Postoperative Surgical Site Infection Research Articles

Comparative analysis of glycemic outcomes following implementation of a pharmacist‐led insulin management service in postoperative cardiothoracic surgery patients

AbstractIntroductionPerioperative hyperglycemia is a predictor of mortality in cardiothoracic surgery (CTS) patients. Cardiothoracic surgery patients with diabetes have improved clinical outcomes with maintained glycemic management, including improved hospital length of stay (LOS), surgical site infection risk, and rates of morbidity and mortality. A pharmacist‐led insulin management service was implemented, granting pharmacists autonomy to adjust basal, bolus, and infusion insulin regimens to optimize glycemic management following CTS. Literature evaluating the impact on glycemic management in CTS patients following a pharmacist‐led insulin management service is limited.ObjectiveThe study objective was to compare postoperative glycemic management in CTS patients before and after implementation of a pharmacist‐led insulin management service.MethodsThis retrospective study included adult CTS patients with diabetes with a hemoglobin A1c (HbA1c) of 6.5% or greater who received at least 2 basal insulin doses following postoperative intravenous (IV) insulin infusion. The primary outcome was the percentage of blood glucose concentrations within the target range (70–180 mg/dL) until postoperative Day 7 or discharge, if sooner. Secondary outcomes were average daily blood glucose, time to discontinuation of postoperative IV insulin infusion, incidence of hypoglycemia and hyperglycemia requiring re‐initiation of an insulin infusion, hospital LOS, and postoperative surgical site infections within 3 months.ResultsA total of 200 patients were included, 100 in each group. Mean percent of glucose checks within target range was higher in the post‐implementation group compared with the pre‐implementation group (60.8 vs. 48.9, p = 0.0004). The post‐implementation group achieved a lower mean daily blood glucose (170 vs. 191, p < 0.0001) and spent fewer days on postoperative insulin infusion (1.24 vs. 1.85, p < 0.0001). There were no differences in the incidence of hypoglycemia, re‐initiation of insulin infusion, LOS, or surgical site infections.ConclusionImplementation of a pharmacist‐led insulin management service was a safe and effective strategy to improve glycemic management in postoperative CTS patients.

Utility of Preoperative Hypoalbuminemia as Independent Predictor of Post-Conversion and Revisional Bariatric Surgery Outcomes: MBSAQIP Registry Analysis.

Anastomotic conversions and revisions remain crucial in addressing complications or sub-optimal outcomes following primary bariatric procedures. Preoperative malnutrition, proxied by hypoalbuminemia, has traditionally been considered a risk factor for postoperative morbidity. This study investigates the validity of this association in revisional and conversion metabolic/bariatric surgery (MBS). A retrospective cohort analysis was performed on 58,327 MBS revisions and anastomotic conversions from the 2020-2022 MBSAQIP registry. Approximately all cases studied were performed laparoscopically (98.8%). A preoperative albumin level of 3.5 g/dL was used as a threshold to identify patients with hypoalbuminemia. We utilized descriptive statistics, univariate and multivariable logistic regression, and 1:1 nearest neighbor matching in complete-case analyses to explore the relationship between albumin levels and postoperative outcomes. While univariate analyses illustrate an association between hypoalbuminemia and postoperative morbidity, multivariable regression and 1:1 matched analysis showed hypoalbuminemia is not an independently significant driver of 30-day overall postoperative complications (including leaks), reoperation, or reintervention. However, 1:1 matched analysis demonstrated significantly increased odds of 30-day postoperative superficial surgical site infection (SSI) (OR 8.138, p=0.049) and readmission (OR 1.75, p=0.045) associated with albumin levels lower than 3.5 g/dL. Following adjustment for confounding patient factors, hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications such as leak, reoperation, or re-intervention after revisional and anastomotic conversion MBS, although there maybe increase in SSI and readmission rates.

Effectiveness of Negative Pressure Wound Therapy on Groin Surgical Site Infection after Lower Extremity Bypass for Chronic Limb-Threatening Ischemia

Surgical site infections (SSIs) are a common cause of patient morbidity, hospital readmission, and reoperation after lower extremity bypass (LEBs) surgery for chronic limb-threatening ischemia (CLTI). Recent studies on the use of incisional negative pressure wound therapy (NPWT) in LEB surgery have reported conflicting results. In this single-center study, we examined our experience on the impact of NPWT on groin SSI rates after LEB surgery. We retrospectively queried electronic medical records for all LEB operations performed for CLTI. Multivariate logistic regression analysis was used to identify risk factors associated with postoperative SSI. Using these risk factors, subset analysis was performed to determine whether NPWT was associated with reduced SSI in high-risk patients. From 2018 to 2022, a total of 367 patients underwent LEB surgery for CLTI. Mean patient age was 66years. Postoperative groin SSI was diagnosed in 22.9% (n=84) of patients. Patients suffering SSI were more frequently morbidly obese (6.0% vs 1.8%, P=0.03) and had higher rates of chronic obstructive pulmonary disease (35.7% vs 23.3%, P=0.02). Other comorbidities and demographic data were similar between groups. NPWT was utilized in 19.6% (n=72) of patients, with no baseline differences between SSI and no SSI cohorts (15.5% vs 20.9%, P=0.28). On multivariate analysis, female sex (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.06-3.35, P=0.03), white race (OR 2.17, 95% CI 1.23-3.82, P=0.007), morbid obesity (OR 3.67, 95% CI 0.93-14.4, P=0.05), and active smoking (OR4.07, 95% CI 1.20-13.8, P=0.02) were independently associated with postoperative SSI. Subset analysis among patients at increased risk of SSI did not reveal any differences in wound infection with NPWT usage. In our experience, NPWT does not appear to be more effective than standard dressings in preventing groin SSI after LEB surgery for CLTI, even among populations at heightened risk for wound infection.

Oral antibiotic prophylaxis induces changes in the microbiology of surgical site infection after colorectal surgery. A matched comparative study.

Oral antibiotic prophylaxis (OAP) lowers rates of surgical site infection (SSI) and may aid anastomotic healing in colorectal surgery. The aim of this study was to analyse the understudied impact of OAP on SSI microbiology after colorectal surgery. A post hoc analysis was performed on a previous prospective, multicentre study of elective colorectal surgery. For 1000 patients with SSI, this study compared the microbiology of SSIs in procedures without OAP (SSI/OAP-) and with OAP (SSI/OAP+). There were 340 patients in the SSI/OAP- group and 660 in the SSI/OAP+ group. The use of OAP increased the presence of Gram-positive cocci (GPC) (OR 1.542, 95% CI 1.153-2.062) and fungi (OR 2.037, 95% CI 1.206-3.440), but reduced rates of Gram-negative bacteria (GNB) (OR 1.461, 95% CI 1.022-2.088) and anaerobe isolation (OR 0.331, 95% CI 0.158-0.696). Specifically, it led to increases in the isolation of Enterococcus faecium (OR 1.450, 95% CI 0.812-2.591), methicillin-resistant Staphylococcus aureus (OR 2.000, 95% CI 1.043-3.834) and Candida spp. (OR 2.037, 95% CI 1.206-3.440). In colon surgery with OAP, GPC infections were more likely (OR 1.461, 95% CI 1.022-2.088). In rectal surgery, organ/space SSIs had a higher risk of harbouring GPC (OR 1.860, 95% CI 1.153-2.999) and a lower risk of GNB (OR 0.321, 95% CI 0.200-0.515). OAP reduced the presence of anaerobes and GNB in SSIs, but increased the isolation of GPCs and fungi, with E. faecium and Candida being of particular concern. This information should guide empirical antibiotic therapy for postoperative colorectal SSIs in patients who have received preoperative OAP.

Seasonality of Surgical Site Infection Rates Across a Broad Surgical Sample and Diverse Health System.

Data from the past two decades suggest that surgical site infections (SSIs) occur more frequently in warmer months. Although several studies have explored the seasonality of SSIs, most do not adequately account for confounding factors or the non-parametric nature of seasonal trends. This study aimed to examine SSI rates following surgeries across multiple hospitals within a single healthcare system, using previously published statistical models applied to electronic health record (EHR) data. We retrospectively analyzed all surgeries across a diverse healthcare system from 2014 to 2019. Preoperative risk and postoperative probabilities of SSIs were estimated using our previously published Automated Surveillance of Postoperative Infections (ASPIN) models. Observed to expected (O/E) ratios were calculated and plotted by week, with cubic smoothing splines used to visualize trends. Seasonality was modeled using generalized linear mixed models with sine and cosine transformations of the week of the year or quadratic transformations as predictors. 348,289 surgeries were analyzed. Most SSIs occurred between July and August. The risk-adjusted O/E ratio and postoperative SSI probabilities significantly increased (P < 0.05) during the summer in Region 1, an academic hospital, but not in the other two regions. Preoperative risk also increased around July but not significantly. Our study supports prior work suggesting a significant peak in SSIs during the summer but not a specific spike in July. We incorporated novel statistical models to predict preoperative risk and postoperative probability of SSI.

Evidence that staphylococcal superantigens promote within-patient bacterial persistence following post-operative surgical site infection.

Staphylococcus aureus is a predominant cause of post-operative surgical site infections and persistent bacteremia. Here, we describe a patient who experienced three episodes of S. aureus infection over a period of 4 months following a total knee arthroplasty. The initial bloodstream isolate (SAB-0429) was a clonal complex 5 (CC5) and methicillin-resistant S. aureus (MRSA), whereas two subsequent isolates (SAB-0485 and SAB-0495) were CC5 isolates but methicillin-sensitive S. aureus. The two latter isolates harbored a plasmid encoding three superantigen genes that were not present in the primary MRSA isolate. SAB-0485 and SAB-0495 both expressed the plasmid-encoded staphylococcal enterotoxin R exotoxin and demonstrated increased superantigen activity compared with SAB-0429. Compared to SAB-0429, the latter isolates also demonstrated an increased bacterial burden in a mouse bacteremia model that was dependent on increased interferon-γ production. Curing of the plasmid from SAB-0485 reduced this virulence phenotype. These findings suggest that the superantigen exotoxins may provide a selective advantage in chronic post-surgical infections.IMPORTANCEIn this study, we investigated bacterial isolates from a patient who experienced three recurrent S. aureus infections over a 4 month period following total knee arthroplasty. Genomic and phenotypic characterization of these isolates revealed that they all belonged to clonal complex 5, yet the latter two strains contained an additional plasmid encoding superantigen exotoxins. Subsequent experimental infection experiments in mice demonstrated that the plasmid-encoded superantigens exacerbated bacteremia by promoting liver abscess formation. These experiments suggest that despite appropriate antibiotic therapy, bacterial superantigens may be able to promote persistent infection following post-surgery.

P-383. Do Intraoperative Bile Cultures in Pancreaticoduodenectomy Change Antibiotic Management? A Retrospective Observational Study

Abstract Background Biliary stenting increases post-operative surgical site infections (SSIs) following Whipple procedure due to bactibilia. Intraoperative bile culture (IOBC) is performed to guide empiric therapy for SSIs; however, its utility and impact on antibiotic utilization is poorly studied. Methods We performed a retrospective cohort study of adult patients undergoing pancreaticoduodenectomy over a 3 year period (2021-2023). Patients with and without IOBCs were compared for pre and post-operative characteristics and complications. Post-operative antibiotic utilization was also compared between cohorts (Fig1). Results 36 patients underwent Whipple’s procedure during the study period; 26 (72%) had IOBC obtained, while 10 (28%) did not. Cohorts were similar in terms of comorbidities, neoplasm, and surgical characteristics (Table 1). All 17 Patients with prior biliary stenting had IOBC obtained, but IOBC were also obtained in 9 patients who had not previously been stented (Table1). Post-operative fever, leukocytosis, SSI, bacteremia, and deep abscess were similar between cohorts, however, more biliary leaks occurred in the group that did not have IOBC (P=0.010)(Table 2a). Compared to the group without cultures, the IOBC group had longer median antibiotic duration (11 versus 3 days, P=0.52), and fewer short course antibiotics under 14 days (65% vs 100%, P=0.197), however these were non-significant trends (Table 2b). Patients in the IOBC group also trended toward more antipseudomonal, carbapenem, and antifungal use (P=0.068 to P=0.285, Table 2b). 10 of 22 (45%) of patients with growth on their IOBC did not have antibiotics adjusted based on that result. Patients whose antibiotics were adjusted did not differ in their microbiology results from those whose cultures were ignored (Figure 2). Conclusion Almost 3 / 4 of patients undergoing Whipple’s procedure had IOBC obtained; some not previously been stented. 45% of patients with positive IOBCs did not have their antibiotics adjusted to target them. Patients who underwent IOBC trended toward longer antibiotic durations and use of broader agents despite having lower rates of post operative biliary leak. These results indicate physicians may feel compelled to treat these cultures without a clinical indication. Disclosures All Authors: No reported disclosures

P-393. Examining Breast Surgical Site Infections: A Case-Control Study on the Effect of Skin Antisepsis Agents and Other Contributing Factors

Abstract Background Postoperative surgical site infections (SSI) in breast mastectomy and reconstruction cases persist despite efforts to control extrinsic factors. SSI may lead to prolonged hospitalization, increased costs of patient and hospital, and patient hardship. Current skin antisepsis practices warrant strict observation, application, and exploration of efficacy, as Gram-positive microorganisms are most commonly associated with breast surgery. The use of an alcohol-based skin preparation has proven to be more effective than those that are aqueous-based, We evaluated potential patient and procedure risk factors for SSI, including the perioperative skin prep used in breast mastectomy, breast plastic reconstructive, and combination breast and plastic cases. Methods A case-control study of breast procedures was performed. Procedures were identified between January 1, 2022 and December 31, 2023 from two campuses in the same health system. Procedures were divided into three case types: breast-only, plastics-only, and combination of breast and plastics. In addition to skin prep solution, factors assessed for SSI risk were: age, in-patients, out-patients, body mass index, diabetes mellitus, duration of procedure, wound class, and ASA. Results 45 SSI cases were identified, and 92 controls were randomly selected. Factors associated with SSI included duration of case, BMI, case type, inpatient procedure, emergent procedure, and wound class. Most SSIs were superficial with Staphylococci the most common organism isolated. Iodophor paint and/or scrub were used in the majority of cases and controls; Chloraprep was used in 0 SSI cases and 3 controls. Conclusion Attention should be focused on the prevention of SSI due to its serious nature. Multiple factors can contribute to the development of SSI and its prevention. The incidence of SSI was higher in patients who underwent either plastics-only or a combination breast/plastics procedures; iodophor skin prep may also be an area of concern. Next steps include implementing a trial of Chloraprep skin prep for all breast procedures, continuing to evaluate other known risk factors, and investigating other potential opportunities, including postoperative patient management. Disclosures All Authors: No reported disclosures

Reported Postoperative Surgical Site Infections in Tertiary Care Hospitals, Systematic Review of Recent Literature.

The objective of this systematic review is to evaluate the patterns of postsurgical site infections, pre-surgical antibiotics prophylaxis, and related clinical outcomes in the recently published literature. This systematic review is registered with PROSPERO registration number CRD42023398963. Several databases and individual journal websites were used to collect data from PubMed/Medline, TRIP, SCOPUS, Elsevier, Springer, ProQuest, and EMBASE. The established criteria of inclusion were RCTs, retrospective, prospective, and cross-sectional studies with patients who had a recent surgical procedure. Excluded from the study designs were systematic reviews, prospective studies, data on pediatrics, and data on disabilities. Quality assessment analysis of the results for randomized controlled trials (RCT) used CONSORT guidelines and STROBE guidelines for cross-sectional and cohort studies. A total of 328 articles were identified from different databases. Among them, 15 studies were included for data extraction and qualitative analysis. A total of 33,193 patients with an average rate of 11.5% (surgical site infections- SSIs) were identified in these studies during 2008-2022. The mean rate of SSIs among the total number of immunocompromised patients/procedures was 10.2%. The SSI on patients undergoing major surgical procedures with visible incisions was 26.0%. The majority of the studies reported the use of pre-surgical antibiotic prophylaxis. Cefazolin was mostly prescribed antibiotics and administered in 90% of patients. Other antibiotics included ceftriaxone (4%), cloxacillin (3%), and vancomycin (4%). The mean reported rate of SSIs with combination antibiotic prophylaxis therapy was 22.8%. This systematic review concluded the limited reported data on surgical site infections (SSIs). The overuse of pre-surgical antibiotic prophylaxis has been reported in several studies. This study recommended developing standardized guidelines on the use of antibiotics related to surgical cases rather than co-morbidities.

Postoperative Surgical Site and Secondary Infections in Colorectal Cancer Patients With a History of SARS-CoV-2: A Retrospective Cohort Study

Postoperative Surgical Site and Secondary Infections in Colorectal Cancer Patients With a History of SARS-CoV-2: A Retrospective Cohort Study

Thickness of Subcutaneous Fat as a Proxy for BMI in Non-ambulatory Patients With Neuromuscular Scoliosis Undergoing Posterior Spinal Fusion

Background: Posterior spinal fusion in neuromuscular scoliosis patients carries a significant risk of postoperative surgical site infection (SSI). Body mass index has been associated with increased risk of surgical site infections, but it is difficult to obtain an accurate height of non-ambulatory children with severe neuromuscular scoliosis. Subcutaneous fat thickness has been associated with increased rates of surgical site infections in other surgeries; however, current literature has not elucidated a relationship between subcutaneous fat thickness and surgical site infections in this patient population. Methods: A retrospective chart review analyzed non-ambulatory patients with neuromuscular scoliosis who underwent posterior spinal fusion. Patients were stratified into 3 groups (underweight, normal weight, and overweight/obese) based on BMI-for-age percentiles. Subcutaneous fat thickness was measured in both the sagittal and coronal planes at 24 landmarks. Comparisons of categorical data were analyzed using χ2 tests. Logistic regression analysis was used to isolate independent factors associated with surgical site infections. Results: A total of 109 patients were analyzed. Thirty-four patients were underweight, 55 patients were normal weight, and 20 were overweight/obese. Twelve patients developed surgical site infections, with only 1 of them requiring an unplanned return to the operating room. Patients in the overweight/obese category had an increased risk of surgical site infection when compared with those in the normal weight and underweight categories (P=0.027). Of the 24 measurements taken, subcutaneous fat thickness to total distance from skin ratios at L2 spinous process (P=0.031), L3 spinous process (P=0.42), and averages of L2, L3, and L4 ratios (P=0.028) were all found to be associated with increased risk of surgical site infection. Conclusion: In this study population of patients with neuromuscular scoliosis who underwent posterior spinal fusion, increased BMI was associated with increased risk of SSI. Furthermore, 3 radiographic measurements of subcutaneous fat thickness associated with a higher risk of surgical site infections were identified. This knowledge could contribute to devising preoperative strategies to mitigate surgical risk and postoperative complications. Level of Evidence: Level III—a retrospective study

Contributing factors to postoperative surgical site infections in pituitary neuroendocrine tumors undergoing endonasal transsphenoidal resection

Pituitary Neuroendocrine Tumors (PitNETs), often treated via endonasal transsphenoidal resection, present a risk for postoperative surgical site infections (SSIs), including intracranial infections such as meningitis. Identifying the risk factors associated with these infections is crucial for improving surgical outcomes and patient care. A retrospective study was conducted at a medical center from June 2020 to June 2023. The study included 20 patients with postoperative intracranial infections and 50 controls without infections. Inclusion criteria involved adult patients diagnosed with PitNETs who underwent standard endonasal transsphenoidal surgery and provided informed consent. Exclusion criteria included previous neurosurgical procedures, preoperative infections, concurrent severe diseases, or alternative surgical approaches. Diagnostic criteria for intracranial infections were based on clinical, hematological, cerebrospinal fluid, radiological, and microbiological findings. Statistical analyses were performed using IBM SPSS, focusing on univariate and multivariate logistic regression analyses. Univariate analysis showed no significant association of intracranial infections with factors like smoking history, previous craniotomy, operation time, hypertension, preoperative sphenoid sinusitis, BMI, and age. However, postoperative CSF leaks, intracranial pneumocephalus, diabetes mellitus, and tumor extension to the third ventricle were significantly associated with infections. Multivariate logistic regression further confirmed these findings, with significant odds ratios for these factors. The study reveals a significant correlation between postoperative CSF leaks, intracranial pneumocephalus, diabetes mellitus, and tumor extension to the third ventricle with the occurrence of SSIs following endonasal transsphenoidal resection of PitNETs. Microbial analysis revealed Escherichia coli as the most prevalent pathogen in post-surgery infections, with notable antibiotic resistance patterns observed in key bacteria, necessitating careful antibiotic selection. Tailored clinical treatment strategies addressing these risk factors are essential to reduce the incidence of postoperative SSIs and enhance patient safety.

Infection rate following mandibular distraction with internal and external devices in infants.

Internal and external devices may be utilized in mandibular distraction osteogenesis (MDO) for the correction of symptomatic micrognathia in infants and children. To compare the rate and severity of infection between internal and external MDO devices. Retrospective cohort study utilizing an institutional database of patients who underwent MDO. Use of internal versus external MDO hardware. Rate of post-operative surgical site infections (minor and major). Patient age, device type, laterality, infection, and treatment were documented. Chi-Square and Fisher Exact Tests were used where appropriate for categorical variables and two-tailed T-tests were used for continuous variables. Significance was set at p<0.05. Between 2010 and 2022, 36 infants (ages 7 days-12 months) underwent bilateral MDO. Thirteen cases utilized internal hardware (n=26 surgical sites) and 23 cases utilized external hardware (n=46 surgical sites). Fifteen patients developed post-operative infections (41.7%), 11 of which were minor infections and 4 were major infections. Seven patients with internal devices (53.8%) and 8 patients with external devices (34.8%) developed an infection (p=0.27). Minor infections occurred in 4 patients with internal hardware (30.8%) and 7 patients with external hardware (30.4%; p=1.00). Major infections occurred in 3 patients with internal hardware (23.1%) and 1 patient with external hardware (4.3%; p=0.25). There were 19 surgical site infections (26.4%), 14 of which were minor infections and 5 of which were major infections. Ten internal devices (38.6%) and 9 external devices (19.6%) were complicated by infection (p=0.08). Minor infections occurred in 6 internal devices (23.1%) and 8 external devices (17.4%; p=0.56). Major infections occurred in 4 internal devices (15.4%) and 1 external device (2.2%; p=0.05). No significant difference was found in overall postoperative infection rate with internal and external MDO. A lower rate of major infection was observed in external devices.

Postoperative prophylactic antibiotics were not associated with decreased surgical site infections following hemilaminectomy in dogs: a retrospective study.

To compare hemilaminectomy surgical site infection (SSI) rates in dogs treated with or without postoperative prophylactic antibiotics. Medical records of 275 client-owned dogs from 1 tertiary referral hospital were retrospectively reviewed for dogs treated with thoracolumbar hemilaminectomy for intervertebral disk herniation between 2018 and 2023. Dogs were grouped according to whether they were treated with prophylactic postoperative antibiotics (group A) or not (group B). Relevant case details including dog signalment, duration of anesthetic procedure, method of incision closure, perioperative and prophylactic postoperative antibiotic prescription, and diagnosis of postoperative SSI (as defined by the CDC) were recorded. Wilson binomial CIs were calculated for SSI rates. Surgical site infection rates between dogs given or not given antibiotics were analyzed with a Fisher exact test. The overall SSI rate was 3% (8 of 275; 95% CI, 1% to 6%). The SSI rate in group A was 3% (5 of 147; 95% CI, 1% to 8%), which was not statistically different from the 2% SSI rate (3 of 128; 95% CI, 1% to 7%) in group B (P = .728). There was not a statistical difference in SSI rates between closure methods (intradermal absorbable, 1% [1 of 79]; cutaneous staples, 4% [7 of 184]; cutaneous nylon, 0% [0 of 12]; P = .611). Overall hemilaminectomy SSI rates in this study were low, and prescription of prophylactic antibiotics was not associated with a decreased SSI rate. Practicing antimicrobial stewardship through avoidance of antimicrobial prophylaxis in clean surgical procedures may not be clinically detrimental to outcomes in hemilaminectomy dogs.

Validation and Recalibration of a Model for Predicting Surgical-Site Infection After Pelvic Organ Prolapse Surgery.

The objective was to externally validate and recalibrate a previously developed model for predicting postoperative surgical-site infection (SSI) after pelvic organ prolapse (POP) surgery. This study utilized a previously validated model for predicting post-POP surgery SSI within 90days of surgery using a Medicare population. For this study, the model was externally validated and recalibrated using the Premier Healthcare Database (PHD) and the National Surgical Quality Improvement Project (NSQIP) database. Discriminatory performance was assessed via the c-statistic and calibration was assessed using calibration curves. Methods of recalibration in the large and logistic recalibration were used to update the models. The PHD contained 420,277 POP procedures meeting the inclusion criteria and 1.6% resulted in SSI. The NSQIP dataset contained 62,553 POP surgeries and 1.4% resulted in SSI. Discrimination of the original model was comparable with that seen in the initial validation (c-statistic = 0.57 in PHD, 0.59 in NSQIP vs 0.60 in the original Medicare data). Recalibration greatly improved model calibration when evaluated in NSQIP data. A previously developed model for predicting SSI after POP surgery demonstrated stable discriminatory ability when externally validated on the PHD and NSQIP databases. Model recalibration was necessary to improve prediction. Prospective studies are needed to validate the clinical utility of such a model.

Inadequate soft tissue coverage and bone loss/comminution are the typical risk factors of surgical site infection in open fractures of the hand: A nomogram prediction model.

Different from other parts of long bone fractures, surgical site infections (SSI) often occurs in open fractures of the hand (OFH) due to the anatomical characteristics and injury mechanisms. Our aim of the study is to investigate the particular risk factors of SSI after emergency surgery in OFH and develop a prediction nomogram model. In our traumatic center, patients with OFH not less than 18 years old were retrieved between October 2020 and April 2024. We excluded patients with other fractures, non-traumatic fractures or surgery before admission. The data of these patients were processed by univariate and multivariate analysis using SPSS (24.0) in order to identify the independent risk factors for SSI. Based on the predictors, the nomogram was constructed and validated by R software (R 4.1.0). The incidence of SSI was 6.96% (43/618). Body mass index (BMI), albumin (ALB), neutrophils (NEU), inadequate soft tissue coverage, and bone loss/comminution were identified as the independent risk factors of post-operative SSI in OFH and enrolled in the prediction nomogram model. The nomogram exhibited a high level of discrimination, with an area under the curve of 0.856 (95%CI 0.790-0.921) in the training group and 0.931 (95%CI 0.848-1.000) in the test group. Hosmer-Lemeshow (H-L) test revealed optimal consistency between the probability of prediction model and the actual probability (training group: X2 = 5.706, P = 0.680; test group: X2 = 3.886, P = 0.867). The calibration curve of both groups demonstrated excellent consistency. Decision curve analysis (DCA) showed favorable applicability of the prediction model. Inadequate soft tissue coverage, serum ALB level, NEU level, bone loss/comminution and BMI were the independent risk factors for post-operative SSI in OFH. The nomogram of this predictors can be used as an effective tool to predict SSI risk in OFH.

Mechanically powered negative pressure dressing reduces surgical site infection after stoma reversal.

The use of closed-incision negative pressure wound therapy (ci-NPWT) has been shown to reduce postoperative wound complications and surgical site infections (SSI) after stoma closures. However, use of this approach has not been widely adopted due to high cost of the devices. We present a novel approach to stoma closure in which a self-contained mechanically powered negative pressure dressing (MP-NPD) is applied to primarily closed stoma reversal wounds. We hypothesized that SSI and wound complication rates would be improved compared to traditional stoma closure methods. This was a prospective investigator-initiated study, in which consecutive patients that underwent stoma reversal with primary stoma wound closure dressed with MP-NPD from May 2021-March 2022. 30-day outcomes from the study group, including surgical site infection, other wound complications, hospital length of stay (LOS), and readmission rates, were then reported. Forty-six patients undergoing local ileostomy or colostomy closure were identified for the study group. Patient demographics and surgical variables were reported. One (2.2%) patient in the study cohort developed superficial SSI within 30days of their surgery. Post-op LOS in the study group versus was 4.1days. Intestinal stoma reversal wounds closed primarily and dressed with the MP-NPD dressings had very low stoma site SSI rates. These results are promising as they pertain to the use of MP-NPD in stoma reversal procedures, however further large prospective RCTs with a matched control group could help better corroborate these findings.

Not Just Another Trigger Finger.

Open A1 pulley release for trigger finger has generally been considered a minor procedure with infrequent complications. Most reported complications are minor, including scar pain and tenderness, mild extension lag, and recurrence of triggering. Rates of major complications, such as bowstringing, neurovascular bundle injury, and infection requiring reoperation, are less than 1% to 4%. We aimed to describe the potentially devastating sequelae of these major complications and the subsequent consequences. Three patients underwent open trigger finger release, which were all complicated by severe postoperative surgical site infection requiring multiple subsequent procedures. We review our initial management, subsequent reconstructive options, and outcomes with up to 19 years follow-up. All 3 adult patients who underwent open A1 pulley release for trigger finger developed a surgical site infection, leading to flexor tenosynovitis requiring urgent operative debridement and multiple subsequent procedures. Two patients were poorly controlled diabetics, and the third patient was otherwise healthy. Each patient ultimately developed distinct consequences from their postoperative course-finger stiffness and contracture, disabling bowstringing requiring the use of a pulley ring, and flexor tendon rupture requiring staged tendon reconstruction, respectively. All 3 patients at final follow-up had a permanent functional deficit. Major complications after trigger finger release are infrequent. However, if left untreated, particularly in diabetic patients, there can be disastrous consequences, resulting in permanent loss of function. This case series highlights the importance of accurate diagnosis of postoperative infections and expedient treatment thereafter.

Impact of antimicrobial stewardship interventions on post-elective caesarean antibiotic prophylaxis and surgical site infections

Background Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use but few studies have described its impact on unique population such as obstetrics. Post-operative antibiotics are unnecessary especially in those without surgical site infections (SSI) risk factors (e.g., obesity). Objectives To evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis rates and patient outcomes. Methods This pre-post quasi-experimental study was conducted over 18 months (2 months pre- and 16 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination and post-eLSCS oral antibiotics was actively discouraged in those without SSI risk factors. This was followed by ASP intervention notes (phase 1) for 3 months, contacting the ward team for the next 7 months (phase 2) and subsequently the primary obstetrics attending in Phase 3 (next 6 months). The primary outcome was post-operative oral antibiotics prescription rates, and secondary outcomes included 30-day post-operative SSI rates. Results A total of 1751 women was reviewed. Appropriateness of pre-operative antibiotic prophylaxis was 99%. There were 244 (13.9%) women pre-intervention and 1507 (86.1%) post-intervention. Post-eLSCS antibiotic prescribing rates reduced significantly post-intervention (200, 82% vs 705, 46.8%, p &lt; 0.001). There was no significant difference in SSI rates pre-post intervention (2, 0.8% vs 28, 1.9%, p = 0.420). There was also no significant difference in SSI rates among those who received post-operative oral antibiotics compared to those without (1.9%, 17 of 905 vs 1.5%, 13 of 846, p = 0.582). Conclusions ASP interventions can reduce unnecessary post-eLSCS antibiotic prophylaxis use without adversely impacting patient safety.

Fungal hepatic abscess formation postlaparoscopic cholecystectomy

Abstract Laparoscopic cholecystectomy is the preferred method for treating acute cholecystitis. Although the incidence of postoperative infections in laparoscopic cholecystectomy is low, serious postoperative surgical site infections are still reported. Hepatic abscesses, particularly fungal, can occur post-cholecystectomy leading to significant mortality and morbidity. We report a case of a 58-year-old female who underwent laparoscopic cholecystectomy and subsequently developed fever, jaundice, and right upper quadrant pain. Laboratory results showed deranged liver function tests with raised inflammatory markers. Radiographic investigations, including CT and MRI, revealed an irregular hilar lesion with periportal changes suggestive of an abscess with portal vein thrombosis. Histopathological examination of the biopsy obtained from the hilar lesion showed a fungal hepatic infection, and particularly conidiobolomycosis. To our best knowledge, this is the first case that reports this fungal infection as a complication of laparoscopic cholecystectomy. The patient was managed with a combination of intravenous antibiotics and antifungals, which yielded mild improvement. Unfortunately, the patient decided to leave the hospital against medical advice, limiting the information on the disease course.