Risk Factors For Surgical Site Infection Research Articles

Development and validation of a nomogram to predict surgical site infection after soft-tissue sarcoma resection.

Surgical site infection (SSI) after soft-tissue sarcoma (STS) resection is a serious complication. The purpose of this retrospective study was to investigate the risk factors for SSI after STS resection, and to develop a nomogram that allows patient-specific risk assessment. A total of 547 patients with STS who underwent tumour resection between 2005 and 2021 were divided into a development cohort and a validation cohort. In the development cohort of 402 patients, the least absolute shrinkage and selection operator (LASSO) regression model was used to screen possible risk factors of SSI. To select risk factors and construct the prediction nomogram, multivariate logistic regression was used. The predictive power of the nomogram was evaluated by receiver operating curve (ROC) analysis in the validation cohort of 145 patients. LASSO regression analysis selected possible risk factors for SSI, including age, diabetes, operating time, skin graft or flap, resected tumour size, smoking, and radiation therapy. Multivariate analysis revealed that age, diabetes, smoking during the previous year, operating time, and radiation therapy were independent risk factors for SSI. A nomogram was developed based on the results of multivariate logistic regression analysis. In the development cohort, the incidence of SSI was 4.5% in the low-risk group (risk score < 6.89) and 26.6% in the high-risk group (risk score ≥ 6.89; p < 0.001). In the validation cohort, the incidence of SSI was 2.0% in the low-risk group and 15.9% in the high-risk group (p = 0.004). Our nomogram will enable surgeons to assess the risk of SSI in patients with STS. In patients with high risk of SSI, frequent monitoring and aggressive interventions should be considered to prevent this.

Incidence of surgical site infection in minimally invasive colorectal surgery.

Surgical site infection (SSI) is a common complication of colorectal surgery. Minimally invasive surgery notably reduces the incidence of SSI. This study aimed to compare the incidences of SSI after robot-assisted colorectal surgery (RACS) vs that after laparoscopic assisted colorectal surgery (LACS) and to analyze associated risk factors for SSI in minimally invasive colorectal surgery. To compare the incidences of SSI after RACS and LACS, and to analyze the risk factors associated with SSI after minimally invasive colorectal surgery. Clinical data derived from patients who underwent minimally invasive colorectal surgery between October 2020 and October 2022 at the First Affiliated Hospital of Soochow University were collated. Differences in clinical characteristics and surgeryrelated information associated with RACS and LACS were compared, and possible risk factors for SSI were identified. A total of 246 patients (112 LACS and 134 RACS) were included in the study. Fortythree (17.5%) developed SSI. The proportions of patients who developed SSI were similar in the two groups (17.9% vs 17.2%, P = 0.887). Diabetes mellitus, intraoperative blood loss ≥ 100 mL, and incision length were independent risk factors for SSI. Possible additional risk factors included neoadjuvant therapy, lesion site, and operation time. There was no difference in SSI incidence in the RACS and LACS groups. Diabetes mellitus, intraoperative blood loss ≥ 100 mL, and incision length were independent risk factors for postoperative SSI.

Influence of additional prophylactic oral antibiotics during mechanical bowel preparation on surgical site infection in patients receiving colorectal surgery.

Prophylactic antibiotics (PAs) are standard for preventing surgical site infections (SSIs) post-colorectal surgery. This study aims to compare the effect of additional empiric oral antibiotics (OAs) alongside routine PAs to identify SSI risk factors. A retrospective observatory analysis was conducted from January 2019 to December 2022 at Asan Medical Center, Seoul, Korea. The cohort was divided into two groups: PA given 1h before surgery and discontinued within 24h, and OA administered empiric OAs during mechanical bowel preparation in addition to PA. From a total of 6736 patients, 3482 were in the PA group and 3254 in the OA group. SSI incidence showed no significant intergroup difference (p=0.374) even after propensity score matching (p=0.338). The multivariable analysis revealed male sex [odds ratio (OR): 2.153, 95% confidence interval (CI): 1.626-2.852, and p=0.001], open surgery (OR: 3.335, 95% CI: 2.456-4.528, and p=0.001), dirty wound (OR: 2.171, 95% CI: 1.256-3.754, and p=0.006), and an operation time of more than 145min (OR: 2.110, 95% CI: 1.324-3.365, and p=0.002) as SSI risk factors. In rectal surgery subgroup, OA demonstrated a protective effect against SSI (OR: 0.613, 95% CI: 0.408-0.922, and p=0.019) and in laparoscopic approach (OR: 0.626, 95% CI: 0.412-0.952, and p=0.028). OA did not affect SSI incidence in colorectal surgeries. Male sex, open surgery, dirty wounds, and longer operation time were risk factors for SSI. However, for rectal and laparoscopic surgery, OA was a protective factor for SSI.

Negative Pressure Wound Therapy to Reduce Surgical Site Infections after CRS/HIPEC.

Surgical site infections (SSIs) are a common cause of morbidity after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancy. Negative pressure wound therapy (NPWT) has been proposed as a method to reduce the rates of SSIs; however, there is paucity in the literature on the efficacy in this population. The goal of this study was to determine whether routine use of NPWT in patients undergoing CRS/HIPEC could reduce the risk of developing SSI. We performed a retrospective before-after study to assess the rates of SSI with NPWT compared with a standard postoperative surgical dressing (SSD) in all patients undergoing CRS/HIPEC from November 2013 to December 2021 at a single tertiary care center. The primary outcome was rate of SSI. A multivariate logistic regression analysis was performed to evaluate for risk factors for SSI. A total of 178 patients were treated with CRS/HIPEC over the study period. Seventy patients had placement of SSD, and 108 patients had placement of NPWT. Rates of SSI were 11.4% (8/70) and 5.6% (6/108) in the two groups, respectively (p = 0.16). On multivariate analysis, patients treated with NPWT had a significantly lower risk of developing an SSI (OR 0.24 [0.06, 0.92], p = 0.037). Patients living >50 km from the hospital had significantly higher risk of developing SSI (OR 2.03 [1.09, 3.78], p = 0.026). These results suggest that routine use of NPWT can reduce the risk of developing an SSI in patients undergoing CRS/HIPEC for peritoneal malignancy.

Perioperative Antibiotic Prophylaxis—Indications and Modalities for the Prevention of Postoperative Wound Infection.

Postoperative surgical site infections (SSI) account for almost 25% of all nosocomial infections in Germany and are a source of increased morbidity and mortality. This review is based on pertinent publications retrieved by a selective search in PubMed and on national and international guidelines. The individual risk factors for SSI must be assessed before any surgical procedure. A body-mass index above 30 kg/m2 is associated with an unadjusted risk ratio of 1.35 [1.28; 1.41] for SSI, which rises to 3.29 [2.99; 3.62] if the patient is also immunosuppressed. The risk of SSI is also significantly higher with certain types of procedure. Perioperative antibiotic prophylaxis (PAP) is clearly indicated for operations that carry a high risk of SSI (e.g., colorectal surgery) and for those that involve the implantation of alloplastic material (e.g., hip endoprostheses). PAP can usually be administered with basic antibiotics such as cefazoline. The basic principles of PAP are that it should be given by the anesthesia team in the interval from 60 minutes preoperatively up to shortly before the incision, and that its administration should only be for a short period of time, usually as a single shot. Continuing PAP onward into the postoperative period leads to increased toxicity, bacterial superinfections, and antibiotic resistance. The evidence shows that perioperative antibiotic prophylaxis is a component of a bundle of measures that can help prevent SSI. Strict indications and adherence to the basic principles of PAP are essential for therapeutic success.

Analysis of risk factor for surgical site infection and other postoperative complications in patients following loop ileostomy reversal.

Introduction:Loop ileostomy reversal (LIR) procedure is associated still with relatively high risk of complications. Surgical site infection (SSI) is the most common complication in this group of patients. As a result of SSI, it leads to prolonged hospital stay, delay the adjuvant therapy and increase the hospital costs. Aim of the study:The aim of the study was to analyze the risk factors for SSI in patients following loop ileostomy reversal procedure.Material and methodsA single-centre retrospective analysis was conducted in a tertiary reference center. Finally, sixty five patients following loop ileostomy reversal procedure performed between 2018 and 2022 were enrolled into the study. Data were collected retrospectively based on the available medical charts. The study group comprised of 23 women (35%) and 42 men (65%) with the mean age 48.914.5 years and the mean body mass index 24.34.9 kg/m2. The most common indication for index surgery was ulcerative colitis (33%) and colorectal cancer (29%). Preferably, handsewn anastomosis was performed (n=42; 64.6%).Results:The most important parameter evaluated in the above study was the diagnosis of surgical site infection, which was important, among others, in during hospitalization after surgery, the need for antibiotic therapy or CRP values. 9 patients (13.8%) were diagnosed with SSI during their hospital stay (more than 86% without SSI). In the group with SSI it was over 13 days compared to almost 6 days in the group without SSI (p=0.00009). The time of the procedure had a statistically significant correlation with antibiotic therapy introduction (p=0.01). The type of intestinal anastomosis had a significant impact on the operative time (p=0.0011) and the time of hospital stay after surgery (p=0.04).Conclusions:Most of the analyzed clinical factors were directly related to the impact on the duration of postoperative hospitalization. The duration of hospitalization is an independent and undeniable factor of increasing the risk of other postoperative complications and significantly increases the cost of hospitalization. Another factor that has a large clinical impact on postoperative treatment is the presence of comorbidities, which made patients more likely to develop SSI, CRP increase or the need for antibiotic therapy. An important factor was the level of CRP, the elevated value of which may be a predictor of many negative aspects in postoperative treatment.

Effect of unidirectional airflow ventilation on surgical site infection in cardiac surgery: environmental impact as a factor in the choice for turbulent mixed air flow

Surgical site infection (SSI) in the form of postoperative deep sternal wound infection (DSWI) after cardiac surgery is a rare, but potentially fatal, complication. In addressing this, the focus is on preventive measures, as most risk factors for SSI are not controllable. Therefore, operating rooms are equipped with heating, ventilation and air conditioning (HVAC) systems to prevent airborne contamination of the wound, either through turbulent mixed air flow (TMA) or unidirectional air flow (UDAF). To investigate if the risk for SSI after cardiac surgery was decreased after changing from TMA to UDAF. This observational retrospective single-centre cohort study collected data from 1288 patients who underwent open heart surgery over 2 years. During the two study periods, institutional SSI preventive measures remained the same, with the exception of the type of HVAC system that was used. Using multi-variable logistic regression analysis that considered confounding factors (diabetes, obesity, duration of surgery, and re-operation), the hypothesis that TMA is an independent risk factor for SSI was rejected (odds ratio 0.9, 95% confidence interval 0.4-1.8; P>0.05). It was not possible to demonstrate the preventive effect of UDAF on the incidence of SSI in patients undergoing open heart surgery when compared with TMA. Based on these results, the use of UDAF in open heart surgery should be weighed against its low cost-effectiveness and negative environmental impact due to highelectricity consumption. Reducing energy overuse by utilizing TMA for cardiac surgerycandiminish the carbon footprint of operating rooms, and their contribution to climate-related health hazards.

Prognostic factors for surgical site infection in patients with spinal metastases and following surgical treatment.

There were few articles reviewed prognostic factors of surgical site infection (SSI) in patients with spinal metastases following surgery. The purpose of the present study was to systematically: (1) investigate the incidence rates of SSI following spinal metastases surgery; (2) identify the factors which were independently associated with postoperative wound infection. One hundred sixty-seven consecutive adult patients with spinal metastases and underwent surgical treatment were retrospectively enrolled from January 2011 to February 2022. Demographic data, disease and operation-related indicators were extracted and analyzed. Univariate and multivariate logistic analysis model were performed respectively to determine independent risk factors of SSI. 17 cases infection were collected in this study. The overall incidence of SSI after surgery of spinal metastases patients was 10.2%. Univariate regression analysis showed that age (P = .028), preoperative ALB level (P = .024), operation time (P = .041), intraoperative blood loss (P = .030), Karnofsky Performance Status score (P = .000), body mass index (P = .013), American Society of Anesthesiologists > 2 (P = .010), Tobacco consumption (P = .035), and number of spinal levels involved in surgical procedure (P = .007) were associated with wound infection. Finally, the multivariate logistic model demonstrated that body mass index (P = .043; OR = 1.038), preoperative ALB level (P = .018; OR = 1.124), and number of spinal levels (P = .003; OR = 1.753) were associated with SSI occurrence. Surgery on multiple vertebral levels for spinal metastases significantly increases the risk of SSI and weight management, nutritional support and palliative surgery have the positive significance in reducing wound complications. Orthopedist should focus on identifying such high-risk patients and decrease the incidence of wound infection by formulating comprehensive and multi-disciplinary care strategy.

Risk factors for surgical site infection in patients undergoing obstetrics and gynecology surgeries: A meta-analysis of observational studies.

The aim of this study was to identify the risk factors for surgical site infection (SSI) in patients undergoing obstetrics and gynecology surgeries through meta-analysis. Relevant original studies published from January 1945 to May 2023 were searched the CBM, PubMed, Embase, WOS, CNKI, Wanfang, vip, and Cochrane Library databases. Studies eligible were evaluated by two investigators following Newcastle-Ottawa Scale(NOS) criteria. Review Manager 5.3 software was used to analyse the combined effect sizes and test for heterogeneity, and Stata 14.0 software's Begg's Test and Egger's Test were used to test for bias. 13 case-control articles, including 860 cases in the case group and 13574 cases in the control group, met the inclusion criteria. Eventually, Our meta-analysis showed that SSI in patients undergoing obstetrics and gynecology surgeries was correlated with body mass index (BMI)≥24 (OR = 2.66; P < 0.0001), malignant lesions (OR = 4.65; P < 0.0001), operating time≥60min (OR = 2.58; P < 0.0001), intraoperative bleeding≥300ml (OR = 2.54; P < 0.0001), retained urinary catheter (OR = 4.45; P < 0.0001), and vaginal digital examination≥3times (OR = 2.52; P < 0.0001). In this study, BMI≥24, intraoperative bleeding≥300ml, malignant lesions, operating time≥60min, retained urinary catheter, and vaginal digital examination≥3times were considered as independent risk factors for SSI in obstetrics and gynecology surgery. It is recommended that scholars be rigorous in designing the experimental process when conducting case-control or experimental studies in order to improve the quality of the study. Controlling patients' weight before obstetrical and gynecological surgery, shortening the operation time intraoperatively, and strictly controlling the indications of vaginal digital examination and retained urinary catheter can effectively reduce the incidence of SSI.

Psoriasis Is a Risk Factor for Surgical Site Infection After Primary TKA.

The relationship between psoriasis and complications after primary TKA is not well defined. Current studies are limited to small, single-center studies evaluating fewer than 150 patients with psoriasis, with some studies reporting an increased risk of surgical site infection (SSI) and another reporting no associated risk. There is a need to reevaluate the risk of psoriasis and postoperative complications, including SSI, to better risk-stratify and guide practice in this patient population. (1) Compared with patients without psoriasis, after accounting for potential confounders such as age, insurance, and comorbidities, do patients with psoriasis have a higher odds of superficial SSI after primary TKA? (2) Do patients with psoriasis have a higher odds of deep SSI after primary TKA? Patients 18 years or older who underwent unilateral, primary TKA between 2015 and 2019 were identified in the PearlDiver database (n = 490,722). Patients with rheumatoid, septic, or posttraumatic arthritis were excluded, as well as patients with bone neoplasias (n = 188,557). Additionally, patients with less than 2 years of follow-up (n = 53,673) were excluded. In all, 248,492 patients were included in this study; 0.4% (1078) were in the psoriasis group and 99% (247,414) were in the control group. Overall 2-year superficial and deep SSI rates were stratified and compared between patients with psoriasis and a control group of patients who did not have psoriasis as the primary outcome. Secondary outcomes included the odds of undergoing an aseptic revision or manipulation under anesthesia. In the multivariable analysis, which controlled for potential confounders such as age, sex, Elixhauser comorbidity index, hypertension, diabetes mellitus, and liver disease, the odds of SSI-either superficial or deep-remained higher for patients with psoriasis (OR 1.74 [95% confidence interval 1.03 to 2.96]; p = 0.04). When focusing on superficial infections in the multivariable analysis, patients with psoriasis had a higher odds of superficial SSI than those in the control group (OR 2.83 [95% CI 1.26 to 6.34]; p = 0.01). The odds of deep SSI were not different between the two cohorts in our multivariable analysis (OR 1.32 [95% CI 0.66 to 2.66]; p = 0.43). Patients with psoriasis did not have an increased odds of undergoing an aseptic revision (OR 0.79 [95% CI 0.48 to 1.32]; p = 0.38) or manipulation under anesthesia (OR 0.74 [95% CI 0.52 to 1.06]; p = 0.10). Patients with psoriasis had higher overall rates of SSI at 2 years of follow-up than patients without psoriasis. Our findings suggest that psoriasis is a risk factor for superficial SSI after primary TKA and is an important comorbidity for surgeons to consider before surgery. Further research is needed to assess the role of adjunctive interventions in patients with psoriasis to mitigate the elevated odds of superficial SSI. Level II, prognostic study.

The area ratio of Modic changes has predictive value for postoperative surgical site infection in lumbar spine surgery: a retrospective study

BackgroundIncreasing evidence suggests an association between Modic changes (MC) and subclinical infection and inflammatory reactions. However, the relationship between preoperative MC and surgical site infection (SSI) has not been fully explored. This study aims to investigate the correlation between MC and SSI.MethodsA retrospective analysis was conducted on patients (n = 646) who underwent single-level lumbar spine surgery for lower back pain in our hospital between 2018 and 2023. According to the Centers for Disease Control and Prevention (CDC) criteria, the patients were divided into an SSI group (n = 40) and a Non-SSI group (n = 606). Univariate analysis was performed to determine the statistical differences in variables between the two groups, and the variables with significant differences were included in a multivariable logistic regression analysis to identify independent risk factors for SSI. Receiver operating characteristic (ROC) curve analysis was performed on the independent risk factors.ResultsThe SSI group and the Non-SSI group exhibited significant differences in diabetes prevalence, MC prevalence, Total endplate score (TEPS) and area ratio of MC (P < 0.05). Age, gender, American Society of Anesthesiologists(ASA)score, hypertension, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), MC classification, and the location of MC in the endplate showed no significant differences (P > 0.05). Multivariate binary logistic regression analysis was performed on the variables with significant differences, and the results indicated a significant correlation between TEPS (P = 0.009) and the area ratio of MC changes (P = 0.001) with SSI. ROC curve analysis was performed on the TEPS and area ratio of MC changes, and the results showed that the diagnostic value of TEPS (AUC: 0.641; CI: 0.522–0.759) is lower than the area ratio of MC (AUC: 0.722; CI: 0.621–0.824), and the combined diagnosis did not significantly improve the diagnostic value (AUC: 0.747; CI: 0.653–0.842). The area ratio of MC had moderate diagnostic value for SSI (AUC: 0.722; CI: 0.621–0.824), with a cut-off value of 24.62% determined by the Youden index (sensitivity: 69.2%; specificity: 73.1%), and for every 1% increase in the area ratio of MC changes, the risk of SSI in MC patients increased by 10.3% (OR = 1.103; CI: 1.044–1.167).ConclusionThe area ratio MC and the TEPS are independent risk factors for SSI after lumbar spine surgery. The predictive value of the area ratio of MC is greater than TEPS, and when the two are combined, the predictive value is not significantly improved. When the rate of MC exceeds 24.62%, caution should be exercised regarding the occurrence of SSI.

Sex differences in surgical site infections following coronary artery bypass grafting: a retrospective observational study

Surgical site infection (SSI) following cardiac surgery poses a significant challenge for healthcare providers. Despite advances in surgical techniques and infection control measures, SSI remains a leading cause of morbidity and mortality, in addition to being a significant economic burden on healthcare services. Current literature suggests there is a reproducible difference in the incidence of SSI following cardiac surgery between sexes. We aim to assess the sex-specific predictive risk factors for sternal SSI following coronary artery bypass grafting (CABG) in addition to identifying any differences in the causative organisms between groups. Adult patients undergoing isolated CABG between January 2012 and December 2022 in one UK hospital organization were included. In this 10-year, retrospective observational study, a total of 10,208 patients met the inclusion criteria. Pre-operative risk factors were identified using univariate analysis. To assess dependence between sex and organism or Gram stain, a Pearson Chi-squared test with Yates correction for continuity was performed. In total there were 8457 males of which 181 developed a sternal SSI (2.14%) and 1751 females, 128 of whom had a sternal SSI (7.31%). Male patients were found to be significantly more likely to develop an SSI secondary to a Gram-positive organism, whereas female patients were more likely to have a Gram-negative causative organism (P<0.00001). Staphylococcus was statistically more likely to be the causative organism genus in male patients. Pseudomonas aeruginosa was found to be twice as common in the female cohort compared with the male group. In our study, we found a statistically significant difference in the causative organisms and Gram stain for post-CABG sternal SSIs between males and females. Male patients predominately have Gram-positive associated SSIs, whereas female SSI pathogens are more likely to be Gram negative. The preoperative risk profiles of both cohorts are similar, including being an insulin-dependent diabetic and triple vessel coronary artery disease. Given these findings, it prompts the question, should we be tailoring our SSI treatment strategies according to sex and associated risk profiles?

Prospective cohort study of surgical site infections following single dose antibiotic prophylaxis in caesarean section at a tertiary care teaching hospital in Medchal, India.

Caesarean section (CS) is considered to be a life-saving operative intervention for women and new-borns in certain antepartum and intrapartum conditions. Caesarean delivery may be accompanied by several complications including surgical site infections (SSI). However, there is a significant lack of uniformity in the administration of antibiotics for preventing surgical site infections (SSI) following caesarean deliveries. The present study was conducted to determine the incidence of post CS SSI following the adoption of single-dose antibiotic prophylaxis as recommended by WHO at a tertiary care teaching hospital in Medchal, India. Also, to identify the risk factors of SSI and reported the bacteriological profiles and the antimicrobial susceptibility pattern of the culture positive isolates. To estimate the incidence of surgical site infections (SSI's) according to CDC criteria following WHO-recommended single-dose antibiotic prophylaxis for caesarean section at a tertiary care teaching hospital in Medchal, India. A prospective hospital-based study was conducted between June 2017 and December 2019, in which women who underwent caesarean delivery were followed up for 30 days post-delivery. Clinical details were collected using a structured questionnaire, and participants were followed up weekly after discharge to document any signs and symptoms of SSI. Symptomatic patients were requested to come to the hospital for further investigation and treatment. Standard microbiological tests were conducted to detect microorganisms and their antibiotic sensitivity. The study included 2,015 participants with a mean age of 24.1 years. The majority were multigravida (n = 1,274, 63.2%) and underwent emergency caesarean delivery (n = 1,232, 61.1%). Ninety two participants (4.6%, 95% CI: 3.7% to 5.6%) developed surgical site infections, with 91 (98.9%) having superficial and 1 (1.1%) having a deep infection. Among those who developed an SSI, 84 (91.3%) did so during their hospital stay, while 8 (8.7%) developed an SSI at home. The adjusted relative risk (a RR) for developing an SSI was 2.5 (95% CI: 1.4 to 4.6; power 99.9%) among obese women and 2.3 (95% CI: 1.1 to 4.7; power 100%) among women aged 25 years or younger. Microbial growth in culture was observed from 55 (75.8%) out of total 66 samples. The most common organisms identified were Staphylococcus aureus (n = 7(12.3%)23, 46.0%), Klebsiella sp. (n = 13, 26.0%), and Escherichia coli (n = 12, 24.0%). The rate of SSI following caesarean deliveries subjected to single dose antibiotic prophylaxis was low. Young women and obese women were at high risk of developing SSI.

Lower bleeding volume contributes to decreasing surgical site infection in radical cystectomy: A propensity score-matched comparison of open versus robot-assisted radical cystectomy.

To compare the incidence of surgical site infections (SSI) between robot-assisted and open radical cystectomies and investigate the risk factors for SSI after radical cystectomies. Consecutive patients who underwent radical cystectomy between July 2008 and December 2022 were retrospectively reviewed. The prevalence and characteristics of SSI after open and robot-assisted radical cystectomies were compared, and the risk factors for SSI were investigated using propensity score matching. This study enrolled 231 patients (open: 145, robot-assisted: 86). In the robot-assisted group, urinary diversion was performed using an intracorporeal approach. SSI occurred in 34 (open: 28, robot-assisted: 6) patients, and the incidence was significantly lower in the robot-assisted group (19.3% vs. 7.0%, p = 0.007). After propensity score matching cohort (open: 34, robot-assisted: 34), increased bleeding volume, blood transfusion, and delayed postoperative oral feeding were significantly associated with SSI. Only increased bleeding volume remained a significant risk factor in the multivariate regression analysis (odds ratio, 1.13 [per 100 mL increase]; 95% confidence interval: 1.02-1.25; p = 0.001). The cutoff bleeding volume for predicting SSI was 1630 mL with an area under the receiver operating characteristic curve, sensitivity, and specificity of 0.773, 0.73, and 0.75, respectively. The incidence of SSI after robot-assisted radical cystectomy was significantly lower than that after the open procedure. However, decreased bleeding volume, which was significantly associated with robot-assisted procedures, was an independent and more significant factor for reducing SSI after radical cystectomy than the differences of the surgical procedure even after propensity score matching.

When is vancomycin prophylaxis necessary? Risk factors for MRSA surgical site infection.

The 2022 SHEA/IDSA/APIC guidance for surgical site infection (SSI) prevention recommends reserving vancomycin prophylaxis to patients who are methicillin-resistant Staphylococcus aureus (MRSA) colonized. Unfortunately, vancomycin prophylaxis remains common due to the overestimation of MRSA risk and the desire to cover MRSA in patients with certain healthcare-associated characteristics. To optimize vancomycin prophylaxis, we sought to identify risk factors for MRSA SSI. This was a single-center, case-control study of patients with a postoperative SSI after undergoing a National Healthcare Safety Network operative procedure over eight years. MRSA SSI cases were compared to non-MRSA SSI controls. Forty-two demographic, medical, and surgical characteristics were evaluated. Of the 441 patients included, 23 developed MRSA SSIs (rate = 5.2 per 100 SSIs). In the multivariable model, we identified two independent risk factors for MRSA SSI: a history of MRSA colonization or infection (OR, 9.0 [95% CI, 1.9-29.6]) and hip or knee replacement surgery (OR, 3.8 [95% CI, 1.3-9.9]). Hemodialysis, previous hospitalization, and prolonged hospitalization prior to the procedure had no measurable association with odds of MRSA SSI. Patients with prior MRSA colonization or infection had 9-10 times greater odds of MRSA SSI and patients undergoing hip and knee replacement had 3-4 times greater odds of MRSA SSI. Healthcare-associated characteristics, such as previous hospitalization or hemodialysis, were not associated with MRSA SSI. Our findings support national recommendations to reserve vancomycin prophylaxis for patients who are MRSA colonized, as well as those undergoing hip and knee replacement, in the absence of routine MRSA colonization surveillance.

Plating versus Intramedullary Nailing of OTA/AO 43C1 and C2 Intra-articular Distal Tibia Fractures: A Propensity Score and Multivariate Analysis.

To compare rates of loss of reduction, nonunion, and infection in intra-articular distal tibia fractures (IADTF) treated with limited open reduction internal fixation and intramedullary nailing (IMN) as compared to open reduction internal fixation with plate and screws (PF). Retrospective Review. Level-I academic trauma center. 110 patients, age ≥ 18 with operatively treated OTA/AO 43C1 and C2 IADTF between 2013-2021. Loss of reduction, surgical site infection (SSI), nonunion, and patient-reported outcomes (PROs). 110 patients met the inclusion criteria (IMN 33, PF 77). There was no loss of reduction reported. 17 nonunions (15% overall; IMN 4/33, PF 13/77) and 13 SSIs (12% overall; IMN 2/33, PF11/77) were identified. Despite several risk factors being identified for nonunion and SSI in bivariate analysis, only open fracture remained significant as a risk factor for both nonunion (OR 0.09 for closed fracture, 95% CI 0.02-0.56, p=0.009) and SSI (OR 0.07 for closed fracture, 95% CI 0.06-0.26, p=0.012) in the multivariate model. Propensity scoring based on presurgical variables was significantly different between patients that received IMN vs PF (p=0.03); however, logistic regression incorporating the propensity score revealed no significant association with nonunion and SSI. Adjusting for the propensity score, there remained no association comparing IMN versus PF with nonunion and SSI (p=0.54 and p=0.17, respectively). There was also no difference in PROs between IMN and PF (Physical function: p=0.25, Pain interference: p=0.21). Overall nonunion and SSI prevalence in our cohort was 15% and 12%, respectively, in operatively treated OTA/AO 43C1 and C2 IADTF. An open fracture is a significant risk factor for nonunion and SSI. Metaphyseal fixation via IMN or PF in IADTF did not affect the loss of reduction, nonunion, SSI, and PROs. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Relationship Between Types of Warming Devices and Surgical Site Infection in Patients Who Underwent Posterior Fusion Surgery Based on National Data.

Perioperative hypothermia can lead to various complications. Although various warming techniques have been used to prevent perioperative hypothermia, the effect of these techniques on surgical site infection (SSI) during posterior fusion surgery is unclear. The effects of warming devices on SSI rates were therefore analyzed using data complied by the Health Insurance and Review Assessment (HIRA) Service in Korea. This study included 5,406 patients in the HIRA Service database who underwent posterior fusion surgery during the years 2014, 2015, and 2017. Factors related to SSI in these patients, including warming devices, antibiotics, and transfusion, were analyzed. The incidence of SSI was higher in patients who underwent forced air warming than in those who did not undergo active warming (odds ratio [OR], 1.73; p = 0.039), especially above 70 years old (OR, 4.11; p = 0.014). By contrast, the incidence of SSI was not significantly higher in patients who underwent device using conduction. Infection rates were higher in patients who received prophylactic antibiotics within 20 minutes before incision, than within 21 to 60 minutes (OR, 2.07; p = 0.001) and who received more blood transfusions (1 pint < volume ≤ 2 pint; OR, 1.75; p = 0.008, > 2 pint; OR, 2.73; p = 0.004). SSI rates were higher in patients who underwent warming with forced air devices than with devices using conduction, as well as being higher in patients who older age, received blood transfusions and administered antibiotics within 20 minutes before incision. Devices using conduction have more advantages in preventing SSI than forced air warming device. In addition, the reduction of other risk factors for SSI may improve postoperative results.

Risk factors for surgical site infection after percutaneous endoscopic lumbar discectomy.

The objective of this study was to investigate the risk factors associated with surgical site infection (SSI) after percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). A retrospective analysis was performed on a cohort of 335 patients who underwent PELD between January 2016 and January 2023. Data were derived from the Hospital Information System (HIS), and a comprehensive statistical assessment was performed using IBM SPSS Statistics version 25.0. Both univariate and multivariate logistic regression analyses assessed a range of risk determinants, such as age, body mass index (BMI), comorbidities, laboratory test parameters and surgery-related variables. The incidence of SSI after PELD was 2.7% (9/335). Univariate analysis highlighted BMI, diabetes mellitus, long-term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant predictors of SSI. Multivariate logistic regression identified BMI, diabetes mellitus, long-term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant risk factors for SSI after PELD. High BMI, diabetes mellitus, long-term corticosteroid consumption, long surgical time and postoperative cerebrospinal fluid leakage are predisposing factors for SSI in patients undergoing PELD. Precise interventions focused on such risk components, including careful preoperative assessment and strategic postoperative care, are essential to reduce the incidence of SSI and improve surgical efficacy.

A meta-analysis of the risk factors for neurosurgical surgical site infection following craniotomy.

The purpose of the meta-analysis was to evaluate and compare the risk factors for neurosurgical surgical site infection (SSI) after craniotomy. Using dichotomous or contentious random or fixed effect models, the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were computed based on the examination of the meta-analysis results. Eighteen analyses, covering 11 068 craniotomies between 2001 and 2023, were included in the current meta-analysis. Subjects with SSIs had a significantly younger age (MD, -2.49; 95% CI, -2.95 to -2.04, p < 0.001), longer operation duration (MD, 10.21; 95% CI, 6.49-13.94, p < 0.001) and longer length of postoperative hospital stay (MD, 1.52; 95% CI, 0.45-2.60, p = 0.006) compared to subjects with no SSI with craniotomy. However, no significant difference was found between craniotomy subjects with SSIs and with no SSI in gender (OR, 0.90; 95% CI, 0.76-1.07, p = 0.23), and combination with other infection (OR, 3.93; 95% CI, 0.28-56.01, p = 0.31). The data that were looked at showed that younger age, longer operation duration and longer length of postoperative hospital stay can be considered as risk factors of SSI in subjects with craniotomy; however, gender and combination with other infections are not. Nonetheless, consideration should be given to their values because several studies only involved a small number of patients, and there are not many studies available for some comparisons.

Risk factors for surgical site infection following orthopaedic surgery for fracture by trauma: a nested case–control study

Surgical site infection (SSI) is associated with higher medical expenses and lower patient quality of life. To identify specific modifiable risk factors for SSI after orthopaedic surgery for fractures caused by trauma. This nested case-control study used a nationwide trauma registry, the Japan Trauma Data Bank (JTDB) database. Patient data from 280 hospitals between January 2004 and May 2019 were retrieved from the JTDB. Patients with SSI and identified patients without SSI as control subjects were included, using propensity score matching adjusted for unmodifiable factors. Risk factors associated with SSI after orthopaedic trauma surgery were assessed using multi-level mixed-effects logistic regression models. In total, 15,910 patients were included in the analysis. Of these patients, 377 (2.4%) had SSI. After propensity score matching, 258 patients with SSI and 2580 matched patients without SSI were selected. In the multi-level mixed-effects logistic regression analysis, blood transfusion within 24h (odds ratio (OR): 1.51; 95% confidence interval (CI): 1.06-2.13) was a significant risk factor for SSI following orthopaedic fracture surgery. The OR (95% CI) values for external fixation, transcatheter arterial embolization, and tourniquet for SSI following orthopaedic fracture surgery were 1.40 (0.96-2.03), 1.66 (0.81-3.38), and 2.99 (0.60-14.87), respectively. These findings highlight the necessity of exercising caution when implementing blood transfusion within 24h as a risk factor associated with SSI following orthopaedic trauma surgery.