Surgical Site Infection Research Articles

The impact of diabetes and presurgical glycemic control on wound morbidity following open complex abdominal wall reconstruction: a single-center experience.

Numerous studies have identified diabetes mellites (DM) as a significant risk factor for postoperative wound morbidity, with suboptimal preoperative glycemic control (GC) posing an even greater risk. However, this data largely excludes ventral hernia patients. Our study examined the association between diabetes and preoperative GC and postoperative outcomes following open complex abdominal wall reconstruction (AWR). We identified diabetic patients who had undergone open, elective, clean VHR with transversus abdominis release (TAR) and permanent synthetic mesh at the Cleveland Clinic Foundation between January 2014 and December 2023. Their 30-day outcomes were compared to non-diabetic patients undergoing the same procedure. Subsequently, diabetic patients were categorized based on GC. status: "Optimal GC" (HbA1c < 7%), "Sub-optimal GC" (HbA1c 7-8.4%), and "Poor GC" (HbA1c ≥ 8.5%) and their outcomes were compared. 514 patients with DM who underwent clean elective TAR were identified, of which 431 met the inclusion criteria. GC was deemed optimal in 255 patients, sub-optimal in 128, and poor in 48 patients. Demographics were similar, except for anticoagulation treatment (p = 0.014). The entire study population exhibited significantly higher rates of wound morbidities and overall complications compared to non-diabetic patients. However, rates of surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring procedural intervention (SSOPI), and reoperation did not differ significantly among the three cohorts of presurgical glycemic control (p = 0.82, p = 0.46, p = 0.51, p = 0.78), respectively. No occurrence of mesh removal was documented. In general, diabetes is a marker for increased wound morbidity and complications following complex abdominal wall reconstruction. However, we could not establish a hard cutoff to justify withholding surgery in symptomatic patients based on an arbitrary HbA1C level. We believe this data is important for shared decision-making when considering AWR for symptomatic ventral hernias in diabetic patients.

Open versus robotic retromuscular ventral hernia repair: outcomes of the ORREO prospective randomized controlled trial.

Robotic retromuscular ventral hernia repair (rRMVHR) potentially combines the best features of open and minimally invasive VHR: myofascial release with abdominal wall reconstruction (AWR) with the lower wound morbidity of laparoscopic VHR. Proliferation of this technique has outpaced the data supporting this claim. We report 2-year outcomes of the first randomized controlled trial of oRMVHR vs rRMVHR. Single-center randomized control trial of open vs rRMVHR. 100 patients were randomized (50 open, 50 robotic). We included patients > 18 y/o with hernias 7-15cm with at least one of the following: diabetes, chronic obstructive pulmonary disease (COPD), body mass index (BMI) ≥ 30, or current smokers. Primary outcome was occurrence of a composite outcome of surgical site infection (SSI), non-seroma surgical site occurrence (SSO), readmission, or hernia recurrence. Secondary outcomes were length of stay, any SSI or SSO, SSI/SSOPI, operative time, patient reported quality of life, and cost. Analysis was performed in an intention-to-treat fashion. Study was funded by a grant from Society of American Gastrointestinal and Endoscopic Surgeons. 90 patients were available for 30-day and 62 for 2-year analysis (rRMVHR = 46 and 32, oRMVHR = 44 and 30). Hernias in the open group were slightly larger (10 vs 8cm, p = 0.024) and more likely to have prior mesh (36.4 vs 15.2%; p = 0.030), but were similar in length, prior hernia repairs, mesh use, and myofascial release. There was no difference in primary composite outcome between oRMVHR and rRMVHR (20.5 vs 19.6%, p = 1.000). Median length of stay was shorter for rRMVHR (1 vs 2days; p < 0.001). All patients had significant improvement in quality of life at 1 and 2years. Other secondary outcomes were similar. There is no difference in a composite outcome including SSI, SSOPI, readmission, and hernia recurrence between open and robotic RMVHR.

The impact of powered circular staplers on anastomotic leak in left-sided colorectal cancer surgeries

BackgroundSince the introduction of powered circular staplers in colorectal surgery, there has been growing interest in their impact on reducing complications, particularly anastomotic leakage. This study compared short-term postoperative outcomes between powered and manual circular staplers.MethodsThis retrospective study included colorectal cancer patients at the tertiary referral center from April to October 2023 who underwent anterior or low anterior resection (LAR) using a circular stapler. According to energy source, patients were divided into powered and manual groups, which used two powered and four types of manual staplers, respectively. All open, laparoscopic, and robotic approaches were included. Propensity score matching (PSM) analysis was used to reduce selection bias. Postoperative complications within 30 days, especially for anastomosis-related complications, were compared between the groups.ResultsAmong 511 patients, the powered group was 161 (32%). After PSM, 143 pairs of 286 patients were analyzed. The proportions of LAR were 53.8% and 51.0%, and initial diverting stoma rates were 23.1% and 22.4% for the Powered and Manual groups, respectively. Comprehensive complication rates were similar between the Powered group and the Manual group, without statistical significance (13.3% vs. 21.0%, P = 0.063). Anastomotic leakage was not different between the Powered and Manual groups (4.2% vs. 4.9%, P = 0.782). There was no significant difference in other complications, including anastomotic bleeding, ileus, surgical site infection, and intra-abdominal hematoma.ConclusionsThe study implies that powered circular staplers may not significantly reduce postoperative complications, including anastomotic leakages, compared to manual staplers in colorectal surgery of high-volume centers.Graphical

Perioperative outcomes using computer navigation in primary total shoulder arthroplasty

IntroductionThe utilization of computer navigation to improve glenoid component placement in primary total shoulder arthroplasty (TSA) is becoming increasingly prevalent. However, there is a paucity of literature examining the perioperative outcomes and cost of this technology compared to standard instrumentation. The purpose of this study was to compare the perioperative complications and healthcare utilization between computer navigation and standard instrumentation in primary TSA. MethodsThe Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients who underwent TSA with computer navigation (n = 752) were propensity score matched in a 1:3 proportion to patients who underwent TSA with standard instrumentation (n = 2256) for age, sex, smoking status, alcohol abuse, hypertension, diabetes mellitus, congestive heart failure, obesity, peripheral vascular disease, chronic kidney disease, chronic liver disease, and chronic lung disease. Bivariate statistical analyses were performed to compare preoperative demographic and comorbidity data, postoperative complications, and hospital utilization metrics between the 2 groups. Chi-square and student t-tests identified differences in categorical and continuous variables, respectively. ResultsPatients undergoing TSA with computer navigation exhibited lower rates of revision within 180 days (P < .001) and lower rates of certain postoperative medical and surgical complications, including acute renal failure (P = .006), urinary tract infection (P = .015), acute respiratory distress syndrome (P = .045), surgical site infection (P = .022), dislocation (P = .012), and prosthetic loosening (P = .032). Computer navigation patients had a higher cost of initial admission (P < .001) but were less likely to have extended hospital stays (P = .047), less likely to be discharged with home healthcare (P < .001), and more likely to be discharged routinely (P < .001). ConclusionTSA with computer navigation was associated with lower revision rates and reduced postoperative complications. Although greater initial costs were observed, decreased extended hospital stays and more routine discharges show promise for long-term cost efficiency. These findings underscore the advantages of computer navigation in TSA and should be considered by orthopedic surgeons when evaluating choice of instrumentation.

Pressure makes diamonds? The impact of closed incision negative pressure wound therapy on complications following abdominoplasty in patients with massive weight loss—results from a case controlled trial

BackgroundThe effectiveness of closed incision negative pressure wound therapy (ciNPWT) has been shown across various studies. However, studies with large patient cohorts comprising post-bariatric patient populations are missing. The objective of this research was to assess the influence of ciNPWT on post-operative wound complications in this demanding patient collective. MethodsWe conducted a retrospective case-control study. Between 1 January 2013 and 31 December 2023, a total of 251 abdominoplasty procedures following massive weight loss were identified. Patients were matched based on resection weights. We matched 118 patients separated into two groups depending on post-surgical wound management (conventional wound dressings vs ciNPWT). The primary outcomes were wound-related disorders and secondary outcomes were the number of readmissions or reoperations within 30 days after the initial surgery. ResultsThe study revealed equal incidence of seroma formation (15 vs 15, p = 1.0), rates of wound dehiscence (23 vs 20, p = 0.56), surgical site infection (11 vs 6, p = 0.18), hematoma (17 vs 9, p = 0.07), complete removal of all drainages (6.7 vs 6.1 days, p = 0.34) and total number of readmission (12 vs 11, p = 0.77) or reoperations (12 vs 10, p = 0.63) within 30 days. The second hospital stay caused by revision was significantly shorter in the ciNPWT group (5.8 days vs 12.0 days, p = 0.02). ConclusionConsequently, we did not find evidence to support the hypothesis that ciNPWT reduces complications after abdominoplasty in patients with massive weight loss.

Infections Following Gender-Affirming Vaginoplasty: A Single-Center Experience.

We describe the epidemiology and incidence of infections following gender-affirming vaginoplasty. Urinary tract and surgical site infections were the most common infections with incidences of 17.5% and 5.5%, respectively. We also identified a significant gap in human immunodeficiency virus screening and prescription of preexposure prophylaxis.

The impact of crohn's disease on patients undergoing total knee arthroplasty.

The knee joint remains the most affected joint in extra-intestinal manifestations of Crohn's disease (CD). Given the increasing prevalence of CD and overall demand for total knee arthroplasty (TKA), it is likely that an increasing number of patients with CD will require TKA. The purpose of this study was to assess the inpatient postoperative complication in patients with CD undergoing TKA. We queried the Nationwide Inpatient Sample (NIS) database between the years of 2016 to 2019, including a total of 558,371 patients who underwent primary TKA. Among these, 1461 were in the CD group and 556,910 were in the non-CD group (controls). Data pertaining to demographics, length of stay (LOS), total healthcare cost, mortality, and in-hospital complications (blood loss anemia, blood transfusion, periprosthetic infection, periprosthetic dislocation, periprosthetic mechanical complication, acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, deep vein thrombosis, superficial/deep surgical site infection, and wound dehiscence) were compared between the two groups. Patients diagnosed with CD had higher postoperative complications such as blood loss anemia (OR: 1.22, 95% CI: 1.07-1.39, p = 0.004), periprosthetic infection (OR: 1.80, 95% CI: 1.23-2.63, p = 0.006), and the need for blood transfusion (OR: 1.447, 95% CI: 1.01-2.06, p = 0.044) in comparison to the control group. In-hospital mortality and acute renal failure were similar in both groups. The CD group had a significantly prolonged LOS (2.54 vs. 2.35 days, p < 0.001). No statistically significant difference was noted concerning in-hospital charges between the two groups. CD patients undergoing TKA experienced increased LOS and postoperative complications. However, these complications were minor and did not affect total hospital cost. Further prospective cohort studies could build upon the findings described to continue to maximize outcomes in CD patients undergoing TKA, which might extend to other cohorts.

Antimicrobial Resistance in Bacterial Species Causing Orthopaedic Surgical Site Infections at a National Trauma Center, Kathmandu, Nepal.

Hospital-acquired infections, including surgical site infections (SSIs), pose a concerning challenge because of the growing resistance to multiple drugs, largely influenced by extensive prophylactic antimicrobial therapy. Although SSIs are well documented in advanced hospitals in developed nations, their prevalence and bacterial profiles are inadequately reported in low- and middle-income nations such as Nepal. This retrospective cohort study explored the prevalence of orthopaedic SSIs in relation to bacterial etiology and antimicrobial resistance. We examined the surgical and bacteriological records of patients suffering SSIs (clean or clean-contaminated wounds) within a month of their surgical procedures between January 2020 and June 2022 at the National Trauma Center, Kathmandu, Nepal. The prevalence of orthopaedic SSIs among hospital-visiting patients was 31.2% (448/1,438; 95% CI: 28.8-33.5). There were 341 (76.1%) males and 361 (80.6%) adults with SSIs. Knee/joint infections (n = 141, 31.5%) were predominant. An SSI typically occurs 7 days after surgery. Enterobacterales were dominated by Escherichia coli (n = 54, 40.9%), whereas nonfermenters gram-positive cocci (GPC) were dominated by Pseudomonas aeruginosa (n = 69, 81.2%) and Staphylococcus aureus (n = 216, 93.5%), respectively. Enterobacterales, nonfermenters, and GPC exhibited penicillin resistance at 74.5%, 29.8%, and 65.1%, respectively, whereas cephalosporin resistance was exhibited at 48.3%, 57.1%, and 49.6%; fluoroquinolone resistance at 25.9%, 40.5%, and 25.7%; and aminoglycoside resistance at 21.5%, 43.2%, and 17.3%. One-third of orthopaedic surgeries resulted in SSIs, mainly caused by S. aureus. Fluoroquinolones and aminoglycosides were moderately effective in treating bacterial SSIs, whereas penicillins and cephalosporins were the least effective. Nonfermenters exhibited higher antimicrobial resistance compared with Enterobacterales and GPC.

Assessing the impact of enhanced hygiene precautions during the COVID-19 pandemic on surgical site infection risk in abdominal surgeries

BackgroundA surgical site infection (SSI) is a postoperative infection that occurs at or near the surgical incision. SSIs significantly increase morbidity, mortality, length of hospital stay, and healthcare costs. The World Health Organization (WHO) has established hospital hygiene precaution guidelines for the prevention of SSIs, which were enhanced during the COVID-19 pandemic. The current study aims to explore the effect of the COVID-19 pandemic on SSI incidence among initially uninfected postoperative patients. We hypothesize that these enhanced precautions would reduce the incidence of SSIs.Materials and methodsA retrospective study comparing surgical outcomes before and during the pandemic. Patients who had abdominal surgery between June and December 2019 (Non-COVID-19) or between February and June 2020 (COVID-19) were included. The two groups were matched in a 1:1 ratio based on age, Sex, acuity (elective or emergent), surgical approach, and comorbidities. Electronic medical records were reviewed to identify SSIs and hospital readmissions within 30 days after surgery. Pearson's chi-square test and Fisher's exact test were used.ResultsData was collected and analyzed from 976 patients who had surgery before the COVID-19 pandemic (non-COVID group) and 377 patients who had surgery during the pandemic (COVID group). After matching, there were 377 patients in each group. In our study, we found 23 surgical site infections (SSIs) in both laparoscopic and open surgeries. The incidence of SSIs was significantly higher in the non-COVID period compared to the COVID period [17 cases (4.5%) vs. 6 cases (1.6%), respectively, p = 0.032], especially in non-COVID open surgeries. The incidence of SSIs in laparoscopic surgeries was also higher during the non-COVID period, but not statistically significant.ConclusionsEnhanced hygiene precautions during the COVID -19 pandemic may have reduced SSIs rates following abdominal surgery.

Modified Cranial Closing Wedge Osteotomy (AMA-Based CCWO) to Treat Cranial Cruciate Ligament Deficient Stifle in 204 Dogs Over 50 Kg: Magnitude of the Craniocaudal Angulation of the Proximal Tibia and Rate of Surgical Site Infection.

The aim of this retrospective study was to report the magnitude of the craniocaudal angulation of the proximal tibia (CCAPT) quantified by the angle between the anatomical axis (AA) and the mechanical axis (MA), called the AMA angle, and the tibial plateau angle (TPA) in dogs >50 kg that were treated by cranial closing wedge osteotomy based on the AMA angle (AMA-based CCWO). Furthermore, the percentage of dogs in which the AA and MA could be aligned postoperatively and the rate of surgical site infection (SSI) were reported. Medical records (between January 2016 and September 2023) were reviewed for 204 dogs that had AMA-based CCWO stabilized with a double locking plate (DLP) fixation with or without joint exploration plus a Robert Jones bandage (RJB) and were given postoperative antibiotics. The median (range) preoperative AMA angle and TPA were 3.1° (0-5.1°) and 30° (22-49.6°), respectively, and the postoperative AMA angle and TPA were 0° (-2.4 to 1.6°) and 9.2° (4-15°), respectively. The AA and MA were aligned in 82% of dogs. Grade 4 healing occurred in all osteotomies by 8 weeks postoperatively. Except for one dog, no SSIs were recorded. Concerning the magnitude of CCAPT in dogs >50 kg and the low SSI rate, AMA-based CCWO stabilized with a DLP fixation plus an RJB and postoperative antibiotics should be considered for treating cranial cruciate ligament-deficient stifles in this subset of dogs.

SP5.2 - Reducing Elective Colorectal Surgical Site Infections with Change of Gloves and Instruments Prior to Abdominal Closure; A Multicycle Audit

Abstract Aims Surgical site infections (SSI) carry a significant impact on patient morbidity, length of stay and antibiotic resistance. Our local colorectal unit has made several interventions over many years with no significant nor sustained improvement in the rate of SSI. The ChEETAh trial (Lancet, 2022) demonstrated a reduction in the rate of 30-day SSI by 13% with routine change of gloves and instruments (COGI) prior to abdominal closure. We aim to reduce our rate of SSI through implementation of COGI prior to abdominal closure; involving whole scrub team change of gloves and use of sterile instruments. Methods Adults undergoing elective colorectal surgery with an abdominal wound greater than 5cm were eligible for this study. Diagnosis of SSI was made based on at least one clinical indicator of infection or at least one symptom of SSI with data collection over 3 cycles spanning 11 months using clinical notes, imaging and microbiology results. The primary outcome was the diagnosis of a SSI involving the skin, subcutaneous, muscle or fascial layer up to 30 days post-operatively. Results The baseline SSI rate prior to intervention was audited at 29%. After implementation of COGI the rate fell to 23%. Further reinforcement of COGI and team education has demonstrated a further decrease in SSI to 15%. This has been sustained across a 6-month period post intervention. Conclusions Change of gloves and instruments is an effective, reliable and sustainable method to reduce the rate of surgical site infection in elective colorectal abdominal surgery.

ThP7.11 - Does Hypoalbuminaemia Increase the Risk of Surgical Site Infection in Neck of Femur Fracture Patients? A Systematic Review and Meta-analysis

Abstract Aim Serum albumin plays an important role in physiological and inflammatory haemostasis; low serum levels are linked with an increased incidence of surgical site infections (SSI). Although this has been demonstrated in spinal and elective arthroplasty surgeries, there is a paucity of evidence with regard to the effect of low preoperative serum albumin on rates of SSI following surgery for adult patients suffering from traumatic, acute hip fractures. Method A systematic review was conducted using the PRISMA guidelines. Four databases were searched for randomised controlled trials, cohort and case-controlled studies. The risk of bias was assessed using the Newcastle-Ottawa Score (NOS). Data was collected and pooled using RevMan Web Software. Results were reported as Odds Ratio (OR) with 95% Confidence Intervals (CI) and statistical significance of p &amp;lt;0.05. An Inverse-Variance model was used in meta-analysis. Results Six retrospective studies (five cohorts, one case-control) with a total of 43,059 patients were included. 45.3% (n=19,496) had low serum albumin (&amp;lt;3.5 g/dL). Hypoalbuminemia was associated with a significantly higher risk of any form of SSI (OR 1.25, p=0.008) and deep SSI (OR 1.76, p=0.05). There was no statistical significance between hypoalbuminemia and the incidence of superficial SSI (OR 1.06, p=0.77). Organ-space SSI was associated with hypoalbuminemia, albeit only one study reported this with poor statistical significance (OR 8.74, p&amp;lt;0.054). Conclusion Hypoalbuminemia increases the risks of most forms of surgical site infections; superficial and deep infections. There is a weak conclusion to draw between incidence of deep-space organ infections and low serum albumin.

MOY 3 - Development and external validation of the “Global Surgical-Site Infection” (GloSSI) predictive model in adult patients undergoing abdominal surgery

Abstract Aims Identification of patients at high-risk of surgical-site infections (SSI) may allow surgeons to minimise associated morbidity. However, there are significant concerns with the methodological quality and transportability of models previously developed. We aimed to develop a novel score to predict 30-day SSI risk following gastrointestinal surgery across a global context, and externally validate against existing models. Methods This was a secondary analysis of 2 prospective international cohort studies: GlobalSurg-1 (July-November 2014) and GlobalSurg-2 (January-July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed in GlobalSurg-2 data, with novel and previous scores externally validated in GlobalSurg-1. The primary outcome was 30-day SSI, with two predictive techniques explored: penalised regression (LASSO) and machine learning (XGBOOST). Final model selection based on prognostic accuracy and clinical utility. Results There were 14,019 patients (SSI=12.3%) for derivation, and 8,464 (SSI=11.4%) for external validation. The LASSO model was selected due to similar discrimination to XGBoost (AUC: 0.738, 0.725-0.750 versus 0.737, 0.709-0.765), but greater explainability. The final score included six variables: country income, ASA grade, diabetes, and operative contamination, approach, and duration. Model performance remained good on external validation (AUC: 0.730, 0.715-0.744; calibration-in-the-large: -0.098, slope: 1.008), and demonstrated superior performance to external validation of all previous models. Conclusion The GloSSI score allowed accurate prediction of the risk of SSI with 6 simple variables which are routinely available at the time of surgery across global settings. This can inform use of intraoperative and postoperative interventions to modify the risk of SSI and minimise associated harm.

SP1.8 - Reducing the burden to deliver remote postoperative surveillance using machine learning for surgical-site infection (SSI)

Abstract Aims Remote postoperative wound (RPW) surveillance has been shown to improve the delivery of care and minimise the harm to patients from surgical-site infection (SSI). The burden for healthcare staff to deliver is a major barrier to implementation, therefore we aimed to develop novel methods for automated assessment of RPW surveillance to reduce this. Methods This was a secondary analysis of two interventional studies on RPW surveillance: “Tracking wound infection with smartphone technology” (TWIST) and “ImplementatioN of Remote Surgical wOund Assessment During the coviD-19 pandEmic” (INROADE). Adult general surgery patients could submit images of their surgical wound(s), and patient-reported outcome measures (PROMs) of SSI for 30-days postoperatively. A multi-input neural network (MNN) was developed to predict a clinical diagnosis of SSI within 48h based on symptoms and wound images. Performance was evaluated using area under the curve (AUC) and externally validated. Results There were 1540 submissions containing PROMs (48h SSI rate = 3.7%, n=57) and 2615 images (48h SSI rate = 3.1%, n=82). The MNN exceeded performance of the component models within the external validation subset (AUC: 0.94, 95% CI: 0.89-0.99) and remained equivalent to clinician triage (AUC: 0.92, 95% CI: 0.90-0.94). Usage to screen out “low-risk” responses prior to clinical triage was estimated to reduce the staff-time required to deliver (6.3h vs 25.5h). Conclusion Automated assessment can be successfully deployed within RPW surveillance pathways to reduce the burden on staff to deliver without compromising care, and allow resources to be appropriately directed to those at greatest risk of SSI.

FP8.11 - Surgical Site Infection Post-operation (gowning vs not gowning): A District General Hospital Experience

Abstract Aims Increasing evidence shows that surgical site infection (SSI) does not differ significantly between main operation theatre and field sterility for many surgical procedures. This audit aimed to assess the rate of surgical site infection (comparing the operating surgeon using a disposable gown vs not using one) for emergency/elective skin procedures like uncomplicated incision and drainage of abscess, excision of lipoma, sebaceous cyst, and pilonidal sinus. Methods The electronic database was used to collect data (September-October 2023) on the type of surgery performed, number of theatre staff scrubbed in. Poster displays and informal education were used to raise awareness of theatre wastage (November 2023). All were advised to wear an apron, mask, sterile gloves, and field sterility only for uncomplicated cases. Data was recollected (December 2023-January 2024). Results 54 cases were performed in September and October 2023. All theatre staff scrubbed in and 160 gowns were used. 5/54 (9.3%) returned with wound infection and managed with antibiotics. The median of the number of days in which the patients returned post-operatively is 7 days. 24 cases were performed from December 2023-January 2024. Theatre staff in 5/24 cases did not scrub in and none of these patients returned with wound infection. Out of the other 17/24 cases, 5/17 (29.4%) returned with wound infection. Conclusions With the limitation of small sample size and multi-factorial aetiology of wound infection, surgeons who did not gown up had no increased risk of wound infection. The higher monetary and environmental costs of complete gowning without improvement of patients’ care are unjustifiable.

EP547 - Colorectal Surgery journey of a DGH

Abstract Colorectal cancer is the fourth most common cancer in the UK, and the management and practice have evolved over the years. A colorectal surgery performance audit was conducted at Pilgrim Hospital. The data collected was analysed and assessed against performance indicator set by NICE. The aim was to track progress and identify areas for improvement. Retrospective data collected from 2011-2020, paper and electronic. Data analysed with SPSS software. Total Anterior Resection. 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Open 18 41 16 12 3 13 10 11 7 13 Laparoscopic 1 4 13 22 26 23 18 27 24 12 Total 18 26 29 35 33 41 31 39 35 25 Length of Stay 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Total 12 12 13 9 9 9 8 8 8 Enhance Recovery Program 9 9 8 7 7 7 7 8 7 Complications 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Return to Theatre 3 5 6 3 2 5 6 3 1 Surgical Site Infection (SSI) 7 7 11 3 6 4 4 4 5 Anastomotic leak 6 2 1 1 3 3 2 3 0 Wound dehiscence 2 3 5 1 4 2 1 3 2 LRTI 1 1 2 1 3 1 2 2 0 The audit showed that, majority of the surgeries performed were open, with the laparoscopies increasing as the years progressed. Length of stay is shorter with ERP. Common complications were surgical site infections, anastomotic leak, return to theatre. Less common complications were lower respiratory tract infections and wound dehiscence.

SP1.5 - PRESS survey: PREvention of surgical site infection—a global pan-specialty survey of practice

Abstract Aims This survey aimed to establish current global practice across surgical subspecialties in the prevention of surgical site infection (SSI). Methodology A cross-sectional survey was formulated following a published protocol, aligning with established global guidelines for SSI prevention. A panel of experts provided guidance during iterative rounds of internal validation, incorporating consensus-based modifications. Prior to online dissemination via QualtricsXM link and QR code through international surgical societies, the survey underwent final external validation. Recruitment strategies were through international societies, snowballing and social media. Findings There were 1232 responses from 97 countries, with 698(56.7%) participants completing all inquiries. Responses were primarily provided by consultants or equivalent (766,75.2%), spanning all ten Royal College of Surgeons-recognised subspecialties. A significant majority (786/889,88.4%) routinely employs clinical examination for SSI diagnosis, while one-third (305/889,34.3%) never use the CDC criteria. Regarding surgical field preparation, less than half regularly use alcoholic povidone-iodine (339/778,43.6%) or chlorhexidine gluconate (370/778,47.6%). However, approximately one-third often or always use aqueous (478/1556,30.7%) or alcoholic (454/1556,29.2%) solutions for hand scrub. Surgeons exhibit a higher likelihood of changing gloves (614/734,83.7%) than instruments (513/734,69.9%) to facilitate clean skin closure. Most UK surgeons (181/206,87.9%) express equipoise in randomising patients for interventions in a potential platform trial evaluating SSI prevention. Conclusions Significant diversity characterizes global and subspecialty-specific practices in various SSI prevention measures, attributable to conflicting guidance and limited evidentiary support for recommendations. Encouragingly, a substantial number of surgeons express readiness to contribute to a robust evidence base through participation in potential platform trials for SSI prevention.

WP5.10 - Improving documentation of Surgical Site Infection Reduction Bundle (SSIRB) use in emergency laparotomies

Abstract Aims Surgical site infections (SSI) are associated with significant morbidity and mortality, substantial costs for hospitals due to increased length of stays, intensive care admissions and hospital re-admissions. NICE and the WHO support evidence based SSI reduction bundles (SSIRB). An evidence based SSIRB consisting of eight steps was implemented in the Surgical Emergency Unit (SEU) of a large teaching hospital to reduce SSI rates after emergency laparotomies. An audit was undertaken to assess documentation of SSIRB use. Methods The first audit cycle evaluated SEU laparotomies in January 2022 (n=31). The operation notes in patients’ electronic records were reviewed to extract SSIRB use. The intervention involved altering the electronic operation note to include a section on SSIRB use, which occurred in October 2022. The surgical team were educated about the importance of documenting SSIRB use and the updated operation note. A re-audit was completed for April 2023 (n=21). Results The first cycle showed that SSIRB documentation was poor (ranging from 0% to 55% for each step). After the operation note was updated, documentation of SSIRB use improved significantly for five of the eight steps. 48% of operation notes used the SSIRB section and documentation was higher for these laparotomies. Conclusions Documentation of SSIRB use improved after the intervention. Trusts are obliged to report accurate post-operative SSI rates. Improved documentation allows evaluation of SSIRB use compliance, enabling SSIRB steps with low compliance to be targeted. A high compliance rate to a SSIRB will reduce SSI rates, ultimately benefiting both patients and trusts.

SP2.5 - The Impact of Timing on Outcomes in Appendicectomy: A Systematic Review and Network Meta-Analysis

Abstract Aims Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes. We aimed to perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed, (2)time elapsed from symptom onset to hospital presentation (patient time), (3)time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes. Methods A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into &amp;lt;24 hours, 24-48 hours and &amp;gt;48 hours. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed. Results Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were &amp;lt;24 hours. Readmission and mortality rates were significantly better when the hospital time was &amp;lt;48 hours. SSI, operative time, and the rate of perforation were comparable in all groups. Conclusion Appendicectomy within 24 hours of hospital admission is associated with improved outcomes. The time-of-day which surgery is performed does not impact outcomes. Appendicectomy should be performed promptly upon confirmation of diagnosis to reduce complication rates and improve outcomes.

Developing and reporting a healthcare-associated infection composite score for health system board review

Background One strategy for supporting a hospital or health system's board of directors (Board), with their quality oversight responsibility is to review the organization's performance on quality measures. But for large systems, the number of measures needing review is quite burdensome and makes priority setting difficult. Our goal was to develop a scoring method that summarizes multiple quality measures together, while still maintaining the Board's opportunity to examine individual measures where there are specific concerns. Methods We calculated an overall health system-level composite performance score using six publicly reported healthcare-associated infections reported by the Centers for Medicare and Medicaid Services on their Care Compare website [central-line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSIs) for colon surgery and abdominal hysterectomy, hospital-onset Methicillin-resistant Staphylococcus aureus bacteremia (MRSA), and hospital-onset Clostridioides difficile ( C. diff)], where relative weights assigned to each infection type reflect the severity of patient harm. We also calculated a health-system composite performance target. For individual infection types, we calculated system-wide scores and targets and categorized individual hospital performance into three performance categories. Results The health system's composite score between 2015 and 2019 ranged from a high of 1.10 to a low of 0.71. The health system's composite score in 2017–2019 was better than the composite target. Of the 34 measures used to calculate the 2019 composite score, 20 were better than internal standardized infection ratio (SIR) targets, seven were between internal targets and SIR of 1.0, and seven were worse than SIR of 1.0. Discussion The Board communicated they find this composite score reporting approach helpful for streamlining their understanding of HAI performance, as compared to traditional approaches of reporting out individual performance measures. Approaches that streamline Board review of quality and safety performance are important as we hold Board members accountable for overseeing quality, seek greater engagement from the Board, and work to minimize measure review overload.