Risk Factors For Wound Infection Research Articles

Effects of Neoadjuvant Radiotherapy on Postoperative Complications in Rectal Cancer: A Meta-Analysis.

Objective Neoadjuvant radiotherapy (nRT) is an important treatment approach for rectal cancer. The relationship, however, between nRT and postoperative complications is still controversial. Here, we conducted a meta-analysis to evaluate such concerns. Methods The electronic literature from 1983 to 2021 was searched in PubMed, Embase, and Web of Science. Postoperative complications after nRT were included in the meta-analysis. The pooled odds ratio (OR) was calculated by the random-effects model. Statistical analysis was conducted by Review Manager 5.3 and STATA 14. Results A total of 23,723 patients from 49 studies were included in the meta-analysis. The pooled results showed that nRT increased the risk of anastomotic leakage (AL) compared to upfront surgery (OR = 1.23; 95% CI, 1.07–1.41; p=0.004). Subgroup analysis suggested that both long-course (OR = 1.20, 95% CI 1.03–1.40; p=0.02) and short-course radiotherapy (OR = 1.25, 95% CI, 1.02–1.53; p=0.04) increased the incidence of AL. In addition, nRT was the main risk factor for wound infection and pelvic abscess. The pooled data in randomized controlled trials, however, indicated that nRT was not associated with AL (OR = 1.01; 95% CI 0.82–1.26; p=0.91). Conclusions nRT may increase the risk of AL, wound infection, and pelvic abscess compared to upfront surgery among patients with rectal cancer.

FATORES DE RISCO PARA INFECÇÃO DE FERIDA OPERATÓRIA APÓS COLECISTECTOMIA LAPAROSCÓPICA ELETIVA

ABSTRACTBACKGROUND:One of the ways to avoid infection after surgical procedures is through antibiotic prophylaxis. This occurs in cholecystectomies with certain risk factors for infection. However, some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any advantage of this practice in the absence of risk factors.AIMS:This study aims to evaluate the incidence of wound infection after elective laparoscopic cholecystectomies and the use of antibiotic prophylaxis in these procedures.METHODS:This is a retrospective study of 439 patients with chronic cholecystitis and cholelithiasis, accounting for different risk factors for wound infection.RESULTS:There were seven cases of wound infection (1.59%). No antibiotic prophylaxis regimen significantly altered infection rates. There was a statistically significant correlation between wound infection and male patients (p=0.013). No other analyzed risk factor showed a statistical correlation with wound infection.CONCLUSIONS:The nonuse of antibiotic prophylaxis and other analyzed factors did not present a significant correlation for the increase in the occurrence of wound infection. Studies with a larger sample and a control group without antibiotic prophylaxis are necessary.

FATORES DE RISCO PARA INFECÇÃO DE FERIDA OPERATÓRIA APÓS COLECISTECTOMIA LAPAROSCÓPICA ELETIVA.

ABSTRACT - BACKGROUND:One of the ways to avoid infection after surgical procedures is through antibiotic prophylaxis. This occurs in cholecystectomies with certain risk factors for infection. However, some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any advantage of this practice in the absence of risk factors.AIM: This study aimed to evaluate the incidence of wound infection after elective laparoscopic cholecystectomies and the use of antibiotic prophylaxis in these procedures.METHODS: This is a retrospective study of 439 patients with chronic cholecystitis and cholelithiasis, accounting for different risk factors for wound infection.RESULTS: There were 7 (1.59%) cases of wound infection. No antibiotic prophylaxis regimen significantly altered infection rates. There was a statistically significant correlation between wound infection and male patients (p=0.013). No other analyzed risk factor showed a statistical correlation with wound infection.CONCLUSIONS: The non-use of antibiotic prophylaxis and other analyzed factors did not present a significant correlation for the increase in the occurrence of wound infection. Studies with a larger sample and a control group without antibiotic prophylaxis are necessary.

Risk Factors for Wound Infections after Vascular Surgery: Kuwait Experience

Introduction: Wound infections represent a serious complication after vascular surgery particularly after vascular reconstructive procedures. We aimed to identify risk factors predisposing patients to these complications. Methods: This was a retrospective review of open vascular surgical procedures performed between April 2014 and March 2019 in Kuwait. Patient demographics, procedures performed and their indications, and post-operative outcomes were collected and analyzed. Patients with pre-operative active infections were excluded from the analysis. Statistical analysis was performed, and odds ratios (ORs) and relative risks were calculated for the outcomes of interest. Fisher’s exact test and two-tailed t test were used where appropriate. Results: 391 patients were identified. The majority (54%) presented with chronic limb threatening ischemia. The mean age was 58 (±10) years, with a male predominance (76%). Wound infection occurred in 53 (14%) patients. The most commonly isolated organism was Staphylococcus aureus (47%). Diabetes (OR 8.03, 95% CI: 1.9142–33.7439, p = 0.0044), hypertension (OR 2.38, 95% CI: 1.2960–4.3684, p = 0.0052), ischemic heart disease (OR 2.30, 95% CI: 1.4349–4.6987, p = 0.0016), hyperlipidemia (OR 2.12, 95% CI: 1.0305–4.3620, p = 0.0412), and chronic renal failure (OR 2.55, 95% CI: 1.0181–6.4115, p = 0.0457) were all found to be significantly associated with the development of post-operative wound infections in vascular surgery patients. Conclusion: Diabetes, hypertension, ischemic heart disease, hyperlipidemia, and chronic renal failure were associated with post-operative wound infections. Anticipation of wound complications in patients with these risk factors may aid early diagnosis and treatment.

Wound infection in elbow fractures: Incidence and new management protocol.

Wound infection in elbow fractures: Incidence and new management protocol.

Comparison Between Subcutaneous Tissue Closure V/S Nonclosure in Elective Surgery

Background and Objectives: Postoperative wound complication are one of the greatest issues in elective surgeries. Obesity, operative time, diabetes, age of the patient, anemia, associated infection and reduced nutrition are recognized risk factors for wound infections. With the seek to avoid wound infection, many research studies were performed and assessed the infuence of subcutaneous tissue closure in the past 20 years suturing of subcutaneous tissue, the anatomy of the fragile subcutaneous tissue layer is imperfect and suturing leads to a decrease in perfusion to the fatty layer thereby compromising the blood supply to the subcutaneous layer leading to fat necrosis. This study was under taken to study the various post-operative complications in elective surgery like ventral hernia, inguinal hernia and modified radical mastectomy closed with or without subcutaneous closure. Materials and Methods: This study was undertaken from December 2018 to December 2020 in the department of General Surgery, Shree M. P. Shah Govt. Medical College and G.G. Govt. Hospital, Jamnagar. After completing major operative steps subcutaneous suturing using 2-0 polyglactin was done in 54 patients and subcutaneous suturing was not done in 46 patients. Total number of patients–100.

A guide to caesarean wound healing

A guide to caesarean wound healing

Predictive Risk Models for Wound Infection-Related Hospitalization or ED Visits in Home Health Care Using Machine-Learning Algorithms.

Wound infection is prevalent in home healthcare (HHC) and often leads to hospitalizations. However, none of the previous studies of wounds in HHC have used data from clinical notes. Therefore, the authors created a more accurate description of a patient's condition by extracting risk factors from clinical notes to build predictive models to identify a patient's risk of wound infection in HHC. The structured data (eg, standardized assessments) and unstructured information (eg, narrative-free text charting) were retrospectively reviewed for HHC patients with wounds who were served by a large HHC agency in 2014. Wound infection risk factors were identified through bivariate analysis and stepwise variable selection. Risk predictive performance of three machine learning models (logistic regression, random forest, and artificial neural network) was compared. A total of 754 of 54,316 patients (1.39%) had a hospitalization or ED visit related to wound infection. In the bivariate logistic regression, language describing wound type in the patient's clinical notes was strongly associated with risk (odds ratio, 9.94; P < .05). The areas under the curve were 0.82 in logistic regression, 0.75 in random forest, and 0.78 in artificial neural network. Risk prediction performance of the models improved (by up to 13.2%) after adding risk factors extracted from clinical notes. Logistic regression showed the best risk prediction performance in prediction of wound infection-related hospitalization or ED visits in HHC. The use of data extracted from clinical notes can improve the performance of risk prediction models.

Decompressive Craniectomy and Risk of Wound Infection After Microsurgical Treatment of Ruptured Aneurysms

Owing to prolonged hospitalization and the complexity of care required for patients with aneurysmal subarachnoid hemorrhage (aSAH), these patients have a high risk of complications. The risk for wound infection after microsurgical treatment for aSAH was analyzed. All patients who underwent microsurgical treatment for aSAH between August 1, 2007, and July 31, 2019, and were recorded in the Post-Barrow Ruptured Aneurysm Trial database were retrospectively reviewed. The patients were analyzed for risk factors for wound infection after treatment. Of 594 patients who underwent microsurgical treatment for aSAH, 23 (3.9%) had wound infections. There was no significant difference in age between patients with wound infection and patients without infection (mean, 52.6 ± 12.2 years vs. 54.2 ± 4.0 years; P= 0.45). The presence of multiple comorbidities (including diabetes, tobacco use, and obesity), external ventricular drain, ventriculoperitoneal shunt, pneumonia, or urinary tract infection was not associated with an increased risk for wound infection. Furthermore, there was no significant difference in mean operative time between patients with wound infection and those without infection (280 ± 112 minutes vs. 260 ± 92 minutes; P= 0.38). Patients who required decompressive craniectomy (DC) were at increased risk of wound infection (odds ratio, 5.0; 95% confidence interval, 1.8-14.1; P= 0.002). Among the 23 total infections, 9 were diagnosed following cranioplasty after DC. Microsurgical treatment for aSAH is associated with a relatively low risk of wound infection. However, patients undergoing DC may be at an increased risk for infection. Additional attention and comprehensive wound care are warranted for these patients.

Nutritional Predictors of Wound Infection in Patients with Lower Extremity Soft Tissue Sarcoma.

Soft tissue sarcoma (STS) frequently requires high-risk surgery that predisposes patients to complex wounds. Past studies have identified a variety of tumor characteristics as risk factors for wound infection (WI); however, physiologic characteristics have not yet been studied in this population. Thus, the objective of this study is to identify any nutritional indicators and physiologic characteristics associated with the development of WI. 633 patients from a large tertiary care center institution were identified with lower extremity STS removed from 1992 to 2017. The primary outcomes of interest were WI at patient's surgical site within 90 days of surgery and additional procedure due to wound infection. Patients' laboratory values, comorbidities, and other characteristics were assessed using multivariable analysis to determine risk factors for WI. Receiver operator characteristic (ROC) curves were used for analysis of plasma glucose and albumin levels to determine a useful risk threshold. Significance was determined to be p < 0.05. Postoperative plasma glucose levels were significantly higher among patients with WI compared with those without (p < 0.001) and showed predictivity in ROC analysis (AUC 0.77, 95% CI 0.72-0.82). Preoperative albumin (p < 0.001) and prognostic nutritional index score (p = 0.002) were significantly lower among patients with WI. Partial thromboplastin time (PTT), international normalized ratio (INR), white blood cell count (WBC), and platelet count values had no effect on WI. Smoking elevated risk for WI (OR 1.64, p < 0.01). Significant risk factors were the same when assessed for those with WI undergoing additional procedures. Postoperative plasma glucose levels, preoperative albumin levels, and smoking status are useful nutritional variables in predicting WI in STS excisional procedures.

Smoking and trimalleolar fractures are risk factors for infection after open reduction and internal fixation of closed ankle fractures: A multicenter retrospective study of 1,201 fractures

IntroductionOne of the complications of the surgical therapy for ankle fractures includes wound infection. This study aimed to evaluate postoperative function and clarify the risk factors associated with postoperative wound infection in patients receiving the open reduction and internal fixation for ankle fracture through a multicenter study. Subjects and methodAmong 1421 patients diagnosed as having closed ankle fracture and who were treated by surgical therapy in 11 institutions from 2014 through 2019, 1201 patients (men, n = 512, women, n = 689; the mean (SD) age, 50.9 (15.6) years; the mean body mass index [BMI] (SD), 24.3 (4.2) kg/m2) were included as subjects. Excluded were 220 patients due to self-termination of treatment, inability to follow up after discharge, open fracture, distal tibia shaft fracture, and pilon fracture. We extracted the following as risk factors of wound infection: age, sex, BMI, fracture type, injury energy and histories of smoking, diabetes, arteriosclerosis, heart failure and myocardial infarction. We conducted logistic regression analysis to investigate the risk factors of wound infection using these extracted items as explanatory variables and the presence or absence of wound infection as the response variable. ResultsWound infection occurred after surgery for closed ankle fracture in 69 the 1201 patients (5.7%). The causative organism was methicillin-susceptible Staphylococcus aureus (MSSA) in 15 patients, methicillin-resistant S. aureus (MRSA) in 4 patients, Finegoldia magna in one patient, and S. haemolyticus in one patient. In the other patients, causative organisms were not detected, culture of the causative organisms was not conducted, or they were unknown. The univariate analysis showed significant differences in sex (p = 0.01) and for smoking (p = 0.002), fracture type (p = 0.02) and heart failure (p = 0.042). Logistic regression analysis showed that smoking and type of fracture (trimalleolar fracture) were significant explanatory factors for infection (odds ratio 1.83 and 1.98, p = 0 .040 and 0.042, respectively). ConclusionsAt 5.7%, the rate of postoperative wound infection in closed ankle fracture was not low. Staphylococcus was the most frequent causative organism. The surgeon should pay attention infection after surgery in the patients who had a trimalleolar fracture or smoking habits.

Risk factors for wound infection caused by Methicillin Resistant Staphylococcus aureus among hospitalized patients: a case control study from a tertiary care hospital in India.

Methicillin Resistant Staphylococcus aureus (MRSA) causes infection in hospitals and communities. The prevalence and risk factors of MRSA infection is not homogenous across the globe. To find the risk factors of MRSA infection among hospitalized patients. Cross-sectional case control study was conducted at a tertiary care hospital in India. The risk factors were collected using checklist from 130 MRSA and 130 Methicillin sensitive staphylococcus aureus (MSSA) infected patients. The pathogens were isolated from the wound swabs according to Clinical and Laboratory Standards Institute guidelines. Both the groups were comparable in terms of age, gender, diabetic status, undergoing invasive procedures, urinary catheterization and smoking (p>0.05). Multivariate logistic regression revealed surgical treatment (OR 4.355; CI 1.03, 18.328; p=0.045), prolonged hospitalization (OR 0.307; CI 0.11, 0.832; p=0.020), tracheostomy (OR 5.298, CI 1.16, 24.298; p=0.032), pressure/venous ulcer (OR 7.205; CI 1.75, 29.606; p=0.006) and previous hospitalization (OR 2.883; CI 1.25, 6.631; p=0.013) as significant risk factors for MRSA infection. Surgical treatment, prolonged and history of hospitalization, having tracheostomy for ventilation and pressure/venous ulcer were the key risk factors. Therefore, special attention has to be given to the preventable risk factors while caring for hospitalized patients to prevent MRSA infection.

Wound infection in colorectal cancer resections through a laparoscopic approach: a single-center prospective observational study of over 3000 cases

ObjectivesThis prospective observational study aimed to clarify the incidence and independent risk factors of wound infection after laparoscopic surgery for primary colonic and rectal cancer.MethodsA prospective surveillance of surgical site infection (SSI) was conducted in consecutive patients with primary colorectal cancer, who underwent elective laparoscopic surgery in a single comprehensive cancer center between 2005 and 2014. The outcomes of interest were the incidence and risk factors of wound infection.ResultsIn total, 3170 patients were enrolled in the study. The overall incidence of wound infection was 3.0%. The incidence of wound infection was significantly higher in rectal surgery than in colonic surgery (4.7 vs. 2.1%, p < 0.001). In rectal surgery, independent risk factors for developing wound infection included abdominoperineal resection (p < 0.001, odds ratio [OR] = 11.4, 95% confidence interval [CI]: 5.04–24.8), body mass index (BMI) ≥ 25 kg/m2 (p = 0.041, OR = 1.97, 95% CI, 1.03–3.76), and chemoradiotherapy (p = 0.032, OR = 2.18, 95% CI, 1.07–4.45). In laparoscopic colonic surgery, no significant risk factors were identified.ConclusionsLaparoscopic rectal surgery has a higher risk of wound infection than colonic surgery. Laparoscopic rectal surgery involving abdominoperineal resection, patients with higher BMI, and chemoradiotherapy requires careful observation in wound care and countermeasures against wound infection.

Incidence and Risk Factors of Wound Infection in Women Who Underwent Cesarean Section in 2014 at King Abdulaziz Medical City, Jeddah.

IntroductionCesarean section (C/S) is considered one of the most commonly performed procedures among women. The maternal morbidity due to infection post-C/S reaches eight-fold higher than that of vaginal delivery. Our aim is to identify the incidence and risk factors of surgical site infection (SSI) among patients at King Abdul Aziz Medical City (KAMC), Jeddah, Saudi Arabia, in order to develop a strong strategy to reduce its occurrence.MethodsThis retrospective cohort study was conducted at KAMC, Jeddah. The study included a total of 387 women who underwent cesarean sections from January 2014 to December 2014. The data were collected consecutively by reviewing medical records of pregnant patients who underwent elective or emergency C/S. The risk factors studied included age, presence of underlying diseases, BMI, hemoglobin level, prophylactic antibiotics, pre-labor rupture of membrane, duration of induction of labor, type of C/S, type of uterine incision, duration of operation, type of anesthesia, estimated blood loss, type of organism, and the duration of hospital stay postoperatively. ResultsThe incidence rate of wound infections (WI) was 3.4% (13/387). The mean age score was 31.1±5.6 years, and the mean score of BMI was 32.7±6.2, where the majority were obese (255, 65.9%). More than half of the participants (205, 53.0%) had elective C/S, with mean hospitalization duration 2.5±1.3 days, and operation duration mean score 59.5±22.0 minutes. The majority (378, 97.7%) received antibiotics before the operation, where cefazolin was the main antibiotic (376, 97.2%). Only 38 (10%) cases had intra-operative complications, where the main complication was postpartum hemorrhage (18, 44.0%). The majority of WI were superficial (11 cases), the main organism was E. coli in four (36.4%) cases, followed by Staphylococcus aureus in three (27.3%) cases. There was a significant association between WI post-C/S and BMI, type of uterine incision, and induction of labor (P=006, P=0.003, respectively). ConclusionsThis study showed that WI post-C/S is associated with high BMI, prolonged induction of labor, and Pfannenstiel incision. Reducing the rate of SSI will help to reduce its morbidity by identifying the risk factors pre-pregnancy and encouraging the implementation of preconception counseling clinics and antenatal classes to educate and increase awareness among patients.

Risk Factors for Wound Infection in Outpatients With Lower Extremity Burns.

We sought to evaluate risk factors for wound infection in patients with lower extremity (LE) burn. Adults presenting with LE burn from January 2014 to July 2015 were included. Data regarding demographics, injury characteristics, and outcomes were obtained. The primary outcome was wound infection. Multivariate logistic regression analysis was performed to identify independent risk factors for wound infection. 317 patients were included with a mean age of 43years and median total body surface area of .8%; 22 (7%) patients had a component of full-thickness (FT) burn; and 212 (67%) patients had below-the-knee (BTK) burn. The incidence of wound infection was 15%. The median time to infection was 5days, and majority (61%) of the patients developed wound infection by day 5. Patients who developed wound infection were more likely to have an FT burn (22% vs. 5%, P < .001) and BTK burn (87% vs. 64%, P = .002), without a difference in other variables. Multivariate logistic regression analysis showed age (Odds ratio (OR) 1.02 and CI 1.00-1.04), presence of FT burn (OR 5.33 and CI 2.09-13.62), and BTK burn (OR 3.42 and CI 1.37-8.52) as independent risk factors for wound infection (area under the curve = .72). Age, presence of FT burn, and BTK burn are independent risk factors for wound infection in outpatients with LE burns.

A COMPARATIVE STUDY BETWEEN THE INCIDENCE OF WOUND INFECTION AND BURST ABDOMEN BETWEEN DELAYED ABSORBABLE (VICRYL) AND MEDICATED VICRYL (VICRYL PLUS) SUTURE MATERIAL IN PATIENTS UNDERGOING MIDLINE INCISION LAPAROTOMY IN ACUTE ABDOMEN CASES IN THE EMERGENC

Midline laparotomy is frequently done in the emergency setting of any hospital and type of suture material used for the fascial closure of the abdominal wall influences the incidence of the postoperative complications. The aim of this study was to compare the efficacy of the medicated Vicryl (Vicryl plus) suture material with plain Vicryl suture material in patients undergoing midline incision laparotomy in acute abdomen cases based on the postoperative complications. In addition, the effect of various risk factors on burst abdomen and wound infection was also evaluated. &#x0D; Methods: 100 patients who have visited the emergency department of the hospital and underwent midline laparotomy were enrolled in this study.&#x0D; Results: Patients were divided into two groups depending on whether they have an intestinal perforation (group A, n=60) or intestinal obstruction (Group B, n=40). These two groups were further divided into two groups depending on the type of suture material used (plain Vicryl: group A1, B1 and medicated Vicryl: group A2, B2). Both these groups had an equal number of patients. The analysis of the data showed that compared to the non medicated suture material the rate of wound infection is considerably less in the cases of medicated polyglactin suture material. In addition, older age, diabetes, anemia, and malnutrition are the significant risk factor for wound infection (p&lt;0.001s) while Older age, malnutrition, and cough were found to be highly significant risk factors for burst abdomen.&#x0D; Conclusion: The medicated suture material was proved to be more effective in preventing the burst abdomen and postoperative wound infections compared to the plain delayed absorbable Vicryl suture material.&#x0D; Keywords: delayed absorbable Vicryl, medicated Vicryl, burst abdomen, wound infection, a midline laparotomy

Some Risk Factors for Hospital Infections at the ICU in the Vietnam National Children’s Hospital

Purpose: To identify some risk factors for hospital infections in the ICU, Vietnam National Children’s Hospital in 2018-2019.&#x0D; Method: A prospective cohort study was conducted.&#x0D; Results: Malnutrition grade II or higher, PRISM &gt; 10, ≥ 3 invasive intervention, use of H2-receptor antagonists and intravenous feeding were risk factors for nosocomial infections. Endotracheal intubation, intubation for &gt; 5 days, re-intubation, and aspiration of vomit were risk factors for nosocomial pneumonia. Intravenous exposure, 3 or more IV lines, and central venous catheterization were risk factors for sepsis. Gastrointestinal surgery, surgery time &gt; 2 hours, postoperative drainage, drainage time &gt; 5 days and no prophylactic antibiotics were risk factors for wound infection. Urinary retention and urinary flow &gt; 3 days were risk factors for urinary tract infections.&#x0D; Conclusion: Nosocomial infections with grade II or higher malnutrition and 3 invasive interventions, the use of H2-receptor resistance and intravenous nutrition associated with nosocomial infections. Pneumonia, urinary tract infections, and sepsis are high risk factors for nosocomial infections.

Increased fat depth is not associated with increased risk of surgical complications following total hip arthroplasty.

Previous research has demonstrated increased early complication rates following total hip arthroplasty (THA) in obese patients, as defined by body mass index (BMI). Subcutaneous fat depth (FD) has been shown to be an independent risk factor for wound infection in cervical and lumbar spine surgery, as well as after abdominal laparotomy. The aim of this study was to investigate whether increased peritrochanteric FD was associated with an increased risk of complications in the first year following THA. We analyzed prospectively collected data on a consecutive series of 1,220 primary THAs from June 2013 until May 2018. The vertical soft tissue depth from the most prominent part of the greater trochanter to the skin was measured intraoperatively using a sterile ruler and recorded to the nearest millimetre. BMI was calculated at the patient's preoperative assessment. All surgical complications occuring within the initial 12 months of follow-up were identified. Females had a significantly greater FD at the greater trochanter in comparison to males (median 3.0 cm (interquartile range (IQR) 2.3 to 4.0) vs 2.0 cm (IQR 1.7 to 3.0); p < 0.001) despite equivalent BMI between sexes (male median BMI 30.0 kg/m2 (IQR 27.0 to 33.0); female median 29.0 kg/m2 (IQR 25.0 to 33.0)). FD showed a weak correlation with BMI (R² 0.41 males and R² 0.43 females). Patients with the greatest FD (upper quartile) were at no greater risk of complications compared with patients with the lowest FD (lower quartile); 7/311 (2.3%) vs 9/439 (2.1%); p = 0.820 . Conversely, patients with the highest BMI (≥ 40 kg/m2) had a significantly increased risk of complications compared with patients with lower BMI (< 40 kg/m2); 5/60 (8.3% vs 18/1,160 (1.6%), odds ratio (OR) 5.77 (95% confidence interval (CI) 2.1 to 16.1; p = 0.001)). We found no relationship between peritrochanteric FD and the risk of surgical complications following primary THA. Cite this article: Bone Joint J 2020;102-B(9):1146-1150.

Risk factors associated with CSF leakage and complications after retrosigmoid surgery

ObjectiveCerebrospinal fluid (CSF) leakage is a common complication of retrosigmoid surgery that may cause dehiscence of the surgical wound or infection. We sought to identify risk factors associated with CSF leakage and accompanying complications. MethodsCharts from patients who underwent a retrosigmoid approach surgery at Ramathibodi Hospital between 2007 and 2019 were retrospectively reviewed. Data from patients who did and did not have CSF leakage were compared to define the patient characteristics, factors related to CSF leakage, types of leakage, and complications encountered after CSF leakage. Multiple logistic regression analyses were conducted to determine the variable factors associated with CSF leakage and accompanying complications. ResultsCSF leakage occurred in 40 of 286 patients (14%). The risk factors associated with CSF leakage were age and body mass index (BMI). Patients with stage I obesity and stage II obesity had a significantly increased risk of CSF leakage. Subgroup analysis revealed that hydrocephalus and radiation were risk factors for pseudomeningocele. Wound dehiscence and CSF wound leakage were associated with pseudomeningocele. All types of CSF leakage, i.e., pseudomeningocele, wound leakage, CSF rhinorrhea, and CSF otorrhea, were risk factors for wound infection and meningitis. ConclusionsAge and BMI were related to CSF leakage. Specifically, younger patients were more likely to have CSF leakage and obese patients had higher CSF leakage rates compared with patients with a normal BMI. Wound infection and meningitis frequently occurred when these complications occurred.

ASSESSMENT OF VARIOUS FACTORS INFLUENCING WOUND INFECTION FOLLOWING ABDOMINAL SURGERY- A CLINICAL STUDY

Background: Wound infection is greatly affected by size and depth of incision, site of surgery etc. The present study was conducted to determine various factors leading to wound infection following abdominal surgery. Materials & Methods: This study was conducted on 154 patients who underwent abdominal operations. Intra- operative factors such as type of incision used, type of antiseptic, pre- existing skin infection, placement of suture and length of operative time was recorded. Post- operative risk factors such as urinary catheterization, anticoagulant therapy etc. was recorded. Results: Common surgery performed was appendectomy in 14, CBD exploration in 12, hernioplasty in 8, pyelolithotomy in 23, cholecystectomy in 54, laparotomy in 36 and supra-pubic cystolithotomy in 7 cases. Out of 154 cases, 20 (12.9%) had wound infection. Out of 20 patients who had wound infection, ASA score 1 was present in 10, 2 in 5, 3 in 3, 4 in1 and 5 in 1. Operative time upto 60 minutes was seen in 11, 61-120 minutes in 6 and >121 minutes in 3 patients. 12 patients were diabetic, 7 were underweight, 6 were smokers, 11 were on steroid use and 3 had re-operation skin infection . Abdominal incision was vertical in 5, horizontal in 7 and oblique in 8. Skin antiseptic agent used was povidine- iodine in 13 and chlorhexidine in 7. Opening of digestive bowel was seen in 4 cases. Urine catheterization was required in 8 patients. Wound was clean in 7 and clean- contaminated in 13, drains were used in 10, 13 patients were on anti- coagulant therapy and 12 required blood transfusion Conclusion: Authors found that common risk factors for wound infection was diabetes, smoking, underweight, patients on steroids, oblique incision, clean- contaminated wound and anti- coagulant therapy.