Risk Of Postoperative Surgical Site Infection Research Articles

Piperacillin/tazobactam for surgical prophylaxis during pancreatoduodenectomy: meta-analysis.

Pancreatoduodenectomy is associated with an increased incidence of surgical-site infections, often leading to a significant rise in morbidity and mortality. This trend underlines the inadequacy of traditional antibiotic prophylaxis strategies. Hence, the aim of this meta-analysis was to assess the outcomes of antimicrobial prophylaxis, comparing piperacillin/tazobactam with traditional antibiotics. Upon registering in PROSPERO, the international prospective register of systematic reviews (CRD42023479100), a systematic search of various databases was conducted over the interval 2000-2023. This inclusive search encompassed a wide range of study types, including prospective and retrospective cohorts and RCTs. The subsequent data analysis was carried out utilizing RevMan 5.4. A total of eight studies involving 2382 patients who underwent pancreatoduodenectomy and received either piperacillin/tazobactam (1196 patients) or traditional antibiotics (1186 patients) as antibiotic prophylaxis during surgery were included in the meta-analysis. Patients in the piperacillin/tazobactam group had significantly reduced incidences of surgical-site infections (OR 0.43 (95% c.i. 0.30 to 0.62); P < 0.00001) and major surgical complications (Clavien-Dindo grade greater than or equal to III) (OR 0.61 (95% c.i. 0.45 to 0.81); P = 0.0008). Subgroup analysis of surgical-site infections highlighted significantly reduced incidences of superficial surgical-site infections (OR 0.34 (95% c.i. 0.14 to 0.84); P = 0.02) and organ/space surgical-site infections (OR 0.47 (95% c.i. 0.28 to 0.78); P = 0.004) in the piperacillin/tazobactam group. Further, the analysis demonstrated significantly lower incidences of clinically relevant postoperative pancreatic fistulas (grades B and C) (OR 0.67 (95% c.i. 0.53 to 0.83); P = 0.0003) and mortality (OR 0.51 (95% c.i. 0.28 to 0.91); P = 0.02) in the piperacillin/tazobactam group. Piperacillin/tazobactam as antimicrobial prophylaxis significantly lowers the risk of postoperative surgical-site infections, major surgical complications (complications classified as Clavien-Dindo grade greater than or equal to III), clinically relevant postoperative pancreatic fistulas (grades B and C), and mortality, hence supporting the implementation of piperacillin/tazobactam for surgical prophylaxis in current practice.

ID: 204123 Surgical Site Infection Risk In Diabetes Patients Undergoing Spinal Cord Stimulation: A Literature Review

Spinal cord stimulation (SCS) has become increasingly utilized for the treatment of various chronic pain conditions over the past two decades. However, despite these improvements, the same complications that were encountered in early SCS implantation surgery continue today, including postoperative surgical site infection (SSI). This literature review was conducted to review the surgical literature regarding the relationship between hemoglobin A1c (HbA1c), diagnosis of diabetes mellitus (DM), and risk of postoperative SSI.

Simple Prediction Score for Developing Surgical Site Infection after Clean Neck Operation.

Background: Clean neck operations (thyroidectomies, parathyroidectomies, and lymph node resection) are among the most common procedures performed in the United States. Surgical site infections (SSIs) after clean neck operations are rare, but the consequences are devastating and often life-threatening. The aim of this study was to develop a score that will identify patients at high risk for developing a SSI after a clean neck procedure. Materials and Methods: Patients with either thyroidectomies, parathyroidectomies, or lymph node resection of the neck were identified from the 2016 and 2017 databases of the American College of Surgeons National Surgical Quality Improvement Program and were used for this analysis. Our primary goal was to build a scoring system with which we will be able to identify patients at high risk for SSI after a clean neck operation. Results: Of a total of 99,877 patients, 72,719 patients had a thyroidectomy, 22,043 patients had parathyroidectomy, and 5,115 patients had lymph node resection of the neck. Multivariable logistic regression identified the following independent risk factors associated with post-operative SSI: male gender (adjusted odds ratio [aOR], 1.25; 95% confidence interval [CI], 1.03-1.51), diabetes mellitus (aOR, 1.34; 95% CI, 1.07-1.67), smoking (aOR, 1.66; 95% CI, 1.36-2.04), pre-operative steroid use (aOR, 1.75; 95% CI, 1.21-2.53), cancer diagnosis (aOR, 1.44; 95% CI, 1.17-1.77), radical lymphadenectomies (aOR, 2.94; 95% CI, 2.16-4), and total operative time ≥198 minutes (aOR, 2.25; 95% CI, 1.82-2.78). Afterward, we developed a prognostic score for calculating the odds of having post-operative SSI. One point was allotted for each of the aforementioned factors, except lymphadenectomies where two points were allotted, and operative time was excluded. Our score was associated with a stepwise higher risk of post-operative SSI after a clean neck operation. Conclusions: Pre-operative and intra-operative factors can predict which patients undergoing a clean neck surgery may develop SSI. Our prognostic score may help guide surgeons identify patients at high-risk for SSI after clean neck surgery and these patients might benefit from prophylactic use of antibiotic agents.

The effect of intraoperative wound protector use on the risk of surgical site infections in patients undergoing pancreatoduodenectomy: a systematic review and meta-analysis.

To evaluate the effect of intraoperative wound protectors on the risk of surgical site infection (SSI) in patients undergoing pancreatoduodenectomy. In compliance with PRISMA statement standards, electronic databases were searched to identify all studies comparing wound protector use with no wound protector use in patients undergoing pancreatoduodenectomy. SSI (superficial or deep) was considered primary outcome measure. The secondary outcome measures included superficial SSI, deep SSI, and organ-space SSI. Random effects modelling was applied to calculate pooled outcome data. The certainty of evidence was assessed using GRADE system. A total of 12159 patients from four studies were included. The included populations in both groups were comparable in terms of baseline characteristics. The use of wound protector was associated with lower risk of superficial or deep SSI (OR: 0.55, 95% CI 0.43-0.70, P<0.00001), superficial SSI (OR: 0.59, 95% CI 0.46-0.76, P<0.0001), and organ-space SSI (OR: 0.80, 95% CI 0.72-0.90, P=0.0002). There was no difference between the two groups in terms of the risk of deep SSI (OR: 0.68, 95% CI 0.43-1.06, P=0.09) although this may be subject to type 2 error. The results of current study suggests that the use of intraoperative wound protector during pancreatoduodenectomy may reduce the risk of postoperative SSI. The quality of the available evidence is moderate with high certainty. While evidence from future randomised controlled trials could increase the robustness of our conclusions, we do not hesitate to recommend the use of wound protectors during pancreatoduodenectomy based on the current evidence.

Incidence and predictors of surgical site infection after distal femur fractures treated by open reduction and internal fixation: a prospective single\u2010center study

BackgroundThere remain limited data on the epidemiological characteristics and related predictors of surgical site infection (SSI) after open reduction and internal fixation (ORIF) for distal femur fractures (DFFs). We designed this single-centre prospective study to explore and forecast these clinical problems.MethodsFrom October 2014 to December 2018, 364 patients with DFFs were treated with ORIF and followed for complete data within one year. Receiver operating characteristic (ROC) analyses, univariate Chi-square analyses, and multiple logistic regression analyses were used to screen the adjusted predictors of SSI.ResultsThe incidence of SSI was 6.0 % (22/364): 2.4 % (9/364) for superficial SSIs and 3.6 % (13/364) for deep SSIs. Staphylococcus aureus (methicillin-resistant S. aureus in 2 cases) was the most common pathogenic bacteria (36.8 %,7/19). In multivariate analysis, parameters independently associated with SSI were: Open fracture (OR: 7.3, p = 0.003), drain use (OR: 4.1, p = 0.037), and incision cleanliness (OR: 3.5, p = 0.002). An albumin/globulin (A/G) level ≥ 1.35 (OR: 0.2, p = 0.042) was an adjusted protective factor for SSI.ConclusionsThe SSI after ORIF affected approximately one in 15 patients with DFFs. The open fracture, drain use, high grade of intraoperative incision cleanliness, and preoperative A/G levels lower than 1.35 were significantly related to increasing the risk of post-operative SSI after DFFs. We recommended that more attentions should be paid to these risk factors during hospitalization.Trial registrationNO 2014-015-1, October /15/2014, prospectively registered.We registered our trial prospectively in October 15, 2014 before the first participant was enrolled. This study protocol was conducted according to the Declaration of Helsinki and approved by the Institutional Review Board. The ethics committee approved the Surgical Site Infection in Orthopaedic Surgery (NO 2014-015-1). Data used in this study were obtained from the patients who underwent orthopaedic surgeries between October 2014 to December 2018.

Comparison of Postoperative Surgical-Site Infection and Symptomatic Intracranial Hemorrhage between Staged and Simultaneous Cranioplasty with Ventriculoperitoneal Shunt Placement: A Meta-Analysis.

ObjectiveConsensus about the sequence of cranioplasty and ventriculoperitoneal shunt placement to reduce postoperative complications has not been established. This meta-analysis investigated and collated further evidence to determine whether staged cranioplasty with ventriculoperitoneal shunt placement would significantly reduce the risk of postoperative surgical-site infection (SSI) and symptomatic intracranial hemorrhage.MethodsTwo independent reviewers identified articles and extracted the data of patients who underwent cranioplasty and ventriculoperitoneal shunt placement from PubMed, Embase, and Cochrane Central Register of Controlled Trials. A random effects model was used to compare the complication rates using odd ratios (ORs) and 95% confidence intervals (CIs). A meta-regression analysis for traumatic brain injury (TBI) was additionally performed.ResultsData from 7 studies with 391 patients were consecutively included. The meta-analysis revealed that staged surgery was significantly associated with lower rates of SSI after decompressive craniectomy (staged group vs. simultaneous group: 6.2% vs. 23.7%, OR: 2.72, 95% CI: 1.46–5.06, I2=2.4%, p=0.407). Pooled analysis did not indicate a statistically significant difference between the 2 groups for symptomatic intracranial hemorrhage (staged group vs. simultaneous group: 10.4% vs. 23.0%, OR: 1.66, 95% CI: 0.74–3.73, I2=0.0%, p=0.407). The meta-regression analysis did not indicate any modifying effect of TBI on postoperative SSI development (p=0.987).ConclusionThis meta-analysis indicated that staged surgery is significantly associated with a lower rate of postoperative SSI as compared with simultaneous surgery, but there is no difference in symptomatic intracranial hemorrhage. Additionally, there is no modifying effect of TBI on SSI.

Outcomes After Bowel Resection for Inflammatory Bowel Disease in the Era of Surgical Care Bundles and Enhanced Recovery

ObjectiveTo compare 30-day postoperative complications in patients with inflammatory bowel disease (IBD) undergoing colorectal resection before and after implementation of a hospital-wide surgical care bundle (SCB) to prevent surgical site infection (SSI) followed by enhanced recovery protocol (ERP). BackgroundPerioperative SCBs to prevent SSI after colectomy have evolved to include ERPs demonstrating reduced rates of SSI, ileus, and length of stay in colorectal surgical patients. IBD patients often present with more risk factors for postoperative complication like malnutrition or immunosuppression, and the impact of SCBs and ERPs in this population is understudied. MethodsCrohn’s disease and ulcerative colitis patients undergoing elective bowel resection at a tertiary-level referral center from 2013 to 2018 were retrospectively evaluated. Postoperative complications at 30 days including SSI, ileus, and anastomotic leak were compared between pre-SCB/ERP, post-SCB, and post-SCB + ERP time periods using institutional ACS-NSQIP data. Pediatric (age < 18 years) and emergent cases were excluded. ResultsOut of 977 patients, 224 were pre-SCB/ERP, 517 post-SCB, and 236 post-SCB + ERP. Gender (P = 0.01), race (P = 0.02), body mass index (P = 0.04), immunosuppressant use (P = 0.01), wound classification (P < 0.001), malnutrition (P < 0.001), duration of procedure (P = 0.04), and procedure performed (P = 0.01) were significantly different between the three cohorts. A significant decrease in the rates of SSI (14.7% to 5.5%), ileus (20.1% to 8.9%), and anastomotic leak (4.7% to 0.0%) was demonstrated after implementation of SCB and ERP (P ≤ 0.01). On multivariable regression, the risk for postoperative SSI and ileus decreased significantly post-SCB + ERP (OR 0.39, CI 0.19–0.82 and OR 0.45, CI 0.24–0.84, respectively). ConclusionSCB and ERP implementation was associated with decreased rates of postoperative SSI, ileus, and anastomotic leak for IBD patients undergoing elective bowel resection.

Abdomen Depth and Rectus Abdominis Thickness Predict Surgical Site Infection in Patients Receiving Elective Radical Resections of Colon Cancer.

Background: Surgical site infection (SSI) hampers the advantages of surgical management, which requires early forecast particularly in patients receiving colorectal surgery. This study is to explore potential relationship between individual abdominal anatomic characteristics including subcutaneous fat thickness (SFT), rectus abdominis thickness (RAT), and abdomen depth (AD), with the incidence of SSI in elective radical resection of colon malignancy.Materials and Methods: This retrospective case-control study has recruited 55 patients in each SSI and non-SSI group with propensity score match method. Demographics, clinical attributes, and pre- and intra-operative information were compared between groups with univariate analysis to elicit significant parameters, which were subsequently brought into logistic regression and receiver-operating characteristic (ROC) analysis.Results: Patients with SSI showed lower preoperative albumin (p = 0.0022), higher RAT (p = 0.014), AD (p = 0.029), and the multiplied value (RAT × AD) (p = 0.0026) contrasted with patients without SSI. Logistic regression demonstrated RAT × AD as an independent risk factor for SSI (OR = 1.007, p < 0.001) and a biomarker for SSI prediction (AUC = 0.83, 95% CI: 0.74 ~ 0.91).Conclusions: Preoperative RAT and abdomen depth are associated with the risk of postoperative SSI in patients receiving elective radical resection of colon cancer.Trial Registration: www.researchregistry.com, identifier researchregistry3669

Effectiveness of Preoperative Antibiotics in Preventing Surgical Site Infection After Common Soft Tissue Procedures of the Hand.

Antibiotic prophylaxis is a common but controversial practice for clean soft tissue procedures of the hand, such as carpal tunnel release or trigger finger release. Previous studies report no substantial reduction in the risk of surgical site infection (SSI) after antibiotic prophylaxis, yet are limited in power by low sample sizes and low overall rates of postoperative infection. Is there evidence that antibiotic prophylaxis decreases the risk of SSI after soft tissue hand surgery when using propensity score matching to control for potential confounding variables such as demographics, procedure type, medication use, existing comorbidities, and postoperative events? This retrospective analysis used the Truven Health MarketScan databases, large, multistate commercial insurance claims databases corresponding to inpatient and outpatient services and outpatient drug claims made between January 2007 and December 2014. The database includes records for patients enrolled in health insurance plans from self-insured employers and other private payers. Current Procedural Terminology codes were used to identify patients who underwent carpal tunnel release, trigger finger release, ganglion and retinacular cyst excision, de Quervain's release, or soft tissue mass excision, and to assign patients to one of two cohorts based on whether they had received preoperative antibiotic prophylaxis. We identified 943,741 patients, of whom 426,755 (45%) were excluded after meeting one or more exclusion criteria: 357,500 (38%) did not have 12 months of consecutive insurance enrollment before surgery or 1 month of enrollment after surgery; 60,693 (6%) had concomitant bony, implant, or incision and drainage or débridement procedures; and 94,141 (10%) did not have complete data. In all, our initial cohort consisted of 516,986 patients, among whom 58,201 (11%) received antibiotic prophylaxis. Propensity scores were calculated and used to create cohorts matched on potential risk factors for SSI, including age, procedure type, recent use of steroids and immunosuppressive agents, diabetes, HIV/AIDs, tobacco use, obesity, rheumatoid arthritis, alcohol abuse, malnutrition, history of prior SSI, and local procedure volume. Multivariable logistic regression before and after propensity score matching was used to test whether antibiotic prophylaxis was associated with a decrease in the risk of SSI within 30 days after surgery. After controlling for patient demographics, hand procedure type, medication use, existing comorbidities (eg, diabetes, HIV/AIDs, tobacco use, obesity), and postoperative events through propensity score matching, we found that the risk of postoperative SSI was no different between patients who had received antibiotic prophylaxis and those who had not (odds ratio, 1.03; 95% CI, 0.93-1.13; p = 0.585). Antibiotic prophylaxis for common soft tissue procedures of the hand is not associated with reduction in postoperative infection risk. While our analysis cannot account for factors that are not captured in the billing process, this study nevertheless provides strong evidence against unnecessary use of antibiotics before these procedures, especially given the difficulty of conducting a randomized prospective study with a sample size large enough to detect the effect of prophylaxis on the low baseline risk of infection. Level III, therapeutic study.

The Association of Perioperative Glycemic Control With Postoperative Surgical Site Infection Following Open Carpal Tunnel Release in Patients With Diabetes.

The primary goal of the study was to evaluate the association of hemoglobin A1c (HbA1c) levels in diabetic patients with the incidence of surgical site infection (SSI) following open carpal tunnel release (CTR). Our secondary objective was to calculate an HbA1c level in diabetic patients that predicted SSI after open CTR. A national private-payer insurance database was queried for patients who underwent open CTR using Current Procedural Terminology (CPT) code 64721. Patients who underwent concomitant procedures were excluded. Diabetic patients who had their HbA1c level checked within 3 months of surgery were stratified into 6 mutually exclusive groups based on HbA1c levels in 1.0 mg/dL increments from <6.0 to >10 mg/dL. The incidence of SSI was determined for each group by either a diagnosis or procedure for SSI within 1 year using CPT and International Classification of Diseases, 9th Revision (ICD-9) codes. A receiver operating characteristic (ROC) analysis was performed to determine an HbA1c level above which the risk of postoperative SSI was significantly increased. 7958 diabetic patients who underwent open CTR and had an HbA1c recorded within 3 months of surgery were assessed. The incidence of SSI within 1 year was associated with HbA1c levels. The inflection point of the ROC curve corresponded to an HbA1c level between 7 and 8 mg/dL. Increased HbA1c levels are associated with increased SSI rates in diabetic patients undergoing open CTR. A perioperative HbA1c between 7 and 8 mg/dL could serve as a threshold for an increased risk of SSI following open CTR.

Effect of delaying same-admission cholecystectomy on outcomes in patients with diabetes

Recent studies have suggested that same-admission delayed cholecystectomy is a safe option. Patients with diabetes have been shown to have less favourable outcomes after cholecystectomy, but the impact of timing of operation for acute cholecystitis during the same admission is unknown. This was a retrospective analysis of patients undergoing laparoscopic cholecystectomy for acute cholecystitis between 2004 and 2010, from the American College of Surgeons National Surgical Quality Improvement Program database. Patients with no significant co-morbidities (American Society of Anesthesiologists grade I or II) were included. Propensity score matching (PSM) was used to match patients with diabetes with those who did not have diabetes, in a ratio of 1:3, to ensure homogeneity of the two groups. Logistic regression models were applied to adjust for differences between early (within 24 h) and delayed (24 h or more) surgical treatment. The primary outcome was development of local and systemic infectious complications. Secondary outcomes were duration of operation and length of hospital stay. From a total of 2892 patients, 144 patients with diabetes were matched with 432 without diabetes by PSM. Delaying cholecystectomy for at least 24 h after admission in patients with diabetes was associated with significantly higher odds of developing surgical-site infections (adjusted odds ratio 4.11, 95 per cent confidence interval 1.11 to 15.22; P = 0.034) and a longer hospital stay. For patients with no diabetes, however, delaying cholecystectomy had no impact on complications or length of hospital stay. Patients with diabetes who undergo laparoscopic cholecystectomy 24 h or more after admission may have an increased risk of postoperative surgical-site infection and a longer hospital stay than those undergoing surgery within 24 h of admission.

Is There an Increased Risk of Post-Operative Surgical Site Infection after Orthopaedic Surgery in HIV Patients? A Systematic Review and Meta-Analysis

BackgroundThere is dilemma as to whether patients infected with the Human Immunodeficiency Virus (HIV) requiring implant orthopaedic surgery are at an increased risk for post-operative surgical site infection (SSI). We conducted a systematic review to determine the effect of HIV on the risk of post-operative SSI and sought to determine if this risk is altered by antibiotic use beyond 24 hours.MethodsWe searched electronic databases, manually searched citations from relevant articles, and reviewed conference proceedings. The risk of postoperative SSI was pooled using Mantel-Haenszel method.ResultsWe identified 18 cohort studies with 16 mainly small studies, addressing the subject. The pooled risk ratio of infection in the HIV patients when compared to non-HIV patients was 1.8 (95% Confidence Interval [CI] 1.3–2.4), in studies in Africa this was 2.3 (95% CI 1.5–3.5). In a sensitivity analysis the risk ratio was reduced to 1.4 (95% CI 0.5–3.8). The risk ratio of infection in patients receiving prolonged antibiotics compared to patients receiving antibiotics for up to 24 hours was 0.7 (95% CI 0.1–4.2).ConclusionsThe results may indicate an increased risk in HIV infected patients but these results are not robust and inconclusive after conducting the sensitivity analysis removing poor quality studies. There is need for larger good quality studies to provide conclusive evidence. To better develop surgical protocols, further studies should determine the effect of reduced CD4 counts, viral load suppression and prolonged antibiotics on the risk for infection.

Surgical Infections in the Traumatized Spine

Patients with acute spinal injury who require operative intervention may be at increased risk for postoperative surgical-site infection when compared with patients having elective spinal surgery. Various local, systemic, and iatrogenic factors predispose this unique population of patients to post-surgical infection. Nonmodifiable risk factors for surgical-site infection in spine trauma include age, medical comorbidities, and neurologic status. Modifiable risk factors include poor postoperative nutritional status, delay from time of injury to surgical intervention, posterior surgical approach, higher number of levels stabilized, length of postoperative stay in the intensive care unit, and treatment by a single specialty team (versus treatment by successive orthopaedic and neurosurgical teams). When treating patients with spine trauma, a high index of suspicion should be maintained for patients with multiple risk factors for infection and every effort should be made to minimize the modifiable risk factors. Level V (expert opinion). Please see the Guidelines for Authors for a complete description of levels of evidence.