Superficial Superficial Surgical Site Infection Research Articles

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

Objective: 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. Background: 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. Methods: 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). Results: 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). Conclusions: Aquacel Ag Hydrofiber dressings can reduce superficial SSIs compared to film dressings in patients undergoing elective gastrointestinal surgery, especially lower gastrointestinal surgery.

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

<b><br>Introduction:</b> 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.</br> <b><br>Aim:</b> The aim of this study is to compare the two wound closure techniques.</br> <b><br>Material and methods:</b> 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.</br> <b><br>Results:</b> 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.</br> <b><br>Conclusions:</b> 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.</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.

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.

Surgical Site Infection in Children with Neuromuscular Disorders after Laparoscopic Gastrostomy: A Propensity-Matched National Surgical Quality Improvement Program Pediatrics Database Analysis.

Background: Prior studies have demonstrated that children with neuromuscular scoliosis have a higher incidence of infection after spine surgery. The purpose of the study is to determine whether children with neuromuscular disorders (NMDs) have higher rate of superficial surgical site infection (SSI) or increased hospital length of stay (LOS) compared with children without NMDs following laparoscopic gastrostomy creation, a common pediatric general surgery operation. Patients and Methods: We performed a retrospective propensity-matched analysis of laparoscopic gastrostomy creation in children from National Surgical Quality Improvement Program Pediatrics database (NSQIP-P) 2018-2019. Patients were stratified based on NMD status. We performed multivariable logistic regression and ordered logistic regression to estimate the odds ratio of superficial SSI within 30 days of surgery and increased LOS. Results: We screened 252,367 patients from the NSQIP-P 2018-2019 dataset. After applying inclusion and exclusion criteria and 1:1 propensity score-matching, there were 991 children with NMDs and 991 children without NMDs. Children with NMDs had higher prevalence of superficial SSI within 30 days of gastrostomy creation: 36 (3.63%) versus 18 (1.82%); p = 0.013. Children with NMDs had increased odds of having a superficial SSI within 30 days of laparoscopic gastrostomy tube (G-tube) placement compared with children without NMD (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.13-3.58; p = 0.018). There was no difference in LOS based on NMD status. Conclusion: Children with NMDs have two-fold increased odds of superficial SSI after laparoscopic gastrostomy creation compared with children without NMDs. Children with NMDs should be the aim of targeted quality improvement initiatives to reduce infection risks.

228. Complications following posterior cervical arthrodesis for cervical spondylotic myelopathy: a single institution's experience

<h3>BACKGROUND CONTEXT</h3> Posterior cervical fusion (PCF) is a frequently performed surgery for treatment of cervical spondylotic myelopathy (CSM). While incidences of these risks have been reported previously, prior studies on this topic either contain small sample sizes, pooled from multiple institutional or public databases, or have low follow-up duration. Here, we report the incidence of postoperative complications following PCF for CSM at a single institution with a large patient cohort. To review the rate of postoperative complications following primary posterior cervical fusion for cervical CSM at a single institution. <h3>PURPOSE</h3> To review the rate of postoperative complications following primary posterior cervical fusion for CSM at a single institution. <h3>STUDY DESIGN/SETTING</h3> Retrospective case series, single institution. <h3>METHODS</h3> Patients with a diagnosis of CSM treated with PCF over a 4-year period at a tertiary care center were identified. Exclusion criteria included: (1) cervical myelopathy secondary to trauma, spinal infection, or spinal neoplasm, (2) fusion constructs that proximally included occiput or C1, or distally extended below T2, and (3) revision PCF procedures. Postoperative data collected included incidence of superficial surgical site infection (SSI), deep wound infection, subsequent irrigation and debridement (I&D), postoperative pneumonia, venous thromboembolism (VTE), epidural hematoma, and C5 nerve palsy during course of follow-up. Multivariable regression analyses were performed to identify patient characteristics and comorbidities that were independent risk factors for these complications. <h3>RESULTS</h3> A total of 176 patients met inclusion criteria (mean age + standard deviation = 63.8 + 11.1 years). An average of four levels (range: 1-7) were fused per surgery. Mean follow-up was one year. Of 176 patients, 33 (18.7%) had at least one documented postoperative complication. There were six cases (3.4%) of superficial SSI and four cases (2.3%) of deep wound infection. One patient (0.57%) developed a postoperative epidural hematoma. There were five cases (2.8%) of VTE and six cases (3.4%) of postoperative pneumonia. Fifteen patients (8.5%) developed C5 nerve palsy, of which 12 of 15 cases were transient and improved. Diabetes was an independent risk factor for postoperative VTE (p=0.03) and pneumonia (p=0.03). <h3>CONCLUSIONS</h3> Almost 1 in 6 patients had some complication after posterior cervical fusion for treatment of CSM. The incidence of C5 nerve palsy at 8.5% was not trivial. Though PCF is a routine procedure, our results highlight the need for appropriate preoperative counseling, especially in patients with diabetes mellitus. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Early Infection Trends for Primary Total Knee Arthroplasty: A 5-Year Review.

The aim of this study was to track the annual rates and trends of overall, deep, and superficial surgical site infections (SSIs) following total knee arthroplasty using the most recent results from a large and nationwide database. A total of 197,192 cases were performed between 2012 and 2016 from a nationwide database stratified into years and based on superficial and/or deep SSIs. Cohorts were analyzed individually and then combined to evaluate overall SSI rates. The infection incidence for each year was calculated. After a 6-year correlation and trends analysis, univariate analyses were performed to compare the most recent year, 2016, with each of the preceding 4 years. Overall, there was a downward trend in overall SSI rates over the study period (2012-2016, with the lowest rate occurring in the most recent year, 2016 [0.11%]). Additionally, there was a decreasing trend for superficial SSI, with the lowest superficial SSI incidence occurring in 2016 (0.47%) and the greatest incidence occurring in 2012 (0.53%). An overall trend of decreasing SSI rates was observed nationwide over the 5-year period evaluated. A similar decreasing trend was also noted specifically for deep SSI rates, which can be potentially more complicated to manage, and result in decreased implant survivorship. The down trending SSI rates observed give potential credence to the value for newer and developing SSI preventative therapies as well as improved medical and surgical patient management. Nevertheless, there is still room for improvement, and continued efforts are needed to further lower SSIs after total knee arthroplasty.

Impact of intraoperative hypocapnia on postoperative complications in laparoscopic surgery for colorectal cancer.

In laparoscopic surgery (LS) for colorectal cancer (CRC), the relationship between intraoperative end-tidal carbon dioxide concentration (EtCO2) and surgery-related complications remains unexplored. This study assessed the impact of intraoperative EtCO2 on postoperative complications in LS for CRC. In total, 909 patients who underwent LS for CRC were enrolled. Hypocapnia and hypercapnia were defined as EtCO2 < 35mmHg and > 40mmHg, respectively, and the relationships between hypocapnia or hypercapnia duration and postoperative complications were analyzed. The median (range) durations of hypocapnia and hypercapnia were 2.0 (0-8.3) h and 0.3 (0-5.8) h, respectively. Complications were observed in 208 cases (23.0%), which included 37 (4.1%) instances of anastomotic leakage and 86 (9.5%) of superficial surgical site infection (SSI). While the hypercapnia duration was not associated with the short-term outcomes, prolonged hypocapnia was significantly correlated with complications (p = 0.02), specifically superficial SSI (p = 0.005). Multivariate analyses adjusted for confounding factors confirmed that hypocapnia prolongation was an independent risk factor for postoperative superficial SSI [OR 1.19; 95% confidence interval (Cl) 1.03-1.36, p = 0.01]. Intraoperative hypocapnia may be a risk factor for postoperative complications, in particular superficial SSI, in LS for CRC.

Revisiting the Value of Drains After Low Anterior Resection for Rectal Cancer: a Multi-institutional Analysis of 996 Patients

BackgroundIntraoperative pelvic drains are often placed during low anterior resection (LAR) to evacuate postoperative fluid collections and identify/control potential anastomotic leaks. Our aim was to assess the validity of this practice. MethodsPatients from the US Rectal Cancer Consortium (2007–2017) who underwent curative-intent LAR for a primary rectal cancer were included. Patients were categorized as receiving a closed suction drain intraoperatively or not. Primary outcomes were superficial surgical site infection (SSI), deep SSI, intraabdominal abscess, anastomotic leak, and need for secondary drain placement. Three subgroup analyses were conducted in patients who received neoadjuvant chemoradiation, had a diverting loop ileostomy (DLI), and had low anastomoses < 6 cm from the anal verge. ResultsOf 996 patients 67% (n = 551) received a drain. Drain patients were more likely to be male (64 vs 54%), have a smoking history (25 vs 19%), have received neoadjuvant chemoradiation (73 vs 61%), have low tumors (56 vs 36%), and have received a DLI (80 vs 71%) (all p < 0.05). Drains were associated with an increased anastomotic leak rate (14 vs 8%, p = 0.041), although there was no difference in the need for a secondary drainage procedure to control the leak (82 vs 88%, p = 0.924). These findings persisted in all subset analyses. Drains were not associated with increased superficial SSI, deep SSI, or intraabdominal abscess in the entire cohort or each subset analysis. Reoperation (12 vs 10%, p = 0.478) and readmission rates (28 vs 31%, p = 0.511) were similar. ConclusionsAlthough not associated with increased infectious complications, intraoperatively placed pelvic drains after low anterior resection for rectal cancer are associated with an increase in anastomotic leak rate and no reduction in the need for secondary drain placement or reoperation. Routine drainage appears to be unnecessary.

A randomised trial of caesarean wound coverage: exposed versus dressed.

To evaluate the superficial surgical site infection (SSI) rate to 28days and patient satisfaction with wound coverage management when their transverse suprapubic caesarean wound is left exposed compared with dressed after skin closure. Randomised trial. University Hospital, Malaysia: April 2016-October 2016. 331 women delivered by caesarean section. Participants were randomised to leaving their wound entirely exposed (n=165) or dressed (n=166) with a low adhesive dressing (next day removal). Primary outcomes were superficial SSI rate (assessed by provider inspection up to hospital discharge and telephone questionnaires on days 14 and 28) and patient satisfaction with wound coverage management before hospital discharge. The superficial SSI rates were 2/153 (1.3%) versus 5/157 (3.2%) (relative risk [RR] 0.4, 95% CI 0.1-2.1; P=0.45) and patient satisfaction with wound management was 7 [5-8] versus 7 [5-8] (P=0.81) in exposed compared with dressed study groups, respectively. In the wound-exposed patients, stated preference for wound exposure significantly increased from 35.5 to 57.5%, whereas in the wound-dressed patients, the stated preference for a dressed wound fell from 48.5 to 34.4% when assessed at recruitment (pre-randomisation) to day 28. There were no significant differences in inpatient additional dressing or gauze use for wound care, post-hospital discharge self-reported wound issues of infection, antibiotics, redness and inflammation, swollen, painful, and fluid leakage to day 28 across trial groups. The trial is underpowered as SSI rates were lower than expected. Nevertheless, leaving caesarean wounds exposed does not appear to have detrimental effects, provided patient counselling to manage expectations is undertaken. An exposed compared with a dressed caesarean wound has a similar superficial surgical site infection rate, patient satisfaction and appearance.