Surgical Site Infection Group Research Articles

Surgical site infection following surgery for spinal deformity: About 102 patients

IntroductionComplex spinal surgery is known to be at risk of complications. Surgical site infection is a serious complication in spine surgery and its frequency is significantly increased in adult spinal deformity correction. The aim of this study is to identify patients’ characteristics and risk factors of surgical site infection (SSI) following an osteotomy. MethodsThis is a single-center retrospective study of patients who underwent an osteotomy between January 2015 and December 2017. Surgical site infection diagnosis was based upon patient's clinical evidence of infection, biologic parameters, microbiological criteria and/or image findings. ResultsIn total, 102 patients were eligible and 70 were women (68.6%). Mean age was 65 years old (27–83 years) and mean body mass index (BMI) was 26.14kg.m−2 (18.4–44.1). Eleven patients were in the SSI group and 91 in the No-SSI group. The mean Schwab grade was 1.5 (1–4) in the SSI group vs. 1.4 (1–5) in the No-SSI group (P=0.435). The mean operative time was on 201.9 minutes (67–377). Mean length of stay was 20.6 days (10–73) in the SSI group vs. 15 days (5–44) in the No-SSI group (P=0.041). Favorable outcome was found in 10 patients (90.9%) in the SSI group. ConclusionCorrection surgery for adult spinal deformity with osteotomies carries a high risk of complications specially SSI. Identification of risk factors, prevention and medical management of SSI should be well assessed.

Does preoperative prognostic nutrition index predict surgical site infection after spine surgery?

Malnutrition is reported as one of the risk factors for surgical site infection (SSI). The prognostic nutritional index (PNI) is a simple method for nutritional evaluation. However, little is known about the relationship between SSI and the PNI in patients after spine surgery. We aimed to determine independent predictors of SSI after spine surgery. We analyzed 1115 patients who underwent spine surgery (369 males, 746 females, mean age 56years, follow-up period: at least 1year). Patients were divided into SSI and non-SSI groups. Preoperative risk factors, including PNI (10 × serum albumin [g/dL] + 0.005 × total lymphocyte count [/μL]), were assessed. Postoperatively, 43 patients (3.9%) experienced SSI. Univariate analysis showed that preoperative PNI (48.5 vs 51.7; p < 0.01), revision status (p < 0.05), male sex (p < 0.01), body mass index (BMI) (p < 0.05), and usage of anticoagulant agents (p < 0.05) differed significantly between the SSI and non-SSI groups. Multivariate logistic regression analysis showed that preoperative PNI (odds ratio [OR], 0.94; 95% confidence interval [CI]: 0.90-0.98; p < 0.01), male sex (OR, 2.64; 95% CI: 1.40-4.99; p < 0.01), length of surgery ≥ 180min (OR, 2.78; 95% CI: 1.30-5.96; p < 0.01), BMI ≥ 30kg/m2 (OR, 2.89; 95% CI: 1.20-6.97; p < 0.05), and revision status (OR, 2.30; 95% CI: 1.07-4.98; p < 0.05) were independently associated with SSI postoperatively. Lower preoperative PNI was found to be a risk factor for SSI after spine surgery. Patients with lower preoperative PNI values should be cautioned about the risk of SSI and provide adequate informed consent.

The role of normal saline irrigation versus povidon iodine of surgical wound in decreasing the rate of surgical site infection in perforated appendicitis

Background: Surgical site infection is most common complication after appendectomy especially in patients with perforated appendicitis.Aim: To assess the role of irrigation of the surgical wound with normal saline in comparison with povidon iodine soaking on the rate of surgical site infection after appendectomy for perforated appendicitis. Methods: This is a prospective randomized study which was carried out in department of surgery at baquba teaching hospital for 116 patients with perforated appendicitis operated on. The study took one year (April 1-2013 to march 31-2014). The patients were divided into two groups: Group A: Surgical wounds washed with normal saline.Group B: Surgical wound washed with povidon iodine.Results: This study have found that 9(15.5%) out of 58 patients developed surgical site infection in group A and 20(34.4%) out of 58 patients develop surgical site infection in group B(p value=0.0320),suggesting that the normal saline is more effective than povidon iodine stacking for surgical site infection of perforated appendicitis with statistically significant results.Conclusions: The syringe pressure irrigation of the surgical wound with normal saline after appendectomy contributes significantly in decreasing the incidence of postoperative surgical site infection in perforated appendicitis.

Predictive Factors for Surgical Site Infections in Patients Undergoing Surgery for Breast Carcinoma.

Operative interventions for breast cancer are generally classified as clean surgeries. Surgical site infections (SSIs), while rare, do occur. This study sought to identify risk factors for SSI, using the National Surgical Quality Improvement Program (NSQIP). NSQIP's participant use data files (PUF) between 2012 and 2015 were examined. Female patients with invasive breast cancer who underwent surgery were identified through CPT and ICD9 codes. Non-SSI and SSI groups were compared and the statistical differences were addressed through propensity score weighting. Multivariate logistic regression testing was used to identify predictors of SSI. This study examined 30 544 lumpectomies and 23 494 mastectomies. SSI rate was 1126/54 038 patients (2.1%). In the weighted dataset, mastectomy, diabetes, smoking, COPD, ASA class-severe, BMI >35 kg/m2, and length of stay (LOS) >1 day were associated with an increased odds ratio (OR) of SSI. The OR for SSI was highest after mastectomy with reconstruction (OR 2.626, P < .001; 95% CI 2.073-3.325). Postoperative variables associated with an increased OR of SSIs included systemic infection, unplanned reoperation wound dehiscence, and renal failure. Mastectomy, diabetes, smoking, COPD, ASA class-severe, BMI >35 kg/m2, length of stay (LOS) >1 day are associated with an increased OR for SSIs following breast surgery.

Surgical site infection in adults undergoing major non-cardiac surgery and its association with anemia, severe bleeding and intraoperative transfusion: A preliminary report from a prospective registry

Introduction&#x0D; Surgical site infection (SSI) is among the most common healthcare-related infections. Given their greater morbidity and surgical complexity, patients undergoing major surgery are exposed to a high risk of SSI.&#x0D; Objective&#x0D; To determine the incidence of SSI in adult patients undergoing major elective non-cardiac surgery, and to identify risk factors associated with its occurrence within the first 30 days after surgery.&#x0D; Methods&#x0D; An analytical study was designed on the basis of a prospective institutional registry. Clinical and laboratory variables associated with perioperative management were recorded. An active search was conducted in order to find SSI episodes, renal failure and multiple organ dysfunction during the first 30 days after surgery. Adjusted logistic regression was done to identify potential associations between risk factors and the development of SSI.&#x0D; Results&#x0D; Overall, 1501 patients were included. The incidence of SSI during the first 30 days after surgery was 6.72% (95% CI 5.57-8.11). ASA III, abdominal surgery and longer procedures were more frequent in the SSI group. Association with the occurrence of SSI was documented for preoperative hemoglobin levels (adjusted OR 0.79 [95% CI 0.72-0.88], p = 0.04), intraoperative transfusion (adjusted OR 2,47 [95% CI 1.16-5.27], p = 0.02) and major blood loss (adjusted OR 3.80 [95% CI 1.63-8.88], p = 0.04).&#x0D; Conclusion&#x0D; Preoperative hemoglobin level, intraoperative transfusion and major bleeding are independent risk factors associated with the occurrence of SSI in adult patients undergoing major elective non-cardiac surgery.

Presence of preoperative Modic changes and severity of endplate damagescore are independent risk factors for developing postoperative surgical site infection: a retrospective case-control study of 1124 patients.

There is increasing evidence of an association between Modic changes (MC) and subclinical infection. However, the association of MC with postoperative surgical site infection (SSI) has not been adequately probed. This study primarily aimed to investigate a probable association between preoperative MC, total endplate damage score (TEPS), and SSI. A retrospective analysis of 1124 patients who underwent surgery in a single institution (2016-2018) was performed, using both univariate and multiple logistic regression analyses to identify independent risk factors for SSI. The prevalence of SSI was 4% (44/1124 patients), with no association with age or sex. The prevalence of MC in the SSI group was significantly higher-79.54% (35/44) compared to 58.79% (635/1080) (p value = 0.006) in the control group with no specific relation to type or location of MC. A higher TEPS was associated with SSI (p value = 0.009). A receiver operating characteristic (ROC) curve for TEPS values to assess predictiveness of SSI showed TEPS ≥ 5.5 to have a better sensitivity of 84% than 72% for a TEPS ≥ 6.5. Univariate analysis showed TEPS > 6 (odds ratio 3.887) to have a stronger association with SSI than the presence of MC (odds ratio 2.725). Among various types of surgeries, discectomy had a higher association with SSI (p value = 0.03) when compared to fusion (p value = 0.071). However, multiple logistic regression analysis revealed only TEPS > 6, presence of MC and hypothyroidism as independent risk factors for SSI. Our data suggest that preoperative MC and TEPS > 6 are independent risk factors for developing surgical site infections. MC could be foci of chronic subclinical infection and not mere markers of degeneration, as initially described.

244. Relationship between 25-hydroxy vitamin D level and surgical site infection in spine surgery

BACKGROUND CONTEXT Surgical site infection (SSI) creates a significant burden on the patient and the health care system. Preoperative medical optimization, antibiotics have been incorporated in standard practice reduce perioperative complications, and many others are currently under investigation. In animal models, 25-hydroxy vitamin D level has been shown to have antimicrobial and wound healing effects. Preoperative levels have been shown to correlate with SSI in thoracic and bariatric surgeries. However, to date it has not been evaluated in spine patients. PURPOSE To investigate whether low vitamin D status is associated with increased risk of developing post-operative infections in spine surgeries. STUDY DESIGN/SETTING Retrospective PATIENT SAMPLE Patients undergoing thoracolumbar spine surgery between November 2012 and March 2019 performed by one fellowship-trained orthopedic spine surgeon at a single academic center. OUTCOME MEASURES The outcome variable was SSI undergoing surgical intervention. METHODS We identified all patients within the stated sample and enrolled only patients with preop vitamin D levels. SSI, age, BMI, season of surgery, race, type of surgery, diagnosis, ASA, smoking status were extracted. The key independent variable was Vit D level (classified as 60 ng/mL= Potentially Harmful). Bivariate analysis with chi-square and t-tests were used to compare characteristics between the non-SSI and SSI cohorts undergoing spine surgery. Multivariable logistic regression analyses were used to determine associations between vitamin D levels and SSIs after controlling for relevant confounders such as BMI, type of surgery, diagnosis, comorbidities. RESULTS A total of 545 patients met our inclusion criteria, 9 (1.7%) of which acquired an SSI. The mean 25-Hydroxy vitamin D was 31.6 ± 13.6 ng/dL in non-SSI group, and 35.7 ± 20.2 ng/dL in SSI group (p-value 0.17). The mean age was 56 ± 15.6 years in the non-SSI group and 64 ± 7.5 years in the SSI group (p- value 0.045). 21.7% of non-SSI patients had moderate risk of vitamin D deficiency, 27.9% had low risk of deficiency, 46.8% had adequate levels and 3.6% had potentially harmful levels. 33.3% of non-SSI patients had moderate risk of Vitamin D deficiency, 11.1% had low risk of deficiency, 33.3% had adequate levels and 22.2% had potentially harmful levels (p-value 0.02). On bivariate analysis, the percentage of patients with potentially harmful levels of Vitamin D in the SSI group was higher than in the non-SSI group (22.2% and 3.6% respectively, p-value 0.02). On multivariable analysis, patients with adequate vitamin D level had lower odds of SSI as compared to vitamin D deficient patients (OR 0.11, CI 0.01-0.98, p-value 0.048). Though not statistically significant, patients with potentially harmful vitamin D level were at higher odds of SSI (OR 1.41, CI 0.11-17.34, p-value 0.79). CONCLUSIONS Our analysis showed that patients with adequate levels of vitamin D has lower risk of SSIs as compared to vitamin D deficient patients after controlling for relevant confounders. Optimizing preop vitamin D levels could potentially reduce the incidence of SSI in spine surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Choice for prophylactic antibiotics: Cefazolin plus metronidazole or cefoxitin alone for endometrial cancer surgical staging.

The use of prophylactic antibiotics has greatly reduced the incidence of surgical site infections after hysterectomy. It is worth discussing which antibiotic is better. The purpose of this study was to investigate the role of the combined utilization of cefazolin and metronidazole for the prevention of surgical site infection in laparoscopic staging surgery of endometrial cancer. A retrospective analysis was performed on the incidence of surgical site infection in patients with endometrial cancer who underwent laparoscopic surgical staging from January 2000 to June 2019 within 1 month after surgery. Logistic regression model was used for univariate and multivariate analysis. A total of 1783 patients were included in this study, of which 641 were treated with cefazoline plus metronidazole (group 1) as a prophylactic antibiotic, while the other 1142 were treated with cefoxitin (group 2). There was no difference in clinical characteristics between the two groups. The rates of surgical site infection in groups 1 and 2 were 3.6% (n = 23) and 5.7% (n = 65), respectively. The most common site of infections was vaginal, with the incidence of 1.7% (n = 11) and 3.3% (n = 38) in groups 1 and 2, respectively. The multivariate analysis disclosed that cefazoline plus metronidazole significantly reduced the incidence of surgical site infections compared with cefoxitin (logistic, odds ratio = 2.213, 95% confidence interval 1.193 to 4.107). Cefazolin plus metronidazole as prophylactic antibiotics for surgical staging of endometrial cancer can more effectively reduce the incidence of surgical site infections than cefoxitin.

Usefulness of inflammatory markers and clinical manifestation for an earlier method to diagnosis surgical site infection after spinal surgery.

To put forward a method for earlier diagnosis of surgical site infection (SSI) after spinal surgery and identify the best cut-offs of the selective signs. Ninety cases were prospectively collected in consecutive patients who underwent spinal surgery. The patients were divided into the SSI group and the normal group. White blood cell (WBC) count, lymphocyte count, serum amyloid A (SAA), procalcitonin (PCT) and C-reactive protein (CRP) were collected pre-operatively and at three andsix days post-operatively. Erythrocyte sedimentation rates (ESR) were acquired pre-operatively and at six days post-operatively. Body temperature (BT) was measured every day during hospitalisation. The conditions of the surgical sites were recorded at three and sixdays post-operatively. Differences of BT, the conditions of the wound and the values of the inflammatory markers between the two groups were studied. Finally, we used the receiver operating characteristic curve (ROC curve) to determine the best cut-offs of the selected signs. Of the 90 patients, SSI occurred in seven and five of them reached a definite diagnosis of SSI as their bacterial cultures were positive. Significant differences were found in CRP levels at three and sixdays post-operatively with a cut-off of > 59.4mg/L and > 34.9mg/L, respectively; ESR level at sixdays post-operatively with a cut-off of > 51.5mm/h; PCT at three days post-operatively with a cut-off of > 0.11ng/mL; and BT at threedays post-operatively with a cut-off of > 37°C. Also, examination of the wound is also an important sign of SSI. CRP, ESR and PCT are considered useful markers for earlier diagnosis of SSI. Combining the above markers with BT and the wound condition yields more accurate results.

Predictive value of CRP/albumin ratio in major abdominal surgery.

Surgical site infection (SSI) is a major cause of morbidity, resulting in significant healthcare and economic implications. The ability to predict patients at high risk of SSI may enable targeted follow-up and management. This study sought to examine the relationship between the CRP/albumin ratio in the prediction of SSI in patients undergoing emergency major abdominal surgery. A retrospective study of all patients who underwent emergency major abdominal surgery in our institution over 2years was performed. Patients were identified from a prospectively maintained database of SSI's and cross-referenced with hospital records. Patient demographics including age, gender, ASA grade, and wound classification (clean, clean/contaminated, contaminated, and dirty) were collated. CRP preoperatively of greater than 5 was statistically significant in predicting an SSI (P < 0.05). In addition, preoperative serum albumin of < 32 was also significant in predicting a superficial site infection. Interestingly, preoperative CRP/albumin ratio did not predict SSI, but postoperative CRP/albumin ratio was predictive at both 24 and 48 hour time points (P < 0.05). Median length of stay in the SSI group was statistically significantly longer at 27.88days (range 7-76) versus 18.32days (1-56) (P < 0.01). Though CRP and albumin have merit in isolation in preoperative identification of patients at risk of SSI, CRP/albumin ratio is a useful postoperatively adjunct in predicting SSI postoperatively at 24 and 48hrs postoperatively.

Postoperative lymphocyte percentage and neutrophil-lymphocyte ratio are useful markers for the early prediction of surgical site infection in spinal decompression surgery.

Although the neutrophil-lymphocyte ratio (NLR) is a simple biomarker for inflammation, its diagnostic value for predicting surgical site infection (SSI) after spinal decompression surgery has not been extensively investigated. We aimed to determine the predictive value of NLR for SSI in patients undergoing spinal decompression surgery. We performed a retrospective observational study of patients who underwent spinal decompression surgery. Consecutive 254 patients were divided into an SSI group and a non-SSI group based on the presence of SSI. We evaluated which markers, including NLR, differed significantly between groups. We then determined the diagnostic cutoff values of these markers for the prediction of SSI based on the significance in the univariate analysis. The incidence of SSI was 7 of 254 patients (2.8%). Univariate analysis showed that there were significant differences in the C-reactive protein (CRP) level at 1 day postoperatively; neutrophil and lymphocyte percentage and NLR at 3-4 days postoperatively; and CRP level, white blood cell count, neutrophil count and percentage, lymphocyte percentage, and NLR at 6-7 days postoperatively between SSI and non-SSI groups. Among these markers, the cutoff values of lymphocyte percentage and NLR at 3-4 days postoperatively for the prediction of SSI were ≤15.1% and ≥4.91, respectively. The cutoff values of lymphocyte percentage and NLR at 6-7 days postoperatively were ≤19.8% and ≥3.21, respectively. Lymphocyte percentage and NLR at 3-4 and 6-7 days postoperatively were useful markers for the early prediction of SSI in patients who had undergone spinal decompression surgery. These parameters may aid in identifying patients at higher risk of SSI after spinal decompression surgery.

Correlation between lumbar multifidus fat infiltration and lumbar postoperative infection: a retrospective case\u2013control study

BackgroundThe aim of this study was to investigate the correlation between lumbar multifidus fat infiltration and lumbar postoperative surgical site infection (SSI). Several clinical studies have found that spine postoperative SSI is associated with age, diabetes, obesity, and multilevel surgery. However, few studies have focused on the correlation between lumbar multifidus fat infiltration and SSI.MethodA retrospective review was performed on patients who underwent posterior lumbar interbody fusion (PLIF) between 2011 and 2016 at our hospital. The patients were divided into SSI and non-SSI groups. Data of risk factors [age, diabetes, obesity, body mass index (BMI), number of levels, and surgery duration] and indicators of body mass distribution (subcutaneous fat thickness and multifidus fat infiltration) were collected. The degree of multifidus fat infiltration was analyzed on magnetic resonance images using Image J.ResultsUnivariate analysis indicated that lumbar spine postoperative SSI was associated with urinary tract infection, subcutaneous fat thickness, lumbar multifidus muscle (LMM) fat infiltration, multilevel surgery (≥2 levels), surgery duration, drainage duration, and number of drainage tubes. In addition, multiple logistic regression analysis revealed that spine SSI development was associated with sex (male), age (> 60 years), subcutaneous fat thickness, LMM fat infiltration, and drainage duration. Receiver operating characteristic curve analysis indicated that the risk of SSI development was higher when the percentage of LMM fat infiltration exceeded 29.29%. Furthermore, Pearson’s correlation analysis demonstrated that LMM fat infiltration was correlated with age but not with BMI.ConclusionIndicators of body mass distribution may better predict SSI risk than BMI following PLIF. Lumbar Multifidus fat infiltration is a novel spine-specific risk factor for SSI development.

Effect of laparoscopic surgery on the risk for surgical site infections in colorectal resection: results from the Health Insurance Review & Assessment Service Database.

PurposeTo compare the hospital length of stay (LOS), duration of antibiotic use, medical costs, and incidence of surgical site infection (SSI) between laparoscopic colorectal surgery (Lap-CRS) and open CRS (Open-CRS).MethodsWe retrospectively reviewed data of the Health Insurance Review and Assessment Service Surgical Antibiotic Prophylaxis assessment (7th assessment, 2015); the nationwide data were collected from patients who underwent CRS from September to November 2015 in low volume hospital to the tertiary hospital level in Korea.ResultsAll 2,751 patients who underwent elective CRS were assessed. The mean hospital LOS (12.18 days vs. 14.16 days, P < 0.001) and mean postoperative LOS (8.21 days vs. 9.46 days, P < 0.001) were shorter in the Lap-CRS group than in the Open-CRS group. The mean duration of antibiotic use was shorter in the Lap-CRS group (2.91 days vs. 3.64 days, P = 0.033). The rate of SSI was lower in the Lap-CRS group, but there was no significant difference between the groups (3.57% vs. 5.01%, P = 0.133). Among the SSI group, the mean LOS (19.5 days vs. 24.9 days, P = 0.081), duration of antibiotic use (12.62 days vs. 15.46 days, P = 0.097), and medical costs showed no significant difference between the 2 groups.ConclusionLap-CRS is significantly associated with reduced hospital LOS and the duration of antibiotic use in this study. However, we could not identify significant differences in the incidence of SSI according to the type of surgery. To assess the overall benefits of Lap-CRS, studies including the rate of SSI up to 30 days postoperatively will be needed in the future.

Procalcitonin and Neutrophil Lymphocyte Ratio After Spinal Instrumentation Surgery.

This was a retrospective observational study. To assess the diagnostic value of procalcitonin (PCT) and neutrophil lymphocyte ratio (NLR) for predicting surgical site infection (SSI) in patients undergoing spinal instrumentation surgery, we analyzed a large consecutive cohort of patients who had undergone spinal instrumentation surgery. Although PCT and NLR are commonly used as markers for bacterial infection, the diagnostic value of these factors for predicting SSI in the context of spinal instrumentation surgery has not been extensively investigated. We retrospectively investigated 242 patients who underwent spinal instrumentation surgery and evaluated the significance of various postoperative measures for predicting SSI, including PCT and NLR. We then determined the diagnostic cut-off values for these markers in the prediction of SSI using receiver operating characteristic curve analysis. Among the 242 patients analyzed, 10 were diagnosed with infection. Even though univariate analysis showed that neutrophil percentage and NLR at 6 to 7 days postoperatively were significant predictors for SSI, PCT at 6 to 7 days postoperatively did not differ significantly between the SSI and non-SSI groups. The cut-off value used for neutrophil percentage at 6 to 7 days postoperatively was more than 69.0% [sensitivity, 80.0%; specificity, 70.0%; area under the curve, 0.737]. The cut-off value used for NLR at 6 to 7 days postoperatively was 3.87 (sensitivity, 70.0%; specificity, 73.2%; area under the curve, 0.688). Neutrophil percentage and NLR at 6 to 7 days postoperatively were more useful markers than PCT at 6 to 7 days postoperatively for early prediction of SSI in patients who had undergone spinal instrumentation surgery. Therefore, routine use of PCT as a predictor of postoperative infection is not supported by the results of this study. 4.

1242. Evaluation of Risk Factors for Development of Total Hip Arthroplasty (THA) Surgical Site Infections (SSI)

BackgroundTHA is one of the most commonly performed surgeries for pathologic diseases of the hip. Multiple risk factors have been identified for SSI including: female gender, previous joint surgery, hematoma, joint dislocation, intraarticular glucocorticoid injection, rheumatoid arthritis, uncontrolled diabetes, anemia, malnutrition, and an immunosuppressed state. The objective of our study is to evaluate obesity (body mass index (BMI) >30) as an independent risk factor for THA SSI and identify other risk factors for SSIMethodsA retrospective case–control (1:3) matched observation study was conducted from January 1, 2014–June 30, 2016. Patients with a THA SSI were identified using NHSN definitions and 3 controls were matched for sex and month of surgery for each SSI case. Patient information was extracted through chart review including BMI, revision surgery, chronic kidney disease (CKD), diabetes mellitus (DM), anemia, malnutrition, smoking, surgery duration, steroid use, pre-operative chlorhexidine (CHG) bathing and nasal povidone–iodine (PI) compliance. Multivariate analysis using a conditional logistic regression model was performed.ResultsAmong 906 THA, 29 patients developed an SSI with 87 matched patients over the 2.5 years. The mean age in the SSI group was 61.0 years, and 37.9% were male. Mean age in the control group was 63.1, and 40.1% were male. In both groups, the most common indications for surgery were osteoarthritis followed by osteonecrosis and malignancy. Results of multivariate analysis identified five independent risk factors for SSI (see Table 1).ConclusionObesity (BMI >30) was identified as an independent risk factor for THA SSI as well as CKD, steroid use and revision arthroplasty. While these risk factors are not easily modifiable, noncompliance with pre-operative CHG bathing and PI administration were also identified as significant SSI risk factor. These findings emphasize the importance of evaluating patients for SSI risk factors including obesity and improving compliance with all pre-operative SSI reduction measures. Disclosures All authors: No reported disclosures.

Abdominal Wound Closure in Gynaecological or Obstetrical Surgery with Vicryl® (Polyglactin910) Versus Vicryl Plus® (Polyglactin910 with Triclosan Added): A Comparative Study

Background: Surgical site infection is the most common post-surgical complication in surgical patients. The incidence of surgical site infection varies from 3-20% (or even more) in different part of the world. To date, the best method and material for skin closure has not been recommended by anybody. Triclosan is an antiseptic agent used for coating a suture material to prevent the infections. This case-controlled study was carried out to determine the comparative efficacy of sutures;&#x0D; Objective: This case-controlled study was carried out to determine the comparative efficacy of sutures: vicryl® and vicryl plus® (triclosan, an antiseptic incorporated with suture), in reducing surgical site infection in laparotomy for clean Gyn/Obs operations.&#x0D; Material and method: This case-controlled study was carried out in Dept. Of Gynae/Obs at Nepalgunj Medical College Teaching Hospital, Kohalpur. The period of the study was from Jan 2018 to January 2019. A total of 50 participants were enrolled in the study, who met the inclusion criteria. The patients were divided into two groups A and B, each consisting of 25 patients. The patients were allocated in the groups alternately to remove bias. The Group A consisted of patients where Vicrylplus® (Ethicon, Johnson &amp; Johnson Company, Ahmadabad, India) polyglactin910 with triclosan) was used and Group B consisted of patients where vicryl ® (Ethicon, Johnson &amp; Johnson Company, Ahmadabad, India) polyglactin910 alone) was used. Patients whose abdominal wounds were found infected, pus swab for culture were taken and sent for aerobic culture and sensitivity. All patients received ceftriaxone and metronidazole single dose before operations prophylactically.&#x0D; Result: Surgical site infection ingroup A was 3 cases out of 25 (12%) and in group B it was 6 cases out of 25(24%). Triclosan added polyglactin910 suture found to be statistically non significant concerning prevention of SSI as compared to polyglactin910 (p=0.472). The mean age of the study population was in group A was (29.76±7.47) and in group B was (27.12±7.42).

Incidence, Prevalence, and Analysis of Risk Factors for Surgical Site Infection After Lumbar Fusion Surgery: ≥2-Year Follow-Up Retrospective Study

Surgical site infection (SSI) in spine surgery remains a significant cause of morbidity and prolonged hospitalization. We intended to document our experience in our center and to highlight possible factors influencing SSI in posterior lumbar fusion surgery. Between June 2015 and March 2017, 448 consecutive patients with lumbar degenerative disease who underwent classic open transforaminal lumbar interbody fusion were enrolled in the study. We divided the patients into the SSI group and the non-SSI group and compared their patient-specific and procedure-specific factors. Univariate and multiple logistic regression analyses were performed to determine risk factors. There was a significant difference between groups in age (P= 0.001), body mass index (P < 0.001), subcutaneous fat thickness (P < 0.001), preoperative American Society of Anesthesiologists (ASA) score (P < 0.001), postoperative hemoglobin (P= 0.003), preoperative serum albumin (P < 0.001), operative time (P < 0.001), operated levels (P < 0.001), postoperative drainage (P= 0.004), time of draining (P < 0.001) and late-presenting dural tear (P= 0.008). Logistic regression analysis of these differences showed that thicker subcutaneous fat thickness, higher preoperative ASA score, lower preoperative serum albumin, and longer time of draining were significantly related to SSI (P < 0.05). The risk factors for SSI after lumbar fusion surgery are multifactorial. These data should provide a step toward the development of quality improvement measures aimed at reducing complications in high-risk patients. These factors may prove useful for patient counseling and for surgical planning.

The incidence and risk factors for surgical site infection in older adults after gastric cancer surgery: A STROBE-compliant retrospective study.

Surgical site infection (SSI) is a well-known complication in older adults. However, there have been no studies on SSI after gastrectomy in older adults. Therefore, we aimed to investigate the incidence, risk factors, and outcomes of SSIs after gastrectomy in older adults.We performed a retrospective cohort study of older adults, aged 65 years or older, who underwent gastrectomy between January 2015 and December 2015 at the Severance Hospital in Seoul, Korea. The incidence and outcomes of SSIs after gastrectomy were evaluated, and the risk factors for SSI were identified using multivariate analyses.We identified 353 older adults who underwent gastrectomy. Of these, 25 patients (7.1%) developed an SSI. Multivariate analysis indicated that open surgery (odds ratio, 2.71; 95% confidence interval, 1.13–6.51; P = .03) and a longer operation time (odds ratio, 1.01; 95% confidence interval, 1.00–1.01; P = .04) were independent risk factors for SSI after gastrectomy. In the SSI group, the incidence of postoperative fever (84.0% vs 51.8%; P < .001), length of postoperative hospital stay (13 days vs 6 days; P < .001), and re-admission rates within 30 days postoperatively (32.0% vs 3.4%; P < .001) were significantly higher than those in the non-SSI group.The risk factors for SSI in older adults after gastrectomy were open surgery and a longer operation time. When an SSI occurred, the postoperative hospital stay was prolonged and the chances of having a postoperative fever and being re-admitted within 30 days increased.

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

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

Do the Severity of Peritonitis and Stoma Creation Influence the Occurrence of Incisional Surgical Site Infections in Patients With Colorectal Perforation?

Objective To identify the risk factors for incisional surgical site infection (SSI) in patients undergoing emergency surgery for colorectal perforation. Summary of Background Data Emergency surgery for colorectal perforation carries an especially high risk of incisional SSI. Although the risk factors of incisional SSI after colorectal surgery have been analyzed, no study has focused exclusively on patients with colorectal perforation. Methods Patients with colorectal perforation who underwent emergent surgery from 2010 to 2015 were enrolled. The factors associated with the occurrence of postoperative incisional SSI were evaluated. Results We enrolled 108 patients with colorectal perforation who underwent an emergency operation. Of these, 13 patients who died within 30 days after surgery were excluded. The mean age of the 95 study patients was 70 ± 13 years; 48 (51%) patients were male. The incisional SSI group comprised 26 patients (27%). Multivariate logistic regression analysis showed that stoma creation [odds ratio: 11.34; 95% confidence interval: 2.06–214.14] was an independent risk factor for incisional SSI. However, none of the clinical indicators of severe peritonitis and sepsis, including body temperature, systolic blood pressure, heart rate, preoperative white blood cell count, and C-reactive protein, were associated with the occurrence of incisional SSI. Conclusions Stoma creation was an independent risk factor for postoperative incisional SSI. Therefore, in this patient population, meticulous postoperative wound management is essential.