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Background: Surgical Site Infection (SSI) is one of the major hospital acquired infections, highly associated with prolonged hospitalisation, morbidity and mortality. In open urological surgeries, little is known on magnitude and factors associated with development of SSI. Methods and Materials: The intervention was a cross-sectional prospective observational study performed between August 2015 and March 2016 at Muhimbili National hospital (MNH), Dar es Salaam, Tanzania. Patients who underwent open urological surgery at MNH during the study period and met inclusion criteria were consecutively enrolled, and followed up for 30 days. Patients´ and operative characteristics were recorded using standard structured questionnaires. Wound/ pus swabs were collected from patients with clinical evidence of SSI for bacteriological processing. Data analysis was performed using SPSS version 20. Results: Of 182 patients who underwent open urological surgery, 22% (40/182) developed SSI. Pre-operative urinary tract infection (aOR 9.73, 95%CI 3.93-24.09, p

Objectives: The present study aimed to identify significant causes of readmission within 30 days following coronary artery bypass graft (CABG) surgery and compare readmission incidence related to surgical site infections (SSIs) before and after implementing international recommendations for antibiotic prophylaxis. Methods: We analyzed 2,225 CABG patients who received either guideline-directed antibiotic prophylaxis (GDAP = 568) or institutional antibiotic prophylaxis (non-GDAP = 1,657) between January 2017 and December 2019. The primary outcome was a composite of sternal wound infection (SWI) or harvest SWI. Secondary outcomes consisted of the individual components of composite end point, the incidence of in-hospital SSIs, and prolonged postoperative length of hospital stay (LOS) (>7 days). Propensity matching was used to select pairs for final comparison. Results: Before implementing GDAP, the most frequent reason for readmission were SSIs, causing 58.2% of all readmissions within 30 days. Of 429 matched pairs, 48 patients in the GDAP group and 67 patients in the non-GDAP group were readmitted to a hospital within 30 days for any cause (11.2 vs. 15.6%, p = 0.048). We found a decreased readmission incidence for reasons related to SSIs, although these differences did not reach statistical significance (7.4 vs. 10.0%, p = 0.069). Adherence to GDAP was associated with reduced in-hospital risks of SSIs and prolonged postoperative LOS (19.6 vs. 26.6%, p = 0.015). Conclusions: In this contemporary clinical practice study, the adherence to GDAP was an insufficient measure to decrease rehospitalization due to SSIs. The present findings warrant further investigation on factors that may contribute to SSIs development after hospital discharge.

Background: Surgical site infections (SSIs) continue to represent a substantial source of morbidity, mortality, and healthcare costs. The purpose of this study was to determine the effect of implementing a protocol using home pre-operative surgical preparation on the SSI rate at a large, urban safety-net medical center. Patients and Methods: From July through December 2020, Nose-to-Toes® (N2T; Sage Products-Stryker Corporation, Cary, IL) full-body preparation was applied by patients at home on the morning of scheduled surgical procedures. This study was a single-institution, retrospective observational analysis to determine the rates of SSI ≤30 days after an operation. Patients having skin preparation during 2020 (post-N2T) were compared with patients having the same operation during 2019 without having skin preparation (pre-N2T). Results: For gynecology, 10 (7.4%) of 135 pre-N2T and three (2.2%) of 135 post-N2T patients had SSIs. For surgical and gynecologic oncology, 13 (15.1%) of 86 pre-N2T and four (4.7%) of 86 post-N2T patients had SSIs. For orthopedics, four (4.3%) of 94 pre-N2T and zerp of 94 post-N2T patients had SSIs. Overall, 27 (8.6%) of 315 pre-N2T and seven (2.2%) of 315 post-N2T patients had SSIs (p = 0.0004). Conclusions: The implementation of pre-operative full-body preparation was associated with a substantial reduction in the incidence of SSI.

Antibiotic prophylaxis is the use of antibiotics in the perioperative period to prevent surgical site infections from local flora. Specific guidelines and criteria exist to prevent these infections while also practicing antimicrobial stewardship. Most dentoalveolar procedures do not require antibiotic prophylaxis. For nondentoalveolar procedures, the decision to provide antibiotic prophylaxis is based on involvement of the respiratory, oral, or pharyngeal mucosa. Special considerations exist for patients at high risk for infective endocarditis, patients with head and neck cancer, and temporomandibular joint replacement procedures. This article discusses indications for antibiotic prophylaxis during oral and maxillofacial surgical procedures.

Introduction Information on the long-term performance of biosynthetic meshes is scarce. This study analyses the performance of biosynthetic mesh (Phasix™) over 24 months. Methods A prospective, international European multi-center trial is described. Adult patients with a Ventral Hernia Working Group (VHWG) grade 3 incisional hernia larger than 10 cm2, scheduled for elective repair, were included. Biosynthetic mesh was placed in sublay position. Short-term outcomes included 3-month surgical site occurrences (SSO), and long-term outcomes comprised hernia recurrence, reoperation, and quality of life assessments until 24 months. Results Eighty-four patients were treated with biosynthetic mesh. Twenty-two patients (26.2%) developed 34 SSOs, of which 32 occurred within 3 months (primary endpoint). Eight patients (11.0%) developed a hernia recurrence. In 13 patients (15.5%), 14 reoperations took place, of which 6 were performed for hernia recurrence (42.9%), 3 for mesh infection (21.4%), and in 7 of which the mesh was explanted (50%). Compared to baseline, quality of life outcomes showed no significant difference after 24 months. Despite theoretical resorption, 10.7% of patients reported presence of mesh sensation in daily life 24 months after surgery. Conclusion After 2 years of follow-up, hernia repair with biosynthetic mesh shows manageable SSO rates and favorable recurrence rates in VHWG grade 3 patients. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report lasting presence of mesh sensation. Results of biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations. Trial registration Registered on clinicaltrials.gov (NCT02720042), March 25, 2016.

Objective To clinically assess the socket healing after tooth extraction and the occurrence of intra- and postoperative complications in chronic kidney failure (CKF) patients on hemodialysis (HD) by comparing them to a control group. Study desing This is a prospective study involving 48 patients with CKF on HD (study group – SG) and 29 participants without CKF (control group – CG) undergoing tooth extractions. No prophylactic antibiotic was given to the participants. One calibrated dentist evaluated all individuals at 3, 7, 21, and 60 days after the tooth extractions and assessed hemostasis time, occurrence of local or distant infection, epithelization, and deposition of alveolar bone. Results In the SG, 87 teeth were extracted through 65 interventions, and in the CG, 76 teeth were extracted through 36 interventions. Bleeding beyond 30 minutes was observed in 12 interventions (18.5%) on SG participants and was controlled with local hemostatic agents. None of the groups had individuals presenting postoperative infectious complications at the surgical site or a distance. After 21 days, we observed delayed epithelialization in 29.9% (26/87) of the individuals of SG compared to 3.9% (3/37) of those of CG (P Conclusions Individuals with CKF on hemodialysis tend to heal up well following dental extractions. They did not have an increased risk of infectious complications after simple tooth extractions, but they showed prolonged bleeding events more often than controls. Additional research studies using larger sample sizes of patients with CKF on hemodialysis are needed to confirm our findings. Clinical relevance This pilot study contributes to dentists ability to provide better dental management for people with chronic kidney failure undergoing hemodialysis through understanding the course of healing following dental extractions.

Background Surgical site infections (SSI) represent a burden on the health care system especially in developing countries with significant morbidity and mortality. In Egypt, especially in our institution, there is no registry for the SSI rate or the contributing factors with no clear guidelines regarding the regimen of perioperative antibiotic prophylaxis. Our study was conducted to assess the local practice and to calculate the rate and risk factors of SSI. Patients and methods A prospective registry was established at the Neurosurgery Department, Demerdash teaching hospital Ain Shams University, Cairo, Egypt. All patients who underwent elective neurosurgical procedures were included in this study. Trauma patients were excluded. Patients were followed-up for incident SSI for 1 month postoperatively. SSIs were identified based on CDC criteria and a standardized data collection form predictor variables including patient characteristics, preoperative, intraoperative, and postoperative factors along with the pattern of antimicrobial prophylaxis. Results The study included 248 patients with 1-month postoperative follow-up. An SSI rate of 19% was recorded being mainly in patients below 10 years of age. Postoperative CSF leak was noticed to be the most significant risk factor of SSI in our study (p value Conclusion Prolonged use of perioperative antibiotics does not seem to have an added benefit in SSI prevention. Tailoring of the used antibiotic regimen is highly recommended according to the latest antimicrobial prophylaxis guidelines and the local culture and sensitivity results.

Background Deep-space surgical site infections carry significant morbidity and mortality. The evidence for gentamicin-containing collagen implants at reducing surgical site infections in open infrainguinal arterial surgery is limited. This study examined whether gentamicin-containing collagen implants reduces 30-day surgical site infections and their severity following open infrainguinal arterial surgery. Methods A retrospective observational cohort study that included all patients undergoing infrainguinal arterial bypass or endarterectomy between November 2015 and March 2019 at a single tertiary vascular unit. Patients with contaminated/infected surgical fields, surgical wounds treated with negative pressure therapy, or the usage of antimicrobial implants and dressings other than Collatamp GⓇ (Aralez Pharmaceuticals, Canada) were excluded. Patients with gentamicin-containing collagen implants placed abutting vasculature were compared against patients without gentamicin-containing collagen implants. Outcomes included the rate of surgical site infections and their severity within 30 days after the operation. Results In 159 procedures (mean age 67.7 years, 74.8% male, 33.3% diabetic, 16.4% chronic renal failure, 25.2% anticoagulated postoperatively, 32.7% with prosthetic implants), 55 (34.6%) procedures received gentamicin-containing collagen implants. There were significantly more males (85.5% vs. 69.2%; P = 0.025), higher rates of obesity (41.8% vs. 26.0%; P = 0.041), and hyperlipidemia (65.5% vs. 49.0%; P = 0.048) in the gentamicin-containing collagen implant group. In total, 6 (3.8%) procedures developed deep-space surgical site infections (1 with gentamicin-containing collagen implant, 5 without) and 13 (8.2%) had severe surgical site infections that required re-intervention (1 with gentamicin-containing collagen implant, 12 without). On logistic regression analysis, the absence of gentamicin-containing collagen implants statistically significantly increased the odds of overall surgical site infections (OR = 2.50; 95% CI 1.01 – 6.19; P = 0.047). There was no statistically significant difference in the odds of deep-space surgical site infections or the severity and need for reintervention of surgical site infections. Conclusions This is the first study that examined the effect of gentamicin-containing collagen implants on the severity of surgical site infections in vascular surgery. Gentamicin-containing collagen implants may reduce the odds of overall surgical site infections. It did not reduce the odds of deep-space surgical site infections or the severity and reintervention rate of surgical site infections following infrainguinal arterial revascularization. Larger studies are required to achieve adequate power to assess for these outcomes.

INTRODUCTION: There is no data regarding the impact of enhanced recovery pathways (ERP) on composite length of stay (CLOS) after procedures with increased risk of morbidity and mortality, such as pancreaticoduodenectomy. METHODS: Patients undergoing open pancreaticoduodenectomy before and after implementation of ERP were prospectively followed for 90 days after surgery and complications were severity graded using the Modified Accordion Grading System. A retrospective analysis of patient outcomes were compared before and after instituting ERP. 1:1 propensity score matching was used to compare ERP patient outcomes to those of matched pre-ERP patients. CLOS is defined as postoperative length of hospital stay (PLOS) plus readmission length of hospital stay within 90 days after surgery. RESULTS: 494 patients underwent open pancreaticoduodenectomy – 359 pre-ERP and 135 ERP. In a 1:1 propensity-score-matched analysis of 110 matched pairs, ERP patients had significantly decreased superficial surgical site infections (5.5% vs 15.5% p=0.015) and significantly increased rates of urinary retention (29.1% vs 7.3% p

Objective To assess the predictive value of swab cultures of cryopreserved skull flaps during cranioplasties for surgical site infections (SSIs). Methods A retrospective review was conducted of consecutive patients who underwent delayed cranioplasties with cryopreserved autografts between 2009 and 2017. The results of cultures obtained from swabs and infected surgical sites were assessed. The accuracy, sensitivity, and specificity of swab cultures for SSIs were evaluated. Results The study included 422 patients categorized into two groups, swab and nonswab, depending on whether swab cultures were implemented during cranioplasties. The overall infection rate was 7.58%. No difference was seen in infection rates between groups. There were 18 false-positive and no true-positive swab culture results. All bacteria between swab cultures and SSI cultures were discordant. Meanwhile, there were 19 false-negative swab cultures. The results showed high specificity but low sensitivity for swab cultures to predict SSI occurrence and the pathogens. Conclusions Owing to low accuracy and sensitivity, swab cultures of cryopreserved autografts should not be routinely performed during delayed cranioplasties.

Zusammenfassung Gegenstand und Ziel Diese retrospektive Studie beschreibt die Methode der ventralen Mandibulatrepanation zur Extraktion erkrankter Unterkieferinzisivi beim Meerschweinchen und evaluiert das klinische Outcome. Material und Methoden Bei 40 Meerschweinchen mit veränderter Futteraufnahme wurde mindestens ein Unterkieferschneidezahn via ventraler Mandibulatrepanation extrahiert, nachdem Befunde der klinischen Allgemeinuntersuchung sowie der intraoralen und radiologischen Untersuchung in Allgemeinanästhesie die Diagnose einer primären mandibulären Inzisivuserkrankung ergeben hatten. Nach dem Eingriff wurden Röntgenaufnahmen angefertigt und die Patienten bis zur Entlassung stationär überwacht und versorgt. Zur Beurteilung und Behandlung der Wunden erfolgten regelmäßige Kontrollen. Ergebnisse Bei den insgesamt 42 extrahierten Unterkieferinzisivi stellten Makrodonten (25/42) den häufigsten Extraktionsgrund dar, gefolgt von periapikalen und alveolären Veränderungen (8/42). Extrahiert wurden ferner Zahnresiduen unklarer Genese (4/42) sowie nach fehlgeschlagenem konventionellem Extraktionsversuch mittels Luxatoren (3/42) und traumatisch bedingt gelockerte Inzisivi (2/42). Bei jeweils 40 % (16/42) der Meerschweinchen lagen zahnassoziierte Kieferabszesse bzw. eine therapiebedürftige sekundäre Elongation der Backenzähne vor. Allen Patienten konnten die veränderten Inzisivi bzw. Residuen vollständig entfernt werden. Durchschnittlich 2 Tagen nach dem Eingriff nahmen die Tiere eigenständig Futter auf und konnten entlassen werden. Die Ausheilung der Wunde war nach durchschnittlich 39 Tagen (Minimum 9 Tage, Maximum 98 Tage) festzustellen. Die 22 Tiere, die 6 Monate nach dem Eingriff nachuntersucht werden konnten, wiesen keine erneuten zahnassoziierten Erkrankungen auf. Schlussfolgerung und klinische Relevanz Die ventrale Mandibulatrepanation ermöglicht es, erkrankte Unterkieferinzisivi beim Meerschweinchen in toto in einer Operation zu entfernen und stellt somit einen kurativen Eingriff dar. Im Gegensatz zur klassischen Extraktion mit Luxatoren birgt sie nicht das Risiko von Zahnfrakturen mit der Folge verbleibender Zahnfragmente in der Alveole.

Objective: Reduction of surgical site infection. Methods: Retrospective evaluation of a surgical infection prevention program consisting of the gradual introduction of specific infection prevention methods and a surveillance system identifying and reporting on potentially preventable surgical site infections as defined by the omission of a preventive method. Setting: A university tertiary referral medical center. Results: The sequential introduction of infection prevention elements in the bundle resulted in a fluctuating rate of potentially preventable surgical site infections simultaneously with a slow, gradual reduction of the clean wound SSI rate. Conclusions: Change in a complex, multidisciplinary environment such as an inpatient surgical unit happens gradually and requires focused attention and input from all involved professionals.

In this case series with retrospective review we compared the outcomes of patients with sialorrhoea who had a submandibular excision (SE) alone and those who had submandibular excision with parotid duct ligation (SE + PL) between 2012 and 2018. Primary endpoints of complication rates and caregivers' perceptions of success were collected. A total of 41 submandibular excisions were performed for sialorrhoea (26 patients underwent SE, while 15 underwent SE + PL). Significant differences in the groups existed at baseline with patients in the SE plus PL group being more likely to have a tracheostomy (p = 0.015), to use sublingual atropine (p = 0.038) and respiratory medications (albuterol p = 0.0075, gentamicin p = 0.018), to have more pneumonias six months prior to the procedure (p < 0.001), and more hospitalisations six months prior to the procedure (p = 0.046). More postoperative surgical site complications were associated with ligation (p = 0.012). There was no difference in systemic infection (p = 0.25), and no difference in caregivers' perceptions of success in reducing sialorrhoea (18/24 SE compared with 10/14 SE + PL, p = 1.00). There were more surgical site complications in those undergoing SE plus PL than in those who had SE alone. Given this data, parotid duct ligation may not yield additional benefit when combined with submandibular excision.

Objective: Surgical site infection (SSI) is the most common serious complication of deep brain stimulation (DBS) implantation surgery. Here, we report a single-surgeon experience on the efficacy of topical, intrawound vancomycin powder (VP) in reducing SSI for DBS surgery and present the first systematic review and meta-analysis examining the effect of topical vancomycin on SSI in patients after DBS surgery. Methods: For the retrospective review, all unique patients undergoing DBS surgery at UCSF for new hardware implantation or internal pulse generator (IPG) replacement by a single surgeon from September 2013 to March 2019, with at least 1 year of follow-up data, were included. For the meta-analysis, we included all primary studies that compared SSIs with and without application of topical vancomycin in DBS surgeries. Results: 368 unique patients met inclusion criteria; 195 patients received topical VP (VP group) and 173 did not (control). 99/195 patients in the VP group underwent new DBS implantation and 96/195 had IPG replacement. 71/173 patients in the control group had new DBS implantation and 102/173 had IPG replacement. There were 10 total cases of SSI: 4 patients from the VP group (3 new implants and 1 IPG replacement) and 6 patients from the control group (3 new implants and 3 IPG replacements), resulting in SSI rates of 2.1 and 3.5%, respectively (p value = 0.337). Including our retrospective analysis, 6 studies met inclusion criteria for the systematic review and meta-analysis. In the 4 studies that examined primary DBS implants, 479 total patients received topical VP and 436 did not; mean odds ratio for SSI with topical vancomycin was 0.802 (95% confidence interval [CI] 0.175–3.678). Across the 5 studies that examined IPG implantations or replacements, 606 total patients received topical VP while 1,173 patients did not; mean odds ratio for SSI with topical vancomycin was 0.492 (95% CI 0.164–1.475). In either case, topical VP application did not significantly decrease risk of SSI. Conclusion: Surgical infections after DBS surgery are uncommon events, with studies demonstrating mixed results on whether topical vancomycin reduces this risk. Our single-institution retrospective analysis and systematic review of prior studies both demonstrated no significant SSI rate reduction with topical VP. This is likely due to low baseline SSI rates, resulting in a small effect size for prevention. Given the cost-effectiveness, simplicity, and low risk, topical, intrawound VP remains a treatment option to further reduce risk of SSI, particularly in settings with higher baseline infection rates.

A referral hospital in Kavre, Nepal.To assess 1) compliance with National Antibiotic Treatment Guidelines (NATG), specifically, whether the administration of surgical antibiotic prophylaxis (SAP) (initial dosing and redosing) was in compliance with NATG for patients who were and were not eligible, and 2) development of surgical site infections (SSIs) among patients who underwent surgery in the Department of General Surgery (July-December 2019).This was a retrospective cohort analysis.The analysis included 846 patients, of which 717 (85%) patients were eligible for SAP and 129 (15%) were ineligible. Of those eligible, 708 (99%) received the initial dose; while 65 (50%) of the ineligible did not receive any dose. Of those who received the initial dose, 164 (23%) were eligible for redosing. Of these, only 23 (14%) received at least one redosing and 141 (86%) did not receive it. Overall compliance with NATG was achieved in 75% (632/846) of patients. SSIs occurred in 23 (3%) patients, 8 (35%) of whom did not have SAP administered according to NATG.A relatively high overall compliance with NATG for SAP administration was reported. Recommendations were made to improve compliance among those who were ineligible for SAP and those who were eligible for redosing.Un hôpital de référence du district de Kavre, Népal.Évaluer 1) le respect des directives nationales sur les traitements antibiotiques (NATG), plus particulièrement si l’administration d’une antibioprophylaxie chirurgicale (SAP) (dose initiale et nouvelle dose) respectait les directives NATG pour les patients qui y étaient ou non éligibles ; et 2) le développement d’infections du site opératoire (SSI) chez les patients ayant subi une intervention chirurgicale dans le service de Chirurgie Générale (juillet–décembre 2019).Il s’agissait d’une analyse de cohorte rétrospective.L’analyse a inclus 846 patients, dont 717 (85%) étaient éligibles à une SAP et 129 (15%) n’y étaient pas éligibles. Parmi ceux qui y étaient éligibles, 708 (99%) ont reçu la dose initiale, alors que 65 (50%) des patients non éligibles n’ont reçu aucune dose. Parmi ceux ayant reçu la dose initiale, 164 (23%) étaient éligibles à une nouvelle dose. Parmi ces derniers, seuls 23 (14%) ont reçu au moins une nouvelle dose et 141 (86%) n’en ont pas reçu. Les directives NATG ont été respectées chez 75% (632/846) des patients. Des SSI ont été observées chez 23 (3%) patients ; pour huit (35%) de ces patients, la SAP n’avait pas été administrée conformément aux directives NATG.Un respect global relativement élevé des directives NATG pour l’administration de la SAP a été rapporté. Des recommandations ont été émises pour améliorer le respect de ces directives chez les patients non éligibles à la SAP et chez ceux éligibles à une nouvelle dose.

Healthcare-associated infections (HCAIs) are a threat to patient safety and cause substantial medical and economic burden in acute care and long-term care facilities. Risk factors for HCAIs include patient characteristics, the type of care and the setting. Local surveillance data and microbiological characterization are crucial tools for guiding antimicrobial treatment and informing efforts to reduce the incidence of HCAI. Skin and soft tissue infections, including superficial and deep incisional surgical site infections, are among the most frequent HCAIs. Other skin and soft tissue infections associated with healthcare settings include vascular access site infections, infected burns and traumas, and decubitus ulcer infections.

Elevated HbA1c is associated with increased surgical site infections (SSI) in neurosurgical patients. How blood glucose control in the early post-operative period relates to SSI is incompletely understood. We hypothesized that poor early post-operative blood glucose control would be associated with SSI. Data from patients undergoing neurosurgical procedures at University of Missouri Hospital was retrospectively collected. Post-operative blood glucose for 72 h after surgery was assessed and categorized by levels of hyperglycemia; those with glucose ≥200 mg/dl were classified as poorly controlled. Patients with SSI were compared to patients without SSI using Chi-Square test with Fisher’s exact test when appropriate. Of 500 patients having surgery, 300 had at least one post-operative blood glucose measurement. Of those 300 patients, 19 (6.33%) developed SSI. Patients with SSI had significantly higher mean post-operative blood glucose levels (p = 0.0081) and a greater mean number of point-of-care glucose level measurements >150 mg/dL (p = 0.0434). Pre-operative HbA1c and SSI were not associated (p = 0.0867). SSI was associated with pre-operative glucocorticoid use (p = 0.03), longer operative procedure (p = 0.0072), and required use of post-operative insulin drip (p = 0.047). Incidence of other wound complications (cellulitis, deep infection, dehiscence) increased with increase in post-operative blood glucose levels to >225 mg/dL. Post-operative hyperglycemia is associated with SSI after neurosurgical procedures, emphasizing the importance addressing blood glucose control after surgery.

Patients who are obese or underweight are traditionally at higher risk for perioperative morbidity and mortality. The effect of body mass index (BMI) on outcomes after carotid endarterectomy (CEA) is unclear. Our goal was to analyze the association of BMI with perioperative and long-term outcomes after elective CEA.The Vascular Quality Initiative (VQI) database was queried from 2003-2018 for patients undergoing elective CEAs. Patients were categorized into 5 BMI cohorts - underweight (UW, BMI18.5 kg/mThere were 89,079 patients included: 2% UW, 26% NW, 38.4% OW, 29.9% OB, and 3.6% MO. Overall, the mean age was 70.6 years, 60% were male, and 91.8% were of white race. There were significant differences among the BMI cohorts in regards to age, sex, smoking status, and comorbidities (all P0.05). For perioperative outcomes, the BMI cohorts differed significantly in reoperation for bleeding and 30-day mortality. On multivariable analysis, BMI was not associated with stroke or perioperative mortality. MO was associated with perioperative cardiac complications (Odds Ratios [OR] 1.26, 95% CI 1-1.57, P = 0.05). UW status was associated with increased return to the operating room (OR 1.89, 95% confidence interval [95% CI] 1.28-2.78, P = 0.001), 30-day mortality (OR 1.68, 95% CI 1-2.86, P =0.05), 1-year mortality (Hazard ratio [HR] 1.37, 95% CI 1.08-1.74, P = 0.01), and 5-year mortality (HR 1.22, 95% CI 1.06-1.41, P =0.005).BMI status was not associated with perioperative stroke, cranial nerve injury, or surgical site infections. Patients with MO had higher perioperative cardiac complications. UW patients have lower short and long-term survival and should be a focus for long-term targeted risk factor stratification and modification.

High body mass index (BMI) increases the risk of postoperative complications and hernia recurrence after abdominal wall reconstruction (AWR). However, BMI does not provide specific information on the mass and distribution of adipose tissue. We hypothesized that visceral fat volume (VFV) was a better predictor than BMI for recurrence after AWR. We included all patients undergoing AWR at our institution from November 2010 to December 2016. Data were collected from a prospective database and all patients were summoned for follow-up. VFV was calculated from preoperative CT. The primary and secondary outcomes were hernia recurrence and 30-day postoperative surgical site occurrences (SSO), respectively. We included a total of 154 patients. At follow-up, 42 (27.3%) patients had developed recurrence. The recurrence rate was significantly higher in patients with a VFV higher than the mean compared to a VFV lower than the mean, P = 0.004. After multivariable Cox-regression, VFV remained significantly predictive of recurrence (HR 1.09 per 0.5 L increase of VFV, P = 0.018). In contrary, BMI was not associated with hernia recurrence. There was no significant difference in the rate of SSO between patients with a VFV above and below the mean. A multivariable logistic regression model showed that VFV was significantly associated with development of SSO (OR 1.12 per 0.5 L increase, P = 0.009). VFV was significantly associated with recurrence and SSOs after AWR. This study suggests VFV as a risk assessment tool for patients undergoing AWR.

Introduction Biliary stents increase surgical site infections (SSIs) following pancreaticoduodenectomy due to bactibilia and contaminated intraoperative bile spillage. Intraoperative bile culture (IOBC) is performed to guide empiric therapy for SSIs; however, its utility is poorly studied. We sought to evaluate IOBC and the interplay between stenting, bactibilia, and SSI following pancreaticoduodenectomy. Methods Patients undergoing pancreaticoduodenectomy from January 2008 to April 2020 were identified through our institutional National Surgical Quality Improvement Project (NSQIP) database; patients without IOBC were excluded. Odds of SSI were analyzed with multivariable logistic regression. Results Four-hundred-eighty-three patients were identified. One-hundred-eighty-nine (39%) patients had plastic stents and 154 (32%) had metal stents. Three-hundred-twenty-nine (96%) patients with stents had bactibilia versus 18 (13%) without stents (P 0.1); however, stent type was not (P > 0.5). Of the 73 speciated SSI cultures, an IOBC-identified organism was present in 42 (58%), while at least one organism not found in the IOBC was present in 49 (67%). Conclusion Bactibilia is associated with incisional but not organ space SSI following pancreaticoduodenectomy and is strongly associated with stent presence. Stent type does not independently influence the biliary microbiome or SSI risk. IOBC has a poor ability to predict causative organisms in SSIs following pancreaticoduodenectomy and is not recommended for routine use.

Treatment of edentulous maxillary anterior region with horizontal ridge atrophy presents a clinical situation in which the placement of endosseous implants might be complex or sometimes impossible without a ridge augmentation procedure. This case report presents management of horizontally deficient maxillary anterior ridge with ridge split procedure using piezotome and simultaneous implant placement. In contrast to other ridge augmentation techniques, ridge splitting allows for immediate implant placement following surgery reducing the overall treatment time and eradicates the possible morbidity from a second surgical site. Keywords: Ridge split, Ridge Augmentation, Esthetic rehabilitation, Prosthetic driven implantology

According to international data, the incidence of infections in the field of surgery in children and adults varies from 2.0 to 20.0 %. The occurrence of the above infections is influenced by many factors: the presence of comorbidities, ASA index, surgical wound class, NNIS risk index. Important factors include the quality of the suture. According to experts of the World Health Organization, 40.0–60.0 % of infections in the field of surgery can be prevented. The first microbiological study of suture (polyglactin 910) with triclosan was published in 2002. According to international studies, the use of a triclosan reduces the adhesion of bacteria to the suture, the viability of microbes and the release of inflammatory mediators. Triclosan actively prevents the colonization of the filament, in addition, concentrations sufficient to suppress the growth and reproduction of pathogens are maintained in the environment for a long time, resulting in the prevention of the development of infectious complications.

In 2010, following the recommendations of the World Health Organization (WHO), our hospital implemented a surgical safety programme centred around a surgical safety checklist.The aim of this study was to compare indicators of surgical site infection, antimicrobial consumption, antimicrobial resistance, costs and in-hospital mortality before (January 2006 to July 2010) and after (August 2010 to December 2014) implementation of the programme.A case-control study was carried out matching patients with surgical site infection (SSI) to surgical patients without infection to examine the impact of the intervention.Use of the surgical checklist was associated with a significant reduction in SSI. When comparing the two time periods, we also identified a reduction in infections due to micro-organisms in the ESKAPE group (from 90.7% to 73.9%, P0.001), a reduction of SSI in patients with contaminated, infected and potentially contaminated wounds, and for those in whom perioperative antimicrobial prophylaxis was discontinued in less than 48 hours. Overall, there was a reduction in antimicrobial resistance, though there was increased resistance to carbapenems for, to glycopeptides for Enterococcus faecium, and to clindamycin for Staphylococcus aureus. We also detected increased antimicrobial consumption of second- and third-generation cephalosporins and clindamycin. We observed a reduction in hospital deaths from 6.4% to 3.2% (P=0.001), but we did not observe any reduction in costs.Implementation of a surgical checklist was an independent predictor of SSI reduction, and was also associated with a decrease in antimicrobial resistance and reduced in-hospital mortality.

Administration of antibiotics within an hour of incision is a common quality metric for reduction of surgical site infections (SSI). Many pediatric patients who undergo surgery for an acute intraabdominal infection are already receiving treatment antibiotics. For these patients, we hypothesized that additional prophylactic antibiotic coverage would not decrease rates of SSI.Single institution retrospective review of patients18 years old undergoing appendectomy or cholecystectomy 7/2014-7/2019. Patients were categorized based on administration of an additional prophylactic antibiotic to cover gram positive bacteria within an hour of incision. The primary outcome was SSI. Secondary outcomes were Clostridium difficile colitis, intraoperative allergic reaction and readmission within 30 days due to infection.Of 363 patients, 261 received pre-operative prophylactic antibiotics and 92 received treatment antibiotics only. There was no difference in rates of organ space SSI (4.3% no prophylaxis vs 4.4% prophylaxis, p = 0.97) or superficial SSI (1.1% no prophylaxis vs. 0.7% prophylaxis, p0.999). One patient who received prophylactic antibiotics was readmitted on post-operative day 29 with C. difficile colitis. There was no difference in rates of intraoperative allergic reaction or readmission.In pediatric patients receiving treatment antibiotics for acute intraabdominal infection, additional prophylactic antibiotics may not reduce SSIs.

Summary Surgical site infections (SSI) pose significant morbidity after colorectal surgery. We sought to document current practices in colorectal surgery SSI prevention in British Columbia (BC). Reporting the current provincial landscape on SSI prevention helps to understand the foundation upon which improvements can take place. We surveyed all BC surgeons performing elective colon and rectal resections, and 97 surveys were completed (60% response rate). Eighty-six per cent of respondent hospitals tracked SSI rates. The reported superficial SSI was less than 5% and the anastomotic leak/organ space rate was less than 10%. All respondents gave preoperative prophylactic antibiotics, with 24% continuing antibiotics postoperatively; 62% are using oral antibiotics (OAB) and mechanical bowel preparation (MBP) and 29% use MBP without OAB. Areas for improvement include OAB with MBP and discontinuing prophylactic antibiotics postoperatively, as recommended by the World Health Organization.

Aim: This study aimed to evaluate two different approaches; subtarsal and transconjunctival approaches for reduction and fixation of ZMC fractures with the aid of Carrol-Girrard T -bar screw regarding the accessibility to the surgical site, adequacy of reduction and incidence of postoperative complications. Materials and Method: twenty patients suffering from zygomatico- maxillary complex fracture (ZMC) were selected conveniently and randomly divided into two equal groups. Transconjunctival incision was used for accessing the fractured ZMC in the study group, while the subtarsal approach was used in the control group. The reduction and fixation in both groups was achieved using the Carrol-Girrard T bar screw. Results: No statistically significant difference was seen among both groups in terms of postoperative pain, edema, ocular or sensory complications and adequacy of ZMC reduction. Conclusion: Transconjunctival incision for the exposure of the infraorbital rim and orbital floor combined with the use of Carroll-Girrard T- bar screw for the reduction and management of ZMC fracture is a convenient approach with minimal reported intra or postoperative complications.

Background: Intra-operative topical vancomycin (VAN) is a strategy used to prevent surgical site infections (SSI). Although evidence supporting efficacy in SSI prevention is evolving, data describi...

Introduction: Hip trauma is a debilitating event that leads to a major limitation in patient’s functional ability. The incidence of hip fractures increases with advancing age and are more common in old age individuals. Closed-suction drainage has been routinely used in total hip arthroplasty to prevent hematoma formation and surgical site infections (SSI). Objective: To compare the frequency of surgical site infections in patients undergoing hip surgery with closed suction drain placed at surgical site and without drain. Study Design: Randomized controlled trial. Place and Duration: The study was completed at department of Orthopedic Surgery Unit III, Bolan Medical College Hospital Quetta, Pakistan. The duration of study was from 1-April-2016 to 31-October-2017. Subjects and Methods: A total number of 176 patients who underwent hip arthroplasty were included in this study. Group A (n=88) patients underwent hip surgery with placement of drain and Group B patients underwent hip surgery without the placement of drains. Data analysis was carried out using SPSS v20.0. Chi-square test was applied to compare surgical site infections in drain group and without drain group. Effect modifiers were controlled by stratification. Post stratification Chi-square test was applied taking P-value

There has not been a consensus on the superiority of a surgical approach for minimally invasive ventral hernia repair. This systematic review and meta-analysis (SRMA) aims to compare clinical, and patient-reported outcomes of robotic-assisted ventral hernia repair (rVHR) to traditional endo-laparoscopic ventral hernia repair (lapVHR). We searched PubMed, EMBASE, Cochrane and Scopus from inception to 16th March 2021. We selected randomised controlled trials and propensity score matched studies comparing rVHR to lapVHR. A meta-analysis was done for the outcomes of operative time, length of hospital stay, open conversion, recurrence, surgical site occurrence and cost. A total of 5 studies (3732 patients) were included in the qualitative and quantitative synthesis. Significantly shorter operative times were reported with the lapVHR as compared to rVHR (weighted mean difference (WMD): 62.52, 95% CI: 50.84–74.19). There was also significantly less rates of open conversion with rVHR as compared to lapVHR (WMD: 0.22, 95% CI: 0.09–0.54). No significant differences in patient-reported outcomes that was discernible from the two papers that reported them. Overall, rVHR is comparable to lapVHR with longer operative times but less open conversion. It is, therefore, important to have proper patient selection to maximise the utility of rVHR.

Background Adult literature has demonstrated chlorhexidine (CH) superiority at preventing surgical-site infections when compared with povidone-iodine (P-I). The purpose of this study is to compare the rate of postoperative infections after preoperative skin cleansing with either CH or P-I in pediatric orthopaedic surgery in an effort to identify superiority. Methods We retrospectively identified all patients (18 y and below) that underwent orthopaedic surgery at our institution in 2015, when P-I was the preoperative skin antisepsis of choice, and in 2018, when a change in protocol resulted in more frequent use of CH. Open fractures, infections, neuromuscular, and tumor surgeries were excluded. Orthopaedic surgeries were classified according to their subspecialty (sports-related/upper extremity, hip and lower extremity, trauma-related, or spine procedure). A 1:1 propensity score matching was conducted within each procedure group on the basis of age, sex, and year using nearest-neighbor matching. Spine procedures could not be matched and were subsequently excluded from analyses. Results Propensity score matching matched 1416 CH cases with 1416 P-I controls. The infection rate for CH was 19 infections per 1000 cases (27/1416; 1.9%) compared with an infection rate of 11 infections per 1000 cases (16/1416; 1.1%) for P-I subjects. No difference was detected in infection rate across preoperative skin antisepsis groups (P=0.12). Moreover, it was found that CH and P-I resulted in significantly equivalent infection rates to within ±1.5% (P=0.004). When stratified by procedure type, CH used in sports/upper extremity procedures resulted in 29 more infections per 1000 cases compared with P-I use (16/450; 3/450; P=0.005). No difference was detected in infection rate across CH and P-I skin antisepsis groups in lower extremity procedures (9/792; 8/792; P=1.00) or in trauma-related procedures (3/174; 4/174; P=1.00). Conclusions CH and P-I are both protective against postoperative infections after sports/upper extremity, lower extremity, and trauma-related pediatric orthopaedic procedures. P-I may provide improved protection over CH as a preoperative skin antisepsis in upper extremity and sports-related procedures. Level of evidence Level III-comparative cohort.

Infections that are found in the wound produced by any surgical process or procedure are termed surgical site infections in medical parlance. They can be caused by a number of virulent microorganisms, and can be prevented partly or fully, by proper precautionary measures and early diagnosis and treatment. We here present a brief, comprehensive review of the epidemiology, causative microbes and management of these infections. Keywords: Surgical site infections, Prevention, Microbiology

Surgical site preparation involves removing debris and microorganisms from the dermal surface and reducing the risk of surgical site infection occurring. It has been noted in many studies that most...

The objective of this study is to evaluate the impact of preoperative frailty on short-term outcomes following intradural resection of skull base lesions. The 2005-2017 ACS-NSQIP database was queried for 30-day post-operative outcomes of patients undergoing intradural resection of the skull base, extracted by CPT codes 61601, 61606, 61608, and 61616. Five-item modified frailty index (mFI) was calculated based on the history of diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, chronic hypertension, and functional status. A total of 701 patients (58.8% female, 72.0% white) were included with a mean age of 51.8 ± 14.7 years. Compared to patients with mFI = 0 (n = 403), patients with mFI ≥ 1 (n = 298) were more likely to have higher rates of reoperation (13.4% vs. 8.7%, p = 0.045), medical complications (20.5% vs. 9.2%, p < 0.001), surgical complications (13.8% vs. 8.4%, p = 0.024), discharge to non-home facility (DNHF) (24.8% vs. 13.3%, p < 0.001), and prolonged length of hospitalization (7.3 ± 6.8 days vs. 5.6 ± 5.0, p = 0.003). Moreover, mFI = 1-3 was also associated with higher BMI, non-white race, high ASA, and older age (all p < 0.05). Upon adjusting for age, BMI, race, ASA score, and surgical site, multivariate regression analysis demonstrated that higher mFI (treated as a continuous variable) was associated with higher odds of medical complications (OR = 1.630, CI = 1.153-2.308, p = 0.006), surgical complications (OR = 1.594, CI = 1.042-2.438, p < 0.031), and LOS ≥ 10 days (OR = 1.609, CI = 1.176-2.208, p = 0.003). In conclusion, the 5-item mFI can be an independent predictor of several important short-term surgical outcomes following intradural resection of skull base lesions, warranting further investigations into its clinical utility.

Background: Dysregulation of the inflammatory and immune response to injury may increase susceptibility to secondary infections after trauma. It is unknown whether cytokines involved in this respon...

Barrier membranes are critical to the success of guided bone regeneration (GBR). Though not directly involved in bone regeneration, barrier membranes hold bone graft materials at the surgical site during the slow process of bone regeneration and prevent the infiltration of fibrotic gingival tissues that would compromise new bone formation. Many options are available on the market, but membranes derived from placental tissues are gaining rapid adoption due to their unique biologic and handling properties. In this case series, a dehydrated human deepithelialized amnion-chorion membrane (ddACM) was used in combination with freeze-dried bone allograft (FDBA) for two-stage GBR procedures. Data from 1-year and 5-year follow-up appointments are presented, as well as predictable indications for the use of ddACM. Using ddACM with FDBA for GBR cases led to predictable bone regeneration with osseointegrated implants at 5-year postoperative visits.

Background: It is a challenging question, especially in bariatric surgery (BS), whether antibiotic prophylaxis is necessary in all cases; considering the serious consequences of surgical site infec...

Guided tissue regeneration (GTR) has been proven to promote attachment and regeneration of periodontal tissue. However, there is a 20 to 40% incidence of attachment loss on regenerated attachments reported in the literature. To my knowledge, this is the first case report on a second attempt in GTR on a previous successful grafted site with clinical attachment loss. A healthy 17-year-old Chinese male patient had GTR performed with xenograft particles and bovine resorbable membrane on his root-canal treated, fused upper right lateral incisor and upper right canine (#12-#13) in 2007. Probing depth on the mid-palatal region of #12-#13 was reduced to 4 mm and maintained for the next 4 years. But in the fifth year, probing depth increased to 11 mm with no endodontic symptoms, and a second attempt of GTR using the same materials was carried out. The probing depth at the surgical site was reduced to 4 mm and successfully maintained for another 5 years. Irregular maintenance and the presence of plaque retentive factor could have caused the clinical attachment loss on #12-#13. This case shows it is possible to attempt GTR on a previous successfully grafted site. GTR did not increase tissue resistance against periodontal breakdown. Hence, proper maintenance planning for GTR sites is important to prevent periodontal breakdown.

Background Hospital characteristics have been recognized as potential risk factors for surgical site infection for over 20 years. However, most research has focused on patient and procedural risk factors. Understanding how structural and process variables influence infection is vital to identify targets for effective interventions and to optimize healthcare services. The aim of this study was to systematically review the association between hospital characteristics and surgical site infection in colorectal surgery. Main body A systematic literature search was conducted using PubMed, Scopus and Web of Science databases until the 31st of May, 2021. The search strategy followed the Participants, Exposure/Intervention, Comparison, Outcomes and Study design. The primary outcome of interest was surgical site infection rate after colorectal surgery. Studies were grouped into nine risk factor typologies: hospital size, ownership affiliation, being an oncological hospital, safety-net burden, hospital volume, surgeon caseload, discharge destination and time since implementation of surveillance. The STROBE statement was used for evaluating the methodological quality. A total of 4703 records were identified, of which 172 were reviewed and 16 were included. Studies were published between 2008 and 2021, and referred to data collected between 1996 and 2016. Surgical site infection incidence ranged from 3.2 to 27.6%. Two out of five studies evaluating hospital size adjusted the analysis to patient and procedure-related risk factors, and showed that larger hospitals were either positively associated or had no association with SSI. Public hospitals did not present significantly different infection rates than private or non-profit ones. Medical school affiliation and higher safety-net burden were associated with higher surgical site infection (crude estimates), while oncological hospitals were associated with higher incidence independently of other variables. Hospital caseload showed mixed results, while surgeon caseload and surveillance time since implementation appear to be associated with fewer infections. Conclusions Although there are few studies addressing hospital-level factors on surgical site infection, surgeon experience and the implementation of a surveillance system appear to be associated with better outcomes. For hospitals and services to be efficiently optimized, more studies addressing these variables are needed that take into account the confounding effect of patient case mix.

Background: Surgical site infections are the infections of the tissues, organs or spaces exposed bysurgeons during the performance of an invasive procedure manifested in the postoperative periodwithin 30 days after a surgical procedure and up to one year if an implant was placed in the patient.SSI is still higher in India as compared to western data leading to increased morbidity and mortality.This study aimed to analyse the factors associated with SSI and its microflora in a tertiary carecentre. Methods: A descriptive cross-sectional study was done for one year in a tertiary care centrein Bareilly, U.P. All the patients who underwent surgeries related to git pathology in the surgerydepartment, either emergency or elective with surgical site infections, were included in this study.Patients less than 18, all cases operated else were, or re-operated were excluded from this study. Alltraumatic abdominal surgeries were also excluded from this study. Results: The present studyrevealed SSI was associated with 82 (9.4%) cases among elective and 80 (21%) in emergencysurgeries. Superficial incision SSI was found to be most common (90 cases), followed by deepincisional SSI (60 patients) and organ/space SSI (12 cases). Minor intestine surgeries were mostcommonly associated with SSI. The microbiological organism most widely isolated was E. Coli(41.2%), followed by Staphylococcus aureus (27.5%), Klebsiella (16.5%), group A beta-haemolyticStreptococci (9.1%) and Pseudomonas (5.5%). Conclusions: Surgical site infection still causesconsiderable morbidity and high cost to the health care system and is becoming increasingly crucialin medico-legal aspects. Prevention of SSI requires a targeted approach to improve health careworkers' knowledge, practising the guidelines strictly regarding asepsis and optimising the patientbefore surgery. Reduction in rate of SSI will improve cosmesis and make the results of operationsbetter as a whole.

Objectives: The objectives of the study were to evaluate the knowledge, attitudes, and practice of orthopedic surgeons practicing in Saudi Arabia regarding surgical antibiotic prophylaxis (SAP). Methods: A cross-sectional study was conducted on certified and under-training orthopedic surgeons registered in the Saudi Council for Health Specialties. An email, including an online validated self-administered survey using a voluntary response sampling technique, was sent between November 2020 and January 2021. The questionnaire comprised 12 questions that tested knowledge regarding SAP, five questions that analyzed surgeon attitudes toward SAP, and three questions on SAP-related practice. Results: This study included 271 orthopedic surgeons from different areas of Saudi Arabia. The majority of respondents were registrars (or equivalent) (n = 92; 33.9%), and most of them were male (n = 257; 94.8%). Almost 95% of respondents reported that SAP was indicated for internal fixation, spinal surgeries, and prosthetic joint replacement. Moreover, 82.7% of the respondents stated that cefazolin was considered the first-line SAP. Almost 85% of the respondents demonstrated a positive attitude toward SAP, with a mean score of 2.48. However, 87.5% of them believed that adhering to SAP general guidelines would reduce the rate of infection in orthopedic surgeries. Almost 53% of respondents reported using only one guideline as a reference in their surgical practice. Moreover, 41.3% of surgeons switched between guidelines depending on the surgery. Conclusion: This study revealed adequate knowledge and a positive attitude toward SAP among orthopedic surgeons. However, a discrepancy in the practice habits of orthopedic surgeons was observed, which is explained by non-adherence to SAP protocols. Common guidelines that can be used by all orthopedic surgeons need to be developed and implemented to reduce surgical site infections and non-adherence to SAP protocols. This task can be done by a general trusted body like the Saudi Orthopedic Association.

Care of surgical instruments and devices is a multifaceted process that begins with an interdisciplinary team's prepurchase determination that the facility has the resources to correctly process the items. Processing encompasses point-of use removal of organic and inorganic material, transport to the processing area, use of chemicals and equipment to clean and decontaminate the item, and inspection for cleanliness and function. Failure to correctly clean and decontaminate surgical instruments can impede subsequent sterilization processes and place patients at risk for developing surgical site infections. The AORN "Guideline for care and cleaning of surgical instruments" provides general guidance for care of reusable medical devices. When processing instruments, perioperative team members should use the guideline in conjunction with the instrument manufacturer's validated instructions for use. This article discusses the guideline recommendations related to prepurchase evaluation, point-of-use treatment, transport, cleaning and decontamination, and education; it also includes a scenario to illustrate these topics.

Surgical site infections (SSIs) are challenging, with highly variable reported rates for children undergoing orthopedic surgery. It has been shown in adults that there is seasonal variability in SSI rates, with peak incidences in the summer months. We reviewed 8766 pediatric orthopedic procedures completed at a quaternary children's hospital over a 43-month period. Data collected included: age, sex, BMI, season of procedure, cultures, and other variables related to risks and treatment of SSIs. Of 4875 male and 3891 female pediatric patients undergoing orthopedic procedures, 47 patients (0.54%) with an average age of 11.3 years (range: 2.0-18.6) developed an SSI. Average time between surgery and diagnosis was 27.7 ± 19.8 days. Sixty percent of SSI patients had a BMI in the 85th percentile or above, and 49% of SSI patients had a BMI above the 95th percentile. Thirty-eight patients had positive cultures, with most common infections being due to methicillin-sensitive Staphylococcus aureus in 11 (29%) cases, polymicrobial in 9 (24%), pseudomonas in 5 (13%), and coagulase-negative Staphylococcus in 5 (13%). SSI rate in winter (0.18%) was significantly lower than in autumn (0.77%, P = 0.006) and summer (0.69%, P = 0.02). The difference did not reach statistical significance from the infection rate in spring (0.53%, P = 0.06). Twenty-nine (62%) SSI cases were considered elective in nature, and the other 18 (38%) cases were for acute traumatic injuries. There is a significantly higher SSI rate in summer and autumn than winter for pediatric patients undergoing orthopedic surgeries. Most patients with SSIs were overweight or obese.

The aims of this study were to (1) characterize the prevalence of hypoalbuminemia (HA), (2) compare complication rates among HA and non-HA patients, and (3) determine the influence of HA on postoperative complications and 30-day mortality among bariatric surgery patients. Data was extracted from the MBSAQIP registry from 2015 to 2018. A presurgical serum albumin level of $$\le$$ 3.5 g/dL was used to organize the patient population into HA and non-HA cohorts. Bivariate analysis and multivariable logistic regression modeling were used. Of 590,971 patients, 42,618 (7.2%) were identified as having serum albumin levels $$\le$$ 3.5 g/dL. HA patients were younger (44.0 + / − 11.9 vs. 44.5 + / − 12.0 years; p

Background and objectives: To study the prevalence of microorganisms and antibiotics activity tests of natural and industrial products, SSIs were found in referral hospitals in Erbil, Iraq's Kurdistan province. MethodsPus samples were collected from 29 surgical patients using sterile swabs and primed for culture collection. Disc diffusion method was used to determine the bacterial activity of three types of plants (cinnamon, ginger, and radish) against three bacterial species including Staphylococcus aureus, Proteus spp., and S.epidermidis. Result: Overall 29 pus samples were processed for culture testing. One gram negative bacterium (7.14%) and thirteen gram positive cocci (92.85%) were isolated from the 14 bacteria. The three most potent isolates were found to be resistant to the variable of tested antibiotics, while they showed any sensitivity to the tested plant extracts. Cinnamon, ginger, and radish extracts were discovered to be among the few variable effective plant extracts against the tested pathogenic bacteria isolates. Conclusion: The data collected from this research showed a better way of explanation of the microorganism’s etiology of surgical site infections (SSIs) in hospitals where they might have epidemiological and healing insinuations. Keywords: Surgical Site Infections, Bacteria isolated from wounds, antimicrobial resistance, pus, plant extract.

Triclosan (TCS), a synthetic antimicrobial, has been incorporated into a variety of personal care products worldwide. Since 2016, upon the recommendation of World Health Organization (WHO), the use of TCS-containing sutures (TCSCS) to prevent surgical site infections (SSI) has become a common practice. However, TCS is a subject of environmental and public health concern and has been ranked as a chemical of serious concern to be avoided based on GreenScreen® hazard assessment. Recent reports on the efficacy of TCSCS to prevent SSI have revealed conflicting results. Here, we aim to highlight and discuss various safety and antimicrobial resistance concerns associated with the generalized use of TCSCS. Further, we emphasize that the long-term health benefits must be evaluated before the incorporation of TCS into surgical sutures.

For high-risk patients, traditional surgical dogma advises open operations, with short operative times, to "get them off the table" instead of longer minimally invasive surgery approaches.The aim of this study was to compare postoperative outcomes in patients with high-risk colon cancer undergoing elective longer minimally invasive surgery operations compared with shorter open operations.Retrospective comparative cohort study.Interventions were performed in hospitals participating in the national surgical database.The National Surgical Quality Improvement Program database was used to identify patients with colon cancer with ASA class 3 to 4 undergoing right and sigmoid colectomy between 2012 and 2017.Thirty-day postoperative outcomes were compared between short open and long minimally invasive groups.A total of 3775 patients were identified as having undergone long minimally invasive right colectomy and short open right colectomy (33% open, 67% minimally invasive surgery), and 1042 patients were identified as having undergone long minimally invasive sigmoid colectomy and short open sigmoid colectomy (36% open, 64% minimally invasive). Patients undergoing long minimally invasive right colectomy had significantly lower rates of overall morbidity, severe adverse events, mortality, superficial surgical site infections, and wound disruptions, as well as discharge to a higher level of care and shorter length of stay ( p0.05). Patients undergoing long minimally invasive sigmoid colectomy had decreased rates of overall morbidity, severe adverse events, and length of stay, as well as discharge to a higher level of care compared with the patients undergoing short open sigmoid colectomy ( p0.05).This study was limited by the retrospective nature and standardized outcome measures.In high-risk patients undergoing colectomy for colon cancer, outcomes were worse with shorter open compared with longer minimally invasive surgery operations. Focus should shift from getting patients "off the table" faster to longer, but safer, minimally invasive surgery in high-risk patients. See Video Abstract at http://links.lww.com/DCR/B642 .ANTECEDENTES:Para los pacientes de alto riesgo, el dogma quirúrgico tradicional aconseja operaciones abiertas, con tiempos quirúrgicos cortos, con el fin de "sacarlos de la mesa" en lugar de enfoques quirúrgicos mínimamente invasivos más prolongados.OBJETIVO:El objetivo de este estudio fue comparar los resultados posoperatorios en pacientes electivos de cáncer de colon de alto riesgo sometidos a operaciones de cirugía mínimamente invasiva más prolongadas en comparación con operaciones abiertas más cortas.DISEÑO:Los resultados posoperatorios de pacientes con cáncer de colon con clase 3-4 de la Sociedad Americana de Anestesiología sometidos a colectomía derecha o sigmoidea se compararon en un análisis multivariado. Se comparó el grupo de colectomía derecha abierta corta (tiempo operatorio116 minutos) y colectomía derecha mínimamente invasiva larga (tiempo operatorio132 minutos). También se compararon la colectomía sigmoidea abierta corta (tiempo operatorio127 minutos) y la colectomía sigmoidea mínimamente invasiva larga (tiempo operatorio161 minutos).ESCENARIO:Las intervenciones se realizaron en hospitales participantes en la base de datos quirúrgica nacional.PACIENTES:La base de datos del Programa Nacional de Mejoramiento de la Calidad Quirúrgica se utilizó para identificar a los pacientes con cáncer de colon con clase 3-4 de la Sociedad Americana de Anestesiología sometidos a colectomía derecha y sigmoidea entre 2012-2017.PRINCIPALES MEDIDAS DE RESULTADO:Se compararon los resultados posoperatorios a los treinta días entre el grupo de procedimientos abiertos cortos y el de mínimamente invasivos largos.RESULTADOS:Se identificó un total de 3.775 pacientes sometidos a colectomía derecha mínimamente invasiva larga y colectomía derecha abierta corta (33% abierta, 67% cirugía mínimamente invasiva) y se identificaron 1042 pacientes sometidos a colectomía sigmoidea mínimamente invasiva larga y colectomía sigmoidea abierta corta (36% abierta, 64% mínimamente invasiva). Los pacientes con colectomía derecha larga mínimamente invasiva tuvieron significativamente menor morbilidad general, eventos adversos graves, mortalidad, infecciones superficiales del sitio quirúrgico, dehiscencia de herida, alta a un nivel más alto de atención y estadía más corta ( p0.05). Los pacientes con colectomía sigmoidea mínimamente invasiva prolongada tuvieron menor morbilidad general, eventos adversos graves, duración de la estadía y alta a un nivel más alto de atención en comparación con los pacientes con colectomía sigmoidea abierta corta ( p0.05).LIMITACIONES:Este estudio estuvo limitado por la naturaleza retrospectiva y las medidas de resultado estandarizadas.CONCLUSIONES:En los pacientes de alto riesgo sometidos a colectomía por cáncer de colon, los resultados fueron peores con operaciones abiertas más cortas en comparación con operaciones mínimamente invasivas más largas. El enfoque debe pasar de hacer que los pacientes "salgan rápido de la mesa quirúrgica" a una cirugía mínimamente invasiva más prolongada pero más segura, en pacientes de alto riesgo. Consulte Video Resumen en http://links.lww.com/DCR/B642 . (Traducción-Dr. Jorge Silva Velazco ).