Postoperative Wound Infection Rates Research Articles

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.

Comparison of the effects of laparoscopic and open hysterectomy on surgical site wound infections in patients with endometrial cancer: A meta-analysis.

This meta-analysis aimed to compare laparoscopic hysterectomy (LH) and open hysterectomy (OH) in terms of surgical site wound infection, length of hospital stay, and postoperative complications in patients with endometrial cancer (EC). PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang databases were comprehensively searched for studies on OH and LH for EC published between 2008 and July 2023, in any language. The literature was screened according to the inclusion and exclusion criteria, and the quality of the included case-control studies was assessed using the Newcastle-Ottawa Scale. Data were collated and analysed using Stata 17.0 software. A total of 1245 articles were screened according to the search strategy, and ultimately 15 studies were included in this meta-analysis, with a total of 1606 patients with EC, of which 751 were treated with LH and 855 with OH. The results showed that the rate of postoperative wound infection was significantly higher (OR: 0.290; 95% CI: 0.169-0.496, p < 0.001), the length of hospital stay was significantly longer (SMD: -1.976, 95% CI: -2.669 to -1.283, p < 0.001), and the incidence of postoperative complications was significantly higher (OR: 0.366; 95% CI: 0.280-0.478, p < 0.001) in the OH group than in the LH group. This study showed that LH was superior to OH for the treatment of EC and is associated with a lower rate of wound infection, shorter length of hospitalisation, and a reduced risk of complications. Thus, our findings support the choice of LH over OH for EC.

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.

Reduction in wound healing complications and infection rate by lumbar CSF drainage after decompressive hemicraniectomy.

Wound healing disorders and surgical site infections are the most frequently encountered complications after decompressive hemicraniectomy (DHC). Subgaleal CSF accumulation causes additional tension of the scalp flap and increases the risk of wound dehiscence, CSF fistula, and infection. Lumbar CSF drainage might relieve subgaleal CSF accumulation and is often used when a CSF fistula through the surgical wound appears. The aim of this study was to investigate if early prophylactic lumbar drainage might reduce the rate of postoperative wound revisions and infections after DHC. The authors retrospectively analyzed 104 consecutive patients who underwent DHC from January 2019 to May 2021. Before January 2020, patients did not receive lumbar drainage, whereas after January 2020, patients received lumbar drainage within 3 days after DHC for a median total of 4 (IQR 2-5) days if the first postoperative CT scan confirmed open basal cisterns. The primary endpoint was the rate of severe wound healing complications requiring surgical revision. Secondary endpoints were the rate of subgaleal CSF accumulations and hygromas as well as the rate of purulent wound infections and subdural empyema. A total of 31 patients died during the acute phase; 34 patients with and 39 patients without lumbar drainage were included for the analysis of endpoints. The predominant underlying pathology was malignant hemispheric stroke (58.8% vs 66.7%) followed by traumatic brain injury (20.6% vs 23.1%). The rate of surgical wound revisions was significantly lower in the lumbar drainage group (5 [14.7%] vs 14 [35.9%], p = 0.04). A stepwise linear regression analysis was used to identify potential covariates associated with wound healing disorder and reduced them to lumbar drainage and BMI. One patient was subject to paradoxical herniation. However, the patient's symptoms rapidly resolved after lumbar drainage was discontinued, and he survived with only moderate deficits related to the primary disease. There was no significant difference in the rate of radiological herniation signs. The median lengths of stay in the ICU were similar, with 12 (IQR 9-23) days in the drainage group compared with 13 (IQR 11-23) days in the control group (p = 0.21). In patients after DHC and open basal cisterns on postoperative CT, lumbar drainage appears to be safe and reduces the rate of surgical wound revisions and intracranial infection after DHC while the risk for provoking paradoxical herniation is low early after surgery.

Intraoperative Peritoneal Lavage in Peritonitis: Normal Saline vs Metronidazole

Introduction: Globally, acute generalized peritonitis ranks among the top surgical emergencies. Different studies have been conducted to show the amplitude of peritonitis worldwide eliciting a huge impact on overall patient morbidity and mortality. Largely peritonitis is caused by a gastrointestinal perforation or anastomotic leak. In peritonitis, anaerobes &amp; gram-negative organisms are mostly responsible for sepsis and morbidity due to the overactive inflammatory cascade by endotoxins which is amenable to timely intervention. Aims &amp; Objectives: The study's aim was to evaluate whether using normal saline or metronidazole solution during intraoperative peritoneal lavage (IOPL), results in a lower rate of postoperative wound infection. Place and Duration of Study: This study was undertaken at the South Surgical Ward, Mayo Hospital Lahore for 6 months from February 2nd, 2021, to August 1st, 2021. Material &amp; Methods: Consecutive sampling strategy followed by a randomized controlled trial were used to induct and provide intervention to 90 patients aged 15-65 years with peritonitis caused by hollow viscus perforation. The patients were subdivided into 2 groups A&amp; B(n=45 each).Two liters of normal saline were used for peritoneal lavage in group A, while two liters of normal saline were combined with 200 mL of metronidazole solution and administered to group B. intraoperatively.Baseline physiological parameters such as age, sex, BMI , intra operative surgical parameters as duration of operation and post-operative course were recorded till discharge. On 10th POD, patients returned to OPD for further monitoring. An infection was diagnosed if the patient had post-operative symptoms such as a high temperature, increased TLC, wound discharge, redness, or pain. Data was entered and analyzed using SPSS version 23. Results: A majority (54.44%) of the patients were young adults. Mean age of 37.33 ± 10.53 years of patients in the metronidazole group was comparable to mean age 40.04 ± 11.96 years in the saline group, difference was not significant (p=0.067). Male/female ratio in Metronidazole and Saline groups were 17/25 and 10/18, respectively. Patients who received intraperitoneal lavage with normal saline were more likely to develop wound infections (17/45) (37.78%), while only 3/45) (6.67% of those who received metronidazole solution did so (p 0.0001). Conclusion: Based on the results of this experiment, using metronidazole solution for intraoperative peritoneal lavage instead of normal saline reduces the occurrence of postoperative wound infection.

Enhanced recovery after surgery care to reduce surgical site wound infection and postoperative complications for patients undergoing liver surgery.

This study comprehensively assessed the effect of enhanced recovery after surgery (ERAS) on wound infection and postoperative complications in patients undergoing liver surgery. The PubMed, EMBASE, MEDLINE, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang electronic databases were searched to collect published studies on the use of ERAS in liver surgery until December 2022. Literature selection was performed independently by two investigators according to the inclusion and exclusion criteria, and quality evaluation and data extraction were performed. RevMan 5.4 software was used in this study. Compared with the control group, the ERAS group showed a significantly lower incidence of postoperative wound infection (odds ratio [OR]: 0.59, 95% confidence interval [CI]: 0.41-0.84, P = .004) and overall postoperative complication rate (OR: 0.43, 95% CI: 0.33-0.57, P < .001) and significantly shorter postoperative hospital stay (mean difference: -2.30, 95% CI: -2.92 to -1.68, P < .001). Therefore, ERAS was safe and feasible when applied to liver resection, reducing the incidence of wound infection and total postoperative complications, and shortening the length of hospital stay. However, further studies are required to investigate the impact of ERAS protocols on clinical outcomes.

Incidence and Risk Factors for Fracture-Related Infection After Peri-Prosthetic Femoral Fractures: A Multicenter Retrospective Study (TRON Group Study).

Background: Fracture-related infection (FRI) sometimes occurs with peri-prosthetic femoral fracture (PPF) treatment. Fracture-related infection often leads to multiple re-operations, possible non-union, a decreased clinical function, and long-term antibiotic treatment. In this multicenter study, we aimed to clarify the incidence of FRI, the causative organisms of wound infection, and the risk factors associated with post-operative infection for PPF. Patients and Methods: Among 197 patients diagnosed with peri-prosthetic femoral fracture who received surgical treatment in 11 institutions (named the TRON group) from 2010 to 2019, 163 patients were included as subjects. Thirty-four patients were excluded because of insufficient follow-up (less than six months) or data loss. We extracted the following risk factors for FRI: gender, body mass index, smoking history, diabetes mellitus, chronic hepatitis, rheumatoid arthritis, dialysis, history of osteoporosis treatment, injury mechanism (high- or low-energy), Vancouver type, and operative information (waiting period for surgery, operation time, amount of blood loss, and surgical procedure). We conducted a logistic regression analysis to investigate the risk factors for FRI using these extracted items as explanatory variables and the presence or absence of FRI as the response variable. Results: Fracture-related infection occurred after surgery for PPF in 12 of 163 patients (7.3%). The most common causative organism was Staphylococcus aureus (n = 7). The univariable analysis showed differences for dialysis (p = 0.001), Vancouver type (p = 0.036), blood loss during surgery (p = 0.001), and operative time (p = 0.001). The multivariable logistic-regression analysis revealed that the patient background factor of dialysis (odds ratio [OR], 22.9; p = 0.0005), and the operative factor of Vancouver type A fracture (OR, 0.039-1.18; p = 0.018-0.19) were risk factors for FRI. Conclusions: The rate of post-operative wound infection in patients with a PPF was 7.3%. Staphylococcus was the most frequent causative organism. The surgeon should pay attention to infection after surgery for patients with Vancouver type A fractures and those undergoing dialysis.

The Comparison of Postoperative Umbilical Port Site-Related Complications Between Transumbilical and Periumbilical Incision After Laparoscopic Surgery in Children.

Introduction: No studies have directly compared postoperative umbilical port site (UPS)-related complications between transumbilical and periumbilical incisions (TUI and PUI) after laparoscopic surgery in children. Patients and Methods: We conducted a retrospective review of 324 children of ≤15 years of age who underwent laparoscopic repair (LR) for inguinal hernia, via either a TUI or PUI, between 2010 and 2020. UPS-related complications, such as wound infection and umbilical deformity, were compared between TUI and PUI. We also investigated the risk factors for the development of UPS-related complications after LR. Results: TUIs and PUIs were used for 228 and 96 children, respectively. The incidence rates of postoperative wound infection and umbilical deformity in the PUI group were higher in comparison to the TUI group; although not to a statistically significant extent (7.3% versus 5.3%, P = .451, 6.3% versus 4.8%, P = .593). One case of incisional hernia at the UPS was seen in the TUI group. In the univariate analysis, sex, age, weight for age Z-score, nutrition status, insertion and closure time, total operative time, American Society of Anesthesiologists score, blood loss, and comorbidities were not significantly associated with the development of UPS-related complications after LR. Conclusion: The incidence of UPS-related complications in TUI and PUI was not significantly different. Due to the low incidence of UPS-related complications, it was difficult to draw conclusions regarding contributing factors; however, meticulous care should be taken to avoid UPS-related complications when closing the UPS (Ethical approval No. 2019-24).

Influence of Smoking on Periodontal and Implant Therapy: A Narrative Review

smoking is considered the most modifiable risk factor for periodontal disease. the aim of this narrative review is to emphasize the effect of smoking on periodontal and implant therapy. The authors reviewed the literature reporting the clinical outcomes of smoking on periodontal surgical and nonsurgical treatment. The impact of smoking on implant therapy and sinus lifting procedures were also reviewed. Periodontal and implant therapy outcomes are adversely affected by smoking. Smokers respond less favorably to periodontal therapy and periodontal flap procedures as compared to nonsmokers. Clinical outcomes for smokers are 50-75% worse than for nonsmokers. Studies reveal that smokers experience a significantly lower reduction in pocket depth compared to nonsmokers as well as less bone growth after treating infra-bony defects with guided tissue regeneration. The relative risk of implant failure is significantly higher in patients who smoke 20 cigarettes or more per day compared to nonsmokers. Additionally, smoking has also been shown to increase postoperative wound dehiscence and infection rates following sinus floor elevation. Longitudinal studies on smoke cessation have shown a reduction in bone loss and probing depths for periodontitis patients after cessation compared to those who smoke. Smoking cessation can reduce probing depths and improve clinical attachment after nonsurgical periodontal therapy. There is insufficient evidence regarding the effect of smoking on peri-implantitis, as well as the loss of implants in the long-term.

338 Ultra-Early Cranioplasty Versus Conventional Cranioplasty: A Retrospective Review at an Academic Level 1 Trauma Center

INTRODUCTION: Decompressive craniectomy (DC) is a common neurosurgical procedure for management of intracranial hypertension following traumatic brain injury. Traditionally, cranioplasty has been delayed for as long as three-to-six months following initial DC. Few studies have assessed the effect of 'ultra-early' cranioplasty on rates of postoperative complications following DC. METHODS: A retrospective review of cranioplasties performed at our institution between January 2016 and July 2020 was performed. Craniectomies performed at other institutions were excluded. Seventy-seven cranioplasties met inclusion criteria.Ultra-early cranioplasty was defined as cranioplasty performed within 30 days of craniectomy whereas conventional cranioplasty occurred after 30 days. Postoperative wound infection rates, rate of return to the operating room with or without bone flap removal, operative length, and rate of post-cranioplasty hydrocephalus were compared between the two groups. RESULTS: 39 and 38 patients were included in the ultra-early and conventional cranioplasty groups, respectively. The average number of days to cranioplasty in the ultra-early group was 17.7 ± 7.75 days compared to 95.7 ± 65.60 days in the conventional group. The mean GCS upon arrival to the ER was 7.28 ± 3.90 and 6.92 ± 4.14 for the ultra-early and conventional groups, respectively. The operative time was shorter in the ultra-early cohort that in the conventional cohort (ultra-early, 2.4 ± 0.71 hours; conventional, 3.0 ± 1.63 hours; p = 0.0336). The incidence of post-cranioplasty hydrocephalus was also lower in the ultra-early cohort (ultra-early, 10.3%; Conventional, 31.6%; p = 0.026). No statistically significant differences were observed regarding postoperative infection, return to the operating room, or bone flap removal. CONCLUSIONS: Our study shows that ultra-early cranioplasty can significantly reduce the rate of post-cranioplasty hydrocephalus, as well as operative time in comparison to conventional cranioplasty. However, the timing of cranioplasty following DC should remain a patient-centered consideration.

Single-level posterior cervical foraminotomy associated with increased incidence of early postoperative wound infection rates relative to anterior cervical discectomy with fusion and cervical disc arthroplasty.

To date, there are no studies comparing perioperative outcomes of cervical radiculopathy patients managed by anterior cervical discectomy with fusion (ACDF), cervical disc arthroplasty (CDA), or posterior cervical foraminotomy (PCF). To assess if there were differences in perioperative outcomes between cervical radiculopathy patients who can be appropriately treated with ACDF, CDA, or PCF. Patients diagnosed with cervical radiculopathy who underwent a single-level ACDF, CDA, or PCF between 2012 and 2019 were retrospectively identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using current procedural terminology (CPT) codes. Patients were subsequently stratified into those who underwent ACDF, CDA, or PCF, and propensity score-matched to adjust for differences in patient demographics/characteristics. Differences were assessed in terms of operative time, healthcare utilization metrics (reoperations, readmissions, lengths-of-stay), as well as medical and surgical complications. A total of 18,614 cervical radiculopathy patients undergoing surgery were identified (ACDF: n=15,862; CDA: n=1,731; PCF: n=1,021). After 1:1 propensity score matching (n=535 each), there were no differences in characteristics in patients undergoing ACDF, CDA, or PCF (P>0.05). PCF patients had statistically higher rates of reoperation (2.1%) than ACDF (0.4%), CDA (0.6%) patients (P=0.010). PCF patients also experienced higher rates of superficial infection (P=0.001), and deep infection (P=0.007), relative to ACDF and CDA patients. There were no other significant differences in medical/surgical complications between the ACDF, CDA, or PCF patients. Cervical radiculopathy patients undergoing PCF are associated with higher rates of perioperative infection and overall reoperation than ACDF or CDA. Further research is required to elucidate the mechanism behind this association.

The Effect of Educational Program on Knowledge, Attitude and Practice on Sterile Technique among Operating Room Nurses of a Private Hospital in Selangor

Surgical site infection continues to be the most common hospital-acquired infection among operated patients, associated with expenses, mortality, and morbidity. Operating room nurses play a big role in preventing and controlling theatre infection by applying sterile technique principles. For that reason, the Operating Room nurses, to accomplish their tasks, must have the knowledge and good attitude to practice the sterile technique. However, various studies revealed that OR nurses have insufficient knowledge, attitude and practice of sterile technique. This study aimed identify the effect of educational programs towards enhancing operating room nurses' knowledge, attitude and practice of sterile technique in two KPJ Hospitals. The research design chosen in this study was Quasi- experimental, where an educational program was conducted as an intervention on a single group pre and posttest posttest. A total of 48 Registered Nurses working in the Operating Room of the two selected Hospitals in Selangor were recruited to use purposive samples. The sample from the Registered Nurses population was selected using the Convenience sampling method. The data were analyzed using the IBM Social Packages for the Social Sciences (SPSS) version 26. The finding of this study revealed that 1 (2.3%) of respondents had low knowledge while 17 (39.5%) had a medium level of knowledge, and 25 (58.1%) had a high level of knowledge for pre-intervention. Post-intervention respondents had medium knowledge, 8 (18.6%) and 35 (81.4%) for high knowledge. There is still a need for nurses to be better educated on the principles of sterile techniques to ensure the operated patient's safety and reduce the rate of postoperative wound infection among the operated patient.

Impact of diabetes mellitus on long-term clinical and graft outcomes after off-pump coronary artery bypass grafting with pure bilateral skeletonized internal thoracic artery grafts

BackgroundThe effect of diabetes mellitus (DM) on the long-term outcomes of coronary artery bypass graft (CABG) remained debatable and various strategies exist for CABG; hence, clarifying the effects of DM on CABG outcomes is difficult. The current study aimed to evaluate the effect of DM on clinical and graft-related outcomes after CABG with bilateral internal thoracic artery (BITA) grafts.MethodsFrom January 2001 to December 2017, 3395 patients who underwent off-pump CABG (OPCAB) with BITA grafts were enrolled. The study population was stratified according to preoperative DM. The primary endpoint was cardiac death and the secondary endpoints were myocardial infarction (MI), revascularization, graft failure, stroke, postoperative wound infection, and a composite endpoint of cardiac death, MI, and revascularization. Multiple sensitivity analyses, including Cox proportional hazard regression and propensity-score matching analyses, were performed to adjust baseline differences.ResultsAfter CABG, the DM group showed similar rates of cardiac death, MI, or revascularization and lower rates of graft failure at 10 years (DM vs. non-DM, 19.0% vs. 24.3%, hazard ratio [HR] 0.711, 95% confidence interval [CI] 0.549–0.925; P = 0.009) compared to the non-DM group. These findings were consistent after multiple sensitivity analyses. In the subgroup analysis, the well-controlled DM group, which is defined as preoperative hemoglobin A1c (HbA1c) of < 7%, showed lower postoperative wound infection rates (well-controlled DM vs. poorly controlled DM, 3.7% vs. 7.3%, HR 0.411, 95% CI 0.225–0.751; P = 0.004) compared to the poorly controlled DM group, which was consistent after propensity-score matched analysis.ConclusionsOPCAB with BITA grafts showed excellent and comparable long-term clinical outcomes in patients with and without DM. DM might have a protective effect on competition and graft failure of ITA. Strict preoperative hyperglycemia control with target HbA1c of < 7% might reduce postoperative wound infection and facilitate the use of BITA in CABG.

Robotic Anastomotic Technique.

The first robotic colectomy was performed 20 years ago. Since that time, the robotic surgery platform has made significant advancements and become increasingly prevalent in colorectal surgery. The da Vinci Xi system (Intuitive Surgical, Sunnyvale, CA) and technology such as integrated table motion has facilitated multiquadrant procedures. Intracorporeal anastomoses (ICAs) have proven benefit in the literature, including decreased length of stay, decreased narcotic requirements, and lower rate of postoperative wound infections and hernias. Additional studies have shown a lower conversion to open rate in robotic surgery compared with laparoscopy. In this article, we will describe techniques for creation of robotic ICAs.

Intramedullary Beaming Superconstructs for the Treatment of Midfoot Deformity in Patients with Charcot Arthropathy

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Charcot arthropathy is a debilitating condition often accompanied by rocker-bottom deformity and plantar ulcerations. Patients with this condition historically experienced poor results, with varying rates of postoperative wound complications, infection, and amputation. Intramedullary beaming in midfoot reconstructions has been previously identified as a viable treatment option for these patients. However, these studies have been limited to small case series. The purpose of this study was to report our experience with realignment and extended fusion with the use of intramedullary beaming superconstructs in patients with Charcot arthropathy and resultant midfoot deformity. Methods: We retrospectively reviewed patients who underwent midfoot Charcot reconstruction with an intramedullary beaming superconstruct between January 2017 to January 2021. Bone resection and/or osteotomy were required to reduce the deformity. Intramedullary screws were placed, either antegrade or retrograde, across the arthrodesis sites. Additional hindfoot and/or tibio- talar arthrodesis was performed as indicated by the patient's deformity. Supplemental plate fixation was performed at the discretion of the treating surgeon. All patients were followed for a minimum of three months. Postoperative imaging was assessed to determine fusion at the arthrodesis site. Patient demographics and comorbidities were recorded to assess for risk factors. Patient deformities were classified according to the Brodsky classification. Postoperative rates of infection, limb salvage, reoperation, hardware fatigue, and return to walking were also recorded. Descriptive statistics, Fisher's exact test, Students T- test, and logistic regression were used to analyze outcomes. Results: Thirty-six patients were included. Limb salvage occurred in 35 (97%) patients, while one patient underwent below knee amputation. Fusion was achieved in 30 (83%) patients at an average time of 5.4+-1.3 months. A stable pseudarthrosis allowing ambulation was achieved in 5 (14%) patients. Thirty-three (92%) patients returned to ambulation. Seven patients (19%) required revision surgery (3 for recurrent ulcer, 4 for deep infection). Four (11%) patients experienced hardware fatigue, but all returned to ambulation. Five (14%) patients required assistive devices and seven (19%) required bracing. No patient characteristics were associated with non-union. Absence of supplemental plate fixation was associated with nonunion (P=0.04) and confirmed as an independent risk factor with regression analysis (P=0.03). Additional subtalar and/or hindfoot fixation was not associated with increased fusion rates. Conclusion: Open reduction and arthrodesis using an intramedullary beaming superconstruct for the surgical correction of midfoot collapse in patients with Charcot arthropathy provides a stable and reliable construct with high rates of limb salvage, fusion, and return to ambulation while minimizing complications. Supplemental plate fixation may provide increased construct stability and higher rates of union. However, this clinical importance of this is unknown.

The Role of Diet and Nutrition on Fracture Healing: A Systematic Review

Category: Other Introduction/Purpose: Not only is poor nutritional status common amongst the elderly, but its incidence is also high amongst orthopedic trauma patients as injuries, and fractures more specifically, cause hypermetabolic states. The purpose of this review was to perform the most comprehensive analysis of literature published within the last decade to determine the effect of nutritional status on fracture healing, as well as outlining the effects of specific herbal supplements, vitamins and minerals. Methods: Following PRISMA guidelines, PubMed, Embase and Web of Science databases were searched using variations of the terms nutrition and malnutrition along with vitamins, minerals and proteins as well as fractures and fracture healing. Two independent reviewers screened articles, graded evidence quality, and extracted data. A total of 31 studies were related to nutritional status - 22 human studies and 9 animal studies - and 45 studies were related to specific herbs or food products - 2 human studies, 36 animal studies, and 7 review articles. Results: There is substantial variability in the definitions of nutritional status, with some quantitative measures including serum albumin and lymphocyte count being the most popular, and questionnaires like the Mini Nutritional Assessment (MNA) and the Malnutrition Universal Screening Tool (MUST). Published human studies predominately studied the effects of nutrition on traumatic fractures in the elderly or bone healing after spinal surgery. Consistently, hypoalbuminemia was found to be an independent risk factor of post-operative complications and longer hospital stays. Few studies reported on nutritional supplementation, but those that did found supplementation to be associated with lower rates of postoperative complications and wound infection, as well as shorter hospital stays. Although there is much evidence published on herbal supplements and food products in animals, there is a dearth of evidence of their benefits to humans with only two RCTs included in this analysis (demonstrating the benefits of Momiai and lactobacillus casei Shirota). Conclusion: Nutrition remains an easily targetable factor that can significantly improve fracture healing, especially amongst elderly populations. Although proper adherence to supplementation is rare, when attained its benefits are profound. To demonstrate that the beneficial effects of herbal supplements and food products on fracture healing seen in animal models persist in humans, future placebo-controlled trials are needed.

Association of Obesity with Increased Rate of Postoperative Superficial Sternal Wound Infection after Coronary Artery Bypass Grafting Surgery

Objective: The objective of this study was to find association of obesity with postoperative superficial sternal wound infection after CABG. Study Design: This was a prospective comparative study. Place and Duration: This study was conducted at the Cardiac surgery Department, PIC, Jail Road, Lahore from 1st July 2020 to 31st Dec 2020. Methodology: Non probability / purposive sampling technique was used. A total of 140 patients (70 in each group) following inclusion criteria were enrolled in this study. Quantitative and qualitative variables were filled to the predesigned performa. A detailed social and demographic profile (age, gender, height, weight, BMI). Clinical history, i.e. (Diabetes Mellitus, Smoking, Hypertension) and clinical trials were assessed, i.e. preoperative EF (percent) was calculated. Using SPSS Version 24.0.0, statistical analysis was carried out. Qualitative variables such as gender, risk factors such as DM, HTN, smoking, and superficial sternal infection were represented as percentages, whereas quantitative variables such as age, height and weight were described as mean ± standard deviation. Chi-square test was used to determine the association of obesity with infection of sternal wound. P value≤0.05 was considered as significant. Results: The mean age of cases in this study in obese and non-obese group was 47.80 ± 9.79 years and 51.23 ± 9.36 years. There were 70(50%) obese patients and 70(50%) non-obese patients in our study. There were 59(84.29%) cases in obese group and 15 (21.43%) case in non-obese group who had developed post-operative infection, p-value was &lt;0.001 which was highly significant showing strong association between postoperative infection and obesity. Conclusion: Sternal wound infection was a significant outcome in our research. We found strong association of obesity with post-operative sternal wound infection. Keywords: CABG, Diabetes, Obesity, Post-operative infection

Inferior Pedicle Reduction Mammoplasty as Corrective Surgery after Breast Conserving Surgery and Radiation Therapy.

Background/Aim—Twenty patients had corrective reconstruction surgery by means of a reduction mammaplasty or mastopexy after a previous BCS (Breast Conserving Surgery) and RT (Radiation Therapy); the risk factors and post-operative complications were reported in order to define a safe and effective technique for reduction mammaplasty in previously irradiated breast cancer patients. Materials and Methods—From June 2011 to December 2019, 20 pts. were operated on at the Breast Surgery Clinic of San Martino Policlinic Hospital, Genoa, Italy. Pre- and post-operative parameters included clinic-pathological features of the primary tumor; a lapse of time from primary radio-surgery; the extent of follow-up; the rate of post-operative wound infections; the persistence of breast asymmetry, and a post-operative patient satisfaction index by means of a BREAST-Q questionnaire. Results—Three patients (15%) developed minor complications in the irradiated breast, but no complication was observed into the non-irradiated breast. No statistically significant correlation was found between the post-operative complications and the risk factors. The statistical analysis of BREAST-Q questionnaire responses gave an average patient’s satisfaction index that was equal to 90.8/100 (range: 44 to 100). Conclusions—Inferior pedicle reduction mammoplasty is an effective reduction mammoplasty technique in regard to the extent of breast tissues that are to be removed both in irradiated and contralateral breast; moreover, the incidence of post-operative complications is clearly limited when a careful technique is adopted, and it can be reasonably applied also in patients with co-morbidity factors.

Frailty predicts readmission, reoperation, and infection after posterior spinal fusion: An institutional series of 3965 patients

ObjectiveFrailty is a measure of physiologic vulnerability conceptualized as the accumulation of deficits with aging, and may be useful for predicting risk of adverse events following posterior spinal fusion. Our objective was to investigate the utility of the Canadian Study on Health and Aging (CHSA) Modified Frailty Index (mFI) in patients undergoing posterior spinal fusion (PSF) as a predictor of several surgical quality metrics including readmission, reoperation, and surgical site infection. MethodsWe examined 3965 consecutive PSF patients treated at our institution between 2000 and 2015, and collected demographic, clinical, and frailty and comorbid disease burden measures using the mFI and Charlson Comorbidity Index (CCI). We examined trends and changes in these clinical and demographic characteristics over the course of the study period. We performed multivariable regression to identify independent predictors of readmission, reoperation, and surgical site infection. ResultsOver the course of the study period, the mean patient age increased linearly year-over-year (ß=0.60 [0.48, 0.72], p < 0.0001, R=0.94), while the SSI rate decreased linearly (ß=−0.14 [−0.27, −0.02], p = 0.0249, R=0.56), and frailty scores did not change significantly (p = 0.8124, R=0.065). Among all patients undergoing PSF, postoperative wound infection was independently associated with number of levels fused (OR=1.104 p < 0.001), frailty as measured by mFI (OR=1.150 p = 0.006), and BMI (OR=1.041 p = 0.008). Frailty was also independently associated with postoperative ICU admission (OR=1.1080 p = 0.005), 30-day readmission (OR=1.181 p < 0.001), and 30-day reoperation (OR=1.128 p < 0.001). Among all patients, rate of postoperative wound infection increased with increasing frailty (p = 0.0002) and increasing comorbid disease burden (chi-square p = 0.0012). ConclusionThe mFI predicts adverse events among patients undergoing PSF, including readmission, reoperation, and surgical site infection. When controlling for frailty, age was not an independent predictor of adverse events.

Ultra-Early Cranioplasty versus Conventional Cranioplasty: A Retrospective Cohort Study at an Academic Level 1 Trauma Center.

The goal of this study was to ascertain the efficacy, safety, and comparability of ultra-early cranioplasty (CP; defined here as <30 days from the original craniectomy) to conventional cranioplasty (defined here as >30 days from the original craniectomy). A retrospective review of CPs performed at our institution between January 2016 and July 2020 was performed. Craniectomies initially performed at other institutions were excluded. Seventy-seven CPs were included in our study. Ultra-early CP was defined as CP performed within 30 days of craniectomy whereas conventional CP occurred after 30 days. Post-operative wound infection rates, rate of return to the operating room (OR) with or without bone flap removal, operative length, and rate of post-CP hydrocephalus were compared between the two groups. Thirty-nine and 38 patients were included in the ultra-early and conventional CP groups, respectively. The average number of days to CP in the ultra-early group was 17.70 ± 7.75 days compared to 95.70 ± 65.60 days in the conventional group. The mean Glasgow Coma Scale upon arrival to the emergency room was 7.28 ± 3.90 and 6.92 ± 4.14 for the ultra-early and conventional groups, respectively. The operative time was shorter in the ultra-early cohort than that in the conventional cohort (ultra-early, 2.40 ± 0.71 h; conventional, 3.00 ± 1.63 h; p = 0.0336). The incidence of post-CP hydrocephalus was also lower in the ultra-early cohort (ultra-early, 10.3%; conventional, 31.6%; p = 0.026). No statistically significant differences were observed regarding post-operative infection, return to the OR, or bone flap removal. Our study shows that ultra-early CP can significantly reduce the rate of post-CP hydrocephalus, as well as operative time in comparison to conventional CP. However, the timing of CP post-DC should remain a patient-centered consideration.