Risk Of Postoperative Wound Complications Research Articles

More Than a Flesh Wound: Trisomy 21 Patients Undergoing Posterior Spinal Fusion for Scoliosis Have High Odds of Wound Complications.

Retrospective cohort study. Patients with trisomy 21 (T21) often have soft tissue differences that lead to greater risk of postoperative wound complications. Our aim was to use a matched cohort of adolescent idiopathic scoliosis (AIS) patients with >2year outcomes to determine odds of specific wound complications when comparing T21 and AIS patients. 14 T21 and 544 AIS patients were available for matching. Propensity score matching was conducted using logistic regression models and yielded a 1:5 match of 14 T21 patients and 70 AIS patients. Bivariate analyses were conducted across both patient groups. The proportion of wound complications was estimated along with a 95% confidence interval. Multivariable logistic regression analysis was utilized to determine if there was a significant association between T21 patients and wound outcomes. 64% of T21 patients experienced a wound complication (9/14; 95% CI = 35.63-86.02) while only 3% of the AIS patients experienced a wound complication (2/70; 95% CI = .50-10.86). Patients with T21 had 56.6 times the odds of having a wound complication compared to matched AIS patients (OR = 56.57; 95% CI = 8.12-394.35; P < .001), controlling for age at surgery, BMI percentile, and propensity score. T21 patients had 10.4 times the odds of reoperation compared to AIS patients (OR = 10.36; 95% CI = 1.62-66.02; P = .01). T21 patients have 10.4× the odds of reoperation and 56.6× the odds of overall wound complication when compared to AIS patients in a 1:5 matched cohort with appropriate controls. This is important for surgical planning, surgeon awareness, and communication with families preoperatively.

Pericranial Flap Reconstruction in Pediatric Patients Undergoing Neuromodulatory Surgery: Impact on Wound Healing

Background: Pediatric patients with medically-intractable epilepsy may require modulation of seizure foci to reduce frequency and severity of seizures. These neuromodulatory procedures, which include responsive neurostimulator (RNS) and deep brain stimulator (DBS), involve the implantation of high-profile and long-term cranial hardware, placing patients at risk of wound healing complications, hardware exposure and infection. A multidisciplinary neurosurgical and plastic surgical approach utilizing pericranial flap coverage of hardware may decrease wound healing complications in these cases. This study compares the wound-healing outcomes in patients undergoing RNS/DBS insertion with and without pericranial flap coverage. Methods: A retrospective chart review was conducted of all patients who underwent RNS and DBS insertion with or without pericranial flap coverage at a level 1 pediatric medical center between 2014 and 2022. Wound healing outcomes at 60 days were evaluated. Data were compared using Fisher’s exact test. Results: Twenty-seven patients underwent 29 neuromodulatory epilepsy procedures (14 DBS, 15 RNS). Twenty of the procedures included a pericranial flap to cover hardware. Median length of stay was 2.0 days for both cohorts. Two subjects without pericranial flap reconstruction had a wound healing complication (22.2%), compared to none of the procedures that included a pericranial flap ( P = .09). Conclusion: In pediatric patients undergoing insertion of responsive neurostimulators and deep brain stimulators for medically-intractable epilepsy, a multidisciplinary neurosurgery and plastic surgery approach utilizing pericranial flap reconstruction may reduce the risk of postoperative wound complications.

The effect of preoperative mechanical bowel preparation in paediatric bowel surgery on postoperative wound related complications: A meta-analysis.

Mechanical bowel preparation (MBP), a routine nursing procedure before paediatric bowel surgery, is widely should in clinical practice, but its necessity remains controversial. In a systematic review and meta-analysis, we evaluated the effect of preoperative MBP in paediatric bowel surgery on postoperative wound-related complications in order to analyse the clinical application value of MBP in paediatric bowel surgery. As of November 2023, we searched four online databases: the Cochrane Library, Embase, PubMed, and Web of Science. Two investigators screened the collected studies against inclusion and exclusion criteria, and ROBINS-I was used to evaluate the quality of studies. Using RevMan5.3, a meta-analysis of the collected data was performed, and a fixed-effect model or a random-effect model was used to analyse OR, 95% CI, SMD, and MD. A total of 11 studies with 2556 patients were included. Most of studies had moderate-to-severe quality bias. The results of meta-analysis showed no statistically significant difference in the incidence of complications related to postoperative infections in children with MBP before bowel surgery versus those with No MBP, wound infection (OR 1.11, 95% CI:0.76 ~ 1.61, p = 0.59, I2 = 5%), intra-abdominal infection (OR 1.26, 95% CI:0.58 ~ 2.77, p = 0.56, I2 = 9%). There was no significant difference in the risk of postoperative bowel anastomotic leak (OR 1.07, 95% CI:0.68 ~ 1.68, p = 0.78, I2 = 12%), and anastomotic dehiscence (OR 1.67, 95% CI:0.13 ~ 22.20, p = 0.70, I2 = 73%). Patients' intestinal obstruction did not show an advantage of undergoing MBP preoperatively, with an incidence of intestinal obstruction (OR 1.95, 95% CI:0.55 ~ 6.93, p = 0.30, I2 = 0%). Based on existing evidence that preoperative MBP in paediatric bowel surgery did not reduce the risk of postoperative wound complications, we cautiously assume that MBP before surgery is unnecessary for children undergoing elective bowel surgery. However, due to the limited number of study participants selected for this study and the overall low quality of evidence, the results need to be interpreted with caution. It is suggested that more high quality, large-sample, multicenter clinical trials are required to validate our findings.

A Multi-Institutional Study Comparing Stoma Location in Neonates With Intestinal Perforation

IntroductionNeonates with intestinal perforation often require laparotomy and intestinal stoma creation, with the stoma placed in either the laparotomy incision or a separate site. We aimed to investigate if stoma location is associated with risk of postoperative wound complications. MethodsA multi-institutional retrospective review was performed for neonates ≤3 mo who underwent emergent laparotomy and intestinal stoma creation for intestinal perforation between January 1, 2009 and April 1, 2021. Patients were stratified by stoma location (laparotomy incision versus separate site). Outcomes included wound infection/dehiscence, stoma irritation, retraction, stricture, and prolapse. Multivariable regression identified factors associated with postoperative wound complications, controlling for gestational age, age and weight at surgery, and diagnosis. ResultsOverall, 79 neonates of median gestational age 28.8 wk (interquartile range [IQR]: 26.0-34.2 wk), median age 5 d (IQR: 2-11 d) and median weight 1.4 kg (IQR: 0.9-2.42 kg) had perforated bowel from necrotizing enterocolitis (40.5%), focal intestinal perforation (31.6%), or other etiologies (27.8%). Stomas were placed in the laparotomy incision for 41 (51.9%) patients and separate sites in 38 (48.1%) patients. Wound infection/dehiscence occurred in 7 (17.1%) neonates with laparotomy stomas and 5 (13.2%) neonates with separate site stomas (P = 0.63). There were no significant differences in peristomal irritation, stoma retraction, or stoma stricture between the two groups. On multivariable regression, separate site stomas were associated with increased likelihood of prolapse (odds ratio 6.54; 95% confidence interval: 1.14-37.5). ConclusionsStoma incorporation within the laparotomy incision is not associated with wound complications. Separate site stomas may be associated with prolapse. Patient factors should be considered when planning stoma location in neonates undergoing surgery for intestinal perforation.

Neoadjuvant Radiotherapy Is Associated with Fewer Acute Adverse Skin Reactions Without Increased Risk of Postoperative Wound Complications in High-Grade Extremity Soft Tissue Sarcoma - A Retrospective Comparative Study with A Mean Follow-Up of 7 Years

Aim: In this study, we aim to compare the adverse effects and oncological outcomes of patients with high-grade extremity soft tissue sarcoma receiving neoadjuvant or adjuvant RT. Methods: From 2008 to 2022, Sixty-four patients underwent limb-preserving surgery in our institute for localized high-grade extremity soft tissue sarcoma were included. Thirty-nine patients received adjuvant radiotherapy while twenty-five patients received neoadjuvant RT before surgery if the soft tissue sarcomas were close to the neurovascular bundles, bones or histological types of myxoid liposarcoma or rhabdomyosarcoma. Primary outcomes were acute RT-related skin adverse reactions and significant side effects comprising postoperative wound complications, pathological fractures and RT-induced sarcoma. Secondary outcomes included surgical margin quality, Local-Recurrence (LR)-free survival, metastasis-free survival and overall survivorship. Results and Discussion: Patients in the neoadjuvant RT group had significantly fewer acute RT-induced adverse skin reactions than the adjuvant RT group (p=0.044, Table 2). None in the neoadjuvant RT group suffered severe acute skin reaction (RTOG grade 3-4). Wound infection (n=2) and pathological fracture (n=1) were rare in both adjuvant and neoadjuvant RT groups (P=0.640 &amp; 1.000 respectively). Survival curves for local-recurrence-free survival, metastasis-free survival and overall survivorship of both neoadjuvant and adjuvant groups were analyzed via Kaplan-Meier Curve. All results are statistically insignificant, with p=0.835, 0.948 and 0.540, respectively. Presence of metastasis was the only statistically significant predictor of the overall survival-adjusted hazard ratio of 8.7 (95%CI 2.7-28), p&lt;0.001. Conclusion: Patients with neoadjuvant RT had lower cumulative radiation doses and fewer acute adverse skin reactions. There was no increased risk of postoperative wound complication compared to adjuvant RT. The LR-free survival, metastasis-free survival and overall survival were comparable in both groups. Our results suggested that postponing surgery to eight weeks after neoadjuvant RT and primary wound closure were associated with fewer wound complications, but further studies were warranted.

The impact of metabolic syndrome in breast reconstruction decision-making and postoperative outcomes: A nationwide analysis

Metabolic syndrome (MetS) is a cluster of cardiometabolic abnormalities including hypertension, obesity, insulin resistance, and dyslipidemia. The safety profiles of patients with MetS undergoing breast reconstruction remain underreported. This study aims to evaluate the impact of MetS on the BR decision-making process and postoperative complication rates. The ACS-NSQIP database was utilized to identify women who underwent BR between 2012 and 2021. Baseline characteristics were compared based on the presence of MetS, defined as patients receiving medical treatment for diabetes mellitus and hypertension, with a body mass index greater than 30kg/m2. Group differences were assessed using t tests and Fisher's exact tests. Multivariate logistic regression models evaluated postoperative complications between the groups. A total of 160,115 patients underwent BR. A total of 4570 had a diagnosis of MetS compared to 155,545 without MetS. No statistically significant differences were observed in the type of BR patients received across cohorts. Logistic regression models demonstrated a higher likelihood of postoperative wound complications (OR 2.21; 95% CI 1.399, 3.478; p=0.001), and readmission rates (OR 2.045; 95% CI 1.337, 3.128; p=0.001) in the MetS group compared to the non-MetS patients. No significant differences were identified in other postoperative complications between groups. Patients with MetS appear to have an increased risk of postoperative wound complications and readmission after breast reconstruction. The synergistic effects of these comorbidities on postoperative outcomes underscore the importance of addressing MetS as a holistic condition and considering choosing Delayed breast reconstruction over Immediate Breast Reconstruction in this population. Thus, integrating MetS management and patient counseling at various stages of BR may improve outcomes and facilitate patient decision-making.

Retrospective Review of 200 Consecutive, Single Surgeon, Fibula Nails with Proximal and Distal Fixation

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures are one of the most common injuries presenting to orthopedic surgeons. Unstable ankle fractures require surgical intervention and the most common fixation method is the use of a plate and screw construct. However, this requires an extensive open incision, which potentially increases the risk of post-operative wound complications and the possibility of hardware irritation. The purpose of this abstract is to evaluate the clinical outcomes of the treatment of unstable lateral malleolar fractures using a fibula nail with both proximal and distal locking capabilities from our original cohort, and in our increased cohort of 200 consecutive single surgeon fibula nails using a mini open incision to anatomically reduce. Methods: We retrospectively reviewed 200 consecutive FibuLock Fibula Nail® fixation constructs (Arthrex, Naples, FL, USA) of a single surgeon in a private practice community hospital. Demographic, operative, clinical, and radiographic outcome data were analyzed. Results: The average follow-up time of the patients was 18.5 months. The demographics of the patients can be found in table 1. There were no cases of infection, loss of reduction, delayed union, or nonunion. All fractures healed. There were two cases of focal superficial epidermal lysis treated with local wound care, that did not require antibiotics. One patient required removal of the nail as a result of it being proud, which was an iatrogenic error. In our previously reported first 110 nails, we had to convert two fractures to plate fixation intraoperatively due to excessive comminution, which made the implantation more difficult. There were no further episodes of this in our next 90 cases due to adoption of plate assisted nail technique. Conclusion: The use of an intramedullary nail with a mini-open technique allows for anatomic fracture reduction and no-profile fixation, thus reducing the risk of wound complications and providing stable fixation. Our technique results in anatomic healing in nearly all patients. Also, there were no incidents of delayed or malunion and no postoperative loss of reduction. Our results demonstrated a very low complication rate compared to traditional plate fixation with good patient reported outcomes.

Biosynthetic meshes in contaminated fields: where are we now? A systematic review and meta-analysis in humans.

Selection of an appropriate mesh reinforcement for hernia repair in contaminated fields is a significant problem for surgeons. To date the proper mesh for contaminated fields has not been found. Biosynthetic meshes have emerged as new treatment option in contaminated fields. This study aims to evaluate the postoperative outcomes of biosynthetic meshes in contaminated fields. Systematic electronic search (PubMed, Medline, Embase, Scopus), according to PRISMA criteria, was performed. A literature search of scientific papers was performed by two reviewers until April 2021. Articles were chosen based on reference to biosynthetic meshes, their use in infected fields, and in human subjects. GRADE methodology and the modified Newcastle-Ottawa scale were used to assess the quality of studies. According to CDC-Centers for Disease Control classes patients were divided into two subgroups, group 1 (CDC class 2) and group 2 (CDC classes 3-4). The research included 21 articles and 1619 patients were analyzed. Long-term follow-up showed a significant higher recurrence rate than short-term follow-up. P < 0.001. Meta-analysis of these studies showed that the SSI were significantly higher in CDC classes 3-4 than CDC class 2 (P < 0.01). No differences were found in SSO (P = 0.06) and recurrence (P = 0.37) rate among the two groups. Phasix™ was the most common mesh in 15 studies. The mean follow-up was 23.0months. The surgical site infection (SSI) rate was 17.3%. The surgical site occurrence (SSO) rate was 32.4%. Recurrence rate was 11.5%. This is the first systematic review and meta-analysis on the clinical outcomes of abdominal wall repair using biosynthetic mesh in contaminated-infected settings. The results show good results in patients at high risk of postoperative wound complications. The aim of this study is to add to the growing literature on biosynthetic mesh a picture of current literature evidence to help future researchers performing further studies on this topic.

Прогностическая значимость элементного состава волос для оценки риска развития послеоперационных раневых осложнений

Введение. Снижение уровня микро- и макро-элементов является одним из факторов увеличения сроков заживления послеоперационных ран, поскольку это препятствует пролиферации фибробластов, синтезу коллагена и эпителизации. цель - оценить прогностическую значимость элементного состава волос для оценки риска осложненного и замедленного течения раневого процесса после хирургического вмешательства. Методика. В исследование включено 49 женщин в возрасте 30-60 лет (46,98±7,10 лет) с избыточной массой тела, которым выполнены плановые хирургические вмешательства по эстетическим показаниям, направленные на коррекцию контуров тела, в ожоговом отделении с пластической хирургией ФГБУ ВЦЭРМ им. А.М. Никифорова МЧС России. Всем пациенткам проведен спектральный анализ волос на микро- и макро-элементы. результаты. У пациенток с замедленным и осложненным заживлением ран выявлены значимые сдвиги в элементном составе волос. Высокую прогностическую значимость в отношении риска замедления раневого процесса и развития длительно незаживающих ран имеют снижение уровней лития (Li &lt; 0,04), германия (Ge &lt; 0,07), бора (B &lt; 1,11) и йода (I&lt;0,06) с уровнями абсолютного риска более 58,1%. Заключение. Пациентам с запланированным хирургическим вмешательством необходим тщательный мониторинг содержания макро- и микро-элементов с целью выявления их дефицита и своевременной коррекции лечебной тактики, что позволит уменьшить риск неблагоприятного течения раневого процесса. Доступным и неинвазивным методом изучения элементного состава организма является спектральный анализ волос. Introduction. Decreased concentrations of micro- and macro-elements are one of the factors for delayed postoperative wound healing since this factor prevents fibroblast proliferation, collagen synthesis, and epithelization. the aim of this study was to evaluate the prognostic significance of the elemental composition of hair to assess the risk of complicated and delayed postoperative wound healing.methods. The study included 49 overweight women aged 30-60 years (46.98±7.10 years) who underwent elective surgical interventions for aesthetic indications aimed at correcting body contours in the department of burns and plastic surgery of the Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia. Spectral analysis of hair for micro- and macro- elements was performed for all patients.results. In patients with delayed and complicated wound healing, significant shifts in the elemental composition of hair were revealed. Reduced levels of lithium (Li &lt;0.04), germanium (Ge &lt;0.07), boron (B &lt;1.11), and iodine (I &lt;0.06) with levels of absolute risk over 58.1% showed a high prognostic significance with respect of the risk for delayed healing and development of persistent wounds.conclusion. Patients scheduled for a surgical intervention need thorough monitoring of the content of macro- and micro- elements for identification of their deficiency and timely correction of the therapeutic tactics, which will reduce the risk of an unfavorable course of the wound process. An affordable and non-invasive method for studying the elemental composition of the body is the spectral analysis of hair.

Wound complications after simple vulvar excisions for premalignant and malignancy lesions: A National Surgical Quality Improvement Program database study (409)

Wound complications after simple vulvar excisions for premalignant and malignancy lesions: A National Surgical Quality Improvement Program database study (409)

Incisional negative pressure wound therapy to reduce surgical-site infections in major limb amputations: a meta-analysis

PurposeIncisional negative pressure wound therapy (iNPWT) has shown effectiveness in the treatment of high-risk surgical wounds. Especially patients with diabetes-induced peripheral arterial disease undergoing major limb amputation have a high intrinsic risk for post-surgical wound infections. While normal gauze wound dressings do not cause stimulation of microvasculature, iNPWT might improve wound healing and reduce wound complications. The purpose of this study was to systematically review the literature for rates of wound complications and readmissions, as well as post-surgical 30-day mortality.MethodsWe conducted a systematic review searching the Cochrane, PubMed, and Ovid databases. Inclusion criteria were the modified Coleman methodology Score >60, non-traumatic major limb amputation, and adult patients. Traumatic amputations and animal studies were excluded. Relevant articles were reviewed independently by referring to the title and abstract. In a meta-analysis, we compared 3 studies and 457 patients.ResultsA significantly overall lower rate of postoperative complications is associated with usage of iNPWT (odds ratio (OR) = 0.52; 95% CI: 0.30–0.89; P = 0.02). There was no significant improvement for 30-day mortality, when iNPWT was used (OR= 081; 95% CI: 0.46 – 1.45; P = 0.48). Nevertheless, we did not note a significant difference in the readmission rate or revision surgery between the two groups.ConclusionOverall, the usage of iNPWT may reduce the risk of postoperative wound complications in major lower limb amputations but does not improve 30-day mortality rates significantly. However, to anticipate surgical-site infection, iNPWT has shown effectiveness and thus should be used whenever applicable.

Smoking increases the risk of postoperative wound complications: A propensity score-matched cohort study.

Cigarette smoking is associated with surgical complications, including wound healing and surgical site infection. However, the association between smoking status and postoperative wound complications is not completely understood. Our objective was to investigate the effect of smoking on postoperative wound complications for major surgeries. Data were collected from the 2013 to 2018 participant use files of the American College of Surgeons National Surgical Quality Improvement Program database. A propensity score matching procedure was used to create the balanced smoker and nonsmoker groups. Multivariable logistic regression was used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative wound complications, pulmonary complications, and in-hospital mortality associated with smokers. A total of 1 156 002 patients (578 001 smokers and 578 001 nonsmokers) were included in the propensity score matching analysis. Smoking was associated with a significantly increased risk of postoperative wound disruption (OR 1.65, 95% CI 1.56-1.75), surgical site infection (OR 1.31, 95% CI 1.28-1.34), reintubation (OR 1.47, 95% CI 1.40-1.54), and in-hospital mortality (OR 1.13, 95% CI 1.07-1.19) compared with nonsmoking. The length of hospital stay was significantly increased in smokers compared with nonsmokers. Our analysis indicates that smoking is associated with an increased risk of surgical site infection, wound disruption, and postoperative pulmonary complications. The results may drive the clinicians to encourage patients to quit smoking before surgery.

Effect of negative pressure wound therapy after surgical removal of deep-seated high-malignant soft tissue sarcomas of the extremities and trunk wall—study protocol for a randomized controlled trial

BackgroundSarcomas are a heterogeneous group of rare malignant tumors of mesenchymal origin in the musculoskeletal system. The main treatment is surgery often supplemented with pre-or postoperative radiotherapy.A retrospective study by Bedi et al. indicated that negative pressure wound therapy (NPWT) reduced the risk of postoperative wound complications in patients treated with preoperative radiation followed by surgical tumor removal of lower extremity soft tissue sarcomas (STS), and the use of NPWT was not associated with an increased risk of local recurrence. Previous studies have shown that NPWT can reduce postoperative complications. STS surgeries are a high-risk procedure concerning wound complications.MethodsNon-blinded single-center randomized controlled trial comparing NPWT versus conventional wound dressing and postoperative wound complications after surgical removal of deep-seated high-malignant STS of the extremities or trunk wallSample-size calculation: 154 STS patients (80% risk of avoiding type II error, 5% risk of type I error, and an 80% wound complication risk)Block randomization of 8 into:Group A: Conventional wound dressingGroup B: NPWT (PREVENA PLUS™ Incision Management System)Inclusion criteria: Surgery for a deep-seated STS of an extremity or the trunk wallExclusion criteria: Age < 18 years, plastic surgery, low malignant/borderline STS, chemotherapy, preoperative radiotherapy, allergic/hypersensitive to acrylic adhesives or silver, unwilling/unable to provide informed consent, metastatic disease, and ischemic surgeriesPrimary study endpoints were set as major wound complications defined by O’Sullivan et al. as a secondary surgery under anesthesia for wound repairs and wound management without secondary surgery within 4 months postoperatively.Secondary study endpoints among others are Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), and European Quality of Life - 5 Dimensions (EQ-5D).Approval from the Scientific Ethical Committee and the Data Protection Agency has been obtained, and the study is registered at clinicaltrial.gov.This study did not apply for external funding.DiscussionMany new medical devices and technical solutions are currently being introduced, and even though some documentation regarding the use of NPWT, e.g., in joint replacement surgery exist, it is also important to seek documentation for this treatment principle in STS surgery.Trial registrationRegistered at ClinicalTrials.gov NCT04960332 and approved on 11 July 2021

Effects of the Chinese Herb Medicine Formula "She-Xiang-Yu-Hong" Ointment on Wound Healing Promotion in Diabetic Mice.

Wound healing in diabetic patients is a difficult problem to be solved at present. In addition, patients with diabetes have an increased risk of postoperative wound complications. “She-Xiang-Yu-Hong” (SXYH) ointment is a type of traditional Chinese medicine (TCM) compound used to treat wounds. Over the past few years, SXYH has been applied in the Affiliated Hospital of Chengdu University of TCM (Chengdu, China) for the treatment of diabetic foot infections and bedsores, whereas there has been rare research on the effect of SXYH ointment on wound healing. In this study, SXYH ointment was first applied to streptozotocin (STZ)-triggered diabetic ICR mice (4–6 weeks, 20 ± 2 g) to observe the accelerated wound healing and the shortened wound healing period. As indicated by the histology and biochemistry analyses of skin biopsies, the wounds treated using SXYH ointment showed an increase in the granulation tissue. Moreover, SXYH also modulated the inflammation response by regulating affinity proinflammatory cytokines release (e.g., IL-6 and TNF-α). Furthermore, SXYH ointment obviously improved collagen fiber deposition and tissue on the wound surface. On the whole, this study indicated that SXYH ointment could accelerate wound healing, promote blood vessel formation, and suppress inflammations. Thus, the clinical potential of SXYH ointment was demonstrated in the treatment of diabetes and refractory wounds.

Do Closed Suction Drains Affect Postoperative Wound Healing after Total Ankle Arthroplasty?

Category:Ankle Arthritis; AnkleIntroduction/Purpose:Although most studies demonstrate no clear benefit of closed suction drains after total joint arthroplasty of the hip, knee, and shoulder, there is no study that has specifically looked at ankle arthroplasty. Despite the paucity of information regarding the potential benefit or lack thereof with postoperative closed suction drains after total ankle arthroplasty, they are still utilized in practice. The purpose of this study is to determine whether or not the use of closed suction drains after total ankle arthroplasty have an affect on wound complications in the first postoperative year.Methods:Following a 3:1 match of patients with-drains to those without-drains, 78 patients with-drains and 28 without-drains were included for analysis. The drain group consisted of patients who had drains placed in the immediate postoperative period and removed prior to discharge from the hospital. The without-drains group acted as the control. Demographic data including age, sex, tobacco use, alcohol use, and medical comorbidities (diabetes, bleeding disorders, anemia, neuropathy, kidney disease, peripheral vascular disease, rheumatoid arthritis, history of leg ulcers or staphylococcus infection) were obtained. Follow-up data was collected and reviewed at 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperative, for minor and major wound complications, as well as wound-related re-operations.Results:At 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperative, there was no statistically significant difference in wound complications with or without the use of a drain. Within the first postoperative year, a total of 4 (14.3%) patients with- drains and 24 (30.8%) patients without-drains had a wound complication. This was not statistically significant (p=0.148). The majority of wound complications were minor. A single superficial infection and two reoperations for major wound complications were noted, all of which were in patients who had a drain placed. Age, sex, tobacco use, alcohol use, as well as a history of diabetes, bleeding disorders, neuropathy, kidney disease, peripheral vascular disease, rheumatoid arthritis, and history of leg ulcers or staphylococcus infection were similar between both groups. A history of anemia was significantly higher in the drain group, however this was not associated with an increased risk of postoperative wound complications.Conclusion:The use of a closed suction drain did not have an effect on postoperative wound complications in the first year after total ankle arthroplasty surgery. Based on the equivocal results in this study and that there is no clear consensus on the use of drains after total ankle arthroplasty surgery, the authors feel it is up to the individual surgeon to determine the necessity of use on a case-by-case basis.

Does Time to Intervention Affect Patient Reported Outcomes after Ankle Fracture?

Category:AnkleIntroduction/Purpose:Advances in surgical technique and technology have allowed orthopedic surgeons to attempt early operative fixation of closed ankle fractures. Little is known about the modifiable factors impacting the recovery of these patients and how early operative intervention affects patient reported outcomes. This study aims to determine if early surgical treatment can be performed safely without increasing a patient’s risk for postoperative wound complications and how time to surgery affects both clinical and patient reported outcomes.Methods:A review of 311 patients records who underwent open reduction and internal fixation (ORIF) for an ankle fracture between July 1st, 2011 and July 1st, 2018 at a single academic center was conducted. Medical records were reviewed. Patients were contacted for collection of PROMIS Physical function, PROMIS Pain Interference, and the Foot Function Index. Patients with open fractures, high energy fractures with ipsilateral lower extremity injuries, pilon fractures, revision cases, non-respondents to the patient reported outcomes survey, and those lost to follow-up prior to radiographic evidence of union or non-union were excluded. After exclusions, 86 patients were then stratified by time to surgery after injury and injury classification. A linear regression model was constructed for each outcome instrument with the covariates of age, BMI, diabetes, smoking status, union, wound complication, time from surgery, and severe injuries by the Lauge-Hansen classification.Results:The delayed union, nonunion, and wound complication rate was similar regardless of timing of operative intervention (p=.470, p=.149, & p=.578, respectively). At a median of 4.5 (2.0 IQR) years postoperatively, outcomes scores were as follows (median (IQR)): PROMIS Physical Function 47.9 (11.2), PROMIS Pain Interference 50.1 (17.4), FFI Pain 26.0 (52.0), FFI Disability 17.0 (49), FFI Activity Limitation 3.0 (22.0), and FFI Total 20.0 (41.5). Time to intervention was not found to have an independent effect on any outcome score. Severe injuries by the Lauge-Hasen classification were found to be independent predictors of PROMIS physical function -6.3 (Unstandardized beta, 95% CI -11.5 to -1.1). Diabetes had a significant independent effect on PROMIS pain interference 52.4 (Unstandardized beta, 95% CI 24.3 to 80.5).Conclusion:Early surgical intervention did not significantly delayed union rate, nonunion rate, wound complications, or patient reported outcomes instruments. Severity of injury classification has a significant independent effect on patient’s physical function. Notably, this effect is above the minimal clinically important difference for PROMIS physical function. Overall, the intermediate term outcomes of ankle fracture fixation indicate patients are within one standard deviation of the population mean in terms of pain and physical function. Surgeons should be aware timing of intervention did not have an effect on outcomes scores at intermediate term follow-up.

Increased risk of postoperative wound complications among obesity classes II & III after ALIF in 10-year ACS-NSQIP analysis of 10,934 cases

BACKGROUND CONTEXTAnterior lumbar interbody fusion (ALIF) procedures for lumbar spine disease have been increasing amid a growing obese patient population with limited studies available focusing exclusively on risk-factors for post-operative ALIF complications. PURPOSEThe objective of this study was to compare 30-day post-operative complications among different obesity World Health Organization classes according to body mass index (BMI) in comparison to non-obese patients who underwent an ALIF procedure. STUDY DESIGN/SETTINGRetrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2009 to 2019. PATIENT SAMPLEA total of 10,934 patients undergoing an ALIF. OUTCOME MEASURESPrimary outcome measures include 30 day cardiac, pulmonary, urinary, infectious, and wound complications. Secondary outcomes included rates of blood transfusion, reintubation, deep vein thrombosis, pulmonary embolism, 30-day return to the operating room (OR), and 30 day mortality. METHODSPatients were identified by use of the current procedural terminology codes 22558 and 22585 from 2009 to 2019. Patients were divided into the following groups: non-obese (BMI 18.5–29.9 kg/m2), Obese I (BMI 30–34.9 kg/m2), Obese II (BMI 35–39.9 kg/m2), and Obese III (BMI ≥40 kg/m2). Age, gender, race, American Society of Anesthesiologists status, smoking status, hypertension requiring medication, steroid used, chronic obstructive pulmonary disease, history of a bleeding disorder, and diabetes was identified as risk factors after a univariate analysis conducted for demographic variables and pre-operative comorbidities. A multivariate logistic regression analysis was then performed to adjust for these preoperative risk factors and compare obesity classes I-III to non-obese patients. RESULTSObesity classes II and III had a significant odds ratio (OR) for superficial infection (OR:2.7, 95%CI(1.7–4.5); OR:2.8, 95%CI(1.5–5.2) respectively), organ space infection (OR:3.8, 95%CI(1.6–7.4); OR:3.2, 95%CI(1.1–9.9) respectively), wound disruption (OR:2.8, 95%CI(1.1–7.4); OR:4.6, 95%CI(1.6–13.6) respectively), and total wound complication (OR:2.6, 95%CI(1.8–3.9); OR:3.4, 95%CI(2.2–5.4) respectively) following a multivariate logistic regression analysis. CONCLUSIONSRisk for post-operative wound complications following an ALIF were found to be significantly higher for obesity classes II-III in comparison to non-obese patients. These findings can further support the use of additional wound care in the perioperative setting for certain levels of obesity.

Wound Complications with Multiple Wrist Incisions in Distal Radius Reconstruction.

Background Placement and spacing of skin incisions are important for maintaining soft tissue perfusion and viability, particularly in the setting of local trauma. Question/Purpose The aim of this article is to determine if multiple skin incisions in the surgical management of distal radius fractures result in an increased risk of postoperative wound complications, particularly in the setting of high-energy mechanisms of injury with substantial initial displacement and associated soft-tissue insult that require multiple incisions for distal radius reconstruction. Patients and Methods A multicenter, retrospective chart review was performed for all adult patients who underwent open reduction, internal fixation of a closed distal radius fracture with multiple (≥2) hand, and wrist incisions with minimum follow-up of 6 weeks. Primary outcome measures included wound healing complications such as partial or complete skin necrosis, dehiscence, delayed healing, and superficial or deep infections. Results For 118 wrists, a total of 305 incisions were utilized, averaging 2.6 incisions per patient (range: 2-6) with the flexor carpi radialis and dorsal distal radius approaches occurring in 86 and 78% of cases, respectively. One patient was identified as having a pyogenic granuloma along an incision. However, two patients were identified as having wound concerns, including fracture blisters ( n = 1) and wound margin epidermolysis ( n = 1) along the incision. There were no cases of skin bridge necrosis, delayed healing, wound dehiscence, or infection. Conclusions There is no increased risk of wound healing complications with the use of multiple skin incisions (≥2) in the surgical management of distal radius fractures, afforded by the abundant and robust angiosomes around the wrist. Surgeons should have the confidence to utilize the necessary number of skin incisions to effectively reconstruct distal radius fractures.

Closed-Incision Negative Pressure Therapy Decreases Wound Morbidity in Open Abdominal Wall Reconstruction With Concomitant Panniculectomy.

Patients undergoing abdominal wall reconstruction (AWR) with concomitant panniculectomy (CP) may be at higher risk for wound complications due to the need for large incisions and tissue undermining. The aim of this study was to evaluate whether the use of closed-incision negative pressure therapy (ciNPT) decreases wound complications in AWR patients undergoing CP. Beginning in February 2018, all patients at this institution who underwent AWR with CP received ciNPT. These patients were identified from a prospectively maintained institutional database. A standard dressing (non-NPT) group was then created in a 1:1 fashion by identifying patients who had AWR with CP immediately before the beginning of ciNPT use (2016-2018). A univariate comparison was made between the ciNPT and non-NPT groups. The primary outcome was wound complication rate; however, other perioperative outcomes, such as requirement for reoperation, were also tracked. Standard statistical methods and logistic regression were used. In total, 134 patients met criteria, with 67 patients each in the ciNPT and non-NPT groups. When comparing patients in the ciNPT and non-NPT groups, they were demographically similar, including body mass index, smoking, and diabetes (P < 0.05). Hernias was large on average (289.5 ± 158.2 vs 315.3 ± 197.3 cm2, P = 0.92) and predominantly recurrent (58.5% vs 72.6%, P = 0.14). Wound complications were much lower in the ciNPT group (15.6% vs 35.5%, P = 0.01), which was mainly driven by a decrease in superficial wound breakdown (3.1% vs 19.7%, P < 0.01). Patients in the ciNPT group were less likely to require a return trip to the operating room for wound complications (0.0% vs 13.3%, P < 0.01). In logistic regression, the use of ciNPT continued to correlate with reduced wound complication rates (P = 0.02). In AWR with CP, the use of ciNPT significantly decreased the risk of postoperative wound complications, particularly superficial wound breakdown, and lessened the need for wound-related reoperation.

Preoperative bacteriuria positivity on urinalysis increases wound complications in primary total hip arthroplasty regardless of the urine culture result

BackgroundCurrent evidence does not recommend screening urine culture and curing asymptomatic bacteriuria (ASB) before joint arthroplasty. The bacteriuria count on pre-operative urinalysis is a more common clinical parameter. We aimed to investigate whether the bacteriuria count on preoperative urinalysis can increase postoperative wound complications in primary total hip arthroplasty (THA).MethodsWe conducted a retrospective study that included patients who underwent primary THA in our institution from 2012 to 2018. We obtained preoperative urinalysis results before THA during the same hospitalization and identified patients with abnormal urinalysis. Receiver operating characteristic (ROC) curves were first generated to evaluate the predicted value of leukocyte esterase (LE), nitrite, bacteriuria, and pyuria in the urinalysis for superficial wound infection. Then, all included patients were divided into two groups according to the preoperative urinalysis: a bacteriuria-positive group and a bacteriuria-negative group. The primary outcome was the superficial wound infection rate within 3 months postoperatively, and the secondary outcomes included wound leakage, prosthetic joint infection (PJI), pulmonary infection, urinary tract infection (UTI), readmission rate within 3 months postoperatively, and length of stay (LOS) during hospitalization. We utilized univariable analyses to compare the outcomes between the two groups. A multivariable logistic regression model was generated to explore the potential association between bacteriuria and the risk of superficial wound infection, wound leakage, and readmission rate controlling for baseline values.ResultsA total of 963 patients were included in the study. One hundred sixty patients had abnormal urinalysis. The AUCs for LE, nitrite, bacteriuria, and pyuria were 0.507 (95% confidence interval (CI), 0.315 to 0.698), 0.551 (0.347 to 0.756), 0.675 (0.467 to 0.882), and 0.529 (0.331 to 0.728), respectively. Bacteriuria was diagnostically superior to LE, nitrite, and pyuria. Among the 963 patients, 95 had a positive bacteriuria on preoperative urinalysis, and only 9 (9.5%) had a positive urine culture. Compared with the bacteriuria-negative group, the bacteriuria-positive group had a higher superficial wound infection rate (4.2% vs. 0.6%, P = 0.008), higher wound leakage rate (11.6% vs. 4.5%, P = 0.007), higher readmission rate (5.3% vs. 1.3%, P = 0.015) within 3 months postoperatively and longer LOS (6.19 ± 2.89 days vs. 5.58 ± 2.14 days, P = 0.011). After adjustment, the bacteriuria-positive group had a significantly increased risk of superficial wound infection (OR = 7.587, 95%CI: 2.002 to 28.755, P = 0.003), wound leakage (OR = 3.044, 95%CI: 1.461 to 6.342, P = 0.003), and readmission (OR = 4.410, 95%CI: 1.485 to 13.097, P = 0.008).ConclusionPreoperative bacteriuria positivity on urinalysis significantly increased the risk of postoperative wound complications, readmission, and LOS in primary THA regardless of the result of the urine culture. Urinalysis is a fast and cost-acceptable test whose advantages have been underestimated.Level of evidenceLevel III, observational study.