Superficial Surgical Site Infection Research Articles

A Comparison of Adverse Short-Term Outcomes After Forefoot Amputation Based on Patient Height.

The objective of this investigation was to evaluate adverse short-term outcomes after partial forefoot amputation with a specific comparison performed based on patient height. The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to select patients with a 28805 Current Procedural Terminology code (amputation, foot; transmetatarsal) who underwent the procedure with "all layers of incision (deep and superficial) fully closed." This resulted in 11 patients with a height of 60 inches or less, 202 with a height greater than 60 inches and less than 72 inches, and 55 with a height of 72 inches or greater. Results of the primary outcome measures found no significant differences among groups with respect to the development of a superficial surgical site infection (0% versus 6.4% versus 5.5%; P = .669), deep incisional infection (9.1% versus 3.5% versus 10.9%; P = .076), or wound disruption (0% versus 5.4% versus 5.5%; P = .730). In addition, no significant differences were observed among groups with respect to unplanned reoperations (9.1% versus 16.8% versus 12.7%; P = .630) or unplanned hospital readmissions (45.5% versus 23.3% versus 20.0%; P = .190). The results of this investigation demonstrate no differences in short-term adverse outcomes after partial forefoot amputation with primary closure based on patient height. Although height has previously been described as a potential risk factor in the development of lower-extremity pathogenesis, this finding was not observed in this study from a large US database.

Results of selective decontamination with oral neomycin and metronidazole for major colorectal surgery in Australia: A cohort study

ObjectiveThe role of selective decontamination with oral antibiotics (OABs) and mechanical bowel preparation (MBP) prior to elective colorectal surgery is still widely debated. The objective of this study was to compare the outcomes of selective decontamination with neomycin, metronidazole and MBP compared to those of decontamination with MBP alone or with no preparation. MethodsSelective decontamination with neomycin and metronidazole combined with bowel preparation was introduced prior to elective colorectal surgery as part of an enhanced recovery after surgery program at Westmead Hospital, a major Australian tertiary referral hospital, between June 2017 and January 2023. Comparisons between short-term outcomes of OAB + MBP and MBP/no preparation were made using prospectively collected data on length of stay (LOS), readmission, mortality within 30 days, anastomotic leakage (AL), surgical site infection (SSI), urinary tract infection, deep venous thrombosis and/or pulmonary embolism, pneumonia, and ileus. Follow-up was limited to hospital stays and subsequent presentations within the health district within thirty days of surgery. The Mann–Whitney U test was used to analyse continuous data, and the chi-square test was used for categorical data. Univariate and multivariate regression modelling was performed to identify risk factors associated with an increased likelihood of SSI and AL. ResultsPatients with oral neomycin and metronidazole combined with bowel preparation had reduced superficial SSI (2.7% vs. 7.6%, p = 0.043) and overall complications (32.7% vs. 44.6%, p = 0.020), particularly Clavien–Dindo 1 complications (7.3% vs. 16.5%, p = 0.009). However, the differences in AL (2.7% vs. 4.5%, p = 0.369) and organ/space SSI (1.3% vs. 3.7%, p = 0.327) were not statistically significant. The median LOS (6 d vs. 6 d, p = 0.370) was not different between the groups. ConclusionSelective decontamination with neomycin and metronidazole reduces the risk of SSIs and overall complications. There was a trend to toward a lower AL, but this difference was not statistically significant.

Antibiotic treatment of hand wounds in children: Contribution of a decision tree

BackgroundThe need for prophylactic antibiotic treatment of hand wounds in children requiring emergency surgical exploration is still controversial. Our starting hypothesis was that the absence of prophylactic antibiotic treatment in this setting (as specified by a decision tree) does not increase the likelihood of surgical site infection. MethodsA decision tree for antibiotic prescription was developed by a working group in compliance with the guidelines issued by the French High Authority for Health, as part of a clinical pathway. One injection of intravenous antibiotics was prescribed for bite injuries, open joint injuries, injuries left untreated for more than 24 h, and suspected contaminated wounds. All children admitted for surgical treatment of a hand wound between July 2018 and March 2023 were included. Demographic data, antibiotic prescription and onset of postoperative surgical site infection were recorded. ResultsThe 238 children included had a mean age of 8 ± 4.8 years; 102 received antibiotics and 136 did not. Eleven children (4.6%) had superficial surgical site infection requiring no revision surgery or antibiotic therapy. 206 children (86.5%) were treated following the decision tree. Ten had superficial surgical site infection: 3 received antibiotics (3.7% of the 80 who were treated) and 7 did not (5.5% of the 126 not treated) (p = 0.74). Thirty-two patients (13.5%) were off-protocol, only 1 of whom received antibiotics for superficial surgical site infection. DiscussionApplying the decision tree standardized the prescription of antibiotics in hand wounds, was not associated with a significantly greater rate of surgical site infection, and avoided exposure to antibiotics for 61.1% of the children, thus limiting potential adverse events. Level of evidenceIII.

Optimizing antibiotic management for patients with acute appendicitis: A quality improvement study

BackgroundTo decrease surgical site infections after appendectomy for acute appendicitis, preoperative broad-spectrum antibiotics are often used in clinical practice. However, this treatment strategy has come under scrutiny because of increasing rates of antibiotic-resistant infections. MethodsThe aim of this multisite quality improvement project was to decrease the treatment of uncomplicated acute appendicitis with piperacillin-tazobactam without increasing the rate of surgical site infections. Our quality improvement intervention had 2 distinct components: (1) updating electronic health record orders to encourage preoperative administration of narrow-spectrum antibiotics and (2) educating surgeons and emergency department clinicians about selecting appropriate antibiotic therapy for acute appendicitis. Patient demographics, clinical characteristics, and outcomes were compared 6 months before and after implementation of the quality improvement intervention. ResultsA total of 352 laparoscopic appendectomies were performed during the 6-month preintervention period, and 369 were performed during the 6-month postintervention period. The preintervention period and postintervention period groups had similar baseline demographics, vital signs, and laboratory test values. The rate of preoperative piperacillin-tazobactam administration significantly decreased after the intervention (51.4% preintervention period vs 20.1% postintervention period, P < .001). The rate of surgical site infections was similar in both groups (superficial surgical site infections = 1.4% preintervention period vs 0.8% postintervention period, P = .50; deep surgical site infections = 1.1% preintervention period vs 0.0% postintervention period, P = .06; and organ space surgical site infections = 3.1% preintervention period vs 3.0% postintervention period, P > .99). Rates of 30-day readmission, reoperation, and Clostridioides difficile infection also did not differ between groups. ConclusionOur quality improvement intervention successfully decreased piperacillin-tazobactam administration without increasing the rate of surgical site infections in patients with acute appendicitis.

Management Outcome and Associated Factors of Perforated Peptic Ulcer Disease at Yekatit 12 Hospital Medical College and Tirunesh Beijing Hospital

Background: Perforated peptic ulcer disease is one of the emergency surgical conditions of peptic ulcer complications with high mortality and morbidity. Although this emergency condition is prevalent in the study areas it is the first study that showed its magnitude and management outcome. Objective: The purpose of this study was to determine the outcome and factors associated with perforated peptic ulcer disease. Methodology: A cross-sectional study design was used. Data were analyzed using SPSS version 25 and binary logistic regression was used to see factors associated with outcomes. P value ≤0.05 was considered significant. Result: A total of 95 patients were studied. Males outnumbered females by a ratio of 8.5:1. The mean and median age of patients was 31.74±13.83 and 27 years respectively. Most perforations were located on the first part of the duodenum (78, 76.5%). Most patients (90, 88.2%) had Graham’s omental patch repair. There were fifty-six post-operative complications recorded in 20 (21.1%) patients. Superficial surgical site infection (10.5%), wound dehiscence (9.5%), respiratory infections (20.1%), sepsis (17.9%), acute kidney injury (12.6%), and ECF (1.1%) were the complications recorded. Co-morbidity [AOR: 19.46 (2.39-158.39)] and SBP&lt;90mmHg [AOR: 5.76 (1.74-19.18)] were significantly associated with post-operative complications. The mortality rate was 5.3% (95% CI: 1.7% to 11.9%) and only co-morbidity [AOR: 10.85 (7.64, 15.40)] was stastically associated with mortality. Conclusion: The mortality rate of this study was low as compared with the majority of studies done the country and the region.

Risk of Fracture and Complications After Fixation in Patients With Pre-injury Psychiatric Illness: A Propensity-Matched Cohort Study.

The purpose was to describe the frequency of orthopaedic trauma and postsurgical complications associated with psychiatric diagnoses. Query of TriNetx Analytics Network. Participating hospitals. Those ≥18 years old with psychiatric illness and orthopaedic trauma. Fractures and postoperative complications were described. A 1:1 propensity score matching function was used. Odds ratios compared intercohort complications. A total of 11,266,415 patients were identified with a psychiatric diagnosis, including bipolar disorder (8.9%), schizophrenia (3.3%), major depression (12.4%), stress-related disorder (9.6%), anxiety disorder (64.5%), borderline personality disorder (1.1%), or antisocial personality (0.2%). Prevalence of 30.2% was found for a fracture and at least 1 psychiatric diagnosis. Antisocial personality disorder had the highest risk ratio relative to people without that mental disorder (relative risk [RR] = 5.09) of having 1 or more associated fracture, followed by depression (RR = 3.03), stress-related disorders (RR = 3.00), anxiety disorders (RR = 2.97), borderline personality disorder (RR = 2.92), bipolar disorder (RR = 2.80), and schizophrenia (RR = 2.69). Patients with at least 1 psychiatric comorbidity had greater risk of pulmonary embolism, superficial and deep surgical site infections, pneumonia, urinary tract infection, deep venous thrombosis, osteonecrosis, and complex regional pain syndrome by 1 month after fixation, when compared with patients without psychiatric disorder. By 1 year, they were also at an increased risk for stroke and myocardial infarction. All psychiatric comorbidities were associated with increased RR of fracture and higher odds of complications compared with patients without psychiatric comorbidities. Providers should be aware of preexisting psychiatric diagnoses during treatment of acute injuries because of these risks. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Psoriasis Is a Risk Factor for Surgical Site Infection After Primary TKA.

The relationship between psoriasis and complications after primary TKA is not well defined. Current studies are limited to small, single-center studies evaluating fewer than 150 patients with psoriasis, with some studies reporting an increased risk of surgical site infection (SSI) and another reporting no associated risk. There is a need to reevaluate the risk of psoriasis and postoperative complications, including SSI, to better risk-stratify and guide practice in this patient population. (1) Compared with patients without psoriasis, after accounting for potential confounders such as age, insurance, and comorbidities, do patients with psoriasis have a higher odds of superficial SSI after primary TKA? (2) Do patients with psoriasis have a higher odds of deep SSI after primary TKA? Patients 18 years or older who underwent unilateral, primary TKA between 2015 and 2019 were identified in the PearlDiver database (n = 490,722). Patients with rheumatoid, septic, or posttraumatic arthritis were excluded, as well as patients with bone neoplasias (n = 188,557). Additionally, patients with less than 2 years of follow-up (n = 53,673) were excluded. In all, 248,492 patients were included in this study; 0.4% (1078) were in the psoriasis group and 99% (247,414) were in the control group. Overall 2-year superficial and deep SSI rates were stratified and compared between patients with psoriasis and a control group of patients who did not have psoriasis as the primary outcome. Secondary outcomes included the odds of undergoing an aseptic revision or manipulation under anesthesia. In the multivariable analysis, which controlled for potential confounders such as age, sex, Elixhauser comorbidity index, hypertension, diabetes mellitus, and liver disease, the odds of SSI-either superficial or deep-remained higher for patients with psoriasis (OR 1.74 [95% confidence interval 1.03 to 2.96]; p = 0.04). When focusing on superficial infections in the multivariable analysis, patients with psoriasis had a higher odds of superficial SSI than those in the control group (OR 2.83 [95% CI 1.26 to 6.34]; p = 0.01). The odds of deep SSI were not different between the two cohorts in our multivariable analysis (OR 1.32 [95% CI 0.66 to 2.66]; p = 0.43). Patients with psoriasis did not have an increased odds of undergoing an aseptic revision (OR 0.79 [95% CI 0.48 to 1.32]; p = 0.38) or manipulation under anesthesia (OR 0.74 [95% CI 0.52 to 1.06]; p = 0.10). Patients with psoriasis had higher overall rates of SSI at 2 years of follow-up than patients without psoriasis. Our findings suggest that psoriasis is a risk factor for superficial SSI after primary TKA and is an important comorbidity for surgeons to consider before surgery. Further research is needed to assess the role of adjunctive interventions in patients with psoriasis to mitigate the elevated odds of superficial SSI. Level II, prognostic study.

Trends in prevalence and complications for smokers who underwent total hip arthroplasty from 2011 to 2019: an analysis of 243,163 patients.

Smoking is an established risk factor for postoperative complications after total hip arthroplasty (THA). It is unknown if the decreasing prevalence of adult smoking in the United States is reflected in the elective THA patient population. We aimed to investigate recent trends in: (1) the prevalence of smoking pre-THA, stratified by patient demographics; and (2) rates of 30-day complications and increased healthcare utilisation post-THA in smokers versus non-smokers. Patients who underwent primary elective THA (2011-2019) were identified using the National Surgical Quality Improvement Program database. A total of 243,163 cases (Smokers: n = 30,536; Non-smokers: n = 212,627) were included. Trends analyses were performed for smoking prevalence across the study period. Smokers were propensity score-matched (1:1) to a cohort of non-smokers (n = 29,628, each), and rates of 30-day complications, readmission, and non-home discharge were compared. The rate of preoperative smoking significantly decreased from 14.0% in 2011 to 11.6% in 2019 (p-trend = 0.0286). When stratified, a significant decreasing trend in smoking was found for males and all races; within races, American-Indian/Alaska-Native race had the sharpest decline (2011:36.3% vs. 2019:23.2%). No significant change in 30-day complication rates among smokers or non-smokers was observed (p-trend > 0.05), but non-home discharge significantly decreased for both smokers (p-trend = 0.001) and non-smokers (p-trend < 0.001). After matching, higher rates of superficial surgical site infections (SSI) (0.9% vs. 0.5%; p < 0.001), deep SSI (0.5% vs. 0.3%; p < 0.001), wound disruption (0.2% vs. 0.1%; p = 0.006), and readmission (4.2% vs. 3.1%; p = <0.001) were found in smokers versus non-smokers. The present study is encouraging that national efforts to reduce the prevalence of smoking may be successful within the THA population, but there is a persistently elevated risk of postoperative complications in smokers after THA.

Assessment of the effectiveness of weight-adjusted antibiotic administration, for reduced duration, in surgical prophylaxis of primary hip and knee arthroplasty.

Prophylactic antibiotics have significantly led to a reduction in the risk of post-operative surgical site infections (SSI) in orthopaedic surgery. The aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed, for the duration of the operation, the minimum inhibitory concentration of the likely organisms that are encountered. Prophylactic antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4% and 8% to between 1% and 3%. Controversy, however, still surrounds the optimal frequency and dosing of antibiotic administration. To evaluate the impact of introduction of a weight-adjusted antibiotic prophylaxis regime, combined with a reduction in the duration of administration of post-operative antibiotics on SSI incidence during the 2 years following primary elective total hip and knee arthroplasty. Following ethical approval, patients undergoing primary total hip arthroplasty (THA)/total knee arthroplasty (TKA) with the old regime (OR) of a preoperative dose [cefazolin 2 g intravenously (IV)], and two subsequent doses (2 h and 8 h), were compared to those after a change to a new regime (NR) of a weight-adjusted preoperative dose (cefazolin 2 g IV for patients < 120 kg; cefazolin 3g IV for patients > 120 kg) and a post-operative dose at 2 h. The primary outcome in both groups was SSI rates during the 2 years post-operatively. A total of n = 1273 operations (THA n = 534, TKA n = 739) were performed in n = 1264 patients. There was no statistically significant difference in the rate of deep (OR 0.74% (5/675) vs NR 0.50% (3/598); fishers exact test P = 0.72), nor superficial SSIs (OR 2.07% (14/675) vs NR 1.50% (9/598); chi-squared test P = 0.44) at 2 years post-operatively. With propensity score weighting and an interrupted time series analysis, there was also no difference in SSI rates between both groups [RR 0.88 (95%CI 0.61 to 1.30) P = 0.46]. A weight-adjusted regime, with a reduction in number of post-operative doses had no adverse impact on SSI incidence in this population.

Innovative device for surgical wound irrigation: a preclinical testing and pilot clinical validation study

Introduction Surgical site infection (SSI) poses a substantial postoperative challenge, affecting patient recovery and healthcare costs. While surgical wound irrigation is pivotal in SSI reduction, consensus on the optimal method remains elusive. We developed a novel device for surgical wound irrigation and conducted preclinical and clinical evaluations to evaluate its efficacy and safety. Methods Two preclinical experiments using swine were performed. In the washability test, two contaminated wound model were established, and the cleansing rate between the device and the conventional method were compared. In the contamination test, the irrigation procedure with a fluorescent solution assessed the surrounding contamination of drapes. Subsequently, a clinical trial involving patients undergoing abdominal surgery was conducted. Results The washability test demonstrated significantly higher cleansing rates with the device method (86.4% and 82.5%) compared to the conventional method (65.2% and 65.1%) in two contamination models. The contamination test revealed a smaller contaminated region with the device method than the conventional method. In the clinical trial involving 17 abdominal surgery cases, no superficial SSIs or adverse events related to device use were observed. Conclusions Our newly developed device exhibits potential for achieving more effective and safe SSI control compared to conventional wound irrigation.

Satisfactory Short-Term Outcomes of Reverse Shoulder Arthroplasty for Complex Three- and Four-Part Fractures of the Humeral Head in Octogenarians.

Proximal humeral fractures with severe comminution and poor bone quality are among the most common injuries in the elderly population. Reverse shoulder arthroplasty (RSA) has been widely used to manage complex three- and four-part humeral head fractures. The purpose of the present study was to report the result of this technique in the demanding population of octogenarians. Twenty-six patients above the age of 80 years were included in the study andfollowed for a minimum of one-year follow-up. To assess the functional outcomes the postoperative range of motion (ROM), the Constant score, the visual analog scale for pain, and the disability of the arm and shoulder score (DASH) were measured at 6 and 12 months. Radiological assessment and potential complications were also recorded. The mean age of the study population was 81.9 years (81-86) at the time of surgery. There was a statistically significant improvement in all outcomes over the follow-up intervals. Shoulder ROM was 125.7o for flexion, 98.2o for abduction, 42.2o for internal rotation, and 43.2o for external rotation at 12 months. The mean Constant, DASH, and VAS scores at the last follow-up were 61.3, 31.9, and 0.5, respectively. Reported complications include one superficial surgical site infection. RSA is a safe and reliable surgical option with satisfactory outcomes to manage complex three- and four-part fractures of the humeral head as it can provide prompt pain relief and function in octogenarians.

The 6:1 short stitch SL-WL-ratio: short term closure results of transverse and midline incisions in elective and emergency operations

AimTo analyze laparotomy closure quality (suture/wound length ratio; SL/WL) and short term complications (surgical site occurrence; SSO) of conventional midline and transverse abdominal incisions in elective and emergency laparotomies with a longterm, absorbent, elastic suture material.MethodProspective, monocentric, non-randomized, controlled cohort study on short stitches with a longterm resorbable, elastic suture (poly-4-hydroxybutyrate, [p-4OHB]) aiming at a 6:1 SL/WL-ratio in midline and transverse, primary and secondary laparotomies for elective and emergency surgeries.ResultsWe included 351 patients (♂: 208; ♀: 143) with midline (n = 194), transverse (n = 103), and a combined midline/transverse L-shaped (n = 54) incisions. There was no quality difference in short stitches between elective (n = 296) and emergency (n = 55) operations. Average SL/WL-ratio was significantly higher for midline than transverse incisions (6.62 ± 2.5 vs 4.3 ± 1.51, p < 0.001). Results in the first 150 patients showed a reduced SL/WL-ratio to the following 200 suture closures (SL/WL-ratio: 5.64 ± 2.5 vs 6.1 ± 2.3; p < 0.001). SL/WL-ratio varied insignificantly among the six surgeons participating while results were steadily improving over time.Clinically, superficial surgical site infections (SSI, CDC-A1/2) were encountered in 8%, while 4,3% were related to intraabdominal complications (CDC-A3). An abdominal wall dehiscence (AWD) occurred in 22/351 patients (6,3%)—twice as common in emergency than elective surgery (12,7 vs 5,1%)—necessitating an abdominal revision in 86,3% of cases.ConclusionWe could show that a short stitch 6:1 SL/WL-ratio with a 2–0 single, ultra-long term, absorbent, elastic suture material can be performed in only 43% of cases (85% > 4:1 SL/WL-ratio), significantly better in midline than transverse incisions. Transverse incisions should preferably be closed in two layers to achieve a sufficient SL/WL-ratio equivalent to the median incision.Clinical Trials.gov IdentifierNCT01938222.

Outcomes of posterior component separation with transversus abdominis release for repair of abdominally based breast reconstruction donor site hernias.

Abdominally based autologous breast reconstruction (ABABR) is common after mastectomy, but carries a risk of complex abdominal wall hernias. We report experience with posterior component separation (PCS) and transversus abdominis release (TAR) with permanent synthetic mesh repair of ABABR-related hernias. Patients at Cleveland Clinic Foundation and Penn State Health were identified retrospectively. Outcomes included postoperative complications, hernia recurrence, and patient-reported outcomes (PROs): Hernia Recurrence Inventory, HerQLes Summary Score, Patient-Reported Outcome Measurement Information System (PROMIS) Pain Intensity 3a Survey, and the Decision Regret Scale (DRS). Forty patients underwent PCS/TAR repair of hernias resulting from pedicled (35%), free (5%), muscle-sparing TRAMs (15%), and DIEPs (28%) from August 2014 to March 2021. Following PCS, 30-day complications included superficial surgical site infection (13%), seroma (8%), and superficial wound breakdown (5%). Five patients (20%) developed clinical hernia recurrence. At a minimum of 1year, 17 (63%) reported a bulge, 12 (44%) reported pain, median HerQLes Quality Of Life Scores improved from 33 to 63/100 (p value < 0.01), PROMIS 3a Pain Intensity Scores improved from 52 to 38 (p value < 0.05), and DRS scores were consistent with low regret (20/100). ABABR-related hernias are complex and technically challenging due to missing abdominal wall components and denervation injury. After repair with PCS/TAR, patients had high rates of recurrence and bulge, but reported improved quality of life and pain and low regret. Surgeons should set realistic expectations regarding postoperative bulge and risk of hernia recurrence.

Closed-incision negative-pressure wound therapy reduces superficial surgical site infections after open colon surgery: an NSQIP Colectomy Study

The use of closed incision negative pressure wound therapy (iNPWT) has increased in the last decade across surgical fields, including colectomy. Compare postoperative outcomes associated with use of (iNPWT) following open colectomy from a large national database. A retrospective review of patients who underwent operations from 2015-2020 was performed using National Surgical Quality Improvement Program (NSQIP) Targeted Colectomy Database. Intraoperative placement of iNPWT was identified using Current Procedural Terminology (CPT) codes in patients undergoing open abdominal operations with closure of all wound layers including skin. Propensity score matching was performed to define a control group who underwent closure of all wound layers without iNPWT. Patients were matched in a 1:4 (iNPWT vs. control) ratio and postoperative rates of superficial, deep and organ-space SSI, wound disruption, and readmission. Between 2015-2020, iNPWT was used in 483 (0.6%) undergoing open colectomies. A matched cohort of 1884 was selected. Patients with iNPWT had longer median operative time (170 [IQR 129-232] vs. 161[IQR:114-226] minutes, p<0.05) (Table 2). Compared to patients without iNPWT, Patients with iNPWT experienced a lower rate of 30-day superficial incisional SSI (3% vs. 7%, p<0.05) and readmissions (10% vs 14%; p < 0.05). iNPWT did not decrease risk of deep SSI, organ-space SSI, or wound disruption. Although there is a slightly increased operative time, utilization of iNPWT in open colectomy is associated with lower odds of superficial SSI and 30-day readmission. This suggests that iNPWT should be routinely utilized in open colon surgery to improve patient outcomes.

Corrugated Rubber Drains Versus Closed Suction Drain in Reducing Superficial Surgical Site Infection in Laparotomy Wounds

Background: Surgical site infections (SSI) remain a substantial problem for patients. Surgery for perforation peritonitis is associated with the highest rate of infective complications, especially surgical site infections because there is contamination of the operative field with microorganisms from endogenous sources. Subcutaneous drains are commonly placed in the operative setting to prevent hematoma or abscess formation in surgical wounds. In contrast to open drains, closed suction drains establish a pressure gradient between the wound and the external environment.Objectives: To evaluate the role of wound drainage in preventing surgical site infections (SSI) in patients undergoing emergency laparotomy and draw comparison between the efficacy of open corrugated rubber drainage and closed suction drainage.Methods: A prospective study was conducted on 50 patients admitted under Department of Surgery, Government Medical College, Jammu, India, between January and July of 2020, who underwent emergency laparotomy for various indications, within 24 hours of admission. All investigations for requisite anaesthesia were conducted on emergency basis. Patients received either corrugated rubber drain (group A), closed suction drain (group B) or no drain (group C) for wound drainage. Patients were followed in the post operative period for development of wound infection.Results: Mean age was 39.2 years with median age of 35 years. Male to female ratio was 1.94:1. 8 out of 19 patients from group A developed wound dehiscence, while only 1 out of 20 patients in group B developed wound dehiscence. 6 out of 11 patients in group C developed wound dehiscence. The difference was statistically significant (P&lt;0.05).Conclusion: Placement of subcutaneous drains in emergency laparotomy wounds is associated with lower incidence of wound infection. Closed suction drains appear to be more effective than open corrugated drains in reducing the risk of SSIs.International Journal of Human and Health Sciences Vol. 08 No. 01 Jan’24 Page: 75-78

Chronic Steroid Use Does Not Increase the Risk of Superficial Surgical Site Infection or Wound Dehiscence Following Total Ankle Arthroplasty.

Introduction Total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle arthritis. Recent surgical and technological advances have led to a significant increase in the surgical volume of TAA. While a majority of ankle arthritis is post-traumatic in nature, other causes include autoimmune or inflammatory conditions. Medical management of these conditions frequently requires chronic corticosteroid administration, which is a well-established risk factor for complications following surgery. The purpose of this study was to investigate the association between chronic preoperative steroid use and postoperative complications following TAA. Methods The American College of Surgeons National Surgical Quality Improvement (NSQIP) database was analyzed to identifyall patients who underwent TAA between 2015 and 2020. Patient characteristics including demographics, comorbidities, surgical characteristics, and 30-day postoperative complication data were collected. The data was analyzed using bivariate and multivariate logistic regression to identify all postoperative complications associated with chronic preoperative steroid use. Results A total of 1,606 patients were included in this study: 1,533 (95.5%) were included in the non-steroid cohort, and 73 (4.5%) were included in the chronic steroid cohort. Chronic steroid use was significantly associated with female sex (p < 0.001) and American Society of Anesthesiologists (ASA) ≥3 (p < 0.001). Chronic steroid use was not associated with superficial surgical site infection (SSI) (p= 0.634) or wound dehiscence (p = 0.999).The postoperative complication that was significantly associated with chronic steroid use was sepsis (p = 0.031). After adjusting for female sex and the ASAgrade, chronic steroid use was found to be independently associated with sepsis (p = 0.013). Conclusion Preoperative chronic steroid use is not associated with superficial SSI or wound dehiscence within 30 days following TAA. As TAA becomes a more attractive alternative to ankle arthrodesis, a better understanding of preoperative risk factors can aid in widening indications and knowing what patients are at risk for complications.

Clinical and radiographic outcomes of negative pressure wound therapy combined with polymethylmethacrylate sealant for wound management of Gustilo type III open tibia fractures.

This study aimed to introduce a new wound management method combining negative pressure wound therapy and polymethylmethacrylate sealant for Gustilo type III open tibia fractures and to evaluate its clinical outcomes. Among 186 patients who visited our institution for the treatment of open tibia fractures between January 2016 and December 2019, 20 male patients who sustained Gustilo type III open tibia fractures and were compelled to undergo delayed flap coverage using negative pressure wound therapy combined with polymethylmethacrylate sealant due to initial critical condition were enrolled in this study. We retrospectively investigated patients' demographics, interval between the injury and flap coverage, number of negative pressure wound therapy changes, flap survival, bone union time, and infection-induced complications. The mean interval from injury until flap coverage was 27.8 (range, 8-63) days. Most soft-tissue defects were reconstructed using free flaps (14/20, 70%); the anterolateral thigh flap was the most frequently used flap (12/20, 60%) in this study. Among 20 flaps trans- ferred, 16 flaps (80%) survived uneventfully, 1 flap (5%) developed partial necrosis, and 3 flaps (15%) failed. The mean follow-up period was 22.7 (range, 12- 43) months. A total of 17 patients (85%) achieved tibia fracture union. The mean bone union time was 31 (range, 12-81) weeks. With regard to infection-induced complications, 3 patients (15%) developed osteomyelitis and no patient showed superficial surgical site infection. Combination therapy using negative pressure wound therapy and polymethylmethacrylate sealant serves as a useful and reliable therapeutic strategy for wound management of Gustilo type III open tibia fractures, especially when delayed soft-tissue recon- struction is unavoidable. Corresponding author: Yoo Joon Sur yoojoon@catholic.ac.kr Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Level IV, Therapeutic Study.

Assessing the utility of deep neural networks in detecting superficial surgical site infections from free text electronic health record data.

High-quality outcomes data is crucial for continued surgical quality improvement. Outcomes are generally captured through structured administrative data or through manual curation of unstructured electronic health record (EHR) data. The aim of this study was to apply natural language processing (NLP) to chart notes in the EHR to accurately capture postoperative superficial surgical site infections (SSSIs). Deep Learning (DL) NLP models were trained on data from 389,865 surgical cases across all 11 hospitals in the Capital Region of Denmark. Surgical cases in the training dataset were performed between January 01st, 2017, and October 30th, 2021. We trained a forward reading and a backward reading universal language model on unlabeled postoperative chart notes recorded within 30 days of a surgical procedure. The two language models were subsequently finetuned on labeled data for the classification of SSSIs. Validation and testing were performed on surgical cases performed during the month of November 2021. We propose two different use cases: a stand-alone machine learning (SAM) pipeline and a human-in-the-loop (HITL) pipeline. Performances of both pipelines were compared to administrative data and to manual curation. The models were trained on 3,983,864 unlabeled chart notes and finetuned on 1,231,656 labeled notes. Models had a test area under the receiver operating characteristic curves (ROC AUC) of 0.989 on individual chart notes and 0.980 on an aggregated case level. The SAM pipeline had a sensitivity of 0.604, a specificity of 0.996, a positive predictive value (PPV) of 0.763, and a negative predictive value (NPV) of 0.991. Prior to human review, the HITL pipeline had a sensitivity of 0.854, a specificity of 0.987, a PPV of 0.603, and a NPV of 0.997. The performance of the SAM pipeline was superior to administrative data, and significantly outperformed previously published results. The performance of the HITL pipeline approached that of manual curation.

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

Using an under-utilised rural hospital to reduce surgical waiting lists.

Objectives This study aimed to evaluate patient outcomes from a 12-month pilot program establishing specialist surgical services in a small rural (Modified Monash Model, MM4) hospital on the south coast of NSW. Methods Suitable patients for ambulatory surgery were selected based on strict anaesthetic, surgical and social criteria. Skills shortfalls among nursing staff, usually with emergency or inpatient experience, were addressed by appropriate re-training and in-service training in scrub, scout and anaesthetic duties. An anonymous post-operative patient survey was administered during the pilot program, which assessed patient experiences and outcomes. Of 162 patients undergoing surgery during the pilot, 50 consecutive participants completed the survey. Results Of the 161 procedures during the pilot program, 100 were performed under sedation and locoregional anaesthesia and 62 under general anaesthesia. Half (n = 86, 53.4%) were complex excisions of malignant skin lesions, and of these 63% also required either a skin graft or local flap repair. Survey respondents reported adequate information and pain relief upon discharge (n = 45, 96%) and 100% were satisfied with the care received. No respondents needed to see a doctor following discharge. There were no mortality events or major issues of morbidity during the study period or subsequently, no further overnight admissions or return to theatre and no re-presentations within 48 h of operating. Two superficial surgical site infections were reported. Conclusions There is merit in drawing on underutilised resources in small rural hospitals in support of initiatives to reduce surgical waitlists. Appropriate outpatient surgeries can be safely performed with high levels of patient satisfaction.