Surgical Site Infection Research Articles

Antibiotic Prophylaxis for Surgical Site Infection After Traumatic Hollow Viscus Injury

This cohort study investigates the association between antibiotic prophylaxis and surgical site infection after traumatic hollow viscus injury.

Bowel preparation before elective right colectomy: Multitreatment machine-learning analysis on 2,617 patients

BackgroundIn the worldwide, real-life setting, some candidates for right colectomy still receive no bowel preparation, some receive oral antibiotics alone, some receive mechanical bowel preparation alone, and some receive mechanical bowel preparation with oral antibiotics, with varying degrees of compliance to preoperative intravenous antibiotic prophylaxis. Previous studies mainly focused on left-sided colorectal anastomoses while less attention has been devoted to right-sided ileocolic anastomoses. When high-level evidence from randomized clinical trials is lacking, multiple-treatment propensity score weighting analysis of prospective data on the basis of generalized boosted model is superior to a simple propensity score-matching analysis and to an inverse probability weighting in terms of external validity and bias reduction. MethodsThis is an analysis on the basis of machine-learning procedures of 2,617 patients who underwent elective right colectomies. ResultsThe risk of surgical-site infections (5.0% after no bowel preparation) was significantly lower after mechanical bowel preparation with oral antibiotics (4.0%, P = .017), significantly greater after mechanical bowel preparation alone (8.6%, P = .019), and comparable after oral antibiotics alone (3.9%). The risk of anastomotic leakage (3.2% after no bowel preparation) was significantly greater after oral antibiotics alone (4.8%, P = .013). Concerning secondary outcomes, no significant differences were recorded for the risk of overall morbidity and reoperation. The risk of readmission (3.0% after no bowel preparation) was significantly reduced after mechanical bowel preparation with oral antibiotics (1.5%, P = .046), and the risk of major morbidity (5.1% after no bowel preparation) was significantly greater after oral antibiotics alone (6.7%, P = .007). ConclusionThis multitreatment machine-learning analysis, despite some limitations, showed that mechanical bowel preparation with oral antibiotics is associated with a decrease in surgical-site infections after elective right colectomy compared with no bowel preparation.

A single-centre, retrospective study of incisional hernia repair outcomes post kidney transplantation.

Incisional hernias (IH) after kidney transplantation (KTx) can cause significant morbidity in kidney transplant recipients (KTR). We aimed to report the outcomes of surgical repair of IH in KTR from our centre. We retrospectively analysed all the IH repairs in KTR from May 2018 to May 2023. We documented pre-transplant baseline characteristics, peri- and post-KTx events and outcomes and post-IH repair complications. We also documented length of stay, survival, and hernia recurrence post-IH repair. We performed 35 incisional hernia repairs in 34 KTR from May 2018 to May 2023 with an overall incidence of 1.63% symptomatic IH. Mean patient age was 56.7 ± 10.1 years and mean body mass index (BMI) 29.7 ± 6.49kg/m2. A history of previous hernia operation and open abdominal operations was present in 11.4% and 22.9% of the population, respectively. The types of repairs performed were primary (5.7%), onlay (62.9%), inlay (2.9%) and retromuscular sublay (28.6%). Mean hernia neck size was 8.9 ± 5.6cm. After IH repair, there was no perioperative mortality with an average 5.5 ± 3.9 days of length of stay. There were seven episodes (20%) of IH recurrence. There was a 6% of superficial wound dehiscence rate and a 3% of surgical site infection. Pearson's correlation test revealed that post-operative hernia recurrence was not related with neck size, post-transplant complications or pre- and post-transplant characteristics, as well as post-transplant outcome. The recurrence rate in our cohort was 20%. Known risk factors for IH in KTR as well as post-KTx events were not correlated with hernia recurrence or other post-hernia repair complications.

Early clinical outcomes and medical complications following long segment fusion for adult spinal deformity with and without three column osteotomy

BackgroundSurgical treatment of adult spinal deformity (ASD) commonly involves long-segment fusion with or without three column osteotomies (3CO) to provide satisfactory correction of sagittal and coronal balance. While some clinical studies have implicated 3CO as a driver of high surgical complication rates, these prior investigations are limited by small sample size. Herein, we compare early outcomes and adverse events in patients undergoing long segment posterior spinal fusion for ASD with and without 3CO. MethodsA multicenter administrative database was queried for patients undergoing elective posterior spinal fusion for ASD. Patients were stratified based upon long segment fusion with and without 3CO. Preoperative patient demographics, procedural characteristics, hospitalization events, and postoperative complication rates were evaluated. Student's t-test and Fisher's exact test were utilized where appropriate to compare differences between the two groups for continuous and categorical variables. Results340 cases met the inclusion criteria, of which 156 involved 3CO. Patients who required 3CO had a lower rate of preoperative diabetes (22.3 % vs 10.3 %, p = 0.003), higher rates of non-home discharge (26.2 % vs 57.1 %, p < 0.001), longer operation time (245.62 ± 9.45 vs. 434.40 ± 11.65, p < 0.001), and longer length of stay (4.17 ± 0.66 vs. 7.76 ± 0.83, p < 0.001). In terms of complications, 3CO patients had higher rates of deep surgical site infection (0 % vs 3.2 %, p = 0.02), reintubation (0 % vs 4.5 %, p = 0.004), inability to wean off ventilator (0 % vs 2.6 %, p = 0.04), and perioperative blood transfusion (20.1 % vs 76.3 %, p < 0.001). ConclusionsIn this retrospective analysis, posterior 3CO was frequently undertaken but associated with higher risk for postoperative adverse events following spinal deformity correction.

Risk-Adapted Use of Vancomycin in Secondary Scoliosis Surgery May Normalize SSI Risk in Surgical Correction of High-Risk Patients.

Introduction: Intrawound application of vancomycin is becoming increasingly controversial for the prevention of surgical site infection (SSI). As children undergoing spinal fusion for secondary scoliosis are at high risk for SSIs, evidence regarding the impact of intraoperative vancomycin installation on SSI rates in these patients is of utmost importance. Methodology: A single surgeon cohort of patients under 18 years of age undergoing surgery for secondary scoliosis in 2017 was analyzed with regard to the development of SSIs requiring surgical revision and adverse events. Use of vancomycin was restricted to cases with higher risk of infection. Patients undergoing distraction surgery for growing devices were excluded. Results: After exclusions, 64 patients remained (vancomycin n = 39, control n = 25). The SSI rates were 12.8% in patients receiving vancomycin (n = 5/39) and 4% in the control group (n = 1/25, p = 0.785). None of the patients suffered from adverse events. Univariable logistic regression revealed younger age (p = 0.03) and meningomyelocele as predictors for SSI (p = 0.006), while the high-risk group receiving vancomycin was not at higher odds for SSI, also after adjustment for possible confounders such as age or MMC (p = 0.031; p = 0.009). Discussion: SSI rates were comparable between groups, suggesting a normalization of SSI risk in the vancomycin-treated patients with a preoperatively increased risk of SSI. Future, larger studies in these rare diseases are needed to confirm these results.

Postoperative Complications in Diabetic type-2 Verses Non-Diabetic Patients Undergoing Appendectomy. A Comparative clinical Study

Background: Diabetes Mellitus (DM) is known to double the risk of postoperative complications because of weak immunity and compromised healing. Objectives: To analyse the rate of postoperative complications among diabetic and non-diabetic patients who have undergone appendectomy to determine whether the level of diabetes management has an impact on wound healing. Methodology: A prospective study was done on n=300 patients who were diagnosed with acute appendicitis and were scheduled to undergo appendectomy; of which n=150 patients had diabetes type-2 and n=150 were non- diabetics. Concerning adverse outcomes, the incidence of surgical site infections (SSIs), prolonged healing of the surgical site, and the number of days spent in the hospital after the operation were identified. Diabetes mellitus was defined based on self-reported diagnosis and glycemic control was evaluated using HbA1c level with the cut-off of &gt;7%. Chi-square and t-tests were used in the analysis of data while multivariate logistic regression was used to assess predictors of complications. p≤0.05 was considered statistically significant. Results: Diabetic patients had a higher incidence of surgical site infections, 15.3% and 5.3%, p= 0.007 for diabetic and non-diabetic patient respectively and delayed wound healing 10.7% and 3. 3%, p = 0.015 for diabetic and non-diabetic patients respectively. Patients with HbA1c &gt; 7% had a higher rate of SSIs of 21. 8 % and delayed healing of 15.4% compared well-controlled diabetics (p = 0.009 and p=0.02 respectively). It was more prolonged in the diabetic patients (6.1 as against 4. 3 days, p&lt;0.001). Diabetes was found to be an independent risk factor for SSIs and slow wound healing. Conclusion: Diabetic patients who have undergone appendectomy were more susceptible to SSIs and slow healing of the wound especially if their blood glucose levels were not well controlled. It is possible that enhanced perioperative glycemic control can decrease postoperative adverse effects.

Magnetic lymphatic tracing for omission of sentinel lymph node biopsies in mastectomy patients: a community cancer center experience.

Patients with ductal carcinoma in situ (DCIS) and patients undergoing risk reduction mastectomy may undergo sentinel lymph node biopsy (SLNB) at the time of mastectomy to complete axillary staging were an underlying invasive malignancy to be found on final pathology. Among patients with DCIS undergoing mastectomy, 15-29% of patients will have invasive disease on final pathology; therefore, approximately 70-85% of patients may benefit from avoiding SLNB. Superparamagnetic tracers (SPMT) have been proven to be non-inferior to the standard radioisotope and blue dye combination. SPMT remains active for several weeks, allowing a large proportion of DCIS and genetic carrier patients to potentially avoid SLNB in the setting of mastectomy. We hypothesize the use of SPMT will reduce the number of SLNB performed in patients undergoing mastectomy for DCIS and risk reduction, ultimately reducing the number of complications associated with axillary surgery. We seek to report our community cancer center's experience with SPMT and omission of SLNB in the DCIS and prophylactic mastectomy patient population. We performed a retrospective review of 52 female patients with DCIS or known genetic predisposition undergoing mastectomy. SPMT (Magtrace®, Endomag Ltd, Cambridge, UK) was injected ipsilateral to DCIS and bilaterally for prophylactic mastectomy patients. Our primary outcome was rate of return to the operating room (OR) for delayed SLNB. Secondary outcomes included post-operative complications within 30days of surgery and operative time. We compared outcomes to a control group of 28 women undergoing mastectomy for DCIS or for risk reduction who underwent SLNB at their index operation in traditional fashion. Continuous variables were reported using median and interquartile ranges (IQR) and were compared using the Mann-Whitney U test. Categorical data were reported using frequency and percent and were compared using Pearson's Chi-Square or Fisher's Exact test, as appropriate. Alpha was set to 0.05 to determine statistical significance. There was a total of 80 patients (52 SPMT, 28 control). Median age of SPMT patients was 49.5 (IQR 40-60.75) vs. 54.5 (48 - 65) in the traditional tracer group. vs. control group. 57.7% of SPMT patients underwent mastectomy for DCIS vs. 89.3% in the control group. Eight SPMT patients (15.4%) had invasive ductal carcinoma (IDC) on final pathology and seven of those patients underwent delayed SLNB (87.5%). None of the delayed SLNB were positive for metastatic disease. Rates of post-operative complications were similar between the two groups, including hematoma, seroma, and surgical site infection. OR times were also similar with median OR time 202min (min) for the SPMT group vs. 195min for the control group. Use of SPMT avoided SLNB in 84.6% of our patients. We found no difference in rates of post-operative complications or operative times in patients using SPMT for omission of SLNB at time of mastectomy compared to the control group. Our findings suggest SLNB can be avoided in a majority of patients undergoing mastectomy for DCIS or risk reduction in the setting of genetic predisposition.

Aneurysmal bone cyst of the greater trochanter: evaluation of surgical outcome of 17 cases

Background: Aneurysmal bone cyst is a benign, aggressive lesion that occurs in childhood and early adulthood. It usually affects the metaphysis of long bones. The aims of this study were to report clinical and radiological outcome following operative treatment of aneurysmal bone cyst of greater trochanter of femur and asses functional outcome by the Musculoskeletal Tumour Society (MSTS) Rating scale for the lower extremity. Methods: This Quasi-experimental study included 17 patients radiologically and histologically diagnosed as having aneurysmal bone cyst involving the greater trochanter of femur from 2015 to 2022. All cases were curetted, chemical cauterization with 5% phenol done and autogenous cortico-cancellous bone graft were added to fill the osseous defect. The patients were followed-up at 6 weeks and then 3 monthly for 1st year, 6 monthly for 2nd and 3rd year and yearly thereafter. In each follow-up, the recurrence, post-operative complications were documented and MSTS scoring was done. Results: The mean age of the patients were 14.5 years; 9 (53%) were female and 8 (47%) were male. The mean follow-up period for the patients was 3.6 years. There were 3 (18%) recurrences and 2 (11.8%) cases developed superficial surgical site infection. The average MSTS score on final follow-up was 22.6. Conclusion: Aneurysmal bone cyst of the greater trochanter is common in second decade among females. Treatment with extended intralesional curettage, chemical cauterization with 5% phenol and application of autogenous bone graft has less than 18% chance of recurrence. Furthermore, there is acceptable radiological bone graft incorporation and average MSTS score on final follow-up suggest a good functional outcome. BIRDEM Med J 2024; 14(3): 124-130

Negative pressure wound therapy for the management of deep brain stimulation‐related surgical site infections: A retrospective case series

AbstractThe management of deep brain stimulation (DBS)‐related surgical site infection (SSI) is challenging. This article aimed to report the efficacy of negative pressure wound therapy (NPWT) in treating DBS‐related SSI while preserving all DBS devices. As a retrospective case series in a single center, localized DBS‐related SSI was treated with complete debridement and NPWT, with preserving all DBS devices. Successful infection control was defined as no clinical or microbiological evidence of recurrent infection 3 months after NPWT. Five patients (three females, two males, median age: 64 years) received NPWT for their DBS‐related SSI. The infection was located in the chest, parietal, and retroauricular areas. Only one patient had the extension wires removed due to the heavy contamination, while no DBS devices were removed in the other patients. All patients showed successful infection control without any remarkable side effects 3 months after debridement and NPWT. These findings suggest that NPWT may effectively promote wound healing with a high probability of preserving all DBS devices in DBS‐related SSI.

COMPARISON OF SURGICAL SITE INFECTIONS IN DIABETIC VERSUS NON-DIABETIC PATIENTS UNDERGOING CLEAN SURGICAL PROCEDURES AT A TERTIARY CARE HOSPITAL

Surgical site infections (SSIs) are a common complication that can significantly impact recovery, particularly in patients with diabetes. Understanding the incidence of SSIs in diabetic versus non-diabetic patients undergoing clean surgical procedures is critical for improving postoperative outcomes. Objective: This study aims to compare the incidence of surgical site infections (SSIs) in diabetic and non-diabetic patients undergoing clean surgical procedures at a tertiary care hospital. Methods: An observational cohort study was conducted with 110 patients, divided into two groups: Group A (diabetic patients) and Group B (non-diabetic patients). All patients underwent clean surgeries, including hernia repair and laparoscopic cholecystectomy. Postoperative complications, including SSIs, wound dehiscence, and seroma formation, were assessed. Statistical analysis was performed to evaluate differences in complication rates between the two groups, with a significance level set at p &lt; 0.05. Results: SSIs were observed in 10.9% of diabetic patients compared to 3.6% in non-diabetic patients, though this difference was not statistically significant (P = 0.14). Wound dehiscence occurred in 3.6% of diabetics versus 1.8% of non-diabetics (P = 0.55), while seroma formation was noted in 1.8% of diabetics, with no cases in the non-diabetic group (P = 0.31). Conclusion: The incidence of surgical site infections was higher in diabetic patients than in non-diabetic patients undergoing clean surgical procedures, though the difference was not statistically significant. Diabetic patients remain at an increased risk of postoperative complications, highlighting the need for enhanced perioperative care to mitigate infection risks.

Effect of surgeon-patient sex discordance on ventral hernia repair outcomes.

Concordance is an important dimension of the physician-patient relationship that may be linked to health care disparities. The purpose of this study was to determine if sex discordance between surgeon and patient impacts surgical outcomes. A retrospective review of prospectively collected data obtained from the Abdominal Core Health Quality Collaborative (ACHQC) registry was performed on all patients who underwent ventral hernia repair. Surgical site occurrences (SSO), surgical site infections (SSI), surgical site occurrence requiring procedural intervention (SSOPI) and 30-day readmission rates were recorded. Female patients operated on by male surgeons have increased odds of having an SSI/SSO (OR 1.099, 95% CI 1.022-1.181), SSOPI (OR 1.156, 95% CI 1.031-1.297), and readmission (OR 1.259, 95% CI 1.128-1.406) when compared to male patients operated on by male surgeons. There was no significant difference in adverse outcomes between patient groups when operated on by female surgeons. Sex discordance between surgeon and patient is associated with increased odds adverse outcomes when male surgeons operate on female patients.

Risk Factors Affecting Surgical Site Infections in Colorectal Cancer Surgery: Analysis of National Multicenter Data

Risk Factors Affecting Surgical Site Infections in Colorectal Cancer Surgery: Analysis of National Multicenter Data

Beyond the distance between juridic and scientific decision-making process: An evidence-based prediction algorithm for professional liability assessment in healthcare-associated infections

BackgroundHAIs (Healthcare-Acquired-Infections) have been recently the subject of judgment n. 6386 pronounced on 3rd March 2023 by the Italian Supreme Court. This sentence provided three criteria to determine whether a health facility is responsible for the patient contracting a nosocomial infection, i.e. time criterion, topographical criterion and clinical criterion. Accordingly, the healthcare facility is obliged to prove the fulfillment of a series of preventive hygiene measures specifically detailed by the legislator. Herein, the positive predictive value of these criteria (“juridic criteria”) in the identification of professional liability for nosocomial infections was evaluated in comparison with clinical criteria reviewed by Infectious Disease specialists (“Infectious-Disease criteria”, i.e. presence of a Multidrug Resistant Organism (MDRO); development of surgical site infection; inadequate antibiotic therapy; inadequate disinfection). MethodsTwo retrospective cohorts were compared from the Portal of Telematic Services of the Ministry of Justice; 51 patients were extrapolated from Italian judgments concerning claims for Gram-negative nosocomial infections in the three-year period 2020–2022. On the other side, from the electronic database of University Hospital of Bari we extracted 349 patients affected by Gram-negative infections in the same timespan. Both “juridic” criteria and “Infectious-Disease” criteria were then applied to the full cohort after stratification for cohort of origin and after stratification for nosocomial or non-nosocomial infections. Predictive value of criteria was evaluated through receiver operating characteristic (ROC) curves and area under the curve (AUC). ResultsOverall, the incidence of definite nosocomial infections (according to final judgement or clinical records discharge letter) was 84 % in juridic cohort and 46 % in “real-world” series.Data suggested that the presence of all three juridic criteria [ROC AUC = 0.944 (95%CI = 0.924–0.963)] or the four clinical criteria [ROC AUC = 0.948 (95%CI = 0.928–0.969)] predicted well a case of nosocomial infection with professional liability.Moreover, by summarizing both criteria in a single classification system, the generated ROC curve (was the one with the highest AUC [0.9488 (95%CI = 0.928–0.969)].Accordingly, further tests were performed, evaluating the predictive value of one juridic criterium plus at one of more Infectious-Disease criteria. Interestingly, the ROCs curves demonstrated that the presence of at least 1 juridic criteria plus at least 2 Infectious Disease criteria reached a predictive value comparable to 2 or 3 juridic criteria. ConclusionsThe results highlight the efficiency of new criteria laid down in the judgment of the Italian Supreme Court to attribute liability for nosocomial infection despite the disputed distance between juridic and scientific decision-making process. In addition, the use of a combined score combining “juridic” and “Infectious-Disease” criteria provides a high-quality tool to be used by technical consultants to make up for lack of clinical documentation by passing judgments concerning litigation about professional liability in case of nosocomial infections. This sheds light on the possibility to face worldwide judicial inquiries with scientific rigor.

Antibiotic prophylaxis practice in gastrointestinal surgery in five hospitals in southern Benin

BackgroundBenin’s healthcare system is characterized by a lack of local guidelines for surgical antibiotic prophylaxis (SAP), which is essential to prevent surgical site infection. AimTo audit compliance for SAP practices in gastrointestinal surgery. MethodsData were prospectively collected from gastrointestinal surgery departments in five hospitals. Over a four month period, SAP was assessed using five conventional criteria (indication, choice of antibiotic, dosage, timing, and duration of administration) among patients admitted for Altemeier class 1 or 2 procedures. Three guidelines were used as reference: World Health Organization (WHO), American Society of Health-System Pharmacists (ASHP)and French Society of Anaesthesia and Intensive Care Medicine (SFAR). FindingsOf 68 surgical interventions, overall compliance with WHO, ASHP, and SFAR was observed in zero (0.0%), one case (1.5%) and two cases (2.9%), respectively. Compliance with indication varied according to the guidelines: 65 (95.6%) were compliant with WHO and ASHP and 47 cases (69.11%) with SFAR. Among compliant cases, the antibiotics administered were rarely selected according to guidelines: WHO, 2 (2.9%) and ASHP, 2 (2.9%), and SFAR, 3 (4.4%). Drug dosage compliance varied from 20 (29.4%) (SFAR) to 49 (72.0%) (ASHP). Timings were respected in 47 (69.1%; WHO), 45 (66.2%; ASHP) and 9 cases (13.2%; SFAR). The number of cases compliant with antibiotic prophylaxis duration were 13 (19.1%; WHO), 17 (25.0%; ASHP) and 16 (23.5%; SFAR). ConclusionThe SAP compliance rate in gastrointestinal surgery based on the five conventional criteria was very low. SAP guidelines must be implemented appropriately for local bacteriological epidemiology.

Application of Closed Incision Negative Pressure Wound Therapy in Ventral Hernia Repair Surgery Using a Polypropylene Mesh: A Randomized Clinical Trial.

Background and Objectives: Surgical site infections (SSIs) are a significant complication following ventral hernia repair, potentially leading to prolonged hospital stays and increased morbidity. This study aimed to evaluate whether closed incision negative pressure wound therapy (ciNPWT) reduces the incidence of SSI after ventral hernia repair with polypropylene mesh compared to standard wound care. Materials and Methods: A randomized study was conducted with 100 patients undergoing ventral hernia repair using a polypropylene mesh. Participants were divided into two groups: a control group (n=50), which received standard sterile gauze dressing with an iodine-based disinfectant, and an intervention group (n=50), treated with the ciNPWT system (Vivano® by HARTMANN) for 5 days postoperatively. The primary outcome was the incidence of SSI within one year after surgery. Secondary outcomes included the influence of factors such as age, sex, smoking status, and hernia size on SSI occurrence. The study was approved by the Ethics Committee at the University Hospital Ostrava, adhering to the ethical standards of the Helsinki Declaration. Results: The incidence of SSI was lower in the ciNPWT group compared to the standard care group (4% vs. 12%), though this difference did not reach statistical significance. No significant effect of sex or smoking status on SSI was observed. The control group had a shorter mean length of hospital stay. Larger hernias in the non-ciNPWT group were more prone to SSIs, as expected. Conclusions: Although limited by a small sample size, the findings suggest that ciNPWT may be associated with a reduced rate of SSI following ventral hernia repair. Further studies with larger populations are needed to confirm these results.

Vaping and Orthopedic Surgery: Perioperative Management

The growing use of electronic cigarettes (ECs) as a perceived safer alternative to traditional combustible smoking has significant implications for orthopedic surgery patients. Surgeons need to recognize the harms and risks associated with ECs beyond their nicotine content. EC aerosols contain cytotoxic elements, including harmful chemicals, carcinogens, heavy metals, and flavoring agents. They can induce oxidative stress, resulting from an imbalance between cell antioxidant defense and reactive oxygen species (ROS). These effects can compromise bone repair, particularly with skeletal system disorders. Furthermore, ECs’ impact on wound healing and surgical site infection (SSI) have been well-documented. Smoking can reduce the inflammatory healing response, impair oxidative bacterial killing mechanisms, delay the proliferation healing response, and alter collagen metabolism. Some surgical practices remain unchanged despite physicians’ efforts to inquire about EC use. Most orthopedic surgeons do not delay surgery due to nicotine consumption, and urine tests for nicotine are rarely used. However, preoperative smoking cessation interventions offer a unique opportunity to help patients stop consuming nicotine. Therefore, it is crucial for orthopedic surgeons to understand the harms of ECs and communicate the associated risks to patients.

Using the modified frailty index as a predictor of complications in adults undergoing transforaminal interbody lumbar fusion

ObjectiveTo correlate the operative characteristics and complications of transforaminal lumbar interbody fusion (TLIF) to patient frailty status for the first time in a multicenter study. MethodsUsing the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database, all patients who underwent TLIF in 2015–2020 were filtered for their demographics, operative characteristics, and 30-day complication outcomes. Patients were stratified into 2 cohorts, low and high frailty, based on their modified frailty index 5 score. Univariate analysis was performed between the 2 cohorts for each collected variable, and multivariable analysis was performed to observe adjusted odds ratios (OR). ResultsThe frail cohort experienced more unplanned readmission (4.3 vs 6.6 %, p < 0.001). During hospital stays, the frail cohort experienced more overall complications (9.8 vs 13.8 %, p < 0.001). In contrast to the low frailty cohort, the high frailty patients saw longer hospital stays (3.27 vs. 3.69 days, p < 0.001). The high frailty group saw more discharges to an institution beside their home (89.6 vs 77.9 %, p < 0.001). Rates of superficial and deep surgical site infection, organ space infection, wound dehiscence, reintubation, renal insufficiency, urinary tract infection, stroke, cardiac arrest, DVT, sepsis, and septic shock were not significantly different. Multivariable analyses showed high frailty status as an independent predictor of unplanned readmissions, major complications, and preventing discharge to home. ConclusionsmFI-5 serves as an effective predictor of surgical outcomes following TLIF and independently predicts unplanned readmission, discharge to home, and major complications. Noninfectious outcomes were more likely to be significantly different between the high- and low frailty groups, while all infectious outcomes apart from superficial surgical site infection and pneumonia were not significantly different between the cohorts.

Unlocking the Potential of Silver Nanoparticles: From Synthesis to Versatile Bio-Applications.

Silver nanoparticles (AgNPs) are leading the way in nanotechnological innovation, combining the captivating properties of silver with the accuracy of nanoscale engineering, thus revolutionizing material science. Three main techniques arise within the alchemical domains of AgNP genesis: chemical, physical, and biological synthesis. Each possesses its distinct form of magic for controlling size, shape, and scalability-key factors necessary for achieving expertise in the practical application of nanoparticles. The story unravels, describing the careful coordination of chemical reduction, the environmentally sensitive charm of green synthesis utilizing plant extracts, and the precise accuracy of physical techniques. AgNPs are highly praised in the field of healthcare for their powerful antibacterial characteristics. These little warriors display a wide-ranging attack against bacteria, fungi, parasites, and viruses. Their critical significance in combating hospital-acquired and surgical site infections is highly praised, serving as a beacon of hope in the fight against the challenging problem of antibiotic resistance. In addition to their ability to kill bacteria, AgNPs are also known to promote tissue regeneration and facilitate wound healing. The field of cancer has also observed the adaptability of AgNPs. The review documents their role as innovative carriers of drugs, specifically designed to target cancer cells with accuracy, minimizing harm to healthy tissues. Additionally, it explores their potential as cancer therapy or anticancer agents capable of disrupting the growth of tumors. In the food business, AgNPs are utilized to enhance the durability of packing materials and coatings by infusing them with their bactericidal properties. This results in improved food safety measures and a significant increase in the duration that products can be stored, thereby tackling the crucial issue of food preservation. This academic analysis recognizes the many difficulties that come with the creation and incorporation of AgNPs. This statement pertains to the evaluation of environmental factors and the effort to enhance synthetic processes. The review predicts future academic pursuits, envisioning progress that will enhance the usefulness of AgNPs and increase their importance from being new to becoming essential within the realms of science and industry. Besides, AgNPs are not only a subject of scholarly interest but also a crucial component in the continuous effort to tackle some of the most urgent health and conservation concerns of contemporary society. This review aims to explore the complex process of AgNP synthesis and highlight their numerous uses, with a special focus on their growing importance in the healthcare and food business sectors. This review invites the scientific community to explore the extensive possibilities of AgNPs in order to fully understand and utilize their potential.

Surgical practices in emergency umbilical hernia repair and implications for trial design

IntroductionThere is variation in the investigation, management, and surgical technique of acutely symptomatic umbilical hernias and optimal strategies remain to be established. This survey aimed to identify key variables influencing decision-making and preferred surgical techniques in emergency umbilical hernia care to help inform trial design and understand potential challenges to trial delivery.MethodsA survey was distributed to surgeons through social media, personal contacts, and ASGBI lists. It comprised five sections: (i) performer of repair, (ii) repair preferences, (iii) important outcomes, (iv) perioperative antibiotic use, and (v) potential future trial design.ResultsThere were 105 respondents, of which 49 (46.6%) were consultants. The median largest defect surgeons would attempt to repair with sutures alone was 2 cm (IQR 2–4 cm). In the acute setting, the most common mesh preferences are preperitoneal plane placement (n = 61, 58.1%), with synthetic non-absorbable mesh (n = 72, 68.6%), in clean (n = 41, 39.0%) or clean-contaminated (n = 52, 49.5%) wounds. Respondents believed suture repair to be associated with better short-term outcomes, and mesh repair with better long-term outcomes. Pre-/intra-operative antibiotics were very frequently given (n = 48, 45.7%) whilst post-operative antibiotics were rarely (n = 41, 39%) or very rarely (n = 28, 26.7%) given. The trial design felt to most likely influence practice is comparing mesh and suture repair, and post-operative antibiotics versus no post-operative antibiotics. Respondents indicated that to change their practice, the median difference in surgical site infection rate and recurrence rate would both need to be 5%.ConclusionThis survey provides insight into surgical preferences in emergency umbilical hernia management, offering guidance for the design of future trials.

Impact of patient's sex on groin hernia repair: A systematic review and meta-analysis.

Groin hernia repair (GHR) is a performed procedure worldwide, with approximately 20million surgeries carried out each year. Despite being less common in females, there is a lack of research on how sex influences the outcomes of GHR. This systematic review and meta-analysis aim to assess how patient sex impacts results in GHR. We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We searched for studies up to October 2023 in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. The studies included focused on sex outcomes for both robotic and open GHR procedures. Data extraction and quality assessment were conducted using the Risk of Bias in Non-Randomized Studies - Of Interventionstool. Our statistical analysis was performed using the metafor package in RStudio. After screening a total of 3917 articles, we identified 29 studies that met our criteria, comprising a total of 1,236,694 patients. Among them, 98,641 (7.98%) patients were females. Our findings showed that females had higher rates of hernia recurrence (RR 1.28), chronic pain (RR 1.52), and surgical site infections (SSIs) (RR 1.46) compared to males. Females showed a lower tendency to undergo minimally invasive surgery (MIS) with a relative risk of 0.82 (95% CI 0.69-0.97; p=0.02). Females tend to face higher rates of complications after GHR such as an elevated risk of chronic pain, recurrence, and surgical site infections (SSI). Moreover, they undergo fewer MIS options compared to males. These results underscore the importance of research to enhance outcomes for women undergoing GHR.