Predictors Of Wound Infection Research Articles

Outcome of External Fixator Management of Gustilo Anderson Type III Tibial Fractures in Lagos University Teaching Hospital

Type III open tibial fracture is the commonest type of open tibia fracture. The aim of this study was to determine the outcome of Gustilo-Anderson type III open tibial fracture managed with external fixator. Patients that presented with Gustilo-Anderson type III open tibial fractures were recruited. Patients with bone pathology, prior debridement and concomitant spinal cord injury were excluded. Ethical approval and informed consent were obtained. A structured proforma was used to collect the participant’s socio-demographic data, time of injury, fracture location, interval and number of debridement, need for skin graft or flap, duration of hospital stay, outcome of treatment, complications and events at follow-up. Wound biopsy was taken and processed for microscopy, culture, and sensitivity. Delayed union was diagnosed when the fracture united between 4-6 months. Non-union was defined as a varus or valgus angulation of >5 degrees or anterior or posterior angulation of >10 degrees. Patients were followed up for 6 months. Chi square was used to determine association between categorical variables. SPSS 20 was used for analysis. Significance was p value <0.05. Of 35 patients, males were 22 (62.9%) while females were 13 (37.1%) and mean age was 38 years. Average interval between injury and presentation was 14.5 hours. Fourteen (40%) patients had type IIIA, 18 (51.4%) patients had type IIIB while 3 (8.6%) patients had type IIIC. Mean time to fixation was 59.2 hours. Wound infection, malunion, delayed union, pin loosening and compartment syndrome were found in 42.9%, 21.3%, 21.3%, 11.5% and 1.6% respectively. Infection rate was significantly positively correlated with grade of fracture (p=0.04) and time to debridement (p=0.018). A significant association between the mechanism of injury and associated injury (p=0.027) but not mechanism of injury and grade of type III fracture (p=0.292). Significant difference between the duration of hospital stays and categories of type III fractures (p = 0.026) but not associated injury (p=0.403). No significant difference in location of fracture and time of union (p=0.723). Type III fractures managed with external fixator is associated with some complications among which infection is the commonest and delay in treatment is associated with higher risk. Post-debridement microscopy and culture is a better predictor of wound infection.

Correlation of Preoperative Nutritional Status and Postoperative Wound Infection in Children

Background: Despite improvements in antimicrobial therapy, surgical technique and postoperative care, wound infection is still a major concern in pediatric surgical practice particularly in developing countries like Bangladesh.
 Objective: This study was conducted to ascertain the relationship between the preoperative nutritional status and postoperative wound infection in children as malnutrition is very prevalent among them. It was also decided to estimate the rate of wound infection in children and to identify the indicator of malnutrition that best predicts wound infection.
 Methods: This prospective study was carried out in the Department of Pediatric Surgery, BSMMU, Dhaka during the period of January 2009 to September 2010 and included consecutive 100 children undergoing routine surgery. Nutritional status was assessed by measuring BMI, serum albumin, haemoglobin and total lymphocyte count and thus children were categorized preoperatively. The children were assessed during the first 30 postoperative days for the evidence of wound infection that were confirmed by culture and sensitivity.
 Results: We found most of the wound infections among the malnourished children with low BMI and low serum albumin.
 Conclusion: Preoperative good nutritional status is associated with less postoperative wound infection and BMI and serum albumin are good indicators but total lymphocyte count and haemoglobin are not good indicators of protein calorie malnutrition and serum albumin is the best predictor of wound infection.
 Journal of Surgical Sciences (2019) Vol. 23(2): 48-53

Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures.

Objective To (1) determine the overall complication rate, wound healing, and wound infection complications and (2) identify preoperative, intraoperative, and postoperative predictors of these complications. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (2006-2012) were assessed. Multivariable logistic regression assessed the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results Of the 515 patients identified, 54% had a complication predicted by longer operating room (OR) time, higher comorbidity index, and oral cavity and pharyngeal tumor sites. Predictors of wound-healing complications (15%) were longer OR time, volume of crystalloid given intraoperatively, and oral cavity and pharyngeal tumor sites. Predictors of wound infection (12%) were younger age, diabetes mellitus, and malnutrition. Conclusions Wound healing and infectious complications account for most complications in patients with head and neck cancer undergoing free flap reconstruction. Clean contaminated wounds are a significant predictor of wound complications. Advanced OR time, advanced age, and comorbidity status, including diabetes mellitus and malnutrition, are other important predictors. Crystalloid administration is also an important predictor of wound-healing complications, and this warrants further study.

Predictors of Wound Infection in Elective Colorectal Surgery. Multicenter Observational Case–Control Study

IntroductionThe aim of this study is to evaluate the usefulness of Vicryl Plus® suture in reducing the rate of postoperative wound infection in elective colorectal surgery. MethodsA prospective case–control multicenter study with 480 patients undergoing elective colorectal surgery was performed between 2006 and 2007. Patients were divided in 2 groups of equal sample size: group 1, closure of the abdominal wall using Vicryl Plus® and group 2 where PDS II® was used. The study involved 5 hospitals in the Spanish State. Wound infection was classified into superficial and deep. All patients diagnosed of wound infection during the hospital stay and up to 30 days after discharge were studied. For the statistical analysis Chi-square test and Fisher exact were used for bivariate analysis and logistic regression model for multivariate analysis. ResultsWound infection rates were significantly lower in group 1: 14.6 vs 29.2. Multivariate analysis showed that risk of wound infection was higher in patients with cancer, lung disease, anemia, operative time greater than 2h, lack of second dose intra-operative prophylactic antibiotic and laparotomy closure with PDS suture II®. ConclusionsThe use of suture coated with triclosan can be an effective prophylactic tool in reducing wound infection rate in patients undergoing elective colorectal surgery.

Differences in sacral neuromodulation device infection rates based on preoperative antibiotic selection

After SNM implantation the most significant complication that can occur is wound infection, which typically requires removal of all components. Such infections have been reported in 5-11 % of patients, but little is known about risk factors. The objective of this analysis is to determine our postoperative wound infection rate after SNM implantation, and examined various potential predictive factors. Our hypothesis is that perioperative antibiotic selection is related to the risk of infections. A retrospective review was performed of all patients who underwent SNM implantation by one of three surgeons from 2007 to 2010. Preoperative antibiotics were administered according to surgeon preference, and included cefazolin alone, vancomycin alone, or vancomycin with gentamicin. Predictors of wound infection were evaluated using multivariate techniques. Variables examined included preoperative antibiotic regimen, surgeon, location (outpatient surgery center vs university hospital), gender, comorbidities (diabetes mellitus, immunosuppression and smoking), history of urinary tract infections, and preoperative skin preparation. A total of 136 patients underwent SNM implantation, and 8 (5.9 %) experienced infections that required device explantation. Cefazolin alone was less effective in preventing infection compared with the other antibiotic regimens (p = 0.03). The odds of having an infection in cefazolin-treated patients was 7.3 times that of other patients treated with another antibiotic regimen. Seven out of the eight infections with explant grew Staphylococcus aureus resistant to cephalosporins. None of the other variables proved to be a statistically significant contributor. Preoperative antibiotic selection was a significant factor in preventing subsequent infection and explantation following SNM placement.

Prevalence and predictors of wound infection in elective clean and clean/contaminated surgery in Khartoum Teaching Hospital, Sudan

Background: Surgical site infections are the second most common cause of hospital acquired infections. The objectives of this study were to quantify the rate of wound infection and to identify risk factors associated for its prevalence among patients admitted for elective surgery in Khartoum Teaching Hospital in Sudan. A prospective study was conducted. All patients, aged >18 years admitted during March 1st 2010 to 31th October 2010 were recruited. Baseline data was collected before patient's operations on. Patients were followed up to one month for detection of wound infection using bedside and post-discharge surveillance. A total of 1387 patients were included with a mean age of 35±14 years. 1138(82%) were females. More than three quarters were healthy (79.3%) and 1367(98.6%) patients were operated on conventionally. The total number of the performed surgical procedures was 1426. The rate of wound infection was found to be 9%. Univariate analysis revealed that five variables were significantly associated with the prevalence of wound infection; namely patient’s body mass index (P=0.041), co-morbidity (P=0.006), presence of diabetes (P=0.010), ASA score (P=0.000) and surgical technique (P=0.007). Multivariate logistic analysis showed that ASA score 2 and ASA score > 3, {adjusted OR, 1.9 (1.2-3.0), P =0.006 and adjusted OR, 3.6 (2.0-6.7); P<0.001 respectively}, laparoscopic surgical technique {adjusted OR, 5.5 (2-14.8); P=0.001} were mostly significantly associated with the prevalence of wound infection. The rate of wound infection was high with patient’s physical status and use of the laparoscope technique being strong predictors of infection.

Prevalence and predictors of wound infection in elective clean and clean/contaminated surgery in Khartoum Teaching Hospital, Sudan

Prevalence and predictors of wound infection in elective clean and clean/contaminated surgery in Khartoum Teaching Hospital, Sudan

Pilot study: does mode of skin closure affect risk of infection after caesarean section?

AimsA pilot study to determine whether the method of skin closure affects wound infection rates following caesarean section (CS). To evaluate current practice and preference of skin closure methods following...

Laparoscopic surgery impairs tissue oxygen tension more than open surgery

Wound infection remains a common and serious complication after colonic surgery. Although many colonic operations are performed laparoscopically, it remains unclear whether this has any impact on the incidence of wound infection. Subcutaneous tissue oxygenation is an excellent predictor of surgical wound infection. The impact of open and laparoscopic colonic surgery on tissue oxygenation was compared. Fifty-two patients undergoing elective open and laparoscopic left-sided colonic resections were evaluated in a prospective observational study. Anaesthesia management was standardized and intraoperative arterial partial pressure of oxygen was kept at 150 mmHg in both groups. Oxygen tension was measured in the subcutaneous tissue of the right upper arm. At the start of surgery subcutaneous tissue oxygen tension (PsqO(2)) was similar in both groups (mean(s.d.) 65.8(17.2) and 63.7(23.6) mmHg for open and laparoscopic operations respectively; P = 0.714). Tissue oxygen remained stable in the open group, but dropped significantly in the laparoscopic group during the course of surgery (PsqO(2) after operation 53.4(12.9) and 45.5(11.6) mmHg, respectively; P = 0.012). Laparoscopic colonic surgery significantly decreases PsqO(2), an effect that occurs early in the course of surgery. As tissue oxygen tension is a predictor of wound infection, these results may explain why the risk of wound infection after laparoscopic surgery remains higher than expected.

P62: Predictors of wound infection after Roux-en-Y gastric bypass

P62: Predictors of wound infection after Roux-en-Y gastric bypass

Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program

Background. Deep wound infection (DWI) in total knee (TKA) and total hip (THA) arthroplasty has been shown to highly correlate with superficial surgical site infection (SSSI). Although several studies have reported hospital factors that predispose to SSSI, patient factors have not been clearly elucidated. Methods. All patients undergoing TKA ( n=1181) and THA ( n=1124) surgery during the period 1977–1995 at our institution were observed at the end of a 30-day post-operative period. Thirty-three patients that developed SSSI during this period constituted the study group. The control group was composed of 64 matched subjects that did not develop SSSI. A chart review was applied to abstract DWI cases during the first 18 post-operative months for the study group and for an average of 6.7 years for the control group (range 5–18.2 years). Potential risk factors for SSSI were used as predictors of SSSI in a logistic regression analysis. Results. During the 18-month observation period 19 out of the 33 study subjects (58%) developed DWI. No DWI was registered in the control group (the difference was significant, p<0.0001). Of the nine pre-operative, five intra-operative, and five post-operative factors examined, only hematoma formation (odds ratio=11.8; p=0.001) and days of post-operative drainage (odds ratio=1.32; p=0.01) were significant predictors of SSSI. The cases consumed more health care resources at all stages of the medical process. Conclusions. Our results (1) confirm the strong correlation between the probability of developing DWI and SSSI; (2) indicate that hematoma formation and persistent post-operative drainage increase the risk of SSSI. We hypothesize that post-operative monitoring of patients for hematoma and persistent drainage enables earlier intervention that may lower the risk of developing SSSI and subsequent DWI.

Clinical benefits of endoscopic vein harvesting in patients with risk factors for saphenectomy wound infections undergoing coronary artery bypass grafting

Objective: The influence of endoscopic harvesting techniques on the prevalence of leg-wound complications after coronary artery bypass grafting remains to be defined for patients at high risk for the development of wound infections. Methods: Among 1473 patients undergoing coronary artery bypass grafting who had the saphenous vein harvested by either a continuous incision or skip incisions leaving intact skin bridges, we determined the prevalence of wound infections to be 9.6%. The following variables were entered into logistic regression analysis to identify significant risk factors that might be predictive of wound infection: diabetes, peripheral vascular disease, obesity, renal failure, steroid use, age, sex, and type of closure. We then prospectively randomized 132 patients found to be at high risk of wound infection to either endoscopic vein harvesting or a continuous open incision. Results: Univariate analysis showed female sex (P = .04), diabetes (P < .001), and obesity (P < .001) to be predictors of wound infection. In a multivariate model diabetes (P = .02) and obesity (P = .001) were independent predictors. In patients at high risk, the prevalence of wound infection was 4.5% for the endoscopic group versus 20% for the open group (P = .01). Vein procurement time was greater in the endoscopic group (65 minutes vs 32 minutes, P < .001), as was the number of vein repairs required (2.5 vs 0.6, P < .001). Conclusion: The use of endoscopic vein harvesting decreases the prevalence of postoperative leg-wound infections in high-risk patients with diabetes and obesity. Whether this translates into an economic benefit that justifies the additional cost of that technology requires further analysis. (J Thorac Cardiovasc Surg 2000;119:69-76)