Prophylaxis In Surgery Research Articles

A New Approach to Evaluate the Bactericidal Activity of Different Antiseptic Ophthalmic Preparations Used as Surgical Prophylaxis

Background: A survey conducted by the European Observatory on Cataract Surgery showed high heterogeneity in the use of antiseptics both preoperatively and in the operating room, highlighting the absence of a global consensus regarding ocular infection prophylaxis in cataract surgery. Methods: The antibacterial activity of seven antiseptic ophthalmic formulations (AOFs) registered as medical devices and the two most common disinfectants were evaluated in vitro against five bacterial species. The viability of bacterial strains after exposure to the antiseptic was evaluated with different techniques: the in vitro Minimum Inhibitory Concentration and the subsequent Minimum Bactericidal Concentration, performed on liquid and solid culture medium. Furthermore, a real-time assessment of bacterial viability was conducted using double staining for live/dead bacterial cells by fluorimetric assay. This evaluation was performed on both the time-killing curve and the tear dilution effect test. Results: We observed a high variability across the different AOFs in terms of inhibitory/bactericidal concentration and timing on Gram-positive and Gram-negative bacterial classes. The results indicated that among the tested AOFs, Visuprime, Iodim, and Oftasteril were the most rapid and effective for ocular surface disinfection against the tested bacterial species. Conclusions: The obtained results can support the clinician’s choice of the most suitable AOF for the prevention and treatment of ophthalmic infections associated with surgery.

Postoperative outcomes after receipt of ertapenem antimicrobial prophylaxis for colon surgery: a multicenter retrospective cohort study.

To evaluate postoperative outcomes among patients undergoing colon surgery who receive perioperative prophylaxis with ertapenem compared to other antibiotic regimens. Multicenter retrospective cohort study among adults undergoing colon surgery in seven hospitals across three health systems from 1/1/2010 to 9/1/2015. Generalized linear mixed logistic regression models were applied to assess differential odds of select outcomes among patients who received perioperative prophylaxis with ertapenem compared to other regimens. Postoperative outcomes of interest included surgical site infection (SSI), Clostridioides difficile infection (CDI) and clinical culture positivity for carbapenem-resistant Enterobacteraciae (CRE). Inverse probability weights were applied to account for differing covariate distributions across ertapenem and non-ertapenem groups. A total of 2,109 patients were included for analysis. The odds of postoperative SSI was 1.56 times higher among individuals who received ertapenem than among those receiving other perioperative antimicrobial prophylaxis regimens in our cohort (46 [3.5%] vs 20 [2.5%]; IPW-weighted OR 1.56, [95% CI, 1.08-2.26], P = .02). No statistically significant differences in odds of postoperative CDI (24 [1.8%] vs 16 [2.0%]; IPW-weighted OR 1.07 [95% CI, .68-1.68], P = .78) were observed between patients who received ertapenem prophylaxis compared to other regimens. Clinical CRE culture positivity was rare in both groups (.2%-.5%) and did not differ statistically. Ertapenem use for perioperative prophylaxis was associated with increased odds of SSI among patients undergoing colon surgery in our study population, though no differences in CDI or clinical CRE culture positivity were identified. Further study and replication of these findings are needed.

Thromboprophylaxis in varicose veins surgery: The everyday concern.

Venous thromboembolic disease (VTE) occupies an important place as a cause of morbidity and mortality in surgical patients in all specialties. Despite the existence of guidelines for thrombo prophylaxis in surgery, it is not clear due to the lack of current evidence, how to develop antithrombotic prophylaxis in varicose vein surgery and many questions arise when the surgeon is faced with a patient to be operated on. A comprehensive review of the literature was conducted to examine the evidence about the prevention of the venous thromboembolism in varicose veins surgery patients, and aims to guide the reader through questions that arise in daily practice, discussing the different scenarios presented in the literature for the choice of the most appropriate prophylaxis for each case. The lack of conclusive literature determines that risk should be individualized using available scales and other procedure-related factors, so that the type and duration of prophylaxis can be determined on a case-by-case basis.

Assessment of preoperative antibiotic prophylaxis in general surgery: A comparative study.

Assessment of preoperative antibiotic prophylaxis in general surgery: A comparative study.

Venous Thromboembolism Prophylaxis in Maxillofacial Surgery.

The aim of this article is to conduct a literature review concerning the need for venous thromboembolism (VTE) prophylaxis among patients undergoing maxillofacial surgery. This article addresses the diagnosis of VTE, patient risk stratification, and prophylactic measures suitable for the various groups of interest in maxillofacial surgery. From a pool of 44 articles identified, nine were chosen as the most pertinent to the aims of this review.Despite limited data on this topic, individuals undergoing oral and maxillofacial surgery generally exhibit a low risk of VTE. This review emphasizes the importance of implementing prophylactic measures tailored to individual risk factors. Pharmacological prophylaxis merits consideration, particularly when the Caprini score is ≥7. However, further research is needed to optimize prophylactic strategies in maxillofacial surgery.

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

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

The Association of Abdominoplasty with Breast Reduction (Mommy Makeover): Experience in An African University Hospital

Background: The popularity of breast reduction and abdominoplasty has significantly increased over the years, according to statistics from the American Society of Plastic Surgeons 2022. As a result, the Mommy Makeover, a procedure combining breast surgery and abdominoplasty, is not uncommon. Patients and Methods: A retrospective descriptive study was conducted over a four-year period within the Plastic and Aesthetic Surgery Department of the IBN SINA University Hospital, Rabat, Morocco. Results: Five cases of Mommy Makeover were operated on within the Plastic and Aesthetic Surgery Department of the IBN SINA University Hospital, Rabat, Morocco. One case was addressed two years after bariatric surgery. The procedure combined breast reduction with the superior-internal pedicle technique with Wise’s pattern and abdominoplasty. No major complications were observed. Discussion: Since the introduction of abdominoplasties combined with breast surgery, several concerns have been associated with this combination. Venous thromboembolism is the most commonly discussed consequence in combined plastic surgery procedures. The risk of venous thromboembolism is not elevated when abdominoplasty and breast reduction are combined. The study emphasizes the importance of careful patient selection and attentive venous thromboembolism prevention. It assesses the validity of the Davison-Caprini framework for venous thromboembolism risk stratification and prophylaxis in plastic surgery. Other measures to prevent complications were cited in the literature and followed by our operating team. Conclusion: With the help of a simple risk stratification tool that takes into account diabetes, age, BMI, and ASA status, we can guarantee favorable results for women who may want combined surgery.

Prevention of ischemic stroke in old age

Stroke is one of the main causes of permanent disability and death and the risk increases with age. Primary and secondary prevention therefore have a high priority. The treatment of risk factors, such as high blood pressure, diabetes mellitus and hyperlipidemia is just as important as anticoagulation in atrial fibrillation, in addition to optimization of lifestyle and diet. Platelet function inhibitors play arole in the prophylaxis of recurrence, carotid surgery and stenting are used in selected patients. There is little study evidence for old people, individualized treatment planning takes functional status and comorbidities into account.

Duration of perioperative antibiotic prophylaxis in neonatal surgery: Less is more

BackgroundThe ideal duration of neonatal antibiotic prophylaxis is not determined with wide variance in practice. This study aims to evaluate the association between duration of antibiotics and surgical site infection (SSI) in neonatal surgery. MethodsA retrospective review regarding antibiotic prophylaxis was performed on <30-day-old surgical patients at a children's hospital from 2014 to 2019. The patients were analyzed based on demographics, presence of SSI, and antibiotic duration. The primary outcome was the development of SSI with ANOVA, chi-square, and recursive partitioning used for statistical analysis. Results19/155 patients developed an SSI (12.26 ​%). Those with an SSI had a lower weight at surgery (p ​= ​0.03). Additionally, wound classification (p ​= ​0.17) and antibiotic duration >48hrs (p ​= ​0.94) made no statistical difference in SSI rate. The two variables most closely linked to SSI development were gestational age (100 ​%) and weight at time of procedure (80.76 ​%). ConclusionsAntibiotic prophylaxis >48 ​h did not decrease the incidence of SSI. Risk factors for SSI development in neonatal surgery were lower gestational age, decreased weight at time of procedure and total length of procedure.

Preoperative single dose versus conventional antibiotic prophylaxis in thyroid surgery

Preoperative single dose versus conventional antibiotic prophylaxis in thyroid surgery

Efficacy and Safety of Preoperative Prophylaxis in Cataract Surgery with Combined Topical Antiseptics: A Microbiological Study.

To evaluate the antimicrobial efficacy of an ophthalmic formulation containing hexamidine diisethionate (HD) 0.05%, polyhexamethylene biguanide (PHMB) 0.0001%, and edetate disodium (EDTA) 0.01% (Keratosept®, Bruschettini, Genova, Italy) on the microbial flora of a healthy ocular surface. Patients were enrolled consecutively. Each patient applied two drops of Keratosept® in the eye scheduled for cataract surgery (study eye) three times daily in the 2 days prior to surgery and one time in the morning of surgery. The contralateral eyes were considered as control (control eye). Bilateral conjunctival swabs were collected before the first administration (T0) and the morning of surgery (T1). The swabs were processed within 3 h from sampling for the automated detection of the presence of replicating microorganisms (colony-forming units, CFU/mL) and the provision of real-time growth curves. Conjunctival swabs of 32 patients (n = 128) were examined. Six patients were excluded from the efficacy analysis because of microbial load < 50 CFU/mL at T0 in the study eye. No difference between study and control eyes was observed at T0 (p = 0.40). Compared with T0, 20 (76.9%) study eyes and 10 (38.5%) control eyes showed a ≥ 1 log reduction of the microbial load at T1, with a significant difference between groups (p = 0.005). Keratosept® showed good tolerability, and no adverse events or eye discomfort were recorded. This study showed that the low-dose combination of antiseptic agents in the Keratosept® ophthalmic solution effectively reduces the bacterial load of healthy flora on the ocular surface.

Duration of surgical antibiotic prophylaxis and surgical site infection in orthopaedic surgery: A prospective cohort study.

The optimal duration for surgical antibiotic prophylaxis (SAP) for preventing surgical site infection (SSI) in orthopaedic surgeries remains poorly supported by high-level evidence. This study aimed to assess the association between SAP duration and the occurrence of SSI within one year postoperatively. This prospective cohort study was based on the database from Surgical Site Infection Surveillance and Improvement Project (SISIP) of a tertiary orthopaedic university hospital from October 2014 to December 2020. The main outcome was SSI, defined according to the CDC/NHSN criteria, determined by review of index hospitalization medical records, microbiology laboratory reports, and readmission records for SSI treatment within one-year after discharge. Adjusted Generalized additive models (GAMs) were performed to assess the relationships between SAP duration and SSI, determined the cut-off point of SAP duration, and estimate the relative contribution of each included variable, across the overall cohort and the three subgroups (open fracture, closed fracture, and non-traumatic group). Multivariable logistic regression models were used to estimate the association between prolonging SAP duration based on the cut-off point and SSI. There were 37,046 patients (55.1% male) included, with the overall SSI incidence of 2.35% (871/37,046). In adjusted GAMs, no statistically significant relationships were observed in overall cohort and open or closed group (P>0.05), but a nonlinear relationship was exhibited non-traumatic group (P=0.03); the cut-off point were 2.4 days for overall cohort and 3.6 days (open), 2.6 days (closed), 1.1 days (non-trauma) for three subgroups. In adjusted logistic regression, prolonging SAP duration did not demonstrate a statistically significant protective effect in overall cohort (aOR=0.868; 95% CI, 0.746-1.011) and three groups (open: aOR=0.867; 95% CI, 0.668-1.124; closed: aOR=0.925; 95% CI, 0.754-1.135; non-trauma: aOR=1.184; 95% CI, 0.832-1.683). The relative contribution ranks of SAP duration were 21st overall among 34 factors, 14th for open fractures, 28th for closed fractures, and 3rd for non-traumatic group among 33 factors. Prolonged postoperative SAP duration has no protective effect against SSI in orthopaedic surgery. Our findings support current guidelines against the practice of continuing SAP postoperatively.

Cost Analysis of Dropless Cataract Surgery Prophylaxis with Intracameral Antibiotics and Subconjunctival Steroids.

To determine whether dropless, injection-based cataract surgery prophylaxis with intracameral antibiotic and subconjunctival steroid may reduce healthcare system costs and patient out-of-pocket costs compared to topical medication regimens. United States national medical expenditures database. Retrospective cost analysis. Costs were analyzed for topical ophthalmics from the 2020 Medical Expenditure Panel Survey (MEPS) and for dropless medications from pharmaceutical invoices/catalogs. Main outcomes included system costs, from insurance and patient payments, and out-of-pocket costs for cataract surgery topical and dropless, injection-based prophylactic medication regimens, per eye and nationally. System costs for individual topical medications and same-class dropless, injection-based medications were compared using two-sided, one-sample t-tests. There were 583 prophylactic topical ophthalmic purchases in MEPS. Mean system costs per eye were $76.20 ± SD 39.07 for the lowest cost topical steroid (prednisolone) compared to $4.01 for the lowest cost subconjunctival steroid (triamcinolone acetonide) (p < 0.001). Per eye, the lowest cost dropless, injection-based regimen, at $15.91, results in an $87.99 (84.7%) reduction in overall healthcare costs and a $43.64 (100%) reduction in patient out-of-pocket costs relative to the lowest cost topical regimen ($103.90 ± 43.14 mean system cost and $43.64 ± 37.32 mean out-of-pocket cost per eye). Use of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce annual national healthcare system and out-of-pocket costs up to $450,000,000 and $225,000,000, respectively. An evidence-based cataract surgery prophylactic medication regimen of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce healthcare system and patient out-of-pocket costs in comparison to various topical regimens.

Evaluation of the Adherence to the Antimicrobial Prophylaxis Guidelines before Cardiac Surgeries in a Specialized University Hospital: A Unicenter Cross-Sectional Study from Iran

Background: Surgical site infection (SSI) is the most common reason for patient readmission after surgery. Because most cases of surgical site infection are preventable with antimicrobial prophylaxis, adherence to appropriate guidelines is critical. The aim of this study was to evaluate adherence to guideline recommendations for antimicrobial prophylaxis of surgical site infections at Shahid Chamran Heart Hospital, Isfahan, Iran. Methods: This cross-sectional observational study was conducted using prospective data collected from December 2021 to June 2022 in the cardiac surgery ward of Chamran Hospital. Adherence to "Clinical practice guidelines for antimicrobial prophylaxis in surgery (2013)" was assessed using data from patient records regarding the type, dosage, timing, and duration of antimicrobial prophylaxis. Results: A total of 363 patients were included in this study. The compliance rate with the guideline in terms of the type, dosing, initiation time, redosing and duration of the antimicrobial agent was 99.72%, 1.6%, 98.8%, 29.28%, and 0% respectively. Conclusion: The present study revealed relatively low adherence to the guidelines in terms of dosing, re-dosing and duration of antimicrobial prophylaxis at Chamran Heart Hospital. Based on the results, developing a local guideline is highly recommended.

Microbiologic Evaluation of Colorectal Surgical Site Infections to Guide Surgical Prophylaxis Recommendations

Background: Use of a combination of parenteral and oral antimicrobial prophylaxis prior to colorectal surgery is recommended to reduce risk of surgical site infection (SSI). Parenteral antibiotic selection is complicated by the need to target organisms likely to cause infection at the surgery site, while mitigating risk of antimicrobial resistance caused by overuse of broad spectrum agents. This study aimed to evaluate microbiologic data from colorectal surgical site infections across an 11-hospital health system. Microbiologic data from SSI events were used to assess continued appropriateness of health system standard recommendations for parenteral antibiotic prophylaxis in colorectal surgery, consisting of either cefazolin with metronidazole or cefoxitin monotherapy. Methods: This multicenter, retrospective, observational study was conducted from January 1, 2019 to March 31, 2023, using data extracted from the National Healthcare Safety Network (NHSN). Microbiologic data from colorectal SSIs from 2019 to 2022 were evaluated for a descriptive review of pathogen and phenotype trends. SSI data excluded patients age &lt; 18 years, those identified as infection present at time of surgery (PATOS), or outpatient procedures. Results: A total of 8059 colorectal procedures were evaluated. Most SSIs were polymicrobial, with at least one pathogen detected in 65% of cases. The most commonly identified organisms were E. coli (22.5%), Enterococcus spp. (19.7%), P. aeruginosa (6.5%), Streptococcus spp. (4.9%), and C. albicans (4.7%). Change over time in antimicrobial-resistant phenotypes from 2019 to 2022 was not statistically significant for extended-spectrum cephalosporin-resistant E. coli (p=0.335), extended-spectrum cephalosporin-resistant K. oxytoca/pneumoniae (p=0.189), multi-drug resistant P. aeruginosa (0.058), methicillin-resistant S. aureus (p=0.906), or among isolates with no identified antimicrobial-resistance phenotype (p=0.096). Among E. coli, change from 2019 to 2022 in cefazolin non-susceptible, ceftriaxone susceptible isolates was not statistically significant (p=0.177). No carbapenem-resistant Enterobacterales isolates were identified among non-PATOS cases. Conclusions: Data does not support a change to broader spectrum agents for colorectal surgery parenteral antimicrobial prophylaxis. Continued use of cefazolin with metronidazole or cefoxitin as IV antibiotic prophylaxis in colorectal surgery is recommended, with ongoing tracking of microbiologic trends and antimicrobial susceptibility.

Antibiotic prophylaxis in surgery for closed fracture of the hand

PurposePreoperative antibiotic prophylaxis is associated to internal fixation for closed phalangeal and metacarpal fracture, but its effectiveness is not known. MethodsIn a consecutive series of 119 adult patients undergoing Kirschner-wire fixation for phalangeal or metacarpal fracture, 56.3% (n = 67) received antibiotic prophylaxis and 43.7% (n = 52) did not. ResultsThe rate of deep surgical site infection was 1.5% (n = 1) in the group with antibiotic prophylaxis and 1.9% (n = 1) in the group without. Minor skin irritation or infection of the pin tract occurred in 13.4% of cases (n = 9) in the group with antibiotic prophylaxis and 9.6% (n = 5) in the group without. ConclusionOur findings suggest that use of antibiotic prophylaxis could be reduced in the treatment of closed fractures of the hand treated with removable pins. Type of study/level of evidenceTherapeutic IV (retrospective review).

752 VTE Prophylaxis and VTE Assessment Form in Plastic Surgery: A Closed-Loop Audit

752 VTE Prophylaxis and VTE Assessment Form in Plastic Surgery: A Closed-Loop Audit

Optimization of appropriate antimicrobial prophylaxis in general surgery: a prospective cohort study

BackgroundSurgical site infections (SSI) are characterized by infections occurring in the surgical incision site, organ or cavity in the postoperative period. Adherence to surgical antimicrobial prophylaxis (SAP) is paramount in mitigating the occurrence of SSIs. In this study, we aimed to evaluate the appropriateness of SAP use in patients undergoing surgical procedures in the field of general surgery according to the American Society of Health-System Pharmacists (ASHP) guideline and to determine the difference between the pre-training period (pre-TP) and the post-training period (post-TP) organized according to this guideline.MethodsIt is a single-center prospective study conducted in general surgery wards between January 2022 and May 2023, with 404 patients pre-TP and 406 patients post-TP.ResultsCefazolin emerged as the predominant agent for SAP, favored in 86.8% (703/810) of cases. Appropriate cefazolin dosage increased significantly from 41% (129 patients) in pre-TP to 92.6% (276 patients) in post-TP (p < 0.001), along with a rise in adherence to recommended timing of administration from 42.2% (133 patients) to 62.8% (187 patients) (p < 0.001). The proportion of patients receiving antibiotics during hospitalization in the ward postoperatively decreased post-TP (21–14.3%; p = 0.012), as did antibiotic prescription at discharge (16.8–10.3%; p = 0.008). The incidence of SSI showed a slight increase from 9.9% in pre-TP to 13.3% in post-TP (p = 0.131).ConclusionsRoutine training sessions for surgeons emerged as crucial strategies to optimize patient care and enhance SAP compliance rates, particularly given the burden of clinical responsibilities faced by surgical teams.

Post mastectomy reconstruction choice: Do race and ethnicity play a role?

1586 Background: The choice regarding reconstruction after mastectomy is based on multiple factors. We hypothesized that race and ethnicity are associated with decision making regarding reconstruction and choice for bilateral mastectomy among a diverse patient population with equal access to reconstructive options. Methods: A retrospective cohort study was performed of patients who underwent mastectomy with or without reconstruction for cancer or prophylaxis from 1/1/2019-12/31/2020 within a single health care system. Clinical and demographicfeatures were recorded. Study endpoints included reconstruction and contralateral prophylactic mastectomy (CPM) choice. Chi square and logistic regression analyses were performed with hypotheses tested at 5% significance level. Results: A total of 663 patients underwent mastectomy for cancer or prevention. Mean age was 54 (range: 24-93) and median BMI 25 (15-58). The majority of women included identified as Non-Hispanic White (NHW) (52%), with other women identifying as Hispanic, Asian, Non-Hispanic Black (NHB), or Other (Table). Of the total cohort, 647 (98%) patients had surgery for cancer, while 16 (2%) had surgery for prophylaxis. Among those with unilateral cancer (N=602, 91%), NHW women were more likely to get CPM (OR 2.12, p&lt;.001), while NHB (OR 0.58, p=.02) and Asian women (OR 0.47, p=.01) were less likely to choose CPM. Asian women were less likely to undergo reconstruction compared to non-Asian women (OR=0.42, p=.01), while Hispanic women were almost twice as likely to undergo reconstruction compared to non-Hispanic women (OR 1.93, p=.016). Hispanic women were more likely to undergo a DIEP flap (OR 2.77, p &lt;.001), while NHW women were more likely to choose implant reconstruction (OR 2.35, p&lt;.001). Conclusions: In our hospital system, choice for reconstruction or CPM was found to differ based on race and ethnicity. NHW women were more likely to choose CPM and undergo implant-based reconstruction, Asian women were more likely to forgo reconstruction, and Hispanics were more likely to undergo DIEP flaps. Future analysis in this cohort will include other factors such as BMI, insurance status, religion, marital status, and employment status.[Table: see text]

Stress Ulcer Prophylaxis in Cardiac Surgery

Stress Ulcer Prophylaxis in Cardiac Surgery