The number of arthroplasty procedures and infection-related complications, including prosthetic joint infections (PJIs) and surgical site infections (SSIs), continues to rise. Although current guidelines recommend cefazolin or cefuroxime as the first-line perioperative prophylactic antibiotic, substitutions with non-cephalosporins remain common, especially among patients with reported β-lactam allergies. These substitutions may increase infection risk and healthcare costs. Evidence comparing outcomes across antibiotic classes remains variable. We conducted a systematic review and meta-analysis of studies comparing single-agent cephalosporin versus single-agent non-cephalosporin prophylaxis in adults undergoing primary arthroplasty. Cochrane, Embase, Medline, Scopus, and Web of Science were searched from database inception through January 2025. Random-effects or fixed-effects models were used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup analyses stratified results by cephalosporin type, study era, and risk of bias. Twenty-three studies (7 randomized controlled trials and 16 observational studies) were included, encompassing 191,527 arthroplasties in the cephalosporin arm and 20,058 in the non-cephalosporin arm. The odds of PJI were lower with cephalosporins (OR 0.59; 95% CI, 0.46-0.75). No overall difference was observed for SSI (OR 0.70; 95% CI, 0.36-1.36), though post-2013 studies and the cefazolin subgroup demonstrated a significant protective effect. Randomized trial estimates were limited and heterogeneous and did not reach statistical significance. Certainty of evidence was graded as moderate. Cephalosporins, particularly cefazolin or cefuroxime, remain the preferred prophylactic agents for primary arthroplasty. This quantitative synthesis reinforces their protective association against prosthetic joint infection and supports adherence to guideline-endorsed prophylaxis.

Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) are known to colonize various bodily locations and present unique challenges in the prevention and treatment of deep surgical site infections (SSIs). The aim of this study was to determine if preoperative colonization testing and decolonization protocols reduce the rate of SSIs in patients undergoing surgical neuromodulation procedures. Using a prospectively maintained database, a single-surgeon, single-facility, retrospective study identified 513 spinal cord stimulation (SCS) procedures, 1050 deep brain stimulation (DBS) procedures, and 414 intrathecal baclofen (ITB) pump procedures performed between June 2013 and June 2024. These procedures were performed in 361 patients receiving SCS devices, 375 patients receiving DBS devices, and 308 patients receiving ITB pumps. Preoperative S. aureus nasal swab results, postoperative superficial and deep SSIs requiring device removal, and patient-related comorbidities were analyzed. Patients were monitored for at least 6 months postoperatively for deep SSIs. Different perioperative colonization screening, decolonization, and antibiotic protocols were assessed. Approximately 20% of all patients undergoing implantation of SCS/DBS devices and 25% of patients undergoing implantation of ITB devices had positive results for S. aureus. MSSA colonization was 14 times more common than MRSA colonization in patients who underwent SCS procedures, 9 times more common in those who underwent DBS procedures, and 3 times more common in those who underwent ITB pump procedures. MRSA colonization was 3 times more common in patients who underwent ITB pump procedures than in those who underwent SCS/DBS procedures. There were no deep SSIs in the SCS group. Patients in the ITB pump group had a decrease in infection rate from 8% down to < 2% after implementation of preoperative decolonization protocols. This study represents the most comprehensive report to date analyzing the prevalence of preoperative MRSA and MSSA colonization in patients undergoing a wide array of surgical neuromodulation procedures. These data support the recommendation that patients receiving neuroimplantable devices, specifically patients undergoing ITB pump procedures, be 1) screened for both MRSA and MSSA, as screening for MRSA alone will not reveal a large fraction of S. aureus colonization; and 2) considered for decolonization protocols prior to surgery. Following these procedures significantly reduced SSIs in patients who underwent ITB pump implantation procedures and might have reduced SSIs for SCS and DBS implantation procedures as well.

The addition of a glycopeptide antimicrobial to cephalosporin therapy has been reportedly adopted in practice to prevent surgical site infections (SSIs). We conducted an economic evaluation from the healthcare sector perspective to assess the cost-effectiveness of adding vancomycin to cefazolin prophylaxis in patients undergoing arthroplasty. Data were collected over 180 days in a randomised controlled trial conducted at 11 hospitals in Australia, involving 2044 patients assigned to vancomycin and 2069 to placebo, both in addition to cefazolin. Health utilities were measured using EQ-5D-3L at baseline and 30 days, 90 days, and 180 days post-surgery. Healthcare costs (Australian dollars [AU$]; 2022 values) were estimated using Medicare claim data and hospital administrative records. Bootstrap was used to estimate means and 95% confidence intervals (CIs) of healthcare costs and quality-adjusted life years (QALYs). The net monetary benefit framework was used to construct a cost-effectiveness acceptability curve. Over 180 days, 96 SSIs occurred in the vancomycin group, and 79 in the placebo group. Mean QALYs were 0.392 (95% CI 0.389-0.395) in the vancomycin group and 0.394 (95% CI 0.391-0.397) in the placebo group. Mean total healthcare costs were AU$5184 (95% CI 4926-5480) in the vancomycin group and AU$5018 (95% CI 4772-5293) in the placebo group. Using willingness-to-pay and willingness-to-accept thresholds from AU$0 to AU$3,000,000, the probability of vancomycin being not cost-effective ranged from 0.79 to 0.87. Adding vancomycin to cephazolin prophylaxis in arthroplasty is most likely not cost-effective. Omitting vancomycin could lead to substantial annual savings for the healthcare sector without compromising health outcomes.

Knowledge and practice of surgical site infection prevention and associated factors among nurses working in public hospitals of Sodo town, Wolaita Zone, Southern Ethiopia.

The trans-axillary reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) technique demonstrates advantages in operative efficiency and cosmetic outcomes. This large-scale study evaluated its surgical safety and identified associated risk factors. We retrospectively analyzed clinical data from patients undergoing R-E-NSM between May 2020 and September 2023. Multivariable logistic regression identified independent risk factors for complications. The analysis included 931 R-E-NSM procedures in 727 patients. Breast reconstruction was performed in 618 (85.00%) cases. The overall complication rate was 14.31%, with major complications occurring in 2.20% of cases. A breast cup size of D or larger was an independent risk factor for major complications (OR, 16.00; 95% CI, 1.89-135.2; P = 0.01). Independent risk factors for any complication included breast ptosis (Grade I: OR, 1.96; 95% CI, 1.13-3.43; P = 0.02; Grade II: OR, 1.77; 95% CI, 1.01-3.90; P = 0.046) and adjuvant chemotherapy (ACT) (OR, 1.76; 95% CI: 1.05-2.96; P = 0.03). Independent risk factors for surgical site infection were prepectoral implant-based breast reconstruction (IBBR) (OR, 4.62; 95% CI, 1.04-20.59; P = 0.045), dual-plane IBBR (OR, 6.87; 95% CI, 1.55-30.45; P = 0.01), and ACT (OR, 2.15; 95% CI, 1.08-4.28; P = 0.03). Late cosmetic revisions occurred in 1.54% of patients. At a median follow-up of 30.20 months, locoregional recurrence and distant metastasis rates were both 1.00%. R-E-NSM is a safe option for treating benign and malignant breast diseases. Special consideration is warranted for patients with larger breast volume (cup size ≥D). Long-term comparative studies are needed to further validate its role.

Social network analysis-informed peer champions for hand hygiene in the operating room: a cluster randomised controlled trial.

Evidence from the literature suggests that vitamin D has indirect antimicrobial effects and may be associated with a reduced risk of infections. This study aimed to systematically evaluate the association between vitamin D deficiency and the risk of developing surgical site infections (SSIs). All types of studies will be included in the systematic review. Up to December 2025, Medline, Embase, Cochrane, Web of Science, CINAHL, Google Scholar, ClinicalTrials.gov, WHO-ICTRP, Cochrane Central Register of Controlled Trials, and relevant citations will be searched. The primary outcome will be the development of SSIs. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Meta-analysis will be performed using bias-adjusted inverse variance heterogeneity methods. The risk of bias will be assessed using the MASTER scale, and the certainty of evidence will be determined using the GRADE framework. Although many risk factors for SSIs have been identified, the role of vitamin D remains unclear. SSIs impose a significant burden on patients and healthcare systems. This systematic review and meta-analysis aims to comprehensively evaluate the impact of vitamin D on SSI risk by including all relevant studies without language restrictions, using rigorous methodology in accordance with the Cochrane Handbook and PRISMA guidelines. If an association is established, preoperative screening and optimization of vitamin D levels could help reduce the burden of SSIs. PROSPERO registration number 427175.

Introduction: Antimicrobial resistance is a notable threat to global health. In an institution-specific report generated through National Surgical Quality-Improvement Pediatric Program (NSQIP-P) for our institution, our orthopaedic surgery department was a high outlier for postoperative antibiotic prophylaxis duration of &gt;24 hours. We describe an initiative to reduce the incidence of postoperative duration of antibiotics of &gt;24 hours for pediatric patients undergoing orthopaedic surgery. Methods: An interdisciplinary team was formed to identify and monitor interventions for improvement. Patients undergoing orthopaedic surgeries and receiving postoperative intravenous antibiotics were included. First-stage interventions included verbal education for front-line staff to ensure that postoperative antibiotic prescribing did not exceed two doses. Second-stage interventions included a modification that changed the default postoperative antibiotic dose from three to two doses for the three most used orthopaedic admission order sets in the electronic medical record. Patient-level, electronic health record data elements were extracted and presented through a created electronic dashboard to track near-real-time metrics. Surgical site infections were tracked through NSQIP-P database as a balancing measure. Results: A total of 2,546 surgical cases met study criteria: 1,680 and 866 cases in the pre- and post-intervention cohorts, respectively. Cefazolin was the primary postoperative antibiotic prescribed in 95.4% of cases. In the preintervention cohort, &lt;24 hours of postoperative antibiotics was 36.7% compared with 84.7% (48.0% improvement) in the post–second stage intervention cohort. A sampling of postintervention cases demonstrated no notable increase in surgical site infection events compared with matched period sampling of preintervention cases. Conclusion: NSQIP-P can be leveraged to improve antibiotic stewardship in pediatric orthopaedic surgical cases. Multidisciplinary collaboration, front-line staff education coupled with electronic medical record order set modification, and near-real-time data tracking for provider feedback resulted in a 48.0% improvement of patients receiving &lt;24 hours of perioperative antibiotics. Level of Evidence: III

Surgical site infections (SSIs) and prolonged length of stay (LOS) are significant challenges in surgical care. The integration of nurse practitioners (NPs) into surgical teams has been recognized as a potential strategy to improve patient outcomes and optimize resource utilization. This retrospective cohort study aimed to evaluate the impact of NP-led ward rounds on SSI incidence, LOS, and health care costs among general and gastrointestinal surgery patients in a Japanese acute care hospital. Patients were divided into non-NP and NP groups. Surgical site infection diagnoses were based on The Centers for Disease Control and Prevention criteria. Data were analyzed using multivariate logistic regression for SSI incidence and gamma regression for LOS. The NP group showed a significant decrease in overall SSI incidence and a significantly shorter LOS. Estimated annual health care costs were substantially reduced through NP intervention. The implementation of NP-led ward rounds significantly improved patient outcomes by reducing SSI incidence and LOS. This intervention also led to a substantial reduction in annual health care costs, demonstrating the value of NPs in optimizing health care resource utilization. Integrating NPs into surgical teams enhances SSI prevention and promotes cost containment. Their comprehensive assessment and early intervention capabilities are vital for improving the quality of patient care and enhancing the efficiency of surgical services.

The aim of this study was to compare outcomes of microsurgical varicocelectomy (MV) versus percutaneous angioembolization (AE) in men with varicoceles causing infertility or scrotal pain. Endpoints included postoperative changes in semen parameters, complication rates, pain relief, need for additional interventions, and the influence of body mass index (BMI). We retrospectively reviewed 264 male patients treated for varicocele from July 2015 to July 2024 (MV: 214 patients, and AE: 50 patients). Only patients older than 18 years were included. Indications were infertility or chronic varicocele-related scrotal pain. Pre- and post-treatment semen analyses were compared in infertile men, and pain outcomes were assessed in those treated for pain. Complications and secondary interventions were recorded, and outcomes were stratified by BMI. MV significantly improved sperm concentration, motility, and total motile count within 3-6 months, while AE showed no significant change. Complications occurred only in the MV group (8.9%), including hydrocele, hematoma, and surgical site infection, while no complications were reported in the AE group. Persistent pain was observed in one-third of patients in both groups, and AE was associated with a higher rate of secondary intervention (14.0%) compared to MV (6.6%). BMI was not linked to complications or operative time but was associated with poorer baseline semen quality. Within 3-6 months post-treatment, varicocelectomy yielded greater improvement in semen quality, while AE offered a favorable safety profile but less reproductive benefit and a higher retreatment rate. Both approaches were safe across BMI categories, though longer-term studies are needed to clarify patient selection and delayed outcomes.

Role of Operating Room Air Pressure Variability on Development of Surgical Site Infections in Surgical Procedures Classified as COLO and HYST by NHSN: A Retrospective Cohort Study.

Surgical Site Infection (SSI) of an abdominal incision is a dreaded infectious complication following colorectal surgery. Understanding the intraoperative microbiology holds the key to prevention. Genomic sequencing has revolutionised culture-independent techniques, allowing for a more sensitive tool in microbial detection. The purpose of this study is to determine whether an aberrant microbiota is present within the intraoperative surgical site in patients that develop an SSI. The subcutaneous abdominal surgical site of patients undergoing elective bowel resection was opportunistically sampled, following fascial closure. DNA was recovered from the swabs and used for 16S rRNA gene amplicon sequencing. The intraoperative microbiota was compared in those with and without a subsequent SSI with focus on alpha diversity and beta diversity, as well as taxonomic composition. 16/123 patients developed an SSI. The bacterial profile within the surgical site showed a strong presence of obligate anaerobes in all patients. Chao1, Shannon, and Simpson measures of alpha diversity from the intraoperative swabs were all significantly increased in SSI patients (p = 0.05, 0.05 and 0.05, respectively). Beta diversity demonstrated no significant separation between patients (Bray-Curtis dissimilarity index, PERMANOVA p = 0.394). To the best of our knowledge this is the first study to demonstrate an aberrant intraoperative microbiota of the surgical site associated with subsequent infection. Pending validation studies, this provides a target for the strategic manipulation of the surgical site to reduce the burden of infection.

BackgroundEmergency abdominal surgeries (EASs) in children are often necessary to address life-threatening congenital and acquired conditions. This study aimed to determine short-term outcomes and predictors of in-hospital mortality after EAS in children at Mbarara Regional Referral Hospital (MRRH), South-Western Uganda.MethodsThis prospective study was conducted from June to September 2024 and included children aged 0–17 years who underwent EAS at MRRH. Outcomes measured were 30-day in-hospital mortality, complications, and length of hospital stay. Overall survival after EAS was plotted using Kaplan-Meier curves. Cox regression analysis was used to determine predictors of in-hospital mortality after EAS.ResultsThe 30-day mortality rate for all pediatric abdominal surgery was 152 per 10 000 person-days of hospitalization. Among 96children who required EAS at MRRH, the risk of death was significantly increased in those who had hypoxemia (adjusted hazard ratio (aHR) 12.4, p=0.011) and hypokalemia (aHR 5.02, p=0.044). Forty-one patients (42.7%) developed postoperative complications, the most common being surgical site infection (14.58%) and pneumonia (5.2%).ConclusionThe 30-day mortality rate after pediatric EAS in our setting is high and children who present with hypokalemia and hypoxemia are at increased risk of mortality after EAS.

Factors associated with infection-related failure in autologous cranioplasty for traumatic brain injury: a matched case-control study in Vietnam.

Background: Esophagectomy is an invasive treatment for esophageal cancer associated with postoperative complications and mortality. Herein, to prevent postoperative complications, early extubation (EE) in the operating room without overnight mechanical ventilation (MV) was introduced. Methods: We compared overnight MV and EE to evaluate the impact on short-term outcomes post-esophagectomy. In total, 91 patients with thoracic esophageal cancer who underwent subtotal esophagectomy were included. In total, 26 patients were extubated in the operating room postoperatively (EE group), and 65 were extubated the following morning (MV group). Propensity score matching was used to assemble a well-balanced cohort. The clinical and postoperative outcomes were investigated; the postoperative fluid balance in the intensive care unit was compared between groups. Results: Propensity score matching produced 21 paired cases from the cohort; the groups were comparable. The EE group had a lower operative time and fluid-in/out balance in the intensive care unit than the MV group. Regarding postoperative outcomes, the EE group had shorter postoperative hospital and intensive care unit stays. In addition, the EE group had significantly fewer incidences of pulmonary complication and surgical site infection. Conclusions: EE was associated with shorter postoperative hospital and intensive care unit stays and reduced incidence of pulmonary complications and surgical site infections by preventing volume overload in the intensive care unit.

To describe the methodology used to identify the contributors to a perceived sudden increase in exploratory celiotomy surgical site infections (SSI) and complications at the North Carolina State University Veterinary Teaching Hospital (NCSU VTH) between 2019 and 2020 and evaluate the effect of the designed intervention up to 4 years after its implementation. Case-control retrospective study over a five-year period. A total of 448 horses that underwent exploratory celiotomy for the treatment of acute abdominal pain were included. Medical records of horses that underwent exploratory celiotomy between 2019-2024 were reviewed from software systems used at the NCSU VTH. A surgical audit was conducted to assess adherence to best practices and identify factors contributing to increased SSI incidence. This led to the development of an evidence-based intervention to address procedural deficiencies and incorporate preventative perioperative strategies. The approach, resultant protocols, and reduction of SSI incidence are described. Data were analyzed using Fisher's exact test and univariate logistic regression. Statistical significance was set to p < .05. A significant increase in %SSI was observed from 7.7% in 2019 to 29% in 2020 (p = .0067). Following new protocol implementation, %SSI decreased to 2.3%. A surgical audit enabled the development of an evidence-based intervention that significantly reduced SSI incidence after exploratory celiotomy surgery. Surgical audits serve as critical quality-of-care measure, allowing hospitals to identify procedural deficiencies. There is currently no literature that describes structured processes to manage this kind of problem in veterinary medicine. Surgical audit implementation may help other hospitals faced with similar challenges.

Incisional hernia is a common postoperative complication, particularly following abdominal surgeries, and is frequently associated with recurrence and impaired healing due to postoperative infections. In this study, a dual-layered hernia repair biopatch was developed by integrating a 3D-printed polycaprolactone/gelatin (PCL/Ge) scaffold, providing mechanical support, with an electrospun nanofibrous layer composed of PCL/Ge/κ-carrageenan (κ-C) to promote wound healing. To impart antimicrobial functionality, the scaffolds were functionalized with eitherAgrimonia eupatoria(AE) extract or the clinically used antibiotic rifampicin (RIF). Commercial polypropylene (PP) meshes were employed as control groups in bothin vitroandin vivoevaluations. Mechanical testing demonstrated that the developed biopatches exhibited tensile strengths within a clinically relevant range, with values of 5.13 MPa and 2.49 MPa for the 3D-printed RIF-loaded and AE-loaded electrospun-coated scaffolds, respectively. Both AE- and RIF-loaded groups showed pronounced antibacterial activity againstS. aureus, a predominant pathogen associated with surgical site infections. Sustained and controlled release profiles were observed over 160 h, with cumulative release values of approximately 30%-35%.In vivoevaluation using a rat incisional hernia model revealed that AE exhibits strong potential as an alternative to conventional antibiotics, attributable to its phenolic-rich composition and associated anti-inflammatory and tissue-remodeling properties. Overall, these findings demonstrate that the proposed dual-layer biopatch, which integrates mechanical reinforcement with sustained antimicrobial activity, represents a promising and effective strategy for infection-resistant incisional hernia repair.

INTRODUCTION Abdominally based free flap breast reconstruction offers excellent long-term outcomes, but donor-site morbidity remains a concern. Lower back pain is a prevalent musculoskeletal condition that may impair core stability and abdominal donor site recovery after surgery. This study evaluated the association between a preexisting diagnosis of lower back pain and long-term physical well-being of the abdomen after surgery. METHODS We conducted a retrospective study of patients who underwent abdominally based free flap breast reconstruction between 2017-2024. Patients were categorized by the presence or absence of a preexisting diagnosis of lower back pain. The primary outcome was physical well-being of the abdomen, assessed using BREAST-Q. Multivariable linear mixed-effects models evaluated the association between lower back pain and abdominal well-being. RESULTS A total of 2,594 patients were included. Donor site complications occurred in 15% of patients, including wound dehiscence (9.1%), surgical site infection (4.3%), palpable bulge (2.4%), seroma (2.2%), and hematoma (0.5%). Patients with preexisting lower back pain (n=298, 11.5%) had significantly lower abdominal well-being scores compared to those without at 1 year (62 vs. 69; p<0.001) and 5 years (65 vs. 76; p=0.014). On multivariable analysis, lower back pain was independently associated with worse abdominal well-being (β = -5, 95% CI: -8.9 to -0.97; p=0.015), exceeding the minimal clinically important difference of ≥4. CONCLUSION Preexisting lower back pain is associated with significantly worse long-term abdominal well-being after breast reconstruction. Future studies should investigate targeted interventions such as pre- and postoperative core rehabilitation protocols to improve outcomes in these high-risk patients.

Efficacy and Safety of Topical Vancomycin for the Prevention of Surgical Site Infections in Spinal Surgery: A Meta-Analysis of Randomized Controlled Trials.

Multicenter evaluation of wound closure techniques and postoperative complications following pediatric nonidiopathic scoliosis surgery.