Postoperative Surgical Infection Research Articles

Smoking impacts outcomes in transcervical Zenker's diverticulectomy

PurposeThere is sparse literature discussing the impact of smoking on postoperative outcomes following surgical treatment of Zenker's diverticulum. In this study, we seek to characterize differences in the management and outcomes of open Zenker's diverticulectomy based on patient smoking status. Methods and materialsThis paper is a retrospective cohort review. The 2005–2018 American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried for patients undergoing open Zenker's diverticulectomy. Chi-square and multivariable logistic regression were performed to determine statistical associations between postoperative outcomes and smoking status. ResultsOf the 715 identified patients, 70 (9.8 %) were smokers and 645 (91.2 %) were non-smokers. Smokers were younger than non-smokers (mean 63.9 vs. 71.7 years, p < 0.001) and more likely to have a prolonged operative time (20.0 % vs. 11.6 %, p = 0.044). On multivariable regression analysis controlling for demographics and comorbidities, smokers had greater odds than non-smokers for developing overall postoperative complications (OR: 2.776, p = 0.013), surgical infections (OR: 3.194, p = 0.039), medical complications (OR: 3.563, p = 0.011), and medical infections (OR: 1.247, p = 0.016). Smokers also had greater odds for requiring ventilation/intubation (OR: 8.508, p = 0.025) and having a prolonged postoperative stay (OR: 2.425, p = 0.030). ConclusionIn a cohort of patients undergoing transcervical Zenker's diverticulectomy, smokers are at increased risk for overall complications, medical complications, medical infections, surgical infections, prolonged postoperative stay, and ventilation/intubation.

Monte Carlo simulations and phantom modeling for spatial frequency domain imaging of surgical wound monitoring.

Postoperative surgical wound infection is a serious problem around the globe, including in countries with advanced healthcare systems, and a method for early detection of infection is urgently required. We explore spatial frequency domain imaging (SFDI) for distinguishing changes in surgical wound healing based on the tissue scattering properties and surgical wound width measurements. A comprehensive numerical method is developed by applying a three-dimensional Monte Carlo simulation to a vertical heterogeneous wound model. The Monte Carlo simulation results are validated using resin phantom imaging experiments. We report on the SFDI lateral resolution with varying reduced scattering value and wound width and discuss the partial volume effect at the sharp vertical boundaries present in a surgical incision. The detection sensitivity of this method is dependent on spatial frequency, wound reduced scattering coefficient, and wound width. We provide guidelines for future SFDI instrument design and explanation for the expected error in SFDI measurements.

Effects of laparoscopic splenectomy on surgical site wound infection in patients with spleen rupture: A meta-analysis.

A meta-analysis was performed to compare the effects of laparoscopic splenectomy (LS) and open splenectomy (OS) for splenic rupture on postoperative surgical site wound infections and postoperative complications. A comprehensive computerised search was conducted for studies comparing LS with OS for the treatment of splenic rupture in the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases, with the search including studies published in any language between the creation of the databases and August 2023. Two researchers independently screened the literature and extracted the data. Literature quality was assessed using the Newcastle-Ottawa Scale, and the included data were collated and analysed using Stata 17.0 software for meta-analysis. Twenty-two studies involving 1545 patients were included. LS was superior to OS in the following aspects: reduced risk of postoperative surgical site wound infection (OR = 0.19, 95% CI: 0.11-0.34, p = 0.000), shortened hospital stay (standardised mean difference = -1.73, 95% CI: -2.05 to -1.40, p = 0.000), and reduced postoperative complication rate (OR = 0.22, 95% CI: 0.16-0.31, p = 0.000). Compared with OS, LS has a lower rate of postoperative wound infection, shorter hospital stay, and reduced rate of postoperative complications. LS is safe and effective for the treatment of splenic rupture and can be promoted clinically.

Effects of tourniquet on surgical site wound infection and pain after total knee arthroplasty: A meta-analysis.

The application of a tourniquet (TNQ) for haemostasis in total knee arthroplasty (TKA) is controversial and lacking systematic evaluation. This meta-analysis assessed relevant international data to quantitatively evaluate the implications of using TNQ in TKA, further guide clinical diagnosis and treatment, and improve postoperative outcomes. A comprehensive computerised search of PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP, and Wanfang databases was conducted to retrieve randomised controlled trials on the application of TNQ in TKA published from database inception to August 2023. The included data, ultimately comprising 1482 patients in 16 studies, were collated and subjected to meta-analysis using Stata 17.0 software. The results showed that the use of TNQ during TKA led to significantly higher rates of postoperative surgical site wound infection (3.96% vs. 1.79%, odds ratio: 2.15, 95% confidence intervals [CIs]: 1.11-4.16, p = 0.023) and wound pain scores on the first (standardised mean difference [SMD]: 0.65, 95% CI: 0.35-0.94, p < 0.001), second (SMD: 0.66, 95% CI: 0.01-1.31, p = 0.045), and third (SMD: 0.68, 95% CI: 0.31-1.05, pP < 0.001) day after the procedure. In conclusion, the application of TNQ in TKA increases the risk of postoperative surgical site wound infection and worsens short-term postoperative wound pain; therefore, TNQ should be used sparingly during TKA, or its use should be decided in conjunction with the relevant clinical indications and the surgeon's experience.

Study to determine the factors related to patient and surgical procedures influencing the rate of postoperative surgical wound infections

Wound infections continue to be a substantial contributor to postoperative morbidity, responsible for around one-fourth of all nosocomial infections. The human bacteria from the endogenous organ microflora and the extrinsic environment continue to have a role in the development of wound infections. The development of postoperative wound infection has been linked to several different perioperative variables that have been studied in detail. Numerous studies have shown that several surgical procedures are more susceptible to postoperative infection complications because of individual risk factors. The majority of patient- and procedure-related variables have been identified to influence the likelihood of surgical site infections in univariate or multivariate analysis. Preexisting infection, older age, and other dangerous pathogens, smoking, and diabetes is also possible patient-related variables. Procedure-related variables include the length of the surgery, the quality of preoperative skin preparation and poor surgical skill. The goal of this study was to recognize the incidence of postoperative surgical wound infections, which is influenced by patient and surgical technique parameters.

Predictive Factors for Delayed Gastric Emptying After Pancreatoduodenectomy: A Swedish National Registry-Based Study

BackgroundDelayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy (PD). DGE causes prolonged hospital stay and a decrease in quality of life. This study analyzes predictive factors for development of DGE after PD, also in the absence of surgical complications.MethodData from the Swedish National Pancreatic Cancer Registry for patients undergoing standard and pylorus preserving open PD from January 2010 until June 30, 2018, were collected. Data were analyzed in two groups, no DGE and DGE. A subgroup of patients with DGE but without surgical complications was compared to patients without DGE or any other surgical complication.ResultsIn total, 2503 patients were included, of which 470 (19%) had DGE. In the DGE group, 238 had other coexisting surgical complications and 232 had not. Postoperative pancreatic fistula (OR = 4.22, p < 0.001), surgical infection (OR = 1.44, p = 0.013), heart disease (OR = 1.32, p = 0.023) and medical complications (OR = 1.35, p = 0.025) increased the risk for DGE. A standard PD compared with pylorus preserving resection (OR = 1.69, p = 0.001) and a reconstruction with a pancreaticojejunostomy compared with a pancreaticogastrostomy (OR = 1.83, p < 0.001) increased the risk. For patients without surgical complications, a standard PD and reconstruction with pancreaticojejunostomy still increased the risk for DGE.ConclusionDGE is more common after standard PD compared to pylorus preserving PD and after reconstruction with PJ compared to PG in this national cohort, both in the presence of other surgical complications as well as in the absence of other complications.

The impact of negative pressure wound therapy on surgical wound infection, hospital stay and postoperative complications after spinal surgery: A meta-analysis.

To systematically assess the effect of negative pressure wound therapy (NPWT) on postoperative surgical wound infection, length of hospital stay and postoperative complications after spinal surgery. Relevant studies on the application of NPWT in spinal surgery were conducted via a computerised database search, including PubMed, EMBASE, Web of Science, MEDLINE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang, from inception to June 2023. The identified literature was rigorously screened and data extraction was performed by two investigators independently. The quality of the relevant studies was evaluated using the Newcastle-Ottawa scale (NOS). The effect size for count data was determined by the odds ratio (OR), while the impact size for measurement data was expressed as the standardised mean difference (SMD). The 95% confidence interval (CI) was calculated for each effect magnitude. Stata 17.0 software was used for the meta-analysis. Ten papers, totalling 1448 patients, were finally included. This study demonstrated that NPWT led to a statistically significant reduction in the occurrence of postoperative surgical wound infections (OR: 0.377, 95% CI: 0.238-0.598, p < 0.001), fewer postoperative complications (OR: 0.526, 95% CI: 0.360-0.770, p = 0.001) and a shortened hospital stay (SMD: -0.678, 95%CI: -1.324 to -0.031, p = 0.040) after spinal surgery compared with the control group. When compared with other treatment approaches, NPWT also demonstrated a substantial reduction in surgical wound infections and postoperative complications, as well as a shorter duration of hospitalisation after spinal surgery.

A meta-analysis comparing the effects of cemented and uncemented prostheses on wound infection and pain in patients with femoral neck fractures.

To providing evidence-based recommendations for surgery in patients with femoral neck fractures, a meta-analysis was conducted to comprehensively evaluate the effects of cemented and uncemented prostheses on postoperative surgical site wound infection and pain in these patients. Relevant studies on the use of cemented prostheses in femoral neck fractures were retrieved from PubMed, EMBASE, Cochrane Library, Ovid, CNKI, and Wanfang databases from the time of their establishment until March 2023. Two authors independently screened and extracted data from the included and excluded literature according to predetermined criteria. Review Manager 5.4 software was used to perform meta-analyses on the collected data. A total of 27 articles comprising 34 210 patients (24 646 cases in the cemented group and 9564 cases in the uncemented group) were included in the final analysis. The results of the meta-analysis showed that, compared with the uncemented group, cemented prostheses significantly reduced the incidence of surgical site wound infections (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.64-0.88, p < 0.001) and relieved surgical site wound pain (standardised mean difference: -0.76, 95% CI: -1.12-0.40, p < 0.001), but did not reduce the incidence of pressure ulcers after surgery (OR: 0.50, 95% CI: 0.20-1.26, p = 0.140). Therefore, existing evidence suggests that the use of cemented prostheses in femoral neck fracture surgery can significantly reduce the incidence of surgical site wound infections and relieve surgical site wound pain, which is worthy of clinical recommendation.

Influence of closed-incision negative-pressure wound therapy on the incidence of surgical site wound infection in patients undergoing spine surgery: A meta-analysis.

The present meta-analysis was conducted to comprehensively assess the impact of closed-incision negative-pressure wound therapy (ciNPWT) on the incidence of surgical site infections (SSIs) in patients undergoing spinal fusion surgery, thereby aiming to provide evidence-based support for the prevention of postoperative wound infections during spinal surgery. Relevant studies pertaining to the application of ciNPWT in spinal surgery were retrieved through searches of the PubMed, Embase, MEDLINE and Cochrane Library databases, spanning from their inception to May 2023. The literature screening and data extraction were performed by two researchers based on predefined inclusion and exclusion criteria, followed by a quality assessment of the included studies. Meta-analyses were performed using the odds ratios (ORs) and standardised mean differences (SMDs) as effect variables. RevMan 14.0 and STATA 17.0 were employed for meta-analysis of the extracted data. In total, eight articles involving 1198 patients, including 391 in the experimental group and 807 in the control group, were included. The meta-analysis results revealed that ciNPWT significantly reduced the incidence of SSIs in patients undergoing spinal fusion surgery (OR, 0.39; 95% CI: 0.22-0.67, p = 0.0007); however, it did not lead to a reduction in hospital stay duration (SMD: -0.48, 95% CI: -0.98 to 0.01, p = 0.06). Existing evidence suggests that ciNPWT has a positive impact on patients undergoing spinal fusion surgery, as it significantly reduces the incidence of postoperative surgical site wound infections; however, it does not result in a shorter hospital stay for patients.

Comparison of the Outcomes of Oral Versus Nasal Endotracheal Intubation in Neonates and Infants Undergoing Cardiac Surgery: A Randomized Controlled Study

The choice of oral or nasal endotracheal intubation in children undergoing cardiac surgery is affected by several factors. This study compared the outcomes of oral versus nasal intubation in neonates and infants who underwent open cardiac surgery. A randomized, controlled, open-labeled study. At a university hospital. A total of 220 infants and neonates who underwent cardiac surgery. Patients were allocated randomly to oral or nasal intubation. The primary outcome measure was postoperative fentanyl consumption (µg/kg/h) by intubated patients. Secondary outcome measures were the increase in heart rate (HR) from baseline during intubation, the time consumed for intubation, accidental intraoperative extubation, the occurrence of epistaxis, time to extubation, the onset of full oral feeding, intensive care unit (ICU) and hospital lengths of stay, and the incidence of postoperative complications (the need for reintubation, stridor, pneumonia, wound infection). The mean (SD) postoperative fentanyl consumption of intubated patients (the primary outcome) was significantly lower (p < 0.001) in the nasal intubation group (0.53 ± 0.48) µg/kg/h compared with the oral intubation group (0.82 ± 0.20) µg/kg/h. The median (IQR) time needed for the intubation (31.5, 27-35 v 16, 14.8-18 seconds) was significantly (p < 0.001) longer, and the mean (SD) increase in HR (beats/min) from baseline during intubation (18 ± 5 v 26 ± 7) was significantly (p < 0.001) lower in the nasal intubation group compared to the oral intubation group. The incidence of inadvertent intraoperative extubation was significantly (p=0.029) higher in the oral (n=6, 6.1%) than in the nasal (n=0, 0%) intubation group. The median (IQR) time to extubation (14, 12.6-17.2 v 20.5, 16.4-25.4 hours) and the ICU length of stay (27, 26-28 v 30, 28-34 hours) were significantly (p < 0.05) shorter in the nasal group compared to the oral group. The median (IQR) time to onset of full oral feeding was significantly (p=0.031) shorter in the nasal intubation group (3, 1-6 days) compared to the oral intubation group (4, 2-7 days). There were no significant differences between the oral and nasal groups in the duration of hospital stay and the indices for reintubation, postintubation stridor, pneumonia, and surgical wound infection. The nasal route for intubation is associated with less postoperative fentanyl consumption, earlier extubation, lower incidence of accidental extubation, and earlier full oral feeding than oral intubation. The nasal route is not associated with an increased risk of postoperative pneumonia or surgical wound infection.

Efficacy and safety of iliofemoral bypass using arm veins as an alternative conduit for chronic limb-threatening ischemia

ObjectiveThe use of basilic vein in iliofemoral revascularizations was previously described in the literature as an autologous option for the treatment of vascular prosthesis infection and as a primary conduit in patients at high risk of infectious surgical complications. However, the publications available include several different indications and are limited to case reports. Therefore, the aim of this study was to evaluate the outcomes of the use of arm veins as a safe and effective autologous alternative for iliofemoral reconstruction in patients with chronic limb-threatening ischemia (CLTI) and at high risk of prosthesis infection. MethodsWe performed a multicenter, retrospective cohort study with 53 consecutive iliofemoral bypasses using arm veins as an alternative conduit. The procedures were performed between November 2013 and November 2021, exclusively for patients with CLTI classified as TASC aortoiliac C or D with increased risk of postoperative surgical infection. Demographic, clinical variables, and outcomes were collected from a prospective database. Main endpoints were amputation-free survival (AFS) and major adverse cardiovascular events. Secondary endpoints included primary and secondary patencies and overall survival. Cox regression analysis was used to identify the predictors of AFS. Postoperative surgical complications and 30-day mortality were also assessed. ResultsThe mean age was 64.2 ± 8.4 years, with a predominance of male gender. The median follow-up period was 615 days. All patients had CLTI, with a predominance of tissue loss (n = 51; 96.2%) and a median ankle-brachial index of 0.28. The basilic vein was utilized in most procedures (69.8%). Thirty-day major adverse cardiovascular events occurred in five cases (9.4%), and the 30-day mortality rate was 3.8%. The AFS, primary patency, secondary patency, and overall survival in 720 days were 71%, 72%, 89%, and 75%, respectively. Cox regression analysis revealed no association between the variables analyzed for AFS. There was no graft late infection nor pseudoaneurysmal degeneration. ConclusionsIliofemoral bypass using arm veins as an autologous conduit proved to be an effective and safe procedure with low incidence of postoperative cardiovascular complications and high rates of AFS in patients with CLTI. Also, this suggests that arm veins can be an interesting and suitable autologous alternative conduit for iliofemoral reconstructions, especially in cases in which a prosthesis should be avoided or when it is not available.

Effect of laparoscopic pancreaticoduodenectomy on the incidence of surgical-site wound infection: A meta-analysis.

A meta-analysis was conducted to assess the impact of robotic and laparoscopic pancreaticoduodenectomies on postoperative surgical site wound infections. A comprehensive computerised search of databases, such as PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data, was performed to identify studies comparing robotic pancreaticoduodenectomy (PD) with laparoscopicPD. Relevant studies were searched from the inception of the database construction until April 2023. The meta-analysis outcomes were analysed using odds ratios (OR) with corresponding 95% confidence intervals (CI). The RevMan 5.4 software was used for the meta-analysis. The findings of the meta-analysis showed that patients who underwent laparoscopic PD had a significantly lower incidence of surgical-site wound (16.52% vs. 18.92%, OR: 0.78, 95% CI: 0.68-0.90, P = .0005), superficial wound (3.65% vs. 7.57%, OR: 0.51, 95% CI: 0.39-0.68, P < .001), and deep wound infections (1.09% vs. 2.23%, OR: 0.53, 95% CI: 0.34-0.85, P = .008) than those who received robotic PD. However, because of variations in sample size between studies, some studies suffered from methodological quality deficiencies. Therefore, further validation of this result is needed in future studies with higher quality and larger sample sizes.

Effect of endoscopic loop ties in acute appendicitis on wound infection rate: A meta-analysis.

A meta-analysis study to measure the consequence of endoscopic loop ties (ELT) in acute appendicitis (AA) on wound infection rate. A comprehensive literature inspection till February 2023 was applied and 2765 interrelated studies were reviewed. The 27 chosen studies enclosed 15 093 subjects with AA in the chosen studies' starting point, 7141 of them were ELT, and 7952 were open surgery. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of ELT in AA on wound infection rate by the dichotomous and continuous styles and a fixed or random model. Open surgery had a significantly higher postoperative surgical site wound infection (SSWI). (OR, 1.41; 95% CI, 1.09-1.83, P = 0.009) with low heterogeneity (I2 = 34%) compared to ELT in AA subjects. Although no significant difference was detected between open surgery and ELT in intra-abdominal abscess rate (OR, 0.88; 95% CI, 0.56-1.40, P = 0.59) with moderate heterogeneity (I2 = 51%) in AA subjects. Open surgery had a significantly higher postoperative SSWI, however, no significant difference was found in intra-abdominal abscess rate compared to ELT in AA subjects. However, caused by the small sample sizes of several chosen studies for this meta-analysis, care must be exercised when dealing with its values.

MP34-20 SEVERE POST-OPERATIVE COMPLICATIONS ARE RARE IN PATIENTS WITH URINARY-PUBIC SYMPHYSIS FISTULAE AND PUBIC BONE OSTEOMYELITIS (UPF-OM) UNDERGOING EXTIRPATIVE SURGERY; DATA FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM

You have accessJournal of UrologyCME1 Apr 2023MP34-20 SEVERE POST-OPERATIVE COMPLICATIONS ARE RARE IN PATIENTS WITH URINARY-PUBIC SYMPHYSIS FISTULAE AND PUBIC BONE OSTEOMYELITIS (UPF-OM) UNDERGOING EXTIRPATIVE SURGERY; DATA FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM Jordan Foreman, Kevin Krughoff, William Eward, Edward Hendershot, Christopher Mantyh, and Andrew Peterson Jordan ForemanJordan Foreman More articles by this author , Kevin KrughoffKevin Krughoff More articles by this author , William EwardWilliam Eward More articles by this author , Edward HendershotEdward Hendershot More articles by this author , Christopher MantyhChristopher Mantyh More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with urinary-pubic symphysis fistulae and resultant pubic bone osteomyelitis (UPF-OM) are riddled with infections prior to extirpative surgery, our prior research noted 91.7% of patients had positive bone cultures at time of surgery. Our pathway requires holding antibiotics for 2 weeks prior to surgery and not administering IV perioperative antibiotics until the bone is removed at the time of extirpative treatment. This study aims to evaluate the rates of post-operative surgical infections and complications after extirpative surgery for UPF-OM. METHODS: Using the NSQIP database, 36 patients undergoing extirpative surgery for UPF-OM were collected between 2016-2021. Pre- and post-operative characteristics and outcomes were evaluated. At our institution patients with UPF-OM undergo a standard workup and treatment pathway including MRI of pelvis confirming osteomyelitis, pre-operative nutritional labs, and optimization of modifiable risk factors. We involve a multi-disciplinary team including urology, orthopedics, infectious disease, plastic surgery, colorectal surgery if concurrent rectourethral fistula, and acute pain service. RESULTS: The median age at time of surgery was 74.32 years (68.46, 78.28). Baseline patient characteristics included history of radiation in all patients, 4 (11.11%) had a history of tobacco use within 1 year, diabetes 10 (27.78%), median albumin 3.4 (3.2, 3.6), and a median BMI of 27.1 (24.2, 30.88). The median operating room time was 371 minutes (344.5, 408) and the median length of hospitalization was 8 days (7, 10). 6 (16.7%) patients had readmissions related to surgery including 1 small bowel obstruction managed conservatively, 2 readmissions for infection, 2 for dehydration, and 1 for anemia/presyncope. No patients had a bowel anastomotic leak, ureteroenteric leak, or rectal injury. During admission no patients had surgical site infections, deep surgical site infections, urinary tract infections, or sepsis/SIRS at 48 hours. CONCLUSIONS: The rates of severe post-operative complications in extirpative surgery for UPF-OM are low. These findings are surprising given the complexity of the disease process and underlying infected/contaminated field inherent to UPF-OM. Given our pathway that withholds antibiotics until late in the extirpative procedure the rates of infection are exceedingly low and were only present at delayed readmissions. Source of Funding: Boston Scientific Fellowship Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e467 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jordan Foreman More articles by this author Kevin Krughoff More articles by this author William Eward More articles by this author Edward Hendershot More articles by this author Christopher Mantyh More articles by this author Andrew Peterson More articles by this author Expand All Advertisement PDF downloadLoading ...

Recent advances in the treatment of biofilms induced surgical site infections.

Recent advances in the treatment of biofilms induced surgical site infections.

The Correlation between Mechanobiology and Fracture Healing; Osteosynthesis, Biomaterial Optimization and TRIZ Design Principles to Develop Ameliorative Implants for Reconstruction of Median Osteochondrotomy of the Sternum.

The application of stainless-steel wire is still the "standard of care" and is believed to be the "gold standard" after trans-sternal thoracotomy. To overcome postoperative instability and surgical wound infection there had been the development of a variety of circumferential, Hemi-circular, and surface on-lay implant designs to enhance bone healing of the sternum particularly in compromised patients. This fundamental descriptive theoretical research study probes into biology and effects of mechanical environment on fracture healing in general and various types of ossifications that may occur during healing of the sternum. Following surgical anatomy of the sternum, the biology of fracture (osteotomy) healing, an update on the conventional and newer biomaterials, and role of 3D printing in custom additive manufacturing of the surgical implants have been discussed in detail. There is discussion on design principles and structural optimization in-line with patient-specific and patient-appropriate osteosynthesis. In support, the Teorija Rezhenija Izobretatelskikh Zadatch engineering principles have been applied to improve implant design in the face of the current strategies to relieve some of the recalcitrant deficiencies underlying the mechanics of the most favored implant for the reconstruction of the sternum. Several scientific domains of the engineering design principles and fracture healing processes have been connected leading to four newly conceptualized prototype designs for the reconstruction of the sternum. In conclusion, despite increased knowledge of the fracture healing process there are limited means to mitigate the adverse mechanical environment experienced by the healing sternum. There are uncertainties how to transfer the well-known facts of tissue strain during healing from the experimental platform to the operating table at the time of fracture fixation and reconstruction of the sternum for its optimal healing.

Assessment of Bundle of Measures Perioperatively to Decrease the Incidence of Surgical Site Wound Infection in Patients Undergoing Abdominal Hysterectomies

Background: Surgical site infections (SSIs) are the second most common reason for unplanned hospital readmissions after hysterectomy and result in increased morbidity and health care costs. The estimated rate of SSI after hysterectomy varies between 1% and 4%. The objective of the study is to investigate if a bundle of perioperative measures (as stated earlier) reduces down the incidence of post-operative surgical site wound infection after abdominal hysterectomy. Materials and Methods: The present prospective study was carried out on total 200 women who were undergo hysterectomy in the operation theater of Department of Obstetrics and Gynecology of IPGMER and SSKM Hospital due to gynecological conditions requiring hysterectomy. Four perioperative bundles of measures are considered – 1. chlorhexidine gluconate and Cetrimide solution (Savlon) wash of the operative field 1 h before the operation, 2. administration of single dose antibiotic (Inj. Ceftriaxone 1 g intravenous) 1 h or less before the incision, 3. vaginal wash with povidone-iodine, and 4. sterile dressing is to be maintained and removed postoperatively after 48 h. Result: We found that in case, 94 (94.0%) patients had Ceftriaxone and 6 (6.0%) patients had clindamycin and gentamicin. In control, 96 (96.0%) patients had ceftriaxone and 4 (4.0%) patients had clindamycin and gentamicin. Association of choice of antibiotic versus group was not statistically significant (P = 0.5164). In case, 6 (6.0%) patients had wound gaping. In control, 11 (11.0%) patients had wound gaping. Association of wound gaping versus group was statistically significant (P = 0.048). Conclusion: The present study found that hospital stay was more in control compared to case which was statistically significant. Fever was more in control compared to case which was statistically significant. In this study, local wound discharge was more in control compared to case which was statistically significant. It was found that wound gaping was more in control compared to case which was statistically significant.

Initial Experience of 60 Cases Pure-Laparoscopic Donor Hepatectomy in Cleveland Clinic

Introduction: The adoption of pure-laparoscopic donor hepatectomy (PLDH) has been slow in North America because of the associated technical complexity and concerns for donor safety. This study aimed to report our initial 60 PLDH and elaborate on the understanding of the pre-requisites for the successful introduction of PLDH. Method: Retrospective review during the initial 2 years after the introduction Results: Between August 2019 and August 2021, 60 PLDH were performed; 33 patients donated left lobe grafts, 25 cases were right lobe grafts, 1 case was right posterior section graft, and 1 patient donated left lateral segment. The characteristics of 60 PLDH were summarized in Table. The median operative time was 345 minutes in the left lobe group and 348 minutes in the right lobe group, respectively. No cases required intraoperative blood transfusion or open conversion. Two patients developed a postoperative surgical wound infection, one patient required postoperative blood transfusion, one patient required laparoscopic portal vein venoplasty for portal vein stenosis. The median in-patient stay was 5 days (4-9) and there were no 30-day readmissions. Conclusions: Seamless introduction of OLDH and donor safety were achieved by: 1) minimizing the learning curve through proctorship from experienced surgeon, 2) establish a dedicated surgical team and accumulate adequate surgical experience in living donor hepatectomy and laparoscopic hepatectomy, especially major hepatectomy, 3) active institutional support to have proper instrumentation necessary for operational efficiency, and 4) proper master planning including the ready availability of a crisis management protocol and team in case of an emergency.Tabled 1Left Lobe (N=33, 55.0%)Right lobe (N=25, 41.7%)Age34 (18-58)43 (25-58)male/Female22/117/18Height178 (158-196)168 (155-189)Weight82 (61-119)76 (54-122)BMI27.6 (21.3-36.6)27.7 (21.3-39.7)Operative time345 (256-501)348 (264-450)EBL200 (50-600)150 (30-500)Complicatio33LOS5 (4-8)5 (4-9) Open table in a new tab

Predisposing Factors for 30-Day Complications Following Leg Amputation

Category:Trauma; Ankle; Diabetes; OtherIntroduction/Purpose:While amputation rates and amputation-related morbidity and mortality have been established for select populations, the impact of general demographic factors on postoperative surgical complications remains little studied. This study aims to analyze the influence of numerous demographic variables on specific surgical complications.Methods:We extracted data from the American College of Surgeons' National Surgical Quality Improvement Program database from 2012 to 2017 and searched for leg amputations using CPT codes 27881, 27882, 27884, and 27886, identifying 4,162 patients. The association of 29 demographic variables with 4 complications (surgical infection, additional service, deep vein thrombosis [DVT], and sepsis) was analyzed using t tests or chi-squared tests. A logistic regression allowed determination of independent risk factors for each outcome, based on results from the bivariate analyses. Variables found to have P < 0.2 on bivariate analysis were subsequently included in the multivariate analysis of the corresponding surgical complication.Results:Preoperative open, 'contaminated,' or 'dirty/infected' wounds, longer intraoperative times, development of sepsis prior to surgery, and admission of patients directly from home or from another hospital's emergency room were found to influence postoperative surgical infection rates. An individual's height, weight, total length of hospital stay, ethnicity, the presence of preoperative open or infected wounds, and wounds classified as 'dirty/infected' preoperatively affected postoperative additional service incidence. Preoperative congestive heart failure and large decreases in body weight, as well as a patient's total length of hospital stay, influenced postoperative DVT rates. A patient's preoperative functional heath status, total length of hospital stay, amputations conducted as emergency cases, as well as preoperative acute renal failure, open or infected wounds, sepsis, 'contaminated' or 'dirty/infected' wounds, impacted postoperative sepsis rates.Conclusion:Understanding these risk factors may allow providers to anticipate and address higher rates of complications in certain patient populations.

English

BACKGROUND Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of chronic pyelonephritis that is characterized by extensive enlargement and destruction of the involved kidney which ultimately results in non-functioning kidney. It often mimics other inflammatory or neoplastic renal disorders. Unlike chronic pyelonephritis, it spreads to the perinephric space with formation of multiple abscesses and fistulas. It is now being recognized as an important cause of renal morbidity and mortality worldwide. METHODS This is a case series undertaken in a tertiary care center. Clinical data was collected from last 6 years. Clinical features, radiological findings, treatment, and its outcome were analysed and presented. RESULTS A total of 23 cases diagnosed clinically were included in our study. The disease is more prevalent in females than in males with ratio of 1.8 : 1, with mean age of 47.04 years. Most of the patients presented with flank pain and fever. 2 patients had unusual presentations that are nephrocutaneous fistula and necrotising fasciitis of flank region. In our study, disease was associated with urolithiasis in 43.47 % and diabetes mellitus (DM) in 60.8 %. E. coli was the most commonly grown organism in urine culture. Most of the patients underwent initial percutaneous nephrostomy (PCN) or double-J (DJ) stenting followed by definitive treatment that is nephrectomy (21 patients, 2 patients lost to follow up). Extraperitoneal flank approach was most commonly chosen compared to subcostal transperitoneal approach. Excess blood loss was the most common complication encountered during surgery; 8 patients required post-operative blood transfusion. 5 patients required intensive care unit (ICU) care with inotropic support postoperatively. 6 patients had post-operative superficial surgical site infection. CONCLUSIONS XGP is a rare form of chronic pyelonephritis resulting in enlarged non-functioning kidney. UTI (urinary tract infection) and urolithiasis are the most important factors involved in pathogenesis. Prompt diagnosis and treatment is essential. Initial antibiotic treatment with drainage procedure (PCN or DJ stenting) followed by nephrectomy is treatment of choice. Early diagnosis and treatment may limit the disease process and associated morbidity, thus leading to good outcome. KEYWORDS Xanthogranulomatous Pyelonephritis, UTI (Urinary Tract Infection), Urolithiasis, Nephrectomy