Wound Complications In Patients Research Articles

Effect of negative pressure wound therapy after surgical removal of deep-seated high-malignant soft tissue sarcomas of the extremities and trunk wall—study protocol for a randomized controlled trial

BackgroundSarcomas are a heterogeneous group of rare malignant tumors of mesenchymal origin in the musculoskeletal system. The main treatment is surgery often supplemented with pre-or postoperative radiotherapy.A retrospective study by Bedi et al. indicated that negative pressure wound therapy (NPWT) reduced the risk of postoperative wound complications in patients treated with preoperative radiation followed by surgical tumor removal of lower extremity soft tissue sarcomas (STS), and the use of NPWT was not associated with an increased risk of local recurrence. Previous studies have shown that NPWT can reduce postoperative complications. STS surgeries are a high-risk procedure concerning wound complications.MethodsNon-blinded single-center randomized controlled trial comparing NPWT versus conventional wound dressing and postoperative wound complications after surgical removal of deep-seated high-malignant STS of the extremities or trunk wallSample-size calculation: 154 STS patients (80% risk of avoiding type II error, 5% risk of type I error, and an 80% wound complication risk)Block randomization of 8 into:Group A: Conventional wound dressingGroup B: NPWT (PREVENA PLUS™ Incision Management System)Inclusion criteria: Surgery for a deep-seated STS of an extremity or the trunk wallExclusion criteria: Age < 18 years, plastic surgery, low malignant/borderline STS, chemotherapy, preoperative radiotherapy, allergic/hypersensitive to acrylic adhesives or silver, unwilling/unable to provide informed consent, metastatic disease, and ischemic surgeriesPrimary study endpoints were set as major wound complications defined by O’Sullivan et al. as a secondary surgery under anesthesia for wound repairs and wound management without secondary surgery within 4 months postoperatively.Secondary study endpoints among others are Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), and European Quality of Life - 5 Dimensions (EQ-5D).Approval from the Scientific Ethical Committee and the Data Protection Agency has been obtained, and the study is registered at clinicaltrial.gov.This study did not apply for external funding.DiscussionMany new medical devices and technical solutions are currently being introduced, and even though some documentation regarding the use of NPWT, e.g., in joint replacement surgery exist, it is also important to seek documentation for this treatment principle in STS surgery.Trial registrationRegistered at ClinicalTrials.gov NCT04960332 and approved on 11 July 2021

PROSPECTIVE OBSERVATIONAL STUDY OF WOUND COMPLICATIONS AFTER BREAST SURGERY FOLLOWING NEOADJUVANT CHEMOTHERAPY IN A TERTIARY CARE CENTER FROM SOUTHERN INDIA.

Introduction: Breast cancer is the most common cancer. One in 29 women in India develop breast cancer during their lifetime. Even though surgery is denitive treatment, Neoadjuvant chemotherapy improves survival and facilitates local therapy. Given the immunosuppressive nature of the drug, concern about increased risk of wound complications are always present. With this background we conducted a prospective observational study of the incidence of wound complications in patients who received neoadjuvant chemotherapy and underwent surgery. Method: Prospective observational study was done on the patients attending our Institute with history of breast lump and histologically proven malignancy. Data was collected from patients after obtaining their consent. All wound complications were recorded and following results were formulated. Results: The study involved 52 patients.At the time of presentation, the average age was 48.17 +/- 10.25 years. Overall, 25% of patients had wound complications, with wound infection accounting for 11.53 percent, seroma for 5.76 percent, and ap necrosis accounting for 13.46 percent. On days 1, 5, and 8, the average drain output was 190.3mL, 57.8mL, and 9.7mL respectively. The total number of days spent in the hospital was 7.92 +/- 2.57 days. The incidence of complications were 50% when associated with comorbidities which was signicantly higher at p=0.04 when compared to patients who had no comorbidities. When compared to other research, the rates of complications were similar. Conclusion: We believe that adding Neoadjuvant chemotherapy to a patient's treatment plan does not enhance the likelihood of wound complications.

Novel Anticoagulants and Hip Fractures in the Elderly.

IntroductionEarly surgery is recommended in hip fractures to reduce morbidity and mortality. Surgery is often delayed in patients on novel direct oral anticoagulants (DOACs). The purpose of our study was to investigate the impact of DOACs on patients with hip fractures.MethodsA retrospective comparative analysis was performed. A total of 766 patients presented with neck of femur fractures in the study period. Patients under the age of 60, those managed conservatively and those on alternative anticoagulation (including warfarin, clopidogrel and aspirin) were excluded. Forty-seven (6.1%) patients were on DOACs, to which a group of 47 patients was matched for age, gender, fracture type and intervention to minimise confounding. Primary outcome data on time to surgery (TTS), pre-/postoperative haemoglobin, haemoglobin drop, length of stay (LOS) and 30-day mortality were collected, as well as secondary outcome data on blood transfusion and wound complications. The Charlson Comorbidity Index (CCI) was calculated for all patients.ResultsThe mean Charlson Comorbidity Index was significantly increased in the DOAC group (p<0.0001). The mean time to surgery was 49.5 hours in the DOAC group versus 31.3 hours in the control group (p=0.0002). Haemoglobin drop for DOAC patients was 16.9 g/L and 15.9 g/L for control patients (p=0.6). Similarly, no significant increase in transfusion was required (p=0.74). Six DOAC patients and two control group patients died within 30 days of surgery (p=0.13). Wound complications were seen in five (10.6%) patients on DOAC and two (4.2%) patients in the control group (p=0.02).ConclusionThe results demonstrate statistically significantly higher comorbidities, delay in surgery and higher wound complications in patients on DOAC but no significant difference in haemoglobin drop, blood transfusion and mortality.

Early post-operative perineal wound complications in patients undergoing etralevator abdominoperineal excision: A Retrospective Study at Department of Surgical Oncology

Background: Extralevator Abdominoperineal Excision (ELAPE) is an emerging technique for the management of locally advanced distal rectal tumors in which sphincter preservation cannot be performed. The technique has not yet been adopted globally, however now as evidence is emerging more and more centers are adopting this technique. Positive circumferential margins (CRM) and intra-operative tumor perforations are one of the major factors that lead to local disease relapse and overall poor patient outcomes.

Intraoperative angiography imaging correlates with wound complications following soft tissue sarcoma resection.

For soft tissue sarcoma patients receiving preoperative radiation therapy, wound complications are common and potentially devastating. The purpose of this study was to assess the feasibility of intraoperative indocyanine green fluorescent angiography (ICGA) as a predictor of wound complications in these patients. A consecutive seriesof patients with soft tissue sarcoma of the extremities or pelvis who received neoadjuvant radiation and a subsequent radical resection received intraoperative ICGA with the SPY PHI device (Stryker Inc.) at the time of closure. Retrospective analysis of fluorescence signal along multiple points of the wound length was performed and quantified. The primary endpoint was wound complication, defined as delayed wound healing or wound dehiscence, within 3 months of surgery. Fourteenpatients with preoperative irradiated soft tissue sarcoma were consecutively imaged. There were six patients with wound complications classified as "aseptic" in five cases. Using the ICGA, blinded surgeons correctly predicted wound complications in 75% of cases. During the inflow phase, a mean ratio of normal of 0.62 maximized the area under the curve (AUC = 0.90) for predicting wound complications with a sensitivity of 100% and specificity of 77.4%. During the peak phase, a mean ratio of normal of 0.55 maximized the AUC (0.95) for predicting wound complications with a sensitivity of 88.9% and a specificity of 100%. Intraoperative use of ICGA may help to predict wound complications in patients undergoing resection of preoperatively irradiated soft tissue sarcomas of the extremities and pelvis.

Risk Factors for Wound Infections after Vascular Surgery: Kuwait Experience

Introduction: Wound infections represent a serious complication after vascular surgery particularly after vascular reconstructive procedures. We aimed to identify risk factors predisposing patients to these complications. Methods: This was a retrospective review of open vascular surgical procedures performed between April 2014 and March 2019 in Kuwait. Patient demographics, procedures performed and their indications, and post-operative outcomes were collected and analyzed. Patients with pre-operative active infections were excluded from the analysis. Statistical analysis was performed, and odds ratios (ORs) and relative risks were calculated for the outcomes of interest. Fisher’s exact test and two-tailed t test were used where appropriate. Results: 391 patients were identified. The majority (54%) presented with chronic limb threatening ischemia. The mean age was 58 (±10) years, with a male predominance (76%). Wound infection occurred in 53 (14%) patients. The most commonly isolated organism was Staphylococcus aureus (47%). Diabetes (OR 8.03, 95% CI: 1.9142–33.7439, p = 0.0044), hypertension (OR 2.38, 95% CI: 1.2960–4.3684, p = 0.0052), ischemic heart disease (OR 2.30, 95% CI: 1.4349–4.6987, p = 0.0016), hyperlipidemia (OR 2.12, 95% CI: 1.0305–4.3620, p = 0.0412), and chronic renal failure (OR 2.55, 95% CI: 1.0181–6.4115, p = 0.0457) were all found to be significantly associated with the development of post-operative wound infections in vascular surgery patients. Conclusion: Diabetes, hypertension, ischemic heart disease, hyperlipidemia, and chronic renal failure were associated with post-operative wound infections. Anticipation of wound complications in patients with these risk factors may aid early diagnosis and treatment.

Effect of Postoperative Immobilization Time on PROMIS Scores and Clinical Outcomes in Ankle Fracture Patients

Category:Ankle; TraumaIntroduction/Purpose:Ankle fractures are among the most common injuries that Orthopaedic Surgeons treat; yet, little guidance exists in postoperative protocols for ankle fractures concerning time of immobilization and weightbearing. Results from previous studies have been mixed; demonstrating improved outcomes, no difference in outcome, or poorer outcomes including increased wound complications in patients who are mobilized early. Here, we aim to investigate the association between early immobilization and patient reported outcomes. Our null hypothesis was that no difference in PROMIS scores would be identified in patients when comparing the effect of time of immobilization and time of weightbearing.Methods:A chart review identified ankle fractures that underwent surgical fixation between 2015 and 2020 at a level 1 trauma center and its associated facilities. One-hundred nineteen patients from 8 providers met inclusion criteria for our final analysis. Fifty patients were immobilized for <6 weeks and 69 patients were immobilized for at least 6 weeks. Our primary outcome measures included the PROMIS questionnaire, time of immobilization, and time to full weightbearing. Our secondary outcome measures included time to return to work, wound complications (infection, delayed healing), and complications associated with fracture fixation (loss of reduction, delayed union, reoperation, hardware failure). Repeated-measures ANOVAs were used to predict each of the PROMIS outcomes of anxiety, depression, physical function, and pain interference. Each model included the predictors of age, sex, race, BMI, payor, provider, time to radiographic union, time to return to work, time to full weightbearing, and early vs late immobilized groups.Results:There were no differences in PROMIS scores between mobilization groups and time to full weightbearing (p>0.05). Furthermore, there were no differences in wound complications nor complications associated with fracture fixation (p>0.05). Across our cohort, physical function scores were negatively impacted by higher BMI, increasing age and longer time to return to work/play (p<0.05). Our analysis further showed that depression, anxiety, pain interference and physical function levels improve as a function of time (p<0.05). African Americans showed more pain interference than other groups of patients (p<0.05). No difference in PROMIS scores were identified between treating providers (p>0.05).Conclusion:In this study, the null hypothesis was accepted. Data from our analysis shows no significant differences between the early and late mobilization and weightbearing groups in terms of PROMIS outcomes nor with wound complications and complications associated with fracture fixation. Our study does suggest that early mobilization after operative treatment of ankle fractures is safe and results in similar patient reported outcomes with no increased risk of complication. We did find that African American patients experienced more pain that other groups and we aim to further explore this topic to find potential modalities to address this disparity.

Wound infection in elbow fractures: Incidence and new management protocol.

Wound infection in elbow fractures: Incidence and new management protocol.

Impact of preoperative and intraoperative management on outcomes in osteoradionecrosis requiring free flap reconstruction.

Perioperative management of advanced osteoradionecrosis of the head and neck requiring free flap (FF) reconstruction varies. Our objectives included assessment of practice patterns and outcomes. Multi-institutional, retrospective review of FF reconstruction for head and neck osteoradionecrosis (n=260). Administration of preoperative antibiotics did not correlate with reduction in postoperative complications. Preoperative alcohol use correlated with higher rates of hardware exposure (p=0.03) and 30-day readmission (p=0.04). Patients with FF compromise had higher TSH (p=0.04) and lower albumin levels (p=0.005). Prealbumin levels were lower in patients who required neck washouts (p=0.02) or a second FF (p=0.03). TSH levels were higher in patients undergoing postoperative debridement (p=0.03) or local flap procedures (p=0.04). Malnutrition, hypothyroidism, and substance abuse correlated with a higher incidence of postoperative wound complications in patients undergoing FF reconstruction for advanced osteoradionecrosis. Preoperative antibiotics use did not correlate with a reduction in postoperative wound complications.

Excessive toxicity of cabozantinib in a phase II study in patients with recurrent and/or metastatic salivary gland cancer

AimBecause the tyrosine kinases c-MET and vascular endothelial growth factor receptors (VEGFR) are often overexpressed in salivary gland cancer (SGC), this study evaluated the efficacy and safety of cabozantinib in patients with recurrent/metastatic (R/M) SGC. Patients and methodsA single-centre phase II study was conducted. Patients with immunohistochemical c-MET-positive R/M SGC were included in three cohorts: adenoid cystic carcinoma (ACC); salivary duct carcinoma (SDC) and other miscellaneous SGCs. No prior systemic treatments were required. Patients started cabozantinib 60 mg once daily. The primary outcome was the objective response rate (ORR). Secondary outcomes included survival, safety and quality of life. Per Simon-two-stage design, depending on efficacy, a maximum of 43 patients would be included. ResultsIn total, 25 patients were included until premature closure owing to severe toxicity. Six patients (24%) had grade 3–5 wound complications, occurring at a median of 7.1 months on cabozantinib treatment (range 2.1–12.6). Remarkably, four of these six patients developed this complication in the area prior exposed to high-dose radiotherapy. Other grade ≥3 adverse events in >1 patient were hypertension (20%), diarrhoea (8%) and dehydration (8%).Twenty-one patients were evaluable for response; 1/15 ACC (ORR: 7%); 1/4 SDC and 0/2 patients with other miscellaneous SGC responded. Median progression-free survival was 9.4 months (95% confidence interval [CI] 7.4–11.4 months), 7.2 months (95%CI 0.0–15.1) and 6.9 months (95%CI 0.0–15.1), respectively. ConclusionThis study showed too many severe cabozantinib-associated wound complications in patients with SGC, especially in prior irradiated areas. Therefore, the study closed prematurely. The efficacy in the limited number of evaluable patients was low to moderate. Trial registrationThis trial was registered on ClinicalTrials.gov: NCT03729297.

Nutrition and Vitamin Deficiencies Are Common in Orthopaedic Trauma Patients.

Macro- and micronutrients play important roles in the biological wound-healing pathway. Although deficiencies may potentially affect orthopaedic trauma patient outcomes, data on nutritional deficiencies in orthopaedic trauma patients remain limited in the literature. The purpose of this study was to (1) evaluate the prevalence of macro- and micronutrient deficiencies in orthopaedic trauma patients with lower extremity fractures and (2) evaluate the impact of such deficiencies on surgical site complications. This retrospective study identified 867 patients with lower extremity fractures treated with surgical fixation from 2019 to 2020. Data recorded included albumin, prealbumin, protein, vitamins A/C/D, magnesium, phosphorus, transferrin and zinc, as well as wound complications. Nutritional deficiencies were found for prealbumin, albumin and transferrin at 50.5%, 23.4% and 48.5%, respectively. Furthermore, a high prevalence of micronutrient deficiencies (vitamin A, 35.4%; vitamin C, 54.4%; vitamin D, 75.4%; and zinc, 56.5%) was observed. We also recorded a statistically significant difference in wound complications in patients who were deficient in prealbumin (21.6% vs. 6.6%, p = 0.0142) and vitamin C (56.8% vs. 28.6%, p = 0.0236). Our study outlines the prevalence of nutritional deficiencies in an orthopaedic trauma population and identifies areas for possible targeted supplementation to decrease wound complications.

Outcomes of Laparoscopic vs. Open Reversal of Hartmann's Procedure: A Single Centre Experience.

IntroductionHartmann’s procedure is widely performed to fix colonic obstruction and perforation. It should ideally be followed by a reversal to restore bowel continuity. Reversal of Hartmann’s procedure was traditionally performed using an open technique. However, in recent days, the use of a laparoscopic approach has become increasingly popular. In our retrospective observational study, we aim to investigate the outcomes of laparoscopic versus open reversal of Hartmann’s procedure in a UK tertiary centre.MethodsAll patients who underwent reversal of their Hartmann’s procedure between January 2017 and December 2019 were included in the study. Data including demographics, days between primary operation and reversal, laparoscopic or open reversal, length of hospital stay following reversal procedure, 30-day readmission, mortality, and complication rate were collected. Statistical analysis was performed using t-test and chi-squared test.ResultsForty-nine patients underwent reversal of Hartmann’s procedure from January 2017 to December 2019. The mean age of our cohort was 59.6 ± 13.2 years. There was no significant difference in baseline demographics of both groups, apart from the number of days between the primary operation and reversal procedure. There was also no statistical difference in length of stay, 30-day readmission, and mortality between laparoscopic and open reversal techniques. However, there was a higher incidence of wound complications in patients who underwent open reversal of Hartmann’s procedure.ConclusionThe reversal of Hartmann’s procedure is a challenging operation. We found no significant difference between both open and laparoscopic approaches, but our study might be confounded by various factors including small sample size and selection bias. A larger, randomised study with greater statistical power is needed to confirm our findings.

A Web-Based Calculator for Predicting the Occurrence of Wound Complications, Wound Infection, and Unplanned Reoperation for Wound Complications in Patients Undergoing Surgery for Spinal Metastases

In the present study, we identified the risk factors for wound complications, wound infection, and reoperation for wound complications after spine metastasis surgery and deployed the resultant model as a web-based calculator. Patients treated at a single comprehensive cancer center during a 7-year period were included. The demographics, pathology, comorbidities, laboratory values, and operative details were collected. Factors with P < 0.15 on univariable regression were entered into multivariable logistic regression to generate predictive models internally validated using 1000 bootstrapped samples. Of the 330 patients included, 29 (7.6%) had experienced a surgical site infection. The independent predictive factors for wound-related complications were a higher Charlson comorbidity index (CCI; odds ratio [OR], 1.41 per point; P < 0.01), Karnofsky performance scale score ≤70 (OR, 2.14; P= 0.04), lower platelet count (OR, 0.49 per 105/μL; P < 0.01), revision versus index surgery (OR, 3.10; P= 0.02), and increased incision length (OR, 1.21 per level; P= 0.02). Wound infection was associated with a higher CCI (OR, 1.60 per point; P < 0.01), a lower platelet count (OR, 0.35 per 105/μL; P < 0.01), revision surgery (OR, 4.63; P= 0.01), and a longer incision length (OR, 1.25 per level; P= 0.03). Unplanned reoperation for wound complications was predicted by a higher CCI (OR, 1.39 per point; P= 0.003), prior irradiation (OR, 2.52; P= 0.04), a lower platelet count (OR, 0.57 per 105/μL; P= 0.02), and revision surgery (OR, 3.34; P= 0.03), The optimism-corrected areas under the curve were 0.75, 0.81, and 0.72 for the wound complication, infection, and reoperation models, respectively. Low platelet counts, poorer health status, more invasive surgery, and revision surgery all independently predicted the risk of wound complications, including infection and unplanned reoperation for infection. Validation of the calculators in a prospective study is merited.

Negative pressure wound therapy does not decrease postoperative wound complications in patients undergoing mastectomy and flap fixation

Patients and breast cancer surgeons are frequently confronted with wound complications after mastectomy. Negative pressure wound therapy (NPWT) is a promising technique for preventing wound complications after skin closure in elective surgery. However, a clinical study evaluating postoperative complications following the use of NPWT, focusing solely on closed incisions in patients undergoing mastectomy, has yet to be performed. Between June 2019 and February 2020, 50 consecutive patients underwent mastectomy with NPWT during the first seven postoperative days. This group was compared to a cohort of patients taking part in a randomized controlled trial between June 2014 and July 2018. Primary outcome was the rate of postoperative wound complications, i.e. surgical site infections, wound necrosis or wound dehiscence during the first three postoperative months. Secondary outcomes were the number of patients requiring unplanned visits to the hospital and developing clinically significant seroma (CSS). In total, 161 patients were analyzed, of whom 111 patients in the control group (CON) and 50 patients in the NPWT group (NPWT). Twenty-eight percent of the patients in the NPWT group developed postoperative wound complications, compared to 18.9% in the control group (OR = 1.67 (95% CI 0.77–3.63), p = 0.199). The number of patients requiring unplanned visits or developing CSS was not statistically significant between the groups. This study suggests that Avelle negative pressure wound therapy in mastectomy wounds does not lead to fewer postoperative wound complications. Additionally, it does not lead to fewer patients requiring unplanned visits or fewer patients developing clinically significant seromas.Trial registration: ClinicalTrials.gov number, NCT03942575. Date of registration: 08/05/2019.

Interventional revascularization prior to operative fixation of fractures below the knee. A retrospective case series

AimsThe goal of the current study was to describe the results of an innovative standardized approach to prevent wound complications in patients with PAD sustaining fractures below the knee. Patients and methodsIn this retrospective case series, patients submitted to our institution with fractures below the knee, which were treated with endovascular recanalization of relevant stenosis or occlusions prior to definitive open reduction and fracture fixation between January 2015 and December 2019 were included. ResultsOverall 23 patients (mean age 77 ± 9.8 years) were included in the current case series. In five patients (21.7 %) PAD was previously diagnosed. Endovascular interventions were performed 6.9 ± 2.5 days after fracture event and 2.5 ± 1.3 days prior to definitive surgical fixation of the lower limb fracture. After intervention 2 patients had one vessel, 10 patients two vessels and 11 patients three vessels for arterial perfusion of the lower limb. No interventional- radiology procedure related complications were observed. In this case series only two wound infections (8.7 %) occurred. ConclusionEndovascular intervention prior to surgical fixation resulted in a low complication rate after surgical fixation of fractures below the knee in patients with PAD. These results emphasize the crucial role of limb perfusion for adequate wound healing in lower limb fractures. Therefore, examination of limb perfusion should be an integral part of preoperative preparation of patients at high risk for PAD presenting with fractures below the knee. Endovascular recanalization seems to be an appropriate method to prevent wound complications.

Evaluating the efficacy of topical vancomycin powder in the treatment of open lower extremity fractures

Introduction Optimal management of lower extremity fractures includes early antibiotics administration, thorough irrigation and debridement, consideration of soft tissue injury, and definitive skeletal management. The purpose of this study was to evaluate the efficacy of topical vancomycin powder in the treatment of open lower extremity fractures. Methods This was a retrospective case control study in which open lower extremity fractures at our institution were reviewed for development of infection (including species and sensitivity if present) and the development of unanticipated wound complications requiring intervention. Patients from 2010-2015 were treated with standard of care consistent with evidence-based literature (IV antibiotics with external fixator, intramedullary nail, etc.). Patients from 2016–18 were additionally treated with vancomycin powder applied directly to the wound before closure. All patients were monitored per the treating surgeon’s standard follow-up protocol and had follow-up of at least two months. Results This retrospective case control study comprised 434 patients. The historical control group (n = 388 patients) and treatment group (n = 46 patients) were similar for age, sex, BMI (body mass index), diabetes, smoking status, and Injury Severity Score (ISS). There were 36 infections (9.28%) in the control group compared to four infections (8.70%) in the vancomycin powder group (p = 0.901). No significant difference was seen after adjusting for age, sex, BMI, diabetes, smoking status, and ISS. The vancomycin powder group experienced significantly more wound complications (15.2%) compared to the control group (6.4%; p = 0.039), which remained significant when adjusting for multiple covariates. Conclusions Topical vancomycin powder did not reduce the infection rate when applied in the surgical site of open lower extremity fractures. Instead, the addition of topical vancomycin powder resulted in significantly more wound complications in patients with open lower extremity fractures.

OUTCOMES AND SAFETY OF STERNAL CLOSURE USING NON-ABSORBABLE POLYESTER BRAIDED SUTURE: SINGLE TERTIARY CARE CENTER EXPERIENCE OF 5 YEARS.

Introduction: Median sternotomy is done as regular practice in cardiac surgery, which can lead to morbidity and mortality after sternal closure. Inappropriate sternal closure can lead to sternal dehiscence, sternal wound infection and mediastinitis. Aim: Efficacy and outcomes of sternal closure in adults weighing 2.5 kgs to 50 kgs using non-absorbable polyester braided suture. Methods: Total of 1091 patients underwent standard median sternotomy, weighing between 2.5 kgs to 50 kgs had sternal closure using non absorbable, braided, sterile, surgical suture composed of Poly ethylene terephthalate [polyester]. A retrospective analysis was done to review outcomes and complications related to this sternal closure technique. Results: Nineteen patients developed superficial surgical site infection and sternal sinus were seen in eight patients, whereas one patient had sternal dehiscence during immediate post-operative period. No sternal sutures were broken during the sternal closure and no case of mediastinitis was seen. Follow-up analyses of patients were done for 6 months after open heart surgery. Conclusion: Sternal closure using non-absorbable polyester braided suture is a safe and effective method with very less chances of post sternal wound complications in patients weighing between 2.5 kgs to 50 kgs.

S0708 The Postoperative Outcomes of Patients With Inflammatory Bowel Disease Undergoing Liver Transplant: A Nationwide Analysis

INTRODUCTION: Due to the shared liver etiologies and metabolic risk factors, patients with IBD develop end-stage liver disease that require liver transplant therapy (LT). It is therefore important to assess the effect of IBD on the postoperative outcomes in patients undergoing LT. METHODS: Patients who underwent LT were selected from the 2011–2017 National Inpatient Sample and were stratified by the presence of IBD (a combination of Crohn's disease and ulcerative colitis). The endpoints included mortality, length of stay, hospitalization costs, and postoperative outcomes. RESULTS: Of the 8063 cases of LT identified from the database, 277 cases had IBD. Compared to the IBD-absent cohort, the IBD cohort was younger (47.1 vs 52.3y P < 0.01) and more likely to be White or Native American (White 80.9 vs 66.4, Black 12.3 vs 9.75, Hispanic 3.25 vs 14, Asian or Pacific islander 0.72 vs 4.03, Native American 0.72 vs 0.62, Other 2.17 vs 5.15% P < 0.01). No difference was found in gender distribution (female 33.6 vs 36.2% P = 0.41). There was no difference between cohorts in terms of postoperative mortality (2.89 vs 3.67% P = 0.6, OR 0.78 95% CI 0.38–1.59), as well as LOS (19.8 vs 21.7d P = 0.86) and hospitalization costs ($486,525 vs $53,7283 P = 0.21). However, the IBD cohort had higher incidences of bowel obstruction (9.03 vs 5.12% P < 0.01, OR 1.84 95% CI 1.20–2.80), wound complications (3.97 vs 1.43% P < 0.01, OR 2.86 95% CI 1.52–5.38), and postoperative infection (3.61 vs 1.79% P = 0.047, OR 2.06 95% CI 1.07–3.96). However, there was no difference between cohorts in the incidence of postoperative bleeding (12.3 vs 13.8% P = 0.53, OR 0.88 95% CI 0.61–1.26) and bowel perforation (0.72 vs 0.48% P = 0.39, OR 1.52 95% CI 0.18–5.96). In a multivariate analysis using separate endpoints, the IBD cohort was associated with wound complication (P = 0.01, aOR 2.33 95% CI 1.12–4.40) despite controlling for age, gender, race, postoperative complications, liver-related covariates, and IBD-related intestinal events. CONCLUSION: The presence of IBD is not associated with increased hospital mortality in patients undergoing LT. However, since these patients have an increased risk of wound complications following LT, they require early postoperative wound assessment and multidisciplinary management of wound complications.Figure 1.: Multivariate model: inflammatory bowel disease is associated with increased postoperative wound complication in patients undergoing liver transplant therapy.

A phase 3 randomized controlled trial of preventive negative pressure wound therapy in postoperative incision management

Objective: The aim of this study was to test whether preventive negative pressure wound therapy decreases the incidence of wound complications in patients of any weight or in those with morbid obesity and benign disease undergoing laparotomy for gynecologic malignancy.

103. Discharge to subacute rehabilitation is a predictor of wound complications after spine surgery

BACKGROUND CONTEXT A significant number of patients are discharged to inpatient care facilities after various procedures in spine surgery. However, data are limited regarding the relationship between nonhome disposition and postdischarge surgical outcomes. PURPOSE The aim of this study was to evaluate differences in wound complications and readmission among discharge settings in patients undergoing elective spine surgery for degenerative cervical and lumbar disease (radiculopathy and/or myelopathy). STUDY DESIGN/SETTING This study is a retrospective analysis of prospectively collected data from a single, high-volume academic medical center. PATIENT SAMPLE Patients undergoing one- to three-level lumbar decompression, one- to three-level lumbar decompression and fusion, or posterior cervical decompression and fusion were retrospectively identified. OUTCOME MEASURES The outcomes of interest in this study were wound complications (surgical site infections, wound dehiscence), revision surgery, 30-day readmission, and 90-day readmission. METHODS Patient characteristics, including age, gender, body mass index (BMI), Charlson Comorbidity Index (CCI), and discharge setting (home, acute rehabilitation, subacute rehabilitation) were collected. Patients were stratified into those discharged to home/self-care (home), those discharged to inpatient rehabilitation (acute), and those discharged to skilled nursing or long-term rehabilitation (subacute). A multivariate logistic regression model was developed to identify variables associated with wound complications. RESULTS A total of 623 patients were included in the final analysis, with 480 patients in the Home group, 72 patients in the Acute group, and 80 patients in the Subacute group. Acute and Subacute patients had a higher mean age compared to the Home group (p CONCLUSIONS Our results suggest that discharge to subacute rehabilitation may be associated with an increased risk of wound complications in patients’ status post elective cervical or lumbar surgery. Moreover, our analysis further supports previous reports establishing an association between increased postoperative wound complications and obesity. Patients across all groups utilized a similar amount of resources in terms of readmissions and revision surgery. Surgeons should understand the need for appropriate risk stratification, and when clinically possible and safe, design pathways aimed at home discharge to reduce the occurrence of postoperative wound complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.