Rate Of Postoperative Wound Complications Research Articles

Knotless suture in revision total joint arthroplasty: a prospective randomized controlled trial.

The use of barbed sutures for wound closure in primary total joint arthroplasty (TJA) has been shown to be effective and safe. However, their effectiveness and safety in revision TJA procedures has not been thoroughly studied. This study aims to evaluate the efficacy and safety of using barbed suture closure in revision TJA setting. A total of 80 patients undergoing revision TJA between September 2020 and November 2022 were included in this randomized controlled trial study. Following informed consent, patients were computer-randomized to the treatment arm (barbed suture wound closure) or to the control arm (conventional wound closure). Closure duration, closure rate, number of sutures used and wound related outcomes including complication rates and Patient and Observer Scar Assessment Scale (POSAS) score were compared between groups. The use of barbed sutures decreased closure time by 6min (30.1 vs. 36.1min, P = 0.008) with a higher wound closure rate (6.5 vs. 5.5mm/minute, P = 0.013). Additionally, the number of sutures used for wound closure in the barbed group was significantly lower than in the control group (6.2 vs. 10.1, respectively, P < 0.001). There were no significant differences in the rate of postoperative wound complications (P = 0.556) or patient and observer POSAS scores (P = 0.211, P = 297, respectively) between the two groups at 3-month follow-up. Closure of revision TJA surgical wound utilizing barbed sutures reduced closure time and the number of needles handled by operative staff, with no significant increase in intra- or post-operative complications rate when compared to traditional closure technique. I.

Application value of laparoscopic surgery in elderly patients (≥ 75 years) with colorectal cancer and prognostic factors influencing 5-year overall survival.

To investigate the application value of laparoscopic surgery in elderly patients (≥ 75 years) with colorectal cancer, and to identify the prognostic factors influencing the long-term survival in this demographic, and to establish a predictive nomogram model. A retrospective analysis was conducted on 146 elderly (≥ 75 years old) colorectal cancer patients who underwent radical surgery in Baoji People's Hospital from August 2016 to February 2018, including 55 patients who underwent laparotomy and 91 patients who underwent laparoscopic surgery. Survival curves were plotted using the Kaplan-Meier method, and differences in prognosis were assessed using the Log-rank test. Prognostic impacts of various factors on 5-year survival were analyzed using a Cox proportional hazards model. Significant predictors identified in the Cox model were used to construct a nomogram for predicting survival, which was then validated for accuracy and clinical utility. Laparoscopic surgery was associated with shorter hospital stays (P = 0.022), although at a higher cost (P = 0.011). The laparoscopic group also had less intraoperative bleeding (P < 0.001), incision length (P < 0.001), time to first postoperative expectoration (P < 0.001), time to first postoperative feeding (P = 0.002), and time to postoperative peritoneal drainage (P = 0.003) compared to the open surgery group. Additionally, the rate of postoperative wound complications was also lower in the laparoscopic group (P = 0.014). There was no significant difference in the 5-year post-treatment survival between the two groups (P = 0.150). Multifactorial Cox regression analysis revealed that a history of diabetes mellitus (P = 0.037), vascular infiltration (P = 0.026), nerve bundle invasion (P = 0.001), and TNM stage (P = 0.001) were independent prognostic factors affecting the 5-year survival of patients with advanced colorectal cancer. The constructed nomogram showed high predictive accuracy for 1-, 3-, and 5-year survival, with AUC values of 0.91, 0.87, and 0.79, respectively. Calibration curves and decision curve analysis confirmed the model's clinical utility. Risk formula: History of diabetes mellitus * -0.696194503 + Vascular infiltration * -0.769736513 + Nerve bundle invasion * -1.1709777 + TNM staging * 1.201933691. Laparoscopic surgery can reduce intraoperative trauma and accelerate postoperative recovery in elderly colorectal cancer patients (≥ 75 years) compared to open surgery. The developed nomogram model based on independent prognostic factors such as diabetes history, vascular infiltration, nerve bundle invasion, and TNM staging, facilitates tailored prognostic assessment, enhancing individual patient management.

Prophylactic Use of Negative Pressure Wound Therapy in High-risk Patients Undergoing Oncoplastic and Reconstructive Breast Surgery.

Negative pressure wound therapy (NPWT) has emerged as an adjunct to reduce wound complication rates in many surgical domains. This study investigated the prophylactic use of PICO NPWT in high-risk patients undergoing oncoplastic and reconstructive breast surgery. This was a prospective multicenter national audit. The findings were compared against Association of Breast Surgery/British Association of Plastic, Reconstructive and Aesthetic Surgeons (ABS/BAPRAS) Oncoplastic Guidelines for best practice. Data from 267 patients were included from seven centers. All patients had at least one high-risk factor for postoperative wound complications, whereas 78 patients (29.2%) had more than one. Thirty-six patients (13.5%) developed postoperative wound complications. An estimated 16 (6%) developed skin flap necrosis, wound dehiscence occurred in 13 patients (4.9%), and 15 patients (5.6%) developed postoperative wound infection. Eleven patients (4.1%) required further surgery due to wound complications. In total, 158 patients underwent mastectomy with immediate implant reconstruction. Postoperative wound complication rate was comparable in this subgroup (n = 22; 13.9%). Implant loss rate was 3.8%, which was within the 5% target mentioned in the ABS/BAPRAS guidelines. The estimated total cost saving was US $105,600 (£84,613) and US $395.50 (£316.90) per patient. Wound infection rate (5.6%) was much lower than the 25% reported by both iBRA study and National Mastectomy and Breast Reconstruction Audit. Our study suggests that prophylactic use of NPWT in oncoplastic and reconstructive breast surgery results in low rates of wound-related complications with associated healthcare cost benefits in patients with high-risk factors for wound-related complications. However, a prospective randomized control trial is required.

Risk-adjusted analysis of perioperative outcomes after the Sistrunk procedure.

Thyroglossal duct cyst (TGDC) is the most common pediatric congenital neck mass. The Sistrunk procedure is the standard method of excision and is associated with low rates of recurrence. This study aimed to review our institution's outcomes following the Sistrunk procedure, specifically the rates of wound complications and cyst recurrence. This was a retrospective case series of pediatric patients undergoing the Sistrunk procedure from June 2009 to April 2021. A total of 273 patients were included. Of these, 139 (53%) patients were male and 181 (66%) were white. The average age at the time of surgery was 7.1 years. The overall cyst recurrence rate was 11%. The most common wound complications were seroma (14%) and surgical site infections (SSIs) (12%). Wound complications were associated with prior history of cyst infection (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.07-3.60, z-test 2.2, p = .03). Pediatric surgery was associated with fewer wound complications (OR 0.18; 95% CI 0.05-0.6, z-test -2.78, p = .005). However, pediatric surgery operated on fewer patients with a history of cyst infection (36% vs. 55%, p = .012). Drain placement and postoperative antibiotics did not affect rates of wound complications. Prior cyst infection is associated with increased rates of postoperative wound complications. Postoperative antibiotics and drain placement did not significantly affect complication rates. 4.

Retromuscular drain output at removal does not influence adverse outcome rate in open ventral hernia repairs.

Retromuscular drains are commonly placed during retromuscular hernia repair (RHR) to decrease postoperative wound complications and help mesh in-growth. Drains are traditionally removed when output is low but the relationship between drain output at the time of removal and postoperative complications has yet to be delineated. This study aimed to investigate outcomes of RHR patients with drain removal at either high or low output volume. An institutional review board-approved retrospective chart review evaluated adult patients undergoing open RHR with retromuscular drain placement between 2013 and 2022 at a single academic medical center. Patients were stratified into low output drainage (LOD, < 50mL/day) or high output drainage (HOD, ≥ 50mL/day) groups based on volume on the day of drain removal. We identified 336 patients meeting inclusion criteria: 58% LOD (n = 195) and 42% HOD (n = 141). Demographics and risk factors pertaining to hernia complexity were similar between cohorts. Low-drain output at the time of removal was associated with a significantly longer drain duration (6.3 ± 4.5 vs. 4.4 ± 1.6days, p < 0.001) and postoperative hospital stay (5.9 ± 3.6 vs. 4.8 ± 2.8days, p < 0.001). With a 97% 30-day follow-up, incidence of surgical site occurrence (SSO) was not statistically different between groups (29.2% LOD, 26.2% HOD, p = 0.63). Surgical site infection and SSO requiring procedural intervention was also not statistically significant between cohort. At 1-year follow-up, hernia recurrence rates were the same between groups (4.2% LOD, 1.4% HOD, p = 0.25). Following open ventral hernia repair with retromuscular mesh placement, the rate of postoperative wound complications was not statistically different based on volume of drain output day of removal. These results suggest that removing drains earlier despite higher output is safe and has no effect on short- or long-term hernia outcomes.

First Results of the Primary Outcome of a Phase II Prospective Clinical Trial to Assess the Feasibility of Preoperative Radiation Boost in Breast Cancer Patients

A radiation boost targeted at the tumor bed is an important component of breast-conserving therapy (BCT) and has been shown to improve outcomes in patients with early-stage breast cancer. This is a prospective phase II study (NCT04871516) to assess the feasibility of delivering the radiation boost pre-operatively. This approach allows more accurate targeting of the high radiation dose at the tumor that may spare more normal breast tissue. We hypothesize wound complication rates to be comparable to standard treatment. The study design was a prospective phase II with a planned accrual of 55 patients. Women with non-metastatic node negative breast cancer or DCIS who were eligible for BCT were included. Patients were treated with pre-operative radiation boost of 1332 cGy in 4 fractions, followed by lumpectomy and adjuvant hypofractionated whole breast radiation to 3663 cGy in 11 fractions. The primary outcome of the study was to demonstrate that the incidence of grade 3 or more wound complications was not inferior to the current standard of care with conventional lumpectomy, postoperative whole breast radiation and a postoperative boost (6- 20%). Secondary outcomes included cosmetic outcome, local-regional control, and immunologic biomarkers induced by the preoperative radiation boost. We report here the results of the primary outcome of the study. Fifty-five women were enrolled between June 2021 and October 2022. Of those, 48 patients had at least 1 month follow up and were included in the analysis. Median age was 64 years-old, (range 40-77). Median follow up time was 2 months, (range 1-15). Forty-three patients (90%) had invasive cancers and 5 (10 %) had DCIS. Median clinical tumor size was 13 mm, (range 5-26). Median pathologic tumor size was 9 mm, (range 0-27). Margins were negative in 47 patients (98%). Two patients were found to have node positive disease on final pathology. Grade 3 wound dehiscence requiring surgical revision occurred in one patient (2%). There were no other grade 3 adverse side effects reported. Three patients (6%) had grade 2 wound infections requiring antibiotics. Cosmetic outcome at 1st follow up was available for 45 patients and was very good or excellent in 39 patients (87%). No patient had a poor cosmetic outcome. The use of a pre-operative radiation boost prior to lumpectomy followed by whole breast radiation as administered in this prospective trial resulted in an acceptable primary outcome with a similar rate of post-operative wound complications as the standard of care. We are currently enrolling patients on an expansion cohort to assess longer term cosmetic outcomes and performing a panel of immunologic markers to assess immune response to the preoperative boost.

Implementation Science in Surgery: Translating Outcomes to Action.

Implementation Science in Surgery: Translating Outcomes to Action.

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.

Evaluating the retro-auricular incision versus reversed question mark incision and Kempe's 'T-bar' incision for decompressive hemicraniectomy

BackgroundThe proper decompression for hemicraniectomy depends on intraoperative surgical technique, so the skin incision, on the other hand, is an important variable throughout hemicraniectomy, and there are a variety of cutaneous incisions, including the Kempe T shaped, the reversed question mark and the retro-auricular incisions. We aim to compare those three types of incisions and assess their effects on the surgical outcomes regarding the skull defect size, survived beyond 1 week, post-operative complications and mortality rates.ResultsA retrospective study included 180 patients were separated into three age- and sex-matched groups according to the type of incision used for their hemicraniectomy. Data including age, sex, causes of surgery, comorbidities, the incision type, the defect area of the skull, intraoperative time and estimated blood loss were recruited for all patients. The mortality and morbidity rates at 3 months post-surgery were documented for all patients. There was a significant difference in the operative time, and the intraoperative measures of blood loss, and insignificant differences in the surviving rate after 1-week post-surgery among the three group patients. There were significant differences between the first and third patient groups compared to the second group regarding wound complications, while the first and third groups were comparable.ConclusionsThe retro-auricular incision is a safe preferable substitute for the reversed question mark and Kempe T-shaped incisions in decompressive hemicraniectomy, due to the better blood flow maintaining, lower rate of post-operative wound complications.

Outcomes with culture-directed antibiotics following microvascular free tissue reconstruction for osteonecrosis of the jaw

ObjectivesRadiation (ORNJ) and bisphosphonate-related (BRONJ) osteonecrosis of the jaw represent challenging entities to treat, with many patients requiring segmental resection and reconstruction with microvascular free tissue transfer (MFTT) in the setting of failed conservative therapy. Microvascular reconstruction is associated with higher post-operative complication rates when performed for advanced osteonecrosis versus oncologic defects. We hypothesize that basing antibiotic therapy on cultures obtained from the healthy bone marrow following resection during MFTT for ORNJ or BRONJ reduces rates of post-operative wound and surgical complications. Materials and methodsIn a retrospective cohort study spanning January 2016 to October 2018, 44 patients undergoing MFTT for ORNJ or BRONJ were identified. Patients were categorized into two cohorts: residual healthy marrow culture (n = 11; RHM), treated with antibiotics guided by cultures from healthy appearing mandible, and all others (n = 33; AO), treated with antibiotics guided by cultures from resected necrotic bone or purulent drainage. Patient, reconstruction, and outcome variables were compared via appropriate statistical tools. Results81.8% of the RHM cohort versus 24.2% of the AO cohort received long-term IV antibiotics. Rates of post-operative wound complications, including those necessitating operative management, were significantly lower in the RHM cohort. Rates of flap failure were similar across both groups. ConclusionAdministration of long-term IV antibiotics directed by native mandible cultures may decrease complication rates following MFTT for ORNJ or BRONJ by treating residual, smoldering infection. Concurrently, transplantation of well-vascularized free tissue likely improves antibiotic delivery. Findings are crucial for the development of a standardized treatment algorithm following microvascular reconstruction for advanced osteonecrosis.

Closed Incision Negative Pressure Therapy vs Standard of Care Dressing in Breast Surgery: A Systematic Review.

The implementation of closed incision negative pressure therapy (CINPT) is widely seen in many surgical subspecialties including orthopaedics, vascular surgery, and abdominal surgery. However, research on its use in breast surgery is still in its infancy. We conducted a systematic review on the use of CINPT vs standard of care dressings (SOC) in wound management of post-operative breast surgery.A literature search was conducted on PubMed, MedLine, and Google Scholar for studies that compared CINPT against SOC. Seven studies were included in this systematic review. The results of our systematic review have shown that CINPT has a positive outcome in reducing post-operative wound complication rates as compared to SOC dressings (commonly Steri-Strips and waterproof dressings), which was 1-8% vs 1-30% in CINPT and SOC, respectively. Furthermore, CINPT has the potential to confer additional cost-savings of up to USD218 per patient for a health institution with regards to reduced complications rates that might have required extended management.The use of CINPT in breast surgery remains highly promising. It has many advantages over SOC, including better wound outcomes and added cost savings. Further studies are required to delineate the potential benefits in different sub-sets of patients.

Enhanced recovery after surgery pathway: association with lower incidence of wound complications and severe hypoalbuminemia in patients undergoing posterior lumbar fusion surgery

BackgroundWound complications are associated with worse satisfaction and additional costs in patients undergoing posterior lumbar fusion (PLF) surgery, and the relationship between enhanced recovery after surgery (ERAS) pathway and wound complications remains poorly characterized.MethodsIn this retrospective single-center study, we compared 530 patients receiving ERAS pathway care with previous 530 patients in non-ERAS group. The primary aim of our study was to identify the relationship between the ERAS program and the incidence of postoperative wound-related complications and other complications following PLF surgery; other outcomes included the length of stay (LOS), 90-day hospital and rehabilitation center readmission.ResultsThe average patient age was 65 yr. More patients with old cerebral infarction were in ERAS group (p < 0.01), and other demographics and comorbidities were similar between groups. Patients in the ERAS group had a lower incidence of postoperative wound-related complications than the non-ERAS group (12.4 vs. 17.8%, p = 0.02). The non-ERAS group had a significantly higher rate of wound dehiscence or poor wound healing (6% vs. 3%, p = 0.02). ERAS group had a lower incidence of severe postoperative hypoalbuminemia (serum albumin less than 30 g/L) (15.8% vs. 9.0% p < 0.01). Additionally, ERAS patients had shorter postoperative LOS (8.0 ± 1.5 vs. 9.5 ± 1.7, p < 0.01), lower rate of readmission within 90 days (1.9% vs. 6.4%, p < 0.01) and discharge to rehabilitation center (4.2% vs. 1.0%, p < 0.01).ConclusionERAS pathway might help decrease the rates of postoperative wound complications and severe hypoalbuminemia following PLF surgery; additionally, it demonstrated that ERAS pathway was also associated with shorter LOS and lower rate of readmissions within 90 days.

Plastic surgery wound closure following resection of spinal metastases

ObjectiveSurgical site infection and dehiscence are devastating complications of surgery for spinal metastases. Wound closure involving plastic surgeons has been proposed as a strategy to lower post-operative complications. Here we investigated whether plastic surgery closure is associated with lower rates of wound complications, wound infection, and wound reoperation compared to simple closure by spine surgeons. MethodsPatients surgically treated for metastatic tumors at a single comprehensive cancer center between April 2013–2020 were retrospectively identified. Primary pathology, demographic information, clinical characteristics, pre-operative laboratory values, tumor location, operative characteristics, and post-operative outcomes were collected. Univariable analyses used student t-tests for continuous variables and χ2 tests for categorical variables. Multivariable regressions were performed to control for confounders. ResultsWe included 317 patients, of which 56 underwent closure by plastic surgeons and 291 by neurosurgeons. Patients in the plastic surgery cohort were more likely to have received prior radiation to the surgical site, more often on long-term corticosteroid therapy, and more likely to have sacrococcygeal tumors. Operations involving plastic surgeons were more likely to be revision surgeries, corpectomies, and to involve a staged approach. Additionally, patients in the plastic surgery cohort had longer incision lengths, longer surgeries, greater intraoperative blood loss (IOBL), were more likely to receive transfusions, and had longer hospitalizations. Local paraspinous advancement flaps were the most common complex wound closure technique. Plastic surgery closure was not significantly associated with a difference in rates of post-operative wound complications, wound infection, or wound-related reoperations compared to simple wound closure. ConclusionWe identified that patients undergoing plastic surgery wound closure had worse baseline risk, longer surgeries, greater IOBL, and longer hospitalizations compared to patients receiving simple closure. Despite their increased risk, complex wound closure did not significantly alter the rates of post-operative wound complications, wound infection, or wound-related reoperations. Consideration may be given to plastic surgery closure in patients at high risk of wound complications or with extensive wound defects.

Negative pressure wound therapy does not decrease postoperative wound complications in patients undergoing mastectomy and flap fixation

Patients and breast cancer surgeons are frequently confronted with wound complications after mastectomy. Negative pressure wound therapy (NPWT) is a promising technique for preventing wound complications after skin closure in elective surgery. However, a clinical study evaluating postoperative complications following the use of NPWT, focusing solely on closed incisions in patients undergoing mastectomy, has yet to be performed. Between June 2019 and February 2020, 50 consecutive patients underwent mastectomy with NPWT during the first seven postoperative days. This group was compared to a cohort of patients taking part in a randomized controlled trial between June 2014 and July 2018. Primary outcome was the rate of postoperative wound complications, i.e. surgical site infections, wound necrosis or wound dehiscence during the first three postoperative months. Secondary outcomes were the number of patients requiring unplanned visits to the hospital and developing clinically significant seroma (CSS). In total, 161 patients were analyzed, of whom 111 patients in the control group (CON) and 50 patients in the NPWT group (NPWT). Twenty-eight percent of the patients in the NPWT group developed postoperative wound complications, compared to 18.9% in the control group (OR = 1.67 (95% CI 0.77–3.63), p = 0.199). The number of patients requiring unplanned visits or developing CSS was not statistically significant between the groups. This study suggests that Avelle negative pressure wound therapy in mastectomy wounds does not lead to fewer postoperative wound complications. Additionally, it does not lead to fewer patients requiring unplanned visits or fewer patients developing clinically significant seromas.Trial registration: ClinicalTrials.gov number, NCT03942575. Date of registration: 08/05/2019.

Real-World Outcomes of Patients Undergoing Open Colorectal Surgery with Wound Closure Incorporating Triclosan-Coated Barbed Sutures: A Multi-Institution, Retrospective Database Study

PurposeOpen colorectal surgery is associated with a high rate of postoperative wound complications. This is a single-arm study of real-world outcomes of triclosan-coated barbed suture (Ethicon’s STRATAFIXTM Symmetric PDSTM Plus Knotless Tissue Control Device [SSPP]) used in open colorectal surgery.MethodsRetrospective cohort study using the Premier Healthcare Database. The study included patients who underwent an inpatient open colorectal surgery with wound closure using SSPP (size 0 or 1 to increase the likelihood the suture was used in fascia) between October 2015–September 2019 (N=593). Wound complications, hospital length of stay, total hospital costs (2019 US$), and all-cause readmissions post-discharge were measured. Post-hoc multivariable analyses compared wound complications between non-elective admissions and elective.ResultsThe overall incidence of wound complications within 30-days post-procedure was 7.1%, with the majority of those being surgical site infections (SSI) (6.0%). Mean operation time was 190 (standard deviation [SD]=64.4) mins, postoperative length of stay was 8.1 (SD=11.9) days, 30-day readmission rate was 11.8%, and total hospital costs were $31,693 (SD=$40,076). As compared with published literature on the rate of SSI in colorectal surgery, the 30-day rate of SSI in the present study (6.0%) fell within the range of 5.4% to 18.2% for open colorectal surgery and from 4.3% to 21.5% for combined open and minimally invasive procedures. Multivariable-adjusted incidence proportions of wound complications were slightly lower for non-elective admissions and did not differ significantly from those of elective admissions.ConclusionThe rate of wound complications observed in the present study falls within the range of rates previously reported in the literature, suggesting a safe and effective role for SSPP in open colorectal surgery. In post hoc analyses, the adjusted rate of wound complications was similar between non-elective and elective admissions. Head-to-head studies are required to determine comparative advantages or disadvantages for SSPP versus other sutures.

The Cost-Effectiveness of Closed Incisional Negative Pressure Wound Therapy for Infection Prevention after Revision Total Knee Arthroplasty.

Recent investigations have shown that closed incisional negative pressure wound therapy (ciNPWT) decreases the rate of postoperative wound complications following revision total knee arthroplasty (TKA). In this study, we used a break-even analysis to determine whether ciNPWT is a cost-effective measure for reducing prosthetic joint infection (PJI) after revision TKA. The cost of ciNPWT, cost of treatment for PJI, and baseline infection rates following revision TKA were collected from institutional data and the literature. The absolute risk reduction (ARR) in infection rate necessary for cost-effectiveness was calculated using break-even analysis. Using our institutional cost of ciNPWT ($600), this intervention would be cost-effective if the initial infection rate of revision TKA (9.0%) has an ARR of 0.92%. The ARR needed for cost-effectiveness remained constant across a wide range of initial infection rates and declined as treatment costs increased. The use of ciNPWT for infection prevention following revision TKA is cost-effective at both high and low initial infection rates, across a broad range of treatment costs, and at inflated product expenses.

Randomised Controlled Clinical Trial of Scalpel Versus Diathermy for Abdominal Skin Incisions

Since the early twentieth century, diathermy has been increasingly used for tissue dissection and haemostasis, but the surgeons, however, are reluctant to use surgical diathermy for making skin incisions. This reluctance is now being challenged by multiple studies suggesting diathermy to be a safer option. This was a randomised, clinical study conducted in the department of General and Gastrointestinal Surgery at Calcutta Medical Research Institute, Kolkata in 2017. The study was done to evaluate the diathermy as an effective alternative to scalpel blade in making skin incisions in elective abdominal surgeries. A total of 72 patients undergoing abdominal surgeries were included and randomly divided into diathermy and scalpel groups. Both groups were compared based on incisional blood loss, early postoperative pain, wound complication rates, and cosmetic outcome of scar by Patient-Observer Scar Assessment Scale. After exclusion, a total of 72 patients, 36 each from the two groups, were analysed based on the above mentioned parameters. We found that the incisional blood loss is significantly lesser in the diathermy group in comparison to that of the scalpel group (p < 0.001). Also, the early postoperative pain was significantly lesser in the diathermy group (p < 0.001). Postoperative wound complication rates were comparable between the two groups, and postoperative scar cosmesis is significantly better with the use of diathermy (p < 0.001). In our study, we found that the diathermy is an effective and safe alternative to the steel scalpel blade for making abdominal skin incisions in elective procedures.

Defining the Scope of Antimicrobial Stewardship Interventions on the Prescription Quality of Antibiotics for Surgical Intra-Abdominal Infections.

Background: The aim of this study was to assess the impact of antimicrobial stewardship interventions on surgical antibiotic prescription behavior in the management of non-elective surgical intra-abdominal infections, focusing on postoperative antibiotic use, including the appropriateness of indications. Methods: A single-center quality improvement study with retrospective evaluation of the impact of antimicrobial stewardship measures on optimizing antibacterial use in intra-abdominal infections requiring emergency surgery was performed. The study was conducted in a tertiary hospital in Germany from January 1, 2016, to January 30, 2020, three years after putting a set of antimicrobial stewardship standards into effect. Results: 767 patients were analyzed (n = 495 in 2016 and 2017, the baseline period; n = 272 in 2018, the antimicrobial stewardship period). The total days of therapy per 100 patient days declined from 47.0 to 42.2 days (p = 0.035). The rate of patients receiving postoperative therapy decreased from 56.8% to 45.2% (p = 0.002), comparing both periods. There was a significant decline in the rate of inappropriate indications (17.4% to 8.1 %, p = 0.015) as well as a significant change from broad-spectrum to narrow-spectrum antibiotic use (28.8% to 6.5%, p ≤ 0.001) for postoperative therapy. The significant decline in antibiotic use did not affect either clinical outcomes or the rate of postoperative wound complications. Conclusions: Postoperative antibiotic use for intra-abdominal infections could be significantly reduced by antimicrobial stewardship interventions. The identification of inappropriate indications remains a key target for antimicrobial stewardship programs.

Outcome of Excision with Primary Midline Closure for Sacrococcygeal Pilonidal Sinus Disease

Sacrococcygeal Pilonidal sinus disease is common chronic inflammatory disease affecting chiefly young adult male . It cause much discomfort and morbidity and affect negatively the quality of life of patients. There are various techniques of surgical treatment for the chronic sinuses but still there is no gold standard one. The aim of this study to report our experience with excision and midline closure technique of chronic Sacrococcygeal Pilonidal sinus disease and to identify the outcome of the procedure for postoperative wound complications and recurrence rate. This is a retrospective study with telephone contact and review of 36 patients operated for Sacrococcygeal pilonidal sinus disease from January 2011 through January 2016 under care of one consultant surgeon (the Author) in Public and Private Hospitals in Rania, Sulaimani, Iraq. Inclusion criteria was all patients with chronic midline located sinuses without evidence of acute inflammation. Exclusion criteria was all infected ,off midline located sinuses and recurrent sinuses. Elliptical Excision of the sinuses with primary midline closure over a vacuum drainage performed. End point of this study was rate of wound complications and recurrence of sinus. Thirty six patients with median age 22 years (range 14-40) with 24/12 male /female ratio. Median follow up was 24 months (12 - 66 months), the recurrence occurred in 3/36 ( 8.3%) patients at a median of 12 months (range 5 - 48), failure of treatment in 5/36 (13.9%) patients, and postoperative wound complications was seen in 5/36 ( 13.9%) patients. In the conclusion, excision and primary midline closure is simple, effective and preferable procedure for management of uncomplicated Sacrococcygeal pilonidal sinus disease associated with early wound healing and low rate of postoperative wound complications and recurrence rate.

Cesarean wound closure in body mass index 40 or greater comparing suture to staples: a randomized clinical trial

Cesarean delivery is the most common major surgical procedure performed in the United States. Women with class III obesity have an increased risk of cesarean delivery and have wound complication rates higher than healthy body mass index counterparts. Available evidence regarding optimal wound closure is lacking specific to the population of women with class III obesity despite a known increased rate of wound complications. This study aimed to compare rates of postoperative wound complications among women with class III obesity (body mass index of ≥40 kg/m2) undergoing cesarean delivery with skin closure by either subcuticular suture or surgical staples. Patients were randomly assigned to skin closure by nonabsorbable stainless steel surgical staples or subcuticular suture of the surgeon's choice at the time of cesarean delivery at 2 university hospitals. Randomization was stratified for scheduled vs unscheduled cesarean delivery and for the 2 study sites. The primary outcome was the rate of any documented wound complication during the first 6 weeks after delivery. Any predictors of the composite outcome that in univariate analysis had a P<.20 were entered into a forward logistic regression. Sample size was calculated based on published literature and estimating the rate of wound complications within 6 weeks of follow-up at 20% with staples and 10% with sutures. For a power of 0.80 with a 2-tailed of 0.05, a total of 199 participants per group were required. From September 2015 to May 2019, 232 women were randomized to staples (n=117) or sutures (n=115). Nearing the planned interim analysis, enrollment in the study was concluded administratively owing to low enrollment. With loss to follow-up and exclusions, a total of 90 women were analyzed in each group. In the suture group, one-third was closed with braided suture and two-thirds were closed with monofilament suture. Median staple removal was 5 days postoperatively. Fewer composite wound complications were noted in the surgical staples group than the subcuticular suture group (20.0% vs 27.6%), although this difference was not statistically significant (P≥.5). The rate of surgical site infection was significantly lower in the staples group (10.5% vs 22.7%; P=.041). In the multiple logistic regression, the 3 significant independent predictors of the outcome were body mass index (odds ratio, 1.08; P=.004), scheduled vs unscheduled cesarean delivery (odds ratio, 0.40; P=.018), and study site (odds ratio, 0.36; P=.028). Surgical staples or subcuticular suture for skin closure at the time of cesarean delivery in women with a body mass index of ≥40 kg/m2 resulted in similar composite wound complication rates; however, lower cesarean wound infection rates were noted among wounds closed with staples.