underwent reconstruction using locoregional perforator propeller flaps. Data on the etiology and location of the defect, the flap of choice and the postoperative course were gathered from patients’ charts retrospectively. Clinical outcome was evaluated based on parameters such as flap survival, color match, duration of hospitalization, and subjective satisfaction of the patient. ResultsA total of 92 locoregional perforator propeller flaps were used in 83 patients with skin and soft tissue defects of the head and neck. The follow-up period ranged from 3 and 36 months, with an average follow-up duration of 12 months. The duration of hospitalization varied between 1 and 6 days, averaging 3 days. Distal partial flap loss occurred in 3 patients, while no postoperative infection, hematomas or seromas were observed. ConclusionLocoregional perforator propeller flaps provide reproducible, functional and aesthetic results in reconstruction of moderate-to-large sized soft tissue defects of the head and neck.

Evaluating the impact of surgery sequence on infection rates in hip or knee arthroplasty: does sequence matter?

The potential influence of surgical sequence of elective hip-and-knee reconstructive surgery in relation to an infection-related procedure on postoperative infection rates is not clearly understood. Therefore, we aimed to examine the impact of surgical sequence on the incidence of postoperative infections within one-year and the longest available follow-up period in patients undergoing hip-and-knee reconstructive surgery. A case-control study with propensity matching was utilized to examine elective surgeries conducted at Sunnybrook Holland Orthopaedic & Arthritic centre, Toronto, Canada between 2015 and 2018. We determined and categorized them based on their operating room (OR) sequence in relation to an infected case; the cases were those performed right after (post-infection cohort), and the controls were those performed before an infection-related procedure in the same OR (pre-infection cohort). We employed survival analysis to compare the infection incidence within one year and at the longest available follow-up among the propensity-matched cohort. A total of 13,651 cases were identified during the four year period. We successfully matched 153 cases (21 post-infection and 132 pre-infection) using propensity scores. Demographic and clinical characteristics were balanced through matching. Kaplan-Meier survival analysis showed no significant difference in infection-free survival within one year and at a median follow-up of 2.2 years [interquartile range 0.9-5.0] between surgeries conducted before and after infected cases (both log-rank p-values = 0.4). The hazard ratios for infection within one year and the longest follow-up period were both 0.37 [95%Confidence Interval 0.03-4.09, p = 0.418], as no more events occurred after one year. The sequence of surgical procedures, whether or not an elective arthroplasty or lower limb reconstructive procedure occurs before or after an infection-related case in the same OR, does not significantly affect postoperative infection rates. This finding supports the efficacy of the current infection control measures and suggests a reconsideration of surgical scheduling standards.

Application of machine learning algorithms to predict postoperative surgical site infections and surgical site occurrences following inguinal hernia surgery.

This study aimed to develop, validate, and evaluate machine learning (ML) algorithms for predicting Surgical site infections (SSI) and surgical site occurrences (SSO) after elective open inguinal hernia surgery. A cohort of 491 patients who underwent elective open inguinal hernia surgery at Fudan University Affiliated Huadong Hospital between December 2019 and December 2020 was enrolled. To create a strong prediction model, we employed five ML methods: generalized linear model, random forest (RF), support vector machines, neural network, and gradient boosting machine. Based on the best performing model, we devised online calculators to facilitate clinicians' access to a linear predictor for patients. The receiver operating characteristic curve was utilized to evaluate the model's discriminatory capability and predictive accuracy. The incidence rates of SSI and SSO were 4.68% and 13.44%, respectively. Four variables (diabetes, recurrence, antibiotic prophylaxis, and duration of surgery) were identified for SSI prediction, while four variables (diabetes, size of hernias, albumin levels, and antibiotic prophylaxis) were included for SSO prediction. In the test set, the RF model showed the best predictive ability (SSI: area under the curve (AUC) = 0.849, sensitivity = 0.769, specificity = 0.769, and accuracy = 0.769; SSO: AUC = 0.740, sensitivity = 0.513, specificity = 0.821, and accuracy = 0.667). Online calculators have been developed to assess patients' risk of SSI ( https://wuqian17.shinyapps.io/predictionSSI/ ) and SSO ( https://wuqian17.shinyapps.io/predictionSSO/ ) after surgery. This study developed a prediction model for SSI/SSO using ML methods. It holds the potential to facilitate the selection of appropriate treatment options following elective open inguinal hernia surgery.

Transverse small incision intrathecal "loop" minimally invasive suture for treatment of acute Achilles tendon rupture

To evaluate the effectiveness and feasibility of a transverse small incision intrathecal "loop" minimally invasive suture for acute Achilles tendon rupture. The clinical data of 30 patients with acute Achilles tendon rupture treated with transverse small incision intrathecal "loop" minimally invasive suture between January 2022 and October 2023 was retrospectively analyzed. The patients were all male, aged from 29 to 51 years, with an average of 39.8 years. The cause of injury was acute sports injury, and the time from injury to operation was 1-14 days, with an average of 3.4 days. The operation time, incision length, intraoperative blood loss, intraoperative complications, wound healing, and hospital stay were recorded. Postoperative appearance and function of ankle were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Vancouver Scar Scale (VSS) score, and Arner-Lindholm score. The operation time ranged from 30 to 90 minutes, with an average of 54.2 minutes; the incision length ranged from 1.3 to 3.5 cm, with an average of 2.2 cm; the intraoperative blood loss ranged from 5 to 70 mL, with an average of 22.3 mL; and the hospital stay ranged from 2 to 6 days, with an average of 3.7 days. All incisions healed by first intention, and there was no incision infection, poor healing, and deep venous thrombosis. All patients were followed up 5.3-22.0 months (mean, 14.7 months). During the follow-up, all the 30 patients had returned to exercise, and there was no complication such as Achilles tendon re-rupture, postoperative infection, and gastrocnemius muscle injury. At last follow-up, the AOFAS ankle-hindfoot score was 82-100, with an average of 95.1; the VSS score was 1-4, with an average of 2.1; according to the Arner-Lindholm score, 24 cases were rated as excellent and 6 cases as good. Transverse small incision intrathecal "loop" minimally invasive suture for the treatment of acute Achilles tendon rupture has the advantages of simple instrument, convenient operation, small trauma, quick recovery, and satisfactory effectiveness.

The Impact of Infection Prevention Bundles on Neurosurgical Outcomes and Healthcare Costs: A Systematic Review

Background: Post-operative infections represent a significant challenge in neurosurgery, leading to increased morbidity, mortality, and healthcare costs. The implementation of infection prevention bundles, which encompass a set of evidence-based practices, has emerged as a potential solution to mitigate these adverse outcomes. This systematic review aims to evaluate the effectiveness of infection prevention bundles in improving neurosurgical outcomes and reducing healthcare costs. Methods: A comprehensive search of electronic databases (PubMed, Scopus, Web of Science) was conducted to identify studies published between 2010 and 2023 that evaluated the impact of infection prevention bundles on neurosurgical outcomes and healthcare costs. The search strategy included keywords such as "neurosurgery," "infection prevention," "surgical site infection," "bundle," "outcomes," and "healthcare costs." Studies were included if they reported on at least one clinical outcome (e.g., surgical site infection rates, mortality, length of stay) and/or healthcare costs. Data extraction and quality assessment were performed independently by two reviewers. Results: The search yielded 45 studies that met the inclusion criteria. The studies encompassed a variety of neurosurgical procedures, including craniotomies, spinal surgeries, and deep brain stimulation. The infection prevention bundles implemented varied across studies but commonly included preoperative antibiotic prophylaxis, skin antisepsis, and intraoperative measures. The pooled analysis demonstrated a significant reduction in surgical site infection rates and length of stay associated with the use of infection prevention bundles. Moreover, several studies reported cost savings, primarily attributed to reduced complications and shorter hospital stays. Conclusion: The evidence suggests that infection prevention bundles are effective in improving neurosurgical outcomes and reducing healthcare costs. The implementation of these bundles should be considered a standard of care in neurosurgery to enhance patient safety and optimize resource utilization. Keywords: Neurosurgery, infection prevention, surgical site infection, healthcare costs, systematic review.

Hyperbranched Poly-l-Lysine Modified Titanium Surface With Enhanced Osseointegration, Bacteriostasis, and Anti-Inflammatory Properties for Implant Application: AnExperimental InVivo Study.

This study aimed to explore multiple effects of hyperbranched poly-l-lysine (HBPL) titanium (Ti) surfaces on osseointegration, bacteriostasis, and anti-inflammation across three different animal models. Ti surfaces were covalently modified with HBPL, with uncoated surfaces as controls. Characterization included scanning electron microscopy (SEM) and surface chemistry and elemental analysis (EDX). Ti and Ti-HBPL implants were placed in conventional canine edentulous sites, post-operative infection canine edentulous sites, and diabetic rat tibias. Implants from canine edentulous models were analyzed using micro-CT and histomorphometry to assess osseointegration at 8 weeks. Post-operative infection beagles were used to evaluate antibacterial efficacy through clinical parameters and bacterial cultures at 1 week. In diabetic rats, micro-CT and histomorphometry were performed at 8 weeks. HBPL was uniformly grafted on Ti-HBPL surfaces. Ti-HBPL surfaces showed higher bone volume/total volume (BV/TV, p < 0.001), bone-implant contact (BIC%, p < 0.001), and trabecular number (Tb.N, p < 0.01) in beagles. Besides, it displayed higher BIC% (p < 0.001) and bone area fraction occupancy (BAFO%, p < 0.01) in hard tissue sections. In an infected model, Ti-HBPL surfaces exhibited lower bleeding on probing (BOP, p < 0.001), and plaque index (DI, p < 0.01), with reduced bacterial colony formation (p < 0.001) compared to the control group. In diabetic rats, Ti-HBPL surfaces showed an increase in BV/TV (p < 0.01) and Tb.N (p < 0.001), downregulated TNF-α and IL-1β (p < 0.01), and upregulated IL-10 (p < 0.01) and osteocalcin (OCN) expression (p < 0.01). HBPL-Ti surfaces demonstrated enhanced osseointegration, bacteriostasis, and anti-inflammatory effects invivo.