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Calu V, Piriianu C, Miron A, Grigorean VT. Surgical Site Infections in Colorectal Cancer Surgeries: A Systematic Review and Meta-Analysis of the Impact of Surgical Approach and Associated Risk Factors. Life (Basel) 2024; 14:850. [PMID: 39063604 PMCID: PMC11278392 DOI: 10.3390/life14070850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Surgical site infections (SSIs) represent a noteworthy contributor to both morbidity and mortality in the context of patients who undergo colorectal surgery. Several risk factors have been identified; however, their relative significance remains uncertain. METHODS We conducted a meta-analysis of observational studies from their inception up until 2023 that investigated risk factors for SSIs in colorectal surgery. A random-effects model was used to pool the data and calculate the odds ratio (OR) and 95% confidence interval (CI) for each risk factor. RESULTS Our analysis included 26 studies with a total of 61,426 patients. The pooled results showed that male sex (OR = 1.45), body mass index (BMI) ≥ 25 kg/m2 (OR = 1.09), American Society of Anesthesiologists (ASA) score ≥ 3 (OR = 1.69), were all independent risk factors for SSIs in colorectal surgery. Conversely, laparoscopic surgery (OR = 0.70) was found to be a protective factor. CONCLUSIONS The meta-analysis conducted revealed various risk factors, both modifiable and non-modifiable, associated with surgical site infections (SSIs) in colorectal surgery. These findings emphasize the significance of targeted interventions, including optimizing glycemic control, minimizing blood loss, and using laparoscopic techniques whenever feasible in order to decrease the occurrence of surgical site infections in this particular group of patients.
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Affiliation(s)
- Valentin Calu
- Elias University Emergency Hospital, 011461 Bucharest, Romania
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Catalin Piriianu
- Elias University Emergency Hospital, 011461 Bucharest, Romania
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Miron
- Elias University Emergency Hospital, 011461 Bucharest, Romania
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Valentin Titus Grigorean
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania
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Saini A, Dbeis A, Bascom N, Sanderson B, Golden T. A Radiographic Abdominal Pannus Sign is Associated With Postoperative Complications in Anterior THA. Clin Orthop Relat Res 2023; 481:1014-1021. [PMID: 36218821 PMCID: PMC10097585 DOI: 10.1097/corr.0000000000002447] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Numerous studies have shown that elevated BMI is associated with adverse outcomes in THA; however, BMI alone does not adequately represent a patient's adipose and soft tissue distribution, especially when the direct-anterior approach is evaluated. Local soft tissue and adipose, especially in the peri-incisional region, has an unknown impact on patient outcomes after direct-anterior THA. Moreover, there is currently no known evaluation method to estimate the quantity of local soft tissue and adipose tissue. The current study introduced a new radiographic parameter that is measurable on supine AP radiographs: the abdominal pannus sign. QUESTION/PURPOSE Are patients who have an abdominal pannus extending below the upper (cephalad) border of the symphysis pubis more likely to experience problems after anterior-approach THA that are plausibly associated with that finding, including infections resulting in readmission, wound complications resulting in readmission, fractures, or longer surgical time, than patients who do not demonstrate this radiographic sign? METHODS Between 2015 and 2020, five surgeons performed 727 primary direct-anterior THAs. After exclusion criteria were applied, 596 procedures were included. Of those, we obtained postoperative radiographs in the postanesthesia care unit in 100% of procedures (596 of 596), and 100% of radiographs (596) were adequate for review in this retrospective study. The level of the pannus in relation to the pubic symphysis was assessed on immediate supine postoperative AP radiographs of the pelvis: above (pannus sign 1), between the upper and lower borders (pannus sign 2), or below the level of the pubic symphysis (pannus sign 3). In this study, we combined pannus signs 2 and 3 into a single group for analysis not only because there was a limited number of patients in each group, but also because there was no statistically significant difference between the two groups. Pannus sign 1 was identified in 82% of procedures (486 of 596), and pannus sign ≥ 2 was identified in 18% (110). We compared the groups (pannus sign 1 versus pannus sign ≥ 2) in terms of the percentage of patients who experienced problems within 90 days of THA that might be associated with that physical finding, including infections resulting in readmission including subcutaneous, subfascial, and prosthetic joint infections; wound complications resulting in readmission, defined as dehiscence or delayed healing; and all fractures, and we compared the groups in terms of surgical time-that is, the cut-to-close time. RESULTS Patients with a pannus sign of ≥ 2 were more likely than those with a pannus sign of 1 to have a postoperative infection (6.4% [seven of 110 procedures] versus 0.6% [three of 486], odds ratio 10.96 [95% confidence interval (CI) 2.83 to 42.38]; p < 0.01), wound complications (0.9% [one of 110] versus 0% [0 of 486] with an infinite odds ratio [95% CI indeterminate]; p = 0.18), and fractures (4.5% [five of 110] versus 0% [0 of 486], with an infinite odds ratio [95% CI indeterminate]; p < 0.01). The mean surgical time was longer in patients with a pannus sign of ≥ 2 than it was in those with a pannus sign of 1 (128 ± 25.3 minutes versus 118 ± 27.5 minutes, mean difference 10 minutes; p < 0.01). CONCLUSION Based on these findings, patients who have an abdominal pannus that extends below the upper (cephalad) edge of the pubic symphysis are at an increased risk of experiencing serious surgical complications. If THA is planned in these patients, an approach other than the direct-anterior approach should be considered. Surgeons performing THA who do not obtain supine radiographs preoperatively should use a physical examination to evaluate for this finding, and if it is present, they should use an approach other than the direct-anterior approach to minimize the risk of these complications. Future studies might compare the abdominal pannus sign using standing radiographs, which are used more often, with other well-documented associated risk factors such as elevated BMI or higher American Society of Anesthesiologists classification. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Atul Saini
- Department of Orthopedic Surgery, Community Memorial Health System, Ventura, CA, USA
| | - Ammer Dbeis
- Department of Orthopedic Surgery, Community Memorial Health System, Ventura, CA, USA
| | - Nathan Bascom
- Department of Orthopedic Surgery, Community Memorial Health System, Ventura, CA, USA
| | - Brent Sanderson
- Department of Orthopedic Surgery, Community Memorial Health System, Ventura, CA, USA
| | - Thomas Golden
- Department of Orthopedic Surgery, Community Memorial Health System, Ventura, CA, USA
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Prophylactic negative pressure wound therapy following colorectal perforation: defining the risk factors for delayed wound healing. Surg Today 2022; 53:728-735. [DOI: 10.1007/s00595-022-02631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/25/2022] [Indexed: 12/14/2022]
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Sawada G, Kim HM, Ichikawa Y, Hayashi R, Takata A, Murakami M, Fukunaga H, Morita S. Clinical Impact of Two-Week Placement of a Subcutaneous Suction Drain in Preventing Incisional Surgical Site Infection in Open Gastrointestinal Surgery with Class 4 Dirty Wound: A Retrospective Study. Surg Infect (Larchmt) 2022; 23:722-728. [PMID: 36070600 DOI: 10.1089/sur.2022.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Two recent randomized controlled trials demonstrated the beneficial effects of subcutaneous drainage in preventing incisional surgical site infection (SSI) in colorectal surgery. This study aimed to evaluate the efficacy of subcutaneous suction drains (SSDs) compared with primary skin closure (PC) in class 4 dirty wound surgery. Patients and Methods: Eighty-one patients undergoing open gastrointestinal surgery with class 4 dirty wounds were enrolled in this study, 30 of whom underwent SSD insertion, whereas the other 51 were treated with PC. Because several studies have reported that the median onset of the development of incisional SSI was eight to 13 days after surgery, we used a two-week placement of an SSD. Comparison of patients treated with SSD and PC and multivariable analysis were performed to test the ability of SSD in decreasing the SSI rate. Results: No differences were observed between the two groups in terms of gender, body mass index, American Society of Anesthesiology score, steroid use, presence of diabetes mellitus, peri-operative transfusion, and surgery type. Surgical site infection incidence was lower in the SSD group (6.6%; 2/30) than that in the PC group (23.5%; 12/51; p = 0.069). Multivariable analysis revealed that the presence of diabetes mellitus was an important independent risk factor for incisional SSI, and the placement of an SSD has substantial preventive effects on incisional SSI (p = 0.018 and p = 0.014, respectively). Conclusions: This study suggested the potential importance of a two-week placement of an SSD for preventing incisional SSI in class 4 dirty wound surgery.
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Affiliation(s)
- Genta Sawada
- Department of Surgery, Itami City Hospital, Itami, Japan
| | - Ho Min Kim
- Department of Surgery, Itami City Hospital, Itami, Japan
| | | | - Rie Hayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Akihiro Takata
- Department of Surgery, Itami City Hospital, Itami, Japan
| | | | | | - Shunji Morita
- Department of Surgery, Itami City Hospital, Itami, Japan
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5
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Jiang Y, Chen H, Liu G, Liu M, Kong M, Sheng H. Incision pressing, a simple and effective intervention to reduce colorectal surgical site infection: A propensity score-matched study. Front Surg 2022; 9:917559. [PMID: 35959115 PMCID: PMC9360615 DOI: 10.3389/fsurg.2022.917559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022] Open
Abstract
Background Colorectal surgery is associated with a high risk of surgical site infection (SSI). In March 2017, we developed an intervention, called “PRESS”, with the aim of reducing colorectal superficial SSI. This study assessed the effect of the new intervention in reducing the rates of superficial SSI in colorectal surgery. Methods This study was a retrospective review of 312 PRESS+ patients compared to 171 historical control PRESS− patients who were 18 years of age or older and underwent elective colorectal surgery with clean-contaminated wounds from January 2015 to June 2020. In the PRESS+ groups, we pressed the incision downward hard with clean gauze after the interrupted suturing of the skin. Propensity score matching with 15 variables was performed in a 1:1 ratio to reduce selection bias. Univariate analysis and multivariate analysis were performed to identify risk factors associated with SSI. Results The characteristics of the PRESS+ (n = 160) and PRESS− (n = 160) groups were well balanced after propensity score matching. The PRESS+ group had a lower superficial SSI rate (1.9% vs. 6.9%, P = 0.029) and a lower overall SSI rate (2.5% vs. 10.0%, P = 0.006) than the PRESS− group. Furthermore, multivariate analysis showed that the incisional press was an effective protective factor for superficial SSI (adjusted odds ratio = 0.215, 95% confidence interval = 0.057–0.818, P = 0.024). In addition, female sex (P = 0.048) and blood transfusion (P = 0.011) were demonstrated to be independent risk factors for superficial SSI. Conclusion The incisional press after suturing is a simple, costless, and effective intervention in reducing superficial incisional SSI.
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Affiliation(s)
- Yugang Jiang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hongyuan Chen
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guotao Liu
- Departmet of General Surgery, Lanling People’s Hospital, Linyi, China
| | - Meifeng Liu
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Meng Kong
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Correspondence: Meng Kong
| | - Hongguang Sheng
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Ruiz-Tovar J, Boermeester MA, Bordeianou L, Chang GJ, Gorgun E, Justinger C, Lawson EH, Leaper DJ, Mahmoud NN, Mantyh C, McGee MF, Nfonsam V, Rubio-Perez I, Wick EC, Hedrick TL. Delphi Consensus on Intraoperative Technical/Surgical Aspects to Prevent Surgical Site Infection after Colorectal Surgery. J Am Coll Surg 2022; 234:1-11. [PMID: 35213454 PMCID: PMC8719508 DOI: 10.1097/xcs.0000000000000022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous studies have focused on the development and evaluation of care bundles to reduce the risk of surgical site infection (SSI) throughout the perioperative period. A focused examination of the technical/surgical aspects of SSI reduction during CRS has not been conducted. This study aimed to develop an expert consensus on intraoperative technical/surgical aspects of SSI prevention by the surgical team during colorectal surgery (CRS). STUDY DESIGN In a modified Delphi process, a panel of 15 colorectal surgeons developed a consensus on intraoperative technical/surgical aspects of SSI prevention undertaken by surgical personnel during CRS using information from a targeted literature review and expert opinion. Consensus was developed with up to three rounds per topic, with a prespecified threshold of ≥70% agreement. RESULTS In 3 Delphi rounds, the 15 panelists achieved consensus on 16 evidence-based statements. The consensus panel supported the use of wound protectors/retractors, sterile incision closure tray, preclosure glove change, and antimicrobial sutures in reducing SSI along with wound irrigation with aqueous iodine and closed-incision negative pressure wound therapy in high-risk, contaminated wounds. CONCLUSIONS Using a modified Delphi method, consensus has been achieved on a tailored set of recommendations on technical/surgical aspects that should be considered by surgical personnel during CRS to reduce the risk of SSI, particularly in areas where the evidence base is controversial or lacking. This document forms the basis for ongoing evidence for the topics discussed in this article or new topics based on newly emerging technologies in CRS.
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Affiliation(s)
- Jaime Ruiz-Tovar
- From the Department of Surgery, Universidad Rey Juan Carlos, Madrid, Spain (Ruiz-Tovar)
| | - Marja A Boermeester
- the Department of Surgery, Free University Hospital, Amsterdam, The Netherlands (Boermeester)
| | - Liliana Bordeianou
- the Department of Surgery, Massachusetts General Hospital, Boston, MA (Bordeianou)
| | - George J Chang
- the Department of Colon and Rectal Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX (Chang)
| | - Emre Gorgun
- the Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH (Gorgun)
| | - Christoph Justinger
- the Department of General and Visceral Surgery, Klinikum Karlsruhe, Karlsruhe, Germany and Albert-Ludwigs-University Freiburg, Freiburg, Germany (Justinger)
| | - Elise H Lawson
- the Division of Colorectal Surgery, Department of Surgery, University of Wisconsin, Madison, WI (Lawson)
| | - David J Leaper
- Emeritus Professor of Surgery, University of Newcastle, Newcastle upon Tyne, UK (Leaper)
| | - Najjia N Mahmoud
- the Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, PA (Mahmoud)
| | - Christopher Mantyh
- the Department of Surgery, Duke University Medical Center, Durham, NC (Mantyh)
| | - Michael F McGee
- the Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL (McGee)
| | - Valentine Nfonsam
- the Department of Surgery, University of Arizona, Tucson, AZ (Nfonsam)
| | - Ines Rubio-Perez
- the General Surgery Department, Colorectal Surgery Unit, La Paz University Hospital, Madrid, Spain (Rubio-Perez)
| | - Elizabeth C. Wick
- the Department of Surgery, University of California, San Francisco, San Francisco, CA (Wick)
| | - Traci L Hedrick
- the Department of Surgery, University of Virginia Health System, Charlottesville, VA (Hedrick)
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Harish R, Kazi FN, Sharma JVP. Efficacy of Subcutaneous Closed Suction Drain in Reduction of Postoperative Surgical Site Infection. Surg J (N Y) 2021; 7:e275-e280. [PMID: 34660890 PMCID: PMC8510787 DOI: 10.1055/s-0041-1735900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background
Surgical site infections (SSIs) are the infections of wound after an invasive operative approach. It remains to be a major morbidity for patients undergoing surgeries although there have been tremendous improvements in the surgical techniques.
Different interventions to suppress the selective serotonin reuptake inhibitors have been proposed. Many of them have been routinely used by surgeons like minimizing shaving, hand washing, and preoperative antibiotics and these are well accepted. Drains are used in major abdominal surgeries, hernia repairs, breast surgeries reducing collections in closed areas.
1
Hematoma, serous fluid, and dead space in surgical incision wounds raise the risk of infection as they serve as the platform for microbial growth. Studies have proved that the usage of subcutaneous drains has lowered the chances of infection.
Results
The patients in the case group had lower incidence of SSI compared with the control group. The patients in the case group had subcutaneous drain which drained any collection that developed in the subcutaneous space. When the incidence of SSI was compared between the emergency cases and elective cases, the emergency cases showed higher propensity for SSI and increased rate for patients who had co-morbidities like diabetes mellitus, hypertension, etc. The most common organism isolated from the SSI was found to be
Escherichia coli
. It was also noted that the mean number of days of hospital stay was comparatively higher for the patients who developed SSI compared with patients who did not develop SSI.
Conclusion
Thus the presence of SSI adds morbidity to the patient and the patients who undergo major surgeries are likely to develop SSI postoperatively. The presence of subcutaneous closed suction drain helps in reducing the SSI to a certain extent.
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Affiliation(s)
- R Harish
- Department of General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Farah Naaz Kazi
- Department of General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - J V Pranav Sharma
- Department of General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
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Alsafrani TA, Alabbasi AA, Dabroom AA, Alhothali MM, Alresini KA, Aboalsamh GA, Abdelhady AK. The Effectiveness of Superficial Drain to Reduce Surgical Site Infection in Colorectal Surgery. Cureus 2021; 13:e17232. [PMID: 34540459 PMCID: PMC8443325 DOI: 10.7759/cureus.17232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background The incidence of surgical site infection (SSI) in colorectal surgery is high, which can complicate and delay postoperative recovery. This study mainly aims to evaluate the efficacy of subcutaneous drains in decreasing superficial surgical site infection in colorectal surgery patients. Study design This is a retrospective cohort study that included patients over 16 years old who underwent colorectal surgery from the 1st of January 2015 till the 31st of December 2020. Patients were divided into two groups, with and without a subcutaneous drain. The incidence of superficial SSI was measured as the primary objective, and the incidence of other complications like seromas, hematomas, and wound dehiscence was measured as the secondary objectives or outcomes. Chi-square and Fisher’s exact were used to analyze the data, and a p-value less than 0.05 was accepted for significance. Results A total of 208 patients who underwent colorectal surgery in our hospital were included. Of these, 29 had a subcutaneous drain, and 179 did not have a subcutaneous drain. Although the incidence of dehiscence was higher in the drain group, the overall incidence of superficial SSI (20.7%) and seroma/hematoma (3.4%) in patients with subcutaneous drains was lower than without subcutaneous drains (25.7% and 7.8%, respectively). However, no statistical significance was found between drain presence and complications. Conclusion In conclusion, this study demonstrated a lower incidence of superficial SSI and seroma/hematoma in patients with a subcutaneous drain than those who did not have a drain.
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Affiliation(s)
- Turki A Alsafrani
- Orthopedics, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine-Western Region, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Abdullah A Alabbasi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Albara A Dabroom
- Orthopaedics, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Moayad M Alhothali
- Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
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Pang K, Sun P, Li J, Zeng N, Yang X, Jin L, Yang Y, Jin L, Yao H, Zhang Z. Prophylactic subcutaneous drainage reduces post-operative incisional infections in colorectal surgeries: a meta-analysis of randomized controlled trials. Int J Colorectal Dis 2021; 36:1633-1642. [PMID: 33723634 DOI: 10.1007/s00384-021-03908-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Due to lack of high-level evidences, prophylactic subcutaneous drainage has so far not been recommended in relevant guidelines as a countermeasure against incisional infections. This meta-analysis aims to clarify the efficacy of subcutaneous drainage in reducing incisional infections in colorectal surgeries. METHODS Cochrane Library, Embase, and PubMed were searched for randomized controlled trials comparing the incidence rate of incisional infections between patients receiving prophylactic subcutaneous drainage (interventions) and those not receiving (controls) after digestive surgeries. Results from included RCTs were pooled multiple times according to different surgical types. Heterogeneity, publication bias, and certainty of evidences were estimated. RESULTS Eight randomized controlled trials were included. Three RCTs each included patients receiving all sorts of digestive surgeries (gastrointestinal, hepatobiliary, and pancreatic); pooled incisional infection rates between the drainage group and the control group were not significantly different (RR = 0.76, 95%CI: 0.48-1.21, p = 0.25). Four RCTs included patients receiving colorectal surgeries; pooled incisional infection rate in the drainage group was significantly lower than that in the control group (RR = 0.34, 95%CI: 0.19-0.61, p = 0.0004). Four RCTs included patients receiving upper GI and/or HBP surgeries; pooled incisional infection rates in the drainage group and the non-drainage group were not significantly different (RR = 0.85, 95%CI: 0.54-1.34, p = 0.49). CONCLUSIONS Prophylactic subcutaneous drainage significantly reduces post-operative incisional infections in colorectal surgeries but was not efficacious in digestive surgeries in general.
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Affiliation(s)
- Kai Pang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Peilin Sun
- Peking Union Medical College, PUMC, Beijing, 100730, China
| | - Jun Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Na Zeng
- Department of Methodology and Statistics, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing, 100050, China
| | - Xiaobao Yang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Lei Jin
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Yingchi Yang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
| | - Lan Jin
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
| | - Hongwei Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
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Arslan K, Hasırcı İ, Şimşek G, İbrahim IA, Şahin A, Eryılmaz MA, Altınkaynak M, Kartal A. Effects of Subcutaneous Jackson-Pratt Drain on Incisional Surgical Site Infection after Open Colorectal Resection for Cancer: a Prospective, Randomized, Multicenter Clinical Study. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02395-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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11
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Esen E, Aytac E, Aydinli HH, Grieco MJ, Erkan A, Kirat HT, Schwartzberg DM, Baca B, Karahasanoglu T, Remzi FH. Ileal Pouch Excision can Be Performed With Similar Outcomes in Obese Patients Compared to Nonobese Counterparts: An Assessment From American College of Surgeons National Surgical Quality Improvement Program. Am Surg 2021; 88:2857-2862. [PMID: 33856901 DOI: 10.1177/00031348211011121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Failed pouches may tend to be managed with only a loop ileostomy in obese patients due to some safety concerns. The effect of obesity on ileal pouch excision outcomes is poorly studied. In our study, we aimed to assess the short-term outcomes after ileal pouch excision in obese patients compared to their nonobese counterparts. METHODS The patients who underwent pouch excision between 2005 and 2017 were included using ACS-NSQIP participant user files. The operative outcomes were compared between obese (BMI ≥30 kg/m2) and nonobese (BMI<30 kg/m2) groups. RESULTS There were 507 pouch excision patients included of which eighty (15.7%) of them were obese. Physical status of the obese patients tended to be worse (ASA>3, 56.3 vs 42.9%, P = .027). There were more patients who had diabetes mellitus (DM) and hypertension (HT) in the obese group (26.3% vs. 11.2%, P = .015; 11.3 vs. 4.4%, P < .001, respectively). Operative time was similar between 2 groups (mean ± SD, 275 ± 111 vs. 252±111 minutes, P = .084). Deep incisional SSI was more commonly observed in the obese group (7.5 vs 2.8%, P = .038). In multivariate analysis, only deep incisional SSI was found to be independently associated with obesity (OR: 2.79, 95% CI: 1.02-7.67). Obese patients were readmitted more frequently than nonobese counterparts (28.3 vs 16%, P = .035). The length of hospital stay was comparable [median (IQR), 7 (4-13.5) vs. 7 (5-11) days, P = .942]. CONCLUSION Ileal pouch excision can be performed in obese patients with largely similar outcomes compared to their nonobese counterparts although obesity is associated with a higher rate of deep space infection.
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Affiliation(s)
- Eren Esen
- Inflammatory Bowel Disease Center, 12297NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Erman Aytac
- School of Medicine, 162328Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - H Hande Aydinli
- Inflammatory Bowel Disease Center, 12297NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael J Grieco
- Inflammatory Bowel Disease Center, 12297NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Arman Erkan
- Inflammatory Bowel Disease Center, 12297NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Hasan T Kirat
- Inflammatory Bowel Disease Center, 12297NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - David M Schwartzberg
- Inflammatory Bowel Disease Center, 12297NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Bilgi Baca
- School of Medicine, 162328Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Tayfun Karahasanoglu
- School of Medicine, 162328Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Feza H Remzi
- Inflammatory Bowel Disease Center, 12297NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
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Characteristics of Subcutaneous Drainage Fluid in Patients After Hepatopancreatobiliary Surgery. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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13
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Shearer J, Agius L, Burke N, Rahardja R, Young SW. BMI is a Better Predictor of Periprosthetic Joint Infection Risk Than Local Measures of Adipose Tissue After TKA. J Arthroplasty 2020; 35:S313-S318. [PMID: 32139192 DOI: 10.1016/j.arth.2020.01.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/15/2020] [Accepted: 01/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Both body mass index (BMI) and local measures of adiposity at the surgical site have been identified as independent risk factors for periprosthetic joint infection (PJI) (periprosthetic joint infection) after total knee arthroplasty (TKA). We aimed to 1) evaluate previously used measures of assessing knee adiposity and 2) determine the best measure for predicting both surgical duration and PJI after TKA. METHODS We performed a multicentre retrospective review of 4745 patients who underwent primary TKA between January 2013 and December 2016. Patient demographic information, surgical duration and postoperative infection status within one year were obtained. Preoperative weight-bearing AP and lateral x-rays were analyzed to determine prepatellar adipose thickness, bony width of the tibial plateau, and total soft tissue knee width. The knee adipose index (KAI) was calculated from the ratio of bone to total knee width. RESULTS We observed substantial variability in both local measures of adiposity compared with BMI. Neither measure of local knee adipose showed a significant correlation with PJI risk. By contrast, there was a strong correlation between PJI risk and BMI >35 (odds ratio 2.9, 95% CI 1.4-6.1). Surgical duration increased with both BMI and measures of local adipose tissue (KAI and prepatellar fat thickness). CONCLUSION Local adipose deposition varies greatly for any given BMI. In this study, BMI was a better predictor of PJI after TKA than local measures of knee adipose tissue.
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Affiliation(s)
- Julia Shearer
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Lewis Agius
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Neil Burke
- Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland
| | - Richard Rahardja
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Simon W Young
- School of Medicine, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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14
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Jain S, Sohi AS, Brar GS, Jain V. An Observational Study to Compare Use of Drains Versus No Drains After Gynaecology Oncology Surgery at a Tertiary Care Centre. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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De Simone B, Sartelli M, Coccolini F, Ball CG, Brambillasca P, Chiarugi M, Campanile FC, Nita G, Corbella D, Leppaniemi A, Boschini E, Moore EE, Biffl W, Peitzmann A, Kluger Y, Sugrue M, Fraga G, Di Saverio S, Weber D, Sakakushev B, Chiara O, Abu-Zidan FM, ten Broek R, Kirkpatrick AW, Wani I, Coimbra R, Baiocchi GL, Kelly MD, Ansaloni L, Catena F. Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines. World J Emerg Surg 2020; 15:10. [PMID: 32041636 PMCID: PMC7158095 DOI: 10.1186/s13017-020-0288-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/01/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. METHODS The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES. RESULTS Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI. CONCLUSIONS The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.
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Affiliation(s)
- Belinda De Simone
- Department of General Surgery, Azienda USL-IRCSS di Reggio Emilia, Guastalla Hospital, Via Donatori di sangue 1, 42016 Guastalla, RE Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, 62100 Macerata, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56124 Pisa, Italy
| | - Chad G. Ball
- Department of Surgery and Oncology, Hepatobiliary and Pancreatic Surgery, Trauma and Acute Care Surgery, University of Calgary Foothills Medical Center, Calgary, Alberta T2N 2T9 Canada
| | - Pietro Brambillasca
- Anesthesia and Critical Care Department, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit and Trauma Center, Cisanello Hospital, Pisa, Italy
| | | | - Gabriela Nita
- Unit of General Surgery, Castelnuovo ne’Monti Hospital, AUSL, Reggio Emilia, Italy
| | - Davide Corbella
- Anesthesia and Critical Care Department, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland
| | - Elena Boschini
- Medical Library, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health and University of Colorado, Denver, USA
| | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps memorial Hospital, La Jolla, CA USA
| | - Andrew Peitzmann
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, Ireland
| | - Gustavo Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | | | - Dieter Weber
- Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Boris Sakakushev
- University Hospital St George First, Clinic of General Surgery, Plovdiv, Bulgaria
| | - Osvaldo Chiara
- State University of Milan, Acute Care Surgery Niguarda Hospital, Milan, Italy
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | | | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Raul Coimbra
- Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | | | - Micheal D. Kelly
- Department of General Surgery, Albury Hospital, Albury, NSW 2640 Australia
| | - Luca Ansaloni
- Department of Emergency and Trauma Surgery, Bufalini Hospital, 47521 Cesena, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, University Hospital of Parma, 43100 Parma, Italy
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Zhuang J, Zheng W, Yang S, Ye J. Modified subcutaneous suction drainage to prevent incisional surgical site infections after radical colorectal surgery. Transl Cancer Res 2020; 9:910-917. [PMID: 35117436 PMCID: PMC8798500 DOI: 10.21037/tcr.2019.12.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/29/2019] [Indexed: 11/21/2022]
Abstract
Background Many studies have been performed to evaluate the effect of subcutaneous suction drainage to prevent incisional surgical site infections (SSIs) after radical colorectal surgery. However, the result has been controversial. The main reason may be that subcutaneous suction drainage is more prone to develop blockages, and the drainage tubes themselves serve as a conduit for bacteria into the wound. Therefore, we modified this method and evaluated this new method (subcutaneous suction drainage and intermittent irrigation) in patients who underwent radical colorectal surgery. Methods A total of 119 patients who underwent open radical colorectal surgery were included in our study from April 2015 to November 2017. A total of 61 patients were included in the irrigation group (subcutaneous suction drainage or intermittent irrigation), and 58 patients were included in the control group (no subcutaneous suction drainage and intermittent irrigation). The key endpoints were the incidence rate of incisional SSIs, the inpatient stay, and hospitalization expenses. All of the patients in our study had the following characteristics: (I) their subcutaneous fat thickness was more than 1.5 cm by means of CT or MRI measure before operation; (II) the patients had at least one of the following cases before operation: diabetes mellitus, hypoalbuminemia (ALB ≤35 g/L), anemia (Hb ≤90 g/L) or tumorous obstruction. Results The incidence of incisional SSIs rate was 27/119 (22.7%) in the overall patients, 22/61 (36.1%) in the control group, and 5/58 (8.6%) in the group. The rate of SSIs in the irrigation group was significantly lower than the control group (P<0.001). The inpatient stay (9.64±4.15) in the irrigation group was shorter than the control group (12.26±5.55) (P=0.004). The hospitalization expenses (57,356±9,518) in the irrigation group were lower than the control group (62,119±11,101) (P=0.014). One of the patients in the control group died of pulmonary infection due to intraoperative aspiration. There was no death in the irrigation group. Conclusions The subcutaneous suction drainage and intermittent irrigation is safe and effective to prevent incisional SSIs in radical colorectal surgery.
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Affiliation(s)
- Jinfu Zhuang
- Department of Gastrointestinal Surgery 2 Section, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Wei Zheng
- Department of Gastrointestinal Surgery 2 Section, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Shugang Yang
- Department of Gastrointestinal Surgery 2 Section, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Jianxin Ye
- Department of Gastrointestinal Surgery 2 Section, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
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17
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Gupta VK, Kejriwal R. Pretubercular Subcutaneous Thickness Is a Protective Factor for Superficial Wound Complications After Total Knee Arthroplasty in Nonmorbidly Obese Patients. J Arthroplasty 2020; 35:255-258. [PMID: 31558297 DOI: 10.1016/j.arth.2019.08.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Anterior knee subcutaneous thickness has been associated with increased risk of early reoperation for surgical site infection after primary total knee arthroplasty (TKA) in morbidly obese patients. However, most patients undergoing TKA are not morbidly obese. The aims of this study were to (1) assess the association between anterior knee subcutaneous thickness and early superficial wound complications and (2) determine a threshold value for anterior knee subcutaneous thickness measures that can assist in preoperative risk stratification in nonmorbidly obese TKA patients. METHODS Using retrospective analysis, we reviewed 494 primary TKAs performed in patients with a body mass index <40 kg/m2 at our institution from January 1, 2010 to December 31, 2017. All patients developing a superficial surgical site infection within 90 days of index arthroplasty requiring treatment with antibiotics or reoperation were identified. Prepatellar thickness and pretubercular thickness were measured on preoperative lateral radiographs and associated with 90-day superficial wound complications. RESULTS Sixty-two of the 494 patients developed a superficial wound complication within 90 days of index arthroplasty. TKA patients in the superficial wound complication group had significantly less pretubercular thickness (P = .027). Risk of developing 90-day superficial wound complication was 1.85-fold lower when pretubercular thickness was ≥12 mm (P = .028). Prepatellar thickness (P = .895) was not significantly associated with superficial wound complications. CONCLUSION Increased pretubercular thickness is a protective factor for developing superficial wound complications, with 12 mm being an ideal threshold value for preoperative risk stratification in nonmorbidly obese patients undergoing primary TKA surgery.
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Affiliation(s)
- Vikesh Kumar Gupta
- Department of Orthopaedic Surgery, Taranaki Base Hospital, New Plymouth, New Zealand
| | - Ritwik Kejriwal
- Department of Orthopaedic Surgery, Taranaki Base Hospital, New Plymouth, New Zealand
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18
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Lyon TD, Boorjian SA, Shah PH, Tarrell R, Cheville JC, Frank I, Karnes RJ, Thompson RH, Tollefson MK. Comprehensive characterization of perioperative reoperation following radical cystectomy. Urol Oncol 2019; 37:292.e11-292.e17. [PMID: 30679081 DOI: 10.1016/j.urolonc.2018.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/06/2018] [Accepted: 11/27/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION To examine the nature, timing, and risk factors underlying return to the operating room (ROR) following radical cystectomy (RC). ROR has been proposed as a surgical quality metric based on data from the general surgery literature, but ROR has not been comprehensively characterized following RC. PATIENTS AND METHODS We queried our institutional Cystectomy Registry from 2000 to 2016 to identify patients with ROR within 90 days of RC. Multivariable logistic regression was used to examine associations between patient features and ROR. Survival outcomes were studied based on whether ROR was necessary. RESULTS Of 1968 patients treated with RC, 112 (5.7%) underwent 125 reoperations within 90 days of RC, of which 93% were unanticipated and due to postsurgical complications. The most common reasons for ROR were facial dehiscence (29%), bowel obstruction (21%), and enteric anastomotic leak (8%). On multivariable analysis, increasing body mass index (odds ratio 1.04, 95% confidence interval (CI) 1.01-1.08, P = 0.045) and albumin <3.5 g/dl (odds ratio 2.15, 95% CI 1.28-3.59, P = 0.004) were associated with greater odds of ROR. Patients with a ROR had significantly decreased 5-year overall survival compared to patients who did not undergo ROR (43% vs. 55%; P = 0.003), and ROR was associated with increased all-cause mortality after multivariable adjustment (hazard ratio 1.33, 95% CI 1.01-1.74, P = 0.04). CONCLUSION ROR principally occurred due to unanticipated complications and was associated with increased mortality after RC. These data suggest ROR may be a useful metric by which urological programs can track the efficacy of interventions aimed at improving perioperative care for RC patients.
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Affiliation(s)
| | | | - Paras H Shah
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Robert Tarrell
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
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Ikeguchi M, Urushibara SI, Endo K, Nakamura S. Preoperative prognostic nutritional index is a strong predictor of surgical site infection after surgery for colorectal perforation. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04848-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Yoshimatsu K, Sagawa M, Yokomizo H, Yano Y, Okayama S, Satake M, Yamada Y, Matsumoto A, Shiozawa S, Shimakawa T, Katsube T, Naritaka Y. Subcuticular Suturing with Closed Suction Drainage for Wound Closure Following Stoma Reversal. J NIPPON MED SCH 2018; 85:183-186. [PMID: 30135346 DOI: 10.1272/jnms.jnms.2018_85-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Incisional surgical site infection (SSI) is a leading complication of stoma reversal procedures. This retrospective study was conducted to assess the incidence of incisional SSI and other wound complications when wound closure was achieved by subcuticular suturing and closed suction drainage following stoma reversal. We analyzed data from a total of 49 patients, all of whom had undergone insertion of a 10 Fr closed suction drainage tube in the fascia, following irrigation with approximately 300 mL of physiological saline. We then performed subcuticular suturing with 4-0 monofilament absorbable sutures. The median age of our patient population (34 men and 15 women) was 68 (range, 35-84) years. Six patients had an end stoma and 43 had a loop stoma. The wound category was 'contaminated' in 18 patients, while an incisional SSI was observed in one patient (2.0%). No wound disruptions, seromas, or drain infections were evident. Our data are reliable, but our study is limited in terms of general applicability; however, the low SSI rate indicates that the procedure is acceptable. Further research into this procedure will require a randomized trial design.
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Affiliation(s)
- Kazuhiko Yoshimatsu
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Masano Sagawa
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Hajime Yokomizo
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Yuki Yano
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Sachiyo Okayama
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Masaya Satake
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Yasufumi Yamada
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Atsuo Matsumoto
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Shunichi Shiozawa
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Takeshi Shimakawa
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Takao Katsube
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
| | - Yoshihiko Naritaka
- Department of Surgery, Tokyo Women's Medical University, Medical Center East
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Wagner RA, Hogan SP, Burge JR, Bates CM, Sanchez HB. The Radiographic Prepatellar Fat Thickness Ratio Correlates With Infection Risk After Total Knee Arthroplasty. J Arthroplasty 2018; 33:2251-2255. [PMID: 29555491 DOI: 10.1016/j.arth.2018.02.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Obesity has been associated with complications after a total knee arthroplasty (TKA). Surgical site infection (SSI) after TKA is one of the feared complications as it increases revision rates, costs, and stress to the patient. There is conflicting evidence in the literature regarding body mass index (BMI) and risk of infection after TKA, and some studies have suggested that site-specific fat distribution may be a better metric for determining risk of postoperative infections. Here, we investigate the correlation of soft tissue distribution about the knee to SSI after TKA. METHODS We retrospectively review 572 patients who underwent primary TKA at a single institution from 2006 to 2010. We introduce the prepatellar fat thickness ratio (PFTR) as a radiographic means to quantitatively assess fat distribution about the knee and evaluate this measurement's ability to assess the risk of developing an SSI after TKA. RESULTS The PFTR was shown to be a better predictor of SSI than BMI in both the univariate (P = .05) and multivariate (P = .01) analyses. CONCLUSION Although BMI cannot fully account for variations in adipose distribution, the PFTR may account for this variability and may be a helpful tool for assessing a patient's preoperative risk of SSI after TKA.
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Affiliation(s)
- Russell A Wagner
- Department of Orthopaedic Surgery, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX; Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX; Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX
| | - Sean P Hogan
- Department of Orthopaedic Surgery, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX
| | - John Ross Burge
- Department of Orthopaedic Surgery, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX
| | - Christopher M Bates
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX
| | - Hugo B Sanchez
- Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX; Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX
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22
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Prophylactic Negative Pressure Dressing Use in Closed Laparotomy Wounds Following Abdominal Operations. Ann Surg 2017; 265:1082-1086. [DOI: 10.1097/sla.0000000000002098] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ploegmakers IBM, Olde Damink SWM, Breukink SO. Alternatives to antibiotics for prevention of surgical infection. Br J Surg 2017; 104:e24-e33. [PMID: 28121034 DOI: 10.1002/bjs.10426] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/29/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Surgical-site infection (SSI) is still the second most common healthcare-associated infection, after respiratory tract infection. SSIs are associated with higher morbidity and mortality rates, and result in enormous healthcare costs. In the past decade, several guidelines have been developed that aim to reduce the incidence of SSI. Unfortunately, there is no consensus amongst the guidelines, and some are already outdated. This review discusses the recent literature regarding alternatives to antibiotics for prevention of SSI. METHODS A literature search of PubMed/MEDLINE was performed to retrieve data on the prevention of SSI. The focus was on literature published in the past decade. RESULTS Prevention of SSI can be divided into preoperative, perioperative and postoperative measures. Preoperative measures consist of showering, surgical scrubbing and cleansing of the operation area with antiseptics. Perioperative factors can be subdivided as: environmental factors, such as surgical attire; patient-related factors, such as plasma glucose control; and surgical factors, such as the duration and invasiveness of surgery. Postoperative measures consist mainly of wound care. CONCLUSION There is a general lack of evidence on the preventive effectiveness of perioperative measures to reduce the incidence of SSI. Most measures are based on common practice and perceived effectiveness. The lack of clinical evidence, together with the stability of the high incidence of SSI (10 per cent for colorectal procedures) in recent decades, highlights the need for future research.
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Affiliation(s)
- I B M Ploegmakers
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - S W M Olde Damink
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, University College London, London, UK
| | - S O Breukink
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
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24
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A randomized controlled trial of subcutaneous closed-suction Blake drains for the prevention of incisional surgical site infection after colorectal surgery. Int J Colorectal Dis 2017; 32:391-398. [PMID: 27783162 DOI: 10.1007/s00384-016-2687-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The effects of subcutaneous closed-suction Blake drain for preventing incisional surgical site infections (SSIs) after colorectal surgery have never been evaluated in a randomized controlled trial (RCT). Thus, we performed a RCT to evaluate the clinical benefits of using a subcutaneous closed-suction Blake drain in patients undergoing colorectal surgery. METHOD Consecutive patients who underwent colorectal surgery were enrolled in this study. Patients were randomly assigned to the subcutaneous closed-suction drainage arm or the control (no subcutaneous drainage) arm. The primary endpoint was incidence rate of incisional SSIs. And, we performed logistic regression analysis to detect predictive factors for incisional SSIs after colorectal surgery. RESULTS From November 2012 to September 2014, a total of 240 patients were enrolled in this study. One-hundred-seventeen patients who were treated by the control arm and 112 patients by the subcutaneous drainage arm were judged to be eligible for analysis. The incidence of incisional SSIs rate was 8.7 % in the overall patients. The incidence of incisional SSIs rate was 12.8 % in the control arm and 4.5 % in the subcutaneous drainage arm. There was significantly reduction of the incidence in the subcutaneous drainage arm than in the control arm (p = 0.025). Logistic regression analysis demonstrated that thickness of subcutaneous fat >3.0 cm, forced expiratory volume in 1 s as percent of forced vital capacity (FEV1.0 %) >70 %, and subcutaneous drain were independent predictors of postoperative incisional SSIs (p = 0.008, p = 0.004, and p = 0.017, respectively). CONCLUSION The results of our RCT suggest that a subcutaneous Blake drain is beneficial for preventing incisional SSIs in patients undergoing colorectal surgery.
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Complications chirurgicales de la transplantation rénale. Prog Urol 2016; 26:1066-1082. [DOI: 10.1016/j.purol.2016.09.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
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Grimes MD, Blute ML, Wittmann TA, Mann MA, Zorn K, Downs TM, Shi F, Jarrard DF, Best SL, Richards KA, Nakada SY, Abel EJ. A Critical Analysis of Perioperative Outcomes in Morbidly Obese Patients Following Renal Mass Surgery. Urology 2016; 96:93-98. [PMID: 27339026 DOI: 10.1016/j.urology.2016.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate if body mass index (BMI) ≥ 40 is associated with risk of postoperative complications, receipt of perioperative blood transfusion (PBT), length of hospital stay (LOS), perioperative death, or hospital readmission rate following renal mass surgery. MATERIALS AND METHODS After Institutional Review Board approval, comprehensive information was collected for patients treated with surgery for renal mass from 2000 to 2015 at one institution. Univariable and multivariable analyses were used to evaluate the association of BMI ≥ 40 among other putative risk factors for perioperative outcomes. RESULTS A total of 1048 patients were treated surgically, including 115 (11%) with BMI > 40. Minimally invasive and open surgical approaches were used for 480 (45.8%) and 568 (54.2%) patients, respectively. Morbid obesity was not associated with risk of major complications, overall complications, receipt of PBT, LOS, hospital readmission rate, or perioperative death. Charlson comorbidity index was the only independent predictor of major complications following renal mass surgery, P = .0006, per point odds ratio 1.2 (95%C.I. 1.08-1.32). Surgical site infections (SSIs) were more common in patients with BMI ≥ 40 vs BMI < 40 (10.5% vs 4.8%, P = .01). Following multivariable analysis, BMI ≥ 40 was the only independent predictor of SSIs, odds ratio 2.6, 95% confidence interval 1.32-5.13; P = .006. CONCLUSION Morbid obesity (BMI ≥ 40) is an independent predictor of developing SSIs following renal mass surgery. Morbid obesity is not predictive of risk for major complications, receipt of PBT, hospital readmission, perioperative death, or LOS.
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Affiliation(s)
- Matthew D Grimes
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael L Blute
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tyler A Wittmann
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael A Mann
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kristin Zorn
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tracy M Downs
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Fangfang Shi
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David F Jarrard
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sara L Best
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kyle A Richards
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Lauscher JC, Schneider V, Lee LD, Stroux A, Buhr HJ, Kreis ME, Ritz JP. Necessity of subcutaneous suction drains in ileostomy reversal (DRASTAR)-a randomized, controlled bi-centered trial. Langenbecks Arch Surg 2016; 401:409-18. [PMID: 27138020 DOI: 10.1007/s00423-016-1436-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/13/2016] [Indexed: 01/24/2023]
Abstract
PURPOSE Data regarding length of hospital stay of patients undergoing ileostomy reversal are very heterogeneous. There are many factors that may have an influence on the length of postoperative hospital stay, such as postoperative wound infections. One potential strategy to reduce their incidence and to decrease hospital stay is to insert subcutaneous suction drains. The purpose of this study was to examine the influence of the insertion of subcutaneous suction drains on hospital stay and postoperative wound infections in ileostomy reversal. Risk factors for postoperative wound infection were determined. METHODS This is a randomized controlled two-center non-inferiority trial with two parallel groups. The total length of hospital stay as primary endpoint and the occurrence of a surgical site infection, the colonization of the abdominal wall with bacteria, and the occurrence of hematomas/seromas as secondary endpoints were monitored. RESULTS One hundred eighteen patients with elective ileostomy reversal were included. Fifty-nine patients were randomly assigned to insertion of a subcutaneous suction drain, and 59 patients were randomly assigned to receive no drain. After 3 months of follow-up, 50 patients in the group with drain and 53 patients in the group without drain could be analyzed. Median total length of hospital stay was 8 days in the SD group and 9 days in the group without SD (p = 0.17). Fourteen percent of patients with SD and 17 % without SD developed SSI, p = 0.68. Multivariate analysis revealed anemia (p < 0.01), intraoperative bowel perforation (p = 0.02) and resident (p = 0.04) or fellow (p = 0.048) performing the operation as risk factors for SSI. CONCLUSIONS This trial shows that the omission of subcutaneous suction drains is not inferior to the use of subcutaneous suction drains after ileostomy reversal in terms of length of hospital stay, surgical site infections, and hematomas/seromas.
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Affiliation(s)
- J C Lauscher
- Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - V Schneider
- Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - L D Lee
- Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - A Stroux
- Institute of Biometry and Clinical Epidemiology, Charité Campus Mitte, Charitéplatz 1, 10098, Berlin, Germany
| | - H J Buhr
- German Society for General and Visceral Surgery, Schiffbauerdamm 40, 10117, Berlin, Germany
| | - M E Kreis
- Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - J P Ritz
- Department of General and Visceral Surgery, HELIOS Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Germany
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Winfield RD, Reese S, Bochicchio K, Mazuski JE, Bochicchio GV. Obesity and the Risk for Surgical Site Infection in Abdominal Surgery. Am Surg 2016. [DOI: 10.1177/000313481608200418] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Obesity is a risk factor for surgical site infection (SSI) after abdominal procedures; however, data characterizing the risk of SSI in obese patients during abdominal procedures are lacking. We hypothesized that obesity is an independent risk factor for SSI across wound classes. We analyzed American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data for 2011. We calculated body mass index (BMI), classifying patients according to National Institute of Health (NIH) BMI groups. We excluded records in which height/weight was not recorded and patients with BMI less than 18.5. We examined patients undergoing open abdominal procedures, performing univariate and multivariate analyses to assess the relative contribution of obesity to SSI. Study criteria were met by 89,148 patients. Obese and morbidly obese patients had significantly greater SSI rates in clean and clean-contaminated cases but not contaminated or dirty/infected cases. Logistic regression confirmed obesity and morbid obesity as being independently associated with the overall SSI development, specifically in clean [Obesity odds ratio (OR) = 1.757, morbid obesity OR = 2.544, P < 0.001] and clean-contaminated (obesity OR = 1.239, morbid obesity OR = 1.287, P < 0.001) cases. Obesity is associated with increased risk of SSI overall, specifically in clean and clean-contaminated abdominal procedures; this is independent of diabetes mellitus. Novel techniques are needed to reduce SSI in this high-risk patient population.
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Affiliation(s)
- Robert D. Winfield
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Stacey Reese
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kelly Bochicchio
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - John E. Mazuski
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Grant V. Bochicchio
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri
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Novel Method of Surgical Incision Management in Patients Undergoing Colorectal Surgery. Int Surg 2016. [DOI: 10.9738/intsurg-d-14-00281.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We previously demonstrated that subcutaneous drain is effective for preventing incisional surgical site infection (SSI) in patients with thick subcutaneous fat in colorectal surgery. We have recently attempted a novel closure technique in colorectal surgery for the prevention of incisional SSI. In the current study, we described this novel method for prevention of incisional SSI and share our assessment of efficiency of this incision management in patients undergoing colorectal surgery. The procedure “wound dressing with temporary negative pressure” using Opsite Post-Op Visible and an Atom Multipurpose Tube, is a simple and easy method. Immediately after incisions were closed, Opsite Post-Op Visible dressing was applied over the incision site with an Atom Multipurpose catheter, and negative pressure was applied through the catheter. We analyzed the cases of 203 patients who underwent colorectal resection. In 60 cases, we performed this negative pressure system for prevention of SSI. We reviewed the clinical features of these cases treated by this novel method and found that the incisional SSI rate in patients who underwent colorectal resection was significantly reduced following the use of the new method. There were no complications in any of the cases due to DNP. This dressing with negative pressure (DNP) may lead to wound drainage and a reduction of dead space in a subcutaneous wound area. These findings indicate that the use of DNP is safe, easy, and effective for preventing incisional SSI in patients undergoing colorectal surgery.
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Yamamoto T, Morimoto T, Kita R, Masui H, Kinoshita H, Sakamoto Y, Okada K, Komori J, Miki A, Kondo M, Uryuhara K, Kobayashi H, Hashida H, Kaihara S, Hosotani R. The preventive surgical site infection bundle in patients with colorectal perforation. BMC Surg 2015; 15:128. [PMID: 26680600 PMCID: PMC4683779 DOI: 10.1186/s12893-015-0115-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/07/2015] [Indexed: 11/30/2022] Open
Abstract
Background Incisional surgical site infection (SSI) is one of the most frequent complications that occur after colorectal surgery. Surgery for colorectal perforation carries an especially high risk of incisional SSI because fecal ascites contaminates the incision intraoperatively, and in patients who underwent stoma creation, the incision is located near the infective origin and is subject to infection postoperatively. Although effectiveness of the preventive SSI bundle of elective colorectal surgery has been reported, no study has focused exclusively on emergency surgery for colorectal perforation. Methods Patients with colorectal perforation who underwent emergency surgery and stoma creation from 2010 to 2015 at our center were consecutively enrolled in the study. In March 2013, we developed the preventive incisional SSI bundle for patients with colorectal perforation undergoing stoma creation. The effectiveness of the bundle in these patients was determined and the rates of incisional SSI between before and after March 2013 were compared. Results We enrolled 108 patients with colorectal perforation who underwent emergency operation during the study period. Thirteen patients were excluded because they died within 30 days after surgery, and 23 patients without stoma were excluded; thus, 72 patients were analyzed. There were 47 patients in the pre-implementation group and 25 patients in the post-implementation group. The rate of incisional SSI was significantly lower after implementation of preventive incisional SSI bundle (43 % vs. 20 %, p = 0.049). Postoperative hospital stay was significantly shorter after implementation of the bundle (27 vs. 18 days respectively; p = 0.008). Conclusions The preventive incisional SSI bundle was effective in preventing incisional SSI in patients with colorectal perforation undergoing emergency surgery with stoma creation.
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Affiliation(s)
- Takehito Yamamoto
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. .,Department of Gastroenterological Surgery and Oncology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, Japan.
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, 1 Mukogawa, Nishinomiya, Hyogo, Japan. .,Clinical Research Center, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Ryosuke Kita
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Hideyuki Masui
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Hiromitsu Kinoshita
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Yusuke Sakamoto
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Kazuyuki Okada
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Junji Komori
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Akira Miki
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Kenji Uryuhara
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Hiroyuki Kobayashi
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Hiroki Hashida
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
| | - Ryo Hosotani
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan.
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Review of Subcutaneous Wound Drainage in Reducing Surgical Site Infections after Laparotomy. Surg Res Pract 2015; 2015:715803. [PMID: 26783556 PMCID: PMC4691488 DOI: 10.1155/2015/715803] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. Surgical site infections (SSIs) remain a significant problem after laparotomies. The aim of this review was to assess the evidence on the efficacy of subcutaneous wound drainage in reducing SSI. Methods. MEDLINE database was searched. Studies were identified and screened according to criteria to determine their eligibility for meta-analysis. Meta-analysis was performed using the Mantel-Haenszel method and a fixed effects model. Results. Eleven studies were included with two thousand eight hundred and sixty-four patients. One thousand four hundred and fifty patients were in the control group and one thousand four hundred and fourteen patients were in the drain group. Wound drainage in all patients shows no statistically significant benefit in reducing SSI incidence. Use of drainage in high risk patients, contaminated wound types, and obese patients appears beneficial. Conclusion. Using subcutaneous wound drainage after laparotomy in all patients is unnecessary as it does not reduce SSI risk. Similarly, there seems to be no benefit in using it in clean and clean contaminated wounds. However, there may be benefit in using drains in patients who are at high risk, including patients who are obese and/or have contaminated wound types. A well designed trial is needed which examines these factors.
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Fockens MM, Alberts VP, Bemelman FJ, van der Pant KAMI, Idu MM. Wound morbidity after kidney transplant. Prog Transplant 2015; 25:45-8. [PMID: 25758800 DOI: 10.7182/pit2015812] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Wound morbidity is an important surgical complication after kidney transplant. OBJECTIVE To assess risk factors for postoperative wound complications and the impact of such complications on outcomes of kidney transplant. DESIGN AND PATIENTS Retrospectively, 108 consecutive kidney transplant patients between January 2010 and December 2010 were included in the analysis. Wound morbidity was defined as a surgical site infection or symptomatic lymphocele requiring intervention. Patient, donor, and surgical characteristics were reviewed. RESULTS Eight lymphoceles and 5 surgical site infections occurred in 12 patients. Risk factors for wound complications were recipient's age (P<.01), body mass index (P=.01), urinary tract infection (P=.01), and prolonged postoperative wound drainage (P=.047). Wound morbidity did not increase the incidence of delayed graft function, acute rejection, graft failure, or mortality. Obesity, recipient's age, urinary tract infection, and prolonged wound drainage are risk factors for wound-related complications. Graft and patient survival rates are comparable between patients with and without wound-related complications.
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Affiliation(s)
- M Matthijs Fockens
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Victor P Alberts
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Karlijn A M I van der Pant
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Mirza M Idu
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
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Pan HD, Wang L, Peng YF, Li M, Yao YF, Zhao J, Zhan TC, Du CZ, Gu J. Subcutaneous vacuum drains reduce surgical site infection after primary closure of defunctioning ileostomy. Int J Colorectal Dis 2015; 30:977-82. [PMID: 25700809 DOI: 10.1007/s00384-015-2168-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical site infection (SSI) is the most common complication after primary closure of defunctioning ileostomy. We use a subcutaneous vacuum drain (SVD) in our institution to prevent infection. This study aimed to analyze the risk factors of SSI and to assess the utility of an SVD for preventing SSI in patients undergoing primary closure of ileostomy. METHODS Patients undergoing ileostomy closure in the Department of Colorectal Surgery, Peking University Cancer Hospital, from September 2006 to March 2013, were included in this study. The clinical features of these patients with or without a subcutaneous drain were reviewed, and the complication rate of SSI was analyzed. The primary endpoints were the incidence and risk factors of SSI, and the secondary endpoints were the rate of overall complications and their management. RESULTS A total of 245 consecutive patients were enrolled in the study. The overall incidence of SSI was 8.6%. Eighty-five (34.7%) patients received placement of an SVD. The use of SVDs was associated with a significantly lower incidence of SSI compared with primary closure (PC) without an SVD (1.2 vs. 12.5%, p = 0.001). Multivariate analyses showed that the presence of an SVD (odds ratio (OR) 0.063, p = 0.012), total operation time >90 min (OR 4.862, p = 0.002), and postoperative complications (OR 10.576, p < 0.001) were independent risk factors of SSI. CONCLUSIONS This study shows that an SVD is effective for reducing SSI in patients undergoing PC of ileostomy. Further randomized trials are required to confirm our findings and to compare SVDs with purse-string sutures.
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Affiliation(s)
- Hong-Da Pan
- Department of Colorectal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing Cancer Hospital, Fucheng Road 52, Haidian District, 100142, Beijing, China
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Doorly M, Choi J, Floyd A, Senagore A. Microbial sealants do not decrease surgical site infection for clean-contaminated colorectal procedures. Tech Coloproctol 2015; 19:281-5. [DOI: 10.1007/s10151-015-1286-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 12/08/2014] [Indexed: 11/29/2022]
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Watanabe M, Suzuki H, Nomura S, Maejima K, Chihara N, Komine O, Mizutani S, Yoshino M, Uchida E. Risk factors for surgical site infection in emergency colorectal surgery: a retrospective analysis. Surg Infect (Larchmt) 2014; 15:256-61. [PMID: 24810804 DOI: 10.1089/sur.2012.154] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Since 2005, we have been conducting prospective surgical site infection (SSI) surveillance and infection control according to the U.S. Centers for Disease Control and Prevention guidelines for patients who undergo gastrointestinal surgery at our institution. Surgical site infection occurs with greater frequency in emergency than in elective surgery because of factors such as ill-conceived preoperative preparation and "dirty" operations. A large number of studies have been reported on risk factors for SSI in elective colorectal surgery; however, there are few papers on such factors in emergency colorectal surgery. The aim of this study was to identify risk factors for incisional SSI in emergency colorectal surgery. METHODS Using our SSI surveillance database, we analyzed retrospectively 78 patients who underwent emergency colorectal surgery between 2005 and 2010. Univariable and multivariable analyses were used to identify risk factors for incisional SSI. Moreover, we subclassified dirty-infected operations (class IV) by the extent of contamination according to our own definition to study the incidence of incisional SSI at each degree. RESULTS The incidence of incisional SSI was 32.1% (25/78 patients). By univariable analysis, seven parameters correlated with a higher risk of incisional SSI: Surgical incision class III-IV, obesity (body mass index ≥25 kg/m(2)), American Society of Anesthesiologists score 3 or 4 points, chronic kidney disease (serum creatinine concentration >1.2 mg/dL), blood loss ≥200 mL, blood transfusion, and ventilator support. Multivariable analyses showed that surgical incision class III-IV (odds ratio [OR] 5.9; 95% confidence interval [CI] 1.7, 25.2) and obesity (OR 11.9; 95% CI 2.1, 87.8) were independent risk factors for incisional SSI. The incidence of incisional SSI in colon perforation with generalized contamination was statistically higher than that in prepared colon perforation and colon perforation with localized contamination (82.4% vs. 25.0%; p<0.001). CONCLUSIONS The risk factors for incisional SSI in emergency colorectal surgery were incision contamination and obesity. Moreover, the incidence of incisional SSI among the incision class IV operations increased significantly with increasing extents of contamination. As a tactic for management of dirty abdominal wounds, we suggest that primary skin closure is suitable in cases of perforation of a prepared colon or colon perforation with localized contamination. On the other hand, in cases of colon perforation with generalized contamination, delayed primary skin closure or leaving an incision open to heal by secondary intention should be considered.
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Affiliation(s)
- Masanori Watanabe
- 1 Institute of Gastroenterology, Nippon Medical School Musashikosugi Hospital , Kawasaki, Kanagawa, Japan
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Novel closing method using subcutaneous continuous drain for preventing surgical site infections in radical cystectomy. ISRN UROLOGY 2014; 2014:897451. [PMID: 24734201 PMCID: PMC3964757 DOI: 10.1155/2014/897451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/09/2014] [Indexed: 11/17/2022]
Abstract
To reduce the incidence of surgical site infection (SSI) after radical cystectomy, a new closing method using subcutaneous continuous aspiration drain was developed and compared to the conventional closing method. The new method involved (a) closed aspiration with an indwelling aspiration drain without suture of the subcutaneous fat and (b) covering with hydrocolloid wound dressing after suture of the dermis with 4-0 absorbable thread and reinforcement using strips. The incidence of SSI was significantly improved by using the new method. Furthermore, univariate and multivariate analysis associated with SSI revealed that the new closing method was statistically correlated with 85% reduction of SSI (odds ratio: 0.15, 95% confidence interval: 0.03–0.69).Our new method using continuous aspiration with subcutaneous drain is useful for preventing SSI through removal of effusions and reduction of dead space by apposition of the subcutaneous fat.
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A prospective randomized controlled trial of subcutaneous passive drainage for the prevention of superficial surgical site infections in open and laparoscopic colorectal surgery. Int J Colorectal Dis 2014; 29:353-8. [PMID: 24385026 DOI: 10.1007/s00384-013-1810-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 02/04/2023]
Abstract
INTRODUCTION A number of studies have evaluated the effects of subcutaneous drainage during digestive surgery. All of the previous studies assessed the usefulness of active-suctioning drain, including two randomized controlled studies which found no benefit for the placement of active-suctioning drains in digestive surgery. The utility of passive drainage has not been evaluated previously. The purpose of this study was to evaluate the efficacy of subcutaneous passive drainage system for preventing surgical site infections during major colorectal surgery. PATIENTS AND METHODS A total of 263 patients who underwent major colorectal surgery were enrolled in this study. Patients were randomly assigned to receive subcutaneous passive drainage or no drainage. The primary outcome measured was the incidence of superficial surgical site infections. The secondary outcomes measured were the development of hematomas, seromas, and wound dehiscence. RESULTS Finally, a total of 246 patients (124 underwent passive drainage, and 122 underwent no drainage) were included in the analysis after randomization. There was a significant difference in the incidence of superficial surgical site infections between patients assigned to the passive drainage and no drainage groups (3.2 % vs 9.8 %, respectively, P = 0.041). There were no cases that developed a hematoma, seroma, or wound dehiscence in either group. A subgroup analysis revealed that male gender, age ≥75 years, diabetes mellitus, American Society of Anesthesiologists (ASA) status ≥2, blood loss ≥100 ml, and open access were factors that were associated with a beneficial effect of subcutaneous passive drainage. CONCLUSIONS Subcutaneous passive drainage provides benefits over no drainage in patients undergoing major colorectal surgery.
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Nakayama H, Takayama T, Okubo T, Higaki T, Midorikawa Y, Moriguchi M, Aramaki O, Yamazaki S. Subcutaneous drainage to prevent wound infection in liver resection: a randomized controlled trial. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 21:509-17. [DOI: 10.1002/jhbp.93] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Hisashi Nakayama
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Takao Okubo
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Tokio Higaki
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Yutaka Midorikawa
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Masamichi Moriguchi
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Osamu Aramaki
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Shintaro Yamazaki
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
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Factors predicting incisional surgical site infection in patients undergoing open radical cystectomy for bladder cancer. Int J Clin Oncol 2013; 19:935-9. [DOI: 10.1007/s10147-013-0646-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/17/2013] [Indexed: 10/25/2022]
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Incisional negative pressure wound therapy significantly reduces surgical site infection in open colorectal surgery. Dis Colon Rectum 2013; 56:1403-8. [PMID: 24201395 DOI: 10.1097/dcr.0b013e3182a39959] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Surgical site infections in colorectal surgery remain a common problem, and are associated with an increase in cost of care and length of stay. OBJECTIVE This study aims to evaluate the effect of known risk factors and the use of incisional negative pressure wound therapy on surgical site infection rates. DESIGN This is a single-center retrospective study with the use of chart review. SETTINGS The study took place at a tertiary academic medical center. PATIENTS All patients undergoing open colectomy at a single institution from 2009 through 2011 were studied. MAIN OUTCOME MEASURES The primary outcome measured was the presence or absence of surgical site infection. RESULTS Overall, 69 of the 254 patients (27.2%) experienced surgical site infection; 4 (12.5%) surgical site infections were seen in patients undergoing incisional negative pressure wound therapy and 65 (29.3%) were seen in patients undergoing standard closure. Multiple logistic regression revealed 2 significant factors: diabetes mellitus increased the chance of surgical site infection (OR, 1.98; p < 0.05), and the use of incisional negative pressure wound therapy decreased the chance of surgical site infection (OR, 0.32; p < 0.05). Obesity was associated with a trend toward increasing surgical site infection (OR, 1.64; p = 0.10). LIMITATIONS This study is limited by its retrospective nature and the high baseline prevalence of surgical site infection. CONCLUSIONS Incisional negative pressure wound therapy appears to reduce surgical site infection in open colorectal surgery. Further study may be helpful to identify patient populations who would have the greatest benefit from this technique(see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A115).
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Tsujita E, Yamashita YI, Takeishi K, Matsuyama A, Tsutsui SI, Matsuda H, Taketomi A, Shirabe K, Ishida T, Maehara Y. Subcuticular absorbable suture with subcutaneous drainage system prevents incisional SSI after hepatectomy for hepatocellular carcinoma. World J Surg 2012; 36:1651-6. [PMID: 22411085 DOI: 10.1007/s00268-012-1524-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effectiveness of subcuticular absorbable suture with subcutaneous drainage to decrease the risk of postoperative incisional surgical site infection (SSI) in hepatocellular carcinoma (HCC) patients was evaluated. METHODS A total of 149 patients with HCC who underwent hepatectomy (Hx) were retrospectively investigated. Patients were divided into two groups: the patients with subcuticular suture combined with subcutaneous drainage (the drainage group; 61 patients) and the patients with nylon suture without subcutaneous drainage (the nylon group; 88 patients). After the operations, the complication rate of postoperative incisional SSI was analyzed and compared between the two groups. RESULTS In the drainage group the rate of incisional SSI was significantly lower compared to the nylon group: 14-3 % (p = 0.033), respectively. Patients with incisional SSI needed significantly longer postoperative hospital care than the patients without incisional SSI: 28 versus 15 days (p < 0.005). Multivariate analysis revealed that subcuticular absorbable suture with subcutaneous drainage significantly reduced the occurrence of incisional SSI (odds ratio; 0.15; p = 0.034). CONCLUSIONS We have demonstrated that the subcuticular suture with subcutaneous drainage is effective in preventing incisional SSI in patients undergoing Hx for HCC.
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Affiliation(s)
- Eiji Tsujita
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, 730-8619, Japan.
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Current world literature. Curr Opin Cardiol 2012; 27:556-64. [PMID: 22874129 DOI: 10.1097/hco.0b013e32835793f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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