Risk Factors For Surgical Site Infection Research Articles

Extended Post-Operative Antibiotic Usage Does Not Reduce Surgical Site Infections after Spinal Surgery.

Background: Currently there is not a clear basis of evidence for post-operative antibiotic duration in spine surgery. A better understanding of risk factors and proper dosing for antibiotics will help improve outcomes and further define appropriate antibiotic use. Patients and Methods: A single-center retrospective cohort study of all patients undergoing spinal fusions and/or decompressions between January 1, 2018, and July 1, 2023 was performed. Patient demographic data and surgical information were collected. The exposure variable assessed was the duration of post-operative antibiotic administration. The primary outcome was incidence of surgical site infections (SSI). Uni-variable and multi-variable analysis were used to determine risk factors for infection. Results: A total of 5,656 procedures were performed by 25 different orthopedic spine- or neurosurgery-trained surgeons. The incidence of SSI was similar between the ≤24 h of antibiotic group and the >24 h antibiotic group, 0.50% and 0.45%, respectively (p = 0.769). In multi-variable analysis, only a body mass index (BMI) over 30 was associated with increased risk for SSI (odds ratio 2.54 [1.12, 5.74]). Conclusion: We observed no significant difference in the incidence of SSI among patients who were administered ≤24 h of post-operative antibiotics compared with those who we administered >24 h post-operative antibiotics. A BMI ≥30 was a risk factor for SSI in both uni-variable and multi-variable analysis.

Combining systemic inflammation biomarkers with traditional prognostic factors to predict surgical site infections in elderly hip fracture patients: a risk factor analysis and dynamic nomogram development

BackgroundSystemic inflammation biomarkers have been widely shown to be associated with infection. This study aimed to construct a nomogram based on systemic inflammation biomarkers and traditional prognostic factors to assess the risk of surgical site infection (SSI) after hip fracture in the elderly.MethodsData were retrospectively collected from patients over 60 with acute hip fractures who underwent surgery and were followed for more than 12 months between June 2017 and June 2022 at a tertiary referral hospital. Biomarkers were calculated from peripheral venous blood collected on admission. The Centers for Disease Control and Prevention (CDC) definition of SSI was applied, with SSI identified through medical and pathogen culture records during hospitalization and routine postoperative telephone follow-ups. Multivariable logistic regression identified independent risk factors for SSI and developed predictive nomograms. Model stability was validated using an external set of patients treated from July 2022 to June 2023.ResultsA total of 1430 patients were included in model development, with 41 cases (2.87%) of superficial SSI and 6 cases (0.42%) of deep SSI. Multivariable analysis identified traditional prognostic factors older age (OR = 1.08, 95% CI 1.04–1.12), ASA class III-IV (OR = 2.46, 95% CI 1.32–4.56), surgical delay ≥ 6 days (OR = 3.59, 95% CI 1.36–9.47), surgical duration > 180 min (OR = 2.72, 95% CI 1.17–6.35), and systemic inflammation biomarkers Platelet-to-lymphocyte ratio (PAR) ≥ 6.6 (OR = 2.25, 95% CI 1.17–4.33) and Systemic Immune-Inflammation Index (SII) ≥ 541.1 (OR = 2.24, 95% CI 1.14–4.40) as independent predictors of SSI. Model’s stability was proved by internal validation, and external validation with 307 patients, and an online dynamic nomogram (https://brooklyn99.shinyapps.io/DynNomapp/) was generated.ConclusionsThis study combined systemic inflammatory biomarkers and developed an online dynamic nomogram to predict SSI in elderly hip fracture patients, which could be used to guide early screening of patients with high risk of SSI and provide a reference tool for perioperative management.

Dogs neutered prior to perineal herniorrhaphy or that develop postoperative fecal incontinence are at an increased risk for perineal hernia recurrence.

To identify risk factors for recurrence and surgical site infection (SSI) after perineal hernia repair surgery in dogs. Medical records of male dogs undergoing perineal herniorrhaphy from 2008 to 2023 at a single institution were retrospectively reviewed. Data pertinent to patient signalment, surgical repair methods, risk factors for SSI, and risk factors for recurrence were collected. Follow-up was obtained via referring veterinarian records and/or owner interviews. Dogs without 12 months of postoperative follow-up were excluded. Statistical analysis was performed with descriptive statistics and compared between groups by use of a combination of univariable analyses. 84 dogs were included in this study. Recurrence occurred in 13 cases (15%), and SSIs occurred in 6 cases (7%). Dogs neutered prior to surgical correction of a perineal hernia were 4.4 times as likely to have a recurrence of the hernia after surgery compared to dogs neutered at time of surgical correction, and dogs that developed fecal incontinence postoperatively were 3.4 times as likely to have a recurrence. There were no other significant associations between perineal hernia recurrence or the development of SSIs and the associated risk factors evaluated. No risk factors for the development of SSI could be identified in this group. Dogs neutered prior to perineal herniorrhaphy compared to dogs neutered at time of surgical correction as well as dogs that developed fecal incontinence postoperatively may have both been at increased risk for recurrence after surgical hernia correction. Owners of dogs undergoing perineal herniorrhaphy after a prior castration should be educated on the possible increased risk of hernia recurrence postoperatively, and owners of dogs that develop fecal incontinence postoperatively should be informed of the possible increased risk for hernia recurrence.

Inadequate soft tissue coverage and bone loss/comminution are the typical risk factors of surgical site infection in open fractures of the hand: A nomogram prediction model.

Different from other parts of long bone fractures, surgical site infections (SSI) often occurs in open fractures of the hand (OFH) due to the anatomical characteristics and injury mechanisms. Our aim of the study is to investigate the particular risk factors of SSI after emergency surgery in OFH and develop a prediction nomogram model. In our traumatic center, patients with OFH not less than 18 years old were retrieved between October 2020 and April 2024. We excluded patients with other fractures, non-traumatic fractures or surgery before admission. The data of these patients were processed by univariate and multivariate analysis using SPSS (24.0) in order to identify the independent risk factors for SSI. Based on the predictors, the nomogram was constructed and validated by R software (R 4.1.0). The incidence of SSI was 6.96% (43/618). Body mass index (BMI), albumin (ALB), neutrophils (NEU), inadequate soft tissue coverage, and bone loss/comminution were identified as the independent risk factors of post-operative SSI in OFH and enrolled in the prediction nomogram model. The nomogram exhibited a high level of discrimination, with an area under the curve of 0.856 (95%CI 0.790-0.921) in the training group and 0.931 (95%CI 0.848-1.000) in the test group. Hosmer-Lemeshow (H-L) test revealed optimal consistency between the probability of prediction model and the actual probability (training group: X2 = 5.706, P = 0.680; test group: X2 = 3.886, P = 0.867). The calibration curve of both groups demonstrated excellent consistency. Decision curve analysis (DCA) showed favorable applicability of the prediction model. Inadequate soft tissue coverage, serum ALB level, NEU level, bone loss/comminution and BMI were the independent risk factors for post-operative SSI in OFH. The nomogram of this predictors can be used as an effective tool to predict SSI risk in OFH.

Influence of skin preparation on surgical site infection and lift of adhesive surgical drapes.

To determine the influence on surgical site infection (SSI) rates when using 0.7% iodophor and 74% isopropyl alcohol versus 2% chlorhexidine and 70% isopropyl alcohol. To evaluate the adherence of an iodophor-impregnated surgical incise drape when used in conjunction with 0.7% iodophor and 74% isopropyl alcohol. Combines retrospective control and prospective data. This study included dogs and cats, 653 retrospective cases and 435 prospective cases, with 447 incisions. The SSI rate of a 2% chlorhexidine and 70% isopropyl alcohol preparation was retrospectively reviewed. The prospective population received 0.7% iodophor and 74% isopropyl alcohol; risk factors for SSI were evaluated and incise drape lift was documented. A 1.8% difference in SSI between the chlorhexidine group and 0.7% iodophor and 74% isopropyl alcohol group was found (p = .25). The drape lift was 13.2%. Drape lift (p = .026), increased body weight (p = .008), and the use of glutaraldehyde for instrument sterilization (p = .055) were associated with an increased risk of SSI development. The 0.7% iodophor and 74% isopropyl alcohol treatments demonstrated similar effectiveness to 2% chlorhexidine and 70% isopropyl alcohol in skin preparation. Using an iodophor-impregnated drape with 0.7% iodophor and 74% isopropyl alcohol reduced both drape lift and the risk of SSI. These findings support the combined use of an incise drape with 0.7% iodophor and 74% isopropyl alcohol preparation, provide evidence against the use of glutaraldehyde, and indicate that heavier patients have an increased risk of SSI.

Risk factors for deep surgical site infection following open posterior lumbar fusion: A retrospective case-control study.

This study aimed to identify risk factors for deep surgical site infection (SSI) following open posterior lumbar fusion (OPLF). We retrospectively analyzed the clinical data of patients who underwent OPLF between January 2014 and December 2022. Patients were divided into SSI and non-SSI groups according to whether deep SSI occurred following OPLF. Patient's sex, age, body mass index (BMI), history of diabetes mellitus and smoking, American Society of Anesthesiologists score, surgical segment, surgical time, preoperative albumin level, local use of vancomycin, and cerebrospinal fluid (CSF) leakage were compared between the 2 groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for postoperative deep SSI. The deep SSI rate was 5.0% (63/1256). Among them, age (P < .001), BMI (P = .008), surgical segment (P < .001), surgical time (P < .001), prevalence of diabetes mellitus (P = .036), and CSF leakage (P < .001) were significantly higher in the SSI group, whereas the preoperative albumin level (P < .001) and proportion of local use of vancomycin (P = .046) were significantly lower in the SSI group than those in the non-SSI group. Multivariate analysis indicated that higher age (P = .046, odds ratio [OR]: 1.036, 95% confidence interval [CI]: 1.001-1.073), BMI (P = .038, OR: 1.113, 95% CI: 1.006-1.232), lower preoperative albumin level (P = .041, OR: 0.880, 95% CI: 0.778-0.995), higher surgical segment (P = .004, OR: 2.241, 95% CI: 1.297n3.871), and CSF leakage (P = .046, OR: 2.372, 95% CI: 1.015-5.545) were risk factors, and the local use of vancomycin (P < .001, OR: 0.093, 95% CI: 0.036-0.245) was the protective factor for deep SSI following OPLF. We identified 5 risk factors (older age and BMI, lower preoperative albumin level, higher surgical segment, and CSF leakage) and 1 protective factor (local use of vancomycin powder) for deep SSI following OPLF. To address these risk and protective factors, comprehensive evaluations and recommendations should be provided to patients to reduce SSI rates.

Development of a novel nomogram for the prediction of surgical site infection risk after loop ileostomy closure

BackgroundA postoperative surgical site infection (SSI) is a prevalent complication after loop ileostomy closure. There are few studies on the risk factors and the development of predictive models for postoperative SSIs. The aim of this study was to develop and validate a nomogram model capable of accurately predicting the occurrence of postoperative SSIs.MethodsThis retrospective analysis examined the clinical data of 369 patients who underwent loop ileostomy closure at a local hospital from January 2015 to March 2022. A logistic regression model was used to identify the potential risk factors for a postoperative SSI after loop ileostomy closure. A nomogram was established using independent risk factors, and the prediction performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC).ResultsForty-eight (13.0%) developed postoperative SSIs after loop ileostomy closure. Multivariate logistic regression analysis revealed that a body mass index (BMI) > 25 kg/m2, diabetes, linear skin closure (LSC), and a prolonged operative time were independent risk factors for SSIs, whereas the presence of a subcutaneous drainage tube was identified as an independent protective factor. The nomogram models constructed using these variables achieved AUCs of 0.833 and 0.823 on the training set and validation set, respectively. The calibration curves demonstrated excellent consistency.ConclusionThe nomogram developed using clinical data from patients who underwent loop ileostomy closure demonstrates a robust predictive capability, offering valuable guidance to clinicians in assessing the risk of postoperative SSIs.

Risk factors for surgical site infection after patellar fracture surgery in the elderly

BackgroundPatellar fractures are a common knee injury among elderly patients, with a high risk of developing surgical site infections (SSI) postoperatively, which severely affects patient prognosis and quality of life. Elderly patients are more susceptible to SSI due to various factors such as decreased immune function and chronic diseases. Therefore, identifying the risk factors for SSI is of great clinical significance for prevention.ObjectiveThis study aims to analyze the risk factors for postoperative SSI in elderly patients with patellar fractures, providing a basis for developing more effective clinical prevention and treatment strategies.MethodsThis retrospective study collected data from 856 elderly patients who underwent patellar fracture surgery at Baoding First Central Hospital between January 2017 and December 2023. Patients were divided into SSI and non-SSI groups based on the occurrence of SSI, and their demographic data, comorbidities, and laboratory results were analyzed. Logistic regression was used to identify independent risk factors for SSI, and ROC curve analysis was conducted to determine the optimal cutoff point for predictive indicators.ResultsThe incidence of SSI was found to be 2.1%. Univariate analysis showed that BMI, surgical delay, diabetes, hematocrit (HCT), and albumin (ALB) were significantly associated with SSI. Logistic regression analysis further confirmed that BMI (p = 0.043), surgical delay (p = 0.000), HCT (p = 0.038), ALB (p = 0.015), and diabetes (p = 0.022) were independent risk factors for SSI. ROC curve analysis indicated that the optimal cutoff points for BMI, HCT, and ALB were 25.39 kg/m2, 35.62%, and 39.3 g/L, respectively, with an AUC of 0.794 for the combined predictive indicators.ConclusionHigh BMI, surgical delay, diabetes, low HCT, and low ALB are independent risk factors for postoperative SSI in elderly patients with patellar fractures. Preoperative management targeting these high-risk factors, such as optimizing patient weight, controlling diabetes, and improving nutritional status, can effectively reduce the incidence of SSI and improve postoperative outcomes. Future multicenter studies may further validate these findings and provide additional prevention strategies.

Risk of Surgical Site Infection in Posterior Spine Surgery Using Different Closing Techniques: A Retrospective Study of Two Neurosurgical Centers.

Objectives: To determine whether a closed dressing protocol reduces the surgical site infections (SSI) rate compared to conventional closing techniques. Methods: Patients who underwent lumbar spine surgery at two neurosurgical centers were retrospectively included from June 2015 to December 2019. Data on patients, general risk factors, and surgical risk factors for SSI were collected. Patients were subdivided into two groups: a Closed Protocol where the Dermabond® ± Prineo® dressing system was used, and a Conventional Protocol, namely sutures or staples. Statistical analysis was undertaken to compare the infection rates among the different closure techniques. Results: Altogether, 672 patients were included. In the whole cohort, 157 (23.36%) underwent skin closure with staples, 122 (18.15%) with sutures, 98 (14.58%) with intracutaneous sutures, 78 (11.61%) with Dermabond®, and 217 (32.29%) with Demabond® + Prineo®. The overall infection rate was 2.23% (n = 15). Skin suture had the highest infection rate (4.10%), while the lowest was Dermabond® (1.28%) and Dermabond® + Prineo® (1.4%), though the difference was not significant. Risk factors for SSI included higher BMI (29.46 kg/m2 vs. 26.96 kg/m2, p = 0.044), other sites infection (20.00% vs. 2.38%, p = 0.004), and a higher national nosocomial infections surveillance score (p = 0.003). Conclusions: This study showed that a closed protocol with the use of adhesive dressing with or without mesh had a slight tendency to lower infection rates compared to conventional protocol with sutures or staples, although no statistically significant difference was found between the closure techniques. Larger randomized studies are needed to investigate this potential benefit avoiding selection bias.

Risk Factors for Surgical Wound Infection and Fascial Dehiscence After Open Gynecologic Oncologic Surgery: A Retrospective Cohort Study.

Numerous studies have identified typical risk factors for surgical site infections (SSI) and fascial dehiscence (FD), but patients with gynecological cancer are often excluded. This study aimed to assess the key risk factors for SSI and FD in gynecological oncological patients undergoing median laparotomy. We conducted a retrospective cohort study of patients who underwent median laparotomy for gynecological cancer between January 2017 and December 2020. Machine learning (random forest) was employed to identify interactions among predictors, while multivariable logistic regression was used to develop a model, validated through bootstrapping. A total of 204 women underwent open surgery for malignant gynecological diseases at our institution. A total of 50 patients developed SSI (24.5%) and 18 of these additionally suffered from FD (8.8%). The duration of the surgical procedure was independently associated with both SSI and FD. However, this association was only significant if the bowel was opened during surgery (either accidentally or intentionally). Conversely, if the bowel was left intact, the duration of the operation had no effect on either SSI (p = 0.88) or FD (p = 0.06). Additionally, a lower age of the patients significantly (p = 0.013) independently influenced the effect of body mass index (BMI) on the SSI rate. Our study supports the importance of duration of surgery in predicting SSI and FD in patients with gynecological cancer. This correlation between operation time and wound complications depends on whether bowel surgery was performed. Additionally, the relevance of obesity as a risk factor is higher in younger than in older patients.

Factors influencing surgical site infections and health economic evaluation in patients undergoing robot-assisted radical resection for colorectal cancer.

To investigate the incidence and factors influencing surgical site infections (SSIs) in patients undergoing robot-assisted radical resection for colorectal cancer and assess their health and economic impact on the patients and hospital. This retrospective case-controlled study comprised patients who underwent robot-assisted radical resection for colorectal cancer at a tertiary hospital in China. Information about baseline characteristics, perioperative details, postoperative SSI incidence, hospitalization costs, and follow-up was collected. Univariate and multivariate analyses were performed to identify the independent risk factors for SSI. Propensity score matching was used to evaluate the health and economic impacts of SSI on the patients and the hospital. The overall incidence of colorectal SSI in 546 patients undergoing robot-assisted radical resection for colorectal cancer was 11.72% (64/546). Intraoperative blood loss, duration of operation, preoperative absolute lymphocyte count, preoperative and postoperative serum albumin levels, tumor location, gender, history of radiotherapy or chemotherapy, surgical wound classification, and preoperative hypoalbuminemia levels were associated with SSI. Rectal cancer, male gender, and class 3 or 4 surgical wounds were identified as independent risk factors for postoperative SSI. SSI prolonged the hospital stay by 6.60 days, increased the patient's direct costs by 31,669.88 CNY, increased the economic burden by 3,262.38 CNY, and caused an indirect economic loss of 50,546.79 CNY for the hospital. Patients undergoing robot-assisted radical resection for colorectal cancer are at a high risk for SSI. SSI can prolong postoperative hospital stays and increase the economic burden for patients and hospitals.

Optimizing Surgical Site Infection Prevention in Dermatologic Surgery.

We aim to review modifiable risk factors and practices for surgical site infections (SSIs) reduction in cutaneous surgeries. The existing norms are assessed with the latest evidence, with the aim of enhancing and optimizing intra and postoperative strategies. This review seeks to offer an updated summary of the results of evidence for SSI reduction strategies tailored for practicing general dermatologists. Searches were conducted for "cutaneous surgery surgical site infection complications" using PubMed Central® and DynaMed®. Articles with pragmatic guideline recommendations were selected. We found evidence for intraoperative factors such as non-sterile gloves, brushless hand scrubbing/simple hand washing, sterile materials, and chlorhexidine gluconate as a skin antiseptic. For postoperative factors, there is a lack of evidence to support the use of topical antibiotic ointments, dressings, or waiting 48 hours before wetting to prevent SSI. Several intra/postoperative factors not specific to dermatologic procedures are briefly discussed for additional context. Several SSI risk factors are inherent to patients or necessary procedures; however, dermatologists have identified modifiable risk factors and developed protocols to mitigate SSI risks intraoperatively and postoperatively. By questioning established practices in cutaneous surgery aimed at preventing SSIs, we can work towards the optimal utilization of resources. This dual-focused approach not only enhances the efficiency of the healthcare system but also diminishes the risks associated with SSIs. It is important to acknowledge that this review does not encompass all factors essential for consideration in these recommendations. Nonetheless, it will approach these factors with an evidence-based lens, placing SSI prevention at the forefront.

Predicting Surgical Site Infections in Spine Surgery: Association of Postoperative Lymphocyte Reduction.

Postoperative lymphopenia is reported as an excellent indicator to predict surgical-site infection (SSI) after spine surgery. However, there is still controversy concerning which serological markers can predict spinal SSI. This study aims to evaluate excellent and early indicators for detecting SSI, focusing on spine instrumented surgery. This study included 268 patients who underwent spinal instrumented surgery from January 2022 to December 2023 (159 female and 109 male, average 62.9 years). The SSI group included 20 patients, and the non-SSI group comprised 248 patients. Surgical time, intraoperative blood loss, and glycemic levels were measured in both groups. The complete blood cell counts, differential counts, albumin, and C-reactive protein (CRP) levels were measured pre-surgery and postoperative on Days 1, 3, and 7. In comparing the groups, the Mann-Whitney U test analysis was used for continuous variables, while the chi-squared test and Fisher's exact test were used for dichotomous variables. The incidence of SSI after spinal instrumentation was 7.46% and was relatively higher in scoliosis surgery. The SSI group had significantly longer surgical times (248 min vs. 180 min, p = 0.0004) and a higher intraoperative blood loss (772 mL vs. 372 mL, p < 0.0001) than the non-SSI group. In the SSI group, the Day 3 (10.5 ± 6.2% vs. 13.8 ± 6.0%, p = 0.012) and Day 7 (14.4 ± 4.8% vs. 18.8 ± 7.1%, p = 0.012) lymphocyte ratios were lower than the non-SSI group. Albumin levels on Day 1 in the SSI group were lower than in the non-SSI group (2.94 ± 0.30 mg/dL vs. 3.09 ± 0.38 mg/dL, p = 0.045). There is no difference in CRP and lymphocyte count between the two groups. SSI patients had lower lymphocyte percentages than non-SSI patients, which was a risk factor for SSI, with constant high inflammation. The Day 3 lymphocyte percentage may predict SSI after spinal instrumented surgery.

RISK FACTORS FOR SURGICAL SITE INFECTION FOLLOWING CESAREAN SECTION

Surgical site infections (SSIs) following cesarean sections (CS) are significant contributors to maternal morbidity and healthcare burdens worldwide. Despite adherence to preoperative guidelines, certain risk factors remain associated with increased SSI rates. Identifying and addressing these factors is essential for improving patient outcomes. Objective: To identify and evaluate the risk factors associated with surgical site infection (SSI) following cesarean section (CS) based on the World Health Organization’s recommended preoperative measures in a tertiary care hospital in Mirpur, AJ &amp; K. Methods: A prospective cohort study was conducted from January 2022 to December 2023 at a tertiary care hospital in Mirpur, AJ&amp;K. A total of 1,500 patients undergoing cesarean sections were enrolled and followed for 30 days post-surgery to monitor for the occurrence of SSI. Data on potential risk factors, such as body mass index (BMI), diabetes, hypertension, preoperative antibiotic use, duration of surgery, type of cesarean section (elective vs. emergency), anemia, and personal hygiene practices, were collected at baseline. The primary outcome was the incidence of SSI, diagnosed according to the Centers for Disease Control and Prevention (CDC) criteria. Risk factors were compared between patients who developed SSI (cases) and those who did not (controls). Statistical analyses, including Chi-squared and Fisher’s Exact tests, were performed to identify significant risk factors. Multivariate logistic regression was used to control for confounding factors. Results: Out of the 1,500 patients, 18% (n=270) developed SSI within 30 days of surgery. Significant risk factors for SSI included obesity (BMI &gt;30), which increased the odds of SSI by 2.5 times (p=0.001); prolonged hospital stay of more than 5 days, associated with a 1.8-fold increase in SSI risk (p=0.004); emergency cesarean sections, which raised the risk by 2.1 times compared to elective procedures (p=0.002); and anemia (hemoglobin &lt;10 g/dL), which increased SSI risk by 1.9 times (p=0.005). Poor personal hygiene practices were also significantly associated with a higher incidence of SSI (p=0.003). On the other hand, the use of preoperative prophylactic antibiotics was protective, reducing the incidence of SSI by 3.2-fold (p=0.0001). No significant associations were observed between the duration of surgery (p=0.21) or patient age (p=0.15) and the occurrence of SSI. Conclusions: This prospective cohort study identified obesity, prolonged hospital stay, emergency cesarean section, anemia, and personal hygiene practices as significant risk factors for the development of SSI following cesarean section, consistent with the World Health Organization’s preoperative guidelines. The use of preoperative prophylactic antibiotics was shown to be an effective intervention in reducing SSI risk. These findings underscore the importance of targeted preventive measures, including weight management, prompt hospital discharge, enhanced personal hygiene education, and the routine use of prophylactic antibiotics, in reducing the burden of SSIs in cesarean sections.

Association between sex-specific criteria for visceral obesity and surgical site infection after gastrectomy

BackgroundHigh visceral fat area (VFA), estimated by computed tomography (CT), is reportedly associated with surgical site infection (SSI) in patients undergoing gastrectomy for gastric cancer (GC). Given that fat distributions vary markedly according to gender, sex-specific definitions of visceral obesity should be applied. We investigated the optimal sex-specific thresholds for VFA at the L3 level for assessing the risk of SSI after gastrectomy. MethodsWe studied 828 patients (564 males and 264 females) who underwent curative gastrectomy. Intra-abdominal or incisional infectious complications with Clavien Dindo scores ≥ 2 were defined as SSIs. Receiver operating characteristics (ROC) analyses were used to determine the optimal sex-specific VFA cut-offs for extracting obese patients prone to develop SSI. We performed logistic regression analyses and the corrected Akaike’s Information Criterion (AICc) was calculated to compare the capability for evaluating the possibility of SSI of our sex-specific VFA-based criteria versus the conventional VFA-based or BMI-based criterion. ResultsSSI developed in 59 males and 16 females. Optimal VFA thresholds were 119.3 cm2 for males and 57.2 cm2 for females. Multivariate analyses revealed visceral obesity, as defined by the sex-specific criteria, to be an independent risk factor for SSI (odds ratio: 2.74; 95% confidence interval: 1.62−4.66; p < 0.01). The logistic regression model with our sex-specific criteria yielded better AICc (456.4) than those with the conventional (461.8) or BMI-based (467.0) criterion for obesity. ConclusionSex-specific criteria can enhance the capability of VFA for assessing the risk of SSI after gastrectomy, as compared with the non-sex-specific criterion.

Clinical Characteristics and Risk Factors of Surgical Site Infection in Patients with Open Abdomen with Fistula Undergoing the Abdominal Wall Reconstruction Utilizing Biological Mesh: A Single-Center Retrospective Study.

Objective: This study aimed to evaluate the clinical characteristics and identify risk factors for surgical site infection (SSI) following abdominal wall reconstruction using biological mesh. Methods: A retrospective analysis was conducted on patients with open abdomen (OA) with fistula who underwent abdominal wall reconstruction with biological mesh at Jinling Hospital between January 2010 and August 2023. Patients were divided into SSI and non-SSI groups, and their perioperative data were compared to identify potential risk factors. Results: The SSI rate following abdominal wall reconstruction was 23.71% (23/97) in patients with OA with fistula. Significant differences (p < 0.05) were found between the SSI and non-SSI groups in body mass index (BMI), BMI classification, nutritional risk index (NRI) classification, abdominal wall defect partition, pre-operative day one neutrophil count (NEUT), post-perative day one white blood cells (WBCs) and NEUT, post-operative day three WBCs and NEUT, post-operative day seven procalcitonin (PCT) and NEUT, length of hospitalization, and total hospitalization cost. Multifactorial analysis identified normal BMI (odds ratio [OR]: 0.151, 95% confidence interval [CI]: 0.041-0.551, p = 0.004) and high BMI (OR: 0.072, 95% CI: 0.010-0.546, p = 0.011) as protective factors against SSI and moderate NRI (OR: 4.054, 95% CI: 1.069-15.376, p = 0.004), severe NRI (OR: 18.233, 95% CI: 2.971-111.897, p = 0.002), and abdominal wall defect partition (OR: 4.032, 95% CI: 1.218-13.349, p = 0.022) as independent risk factors for SSI. Conclusions: Normal BMI and high BMI act as protective factors against SSI, whereas moderate NRI, severe NRI, and abdominal wall defect partition are independent risk factors for SSI. Nutritional management and surgical care should be emphasized to reduce SSI incidence in patients with OA with fistula undergoing abdominal wall reconstruction.

Prevalence of Surgical Site Infections Following Coronectomy: A Systematic Review and Meta-Analysis.

Background/Objectives: This systematic review and meta-analysis aimed to investigate the prevalence of surgical site infections (SSIs) following coronectomy of mandibular third molars. Methods: A comprehensive literature search was conducted in Medline, Scopus, Web of Science, and Google Scholar databases up to 30 July 2024. Two independent reviewers performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Observational studies assessing SSI prevalence following coronectomy were included. The pooled prevalence of SSI with 95% confidence intervals (CI) was calculated using a random-effects model. Heterogeneity was assessed using the I2 statistic, and meta-regression was conducted to explore the influence of continuous variables. Results: A total of 22 studies involving 2173 coronectomy procedures were included. The overall pooled prevalence of SSI was 2.4% (95% CI: 1-4.3%), with substantial heterogeneity (I2 = 81%). Meta-regression showed no significant effect of the examined variables on SSI prevalence. No study was identified as a significant outlier. Quality assessments revealed that all studies had moderate methodological quality. Conclusions: Considerable heterogeneity was observed, likely due to variations in study settings, geographical regions, and timeframes, among other factors. Therefore, this study underscores the need for further rigorous research to better understand SSI risk factors and enhance management strategies for this postoperative complication.

Risk factors for surgical site infection after general surgery in HIV-infected patients: a retrospective study

BackgroundAs the number of HIV-infected patients increased, the number of patients requiring general surgery has subsequently increased. However, impairment of immune function due to HIV infection increases the risk of postoperative surgical-site infection and significant harm to patient health. This study aimed to examine the risk factors for surgical-site infection after general surgery.MethodsThe patients’ data were from Zunyi fourth hospital medical information system. Machine learning based Boruta algorithm were used for variable screening. Univariable and multivariable logistic regression and restricted cubic spline analysis were performed to examine the relationship between significant variables and surgical-site infection.ResultsA total of 125 general surgery postoperative HIV-infected patients participated in the study. Surgical-site pathogen culture identified Escherichia coli, Klebsiella pneumoniae, and mixed bacteria as the three most common pathogens causing Surgical-site infection. Univariable and multivariable logistic regression analysis to adjust for risk factors identified type III surgical incision (OR = 9.92, 95% CI = 1.28–76.75) and elevated preoperative white blood cell (WBC) count (OR = 1.30, 95% CI = 1.12–1.51) as independent risk factors for postoperative surgical-site infection, whereas CD4 + T lymphocyte count greater than 400 cells/µL was identified as a protective factor (OR = 0.23, 95% CI = 0.09–0.60) while. The restricted cubic spline analysis results directly reflected the dose-response relationship between continuous variables and postoperative surgical-site infection.ConclusionsType III incision and an elevated WBC count pose a higher risk of postoperative surgical-site infection. A CD4 + T lymphocyte counts greater than 400 cells/µL provided a protective effect of lower risk of surgical site infection. Preoperative serum neutrophil percentage, albumin level, red blood cell count, and serum urea level within a specific range were beneficial in reducing the risk of incisional infections. Our research provides a theoretical basis for clinical practice.

Risk factors for surgical site infection following thyroid surgery: a systematic review and meta-analysis.

Thyroid surgery is a common surgical procedure for the treatment of thyroid diseases, such as thyroid nodules, thyroid cancer, and hyperthyroidism. Despite significant advancements in surgical techniques and perioperative care, surgical site infection (SSI) remains a frequent postoperative complication, which can lead to prolonged hospital stays, increased medical costs, and decreased quality of life for patients. Identifying risk factors for SSI is crucial for developing effective prevention strategies. This study aimed to systematically investigate and quantify the incidence and risk factors associated with SSI following thyroid surgery through a meta-analysis and systematic review. A comprehensive search strategy was employed across major databases [PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data] up to June 15, 2024. Additionally, we conducted a supplementary search for relevant literature up to October 4, 2024. Studies were selected based on stringent inclusion and exclusion criteria focusing on SSI risk factors in patients undergoing thyroid surgery. The methodological quality of eligible studies was critically appraised. Statistical analyses were conducted using Stata 15.1 with meta-analytic techniques to estimate means and standard deviations, and calculating odds ratio (OR) with 95% confidence interval (CI) using appropriate effect models. Publication bias was assessed using Egger's test. The systematic review and subsequent meta-analysis included nine studies (eight case-control and two cohort) involving a total of 127,467 patients, with 703 cases of postoperative SSI documented. Key findings indicated that prolonged surgical duration greater than 2 hours [OR =4.50; 95% CI: (2.74, 7.37); P<0.001], presence of comorbidities [OR =1.91; 95% CI: (1.16, 3.15); P=0.01], age greater than 50 years [OR =1.81; 95% CI: (1.24, 2.64); P=0.002], incision length greater than 5 cm [OR =2.79; 95% CI: (1.92, 4.04); P<0.001], lymph node dissection [OR =1.90; 95% CI: (1.28, 2.80); P=0.001], and male [OR =1.78; 95% CI: (1.38, 2.29); P<0.001] were significant risk factors for SSI after thyroid surgery. Conversely, male gender did not present a statistically significant association with SSI risk. Surgical duration greater than 2 hours, presence of comorbidities, age greater than 50 years, incision length greater than 5 cm, lymph node dissection, and male emerge as critical risk factors for SSI in patients recovering from thyroid surgery. However, the small number of included articles and the lack of differentiation between OR, risk ratio (RR), and hazard ratio (HR) are limitations of this analysis.

Predictive Value of Preoperative Peripheral Blood Inflammatory Markers for Surgical Site Infection in Laparoscopic Radical Gastrectomy for Gastric Cancer.

Background: To investigate the predictive value of preoperative peripheral blood inflammatory markers for surgical site infection (SSI) in laparoscopic radical gastrectomy for gastric cancer. Methods: A retrospective analysis was conducted on patients undergoing laparoscopic radical gastrectomy for gastric cancer, categorized into SSI and non-SSI groups based on postoperative SSI occurrences. Patient demographics, surgical details, laboratory results, and SSI incidence data were extracted. Differences in indicators, including neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and platelet-lymphocyte ratio (PLR), were assessed between the two groups. Multivariate logistic regression was utilized to determine the independent association of each indicator with SSI. Receiver operating characteristics (ROC) curve analysis was utilized to evaluate the predictive value of parameters. Results: Of 169 patients, 36 (21.30%) experienced SSI postoperatively. The SSI group exhibited higher preoperative NLR and SII (p < 0.05). After adjusting for variables, preoperative NLR (OR = 1.691, 95% CI: 1.211-2.417, p = 0.003) and SII (OR = 1.001, 95% CI: 1.000-1.002, p = 0.006) were identified as independent risk factors for SSI. Both NLR (AUC = 0.758, 95% CI: 0.666-0.850) and SII (AUC = 0.753, 95% CI: 0.660-0.850) demonstrated favorable diagnostic performance for predicting postoperative SSI. Conclusion: Preoperative NLR and SII significantly associate with postoperative SSI in laparoscopic radical gastrectomy for gastric cancer, making them valuable indicators for early prediction of SSI.