Risk Factors For Wound Infection Research Articles

Study of Risk Factors in Patients with Post Lapartomy Wound Dehisence

Background: Post-laparotomy wound dehiscence is a significant complication in abdominal surgeries, characterized by the partial or complete separation of the surgical wound layers. This complication can lead to severe morbidity, extended hospital stays, and increased healthcare costs. Objective: To assess the risk factors associated with wound dehiscence in patients post-laparotomy. Methods: A cross-sectional study was conducted at the Department of Surgery from January 25, 2024, to April 25, 2024. A total of eighty patients who developed wound dehiscence following emergency or elective laparotomy were selected. Patient demographics, comorbid conditions, and clinical variables were recorded. The risk factors for wound dehiscence, including peritonitis, infection, malignancy, hypoproteinemia, and anemia, were assessed. Statistical analysis was performed using SPSS version 25, with Chi-square tests employed to assess associations between risk factors and comorbid conditions. A significance level of P ≤ 0.05 was considered statistically significant. Ethical approval was obtained, and the study adhered to the Declaration of Helsinki principles. Results: The mean age of patients was 42.67 ± 15.26 years. Males had a higher frequency of wound dehiscence compared to females. The identified risk factors included wound infection (47; 58.8%), malignancy (37; 46.2%), hypoproteinemia (35; 43.8%), anemia (30; 37.5%), and peritonitis (22; 27.5%). A significant association was found between hypertension and the risk factors of wound infection (P=0.01), malignancy (P=0.002), and hypoproteinemia (P=0.01). Conclusion: The study concluded that wound infection, malignancy, hypoproteinemia, anemia, and peritonitis are significant risk factors for wound dehiscence post-laparotomy. Hypertension showed a notable association with wound infection, hypoproteinemia, and malignancy. These findings underscore the importance of preoperative assessment and management of these risk factors to minimize the incidence of wound dehiscence.

Risk Factors of Postoperative Complication and Hospital Mortality after Colorectal Perforation Surgery.

Colorectal perforation is associated with high morbidity and mortality rates after surgery. We investigated various clinical features of patients who underwent emergency surgery for colorectal perforation and explored the risk factors for postoperative complications and hospital mortality. Data from 147 patients who underwent surgery for colorectal perforation were retrospectively reviewed. We investigated various clinical and operative factors, including inflammation-based prognostic scores (IBPSs), and evaluated the risk factors for postoperative complications and hospital mortality due to colorectal perforation. Among 147 patients, the most frequent postoperative complication was wound infection (32 cases, 21.8%), followed by intra-abdominal abscesses (27 cases, 18.4%) after surgery for colorectal perforation. Time from onset to surgery ≥ 2 days (Hazard ratio [HR] = 2.810, p = 0.0383) and prognostic nutritional index (PNI) < 30 (HR = 3.190, p = 0.0488) were identified as risk factors for intra-abdominal abscess, while neutrophil-lymphocyte ratio (NLR) < 6.15 (HR = 5.020, p = 0.0009) was identified as a risk factor for wound infection. Time from onset to surgery ≥ 2 days (HR = 7.713, p = 0.0492), severe postoperative complications (Clavien-Dindo grade ≥ IIIa) (HR = 10.98, p = 0.0281), and platelet-lymphocyte ratio (PLR) < 144 (HR = 18.84, p = 0.0190) were independent predictive factors for hospital mortality. Time from onset to surgery and IBPSs such as PNI, NLR, and PLR, may be associated with postoperative complications and hospital mortality due to colorectal perforation.

Pooperacinių antriniu būdu gyjančių žaizdų priežiūra: literatūros apžvalga

Abstract. According to the World Health Organisation (WHO) ‘Half the cases of post-operative hard-to-heal wounds can be avoided’ [1]. Foreign authors A. E. Boniakowski, A. S. Kimball, B. N. Jacobs, et al. (2017) state that ‘Wound monitoring and periodic post-operative wound care performed at periodically planned time are important at all stages of wound healing’ [2]. &#x0D; Objective of the literature review. To analyse scientific articles on risk factors and wound management of hard-to-heal wounds. &#x0D; Methods. The literature review was conducted using the PubMed, ECDC, and Google Scholar search in the electronic MEDLINE database. The search was carried out between September and December 2023. Keyword phrases and their combinations were used for the search. Twenty three articles on the examined topic were included in the literature review. &#x0D; Results of the literature review. The present article discusses the main risk factors for wound infection and preventive measures. After analysing scientific articles, the causes of hard-to-heal wounds have been elucidated, which depend on the nature of the surgery, different pathogenic microorganisms, and the selection of dressings at each stage of wound healing.&#x0D; Conclusions. 1. Favourable conditions must be created for wound healing. Regular assessment of the wound healing process based on clinical indicators is attributed to an important factor. 2. Topical antimicrobial agents are used when wound healing is suspected to be impaired; dressings are selected based on the type of wound healing.

Risk and protective factors associated with wound infection after neurosurgical procedures: A meta-analysis.

To systematically evaluate the risk factors for wound infection at the surgical site after neurosurgical craniotomy by meta-analysis, and to provide an evidence-based basis for preventing the occurrence of wound infection. A computerised search of PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure and Wanfang database was conducted for relevant studies on risk factors for surgical site wound infection after neurosurgical craniotomy published from the database inception to November 2023. Two researchers independently screened the literature, extracted the data and performed quality assessment in strict accordance with the inclusion and exclusion criteria. STATA 17.0 software was applied for data analysis. Overall, 18 papers with 17 608 craniotomy patients were included, of which 905 patients developed wound infections. The analysis showed that underlying diseases [OR = 2.50, 95% CI (1.68, 3.72), p < 0.001] and emergency surgery [OR = 2.47, 95% CI (1.80, 3.38), p < 0.001] were the risk factors for developing wound infections after craniotomy, age < 60 years [OR = 0.72, 95% CI (0.52, 0.98), p = 0.039] was a protective factor for wound infections; whereas sex [OR = 1.11, 95% CI (0.98, 1.27), p = 0.112] and the antimicrobial use [OR = 1.30, 95% CI (0.81 2.09), p = 0.276] were not associated with the presence or absence of wound infection after craniotomy. Underlying disease and emergency surgery are risk factors for developing wound infections after craniotomy, whereas age < 60 years is a protective factor. Clinicians can reduce the occurrence of postoperative wound infections by communicating with patients in advance about the possibility of postoperative wound infections based on these factors, and by doing a good job of preventing postoperative wound infections.

Effect of initial treatment with chemotherapy or surgery on wound complications in patients with advanced ovarian cancer: A meta‐analysis

AbstractThere has been controversy over the use of neoadjuvant chemotherapy or surgery in the treatment of ovarian cancer. The purpose of this meta‐analysis is to assess the hazard evaluation of the effect of adjuvant chemotherapy over primary debulking surgery (PDS) on the incidence of wound infection in women with ovarian carcinoma. In this research, we looked at PubMed, Embase and Cochrane Library to evaluate the impact of PDS and chemotherapy on the incidence of wound infections in women with ovarian cancer. Based on the keywords of ‘Ovary Cancer’, ‘Surgical’ and ‘Chemotherapy’, we looked up the data in the digital database, and at last, we selected six of them from 1453 studies. There was no time limitation in the studies. The meta‐analyses included studies that described the risk factors of wound infection in ovarian carcinoma patients, particularly those who reported OR value. The Chi‐square method was employed to perform statistical analysis of the inter‐study heterogeneity, with additional analyses dependent on I2. A sensitivity analysis was conducted, and a possible publication bias was evaluated. The findings suggest that there is a significant reduction in the rate of wound infections among patients with ovarian cancer treated with primary chemotherapy than with PDS (OR, 2.80; 95% CI, 1.79, 4.39, p &lt; 0.0001). There was a significant reduction in the incidence of thrombus in patients with ovarian cancer who were treated with primary chemotherapy than in those who did have prior surgical intervention (OR, 2.77; 95% CI, 1.34, 5.74, p = 0.006). Our findings indicate that early chemotherapy in ovarian cancer patients may lower their chances of developing wound infection.

Incidence and Risk Factors for Wound Infections after Trimeresurus stejnegeri Snakebites in Taiwan.

Snakebite envenomation is a neglected tropical disease. Taiwan, with its subtropical and Southeast Asian environment, provides suitable habitat for several venomous snake species. Trimeresurus stejnegeri, an arboreal pit viper, is the most common cause of venomous snakebite in Taiwan. Trimeresurus stejnegeri envenomation can cause local swelling, occasional ecchymosis, and wound infection. The primary treatment of T. stejnegeri envenomation is the binary antivenom, vacuum freeze-dried F(ab')2 fragments of equine antibodies, against T. stejnegeri and Protobothrops mucrosquamatus. This study aimed to analyze the incidence of post-envenomation wound infections caused by T. stejnegeri based on data collected over a decade from institutions affiliated with the Chang Gung Memorial Hospital in Taiwan. A total of 254 patients were enrolled in this study. Clinical and laboratory data, treatment information, and patient outcomes were extracted from electronic medical records. Wound infection was associated with delay in antivenom initiation (adjusted odds ratio: 3.987; 95% CI: 1.406-11.302). The infection rates were 20.5%, 12.5%, 31.3%, and 48.1% for antivenom administration within 2 hours, 2-4 hours, 4-6 hours, and > 6 hours, respectively. Therefore, early initiation of antivenom treatment (within 6 hours) is recommended. Morganella morganii was cultured from wounds of the patients, whereas Enterobacter cloacae and Enterococcus faecalis were cultured from both the oral cavity of snakes and the wounds of the patients. For post-envenomation patients who develop a local infection, empiric antibiotics such as third-generation cephalosporins, quinolones, and piperacillin/tazobactam are recommended because snakebite wound infections are often polymicrobial in nature.

Meta-Analysis on Efficacy and Complications of Bone Morphogenetic Protein-2 for Posterior Fusion of Cervical Spine

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is effective for promoting robust fusion for long-level cervical deformity and revision surgeries. However, only a few studies have reported its efficacy and complications in posterior cervical fusion (PCF). Therefore we evaluated the efficacy and complications of rhBMP-2 application in PCF surgery by searching 3 electronic databases (PubMed, Cochrane Database, and EMBASE) for studies that evaluated the use of rhBMP-2 in PCF. Five studies (1 prospective and 4 retrospective) were included in the meta-analysis. The quality of each study was assessed, and data on pseudarthrosis, wound infection, neurologic, and immediate medical complications were extracted and analyzed. We found that the use of rhBMP-2 in PCF showed significant benefits in terms of pseudarthrosis and no significant increases in the risk for neurologic and immediate medical complications regardless of the dose. However, high-dose (>2.1 mg/level) rhBMP-2 was a risk factor for wound infection after PCF. Our meta-analysis of the currently available literature suggests that patients with PCF may benefit from BMP-2 usage without increasing the risk of complications. However, dose control and containment are important to ensure a low risk of complications.

Incidence, Timing, and Possible Risk Factors for Post-Cesarean Wound Infection among Low-Risk Patients in Zaria, Nigeria: A Cross-Sectional Study

Context: Rising cesarean section rates worldwide have led to an increase in post-operative complications, especially wound infection, and endometritis. Low-risk cesarean sections are still at risk of these infections despite the absence of common risk factors. The burden and possible risk factors for these have not been widely documented in patients without major risk factors. Aim: To determine the incidence, timing of diagnosis, and possible risk factors for wound infection in low-risk cesarean sections. Settings and Design: A prospective cross-sectional study conducted among consenting women undergoing low-risk cesarean sections, defined as the absence of established risk factors for post-operative wound infection. Materials and Methods: Participants' sociodemographic and obstetric characteristics were documented in a structured proforma. The primary outcome measure was the incidence and timing of wound infection. Secondary outcome measures were the incidences of endometritis and febrile morbidity. The data were analyzed using SPSS version 21 and Windows WINPEPI. Results: The incidence of wound infection was 11.2% (19); endometritis—20.6% (35); febrile morbidity—4.1% (7). The mean timing of diagnosis of wound infection and endometritis were 10.22 ± 3.64 and 11.57 ± 3.34 days, respectively. Grandmultiparity (P = 0.007), low maternal educational levels (P = 0.014), endometritis (p = &lt;0.0001), and febrile morbidity (P = 0.017) were the demonstrated risk factors for wound infection. Conclusion: The incidence of wound infection in the study population was high and mostly diagnosed after discharge from the hospital. Risk factors for wound infection were grand multiparity, lower educational level, endometritis, and febrile morbidity.

Prevention of surgical site infections: a personal odyssey

Prevention of surgical site infections: a personal odyssey

Superbugs and Bacterial Epidemiology from Wound Infection at Health Institutions in Northeast Ethiopia.

Wound infection plays an important role in the development of chronicity by delaying wound healing, prolonging hospital stay, increasing treatment cost and is responsible for significant morbidity. The aim of this study was to investigate the bacterial epidemiology, multi-drug resistance, and associated risk factors for wound infection at health institutions in Northeast Ethiopia. A facility-based cross-sectional study was conducted from February to April 2021. Demographic, clinical, and risk factor variables were collected using a structured questionnaire. Swabs/pus from wound were collected using sterile applicator swab. Specimens were inoculated on culture media and bacterial isolates were identified using microbiological techniques. Antimicrobial susceptibility test was performed using Kirby-Bauer disc diffusion method. Statistical analysis was done using SPSS software. A total of 229 participants were included in this study. A total of 170 bacterial isolates (74.2%) were isolated. The predominant isolates were S. aureus 80 (47.05%), followed by P. aeruginosa 29 (17.05%), E. coli 22 (12.94%), and Klebsiella spp. 16 (9.41%). Tetracycline (71.7%), clindamycin (15.2%), erythromycin (30.4%), penicillin (80.4%), and co-trimoxazole (80.4%) resistance rates were observed among Gram positive bacterial isolates. The overall prevalence of multi-drug resistance was 71%. Hence, improving the laboratory setup for culture and drug susceptibility testing is recommended for effective treatment of wound infection and to improve infection prevention and control practices in healthcare settings.

Surgical site infection in skin surgery-An observational study.

Surgical site infection (SSI) has a significant impact on patients' morbidity and aesthetic results. To identify risk factors for SSI in dermatologic surgery. This prospective, single-centre, observational study was performed between August 2020 and May 2021. Patients that presented for dermatologic surgery were included and monitored for the occurrence of SSI. For statistical analysis, we used a mixed effects logistic regression model. Overall, 767 patients with 1272 surgical wounds were included in the analysis. The incidence of SSI was 6.1%. Significant risk factors for wound infection were defect size over 10cm2 (OR 3.64, 95% confidence interval [CI] 1.80-7.35), surgery of cutaneous malignancy (OR 2.96, CI 1.41-6.24), postoperative bleeding (OR 4.63, CI 1.58-13.53), delayed defect closure by local skin flap (OR 2.67, CI 1.13-6.34) and localisation of surgery to the ear (OR 7.75, CI 2.07-28.99). Wound localisation in the lower extremities showed a trend towards significance (OR 3.16, CI 0.90-11.09). Patient-related factors, such as gender, age, diabetes, or immunosuppression, did not show a statistically significant association with postoperative infection. Large defects, surgery of cutaneous malignancy, postoperative bleeding, and delayed flap closure increase the risk for SSI. High-risk locations are the ears and lower extremities.

Risk Factors in Post Operative Wound Infections Following Elective Abdominal Operations

Introduction: Surgical site infections are common post operative complication and cause significant post operative morbidity and mortality, and have serious consequences for outcomes and costs. Different risk factors are involved, including age, sex, smoking, nutrition, diabetes, pre existing illness, pre operative hospital stay time, pre operative shaving, level of surgeon, length of incision, duration of operation, per operative blood transfusion, wound drainage and nature of wound. The objective of this study was to determine the risk factors affecting abdominal surgical site infections and their rate at Dhaka Medical College &amp; Hospital, a major referral teaching hospital in Bangladesh. Objectives: were to identify risk factors in post operative wound infections following elective abdominal surgery. Materials and Methods: A Cross sectional type of observation study was carried out among 153 patients in Department of Surgery, Dhaka Medical College Hospital, Dhaka from January 2008 to December 2009. Results: Patients (n = 153) who had undergone elective surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. To test the independence of the risk factors, the significant variables (p _.05) in the univariate analyses were entered into a stepwise logistic regression equation. Data were collected through pre and postoperative examinations. The subjects were followed till discharge. Of the 153 patients, 13 suffered from SSI (8.5%). Among the infections superficial SSI was in 8 cases (61.54%), deep SSI in 3 cases (23.08%), and organ/space SSI in 2 (15.38%) cases. There were 14 different variables in study to determine the risk factors. In univariate analysis ten risk factors were identified: age, underweight, diabetes, ASA score, pre operative hospital stay, per operative blood transfusion, length of incision, duration of operation, wound drain and contaminated wound. And in multivariate analysis duration of operation, diabetes mellitus and ASA score appeared to be independent risk factors for wound infection. Conclusion: The total elimination of wound infection is not possible, a reduction in the infection rate to a minimal level could have significant benefits in terms of both patient comfort and medical resources used. The SSI may be reduced to a more acceptable level by reducing the average operation time to less than 2 hours, pre operative hospital stay, and by reducing contamination during operation and wound drainage. Furthermore post operative study in large scale is recommended. Medicine Today 2023 Vol.35(1): 56-62

Interaction of basic diseases and low red blood cell count as critical murderer of wound infection after osteosarcoma resection: Wound infection after osteosarcoma resection.

Background:Surgical wound infection is one of the common complications in patients after osteosarcoma resection. It is imperative to grasp the risk factors comprehensively. Therefore, this study aimed to explore the risk factors of wound infection and deeply analyze the correlation between risk factors and wound infection.Methods:The study subjects were 101 patients who underwent osteosarcoma resection between April 2018 and August 2021. The diagnosis of postoperative wound infection was confirmed by postoperative observation of the incision, ultrasound imaging, and pathogenic examination. This study included a series of potential factors, mainly laboratory examination indicators and patients’ general information. The statistical methods had Pearson Chi-square test, Spearman-rho correlation test, multifactorial linear regression model, logistic regression analysis, and receiver operating characteristic (ROC) curve.Results:Pearson Chi-square test and Spearman correlation test showed that red blood cell (RBC) count (P = .033) and basic diseases (P = .020) were significantly correlated with a surgical wound infection after osteosarcoma resection. Logistic regression analysis manifested that basic disease (OR = 0.121, 95% CI: 0.015‐0.960, P = .046) and RBC (OR = 0.296, 95% CI: 0.093‐0.944, P = .040) have a clear correlation with whether the patients have surgical wound infection after osteosarcoma resection. And the interaction of basic diseases and RBC could diagnose the surgical wound infection sensitively and accurately (AUC = 0.700, P = .014, 95% CI = 0.564‐0.836) via the ROC analysis.Conclusion:Patients with basic diseases and low RBC were risk factors for surgical wound infection after osteosarcoma resection.

Analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource-limited setting.

BackgroundMachete cut fracture is a unique subset of open fracture. The sharp force of a wielded machete that cleanly divides soft tissue envelope with minimal or no contusion results in an open fracture wound that is relatively less prone to infection. However, in resource-limited settings, the wound infection rate after machete cut fracture is relatively high. This study aimed to determine the risk factors for wound infection after extremity machete cut fractures in a Nigerian setting.MethodsWe undertook a retrospective analysis of the patients who were seen in the Emergency room of two tertiary hospitals in Nigeria with a machete cut extremity fracture from 2009 to 2018. The association of wound infection with population and wound characteristics as well as intervention related factors were evaluated. Statistical significant factors for wound infection in the Univariable analysis were entered into a Multivariable regression analysis to evaluate the risk of each factor when adjusted to other factors.ResultsThere were 113 machete-cut fractured bones in 67 eligible patients and wound infection was a complication in 45 (39.8%) of the cases (95%CI 30.3 – 49.7%).The factors significantly associated with high wound infection rate were smoking, haematocrit < 30%, fractures sustained outdoors, lower extremity fractures, a wound size of >5cm in length, injury-to-hospital arrival interval > 6hrs. Multivariable regression analysis identified wound size >5 cm (aOR 14.142, 95%CI (2.716 - 73.636); p = 0.002), injury-to- hospital arrival interval later than 6hrs (aOR 4.410, 95% CI (1.003-19.394); p = 0.050) and administration of antibiotics later than 3hrs of injury (aOR 5.736, 95%CI (aOR1.362 - 24.151; p = 0.017) as independent risk factors for wound infection.ConclusionWound infection after open fractures caused by machetecut is more likely to occur in patients that present later than six hours after injury, wounds more than 5cm in length and delayed antibiotic administration. Appropriate treatment protocols can be instituted with this knowledge.

Risk factors of wound infection after lung transplantation: a narrative review.

Background and ObjectiveThe incidence of incision infection after lung transplantation is prominently high which affect the prognosis. Summarizing the risk factors related to incision infection after lung transplantation contribute to the control of incision infection by pre-controlling the risk factors. The objective is to summarize risk factors related to wound infection after lung transplantation.MethodsPubMed was used to research the literature relating to the risk factors to incision infection after lung transplantation through 1990 to 2022. The retrieval strategy were Medical Subject Heading (MeSH) terms combined entry terms. Two researchers conducted the literature retrieval independently. Two researchers independently evaluate the quality of the literature and summarize the indicators.Key Content and FindingsA total of 98 researches were collected from PubMed and 8 articles described the related risk factors of incision infection after lung transplantation. All of the 8 articles were retrospective studies, of which 4 articles were grouped by the delayed chest closure (DCC) execution and the other 4 articles were grouped by the surgical site infection (SSI) occurred. Two articles performed multivariate regression analysis to determine the independent risk factors of SSI after lung transplantation and the other 6 articles compared the SSI rate in different patients population. The integrated results showed that bronchoalveolar lavages (BALs), smoking status, body mass index (BMI), diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation.ConclusionsBALs, smoking status, BMI, diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation.

The importance of microbiological results for the treatment of complicated appendicitis-a monocentric case-control study

Patients with complicated appendicitis frequently develop postoperative septic complications. There are no uniform standards for the choice of perioperative antibiotic prophylaxis and the duration of postoperative antibiotic treatment. The purpose of this study was to investigate associations between microbiological samples and postoperative complications. Patients with appendectomy and positive intraoperative swabs during 2013-2018 were included in this case-control study. Pathogen classes and their resistance patterns were evaluated in initial and follow-up swabs and compared in each of the groups with and without complications. Atotal of 870patients underwent surgery during the period studied. Pathogen detection succeeded in 102 of 210cases (48.6%) with suspected bacterial peritoneal contamination. Conversion from laparoscopic to open intra-abdominal perforation and the presence of an abscess were independent risk factors for wound infections in the multivariate analysis. The combination of different classes of pathogens resulted in significantly increased overall resistance to ampicillin/sulbactam in both the initial swabs (57%) and the follow-up swabs (73%). Resistant E.coli strains combined with certain anaerobes were also regularly detected in postoperative intra-abdominal abscesses. Piperacillin/tazobactam was effective against 83% of positive swabs in our resistance tests. Surgical treatment for complicated appendicitis remains the central therapeutic column. Aregular review of the existing resistance patterns in perforated appendicitis can help to adjust and improve antibiotic treatment. Piperacillin/tazobactam should be used cautiously as areserve antibiotic. Avalid alternative is second or third generation cephalosporins in combination with metronidazole.

Patient-dependent risk factors for wound infection after skin surgery: A systematic review and meta-analysis.

Postoperative wound infection in dermatologic surgery causes impaired wound healing, poor cosmetic outcome and increased morbidity. Patients with a high-risk profile may benefit from perioperative antibiotic prophylaxis. The objective of this systematic review was to identify risk factors for surgical site infection after dermatologic surgery. In this article, we report findings on patient-dependent risk factors. The literature search included MEDLINE, EMBASE, CENTRAL and trial registers. We performed meta-analysis, if studies reported sufficient data to calculate risk ratios with 95% confidence intervals. Study quality was assessed according to the Newcastle-Ottawa-Scale. Seventeen observational studies that analysed 31213 surgical wounds were eligible for inclusion. Fourteen studies qualified for meta-analysis. Nine studies showed good, three fair and five poor methodological quality. The reported incidence of surgical site infection ranged from 0.96% to 8.70%. Meta-analysis yielded that male gender and immunosuppression were significantly associated with higher infection rates. There was a tendency towards a higher infection risk for patients with diabetes, without statistical significance. Meta-analysis did not show different infection rates after excision of squamous cell carcinoma or basal cell carcinoma, but studies were substantially heterogenous. There was no significant association between risk for wound infection and smoking, age over 60 years, oral anti-aggregation or anti-coagulation or excision of malignant melanoma. In conclusion, the risk for surgical site infection in dermatologic surgery is low. Infection rates were increased significantly in male as well as immunosuppressed patients and non-significantly in diabetics.

Antibiotic-Resistant Bacteria Colonizing the Bile Duct Are Associated with Increased Morbidity and Mortality after Resection of Extrahepatic Cholangiocarcinoma.

Background: Patients with extrahepatic cholangiocarcinoma (CCA) face considerable morbidity including septic complications after surgery. The aim of this study was to characterize the bacterial spectrum of the common hepatic duct (CHD) and its clinical relevance regarding morbidity and mortality after resection of extrahepatic CCA. Methods: We retrospectively analyzed data from 205 patients undergoing surgery for extrahepatic CCA in our department between January 2000 and March 2015. Patients were reviewed for pre-operative medical conditions, biliary bacterial flora obtained from intra-operative swabs, different septic complications, and post-operative outcome. Results: Bacterial colonization of the CHD was observed in 84.9% of the patients, with Enterococcus faecalis being detected most frequently (28.3%). Wound infections occurred in 30.7% of patients. Bacterial flora of the CHD and of the post-operatively colonized wounds coincided in 51.5% and of intra-abdominal swabs obtained during surgical revisions in 40.0%. Ciprofloxacin-resistant bacteria in the CHD were identified as independent risk factor for wound infections (odds ratio [OR], 3.330; 95% confidence interval [CI], 1.771-6.263; p < 0.001) and for complications requiring surgical revision (OR, 2.417; 95% CI, 1.288-4.539; p = 0.006). Most important independent risk factors for intra-hospital mortality were ampicillin-sulbactam-resistant bacteria in the CHD (OR, 3.969; 95% CI, 1.515-10.399; p = 0.005) and American Society of Anesthesiologists (ASA) grading >2 (OR, 2.936; 95% CI, 1.337-6.451; p = 0.007). Conclusions: Antibiotic-resistant bacteria from the CHD are associated with increased morbidity and mortality in patients undergoing resection for extrahepatic CCA.

Le Fort I osteotomy with segmentation for the treatment of maxillary dentoalveolar protrusion: a single-centre, 10-year outcome study

A retrospective study was conducted to evaluate the stability and complications of Le Fort I osteotomy with segmentation for the treatment of bimaxillary dentoalveolar protrusion. A total of 120 consecutive patients who had undergone orthognathic surgery between 2008 and 2017 at a single centre were recruited. Lateral cephalometric radiographs were taken before surgery, within 6 weeks after surgery, and at 2 years after surgery. U1–SN and U1–PP underwent mean uprighting of 8.7° and 9.6°, respectively, and mean relapse of 2.1° and 2.6°, respectively (both P < 0.05). The only significant risk factor for relapse was the use of intermaxillary fixation (risk ratio (RR) 1.2, P = 0.01). The most common complication was wound dehiscence (41.7%), which was a significant risk factor for wound infection (RR 3.3, P < 0.01) and fixation hardware exposure (RR 3.7, P < 0.01). Other common complications were gingival recession (40.8%), periodontal bone loss (40%), and blood loss requiring transfusion (26.7%), the latter of which was associated with the preoperative diagnosis of vertical maxillary excess (RR 2.4, P = 0.01). Some degree of relapse occurred in more than 90% of the patients by 2 years after surgery. The procedure is not without risks and complications but may be useful in severe cases.

Are Specific Body Sites Prone for Wound Infection After Skin Surgery? A Systematic Review and Meta-Analysis.

Identifying risk factors for wound infection may guide clinical practice for optimal use of perioperative antibiotic prophylaxis in dermatologic surgery. To summarize the current evidence whether specific body sites have higher risks for surgical site infections (SSI). The systematic literature search included MEDLINE, Embase, CENTRAL, and trial registers. Only observational studies qualified for inclusion and meta-analysis. We assessed the risk of bias according to the Newcastle-Ottawa Scale. Eighteen studies with 33,086 surgical wounds were eligible. Eight studies were of good, 4 of fair, and 6 of poor quality. The mean infection rate was 4.08%. Meta-analysis showed that the lips had significantly higher infection rates. The lower extremity and ears had or tended toward a higher risk for infection, but studies were clinically heterogeneous. A large prospective trial found that surgical wounds on the hands were at higher risk for infection. The trunk showed the lowest infection rate. The risk for SSI in other body locations was not different or remained uncertain because of substantial heterogeneity among studies. Lips, lower extremities, and probably ears and hands may have a higher risk for wound infection after skin surgery. The trunk showed the lowest infection rate.