Risk Factors For Postoperative Infection Research Articles

Infection of surgery for bone and soft tissue sarcoma with biological reconstruction: Data from the Japanese nationwide bone tumor registry

BackgroundAlthough biological reconstruction (such as recycled autograft, vascularized autograft, allograft, or bone transport) is possible for bone defects after malignant bone or soft tissue tumor resection, a high incidence of postoperative complications, including infection, poses a problem. The difficulty in accumulating cases has resulted in a lack of reliable etiological information, such as the incidence and risk factors of postoperative infections. MethodsWe conducted a retrospective study on the nationwide registry data. The primary endpoint was the need for additional surgical intervention for infection control. The overall incidence of postoperative infection and the related risk factors were analyzed. ResultsWe included 707 malignant bone and soft tissue tumors with biological reconstruction, including recycled autograft, vascularized autograft, allograft, bone transport, and combinations of these. The incidence of postoperative infection was 10.8%. Patients reconstructed by pedicled autograft showed a higher incidence of infection, while cases involving the combination of recycled and pedicled autograft or allograft showed a lower incidence. Independent risk factors for infection included age over 17, tumor diameter over 10 cm, the tumor located on the trunk or being high grade, reconstruction by pedicled autograft, and delayed wound healing. ConclusionInfection incidence was comparable to those in previous reports. Several conventional and novel risk factors were extracted by administering nationwide registry data. Data from the nationwide registry was informative for analyzing the incidence of postoperative infection in biological reconstruction with malignant bone and soft tissue tumor resection.

Integra® Dermal Regeneration Template in Complex Scalp Reconstruction.

Background/Objectives: The need for surgical reconstruction of scalp defects following the excision of cutaneous skin cancers is an increasingly common procedure. Particular challenges arise when considering options for reconstruction of large defects not amenable to local skin flap coverage. The use of skin grafts poses the risk of donor site morbidity. This paper investigates the emerging use of Integra®, a synthetic acellular dermal regeneration template, as an alternative or adjunct to skin grafting in scalp reconstruction. Methods: The study presents a retrospective analysis of 101 patients who underwent Integra®-based reconstruction of scalp defects. Demographics, procedure details, complications, need for further surgery, and time to healing were evaluated. Results: The overall success rate of the one-stage Integra®-only procedure was 95%, with a minor complication rate of 30.7%. Anticoagulation medication was identified as an independent risk factor for post-operative infection, while previous head and neck radiotherapy and increased defect depth were associated with the requirement for a second-stage skin graft. Conclusions: These findings support the consideration of Integra® as a safe and viable alternative for both partial and full thickness scalp defects in a select cohort of complex highly co-morbid patients, reducing complications and the need for additional procedures.

The impact of diabetes on postoperative infections in colorectal cancer: A meta-analysis

Objective: This study aims to analyze and summarize the evidence concerning the relationship between diabetes and postoperative infections in colon cancer through a literature review. Methods: A comprehensive search was conducted on Chinese databases, including CNKI, VIP, Wanfang, and the biomedical literature database, as well as the English database PubMed. The search covered the period from February 1, 2003, to February 28, 2023. The Newcastle-Ottawa Scale was employed to score the included literature, and funnel plots along with Eggers regression test were used to analyze publication bias. Stata 12.0 was utilized for the analysis of the collected raw data. Results: Following inclusion and exclusion criteria, this study incorporated seven retrospective studies, with a total of 4607 cases in the infection group and 9102 cases in the non-infection group. The quality scores of the seven studies ranged between 7 and 8 points. Funnel plot and Eggers regression test analyses revealed no significant publication bias in the included literature. A correlation was identified between diabetes and postoperative infections in colon cancer, implicating diabetes as a risk factor for such infections. Subgroup analysis indicated that nationality, surgical methods, and infection types had no significant impact on the meta-analysis results. Conclusion: The analysis revealed a significant correlation between diabetes and postoperative infections in colon cancer. Diabetes emerged as a risk factor for postoperative infections, with odds ratios (OR) of 3.82 (P0.1) and 95% CI of 2.91-5.01. Controlling blood glucose levels was associated with a reduced risk of postoperative infections in colon cancer.

Risk factors analyses associated with postoperative infection in choledochoscopy for intrahepatic bile duct stones (IHDs): a single-center retrospective study in real-world setting.

Choledochoscopy is a highly effective approach for managing intrahepatic bile duct stones (IHDs). However, postoperative infection is a common complication that significantly impacts treatment outcomes. Despite its clinical relevance, the risk factors associated with this procedure remain largely unexplored. This study focused on a consecutive cohort of patients who underwent choledochoscopy for IHDs at our institution between January 2016 and December 2022. The primary objective was to analyze the relationship between various clinical factors and postoperative infection, and to compare the postoperative infection of different choledochoscopic procedures. The study cohort consisted of 126 patients, with 60 individuals (47.6%) experiencing postoperative infection. Notably, preoperative biliary obstruction (odds ratio [OR] 1.861; 95% confidence interval [CI] 1.314-8.699; p = 0.010) and operation time (OR 4.414; 95% CI 1.635-12.376; p = 0.004) were identified as risk factors for postoperative infection. Additionally, biliary tract infections (60.00%) were primarily responsible for postoperative infection, with Escherichia coli (47.22%) being the predominant bacterial strain identified in bile cultures. Furthermore, biliary tract obstruction (OR 4.563; 95% CI 1.554-13.401; p = 0.006) and body mass index (BMI) (OR 1.186; 95% CI 1.015-1.386; p = 0.031) were determined to be independent risk factors for postoperative biliary tract infection. The occurrence of postoperative infection in patients undergoing choledochoscopy was primarily associated with the duration of the operation and the presence of preoperative biliary obstruction.

Risk Factors for Postoperative Infections Following Appendectomy of Complicated Appendicitis: A Meta-analysis and Retrospective Single-institutional Study.

Patients with complicated appendicitis have an increased risk for postoperative infections. Potential risk factors for postoperative infections through a meta-analysis and retrospective chart review are discussed. A meta-analysis consisting of 35 studies analyzing complicated appendicitis treated with an appendectomy noting at least 1 postoperative infection was performed. A retrospective review was then conducted in patients diagnosed with complicated appendicitis after appendectomy. Of 5326 patients in total, 15.4% developed postoperative infections. Laparoscopic surgery and perioperative hyperoxygenation were found to be protective factors for the development of infection. Retrospectively, 53.2% of patients presented with complicated appendicitis. Patients with complicated appendicitis were more likely to be older in age and have an increased length of stay. Patient demographics, operative time, and comorbid status had no effect on postoperative infection or readmission rate. Physicians should strongly consider minimally invasive techniques to treat all cases of complicated appendicitis irrespective of comorbidities, age, sex, or body mass index.

Do We Need Routine Postoperative Prophylactic Oral Antibiotics in Elective Foot and Ankle Surgery?

Previous studies about antibiotic prophylaxis in foot and ankle surgery have focused on perioperative intravenous administration, with few studies reporting on the efficiency of postoperative oral antibiotics. The purpose of this study is to investigate differences in the rate of postoperative infection and wound complications between patients with and without postoperative oral antibiotics and to identify independent risk factors for these complications following foot and ankle surgeries. A retrospective review of all elective foot and ankle surgeries with at least a 6-month follow-up was performed over a 2-year time span. Patients were divided into 2 groups based on if they received postoperative oral antibiotics. We compared the rates of postoperative infections and wound complications between the 2 groups. The surgical site, the number of Current Procedural Terminology codes, and the number of surgical incisions were also noted. Multivariable logistic regression analysis was performed to identify independent risk factors of postoperative infection and wound complications. A total of 366 patients were included in this study-240 with antibiotics and 126 without antibiotics. There was no significant difference in the rates of postoperative infection and wound complications between the 2 groups. The rate of superficial infection, deep infection, and wound complications was 1.7%, 0.8%, and 5.8% in the antibiotic group vs 3.2%, 0.0%, and 4.0% in patients without antibiotics, respectively. Multivariable logistic regression analysis identified independent risk factors of postoperative infection and wound complications as follows: smoking (OR: 4.7), male (OR: 4.0), history of neoplasm (OR: 6.7), and multiple incisions (OR: 4.1). Our results suggest that routine postoperative prophylactic oral antibiotics are not needed following elective foot and ankle surgeries. However, certain risk factors may increase the risk for postoperative infection and wound complications in foot and ankle surgery. Level III, case-control study.

Risk Factors of Postoperative Infection in Newborns with Congenital Heart Disease.

This study aims to explore the risk factors of postoperative infection in newborns with congenital heart disease. From January 2019 to January 2023, 78 neonates with congenital heart disease who were diagnosed and treated in our hospital with postoperative infection as well as an age- and sex-matched non-infected group (n = 78) were enrolled. After collecting the data and clinical information of 156 children, we compared the differences in the days of catheter indwelling, days of mechanical ventilation, times of blood transfusion, days of intensive care unit (ICU) stay, and survival status between postoperative infection and non-infection groups. Multivariate logistic regression was used to analyze the risk factors of postoperative infection in newborns with congenital heart disease. Age (11 ± 4 vs. 10 ± 5 days) and sex (56.4% vs. 52.6%) were comparable between the infection and non-infection groups. Children in the infection group had lower birth weight, higher proportion of cesarean section, lower oxygen saturation levels, and higher risk adjustment in congenital heart surgery (RACHS-1) scores than those in the non-infection group. In terms of postoperative indicators, neonates in the infection group had longer catheter indwelling time, mechanical ventilation time, ICU hospitalization days, and more blood transfusion times than those in the non-infection group. Multivariate logistic regression analysis showed that oxygen saturation <85% (OR: 6.5; 95% CI: 3.7-15.4), catheter indwelling days >14 days (OR: 3.2; 95% CI: 2.1-10.7), and ICU stay >10 days (OR: 7.1; 95% CI: 3.6-18.5) were independent risk factors for postoperative infection in newborns with congenital heart disease. Low oxygen saturation, prolonged catheterization days, and prolonged ICU stay were independent risk factors for postoperative infection in neonates with congenital heart disease undergoing cardiac surgery.

Postoperative infection after ureterorenoscopic lithotripsy in Songkhla Hospital

Objective: Ureterorenoscopic lithotripsy (URSL) is the procedure of choice for treatment of ureteral stones. Postoperative acute pyelonephritis (APN) is a serious complication after URSL which may potentially progress to urosepsis and death. In this study we aimed to explore and record potential predictive factors associated with postoperative APN after URSL. Materials and Methods: Ninety patients (2016-2022) with ureteral stone managed with URSL were identified. Postoperative APN was defined in patients with a body temperature &gt; 38 °C which persisted for at least 48 hours after URSL with clinical symptoms and/or urine culture was positive for organism growth. Multivariable analysis with logistic regression was used to identify predictive factors for postoperative APN. Results: Seven patients (7.8%) experienced postoperative APN and six patients (85.7%) developed systemic inflammatory response syndrome. All patients were managed conservatively with selective antibiotics, specifically treated with meropenem (n = 3), piperacillin/tazobactam (n = 3), and imipenem/cilastatin (n = 1). Most patients with postoperative APN were women (5/7 patients, 71.4%). The median age of the seven postoperative APN patients was 57.6 vs 54 years (p = 0.48) and the hospital stay was longer 5 vs 2 days, (p &lt; 0.01). Preoperative APN was found in 12 patients (13.3%) and six patients (50%) developed perioperative APN. The multivariable analysis, showed that the only independent factor of postoperative APN was a history of preoperative APN Conclusion: Postoperative infection is a serious condition after URSL that can increase the risk of morbidity and mortality. A single significant risk factor for postoperative infection was a history of preoperative APN. These patients should receive rigorous postoperative care to avoid serious complications.

Risk factor analysis for infection and bleeding after lateral decubitus percutaneous nephrolithotomy.

This study aimed to explore the risk factors for infection and bleeding after lateral decubitus percutaneous nephrolithotomy procedures to prevent their occurrence and improve surgical outcomes. A retrospective analysis was conducted on 356 patients who underwent lateral decubitus percutaneous nephrolithotomy for the treatment of kidney stones and upper ureteral stones from January 2015 to August 2022. Among them, 290 patients had complete clinical data. General clinical data, perioperative data, and stone characteristics were collected for each patient. Univariate and multivariate logistic regression analyses were performed to identify risk factors for infection and bleeding after lateral decubitus percutaneous nephrolithotomy. The postoperative infection rate after lateral decubitus percutaneous nephrolithotomy was 19.31%, and the postoperative bleeding rate was 12.07%. Independent risk factors for postoperative infection were multiple stones (P < .001), stone size (P < .001), and stone co-infection (P = .012). Independent risk factors for postoperative bleeding were multiple stones (P = .008) and stone size (P = .014). Multiple stones, stone size, and stone co-infection are independent risk factors for postoperative infection after lateral decubitus percutaneous nephrolithotomy. Multiple stones and stone size are independent risk factors for postoperative bleeding after lateral decubitus percutaneous nephrolithotomy.

Incisional negative pressure wound therapy may not protect against post-operative surgical site complications in bicondylar tibial plateau fractures.

To determine if incisional negative pressure wound therapy is protective against post-operative surgical site complications following definitive fixation of bicondylar tibial plateau fractures. A retrospective analysis of patients diagnosed with an acute bicondylar tibial plateau fracture (AO/OTA 41-C) undergoing ORIF from 2010 to 2020 was performed. Patients received either a standard sterile dressing (SD) or incisional negative pressure wound therapy (iNPWT). Primary outcomes included surgical site infection, osteomyelitis, and wound dehiscence. Secondary outcomes included non-union and return to the operating room. Multivariate logistic regression analyses were performed. 180 patients were included and 22% received iNPWT (n = 40) and 78% received standard dressings (n = 140). iNPWT was more common in active smokers (24.7% vs. 19.3%, p = 0.002) and the SD group was more likely to be lost to follow up (3.6% vs. 0%, p = 0.025). iNPWT was not protective against infection or surgical site complications, and in fact, was associated with higher odds of post-operative infection (OR: 8.96, p = 0.005) and surgical site complications (OR:4.874, p = 0.009) overall. Alcohol abuse (OR: 19, p = 0.005), tobacco use (OR: 4.67, p = 0.009), and time to definitive surgery (OR = 1.21, p = 0.033) were all independent risk factors for post-operative infection. In this series of operatively treated bicondylar tibial plateau fractures, iNPWT did not protect against post-operative surgical site complications compared to conventional dressings. Tobacco use, alcohol abuse, and time to definitive surgery, were independent risk factors for post-operative infection. Further studies are needed to determine if iNPWT offers a protective benefit in exclusively high-risk patients with relevant medical and social history.

Factors influencing the surveillance of re-emerging intracranial infections in elective neurosurgical patients: A single-center retrospective study.

At present, many studies have reported the risk factors for postoperative intracranial reinfection, including age, sex, time to surgery, duration of postoperative catheterization, emergency procedures, type of disease and cerebrospinal fluid leakage, but the academic community has not reached a unified conclusion. To find factors influencing the surveillance of re-emerging intracranial infections in elective neurosurgical patients. Ninety-four patients who underwent elective craniotomy from January 1, 2015 to December 31, 2022 in the Department of Neurosurgery, First Hospital of Jilin University, were included in this study. Of those, 45 patients were enrolled in the infection group, and 49 were enrolled in the control group. The clinical data of the patients were collected and divided into three categories, including preoperative baseline conditions, intraoperative characteristics and postoperative infection prevention. The data were analyzed using SPSS 26.0 software. There were 23 males and 22 females in the infection group with a mean age of 52.8 ± 15.1 years and 17 males and 32 females in the control group with a mean age of 48.9 ± 15.2 years. The univariate analysis showed that the infection group had higher systolic blood pressures and postoperative temperatures, fewer patients who underwent a supratentorial craniotomy, more patients with a history of hypertension and higher initial postoperative white blood cell counts than the control group, with statistically significant differences (P < 0.05). The multifactorial logistic regression analysis showed that a history of hypertension and a high postoperative body temperature were independent risk factors for postoperative infection in neurosurgical patients. The results obtained in this study indicated that a history of hypertension and a high postoperative body temperature were independent risk factors for postoperative neurological symptoms.

Risk factors for postoperative infection after bilateral sagittal split ramus osteotomy: A retrospective analysis

BackgroundThis retrospective clinical study investigated risk factors for infection following bilateral sagittal split ramus osteotomy (BSSO) as orthognathic surgery, including the patients' general condition, local factors, and surgical factors. Patients and methodsThe cases of 160 mandibular sites of 80 Japanese patients (26 males, 54 females; mean ± SD age: 25.3 ± 7.7 years, range 16–55 yrs) with a jaw deformity who underwent BSSO orthognathic surgery at our Department of Oral and Maxillofacial Surgery between Jan. 2017 and Dec. 2022 were analyzed. Potential risk factors were classified as clinical predictive variables. Descriptive and univariate statistics were computed. A multivariate analysis was performed with logistic regression. ResultsFifteen mandibular sites (9.4 %) were complicated with postoperative infection. The multivariate analysis revealed significant differences in facial asymmetry (OR 24.0, p = 0.0002) and the amount of mandibular movement (OR 0.664, p = 0.011) between the sites with and without infection. ConclusionsAmong clinical variables, facial asymmetry was the strongest risk factor for post-BSSO infection, followed by the amount of mandibular movement.

Risk factors for postoperative infections in esophageal tumor patients

Postoperative infections (PI) are a serious complication after esophageal cancer surgery, as they might be correlated with an elevated risk of death. While several reports discuss risk factors for PI in esophageal tumor surgery, there is a limited amount of research on overall postoperative infections. Therefore, investigating the factors that influence PI holds great clinical significance. We retrospectively reviewed surgical data from a cohort of 902 patients diagnosed with esophageal tumors. The study included esophageal cancer patients treated in the Department of Thoracic Surgery at Anyang Tumor Hospital from January to December 2021. Preoperative and operative risk factors for PI were evaluated using univariable and multivariable analyses. The overall incidence of PI was 28.3% (255/902). Multivariable logistic regression analysis revealed that smoking and preoperative hospital stays are significant risk factors for PI after esophageal tumor surgery. Smoking and preoperative hospital stays are identified as risk factors for PI following esophageal tumor surgery. Based on our results, we predict that certain groups of patients may have a higher risk of PI following esophageal tumor surgery. Preventive measures or closely monitor of these patients may be required to reduce the incidence of postoperative PI.

Influence and risk factors of postoperative infection after surgery for ischemic cardiomyopathy.

Studies on postoperative infection (POI) after surgery for ischemic cardiomyopathy are still lacking. This study aimed to investigate the risk factors of POI and its influence on clinical outcomes in patients undergoing ischemic cardiomyopathy surgery. The Surgical Treatment for Ischemic Heart Failure (STICH) trial randomized patients with ischemic cardiomyopathy [coronary artery disease (CAD) with left ventricular ejection fraction ≤35%] to surgical and medical therapy. In this study, a post hoc analysis of the STICH trial was performed to assess the risk factors and clinical outcomes of POI in those undergoing coronary artery bypass graft (CABG). Patients were divided according to whether POI developed during hospitalization or within 30 days from operation. Of the 2,136 patients randomized, 1,460 patients undergoing CABG per-protocol was included, with a POI rate of 10.2% (149/1,460). By multivariable analysis, POI was significantly related to patients' age, body mass index, depression, chronic renal insufficiency, Duke CAD Index, and mitral valve procedure. Compared to patients without POI, patients with POI had significantly longer durations of intubation, CCU/ICU and hospital stay, and higher rates of re-operation, in-hospital death and failed discharge within 30 days postoperatively. In addition, these patients had significantly higher risks of all-cause death, cardiovascular death, heart failure death, and all-cause hospitalization during long-term follow-up. However, the influence of POI on all-cause death was mainly found during the first year after operation, and the influence was not significant for patients surviving for more than 1 year. POI was prevalent after surgery for ischemic cardiomyopathy and was closely related to short-term and long-term clinical outcomes, and the effect of POI mainly occurred within the first postoperative year. This study first reported and clarified the relationship between POI and long-term prognosis and the predictors for POI after surgery for ischemic cardiomyopathy worldwide, which may have certain guiding significance for clinical practice. https://www.clinicaltrials.gov, identifier (NCT00023595).

Risk Factors for Postoperative Infections in Cardiac Surgery Patients: A Retrospective Study.

Background and objective Cardiac surgery is one of the most common surgical proceduresglobally; its incidence has been on the risedue to the faster pace ofpopulation aging thanks to technological and epidemiological advances. Patients who undergo cardiac surgeriesmayface various postoperative complications that might affect their survival, and one of these major complicationsis infection. Nosocomial pneumonia, surgical site infection (SSI), mediastinitis, bacteremia, and sepsis are common infections encountered after surgeries. In this study, we aimed to determine the common risk factors related to postoperative infections at the King Faisal Cardiac Center from January 2014 to September 2020. Materials and methods Records from 364 patients who underwent cardiac surgery and were aged above 18 yearswere assessed for postoperative infections in this retrospective cohort study. Patients who were immunosuppressed or had active systemic infections were excluded. Consent was waived by the Institutional Review Board. All procedures were performed at the King Faisal Cardiac Center, National Guard Hospital, Jeddah. Results Of the total 364 patients,105 were women and 259 were men. The mean age of the cohort was 59 years (SD = 13) and the mean BMI was 29.1 kg/m2 (SD = 5.3). The study population showed a high prevalence of cardiac risk factors and diseases: diabetes (n = 244, 67%), hypertension (n = 230, 63%), dyslipidemia (n = 144, 40%), smoking (n = 80, 22%), heart failure (n = 41, 11%), and chronic obstructive pulmonary disease (n = 6, 1.6%). The overall rate of postoperative infection was 32.7% (n = 120), and 17 (14%) of these infected patients underwent reoperations for infection. Conclusion Based on a thorough analysis of 364 patients undergoing various cardiac surgical procedures, including a multivariate analysis accounting for preoperative factors, there was a significant association between postoperative infections and hypertension, diabetes, increased preoperative activated partial thromboplastin time, and elevated HbA1c.

Retracted: Efficacy of Super-Mini-PCNL and Ureteroscopy in Kidney Stone Sufferers and Risk Factors of Postoperative Infection.

[This retracts the article DOI: 10.1155/2022/4733329.].

Risk factors for the occurrence of infection in patients with oral squamous cell carcinoma after restorative reconstruction and its impact on recurrence and quality of life: a retrospective cohort study.

Worldwide, there are approximately 300,000 new cases of oral squamous cell carcinoma (OSCC) and 100,000 deaths each year. The complexity of oral and maxillofacial structures leads to a high risk of surgical infection such as radical tumor resection and free flap reconstruction. Previous studies have shown that diabetes mellitus, previous radiotherapy, oral-neck communication, etc. are risk factors for postoperative infection, but the influence of time on prognosis has not been clarified in detail. This study supplements this aspect and provided a reference for improving the quality of life of patients. We retrospectively analyzed a total of 168 patients who developed OSCC from July 2014 to September 2019. According to the inclusion and exclusion criteria of this study, the general data questionnaire designed by ourselves was used to sort out the general characteristics and clinical data of the subjects. The t test, Chi-square test and binary logistic regression were used for statistical analysis. Surgical site infections (SSI) are defined as infections associated with surgical procedures. The quality of life was evaluated by the 36-Item Short Form Survey (SF-36) score. A 3-year follow-up was conducted by telephone, Email and outpatient review. Among the 168 patients, the total number of postoperative infections was 22 (13.1%). Binary logistic regression analysis showed that body mass index (BMI) (OR =0.029, P=0.039), American Society of Anesthesiologists (ASA) classification (OR =21.443, P=0.042), preoperative radiotherapy (OR =19.993, P=0.022), Jaw resection status (OR =29.665, P=0.021), Perioperative transfusion (OR =29.148, P=0.020), preoperative white blood cell count (OR =1.763, P=0.017), albumin level (OR =0.853, P=0.033) were independent influencing factors between the two groups (P<0.05). Except for the social functioning and role-emotional dimensions, all dimensions of SF-36 in patients with infection were significantly lower than those without infection. The incidence of postoperative infection after restorative and reconstructive surgery for OSCC deserves the attention of clinicians. For high-risk infected persons, relevant anti-infection measures should be taken early against the infectious source, and the possibility of nosocomial infection should be attached great importance in clinical work. After discharge, patients should also actively do follow-up, education and other related work to reduce the incidence of postoperative infection.

Risk Factors of Infectious Complications in Pediatric Patients With Cerebral Palsy After Spinal Arthrodesis.

This was a retrospective study. The main objective of this study was to investigate (1) whether pediatric patients with cerebral palsy (CP) have higher rates of postoperative infectious complications after spinal fusion and (2) risk factors for postoperative infections. Prior studies have shown that patients with CP undergo corrective spine surgery more often than the general population, yet typically have worse postoperative outcomes. Further investigation is needed to improve our understanding of the perioperative factors that place children with CP at greater risk of postoperative infectious complications. The 2019 "American College of Surgeons National Surgical Quality Improvement Program" Pediatric database was used for patient data. The univariable analysis compared the prevalence of preoperative comorbidities and perioperative factors between children with and without CP. Multivariable logistic regression modeling was used to ascertain independent risk factors for postoperative infectious complications. A total of 4445 patients were included in the study; 606 (13.63%) patients had CP and 3839 (86.37%) did not. Patients with CP were more likely to have several notable preoperative comorbidities, and the rate of developing any infectious complication was more than 7 times greater in the CP cohort than in the control cohort (14.36% vs 1.88%; P <0.001). Multivariable analysis revealed CP [odds ratio (OR): 3.55, CI: 2.25-5.60; P <0.001], American Society of Anesthesiologists class 3 or higher (OR: 2.10, CI: 1.29-3.42; P = 0.003), and hematologic disorders (OR: 2.01, CI: 1.06-3.83; P = 0.033) to be independent risk factors for increased postoperative infectious complications. CP is an independent risk factor for the development of 30-day postoperative infectious complications in pediatric patients. In addition, the American Society of Anesthesiologists class 3 or higher and hematologic disorders were risk factors for postoperative infections after spinal fusion surgery.

Risk Factors for Postoperative Infection After Maxillary Reconstruction Using Skeletal Grafts.

Skeletal grafts are usually required to reconstruct defects after maxillectomy for acceptable aesthetic and functional results. Postoperative infection is a serious complication; however, few studies have evaluated the vulnerability to infection of various skeletal reconstructive materials used for maxillary reconstruction. A retrospective study was conducted on 53 cases in which maxillary skeletal reconstruction was performed between 2010 and 2021. The postoperative infection rate was compared between various skeletal reconstructive materials, including costal cartilage, scapula, fibula, ilium, cranium, and titanium mesh. In addition, the risk factors for postoperative infection were evaluated using 2-group comparison tests. Of 53 patients, 14 (25.4%) contracted an infection postoperatively. No significant differences were observed in the infection rates among the materials used for skeletal reconstruction. Cases undergoing secondary reconstruction tended to have a higher infection rate (34.4%) than primary reconstruction (14.3%). For nonvascularized skeletal grafts (41 cases), the concomitant use of soft-tissue flaps decreased the infection rate from 30.8% to 17.9%. Costal cartilage was the most frequently used material (31 cases), primarily for orbital floor reconstruction. Regarding the costal cartilage, nasal wall reconstruction had a higher infection rate (100%) than reconstruction of other parts of the maxilla (0.0%-17.9%). Nonvascularized skeletal grafts, mainly costal cartilage grafts, were safely used for maxillary reconstruction. However, caution should be exercised for postoperative infection in secondary cases and in cases where costal cartilage is used for nasal wall reconstruction. Covering nonvascularized skeletal grafts with soft-tissue flaps may be an effective countermeasure.

Establishment of a prediction model of postoperative infection complications in patients with gastric cancer and its impact on prognosis.

Postoperative infection delays postoperative adjuvant therapy and can lead to poor prognosis in gastric cancer patients. Therefore, accurately identifying patients at high risk of postoperative infection in patients with gastric cancer is critical. We therefore conducted a study to analyze the impact of postoperative infection complications on long-term prognosis. From January 2014 to December 2017, we retrospectively collected the data of 571 patients with gastric cancer admitted to the Affiliated People's Hospital of Ningbo University. The patients were divided into an infection group (n=81) and control group (n=490) according to whether the patients experienced postoperative infection. The clinical characteristics of the 2 groups were compared, and the risk factors of postoperative infection complications in patients with gastric cancer were analyzed. Finally, the prediction model of postoperative infection complications was established. There were significant differences in age, diabetes, preoperative anemia, preoperative albumin, preoperative gastrointestinal obstruction, and surgical methods between the 2 groups (P<0.05). Compared with that in the control group, the mortality rate of patients in the infection group at 5 years after surgery was significantly increased (39.51% vs. 26.12%; P=0.013). Multivariate logistics regression analysis showed that age >65 years, preoperative anemia, albumin <30 g/L, and gastrointestinal obstruction were risk factors of postoperative infection in patients with gastric cancer (P<0.05). The data set was randomly divided into a training set and validation set; the sample size of the training set was 286 while the sample size of the validation set was 285. In terms of the predictive model's value in predicting postoperative infection in patients with gastric cancer, the area under the curve of the receiver operating characteristic (ROC) curve in the training set was 0.788 (95% confidence interval: 0.711-0.864), and the area under the curve of the ROC curve in the validation set was 0.779 (95% confidence interval: 0.703-0.855). In the validation set, the model was evaluated with the Hosmer-Lemeshow goodness-of-fit test, resulting in a chi-squared value of 5.589 and a P value of 0.693. The present model can effectively identify patient as high risk of postoperative infection.