Superficial Superficial Surgical Site Infection Research Articles

Preoperative optimization of modifiable risk factors is associated with decreased superficial surgical site infections after total joint arthroplasty: a prospective case-control study.

The aim of our study was to investigate change in modifiable risk factors following preoperative optimization and whether risk of superficial surgical site infection (SSI) after total joint arthroplasty (TJA) could be reduced. This is a prospective study of implementation of a preoperative optimization pathway for patients waiting for primary TJA. Information regarding the intervention arm was collected from January 2019 to January 2021, first at decision for operation and then at preoperative assessment 1 week prior to operation. The control arm was included between August 2018 and September 2020 after receiving conventional preoperative preparation and information gathered at preoperative assessment. Follow up occurred 6 weeks postoperatively for both groups. The primary outcome was postoperative superficial SSI. The optimization effort resulted in improvement of weight, anemia, HbA1c, vitamin D, and patient engagement. At preoperative assessment the baseline characteristics of the 2 groups were similar except that the intervention group had substantially more comorbidities. Regarding superficial SSI, association was found with BMI ≥ 30 and HbA1c ≥ 42 mmol/mol in the control group but not in the intervention group. When corrected for differences in ASA classification (reflecting comorbidities), age, and sex, being in the intervention group was associated with lower odds of occurrence of superficial SSI compared with the control group (OR 0.64, 95% confidence interval 0.42-0.97). We showed that preoperative optimization in a structured cooperation between hospital and primary care was associated with a reduced risk of superficial SSI.

The Effect of Subcutaneous Saline Irrigation on Wound Complications After Cesarean Section: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Subcutaneous (SC) saline irrigation was reported as a feasible and cost-effective procedure to prevent cesarean section (CS) surgical site complications. We aim to investigate the efficacy of SC saline irrigation to prevent CS surgical site complications. A systematic review and meta-analysis were conducted synthesizing evidence from randomized controlled trial(RCT) studies obtained from PubMed, Embase Cochrane, Scopus, and Web of Science from inception to March 2024. Pooled outcomes included wound complications (superficial surgical site infections (SSI), hematoma, seroma, and wound separation) and operative time. We used RevMan v.5.4. (TheCochraneCollaboration, Oxford, UK) to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean differences (MD) with a 95% confidence interval (CI). Five RCTs with 4,025 patients were included. Four studies had a low overall risk of bias and only one trial with some concerns about selection bias. There was no difference between SC saline irrigation and no irrigation regarding the incidence of superficial SSI (five RCTs, RR: 0.72 with 95% CI [0.47, 1.10], P = 0.13), seroma (four RCTs, RR: 0.73 with 95% CI [0.32, 1.65], P = 0.45), wound separation (four RCTs, RR: 0.66 with 95% CI [0.36, 1.24], P = 0.2), and operative time (four RCTs, MD: -1.26 with 95% CI [-5.14, 2.62], P = 0.52). However, SC saline irrigation significantly decreased the incidence of hematoma (three RCTs, RR: 0.54 with 95% CI [0.45, 0.65], P = 0.00001). SC saline irrigation of the surgical site after CS was not effective in preventing the incidence of superficial SSI, seroma, or wound separation, while only preventing the incidence of hematoma.

Association between operative duration and adverse outcomes after hip fracture surgery: A NSQIP matched cohort study

BackgroundProlonged operative duration is an independent risk factor for surgical complications in numerous subspecialties. However, associations between adverse events and operative duration of hip fracture fixation in older adults have not been well-quantified. This study aims to determine if prolonged operative duration of hip fracture surgery is related to adverse outcomes. We hypothesized that patients with high operative durations experience greater rates of 30-day complications. MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was retrospectively reviewed to identify older adults (55 years and above) who underwent hip fracture fixation between 2015–2019. Prolonged operative duration was defined as >75th percentile, and cases were matched using propensity scores based on demographic, surgical, and comorbidity factors. Univariate differences in adverse events (including readmission, reoperation, mortality, and organ-system complications) were analyzed. Multivariable mixed-effects logistic regression analyses were completed for statistically significant events. ResultsA total of 8827 case-control pairs were identified for comparison. Rates of superficial surgical site infection (SSI) (p= 0.022), any SSI (p= 0.032), and any complication (p < 0.001) were elevated in those with prolonged surgical duration in univariate analyses. In multivariable models, prolonged operative time was associated with superficial SSI (OR 1.50, p= 0.019), any SSI (OR 1.35; p= 0.029) and any complication (OR 1.58; p < 0.001). In subgroup analyses, all findings persisted for IMN with operative time associated with superficial SSI (OR 1.98, p= 0.012), any SSI (OR 1.71; p= 0.019), and any complication (OR 1.84; p < 0.001). Operative time was associated only with any complication for hemiarthroplasty/internal fixation and sliding hip screw (OR 1.27 and 1.89, respectively; p < 0.001). ConclusionOur study demonstrates that duration of surgery is an independent risk factor for superficial SSI, any SSI, and any complication. Notably, our findings suggest that high operative durations may be most concerning for SSIs in IMN fixation, which is currently the most common choice for hip fracture fixation in the US. However, the rate of any complication is significantly elevated when surgical duration is prolonged, regardless of surgery type.

The utility of intraperitoneal drain placement after laparoscopic appendectomy for perforated appendicitis in postoperative intraperitoneal abscess prevention.

Perforated appendicitis is associated with postoperative development of intraperitoneal abscess. Intraperitoneal drain placement during appendectomy is thought to reduce the risk of developing postoperative intraperitoneal abscess. The aim of this study was to determine whether intraperitoneal drainage could reduce the incidence of intraperitoneal abscess formation after laparoscopic appendectomy for perforated appendicitis. This is a retrospective study of all patients (aged 7 and above) who were diagnosed with perforated appendicitis and subsequently underwent laparoscopic appendectomy between January 2018 and December 2022 at two government hospitals in the state of Kuwait. Demographic, clinical, and perioperative characteristics were compared between patients who underwent intraoperative intraperitoneal drain placement and those who did not. The primary outcome was the development of postoperative intraperitoneal abscess. Secondary outcomes included overall postoperative complications, superficial surgical site infection (SSI), length of stay (LOS), readmission and postoperative percutaneous drainage. A total of 511 patients met the inclusion criteria between 2018 and 2022. Of these, 307 (60.1%) underwent intraoperative intraperitoneal drain placement. Patients with and without drains were similar regarding age, sex, and Charlson Comorbidity Index (CCI) (Table1). The overall rate of postoperative intraperitoneal abscess was 6.1%. Postoperatively, there was no difference in postoperative intraperitoneal abscess formation between patients who underwent intraperitoneal drain placement and those who did not (6.5% vs. 5.4%, p = 0.707). Patients with intraperitoneal drains had a longer LOS (4 [4, 6] vs. 3 [2, 5] days, p < 0.001). There was no difference in the overall complication (18.6% vs. 12.3%, p = 0.065), superficial SSI (2.9% vs. 2.5%, p = 0.791) or readmission rate (4.9% vs. 4.4%, p = 0.835). Following laparoscopic appendectomy for perforated appendicitis, intraperitoneal drain placement appears to confer no additional benefit and may prolong hospital stay.

Obesity Portends Increasing Rates of Superficial Surgical Site Infection Following Pediatric Reduction Mammoplasty: A National Surgical Database Analysis.

Pediatric reduction mammoplasty has become increasingly common due to the obesity epidemic. While obesity remains the leading cause of macromastia leading to surgery, it may also be a risk factor for postoperative complications. This study examines the safety of pediatric reduction mammoplasty and the risk of obesity for complications following this procedure. The American College of Surgeons National Surgical Quality Improvement Program Pediatrics was queried to obtain all reduction mammoplasty cases from 2012 to 2020. Univariate and multivariate logistic regression analyses controlling for confounders were carried out to assess the relationship between body mass index (BMI) and rates of complication. One thousand five hundred eighty-nine patients with the primary Current Procedural Terminology code 19318 were included in the final analysis. The mean age was 16.6 (SD, 1.1) years, and the mean BMI was 30.5 (SD, 6.2) lb/in2. Notably, 49% of the patients were obese, and 31% were overweight, while only 0.4% were underweight. Forty-three patients (2.7%) sustained a superficial surgical site infection (SSI) postoperatively. Other complications were less prevalent, including deep SSI (4 patients, 0.3%), dehiscence (11, 0.7%), reoperation (21, 1%), and readmission (26, 1.6%).Independent variables analyzed included age, sex, BMI, diabetes mellitus, American Society of Anesthesiologists (ASA) class, and operative time, of which only BMI and ASA class were found to be significantly associated with SSI on univariate analysis. On multivariate logistic regression while controlling for ASA class and the false discovery rate, there was a strong association between increasing rates of superficial SSI and increasing BMI (unit odds ratio, 1.05; 95% confidence interval, [1.01, 1.09]; P = 0.02). The OR indicates that for each 1-unit increase in BMI, the odds of SSI increase by 5%. Complications following pediatric reduction mammoplasty are uncommon, demonstrating the safety of this procedure. High BMI was found to have a significantly higher risk for superficial SSI. Increased caution and infection prophylaxis should be taken when performing this operation on obese patients.

Effects of Preoperative Glucocorticoid Use on Patients Undergoing Single-Level Lumbar Fusions: A Retrospective Propensity Score-Matched Registry Study.

Objective Spinal fusions are gaining popularity as a means of treating spinal deformity and instability from a range of pathologies. The prevalence of glucocorticoid use has also increased in recent decades, and their systemic effects are well-documented. Although commonly used in the preoperative period, the effects of steroids on outcomes amongpatients undergoing spinal fusions are inadequately described. This study compares the oddsof developing complications amongpatients who underwent single-level lumbar fusions with and without preoperative glucocorticoid use in hopes of establishing more evidence-based parameters for guiding preoperative steroid use. Methods The TriNetX multi-institutional electronic health record database was used to perform a retrospective, propensity score-matched analysis of clinical outcomes of two cohorts of patients who underwent posterior or posterolateral single-level lumbar fusions with and without interbody fusion, those who used glucocorticoids for at least one week within a year of fusion and those who did not. The outcomes of interest were examined within 30 days of the operation and included death, reoperation, deep or superficial surgical site infection (SSI), pneumonia, reintubation, ventilator dependence, tracheostomy, acute kidney injury (AKI), renal insufficiency, pulmonary embolism (PE) or deep venous thrombosis (DVT), urinary tract infection (UTI), emergency department (ED) visit, sepsis, and myocardial infarction (MI). Results The odds of developing pneumonia within 30 days of spinal fusion in the cohort that used glucocorticoids within one year of operation compared to the cohort without glucocorticoid use was 0.67 (p≤0.001, 95% CI: 0.59-0.69). The odds of requiring a tracheostomy within 30 days of spinal fusion in the cohort that used glucocorticoids within one year of operation compared to the cohort without glucocorticoid use was 0.39 (p≤0.001, 95% CI: 0.26-0.60).The odds of reoperation, deep and superficial SSI, and ED visits within 30 days of operation were significantly higher for the same glucocorticoid-receiving cohort, with odds ratios of 1.4 (p=0.003, 95% CI: 1.11-1.65), 1.86 (p≤0.001, 95% CI: 1.31-2.63), 2.28 (p≤0.001, 95% CI: 1.57-3.31), and 1.25 (p≤0.001, 95% CI: 1.17-1.33), respectively. After propensity score-matching, there was no significant difference between the odds of death, DVT, PE, MI, UTI, AKI, sepsis, reintubation, and ventilator dependence between the two cohorts. Conclusion In support of much of the current literature regarding preoperative glucocorticoid use and rates of complications, patients who underwent a single-level lumbar fusion and have used glucocorticoids for at least a week within a year of operation experienced significantly higher odds of reoperation, deep and superficial SSI, and ED visits. However, these patients using glucocorticoids were also found to have lower odds of developing pneumonia, renal insufficiency, and tracheostomy requirement than those who did not use steroids within a year of surgery.

A Randomized Trial of Ionic Silver Dressing to Reduce Surgical Site Infection After Gastrointestinal Surgery.

To determine whether Aquacel Ag Hydrofiber dressings containing ionic silver are superior to film dressings for preventing superficial surgical site infections (SSI) in patients undergoing elective gastrointestinal surgery. Multiple clinical trials have assessed the effectiveness of silver-containing wound dressings; however, systematic reviews failed to find any advantages of these dressings and concluded that there was insufficient evidence to indicate that they prevented wound infections. This study aimed to evaluate the efficacy of Aquacel Ag Hydrofiber dressings for preventing superficial SSIs in patients undergoing gastrointestinal surgery. Patients undergoing elective gastrointestinal surgery were randomly assigned to receive either Aquacel Ag Hydrofiber (study group) or film dressings (control group). The primary end point was superficial SSI within 30 days after surgery (UMIN Clinical Trials Registry ID: 000043081). A total of 865 patients (427 study group, 438 control group) were qualified for primary end-point analysis. The overall rate of superficial SSIs was significantly lower in the study group than in the control group (6.8% vs 11.4%, P = 0.019). There was no significant difference in superficial SSI rates between the groups in patients undergoing upper gastrointestinal surgery; however, the rate was significantly lower in the study group in patients undergoing lower gastrointestinal surgery (P = 0.042). Multivariate analysis identified Aquacel Ag Hydrofiber dressings as an independent factor for reducing superficial SSIs (odds ratio, 0.602; 95% confidence interval, 0.367-0.986; P = 0.044). Aquacel Ag Hydrofiber dressings can reduce superficial SSIs compared to film dressings in patients undergoing elective gastrointestinal surgery, especially lower gastrointestinal surgery.

Infection After Total Knee Arthroplasty: Does Timing of Pre-operative Antibiotics Matter?

Background: Since the 2003 NIH consensus statement, the use of prophylactic antibiotics in total knee arthroplasty (TKA) has been the standard of care. Some studies recommend antibiotic administration within 1 h of skin incision, but no specific time frame has been delineated. The objective of this study was to determine if timing of pre-operative antibiotics is associated with post-operative infection after TKA. Materials and Methods: An institutional database from a multi-center health-care system was queried with ICD-10 codes and reviewed for patients undergoing primary TKA between March 2020 and December 2020. The rate of superficial surgical site infection (SSI) and periprosthetic joint infection (PJI) was compared with pre-operative antibiotic timing. PJIs were defined based on 2018 MSIS criteria and superficial SSIs were other infections that did not meet MSIS criteria. Antibiotic timing was separated into 15-min cohorts from 0 min before skin incision to over 45 min before incision. Further comparison between patients who received antibiotics within 30 min of incision with those who received antibiotics greater than 30 min prior was performed. Results: Of the 2511 patients who underwent primary TKA, 19 were found to have post-operative infections. There were 7 SSIs, and 12 PJIs, 16 of the post-operative infections occurred when patients received antibiotics &lt;30 min before incision. There was no significant difference in SSIs or PJIs between each 15-min time interval of antibiotic administration (P = 0.45) or between the 30-min time intervals (P = 0.09). Conclusion: Our study demonstrates no difference in post-operative infection based on pre-operative antibiotic timing. As long as antibiotics are given within 60 min of incision, preferentially 30–60 min before incision, their timing does not have a significant effect on post-operative infection following TKA. Keywords: Pre-operative antibiotics, periprosthetic joint infection, superficial skin infection, total knee arthroplasty, complications

Superficial surgical site infection in delayed primary vs primary. Wound closure in complicated appendicitis.

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Wound infection is the most common post-operative complication encountered after open appendectomy. Various studies have compared the risk of superficial surgical site infection (SSI) in primary closure (PC) and delayed primary closure (DPC) of wounds. However, there is no uniform consensus regarding the method of wound closure.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of this study is to compare the two wound closure techniques.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Material and methods:&lt;/b&gt; This is a prospective study which enrolled 50 patients who underwent open appendectomy. The patients' demographics, characteristics, and operative findings were recorded. Those who were older than 18 years and had an appendectomy with a right lower quadrant incision were included. Patients with any comorbidity, morbid obesity, or pregnancy were excluded. Patients were randomized to undergo two techniques of wound closure: PC and DPC. During follow- -up at 1 week and 1 month, SSI, post-op pain, and LOS were compared among the two groups. Clinical assessment included the Visual Analog Scale (1-10) for pain.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; In our study, the incidence of SSI in the DPC group was significantly lower than in the PC group (p = 0.0002), while post-op pain and LOS were not significantly different between the two groups.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; We concluded that DPC was superior to PC in terms of reducing the incidence of superficial SSI, but with respect to post-op pain and LOS, the two techniques of wound closure were not different.&lt;/br&gt.

Effect of conditions being present at time of surgery (PATOS) on outcomes in liver surgery

IntroductionInformation about condition(s) being present at time of surgery (PATOS) in the American College of Surgeons (ASC) National Surgical Quality Improvement Program (NSQIP) database can influence the postoperative complication rates after liver surgeries. Here, we compare the postoperative complication rates with and without taking condition(s) being PATOS into account. MethodsWe retrospectively reviewed the ACS NSQIP Participant User Files (PUFs) from 2015 through 2019. We analyzed rates of eight different postoperative complications: superficial surgical site infection (SSI), deep SSI, organ space SSI, pneumonia, urinary tract infection, ventilator, sepsis, and septic shock. In addition, we calculated the percent change in event rates after taking into account whether a condition is PATOS. ResultsOf the 22,463 patients in the ACS NSQIP PUFs for liver surgery, 334 (1.49%) had one or more conditions PATOS. The percentages of patients with PATOS events ranged from 2.03% for superficial SSI to 14.74% for sepsis. For all complications, event rates declined when taking condition(s) PATOS into account. From 2015 through 2019, the observed-to-expected ratios for most complications remained unchanged. ConclusionWhether a condition is PATOS is important in reporting postoperative complication rates for patients undergoing liver surgery. When taking whether a condition is PATOS into account, we demonstrated an overall decrease in event rates across all eight postoperative complications.

Superficial Surgical Site Infection in Hand Surgery: A Cross- sectional Study in a Hand Surgery Unit

Introduction: Superficial surgical site infection (SSI) in hand surgery is generally considered to be less common. Infection of surgical site can lead to poor outcomes. Burden of surgical site infection in hand surgery has not been studied in our part of the world. We sought to determine the prevalence rate superficial surgical site infection in patients undergoing hand surgery. Methods: We used standard definition of CDC National Healthcare Surveillance Network (NHSN) criteria to evaluate 112 consecutive adults undergoing various hand surgery procedures outcome at the end of the second week for superficial SSI. The study was conducted over a period of six month (November 2022 to May 2023). Results: The prevalence of superficial surgical site infection was 6.25% . Among those affected 0.02% cases were diagnosed based on signs and symptoms criteria. In 0.03% patient the wound discharge yielded Staphylococcus aureus. The most common cause requiring hand surgery were workplace injuries, household injuries, and injuries due to road traffic accounting for 45.54%, 26.79%, and 18.75% , respectively. Crushing type of injury which was the most common of all mechanisms of injury. Conclusion: The prevalence rates of hand procedures are low but not negligible. This under-evaluated condition must be more extensively evaluated in a multicenter study involving larger population.

A Comparison of Perioperative Complications of Hand and Wrist Arthroplasty for Osteoarthrosis by Orthopedic Versus Plastic Surgeons.

Arthroplasty is commonly performed in the management of osteoarthrosis of the hand and wrist by orthopedic or plastic surgeons with a fellowship in hand. The differences between operative outcomes between the 2 groups have not been described. Therefore, we analyzed a national database to determine acute outcomes between orthopedic and plastic surgery when performing arthroplasty for osteoarthrosis of the hand and wrist. A retrospective cross-sectional analysis was performed by including patients with osteoarthrosis of the hand and wrist by International Classification of Diseases codes. Demographic, operative, and outcome variables were collected. Pearson χ2 and Fischer exact tests were used for categorical variables, while a Mann-Whitney U test was performed for continuous variables. Multivariate regression analysis was performed to determine strength of predictors. There were 3721 patients who received arthroplasty for osteoarthrosis of the hand and wrist from 2007 to 2020. Most cases were performed by orthopedic surgeons (82.7%); however, there were an increasing number of surgeries performed by plastic surgeons. Most cases were performed on the intercarpal or carpometacarpal joints (81.7%). The incidence of acute complications was low (1.9%) with superficial surgical site infections (SSIs) being the most common complication. Univariate analysis found that plastic surgery may result in higher chances of superficial SSIs, but multivariate analysis indicated that there were no significant differences between the 2 groups. There were no significant differences on multivariate regression analysis between plastic and orthopedic surgeons, suggesting that both can perform arthroplasty of the hand and wrist without safety concerns.

MP21-11 ASSOCIATION OF RACE AND 30-DAY POSTOPERATIVE COMPLICATIONS AFTER UROLOGIC SURGERY: A PROPENSITY-SCORE MATCHED ANALYSIS ON 138,777 CASES

You have accessJournal of UrologyCME1 Apr 2023MP21-11 ASSOCIATION OF RACE AND 30-DAY POSTOPERATIVE COMPLICATIONS AFTER UROLOGIC SURGERY: A PROPENSITY-SCORE MATCHED ANALYSIS ON 138,777 CASES Alex Bak, Bruce Gao, Jason Lee, and Christopher Wallis Alex BakAlex Bak More articles by this author , Bruce GaoBruce Gao More articles by this author , Jason LeeJason Lee More articles by this author , and Christopher WallisChristopher Wallis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Diversity, equity, and inclusion is a priority in healthcare. Despite this mission, there is limited literature on race and post-operative complications in urology. METHODS: Adult patients undergoing urologic surgeries (i.e., nephroureterectomy, radical prostatectomy, radical cystectomy, radical and partial nephrectomy, and percutaneous nephrolithotomy) between 2015 to 2019 were identified from NSQIP. Black-identifying patients were matched with White-identifying patients using a 1:1 nearest-neighbour propensity-score matching protocol including surgical procedure and baseline variables that were significantly different between groups. Between group comparisons were estimated using logistic regression and presented as odds ratios (OR) with 95% confidence intervals (CI) and p-values. RESULTS: A total of 138,777 individuals that underwent urologic procedures were identified (48.3±11.5 years, 83.2% male, 12.1% Black-identifying). After matching, a well-balanced cohort of 33,380 patients were included for analysis (Table 1). Medically, Black-identifying patients were more likely to be diagnosed with pneumonia (OR: 1.31, 95% CI[1.03–1.66], p=0.029), have unplanned reintubation (OR: 1.48, 95% CI[1.12–1.97], p=0.006), have a ventilator for >48 hours (OR: 1.49, 95% CI[1.05–2.14], p=0.027), have progressive renal insufficiency (OR: 1.72, 95% CI[1.32–2.26], p<0.001), acute renal failure (OR: 1.49, 95% CI[1.07–2.07], p=0.018), and bleed requiring transfusion (OR: 1.11, 95% CI[1.01–1.21], p=0.035) compared to White-identifying patients. Black-identifying patients were less likely to be diagnosed with myocardial infarction (OR: 0.63, 95% CI[0.42–0.94], p=0.024). Surgically, Black-identifying patients were less likely to be diagnosed with a superficial surgical site infection (SSI) (OR: 0.68, 95% CI[0.52–0.88], p=0.003). CONCLUSIONS: Black-identifying patients undergoing urologic surgery were significantly more likely to have respiratory, renal, and bleeding complications and less likely to be diagnosed with myocardial infarction and superficial SSI. Although this raises questions about health equity in urology, more research is needed. Confounders such as socioeconomic status and access to care were not measured. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e289 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Bak More articles by this author Bruce Gao More articles by this author Jason Lee More articles by this author Christopher Wallis More articles by this author Expand All Advertisement PDF downloadLoading ...

Reduction Mammoplasty in the Pediatric Population: An Analysis of Pediatric NSQIP Data From 2012 to 2019.

Introduction: Reduction mammoplasty is becoming more commonly performed in the pediatric population yet the risk factors for complications have not been well-studied. The purpose of this study was to assess the relationship between preoperative patient characteristics and postoperative complications in a large population of pediatric patients undergoing reduction mammoplasty. Methods: Pediatric patients undergoing reduction mammoplasty were identified within the 2012 to 2019 National Surgical Quality Improvement Program database for cross-sectional study. The predictor variables were age, body mass index (BMI), diabetes, chronic steroid use, time under anesthesia, and operative time, and the primary outcome was a 30-day postoperative surgical site-related complication. Multivariate logistic regression was performed to identify a relationship between predictor variable and primary outcome. Results: A total of 1216 pediatric patients were identified with a mean age of 16.6 years and mean BMI of 30.8 kg/m2. The incidence of overall postoperative complications was 4.6%. Superficial surgical site infection (SSI) was the most common complication (29/1216; 2.4%). BMI was significantly associated with superficial SSI (odds ratio: 1.03, 95% confidence interval: 1.00-1.05, P = .02). Sixteen patients (1.32%) underwent a second operation, most commonly to address hematoma/seroma (7/16; 43.8%). Conclusion: In a large series of patients, pediatric reduction mammoplasty is a safe procedure with a low complication rate. BMI was significantly associated with the incidence of superficial SSIs with the most common cause for reoperation being a hematoma/seroma. This study can help guide the discussion between physicians and patients regarding potential risks associated with pediatric reduction mammoplasty.

30-Day Post-Operative Complications of Facial Fracture Repairs: A United States Database Study.

Cross-sectional database analysis. To define post-operative complication rates in facial fracture repair and to assess this data for patient characteristics which may be associated with post-operative complications. We performed a retrospective cohort analysis of the National Surgical Quality Improvement Program (NSQIP) database between January 1, 2015, and December 31, 2019. All patients included in this study sample must have (a) been ≥18 years old and (b) underwent surgical repair of a facial fracture during the study period by a plastic surgeon or otolaryngologist. Adverse outcomes at 30 days were characterized into four groups: superficial surgical site infection (SSI), deep SSI, organ space infection, and wound disruption. In total, 2481 patients met the primary outcome of facial fracture. Among the four fracture types assessed, 1090 fractures (43.9%) were mandibular, 721 were zygomatic (29.1%), 638 were orbital (25.7%), and 32 (1.3%) were Lefort. Of the entire cohort, 25 patients (1.01%) experienced a superficial SSI, 14 patients (.56%) presented with a deep SSI, 25 fractures (1.01%) returned with an organ space infection, and 23 patients (.93%) experienced some type of wound disruption. Smokers had a significantly higher risk of superficial SSIs (P < .05) and organ space infections (P < .05). The majority of facial fracture patients do not experience post-operative complications. However, smokers and patients with diabetes mellitus were shown to be at an elevated risk of developing complications. Future research should further investigate this relationship and focus on developing interventions to improve post-operative outcomes.

Prolonged antibiotics after ovarian cancer debulking with intestinal surgery are not associated with improved infectious outcomes (302)

<b>Objectives:</b> While limited data support prolonged antibiotic therapy for infectious prophylaxis following intestinal surgery in epithelial ovarian cancer (EOC), the practice is often performed. The purpose of this study was to determine whether prolonged antibiotic therapy is associated with decreased incidence of postoperative incisional infections in patients with EOC undergoing cytoreductive surgery (CRS) with colorectal resection. <b>Methods:</b> An IRB-approved, retrospective single-institution cohort study was performed in women with EOC who underwent CRS with colorectal resection from 2008 to 2017. Superficial surgical site infections (SSI) and combined superficial and deep pelvic/intra-abdominal abscesses were assessed independently and defined according to the Centers for Disease Control (CDC). The impact of extended antibiotics (piperacillin/tazobactam x 72 hours) was assessed using univariate models. Cox regression was used to determine the impact of infectious outcomes on progression-free survival (PFS) and overall survival (OS). <b>Results:</b> Of 268 eligible patients, 161 (60.1%) patients received additional antibiotic therapy, and 107 (39.9%) patients received standard antibiotic therapy only. There was no difference seen in the age, race, preoperative ASA score, residual disease, or medical comorbid conditions between the groups. Stage of disease at the time of surgery, histopathologic diagnosis, type of chemotherapy given (neoadjuvant vs adjuvant) were not significantly different among patients who received additional antibiotics (p >0.05) compared to those who did not. Patients who underwent a transverse colectomy were less likely to receive additional antibiotics than other colorectal resections (p=0.032). There were no differences in the rate of superficial SSI or combined superficial-deep SSI or intra-abdominal infections between those who received standard versus prolonged antibiotics (p=0.35). Extended/prolonged antibiotics did not significantly alter PFS (HR: 1.06, p=0.68) or OS (HR: 1.12, p=0.49). <b>Conclusions:</b> In our retrospective study, additional antibiotics did not reduce incisional infectious morbidity in women with EOC undergoing CRS with colorectal resection. Specifically, the addition of extended antibiotics did not improve outcomes in SSI or superficial and deep abscesses. Given the recent association of antibiotic use with poor outcomes after platinum-based chemotherapy and immunotherapy, antibiotic stewardship should be encouraged. Further study of the potential benefit, or lack thereof, of prolonged antibiotics in gynecologic oncology is warranted.

Effect of the COVID-19 Pandemic on Rates of Ninety-Day Peri-Prosthetic Joint and Surgical Site Infections after Primary Total Joint Arthroplasty: A Multicenter, Retrospective Study.

Background: The impact of the coronavirus 2019 (COVID-19) pandemic on the rate of primary total joint arthroplasty (TJA) peri-prosthetic joint infection (PJI) and superficial surgical site infections (SSI) is currently unknown. The purpose of this multicenter study was to evaluate any changes in the rates of 90-day PJI or 30-day SSI, including trends in microbiology of the infections, during the COVID-19 pandemic compared to the three years prior. Patients and Methods: An Institutional Review Board-approved, multicenter, retrospective study was conducted with five participating academic institutions across two healthcare systems in the northeastern United States. Primary TJA patients from the years 2017-2019 were grouped as a pre-COVID-19 pandemic cohort and patients from the year 2020 were grouped as a COVID-19 pandemic cohort. Differences in patient demographics, PJI, SSI, and microbiology between the two cohorts were assessed. Results: A total of 14,844 TJAs in the pre-COVID-19 pandemic cohort and 5,453 TJAs in the COVID-19 pandemic cohort were evaluated. There were no substantial differences of the combined 90-day PJI and 30-day superficial SSI rates between the pre-COVID-19 pandemic cohort (0.35%) compared with the COVID-19 pandemic cohort (0.26%; p = 0.303). Conclusions: This study did not find any change in the rates of 90-day PJI or 30-day superficial SSI in patients undergoing primary TJA between a pre-COVID-19 pandemic and COVID-19 pandemic cohort. Larger national database studies may identify small but substantial differences in 90-day PJI and 30-day superficial SSI rates between these two time periods. Our data may support continued efforts to maintain high compliance with hand hygiene, use of personal protective equipment, and limited hospital visitation whenever possible.

Impact of preoperative biliary drainage on 30 Day outcomes of patients undergoing pancreaticoduodenectomy for malignancy.

Preoperative biliary drainage (PBD) has been advocated to address the plethora of physiologic derangements associated with cholestasis. However, available literature reports mixed outcomes and is based on largely outdated and/or single-institution studies. Patients undergoing PBD prior to pancreaticoduodenectomy (PD) for periampullary malignancy between 2014-2018 were identified in the ACS-NSQIP pancreatectomy dataset. Patients with PBD were propensity-score-matched to those without PBD and 30-day outcomes compared. 8,970 patients met our inclusion criteria. 4,473 with obstruction and PBD were matched to 829 with no preoperative drainage procedure. In the non-jaundiced cohort, 711 stented patients were matched to 2,957 without prior intervention. PBD did not influence 30-day mortality (2.2% versus 2.4%) or major morbidity (19.8% versus 20%) in patients with obstructive jaundice. Superficial surgical site infections (SSIs) were more common with PBD (6.8% versus 9.2%), however, no differences in deep or organ-space SSIs were found. Patients without obstruction prior to PBD exhibited a 3-fold increase in wound dehiscence (0.5% versus 1.5%) additionally to increased superficial SSIs. PBD was not associated with an increase in 30-day mortality or major morbidity but increased superficial SSIs. PBD should be limited to symptomatic, profoundly jaundiced patients or those with a delay prior to PD.

Timing of early complications following hysterectomy for pelvic organ prolapse: national database analysis

To analyze the time to diagnosis of early complications following hysterectomy for pelvic organ prolapse (POP) and assess factors impacting timing of diagnosis. Cases were selected from the National Surgical Quality Improvement Program (NSQIP) using procedural codes for hysterectomy and diagnostic codes for POP for the years 2015-2019. Median and interquartile range (IQR) in days to diagnosis for the 22 complications reported in the NSQIP database were assessed. Bivariate analyses, Kaplan-Meier curves, and Cox proportional hazard models were used for the 5 most common complications to assess differences in time to diagnosis based on peri-operative factors. A total of 14,748 patients were included with average age of 60.5 ± 11.8 and BMI of 28.3 ± 5.6 kg/m2. Apical prolapse was the primary diagnosis in 84.1% of cases. The most common complications with their median and IQR for time to diagnosis in days were urinary tract infection (UTI) (11 [7-18], N=775), blood transfusion (1 [0-2], N=128), superficial surgical site infection (SSI) (15 [10-21], N=110), organ space infection (13 [8-18.5], N=109), intestinal obstruction (6 [4-10], N=47), sepsis (11 [6.75-16.75, N=38), and pneumonia (8.5 [2-16], N=26). Out of infectious etiologies, earliest median day to diagnosis was noted for septic shock (8.5) and pneumonia (8.5) and latest for superficial SSI (15, p<0.001). Kaplan-Meier curves showed that time to diagnosis was earlier for UTIs in cases with concurrent sling, urogynecologist surgeon, and vaginal hysterectomy (all p<0.001). These differences persisted when controlling for peri-operative and demographic factors in the Cox regression (Table). Vaginal and laparoscopic hysterectomies compared to abdominal route had lower hazard ratios (HR) for superficial SSI and blood transfusion (Table). For intestinal obstruction, HRs were lower for laparoscopic and vaginal hysterectomies compared to abdominal route (0.36, p=0.028 and 0.24, p=0.003, respectively). Time to diagnosis varies for different complications after hysterectomy for POP which may assist in providing patients with anticipatory guidance after surgery.

Peri-operative outcomes between primary and replacement artificial urinary sphincter surgery: An ACS-NSQIP analysis.

To evaluate differences in perioperative clinical outcomes in men undergoing artificial urinary sphincter (AUS) implantation in primary versus replacement settings. Secondarily, we aimed to identify patient-related factors contributing to complications associated with AUS placement. A review of the American College of Surgeons-National Surgical Quality Improvement Program was performed between 2010 and 2018 identifying males undergoing AUS implantation. Subjects were further subdivided into primary implantation or removal/replacement of AUS simultaneously via current procedural terminology codes 53445 and 53447, respectively. 30-Day postoperative outcomes were compared between cohorts using t-test and Fisher's exact test. The relationship between patient factors and complications was evaluated using logistic regression. A total of 1,892 patients were identified: 1,445 primary AUS placement and 447 AUS replacement procedures. Patients undergoing AUS replacement were statistically older than those undergoing primary implantation (71.4 vs 69.7 years, P < .001). AUS replacement procedures were associated with an increased rate of superficial surgical site infection (SSI) compared to primary procedures (1.3% vs 0.4%, P ¼ .042). There were no differences identified between cohorts for deep SSI, cardiopulmonary complications, reoperation, operative time, or length of stay. Logistic regression demonstrated that higher body mass index was found to be independent risk factors for any complications, and diabetes mellitus was associated with increased risk of AUS-related readmission. Within the perioperative period, patients undergoing replacement AUS have an increased risk of superficial SSI compared to primary AUS implantation. These findings can assist with appropriate perioperative counseling of patients undergoing primary and replacement AUS implantations.