Surgical Site Infection Research Articles

The Godina Principle in the 21st Century: Free Flap Timing after Isolated Lower Extremity Trauma in a Retrospective National Cohort.

The timing of free flap reconstruction after lower extremity trauma has been a controversial debate since Marko Godina's original 72-hour recommendation. Recent advances in microsurgery warrant an evaluation of the optimal time to reconstruction. The Nationwide Readmission Database (2014-2019) was used to identify patients undergoing free flap reconstruction after lower extremity trauma. Risk-adjusted statistical methods were used to identify optimal time where risk of infectious and microsurgical complications increase and to quantify the risk associated with time delays. A total of 1,030 patients undergoing reconstruction were identified. The mean time to flap coverage was 24.3 days. Thirty-three percent were performed within 72 hours, 24% from 72 hours to 10 days, 18% from 10 to 30 days, and 24% after 30 days. Flaps performed after 10 days were associated with increased risk of surgical site infection, osteomyelitis, and other wound complications, compared with those performed within 72 hours. There was no increased risk in the period of 72 hours to 10 days. Revision amputation and microsurgical complications were not increased after 10 days. The predicted optimal cutoff was 9.5 days for microsurgical complications and 14.5 days for infectious complications. Advances in microsurgery may be responsible for extending the time in which definitive soft tissue coverage is required for wounds resulting from lower extremity trauma. Although it appears the original 72-hour time window can be safely extended, efforts should be made to refer patients to specialty limb salvage centers in a timely fashion.

Risk of Surgical Site Infections after Tooth Extraction in Chronic Kidney Disease: A Retrospective Real-World Study in Japan.

Risk of Surgical Site Infections after Tooth Extraction in Chronic Kidney Disease: A Retrospective Real-World Study in Japan.

Factors related to surgical site infection in spinal instrumentation surgery: a retrospective study in Japan.

A retrospective study. To identify factors involved in surgical site infections (SSIs) after spinal instrumentation surgery performed at a single institution. SSIs after spinal instrumentation surgery are a serious complication. Despite reports on risk factors for SSIs in spine surgery, limited studies are related to spinal instrumentation surgery. In total, 828 patients (338 males and 490 females; mean age, 65.0 years) who underwent spinal instrumentation surgery from 2013 to 2021 in Kyorin University School of Medicinewere retrospectively investigated. Patients were divided into the SSI (group I) and non-SSI (group N) groups. Patient characteristics, comorbidity, laboratory, and surgical factors were investigated. Univariate analysis was performed for each item, and multivariate logistic regression analysis was performed for items with significant differences. Fifteen patients (1.85%) had SSIs. Univariate analysis revealed significant differences between groups I and N in history of steroid use, serum albumin, C-reactive protein, number of fixed vertebrae, and perioperative blood transfusion. Multivariate logistic regression analysis showed that a history of steroid use (odds ratio [OR], 5.38; 95% confidence interval [CI], 1.41-20.49; p=0.014), serum albumin (OR, 0.34; 95% CI, 0.13-0.84; p=0.020), and perioperative blood transfusion (OR, 5.85; 95% CI, 1.46-23.50; p=0.013) were independent risk factors for SSIs. The results of this study indicate that preoperative nutritional intervention, appropriate management of anemia, and intraoperative and postoperative bleeding control may decrease the incidence of SSIs. However, this study has several limitations, including its retrospective design, analysis of a few SSI cases, and inclusion of various surgical approaches and disease types. Future studies that address these limitations are desirable.

Benefits of laparoscopic liver resection for liver tumors in obese patients: a meta-analysis.

The superiority of laparoscopic liver resection (LLR) and open liver resection (OLR) in obese patients remains controversial. The study aims to assess the available literature and compare the perioperative outcomes of LLR and OLR for liver tumors in obese patients. We searched PubMed, Cochrane Library, Embase, and Web of Science databases for studies comparing LLR and OLR. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Nine studies were included, with a total of 1116 patients (LLR group: 482 patients; OLR group: 634 patients). Compared with OLR, LLR has lower overall morbidity (OR 0.47, 95% CI 0.34, 0.64), major complications (OR 0.45, 95% CI 0.25, 0.82), surgical site infection (OR 0.18, 95% CI 0.07, 0.48), bile leak (OR 0.45, 95% CI 0.22, 0.95), less blood loss (MD, -329.12 mL; 95% CI, -623.35, -34.88), and shorter length of stay (MD, -5.20 days; 95% CI, -7.43, -2.97). There were no significant differences in mortality, operation time, liver failure, and blood transfusion between the two groups. LLR for obese patients is safe and feasible. Compared to OLR, it offers better short-term outcomes. Further randomized controlled trials to verify the potential advantages of LLR over OLR are warranted.

Exploring the Incidence and Determinants of Surgical Site Infections in Caesarean Sections: A Five-Year Study

Background: Surgical site infection (SSI) is one of the most common complications following a cesarean section and has an incidence of 0.63 to 9.85%. It places physical, emotional and financial burden on the mother herself and on the health care system. Aims and Objectives: The study aimed to identify and analyze the risk factors associated with SSIs in women undergoing both elective and emergency cesarean sections and to assess the risk factors and propose modifications to preoperative, intraoperative and postoperative practices to reduce the incidence of SSI. Optimization of maternal comorbidities, appropriate antibiotic prophylaxis, and evidence-based surgical techniques are some of the practices proven to be effective in reducing the incidence of SSI.

Qualitative drivers of postoperative prophylactic antibiotics use and resistance in Ethiopia.

The World Health Organization (WHO) cautions against unnecessary prolongation of postoperative antibiotics to prevent surgical site infections (SSI), however this practice is still common in many countries. This study aims to describe drivers of prolonged postoperative antibiotic prescribing and clinicians' perspectives on antibiotics resistance and stewardship in Ethiopia. We conducted semi-structured interviews of 16 surgeons and nine surgical ward nurses at three academic referral hospitals in Addis Ababa. Audio recordings were transcribed verbatim and coded. Codes were inductively and iteratively derived between two researchers, tested for inter-rater reliability (IRR), and the codebook was consistently applied to all transcripts. Thematic analysis was performed to understand drivers of prolonged prophylactic antibiotic use in surgical patients. Interviews revealed factors contributing to postoperative prophylactic antibiotics overprescribing, including inadequate infection prevention and control (IPC) practices, wide variability in local prescribing practices, and distrust in the applicability of WHO guidelines. Antimicrobial resistance was also identified as a major concern by staff. Barriers to improving stewardship included a lack of multidisciplinary teamwork to inform prescribing decisions, while solutions included constructing appropriate context-specific guidelines and improving evidence-based practices through input from local stakeholders, including surgeons, clinical pharmacists, and nurses. Study participants perceived that existing evidence and guidelines did not apply in their settings due to high rates of surgical site infections and gaps in perioperative IPC practices (e.g., availability of water for handwashing, sterility breaches). These gaps were a key contributor to prophylactic antibiotic overprescribing, reinforcing the need to strengthen upstream and perioperative surgical antisepsis processes. The findings of this study underscore the importance of engaging multidisciplinary teams in strengthening antimicrobial stewardship efforts, aligning processes to achieve compliance with best practices, and the need for rigorous, contextually appropriate studies from these settings to inform policy.

A differentiated approach to the surgical treatment of intraarticular fracture of the proximal tibia

Background. For a long time, the question of optimal ways and methods of surgical treatment of fractures of the proximal part of the tibia (PPT) remains debatable. The purpose was to study the results of surgical treatment of fractures of the PPT using differentiated use of minimally invasive techniques. Materials and methods. The work consisted of a prospective analysis of the treatment outcomes of 87 patients who were treated 2018 to 2023. Fractures were classified according to Schatzker. The tactics of surgical treatment depended on the type of fracture, the age of the patients and the presence of concomitant diseases. A comprehensive assessment of knee function was performed using the Knee Society Score. For X-ray assessment of the degree of progression of post-traumatic arthritis, the Resnik/Niwoyama system was used. ­Results. The results of surgical treatment were studied in terms from 6 to 24 months. 19.8 % of excellent, 57.5 % good, 15.6 % sa­tisfactory and 7.1 % unsatisfactory treatment results were obtained. Progression of post-traumatic arthritis was observed in 36 patients (28 patients at one stage, 4 subjects at 2 stages and 5 patients at 3 stages). Of the complications, 7 (8.0 %) were surgical site infections, which required debridement of the focus and longer antibiotic therapy. Over time, loss of reposition and secondary displacement were identified in 5 (5.7 %) cases. The most common complications were the progression of knee osteoarthritis, the development of contractures in 11 (12.6 %) patients. Conclusions. The use of a differential approach to the surgical treatment of intra-articular fractures of PPT, based on the severity of injuries according to Schatzker, allowed to obtain positive functional results in 77.3 % of the victims. The negative consequences of intra-articular fractures of the tibial plateau that worsen the functional outcomes of treatment include the progression of knee osteoarthritis. The degree of its manifestations is largely determined by the severity of the injury, the quality of reduction, the stability of fragment fixation, and the rationality of restorative treatment and rehabilitation.

Incisional Negative Pressure Wound Therapy Versus Primary Wound Suturing after Intestinal Ostomy Closure: A Systematic Review and Meta-Analysis.

Objective: Wound infection after intestinal ostomy closure is a very common postoperative complication. An alternative to primary wound suturing by single sutures or purse string sutures (PSS) is applying incisional negative pressure wound therapy (iNPWT). The aim of the following systematic review and meta-analysis was to assess and compare clinical outcomes in patients after PSS and iNPWT use. Approach: The aim of the study was to find relevant clinical data comparing outcomes of iNPWT and primary wound closure after intestinal ostomy closure. The search was conducted using the MEDLINE/PubMed, ScienceDirect, EMBASE, Scopus, Cochrane Controlled Register of Trials, SciELO, and Web of Science databases and took place up to November 12, 2022. The authors did not use date or language filters. Statistical analysis was performed using Review Manager 5.4 (The Cochrane Collaboration, 2020, London, UK). The authors conducted a meta-analysis of the following four parameters: wound healing time (WHT), surgical site infections (SSIs), complications, and length of hospital stay (LOS). Odds ratios (OR) and inverse variance (IV) were generated with 95% confidence intervals (CI). The meta-analysis was registered in the International Prospective Register of Systematic Reviews database under registration number CRD42023391640. Results: The analysis revealed that the iNPWT group and the control group did not differ significantly with regard to the WHT parameter (Z = 2,73; p = 0.006; χ2 = 0.37, df = 1, p = 0.54, I2 = 0%). Meta-analysis of SSI incidence revealed a significant difference favoring the iNPWT group over the observational group (OR = 0.42; 95% CI = 0.25-0.72; p = 0.002; I2 = 14%). Patients included in the iNPWT group had a significantly lower pooled incidence of overall complications than the observational group (OR = 0.52; 95% CI = 0.35-0.77; p = 0.001, I2 = 71%). Subgroup analysis limited to randomized studies also presented significant differences favoring the iNPWT group over the observational group (OR = 0.27; 95% CI = 0.14-0.52; p < 0.001, I2 = 67%). Our analysis showed that LOS did not differ significantly between the groups treated with and without iNPWT (IV = 0.19; 95% CI = -0.66 -1,04; p = 0.76, I2 = 0%). In addition, subgroup analysis of randomized studies also did not present a significant difference (IV = 0.25; 95% CI = -0.80 -1,30; p = 0.33, I2 = 10%). Innovation: This study shows that the use of iNPWT can reduce the risk of SSIs with other complications, such as wound hematomas, wound seromas, wound dehiscence, fistulas, and ileus, in patients undergoing intestinal ostomy closure without extended hospital stay. Conclusions: Use of iNPWT can be considered in postoperative care after elective ostomy closure to decrease the rate of the most common complications after ostomy closure.

Polyetheretherketone (PEEK) Into the Future: Lowering Infection Rates in Cranioplasty.

Surgical site infection (SSI) is one of the most common complications following cranioplasty. At our institution, 3D printing has emerged as a popular option for creating customized polyetheretherketone (PEEK) cranioplasty implants that are lower profile than older, non-3D-printed implants. The 3D-printed implants can be integrated, with fixation plates already attached, or nonintegrated, with separate fixation plates available. To our knowledge, no study has analyzed the differences in infection rates between integrated and nonintegrated 3D-printed implants. This study aimed to explore whether integrated 3D-printed cranioplasty implants lead to decreased infection risk and improved patient outcomes compared to nonintegrated 3D-printed implants and further aims include exploring how operating room time and hospital length of stay affect infection risk. A retrospective chart review of 197 patients who underwent cranioplasty surgery from 2012 to 2023 was conducted. The postcranioplasty infection rate was compared between the integrated and nonintegrated 3D implants. Pre- and postoperative antibiotic use, operating time, hospital stay length, and patient comorbidities were also evaluated. Statistical analysis was conducted using SPSS version 28.0 (IBM Corp., Armonk, NY). Initial bivariate statistics were utilized where appropriate, and ultimately, a binary logistic regression model was employed. Our overall infection rate was 12.2%, higher than the national average of 7.89%. There was no significant association between the implant type and postcranioplasty infection. However, when controlling for the clinical and demographic covariates in our study, patients who had a Charlson comorbidity index (CCI) of 3-4 were 6.36 times as likely to experience a postcranioplasty infection when compared to their counterparts with a CCI of 0, OR of 6.36, 95% CI of 1.01-40.0, and a p value of 0.048. Additionally, with every one-year increase in age, the number of infections decreased by 0.955, with an OR of 0.955, 95% CI of 0.915-0.996, and a p value of 0.031. While there was no significant difference in SSI between the integrated and nonintegrated 3D-printed PEEK implants, elevated CCI and age were associated with a greater risk of infection. Our overall infection rate exceeds that reported in a recent large-scale review, which may be attributable to the higher average CCItypically observed in our tertiary care setting. Our findings illustrate that integrated and nonintegrated 3D implants offer viable and efficacious options for patients with cranial vault deformities requiring surgical repair.

Time-Dependent Electrical Active and Ultrasound-Responsive Calcium Titanate Implant Coating with Immunomodulation, Osteogenesis, and Customized Antibacterial Activity.

Surgical site infection and insufficient osseointegration are notable risks factors associated with oral implant surgery. In this study, the development of a polarized calcium titanate (CT-P) coating for titanium surfaces is proposed as a solution to these problems. The coating generated electrical stimulation (ES) can inhibit pro-inflammatory M1-type macrophage polarization and promote anti-inflammatory M2-type macrophage polarization, resulting in favorable bone immunomodulation. The ES generated by the coating can match the physiological electrical potential that will change during bone repair, thereby promoting osseointegration in vivo. In addition, the system can also achieve on-demand antibacterial activity, mainly depending on the CT-P coating responding to ultrasound (US) irradiation to produce reactive oxygen species (ROS) and remove Staphylococcus aureus (S. aureus) on the surface of the implant. In conclusion, this work provides valuable insights for the development and clinical application of highly efficient electroactive coatings, as well as novel solutions for the selective treatment of bacterial infections in the surgical area.

Ventral hernia repair with permanent mesh for non-Hispanic black versus white patients: access and post-operative outcomes in the era of robotic surgery.

Robotic ventral hernia surgery may provide better patient outcomes. Whether it is provided equitably based on race remains unknown. We examined whether patients from the Abdominal Core Health Quality Collaborative who were Black had equitable access to robotic surgery for ventral hernia repair with permanent mesh compared to white counterparts from 2013 to 2023. We performed propensity-score matching to address confounding and then chi-squared testing to examine access to robotic, laparoscopic, and open approaches. Secondary outcomes included 30-day readmissions, complications, and death and 1- and 2-year hernia recurrence and quality of life measured by HerQLes Summary and PROMIS Pain T-Scores analyzed with chi-squared, Fisher exact, and Wilcoxon testing. 2397 patients identified as Black, and 21,900 identified as white. Our propensity-score matched cohort included 2374 Black patients and 7122 white. Black and white groups had the same rates of laparoscopy (15% vs 15%). Patients who identified as Black were more likely to undergo robotic surgery (36% vs 32%). Open approach was 49% for Black and 53% for white (p = 0.005). For 30-day complications, we found Black patients were more likely to experience reoperation (2% vs 1%, p = 0.005) and less likely surgical site infection (1% vs 2%, p < 0.001). Hernia recurrence scores and perceived abdominal health based on HerQLes were not statistically significantly different. At 2years, absolute reported T-Scores were higher for Black patients (median 40 (IQR 31-49) vs 36 (31-46), p = 0.031). This is the first large-scale study examining access to robotic surgery, complications, and quality of life measures. We found patients who identified as Black were more likely than white counterparts to undergo robotic surgery, but they were more likely to require reoperation and had higher pain scores. Our data suggest equitable access still may not translate to equitable patient outcomes.

Utility of syndromic surveillance for the surveillance of healthcare-associated infections in resource-limited settings: a narrative review.

Globally, Healthcare-associated infections (HCAIs) pose a significant threat to patient safety and healthcare systems. In low- and middle-income countries (LMICs), the lack of adequate resources to manage HCAIs, as well as the weak healthcare system, further exacerbate the burden of these infections. Traditional surveillance methods that rely on laboratory tests are cost-intensive and impractical in these settings, leading to ineffective monitoring and delayed management of HCAIs. The rates of HCAIs in resource-limited settings have not been well established for most LMICs, despite their negative consequences. This is partly due to costs associated with surveillance systems. Syndromic surveillance, a part of active surveillance, focuses on clinical observations and symptoms rather than laboratory confirmation for HCAI detection. Its cost-effectiveness and efficiency make it a beneficial approach for monitoring HCAIs in LMICs. It provides for early warning capabilities, enabling timely identification and response to potential HCAI outbreaks. Syndromic surveillance is highly sensitive and this helps balance the challenge of low sensitivity of laboratory-based surveillance systems. If syndromic surveillance is used hand-in-hand with laboratory-based surveillance systems, it will greatly contribute to establishing the true burden of HAIs in resource-limited settings. Additionally, its flexibility allows for adaptation to different healthcare settings and integration into existing health information systems, facilitating data-driven decision-making and resource allocation. Such a system would augment the event-based surveillance system that is based on alerts and rumours for early detection of events of outbreak potential. If well streamlined and targeted, to monitor priority HCAIs such as surgical site infections, hospital-acquired pneumonia, diarrheal illnesses, the cost and burden of the effects from these infections could be reduced. This approach would offer early detection capabilities and could be expanded into nationwide HCAI surveillance networks with standardised data collection, healthcare worker training, real-time reporting mechanisms, stakeholder collaboration, and continuous monitoring and evaluation. Syndromic surveillance offers a promising strategy for combating HCAIs in LMICs. It provides early warning capabilities, conserves resources, and enhances patient safety. Effective implementation depends on strategic interventions, stakeholder collaboration, and ongoing monitoring and evaluation to ensure sustained effectiveness in HCAI detection and response.

Allogeneic abdominal non-vascularized rectus fascia transplantation without immunosuppression equals syngeneic transplantation in a rabbit model at short-term follow-up

Complex abdominal wall repair remains a major surgical challenge. In transplant patients, non-vascularized rectus fascia (NVRF) is successfully used to bridge the defect. To extrapolate this to non-transplant patients, we developed a rabbit model of NVRF-transplantation without immunosuppression comparing syngeneic versus allogeneic transplants. Short-term outcome (4 weeks) was evaluated macroscopically (ingrowth, seroma/hematoma, herniation, and infection), histologically at the graft interface and center (inflammation, neovascularization, and collagen deposition) and by mechanical testing. In both groups a similar macroscopic ingrowth of the NVRF was observed. In the syn-group, one seroma and one hematoma was seen. Two small herniations were detected at the suture line in the allo-group. No surgical site infections were observed. Histologically, graft neovascularization was observed in all animals. Infiltration of T-lymphocytes was seen at the graft interface in both groups, but more in the allo-group (p < 0.0001). Deposition of collagen was not different between groups. Macrophages were present in both groups around sutures and in the center more abundantly in the allo-group (p = 0.0001). Graft stiffness and strength were similar for both groups. With this model, we showed that allogeneic transplantation without immunosuppression results in favorable short-term inflammatory and mechanical outcomes. Long-term experiments are needed to further evaluate the effect on graft integration and hernia development.

Innovative needle-assisted technique for intracorporeal anastomosis: Simplifying closure of common enterotomy in laparoscopic gastrointestinal surgery.

Intracorporeal anastomosis offers notable advantages over extracorporeal techniques, including reduced tissue manipulation leading to faster recovery and potentially lower risks of surgical site infections and complications. However, it also involves several challenges, such as increased operative time and the need for experienced assistants and multiple trocars. Our novel technique addresses these problems. We present a novel approach for closing common enterotomies during intracorporeal anastomosis by using a linear stapler. This technique involves the use of a 6-cm straight needle, which facilitates closure of the common enterotomy. The technique can be performed independently by a single surgeon without the need for additional trocars or assistants. This technique was applied for 20 patients undergoing laparoscopic gastrointestinal surgery between June 2023 and February 2024. The median age of the enrolled patients was 65years, with laparoscopic right hemicolectomy with intracorporeal ileocolostomy being the most common procedure (60% of cases). The median anastomosis time was 22.5min. No occurrence of anastomotic leakage was reported, and only one patient (5%) developed temporary postoperative bowel obstruction, which was managed conservatively. Our technique enables efficient and safe closure of common enterotomies during intracorporeal anastomosis, minimizing reliance on additional trocars and experienced assistants. It simplifies the procedure and ensures fullthickness stapling, potentially reducing the likelihood of complications. Because of its broad applicability across various laparoscopic surgeries, this technique offers substantial benefits and is worth recommending for intracorporeal anastomosis.

A Scoping Review of 'Smart' Dressings for Diagnosing Surgical Site Infection: A Focus on Arthroplasty.

Early diagnosis and treatment of surgical wound infection can be challenging. This is especially relevant in the management of periprosthetic joint infection: early detection is key to success and reducing morbidity, mortality and resource use. 'Smart' dressings have been developed to detect parameters suggestive of infection. This scoping review investigates the current status of the field, limited to devices tested in animal models and/or humans, with a focus on their application to arthroplasty. The literature was searched using MEDLINE/PubMed and Embase databases from 2000 to 2023. Original articles assessing external sensing methods for the detection of wound infection in animal models or human participants were included. Sixteen articles were eligible. The results were broadly divided by sensing method: colorimetric, electrochemical and fluorescence/photothermal responses. Six of the devices detected more than one parameter (multimodal), while the rest were unimodal. The most common parameters examined were temperature and pH. Most 'smart' dressings focused on diagnosing infection in chronic wounds, and none were tested in humans with wound infections. There is limited late-stage research into using dressing sensors to diagnose wound infection in post-surgical patients. Future research should explore this to enable inpatient and remote outpatient monitoring of post-operative wounds to detect wound infection.

Prevention of vascular surgical site infections in the groin with negative pressure wound therapy

Bevezetés: A negatív nyomású sebkezelés egyre nagyobb szereppel bír a krónikus, nehezen gyógyuló sebek, sebfertőzések kezelésében. Az érsebészeti műtéteket követően kialakuló sebfertőzések predilekciós helye a femoralis háromszög műtéti bemetszései. A sebfertőzés kialakulásában szerepet játszó tényezők: diabetes, elhízás, korábbi műtétek ugyanebben a régióban, azonos oldali alsó végtagi gangraenák, fekélyek. Célkitűzés: Hipotézisünk, hogy a femoralis hajlat sebfertőzéseit csökkentheti a negatív nyomású sebkezelés zárt seben való alkalmazása a nagy rizikójú csoportokban, ezzel együtt csökkenthető a rettegett érsebészeti szövődmény, a szeptikus graft kialakulása. Módszer: Vizsgálatunkba 38 beteget vontunk be, akiknél legalább egy kritérium teljesült a következők közül: testtömegindex &gt;30; korábbi műtét ugyanebben a régióban; azonos oldali végtagon jelen lévő szövetelhalás, seb. A kontrollcsoportba kerülő betegeknél (n = 19) hagyományos sebfedést (Cosmopor E) alkalmaztunk. Az incisionalis negatív nyomású sebkezelésben részesülő csoportban (n = 19) a műtőben a varratokkal egyeztetett sebet fehér szivaccsal (VivanoMed White Foam) fedtük, fóliával légmentesen lezártuk, és ide csatlakoztattuk a vákuumgép portját, amelyen keresztül azonnal megkezdődött a seb szívása (folyamatos üzemmód, 100 Hgmm). A kezelés időtartamát átlagosan 7 napig terveztük. A betegeket a posztoperatív 10., 30., 60. napon, ambulanciánkon ellenőriztük. Eredmények: A kontrollcsoportban a betegek 42,1%-ában (n = 8) sebgyógyulási zavar, 36,8%-ában (n = 7) sebfertőzés alakult ki. Egy esetben szeptikus graft miatt reoperációt végeztünk. Az incisionalis negatív nyomású sebkezelésen átesett csoportban 31,6%-ban (n = 6) jelentkezett sebgyógyulási zavar, 26,3%-ban (n = 5) sebfertőzés, egy esetben szeptikus graft. Következtetés: Bár a vizsgált csoportok között nem találtunk szignifikáns különbséget a primer végpont tekintetében, kimutattuk, hogy az elhízott, valamint a korábban lágyékfeltárásból végzett műtéten átesett betegek esetén az incisionalis vákuumkezelés előnyös lehet a hagyományos sebkezeléssel szemben. Orv Hetil. 2024; 165(42): 1652–1658.

Perioperative Antibiotic Use in Pediatric Solid Tumor Resection: A Two-center Retrospective Cohort Study

PurposeThere is no consensus on the perioperative use of antibiotics in pediatric solid tumor resection. This study collected data from two pediatric centers that utilize perioperative antibiotics to varying degrees in pediatric solid tumor patients to investigate the occurrence of postoperative sepsis and infectious complications. MethodsA two-institution, retrospective cohort study was performed. Charts of children who underwent solid tumor resection between July 2018–June 2021 were reviewed. Patient characteristics, diagnosis, operative data, perioperative antibiotic use, and postoperative infection/sepsis were analyzed within 30 days of surgery. The primary outcome was surgical site infection (SSI) or systemic sepsis within 30 days of surgery. Fisher's tests were performed to evaluate differences. Results250 patients underwent tumor resection between July 2018 and June 2021 at both centers. The median age was 4 years [Range: 0.02–26.1]. Seventy-five percent (N = 188) received perioperative antibiotics prophylaxis (AP), while 25 % of patients did not receive AP (N = 62). Only one patient in the AP group (0.5 %) developed postoperative sepsis, while 12 patients (19.4 %) in the non-AP group developed sepsis (p < 0.0001). There were 3 SSI in the AP group and none in the non-AP group (p = 1.0). ConclusionsThe administration of AP in children undergoing solid tumor resection is associated with a reduced rate of postoperative sepsis but no difference in SSI. This could possibly be related to bacterial translocation during surgery and the seeding of indwelling central venous access catheters. Our results support the standardized use of AP in this population. Type of StudyRetrospective Cohort Study. Level of EvidenceIII.

Intraoperative redosing of antibiotics for prevention of surgical site infections: A systematic review and meta‐analysis

AbstractBackgroundAppropriate antibiotic prophylaxis is essential for preventing surgical site infections (SSI); however, the clinical benefit of intraoperative redosing remains unclear and controversial owing to insufficient reliable evidence. Therefore, we performed a systematic review and meta‐analysis to assess the effectiveness of prophylactic antibiotic redosing in lengthy surgical procedures.MethodsWe systematically searched the PubMed, Cochrane Library, Web of Science, and Ichushi‐Web databases for articles published until 31 December, 2023. We compared the incidence of SSI between patients receiving and not receiving intraoperative redosing of antibiotics in surgeries lasting ≥3 h. Subgroup analyses were conducted across study characteristics. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel random effects model. The risk of bias was assessed using the ROBINS‐I.ResultsOverall, seven observational studies involving 4,671 patients were included. Intraoperative antibiotic redosing significantly reduced the risk of SSI compared with non‐redosing (OR = 0.65, 95% CI = 0.45–0.94, p = 0.02). Subgroup analyses showed that intraoperative redosing decreased SSI risk in studies with a minimum 4‐h operative time, no postoperative antibiotic continuation, and a moderate risk of bias. However, the statistical heterogeneity of the analyses was high among the studies.ConclusionsIntraoperative redosing with prophylactic antibiotics during lengthy surgeries may be associated with a lower risk of SSI than non‐redosing. Therefore, we recommend intraoperative redosing for surgeries lasting beyond 3–4 h to reduce the risk of infection. Further research is required to clarify the optimal redosing interval, which should be prioritized in future studies.

The collection and application of autologous amniotic fluid to cesarean delivery closure – a feasibility study

Amniotic fluid and amnion membranes have been used in surgery specialties to improve wound healing. The objective was to determine if amniotic fluid could be collected at cesarean delivery and then reapplied to the layers of the closure using the CeaLogic Specimen Collection and Ratio Applicator Kit. Autologous amniotic fluid from 20 subjects was collected at cesarean delivery using the collection kit, and then transferred to the applicator kit, mixed with calcium chloride solution, and applied directly to each of the surgical repair layers during closure. The Modified Hollander Cosmesis Score was used to assess wound appearance from photographs of the incision taken in the postpartum setting. The median (IQR) Modified Hollander Cosmesis Score (range 0-best, to 6-worst) at the one week and four-week postpartum visits was 0 (0,1) and 0 (0,2), respectively. There were no wound complications nor surgical site infections. The CeaLogic Specimen Collection and Ratio Applicator Kits can be used to collect and reapply autologous amniotic fluid at cesarean delivery. Future studies can determine if the application of autologous amniotic fluid to cesarean delivery closure can improve cosmesis and wound healing, as well as decrease the risk for the development of intraabdominal adhesions.

Comparison of Early Outcomes in Patients Who Underwent Common Femoral Thromboendarterectomy with Vein versus Bovine Pericardial Patches

The treatment outcomesof vein and bovine pericardial patches in thromboendarterectomy (TEA) for common femoral artery (CFA) lesions in patients with peripheral arterial disease (PAD) remain unclear. The purpose of this study was to evaluate the efficacy and safety of the bovine pericardial patch by comparing it with vein patch angioplasty. This was a multicenter retrospective study. We reviewed the data of patients who underwent TEA with patch angioplasty (vein versus bovine pericardial patch angioplasty) for PAD between January 2018 and December 2022. Indication for revascularization is PAD patients with claudication symptoms to rest pain and foot ulcers that interfere with daily life, with lesions in the CFA region. The primary endpoint was 2-year patency. The secondary endpoints were postoperative wound complications, including patch rupture, and safety of remote-phase puncture of the patch area after patch angioplasty. Within the observation period, TEA was performed on 157 limbs in 136 patients using vein patches, and on 86 limbs in 79 patients using bovine pericardial patches. The number of claudication/rest pain/tissue loss was 110/13/34 cases in the vein patch group and 57/14/15 cases in the bovine pericardial patch group, respectively. No significant differences were observed in patient characteristics. No significant between group differences were observed in operative time, blood loss, or percentage of patients who underwent concomitant revascularization during the procedure. The 2-year primary patency rates of the vein and bovine pericardial patch were 95.6% and 92.8%, respectively (P= .49). The rate of surgical site infection (SSI) in this study was 2.5% in the vein patch group and 5.8% in the bovine pericardial patch group, respectively (P=.29). Rupture of the patch occurred in 4 (2.5%) and 4 (4.7%) patients in the vein and bovine pericardial patch groups, respectively (P= .46), and the percentage of cases requiring revision of the patch site was 7 (4.5%) and 5 (5.8%) in the vein and bovine pericardial patch groups, respectively (P= .76). Postoperatively, 23 patients in the vein and 13 patients in the bovine pericardial patch groups underwent patch puncture during the remote period. The median follow-up duration from the date of the surgery to the date of the puncture was 544 days and 374 days in the vein and bovine pericardial patch groups, respectively. No patch-related complications were observed during remote stage puncture. Compared with vein patches, TEA with bovine pericardial patches had acceptable outcomes in terms of patency and postoperative complications.