Risk Factors For Surgical Site Infection Research Articles

SG-APSIC1107: Surgical-site infection in Hung Vuong Hospital, a gynecology and obstetrics tertiary-care hospital in Ho Chi Minh City, Vietnam

Objectives: Surgical site infection (SSI) is the most common healthcare-associated infection (HAI) in our gynecology and obstetrics hospital. SSI among patients following gynecological and obstetrical surgery not only results in increased morbidity but also has far-reaching implications. Thus, this study was conducted to determine the incidence, risk factors, and bacterial pathogens related to SSI. Methods: We conducted this retrospective study based on medical records from January 2019 to December 2020 at Hung Vuong Hospital. Results: Of 51,466 patients undergoing surgery, 581 patients (1.34%) developed an SSI after cesarean section and 145 patients (1.77%) developed an SSI after gynecological surgery. A multivariate logistic regression analysis identified the following risk factors among patients who underwent cesarean section: age (OR, 1.02; 95% CI, 1.01–1.04), emergency cesarean section (OR, 1.62; 95% CI, 1.36–1.93), operation time >60 minutes (OR, 2.04; 95% CI, 1.48–2.80), surgery during the night shift (OR, 1.29; 95% CI, 1.08–1.54), and prolonged hospital stay ≥2 days (OR, 1.51; 95% CI, 1.21–1.89). SSI risk factors for patients following gynecological surgery included age (OR, 1.03; 95% CI, 1.02–1.05), contaminated wound (OR, 3.44; 95% CI, 1.56–7.57), dirty wound (OR, 3.61; 95% CI, 1.44–9.05), vertical abdominal incision (OR, 2.49; 95% CI, 1.65–3.77), and duration of surgery >180 minutes (OR, 2.02; 95% CI, 1.24–3.29). Staphylococcus aureus was the most commonly identified SSI pathogen following cesarean section (49.56%), and Escherichia coli was isolated in 44.93% of SSIs among patients undergoing gynecological surgery. Conclusions: SSI interventions should target this high-risk group. Based on microbiology culture and susceptibility results isolated from SSI cases, novel antibiotic therapies are needed to treat SSIs.

Incidence and risk factors for surgical site infection (SSI) after primary hip hemiarthroplasty: an analysis of the ACS-NSQIP hip fracture procedure targeted database

IntroductionPrimary hip hemiarthroplasty (HHA) is frequently utilized to treat geriatric hip fractures, which are associated with significantly higher morbidity and mortality. While not particularly common, surgical site infection (SSI) is a major complication that frequently requires revision surgery in a frail population. The objective of this study was to determine the incidence of and risk factors for SSI after HHA in hip fracture patients.Materials and methodsThis retrospective cohort study was performed using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Geriatric patients (65+) who underwent HHA for non-pathologic, traumatic hip fractures between 2016–2017 were included. Demographic variables, comorbidities, operative variables, and complications were compared between "SSI" and "non-SSI" groups. Multivariate regression identified independent risk factors for postoperative SSI. Significance was set at P = 0.05.ResultsA total of 6169 patients were included. The overall incidence of SSI was 1.3%. SSI was significantly associated with body mass index (BMI), preoperative functional status, congestive heart failure, chronic corticosteroid use, intraoperative time, sepsis, wound dehiscence, readmission within 30-days, and reoperation. On multivariate analysis, chronic steroid use (OR: 2.30, 95% CI: 1.13–4.70), BMI ≥ 35 kg/m2 (OR: 3.59, 95% CI: 1.57–8.18), and intraoperative time ≥120 mins (OR: 2.15, 95% CI: 1.08–4.27) were found to be independent risk factors.ConclusionsPostoperative SSI is a serious complication that is responsible for prolonged hospital stays, increased mortality, and greater healthcare costs. Here, we identified multiple risk factors for SSI after primary HHA in the US elderly population.

Incidence of surgical site infection after internal fixation of the first phalangeal bone and the third metacarpal/metatarsal bone fractures in Thoroughbred racehorses.

Surgical site infection (SSI) is one of the major complications of equine fracture surgery. The purpose of this study was to investigate the incidence of and risk factors for SSI after internal fixation of the first phalangeal bone (P1) and the third metacarpal/metatarsal bone (MC3/MT3) fractures in Thoroughbred racehorses. Between 2011 and 2020, 451 cases underwent surgery with screws or a locking compression plate (LCP) for sagittal fractures of P1 or condylar fractures of MC3/MT3. Overall, 2.9% (13/451) of the cases developed an SSI. The incidence was significantly higher in plate fixation (21.4%) than in screw fixation (2.3%). There was no significant association with other variables, such as sex, age, number of screws, experience of surgeon, or prophylactic antimicrobials. The median duration of hospitalization for screw fixation was 14 days without an SSI and 20 days with an SSI, and those for plate fixation were 26 and 25-88 days, respectively, indicating that the development of SSI prolongs the duration of hospitalization. On the other hand, there were no significant differences in discharge and race resumption rates between cases with and without an SSI. These data indicate that the incidence of SSI in this study was low and that it was higher following plate fixation than screw fixation.

The use of absorbable skin stapler in mastectomy does not increase the rate of surgical site infection.

The use of absorbable skin staplers (ASS) for skin closure has been increasing due to their convenience and time-saving effect. In this study, we evaluated the effectiveness of ASS in reducing skin closure time and its safety regarding surgical site infection (SSI), comparing it to conventional hand sewing (HS) in patients who underwent mastectomy. A single-center, retrospective study was conducted. The electronic medical records of patients who underwent mastectomy between July 2015 and June 2020 in Samsung Medical Center were reviewed. The data included previously known risk factors for SSI. We compared the time expended on skin closure and the occurrence rate of SSI between the ASS group and the HS group. We included 4,311 patients in the analysis. Among them, 520 patients were treated with ASS and 3,791 patients with HS. The average time for skin closure was 16.2 ± 10.1 minutes in the ASS group and 36.5 ± 29.0 minutes in the HS group (P < 0.001). The SSI rate was 0.38% (2 of 520) in the ASS group and 0.36% (14 of 3,791) in the HS group (P > 0.999). The use of ASS in mastectomy reduced the time for skin closure significantly but did not increase the SSI. Therefore, it can be an effective and safe choice to use ASS instead of HS for skin closure in mastectomy.

CLINICOEPIDEMIOLOGICAL PROFILE OF SURGICAL SITE INFECTION FOLLOWING EMERGENCY LAPAROTOMY IN A TERTIARY CARE CENTRE

Abstract. Background and aim:Surgical site infections (SSIs) are defined as infections occurring up to 30 days after surgery (or up to one year after surgery in patients receiving implants) and affecting either the incision or deep tissue at the operation site.Multiple risk factors for SSI have been identified can be compiled within three major determinants of SSI: bacterial factors, local wound factors, and patient factors. This study aims to determine the incidence, associated risk factors and type of pathogen causing surgical site infection following Emergency Laparotomy in aTertiary Care Centre. Methods: This study was done on 250 patients undergoing emergency laparotomy in Department of Surgery at Dr.Susheela Tiwari Hospital from January 2021 to September 2022. A questionnaire was used to obtain biodata, comorbidities, operative procedure and operative duration, wound classification, ASA score and perioperative transfusion. A personal history was collected, including information on diet, alcoholism, and smoking, and any prior abdominal surgery. Culture and sensitivity testing was done on infected wounds. Results: SSI was clinically diagnosed in 141 patients giving an incidence rate of 56.4%. 100 (70.9%) were superficial SSI while 41 (29.1%) were deep SSI. Identifiable Risk factors beingclean-contaminated and dirty wound, male sex, increased age, smoking, diabetes mellitus, anemia, and duration of surgery &gt; 2hrs. Most common organism isolated was Methicillin-resistant coagulase-negative Staphylococci. Conclusions:Our goal should be to lower the rate of SSI, and in order to do this, effective actions should be taken to monitor wound infection properly, identify its causesand study them routinely.

Overview of Rate and Risk Factors of Surgical Site Infection in a Tertiary Hospital in Liberia: A Prospective Cohort Study.

Surgical site infection (SSI) is accountable for a third of postoperative deaths and for 8% of all deaths due to hospital-acquired infections. There is a wide disparity in the incidence and burden of SSI in low and high-income countries. To assess the rates and risk factors of SSI in a tertiary hospital in a resource-limited sub-Saharan African country and generate institutional baseline data for future monitoring and interventions. This was a descriptive prospective cohort study done at John F Kennedy Memorial Hospital, a tertiary hospital in Monrovia, Liberia, from October 18 to December 18, 2021. Consecutive participants, including children and adults that had surgical operations within the study period, were recruited. Criteria for diagnosis of SSI were as defined by the Centre for Disease Control (1999). Data were collected on the demography of the participants, type of surgery done, presence of SSI, comorbidities, and risk factors for SSI. Of the 111 patients analyzed, thirty-two patients had SSI giving a hospital incident rate of 28.8%. This comprises superficial SSI (22/31; 71.0%), deep SSI (6/31; 19.4%), and organ/space SSI (3/31; 9.7%). Twelve out of 42 females (28.6%) and 20 of 69 males (29.0%) had SSI. There is no statistically significant difference in gender SSI rate (P = 0.963). SSI occurred more in dirty wounds (13/23; 56.5%), compared to contaminated wounds (6/11, 54.6%), clean contaminated (7/22; 31.8%), and clean wounds (6/55, 10.9%). There is a statistical difference in the rate of SSI among the wound classes (P = 0.001). The infection rate is also more in emergency surgeries (18/39, 46.2%) compared to elective surgeries (14/72, 19.4%), and it is significant (P = 0.003). Statistically, there was no significant difference between the two skin preparation agents used (P = 0.351). The abdomen was the most common site of surgical incision and had the highest rate of SSI (24/79; 30.4%) (P = 0.045). There was no statistical difference in SSI rate between those whose hairs were removed in the ward or in the theatre (P = 0.114); length of incision (P = 0.297), or duration of surgery (P = 0.715) (see table for classification and rates). The SSI rate in our study is high at 28.8%. Abdominal surgeries, emergencies, and wound class accounted for the majority of the SSIs. The baseline data will be useful in developing infection control strategies.

Independent risk factor for surgical site infection after orthopedic surgery

No significant progress has been made in the study of orthopedic surgical site infection (SSI) after different orthopedic surgery, and the analysis and prevention of risk factors for orthopedic SSI urgently need to be solved. A total of 154 patients underwent orthopedic surgery from April 2018 to December 2020. General information such as gender, age, marriage, diagnosis, surgical site, and anesthesia method was recorded. Statistical methods included Pearson chi-square test, univariate and multivariate logistic regression analyses, and receiver operating characteristic (ROC) curves. Based on Pearson's chi-square test, sex (P = .005), age (P = .027), marriage (P = .000), diagnosis (P = .034), and surgical site (P = .000) were significantly associated with SSI after orthopedic surgery. However, in the multiple linear regression analysis, only the surgical site (P = .035) was significantly associated with SSI after orthopedic surgery. In terms of multivariate logistic regression level, surgical site (odds ratio [OR] = 1.568, P = .039) was significantly associated with SSI. ROC curves were constructed to determine the effect of the surgical site on SSI after different orthopedic surgery (area under the curve [AUC] = 0.577, 95% CI = 0.487-0.0.666). In summary, the surgical site is an independent risk factor for SSI after orthopedic surgery, and "trauma" is more likely to develop SSI than spine, arthrosis, and others.

Evaluation of independent risk factors associated with surgical site infections from caesarean section

BackgroundThe present study assessed factors associated with the risk of surgical site infections (SSI) after a caesarean section (C-section).MethodsData were collected in 1682 women undergoing elective (53.9%) and emergency (46.1%) C-sections between 1st August 2020, and 30th December 2021, at a National Health Service hospital (Surrey, UK).ResultsAt the time of C-section, the mean age was 33.1 yr (SD ± 5.2). Compared to women with BMI < 30 kg/m2, those with a BMI ≥ 35 kg/m2 had a greater risk of SSI, OR 4.07 (95%CI 2.48–6.69). Women with a history of smoking had a greater risk of SSI than those who had never smoked, OR 1.69 (95%CI 1.05–2.27). Women with a BMI ≥ 30 kg/m2 and had a smoking history or emergency C-section had 3- to tenfold increases for these adverse outcomes. Ethnic minority, diabetes or previous C-section did not associate with any of the outcomes.ConclusionsHigh BMI, smoking, and emergency C-section are independent risk factors for SSI from C-section. Women planning conception should avoid excess body weight and smoking. Women with diabetes and from ethnic minority backgrounds did not have increased risks of SSI, indicating a consistent standard of care for all patients.

Management and Prevention of Surgical Site Infections in Spine Surgery in a Resource Poor Setting: The Irrua Protocol

Background and Aim: Surgical site infections (SSIs) in spine surgeries represent one of the most common hospital-acquired infections. SSI (refers to surgical wound infection within 30 days of surgery or 1 year after implant) portends a huge disease burden with devastating consequences for the patient and the hospital facilities with physical and psychological trauma to the patient and it is associated with an increased rate of morbidity and mortality. Despite improvements in the surgical protocol for asepsis and the role of prophylactic antibiotics in clean spine surgeries, a substantial increase still exists in the rate of SSIs. It is essential to review and identify factors predisposing patients with spinal problems to SSIs and its goal is to formulate a local protocol that helps to curtail SSIs and can be replicated in any setting in the world, considering the limitations of our setting. This study aims to review the risk factors for SSI following spine surgeries considering a 54-year-old woman with obesity who had SSI and highlights prevention ways. Methods and Materials/Patients: This study includes the search of the literature using several platforms, such as Google Scholar, Hinari, PubMed, Academia, and other search engines with related keywords to surgical site infections in spine surgery. The retrieved articles were reviewed and in some parts, the narrative case of the 54-year-old obese woman was discussed in the literature. Results: A total of 37 articles were found that matched the search words and satisfied the objective of the study. These articles were reviewed and used in writing this manuscript. Conclusion: SSIs are on the increase, and identifying risk factors on a patient basis is key to prevention. Protocol on preventive measures should be strictly followed to avoid catastrophes associated with SSIs.

Impact of Infection Control on Prevalence of Surgical Site Infections in a Large Tertiary Care Hospital in Haiphong City.

Few point prevalence surveys (PPS) have been conducted in Vietnam on Surgical Site Infections (SSI) or antimicrobial use in surgery. The objective of this study was to evaluate the PPSs of SSI before and after implementation of antibiotic stewardship programs (ASP) and infection control (IC) in a Vietnamese tertiary care hospital. ASP and IC practices were implemented in operating rooms and the orthopedic department, including antibiotic training, skin preparation, hand hygiene, gloves and sterile instruments, and SSIs risk factors. A PPS of SSIs and antimicrobial use was performed in January 2016 according to methods from the Centers for Disease Control and Prevention, before ASP and IC, and in December 2019. Information recorded included surgical data, antibiotic prophylaxis, microorganisms, and SSI risk factors. Skin preparation compliance assessed preoperative washing and antisepsis. SSI prevalence was 7.8% in 2016 versus 5.4% in 2019 (p = 0.7). The use of prophylactic antibiotics decreased from 2016 to 2019. A third-generation cephalosporin was prescribed more than 48 h after surgery for most patients. Skin preparation compliance increased from 54.4% to 70.5% between assessments. The decreased SSI, although non-statistically significant, warrants continuing this program. Vietnamese hospitals must provide comprehensive IC education to healthcare workers to address the prevention of SSI and establish IC policies.

Postoperative spine surgical site infections: high rate of failure of one-stage irrigation and debridement

BACKGROUND CONTEXTFollowing spine surgery, postoperative surgical site infection (SSI) is a rare but potentially devastating complication. Previous studies have assessed risk factors for spine SSI and one aimed to develop risk stratification tool to assess management options, but this tool has not been externally validated or regularly used. PURPOSEThe current study aimed to investigate the rate of SSI following elective spine surgery, surgical management pursued, and success of traditionally utilized one-stage of irrigation and debridement (I&D) with closure over drains. STUDY DESIGNRetrospective case-control study. PATIENT SAMPLEAdult, elective spine surgeries performed at a single academic institution between 2013 and 2021 were evaluated. Patients who developed SSI requiring surgical intervention were identified. OUTCOME MEASURESThose who underwent initial management with I&D and closure over drains were assessed for need of subsequent I&D (considered failure of initial infection management). METHODSOf spine surgeries meeting inclusion criteria, those with SSI were identified and management was characterized. For those who did and did not fail attempted one stage I&D with closure over drains, pre-operative and surgical variables from the index procedure as well as infection characteristics were assessed and compared with univariable and multivariable analyses. RESULTSOf 11,023 elective spine surgeries, SSI was identified for 76 (0.7%). For initial management, I&D with closure over drains was used for 66 (86.8%) while I&D and wound vacuum management was used 10 (13.2%). Failure of attempted one stage I&D (requiring subsequent I&D procedure) was identified for 18 (27% of those undergoing I&D and closure over drains). Of multiple patient, surgical, and infection characteristics, the only factor identified as independently predictive of one stage I&D failure was presence of bacteremia (odds ratio [OR] 38.3, p=0.0007). Within the sub-cohort of patients with bacteremia, failure of attempted one stage I&D was noted for 80%. CONCLUSIONLess than one percent of a large cohort of patients undergoing spine surgery were found to develop SSIs. Of those undergoing attempted one stage I&D, most patient, surgical, and infection variables did not influence outcome of the intervention. However, those with bacteremia were at 38.3 times greater odds of failing attempted one-stage I&D. These results suggest considering delayed closure approaches in these cases.

Impact of large amount of intra-abdominal lavage on surveillance of surgical site infection after hepato-pancreato-biliary surgery: A prospective cohort study.

In hepatobiliary and pancreatic (HBP) surgery, the role and significance of intra-abdominal lavage (IAL) for surgical site infection (SSI) is controversial. This prospective study was performed between July 2020 and July 2022. A total of 150 patients, 10-L IAL was performed. The lavage fluid at 1-L, 5-L, and 10-L was subjected to bacterial culture examination. Risk factors for SSI were evaluated. Bacterial positivity rate significantly decreased as follows: 1-L, 36% (n=54); 5-L, 27% (n=41); 10-L, 23% (n=35) (36% vs 23%, p= .001). Patients with positive lavage fluid culture at 10-L had significantly higher incidence of both incisional (37% vs 6%, p< .01) and organ/space (54% vs 3%, p< .01) SSI. Multivariate analysis revealed positivity for bacterial culture at 10-L as the strongest independent risk factor for incisional SSI (OR 13.0, 95% CI: 3.86-43.6, p< .01), followed by postoperative pancreatic fistula (OR 11.7, 95% CI: 3.03-45.6, p< .01). Likewise, in organ/space SSI, positivity for bacterial culture at 10-L was the strongest independent risk factor (OR 48.9, 95% CI:12.1-197.7, p< .01), followed by digestive reconstruction (OR 5.20, 95% CI: 1.45-18.6, p= .01). IAL decreased the intraperitoneal contamination rate in a volume-dependent manner and can be useful in the surveillance of SSI development in HBP surgery.

Risk of reoperation due to surgical site infection in 74,771 hip fracture patients: a Danish nationwide cohort study.

Background and purposeSurgical site infection (SSI) after hip fracture surgery is a feared condition. We examined the trend in incidence of reoperation due to SSI up to 1 year following hip fracture surgery from 2005 to 2016 and risk factors of SSI by age, sex, comorbidity, type of fracture, and surgery.Patients and methodsWe conducted a population-based, nationwide cohort study using data from the Danish Multidisciplinary Hip Fracture Register (DMHFR). We included 74,771 patients aged 65 and up who underwent surgery from 2005 to 2016 for all types of hip fracture. We calculated net risk of reoperation using Kaplan–Meier method, and, with Cox regression, adjusted hazard ratios (HRs) with a 95% confidence interval (CI) for reoperation due to SSI.ResultsOverall, the 1-year net risk of reoperation due to SSI was 2.7%. The HR was lower for patients undergoing total/hemiarthroplasty surgery versus internal fixation (HR = 0.6; 95% CI 0.5–0.6) and for patients with per-/subtrochanteric fracture versus femoral neck fracture (HR = 0.7; CI 0.6–0.8). The risk of reoperation due to SSI decreased over time; HR was 0.6 (CI 0.5–0.7) for 2015–2016 compared with 2005–2006. Risk of reoperation decreased with increasing age; the HR was 0.6 (CI 0.6–0.7) in the more than 85-year-olds compared with 65–74-year-old patients.InterpretationThe net risk of reoperations due to SSI in our study was higher than previously assumed. We identified several risk factors for increased risk of reoperation due to SSI, most noticeably treatment with internal fixation vs. arthroplasty, as well as younger age and femoral neck fracture diagnosis.

Incidence and Predictors of Surgical Site Infection in Women Who Are Obese and Give Birth by Elective Cesarean Section: A Secondary Analysis

(Aust N Z J Obstet Gynaecol. 2022;62:234–240. doi: 10.1111/ajo.13428) Risk factors for surgical site infection (SSI) following cesarean delivery (CD) are numerous and include maternal obesity (BMI ≥30 kg/m2). The interaction of high BMI with other risk factors for SSI (advanced maternal age, smoking, diabetes, emergency procedures, nontransverse incision, previous CD, premature membrane rupture, etc.) is not well understood and may interplay variably among individuals, making it difficult to predict risk for individual women. The authors analyzed the incidence of SSI in women with BMI ≥30 kg/m2 undergoing elective CD to identify specific predictive risk factors.

Effect of climate on surgical site infections and anticipated increases in the United States

Surgical site infections (SSI) are one of the most common and costly hospital-acquired infections in the United States. Meteorological variables such as temperature, humidity, and precipitation may represent a neglected group of risk factors for SSI. Using a national private insurance database, we collected admission and follow-up records for National Healthcare Safety Network-monitored surgical procedures and associated climate conditions from 2007 to 2014. We found that every 10 cm increase of maximum daily precipitation resulted in a 1.09 odds increase in SSI after discharge, while every g/kg unit increase in specific humidity resulted in a 1.03 odds increase in SSI risk after discharge. We identified the Southeast region of the United States at highest risk of climate change-related SSI, with an estimated 3% increase in SSI by 2060 under high emission assumptions. Our results describe the effect of climate on SSI and the potential burden of climate-change related SSI in the United States.

Prevalence, Risk Factors and Microbiological Profile of Orthopaedic Surgical Site Infection in North-Eastern Peninsular Malaysia.

The devastating outcome of orthopaedic surgical site infections (SSI) are largely preventable if its risk factors, causative organisms and antimicrobial susceptibility patterns in the regional area are known. We conducted a retrospective study to address the lack of epidemiological and microbiological data on orthopaedic SSI in Malaysia. All the 80 patients diagnosed and treated for microbiologically proven orthopaedic SSIs in a tertiary hospital in Malaysia from April 2015 to March 2019 were included in a 1:2 case control study. The prevalence of SSI in clean and clean-contaminated surgeries was 1.243%, which is consistent with most of the studies worldwide, but is low compared to other studies done in Malaysia. The most common type of orthopaedics SSI were internal fixation infections (46.25%), superficial SSIs (25.2%) and Prosthetic joint infections (18.75%). Obesity and tobacco use were found to be significant risk factors of orthopaedic SSI. The most common perioperative prophylaxis used was IV cefuroxime. Majority of the cases (86.5%) received prolonged prophylactic antibiotics. The most common causative agent was Staphylococcus aureus (31.25%), followed by Pseudomonas aeruginosa (26.25%) and Enterobacter spp (7.5%). Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 20% of the S. aureus infections. Up to 19.4% of the Gram-negative organisms are multidrug resistant. The higher rate of isolation of organisms resistant to the prophylactic antibiotics being used may be related to the prolonged use of prophylactic antibiotics, which exerted selective pressure for the acquisition of resistant organisms. Despite its relatively low prevalence in our local institution and worldwide, the prevention of SSI in orthopaedic practice is crucial to avoid morbidity, mortality and high healthcare cost. This may be achieved by control of modifiable risk factors such as obesity and tobacco use, appropriate use of prophylactic antibiotics and implementation of good surgical and infection control practices.

Risk Factors for Surgical Site Infections After Lower Extremity Open Revascularization

Surgical site infection (SSI) is a serious complication of lower extremity open revascularization and is associated with increased morbidity, increased healthcare costs, and decreased postoperative quality of life. The objective of this study was to determine factors associated with an increased risk of developing postoperative SSI in patients undergoing lower extremity revascularization. Associations between SSI and postoperative complications were also identified. Patients who underwent lower extremity open revascularization from 2014-2017 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). A multivariate logistic regression analysis was used to determine risk factors associated with SSIs within 30days of the operation and postoperative complications. Odds ratios (ORs) were adjusted for demographics, preoperative comorbidities, procedure type, and intraoperative variables. Ten thousand nine hundred ten patients who underwent lower extremity open revascularization were identified, with a mean age of 67.24 years and of whom 7,318 (67%) were male. Of the 10,910 patients, 922 (8.45%) had an SSI within 30days of the operation. Risk factors associated with developing SSI included body mass index 25-29.9 (OR, 1.34; 95% confidence interval [CI], 1.08-1.67), body mass index ≥ 30 (OR, 2.12; 95% CI, 1.71-2.62), history of severe chronic obstructive pulmonary disease (OR, 1.47; 95% CI, 1.18-1.84), preprocedural beta-blocker use (OR, 1.25; CI 95%, 1.05-1.49), procedure time > 214minutes (OR, 1.44; 95% CI, 1.22-1.70), and creatinine > 1.2 (OR 1.03; 95% CI, 0.87-1.21). One factor associated with a decreased risk of developing SSI was male gender (OR, 0.71; 95% CI, 0.60-0.84). Patients who developed an SSI were more likely to have adverse outcomes such as myocardial infarction/stroke, major amputation, bleeding requiring transfusion or secondary procedure, or require a reintervention in the treated segment. There are various patient-related and operative factors that increase the likelihood of developing an SSI after lower extremity open revascularization. These findings indicate that addressing modifiable perioperative SSI risk factors may be beneficial in decreasing rates of SSI and improving postoperative outcomes.

Comparing the efficacy of povidone-iodine and normal saline in incisional wound irrigation to prevent superficial surgical site infection: a randomized clinical trial in gastric surgery

Prevention of surgical site infection (SSI) after gastrectomy has received increasing attention. Prophylactic incisional wound irrigation has been advocated to reduce SSI, but the choice of solution remains under debate. To compare the efficacies of wound irrigation with normal saline (NS) and povidone-iodine (PVI) for the prevention of SSI after gastrectomy, and to identify the risk factors for SSI. This randomized, single-centre clinical trial included 340 patients with gastric cancer. They were assigned at random into two groups (ratio 1:1) to receive either 0.9% NS or 1.0% PVI solution for incisional irrigation before wound closure. The primary endpoint was postoperative SSI within 30 days of gastrectomy, and the secondary endpoint was the length of hospital stay. In total, 333 patients were included in the modified intent-to-treat group, and the SSI rate did not differ significantly between the PVI group (11/167, 6.59%) and the NS group (9/166, 5.42%) [odds ratio (OR) 1.131, 95% confidence interval (CI) 0.459-3.712; P=0.655]. Moreover, the difference between the two groups in terms of length of hospital stay was not significant (P=0.301). Body mass index (BMI) (OR 2.639, 95% CI 1.040-6.694; P=0.041) and postoperative complications (OR 2.565, 95% CI 1.023-6.431; P=0.045) were identified as independent risk factors for SSI. NS and PVI had similar efficacy as prophylactic wound irrigation for the prevention of SSI after gastrectomy. The risk of SSI was higher in patients with high BMI or postoperative complications.

Surgical site infection in thoracic and lumbar fractures: incidence and risk factors in 11,401 patients from a nationwide administrative database

BACKGROUND CONTEXTThe rate of surgical site infection (SSI) following elective spine surgery ranges from 0.5%‒10%. Published reports suggest a higher SSI rate in non-elective spine surgery such as spine trauma; however, there is a paucity of large database studies examining this issue. PURPOSEThe objective of this study was to investigate the incidence and risk factors of SSI in patients undergoing spine surgery for thoracic and lumbar fractures in a large population database. STUDY DESIGN/SETTINGThis is a retrospective study utilizing the PearlDiver Patient Claims Database. PATIENT SAMPLEPatients undergoing spine surgery for thoracic and lumbar fractures between 2015-2020 were identified in the PearlDiver Patient Claims Database using ICD-10 codes. Patients were excluded who had another surgery either 14 days before or 21 days after the index spine surgery, or pathologic fracture. OUTCOME MEASURESRate of surgical site infection. METHODSClinical data collected from the PearlDiver database based on ICD-10 codes included gender, age, diabetes, smoking status, obesity, Elixhauser Comorbidity Index (ECI), Charlson Comorbidity Index (CCI), and SSI. Univariate analysis was used to assess the association of potential risk factors and SSI. Multivariable analysis was used to identify independent risk factors of SSI. The authors have no conflicts of interest or funding sources to declare. RESULTSA total of 11,401 patients undergoing spine surgery for thoracic and lumbar fractures met inclusion criteria, and 1,065 patients were excluded. 860 patients developed SSI (7.5%). Risk factors significantly associated with SSI in univariate analysis included diabetes (OR 1.50; 95% CI, 1.30‒1.73; p<.001), obesity (OR 1.66; 95% CI, 1.44‒1.92; p<.001), increased age (p<.001), ECI (p<.001), and CCI (p<.001). On multivariable analysis, obesity and ECI were independently associated with SSI (p<.001 and p<.001, respectively). CONCLUSIONSNon-elective surgery for thoracic and lumbar fractures is associated with a 7.5% risk of SSI. Obesity and ECI are independent predictors of SSI in this population. Limitations include the reliance on accurate insurance coding which may not fully capture all SSI, and in particular superficial SSI. These findings provide a broad overview of the risk of SSI in this population at a national level and may also help counsel patients regarding risk.

Time trends in Surgical Site Infection rates in a Tunisian university hospital

Abstract Background Surgical site infections (SSIs) are the most common hospital-acquired infections (HAIs) in low- and middle-income countries. Many reports have shown that surveillance and management of factors associated with SSI decreased rates and improved overall outcomes.This study aimed to appraise the prevalence trend and risk factirs of SSIs during 10-year period (2012 - 2021) in a Tunisian university hospital. Methods The SSI surveillance module is based on the National Healthcare Safety Network (NHSN), Centers for Disease Control and Prevention (CDC). For the current study, data collected over ten years through point prevalence surveys were analyzed. Univariate and multivariate logistic analysis were used to identify SSI risk factors. Results Overall, 2957 patients were observed; the mean age was 48.4 ± 23.5 years and 57.2% were male. We identified 289 infected patients (9.8%) and 319 HAIs (10.8%). SSIs were found in 21.6% of cases.The prevalence of SSI decreased from 27.9% in 2012 to 21.6% in 2021. However, this decrease was not statistically significant. The majority of the positive cultures were Staphylococcus aureus (14.3%) followed by Escherichia Coli (11.1%) and Klebsiella pneumoniae (9.5%). Antimicrobial resistance was found in 17.5% of cases. Univariable analysis found that lenght of stay (p &amp;lt; 10-3), obesity (p = 0.047), the use of antibiotic treatment in 6 months (p = 0.002), and the use of central line (p &amp;lt; 10-3) were associated with SSI. Independent risk factors significantly associated with SSIs were length of stay (aOR=8.6), the use of central line (aOR=3), and the use of antibiotic treatment in 6 months (aOR=2.2). Conclusions With continuous surveillance, the prevalence of SSIs decreased. In Sahloul university hospital, there has been a strengthening of the application of hygiene standard precautions during the two last years, and more particularly the respect of hand hygiene, combined with continued inpatient antimicrobial stewardship programs. Key messages • Active surveillance and management of factors associated with surgical site infection (SSI) decreased the incidence and improved overall outcomes. • With continuous surveillance, the prevalence of SSIs decreased over the 10-year study period.