Risk Factors For Wound Complications Research Articles

Identifying Risk Factors for Wound Complications Following Fronto-Orbital Advancement in Patients With Craniosynostosis: 3-dimensional Craniometrics Analysis.

This study aims to identify 3-dimensional (3D) craniometric predictors of wound complications following fronto-orbital advancement (FOA) surgery in craniosynostosis patients. The authors conducted a retrospective review of medical records for 43 patients (25 female, 18 male) who underwent open FOA between 2006 and 2023, with an average follow-up duration of 91.8 months. The data collected included age at surgery, sex, whether the craniosynostosis was syndromic, involvement of multiple sutures, history of suturectomy, wound complications (categorized as minor or major), and preoperative and postoperative 3D CT scans. The authors quantified relative changes in intracranial volume (ICV), cranial area above the Frankfurt Horizontal plane, anteroposterior diameter (APD), and cranial height (CH) using Mimics software. A logistic regression analysis was performed to identify predictors of wound complications post-FOA. Among the 43 patients who underwent FOA, 10 experienced postoperative wound complications (4 minor, 6 major), revealing significant associations with multisuture involvement and changes in △cranial area, △APD, and △CH (all P<0.05). In the multivariable analysis with backward elimination, △cranial area, and △CH were identified as significant risk factors for wound complications (OR 1.17, 95% CI: 1.01-1.36, P=0.032; and OR 0.59, 95% CI: 0.38-0.92, P=0.019, respectively). The cutoff values for △cranial area and △APD were 5.95% and 7.93%, respectively. This study identified measurable craniometric changes, especially in the cranial area, as risk factors for wound complications following FOA. It underscores the necessity for personalized surgical planning and meticulous postoperative wound care in FOA to enhance patient outcomes through risk-aware strategies.

Wound Healing Complications Associated with Staged Reconstruction after Facial Lentigo Maligna Resection.

Background: The rates and risk factors for wound complications following staged reconstruction after facial lentigo maligna (LM) resection have not been well described. Objectives: (1) To identify the rate and types of wound complications, including infection, graft necrosis, distal flap necrosis, hematoma, superficial epidermolysis, and seroma among patients undergoing staged reconstruction after resection of LM as documented in the surgeon's clinical notes within 30 days of the procedure. (2) To determine a threshold defect size that may predict the development of wound complications. Design and Outcomes: Retrospective review at an academic medical center of patients who underwent staged reconstruction after facial LM resection over a 5-year period. Results: Ninety-eight patients were identified with a mean age of 69.2 ± 13.6 years; 37% of patients were female. The most common defect sites were the cheek (n = 41; 42%) and nose (n = 22; 22%). Twenty-five of 98 patients (26%) demonstrated complications, with the most common being wound infection (36%) and graft necrosis (24%). Those receiving perioperative antibiotics had lower rates of complication (odds ratio [OR]: 0.36; 95% confidence interval [CI]: 0.13,0.96; p = 0.041). Defects greater than 2.7 cm in maximal diameter had the highest sensitivity for predicting complications. Conclusions: Patients undergoing staged reconstruction after facial LM resection have a high rate of wound complication (26%) and defect size > 2.7 cm may be an important risk factor.

IMPLANTABLE MEDICAL DEVICES: A NON INVASIVE AND COSMETIC FRONTIER FOR WOUND CLOSURE

Abstract Cardiovascular implantable electronic devices (CIEDs) implantation procedures have undergone continuous improvement. Every aspect of the procedure can contribute to these improvements, including incision closure. The aim of this study was to assess the accuracy and validity of a non–invasive method using adhesive skin closure strips for wound closure of CIEDs in older adults, instead of surgical suture, evaluating parameters such as infection, erythema, skin reaction, itching, pain, oedema, time for closure, cosmetic outcomes and patients’ satisfaction. A retrospective study was carried out in 152 subjects (mean age 81 +9.3 years).undergoing application of adhesive strips after CIEDs substitution/implant and 132 usual care control subjects (mean age 76.6+8.9). Variables considered were: age, gender, risk factors for wound complications. Wound evaluation was conducted by using the Visual Analogue Scale (VAS) and the Patient and Observer Scar Assessment Scale (POSAS). Operative time for closing the incision and for removing sutures or strips were significantly lower in both application and removal in the adhesive strip group. At follow–up evaluations, each parameter considered by evaluation of the patients and staff was significantly better than in the control group. Fewer complications were observed in the patients undergoing wound closure wit adhesive strips. Previoulsy, to the best of our knowledge, the use of adhesive strips in closing surgical wounds of patients undergoing CIEDs implant/replacement has never been considered. Adhesive strips for wound closure of CIEDs incision are characterized by shorter procedural time, optimal early and late cosmetic results, fewer complications in older patients and is cheaper. Its use for CIEDs wound closure is reasonably supported.

Phase II Clinical Trial of Intravenous Levothyroxine to Mitigate Pharyngocutaneous Fistula in Euthyroid Patients Undergoing Salvage Laryngectomy.

Patients undergoing head and neck cancer surgery after prior radiation or chemoradiation are at high risk for wound complications. Hypothyroidism is a known risk factor for wound complications, especially fistulae after salvage total laryngectomy. The purpose of this phase II clinical trial is to investigate the effect of perioperative intravenous levothyroxine supplementation on wound complications in patients undergoing salvage total laryngectomy. Euthyroid patients previously treated with radiation/chemoradiation undergoing total laryngectomy were prospectively recruited (n = 72). Postoperatively, intravenous levothyroxine was administered at a weight-based dose (1.3 mcg/kg/d) and transitioned to enteral dosing on day 7. Free T3, T4, and thyroid-stimulating hormones were collected, and dosing was adjusted accordingly. The primary endpoints were rates of fistula formation and fistula requiring reoperation, compared with matched historic controls. All patients were monitored for adverse effects. The rate of postoperative hypothyroidism was 21% compared with 49% in a matched historic cohort. The rate of fistula formation was 18.1%, whereas the rate of fistula requiring reoperation was 4.2%, significantly lower than rates in our historic cohort (34.6% and 14.8%, respectively; P = 0.02 and 0.01). Postoperative hypothyroidism and recurrent clinical stage predicted fistula requiring reoperation in multivariate analysis; other acute phase reactants were not predictive. There were no observed adverse events related to levothyroxine supplementation. Postoperative intravenous levothyroxine supplementation reduced rates of acute hypothyroidism, fistula formation, and fistula requiring reoperation in patients undergoing salvage total laryngectomy without adverse effects. Intravenous levothyroxine is a viable strategy to reduce wound complications in this high-risk patient population.

Surgical Approach and Body Mass Index Impact Risk of Wound Complications Following Total Hip Arthroplasty

BackgroundPrevious studies have suggested that wound complications may differ by surgical approach after total hip arthroplasty (THA), with particular attention toward the direct anterior approach (DAA). However, there is a paucity of data documenting wound complication rates by surgical approach and the impact of concomitant patient factors, namely body mass index (BMI). This investigation sought to determine the rates of wound complications by surgical approach and identify BMI thresholds that portend differential risk. MethodsThis multicenter study retrospectively evaluated all primary THA patients from 2010 to 2023. Patients were classified by skin incision as having a laterally based approach (posterior or lateral approach) or DAA (longitudinal incision). We identified 17,111 patients who had 11,585 laterally based (68%) and 5,526 (32%) DAA THAs. The mean age was 65 years (range, 18 to 100), 8,945 patients (52%) were women, and the mean BMI was 30 (range, 14 to 79). Logistic regression and cut-point analyses were performed to identify an optimal BMI cutoff, overall and by approach, with respect to the risk of wound complications at 90 days. ResultsThe 90-day risk of wound complications was higher in the DAA group versus the laterally based group, with an absolute risk of 3.6% versus 2.6% and a multivariable adjusted odds ratio of 1.5 (P < .001). Cut-point analyses demonstrated that the risk of wound complications increased steadily for both approaches, but most markedly above a BMI of 33. ConclusionsWound complications were higher after longitudinal incision DAA THA compared to laterally based approaches, with a 1% higher absolute risk and an adjusted odds ratio of 1.5. Furthermore, BMI was an independent risk factor for wound complications regardless of surgical approach, with an optimal cut-point BMI of 33 for both approaches. These data can be used by surgeons to help consider the risks and benefits of approach selection. Level of EvidenceLevel III.

Preoperative hypocoagulative state is an independent risk factor for wound complications and infection in gender-affirming bottom surgeries

BackgroundBottom gender affirmation surgery (GAS) involves the risks of bleeding and associated complications. Effective preoperative blood management is paramount across surgical disciplines with international normalized ratio (INR)≤1.5 advised prior to certain surgeries. This study aimed to examine the proportion of patients who were hypocoagulative before they underwent bottom GAS and assess the influence of hypocoagulability on their 30-day post-operative outcomes. MethodA retrospective study on female-to-male (FtM) and male-to-female (MtF) bottom GAS was performed based on American college of surgeons national surgical quality improvement program (ACS-NSQIP) database from 2005 to 2021. Patients with hypocoagulation were identified when PTT> 60 s, PT > 30 s, and/or INR> 2. Multivariable logistic regression was used to compare the 30-day perioperative outcomes between patients with hypocoagulation and controls. ResultsIn this study, 380 patients (182 FtM, 198 MtF) with hypocoagulation and 1176 controls (886 FtM, 310 MtF) were included. Mortality and organ system complications were infrequent in both groups. Patients with hypocoagulation had higher wound complication rates (13.68% vs. 2.64%, aOR 2.858, p < 0.01), especially wound dehiscence (10.00% vs. 0.60%, aOR 4.424, p < 0.01) and organ space infection rates (2.11% vs. 0.26%, aOR 12.77, p < 0.01). Additionally, patients with hypocoagulation had higher sepsis (0.79% vs. 0.09%, aOR 15.508, p = 0.04) and readmission rates (4.74% vs. 2.47%, aOR 1.919, p = 0.03), but lower rates of discharge not to home (7.92% vs. 25.38%, aOR 0.324, p < 0.01). ConclusionPreoperative hypocoagulative state is observed in approximately a quarter of the patients undergoing bottom GAS and is an independent risk factor for increased risks of 30-day wound complications and infections. Therefore, meticulous monitoring of preoperative hemostasis and implementing hemostasis control before surgery may be necessary. Thus, it may be advisable to discontinue oral anticoagulants before the surgery.

Wound complication risk factors following open reduction and internal fixation of ankle fractures.

This study was designed to identify risk factors for wound complications including surgical site infection (SSI) and wound healing issues following open reduction and internal fixation (ORIF) of ankle fractures. A retrospective analysis of individuals with ankle fractures treated with ORIF was undertaken. Study subjects were divided into a wound complications (WC) group and a no wound complication (NWC) group. The WC group was further divided into an SSI group and wound healing issues group. Twenty-one potential risk factors associated with wound complications after ORIF were tracked. Uni- and multivariate binary logistical regression analyses were used to identify risk factors associated with wound complications, ISS and wound healing issues. In total, 613 individuals, who had undergone surgery for ankle fractures formed the study cohort. The incidence of postoperative wound complications was 10.3% (63 cases), including 5.2% of SSI (32 cases) and 5.1% of wound healing issues (31 cases). The independent risk factors for wound complications were age 65 years or older, preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture, fewer than seven cases per year in surgical volume, and attending surgeon level. The independent risk factors for SSI were age 65 years or older, preoperative serum albumin level below 35 g/L, open fracture and fewer than seven cases per year in surgical volume. The independent risk factors for wound healing issues were preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture and attending surgeon level. Herein we found both factors inherent to the injury and individual and those pertaining to the surgical team affected the frequency of wound complications after ORIF of ankle fractures. Specifically, advanced age and low surgical volume were associated with a greater risk of SSI. Peripheral neuropathy and the low expertise level on the part of the surgeon were associated with a greater risk of wound healing issues. Hypoproteinaemia and open fracture were both associated with a greater risk of both SSI and wound healing issues.

Predicting wound complications following lower extremity revascularization

ObjectiveThe aim of this study was to create a simple risk score to identify factors associated with wound complications after infrainguinal revascularization. MethodsThe Veterans Affairs Surgical Quality Improvement Program national data set was queried from 2005 to 2021 to identify 22,114 patients undergoing elective open revascularization for peripheral arterial disease (claudication, rest pain, tissue loss) or peripheral aneurysm. Emergency and trauma cases were excluded. The data set was divided into a two-thirds derivation set and one-third validation set to create a risk prediction model. The primary end point was wound complication (wound dehiscence, superficial/deep wound surgical site infection). Eight independent risk factors for wound complications resulted from the model and were assigned whole number integer risk scores. Summary risk scores were collapsed into categories and defined as low (0-3 points), moderate (4-7 points), high (8-11 points), and very high (>12 points). ResultsThe wound complication rate in the derivation data set was 9.7% (n = 1428). Predictors of wound complication included age ≤73 (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.08-1.46), body mass index ≥35 kg/m2 (OR, 1.99; 95% CI, 1.68-2.36), non-Hispanic White (vs others: OR, 1.48; 95% CI, 1.30-1.69), diabetes (OR, 1.23; 95% CI, 1.10-1.37), white blood cell count >9900/mm3 (OR, 1.18; 95% CI, 1.03-1.35), absence of coronary artery disease (OR, 1.27; 95% CI, 1.03-1.35), operative time >6 hours (OR, 1.20; 95% CI, 1.05-1.37), and undergoing a femoral endarterectomy in conjunction with bypass (OR, 1.34; 95% CI, 1.14-1.57). In both the derivation and validation sets, wound complications correlated with risk category. Among the defined categories in the derivation set, wound complication rates were 4.5% for low-risk patients, 8.5% for moderate-risk patients, 13.8% for high-risk patients, and 23.8% for very high-risk patients, with similar results for the internal validation data set. Operative indication did not independently associate with wound complications. Patients with wound complications had higher rates of reoperation and graft failure. ConclusionsThis risk prediction model uses easily obtainable clinical metrics that allow for informed discussion of wound complication risk for patients undergoing open infrainguinal revascularization.

Wound complications following revision total knee arthroplasty: Prevalence and outcomes

BackgroundWound complications following revision TKA can be catastrophic and can compromise joint and even limb. The purpose of this study was to determine the prevalence of superficial wound complications requiring return to the OR in revision TKA, rates of subsequent deep infection, factors that increase the risk of superficial wound complications, and the outcomes of revision TKA following development of superficial wound complications. MethodsWe retrospectively reviewed 585 consecutive TKA revisions with at least two years follow-up, including 399 aseptic revisions and 186 reimplantations. Superficial wound complications without deep infection requiring return to the OR within 120 days were compared to controls. ResultsFourteen patients following revision TKA (2.4%) required return to the OR for a wound complication, including 7 of 399 (1.8%) patients who underwent aseptic revision TKA and 7 of 186 (3.8%) patients undergoing reimplantation TKA (p = 0.139). Aseptic revisions with wound complications were more likely to develop subsequent deep infection (HR 10.04, CI 2.24–45.03, p = 0.003), but this did not hold true for reimplantations (HR 1.17, CI 0.28–4.91, p = 0.829). Risk factors for wound complication included atrial fibrillation when all patients were combined (RR 3.98, CI 1.15–13.72, p = 0.029), connective tissue disease in the aseptic revision group (RR 7.1, CI 1.1–44.7, p = 0.037), and a history of depression in the re-implantation group (RR 5.8, CI 1.1–31.5, p = 0.042).

HDR-brachytherapy for accelerated partial breast irradiation: Long-term experience from a Japanese institution.

We investigated the long-term oncological outcome of high-dose-rate (HDR) multicatheter interstitial brachytherapy (MIB) for adjuvant accelerated partial breast irradiation (APBI) after breast conserving surgery in Japanese patients. Between June 2002 and October 2011, 86 breast cancer patients were treated at National Hospital Organization Osaka National Hospital (trial number of the local institutional review board, 0329). Median age was 48 years (range, 26-73 years). Eighty patients had invasive and 6 patients non-invasive ductal carcinoma. Tumor stage distribution was pT0 in 2, pTis in 6, pT1 in 55, pT2 in 22, and pT3 in one patient, respectively. Twenty-seven patients had close/positive resection margins. Total physical HDR dose was 36-42 Gy in 6-7 fractions. At a median follow-up of 119 months (range, 13-189 months), the 10-year local control (LC) and overall survival rate was 93% and 88%, respectively. Concerning the 2009 Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology risk stratification scheme, the 10-year LC rate was 100%, 100%, and 91% for patients considered as low-risk, intermediate-risk, and high-risk, respectively. According to the 2018 American Brachytherapy Society risk stratification scheme, the 10-year LC rate was 100% and 90% for patients 'acceptable' and 'unacceptable' for APBI, respectively. Wound complications were observed in 7 patients (8%). Risk factors for wound complications were the omission of prophylactic antibiotics during MIB, open cavity implantation, and V100 ≥ 190 cc. No grade ≥ 3 late complications (CTCVE version 4.0) were observed. Adjuvant APBI using MIB is associated with favorable long-term oncological outcomes in Japanese patients for low-risk, intermediate-risk, and acceptable groups of patients.

Endovascular therapy and free flap transfer in chronic limb-threatening ischemia

Although revascularization has evolved, treating foot gangrene with chronic limb-threatening ischemia remains challenging. There have been many reports on bypass surgery and free flap transfer. Meanwhile, few studies have reported on endovascular therapy and free flap transfer, with high flap survival rates and high wound complication rates. Wound complications are a serious problem that can lead to limb amputation, but previous studies have failed to identify risk factors for wound complications. In this study, we evaluated the results of endovascular therapy and free flap transfer for chronic limb-threatening ischemia and analyzed risk factors for wound complications. A total of 31 legs from 28 patients who underwent endovascular therapy and free flap transfer for lower limb salvage between August 2016 and April 2020 were retrospectively reviewed. The primary endpoints were flap survival and limb salvage rates and wound complication rates. In addition, we performed a statistical analysis of risk factors for wound complications. The flap survival rate was 100%, with partial necrosis in 6% of the patients. The limb salvage rate was 100%. The wound complication rate was 45%. The multivariate analysis showed end-stage renal failure on dialysis as a significant risk factor for wound complications (odds ratio = 133, 95% confidence interval = 2.74–6430, p = 0.014). Endovascular therapy and free flap transfer in chronic limb-threatening ischemia achieved high flap survival rate and limb salvage, but had a high incidence of wound complications. We identified end-stage renal failure on dialysis was a significant risk factor for wound complications.

Risk Factors for Wound Complications Following Conversion TKA after Tibial Plateau Fracture.

The purpose is to investigate the incidence of wound complications for total knee arthroplasty (TKA) following tibial plateau open reduction and internal fixation (ORIF). A prospective arthroplasty registry was queried for patients with CPT codes for primary TKA, tibial plateau ORIF, removal of hardware (ROH), and diagnosis of post-traumatic arthritis. Patients were included if they had undergone tibial plateau ORIF and subsequent TKA. Chart review was performed to obtain demographic, clinical and post-operative information. Twenty-one patients were identified, with average age of 56.23 ± 13.2years at time of tibial plateau ORIF and 62.91 ± 10.8years at time of TKA. Seven (33.3%) patients had a tibial plateau fracture-related infection (FRI). Eight (38.1%) patients underwent ROH prior to TKA. Seven (33.3%) patients' TKA incision incorporated the prior plateau incisions. Eight (36.4%) patients developed wound complications following TKA and 5 (23.8%) developed an acute periprosthetic joint infection (PJI) following TKA and had the plateau incision incorporated into the TKA incision. FRI history did not increase the rate of wound complications but did increase the rate of ROH prior to TKA. Previous FRI involving tibial plateau repair surgery doesn't correlate with PJI after conversion TKA for post traumatic OA. Surgeon-controlled factors such as staged ROH and incision placement can help reduce the rate of wound complications following TKA performed after tibial plateau ORIF. Prognostic Level IV. The online version contains supplementary material available at 10.1007/s43465-022-00709-1.

Pedicled vastus lateralis myocutaneous flap for sacropelvic defects after wide oncologic resection: Wound complications and outcomes.

Adequate coverage of the soft tissue defects from wide resection of sacropelvic malignancies remains challenging. The vastus lateralis flap has been described for coverage in the setting of trauma and infection. This flap has not been described for coverage of sacropelvic tumor defects. This is a retrospective cohort study of adult patients who underwent wide resection of a primary sacropelvic malignancy with reconstruction employing a pedicled vastus lateralis flap at two tertiary care centers. Patient demographics, tumor staging, and rate of complications were assessed. Twenty-eight patients were included, with a median age of 51 years. The most common primary tumor was chondrosarcoma followed by chondroblastic osteosarcoma. The median follow-up was 1.1 years. There were 10 cases of wound infection requiring re-operation and three cases of flap failure. We describe a pedicled vastus lateralis flap for coverage of defects after wide resection of sacropelvic malignancies. A large proportion of our cohort had independent risk factors for wound complications. Even with a cohort with high baseline risk for wound complications, we show that the use of a pedicled vastus lateralis flap is a safe reconstructive option with a wound complication rate in line with the literature.

Incidence and risk factors for surgical wound complications in women with body mass index >30 kg/m2 following cesarean delivery: a secondary analysis

BACKGROUNDSurgical wound complications are common and occur in between 3% and 12% of obese women after cesarean delivery. An understanding of the risk factors for wound complications may inform potential areas for clinical care improvement.OBJECTIVEThis study aimed to identify the incidence and predictors of surgical wound complications in obese women after cesarean delivery.STUDY DESIGNThis was a secondary analysis of the ADding negative pRESSure to improve healING, or DRESSING, randomized controlled trial conducted at 4 maternity hospitals in Australia. A total of 2035 women with a prepregnancy body mass index ≥30 kg/m2 undergoing cesarean delivery were included. Data were collected between October 2015 and December 2019 using self-reporting of signs and symptoms, the research nurses’ direct observation of the surgical site, and medical records. Independent blinded outcome assessors ascertained wound outcomes on the basis of self-reported data and medical records. Multivariable logistic regression models were used to identify independent risk factors for wound complications and surgical wound dehiscence. The 30-day cumulative incidence of wound complications and surgical wound dehiscence was calculated.RESULTSOf the 2035 women, 317 (15.6%) developed a wound complication, whereas 211 (10.4%) developed surgical wound dehiscence. The predictors of a wound complication included 1 previous cesarean delivery (odds ratio, 1.41; 95% confidence interval, 1.05–1.90; P=.02) and ruptured membranes >12 hours (odds ratio, 1.69; 95% confidence interval, 1.08–2.66; P=.02). The odds of developing any wound complication decreased by 45% with vaginal cleansing (odds ratio, 0.55; 95% confidence interval, 0.42–0.72; P<.001) and by 59% for low transverse incision (odds ratio, 0.41; 95% confidence interval, 0.18–0.94; P=.04). The predictors of surgical wound dehiscence included 1 previous cesarean delivery (odds ratio, 1.62; 95% confidence interval, 1.14–2.31; P=.008) and ruptured membranes >12 hours (odds ratio, 1.85; 95% confidence interval, 1.10–3.12; P=.02). The odds of developing surgical wound dehiscence decreased by 50% for vaginal cleansing (odds ratio, 0.50; 95% confidence interval, 0.36–0.69; P<.001) and by 42% for using a double-layer uterine closure (odds ratio, 0.58; 95% confidence interval, 0.35–0.97; P=.04).CONCLUSIONWound complications and surgical wound dehiscence in this population are high. The predictors observed herein would assist in identifying high-risk women. Such information may guide patient-centered decision-making in the planning of surgical births and individualized postoperative care.

The Association Between Metabolic Derangement and Wound Complications in Elective Plastic Surgery

IntroductionThe incidence of metabolically unhealthy obesity is rising nationally. In this study, we compare wound and overall complications between metabolically unhealthy obese and healthy patients undergoing elective plastic surgery and model how operative time influences a complication risk. MethodsPatients undergoing elective breast and body plastic surgery procedures in the 2009-2019 National Surgical Quality Improvement Program (NSQIP) dataset were identified. Complications were compared between metabolically unhealthy obese (body mass index [BMI] > 30 with diabetes and/or hypertension) versus metabolically healthy obese patients (BMI > 30 without diabetes or hypertension). Logistic regression was used to model the probability of wound complications across operative times stratified by metabolic status. ResultsOf 139,352 patients, 13.4% (n = 18,663) had metabolically unhealthy obesity and 23.8% (n = 33,135) had metabolically healthy obesity. Compared to metabolically healthy patients, metabolically unhealthy patients had higher incidence of wound complications (6.9% versus 5.6%; P < 0.001) and adverse events (12.4% versus 9.6%; P < 0.001), in addition to higher 30-d readmission, returns to the operating room, and length of stay (all P < 0.001). After adjustment, BMI (Odds ratio [OR] 7.86), hypertension (OR 1.15), and diabetes (OR 1.25) were independent risk factors for wound complications (all P < 0.001). Among metabolically unhealthy patients, the operative time was log-linear with a wound complication risk (OR 1.21; P < 0.001). ConclusionsDiabetes and hypertension are additive risk factors with obesity for wound complications in elective plastic surgery. Among patients with metabolically unhealthy obesity, a risk of wound complications increases logarithmically with operative time. This distinction with regard to metabolic state might explain the unclear impact of obesity on surgical outcomes within existing surgical literature.

Impact of preoperative smoking on patients undergoing right hemicolectomies for colon cancer

PurposeThe tobacco epidemic is one of the biggest global public health issues impacting quality of life and surgical outcomes. Although 30% of colon cancers warrant a right hemicolectomy (RH), there is no specific data on the influence of smoking on postoperative complications following RH for cancer. The aim of this study was to determine its effect on post-surgical outcomes.MethodsPatients who underwent elective RH for colon cancer between 2016 and 2019 were identified from the ACS-NSQIP database. Propensity score matching (PSM) was used with a maximum absolute difference of 0.05 between propensity scores. Primary outcome was to assess the 30-day complication risk profile between smokers and non-smokers. Secondary outcomes included smoking impact on wound and major medico-surgical complication rates, as well as risk of anastomotic leak (AL) using multivariable logistic regression models.ResultsFollowing PSM, 5652 patients underwent RH for colon cancer with 1,884 (33.3%) identified as smokers. Smokers demonstrated a higher rate of organ space infection (4.1% vs 3.1%, p = 0.034), unplanned return to theatre (4.8% vs 3.7%, p = 0.045) and risk of AL (3.5% vs 2.1%, p = 0.005). Smoking was found to be an independent risk factor for wound complications (OR 1.32, 95% CI 1.03–1.71, p = 0.032), primary pulmonary complications (OR 1.50, 95% CI 1.06–2.13, p = 0.024) and AL (OR 1.66, 95% CI 1.19–2.31, p = 0.003).ConclusionSmokers have increased risk of developing major post-operative complications compared to non-smokers. Clinicians and surgeons must inform smokers of these surgical risks and potential benefit of smoking cessation prior to undergoing major colonic resection.

Complications of Morbid Obesity in the Treatment of Acetabular Fractures: Re-evaluating Outcomes a Decade Later.

To determine the rate of perioperative complications between morbidly obese (body mass index greater than 40 kg/m2) and nonmorbidly obese patients undergoing operative treatment of acetabular fractures across 2 periods (2000-2005 and 2012-2019). Retrospective, case-control study. Level I academic trauma center. Four hundred thirty-five consecutive patients from 2000 to 2005 and 216 consecutive patients from 2012 to 2019 with acetabular fractures treated by a single surgeon. Operative fixation of acetabular fracture. Outcome variables include positioning time, operative time, estimated blood loss, hospital stay, wound complications, and perioperative complications. Twenty-eight morbidly obese and 188 nonmorbidly obese patients from 2012 to 2019, as well as 41 morbidly obese patients and 394 nonmorbidly obese patients from 2000 to 2005 were included in the study. The relative risk (RR) of wound complications between 2012 and 2019 groups was significantly higher for morbidly obese patients (RR = 5.31, P = 0.009) but has decreased significantly for morbidly obese patients between 2000-2005 and 2012-2019 (RR = 0.31, P = 0.017). The rate of total perioperative complications was similar between morbidly obese and nonmorbidly obese groups from 2012 to 2019 (21% vs. 8%, P = 0.230). For morbidly obese patients, the rate of total perioperative complications decreased significantly between 2000-2005 and 2012-2019 (63% vs. 21% P = 0.010). Acetabular fracture surgery can be safely performed in morbidly obese patients. Although obesity remains a significant risk factor for wound complications, the risk for morbidly obese patients has decreased significantly since our initial investigation because of adaptations to surgical techniques and surgeon's experience. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Influence of overweight on the course of a mechanical injury

A literature review deals with the importance of overweight in victims with severe mechanical injury. Mechanical trauma remains an important medical and social problem for humanity. The course of injury and its consequences depend not only on the nature of the trauma, but also on the initial status of victim. The individual characteristics of the patient (gender, age, concomitant somatic pathology, etc.) and the treatment strategy are of great importance, in particular the timing and extent of surgical interventions. In this aspect, the role of overweight, which is a serious health problem worldwide, deserves attention. Many clinical studies and meta-analyses have shown the impact of overweight and obesity on the severity of certain injuries, the course of the post-traumatic period, the frequency of general and local complications, and mortality. Most studies have found that obesity is a marker of a negative prognosis in abdominal injury, and increases the risk of major complications and death. Obesity has been found to be a risk factor for wound complications, intra-abdominal hypertension and abdominal compartment syndrome, acute kidney injury, infectious complications, deep vein thrombosis, thromboembolism and pneumonia. Obese patients who underwent laparotomy for abdominal trauma had higher mortality, longer duration of hospital treatment, and longer duration of stay in the intensive care unit. In addition, obesity impedes interventional manipulations (the placement of the central venous catheter, tracheal intubation, ventilation) and surgical interventions (fracture stabilization, abdominal and thoracic interventions), and reduces the diagnostic value of traditional methods for examination of patients. The negative impact of overweight and obesity should be taken into account when planning diagnostic and treatment strategy, but needs to be further investigated.

A Web-Based Calculator for Predicting the Occurrence of Wound Complications, Wound Infection, and Unplanned Reoperation for Wound Complications in Patients Undergoing Surgery for Spinal Metastases

In the present study, we identified the risk factors for wound complications, wound infection, and reoperation for wound complications after spine metastasis surgery and deployed the resultant model as a web-based calculator. Patients treated at a single comprehensive cancer center during a 7-year period were included. The demographics, pathology, comorbidities, laboratory values, and operative details were collected. Factors with P < 0.15 on univariable regression were entered into multivariable logistic regression to generate predictive models internally validated using 1000 bootstrapped samples. Of the 330 patients included, 29 (7.6%) had experienced a surgical site infection. The independent predictive factors for wound-related complications were a higher Charlson comorbidity index (CCI; odds ratio [OR], 1.41 per point; P < 0.01), Karnofsky performance scale score ≤70 (OR, 2.14; P= 0.04), lower platelet count (OR, 0.49 per 105/μL; P < 0.01), revision versus index surgery (OR, 3.10; P= 0.02), and increased incision length (OR, 1.21 per level; P= 0.02). Wound infection was associated with a higher CCI (OR, 1.60 per point; P < 0.01), a lower platelet count (OR, 0.35 per 105/μL; P < 0.01), revision surgery (OR, 4.63; P= 0.01), and a longer incision length (OR, 1.25 per level; P= 0.03). Unplanned reoperation for wound complications was predicted by a higher CCI (OR, 1.39 per point; P= 0.003), prior irradiation (OR, 2.52; P= 0.04), a lower platelet count (OR, 0.57 per 105/μL; P= 0.02), and revision surgery (OR, 3.34; P= 0.03), The optimism-corrected areas under the curve were 0.75, 0.81, and 0.72 for the wound complication, infection, and reoperation models, respectively. Low platelet counts, poorer health status, more invasive surgery, and revision surgery all independently predicted the risk of wound complications, including infection and unplanned reoperation for infection. Validation of the calculators in a prospective study is merited.

Twenty Years of Breast Reduction Surgery at a Veterans Affairs Medical Center.

Breast reduction surgery has a high patient satisfaction rate for the treatment of symptomatic macromastia. However, complications from the surgery can significantly disrupt a woman's life due to time in the hospital, clinic appointments, wound care, time off work, and poor aesthetic outcome. Beginning July 2007, the Malcom Randall Veterans Affairs Medical Center (MRVAMC) Plastic Surgery Service in Gainesville, Florida, started using a preoperative screening protocol to help patients achieve a healthier and more favorable risk profile. A retrospective chart review was conducted on all breast reduction surgeries performed at the MRVAMC from July 1, 2000 to June 30, 2020. Medical records were queried for all primary breast reduction surgeries performed for symptomatic macromastia. Potentially modifiable or predictable risk factors for wound complications were recorded: nicotine status, body mass index (BMI), diabetes mellitus (DM) status, skin incision pattern, and pedicle location. Records were reviewed for 3 months after surgery for local wound complications that included: hematoma, infection, wound breakdown, skin and nipple necrosis. Major complications required an unplanned hospital admission or operation. Over the 20-year period, 115 bilateral breast reduction surgeries were performed. There were 48 wound complications (41.7%) and 8 major complications (7%). Most complications were identified in the first 7 years of the study. BMI > 32 (P = .03) and active nicotine use (P = .004) were found to be statistically significant risk factors for wound complications. DM status (P = .22), skin incision pattern (P = .25), and pedicle location (P = .13), were not predictors of wound complications. Breast reduction surgery has a high wound complication rate, which can be predicted and improved upon so that patients can receive their indicated surgery with minimal inconvenience and downtime. This review confirms that preoperative weight loss and nicotine cessation were the appropriate focus of the MRVAMC Plastic Surgery service's efforts to achieve a safer surgical experience.