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Yang Y, Zhang X, Zhang J, Zhu J, Wang P, Li X, Mai W, Jin W, Liu W, Ren J, Wu X. Prediction models of surgical site infection after gastrointestinal surgery: a nationwide prospective cohort study. Int J Surg 2024; 110:119-129. [PMID: 37800568 PMCID: PMC10793813 DOI: 10.1097/js9.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE This study aimed to construct and validate a clinical prediction model for surgical site infection (SSI) risk 30 days after gastrointestinal surgery. MATERIALS AND METHODS This multicentre study involving 57 units conducted a 30-day postoperative follow-up of 17 353 patients who underwent gastrointestinal surgery at the unit from 1 March 2021 to 28 February 2022. The authors collected a series of hospitalisation data, including demographic data, preoperative preparation, intraoperative procedures and postoperative care. The main outcome variable was SSI, defined according to the Centres for Disease Control and Prevention guidelines. This study used the least absolute shrinkage and selection operator (LASSO) algorithm to screen predictive variables and construct a prediction model. The receiver operating characteristic curve, calibration and clinical decision curves were used to evaluate the prediction performance of the prediction model. RESULTS Overall, 17 353 patients were included in this study, and the incidence of SSI was 1.6%. The univariate analysis combined with LASSO analysis showed that 20 variables, namely, chronic liver disease, chronic kidney disease, steroid use, smoking history, C-reactive protein, blood urea nitrogen, creatinine, albumin, blood glucose, bowel preparation, surgical antibiotic prophylaxis, appendix surgery, colon surgery, approach, incision type, colostomy/ileostomy at the start of the surgery, colostomy/ileostomy at the end of the surgery, length of incision, surgical duration and blood loss were identified as predictors of SSI occurrence ( P <0.05). The area under the curve values of the model in the train and test groups were 0.7778 and 0.7868, respectively. The calibration curve and Hosmer-Lemeshow test results demonstrated that the model-predicted and actual risks were in good agreement, and the model forecast accuracy was high. CONCLUSIONS The risk assessment system constructed in this study has good differentiation, calibration and clinical benefits and can be used as a reference tool for predicting SSI risk in patients.
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Affiliation(s)
- Yiyu Yang
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Southeast University
| | - Xufei Zhang
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Southeast University
| | - Jinpeng Zhang
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing
| | - Jianwei Zhu
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong
| | - Peige Wang
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao
| | - Xuemin Li
- Department of Hepatopancreatobiliary Surgery, Zhengzhou Central Hospital Affiliated To Zhengzhou University, Zhengzhou
| | - Wei Mai
- Department of Gastrointestinal Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning
| | - Weidong Jin
- Department of General Surgery, General Hospital of Central Theatre Command, Wuhan
| | - Wenjing Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Southeast University
| | - Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Southeast University
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Chen M, Liang H, Chen M, Wang M, Lin L, Zhou C, Wei L. Risk factors for surgical site infection in patients with gastric cancer: A meta-analysis. Int Wound J 2023; 20:3884-3897. [PMID: 37337711 PMCID: PMC10588342 DOI: 10.1111/iwj.14264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023] Open
Abstract
Surgical Site Infection (SSI) is one of the common postoperative complications after gastric cancer surgery. Previous studies have explored the risk factors (such as age, diabetes, anaemia and ASA score) for SSI in patients with gastric cancer. However, there are large differences in the research results, and the correlation coefficients of different research results are quite different. We aim to investigate the risk factors of surgical site infection in patients with gastric cancer. We queried four English databases (PubMed, Embase, Web of Science and the Cochrane Library) and four Chinese databases (China National Knowledge Infrastructure, Chinese Biological Medicine Database, Wanfang Database and Chinese Scientific Journal Database (VIP Database)) to identify published literature related to risk factors for surgical site infection in patients with gastric cancer. Rev Man 5.4 and Stata 15.0 were used in this meta-analysis. A total of 15 articles (n = 6206) were included in this analysis. The following risk factors were found to be significantly associated with surgical site infection in gastric cancer: male (OR = 1.28, 95% CI [1.06, 1.55]), age >60 (OR = 2.75, 95% CI [1.65, 4.57]), smoking (OR = 1.99, 95% CI [1.46, 2.73]), diabetes (OR = 2.03, 95% CI [1.59, 2.61]), anaemia (OR = 4.72, 95% CI [1.66, 13.40]), preoperative obstruction (OR = 3.07, 95% CI [1.80, 5.23]), TNM ≥ III (OR = 2.05, 95% CI [1.56, 2.70]), hypoproteinemia (OR = 3.05, 95% CI [2.08, 4.49]), operation time ≥3 h (OR = 8.33, 95% CI [3.81, 18.20]), laparotomy (OR = 2.18, 95% CI [1.61, 2.94]) and blood transfusion (OR = 1.44, 95% CI [1.01, 2.06]). This meta-analysis showed that male, age >60, smoking, diabetes, anaemia, preoperative obstruction, TNM ≥ III, hypoproteinemia, operation time ≥3 h, open surgery and blood transfusion were the risk factors for SSI in patients with gastric cancer.
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Affiliation(s)
- Muxin Chen
- The Second Clinical Medical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Hao Liang
- The Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Meiying Chen
- The Second Clinical Medical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Mingxin Wang
- The Second Clinical Medical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Lijun Lin
- The Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Chunjiao Zhou
- The Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Lin Wei
- The Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
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Nasseri Y, Kasheri E, Zhu R, Smiley A, Cohen J, Ellenhorn J, Barnajian M, Oka K. Novel antibiotic irrigation device versus standard O-ring wound retractor in the prevention of surgical site infection following colorectal resection. Int J Colorectal Dis 2023; 38:252. [PMID: 37819537 DOI: 10.1007/s00384-023-04542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE We sought to compare the effectiveness of a novel antibiotic irrigation device to the standard O-ring wound retractor in preventing surgical site infections (SSIs) following colorectal resections. METHODS This single-arm clinical trial included patients undergoing colorectal resections utilizing the novel device. A retrospective cohort of patients undergoing the same procedures with the O-ring retractor was selected as the control group. The primary outcome assessed was SSI. Secondary outcomes assessed were overall complications, hospital length of stay (LOS), and 30-day readmission. A univariable and multivariable logistic regression model was built to evaluate the association between SSI as the outcome variable and the use of the novel device as the main independent variable. The model was adjusted for any confounding variables. RESULTS Eighty-six novel device cases and 170 O-ring retractor cases were enrolled. There were no significant differences between the two groups in terms of demographics and preoperative comorbidities. Cases with the novel device had fewer Pfannenstiel incisions (1.2% vs. 14.6%, p < 0.001). There were no other significant differences in intraoperative variables. SSI rates were significantly lower in the novel device group (1.2% vs. 9.1%, p = 0.014). There were no other significant differences in postoperative complications. Multivariable logistic regression with backward elimination showed that the use of the novel device was significantly more effective against SSI by 92.5% compared to the use of the O-ring retractor. CONCLUSION The novel device may contribute to lower SSI rates compared to the O-ring retractor following colorectal resection.
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Affiliation(s)
- Yosef Nasseri
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
- Department of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eli Kasheri
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
| | - Ruoyan Zhu
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
| | - Abbas Smiley
- Department of Colorectal Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Jason Cohen
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
- Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joshua Ellenhorn
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
- Department of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Moshe Barnajian
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
- Department of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kimberly Oka
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA.
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Malheiro RM, Peleteiro B, Silva G, Lebre A, Paiva JA, Correia S. Surveillance of surgical site infection after colorectal surgery: comprehensiveness and impact of risk factors. Infect Control Hosp Epidemiol 2023; 44:1601-1606. [PMID: 36945140 DOI: 10.1017/ice.2023.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE The incidence of surgical site infection (SSI) is highest after colorectal surgery. We assessed the impact of risk factors for SSI using the population attributable fraction (PAF). DESIGN Retrospective cohort study. SETTING Portuguese hospitals performing regular surveillance. PATIENTS We identified patients who underwent colorectal procedures in hospitals that reported colorectal surgeries every year between 2015 and 2019. Among 42 reporting hospitals, 18 hospitals were included. METHODS Risk-factor incidence was estimated using the National Epidemiological Surveillance platform from 2015 to 2019. This platform follows the methodology recommended by the European Centre for Disease Prevention and Control. American Society of Anaesthesiologists (ASA) physical classification, wound classification, open surgery, urgent operation, antibiotic prophylaxis, operation time, and male sex were included as risk factors. Measures of association were retrieved from published meta-analyses. PAFs were calculated using the Levin formula. To account for interaction between risk factors, communality of risk factors was used in a weighted-sum approach, providing a combined value that serves as a measure of the comprehensiveness of surveillance. RESULTS Among 11,219 reported procedures, the cumulative SSI incidence was 16.8%. The proportion of SSI attributed to all risk factors was 61%. Modifiable variables accounted for 31% of procedures; the highest was laparotomy (16.8%), and urgent operations (2.7%) had the lowest value. Nonmodifiable factors accounted for 28.7%; the highest was wound classification (14.3%). CONCLUSIONS A relevant proportion (39%) of SSI remains unaccounted for by current surveillance. Almost one-third of SSI cases have potentially modifiable factors. Interventions focusing on shorter, less invasive procedures may be optimally effective in reducing the SSI incidence.
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Affiliation(s)
- Rui M Malheiro
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Bárbara Peleteiro
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departmento de Saúde Pública, Ciências forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
| | - Goreti Silva
- Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde, Lisboa, Portugal
| | - Ana Lebre
- Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde, Lisboa, Portugal
- Instituto Português de Oncologia do Porto Francisco Gentil, E.E., Porto, Portugal
| | - José Artur Paiva
- Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde, Lisboa, Portugal
- Unidade de Cuidados Intensivos, Centro Hospitalar Universitário São João, Porto, Portugal
- Departmento de Medicina, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
| | - Sofia Correia
- Departmento de Saúde Pública, Ciências forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
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Sun H, Jiang H, Jiang ZW, Fang G, Dai ZX, Wang Z, Sun X, Wang W. Analysis of risk factors for surgical site infection after colorectal surgery: a cross-sectional study in the east of China pre-COVID-19. Front Public Health 2023; 11:1204337. [PMID: 37637824 PMCID: PMC10457116 DOI: 10.3389/fpubh.2023.1204337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Background The occurrence of surgical site infection (SSI) can prolong the postoperative hospital stay, increase the economic burden of patients, and even endanger their lives. The purpose of this study was to investigate the incidence, risk factors, and microbiology of SSI after colorectal surgery (CRS) and to provide a basis for the prevention and control of SSI. Methods A single-center, prospective, cross-sectional study of adult patients undergoing CRS was conducted from 2010-2019. Univariate and multivariate logistic regression models were used to collect and analyze demographic information, hospital characteristics, and potential perioperative risk factors of SSI. Results A total of 3,302 eligible patients were included in this study, with 213 cases experiencing SSIs, resulting in an infection rate of 6.45%. Notably, the incidence of SSI decreased from 13.33% in 2010 to 3.56% in 2019 (Ptrend < 0.001). Escherichia coli accounted for the majority of isolated microorganisms (37.09%), with 49 strains exhibiting resistance to one or more antibiotics (35.25%). Multivariate analysis showed that diabetes, anastomosis leakage, wound classification (contaminated/dirty), operation duration, blood loss greater than 200 ml, and NNIS risk index score for 2 or 3 were independent risk factors. Conversely, laparoscopic approach, preoperative bowel preparation and preoperative albumin levels emerged as protective factors against SSI after CRS. Furthermore, compared to non-SSI patients, SSI patients had a significantly higher 30-day mortality rate following surgery (0.23% vs. 2.35%, p < 0.05). Conclusion SSI after CRS was susceptible to many factors, and the pathogen of SSI was mainly Escherichia coli. In clinical practice, measures such as correcting preoperative hypoproteinemia, choosing laparoscopic surgery, preoperative bowel preparation and shortening the duration of surgery should be taken to reduce the incidence of SSI.
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Affiliation(s)
- Hui Sun
- Medical Department, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Hua Jiang
- Medical Department, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Zhi-Wei Jiang
- Medical Department, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Ge Fang
- Medical Department, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Zheng-Xiang Dai
- Infection Management Department, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Zhiguo Wang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Xiang Sun
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Wen Wang
- Department of Rheumatology and Immunology, The Affiliated Suqian First People’s Hospital of Nanjing Medical University, Suqian, Jiangsu Province, China
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Zhao Q, Wu L, Yang F, Han S, Xing N. Application of Transvaginal Natural Orifice Specimen Extraction Surgery in Urological Surgery. J Laparoendosc Adv Surg Tech A 2023; 33:231-235. [PMID: 36108338 DOI: 10.1089/lap.2022.0369] [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: 11/12/2022] Open
Abstract
Background: To summarize and analyze the application of transvaginal natural orifice specimen extraction surgery (TV-NOSES) in the operation of renal carcinoma, upper tract urothelial carcinoma, and bladder cancer. Methods: Fifty-seven female patients who underwent 3D laparoscopic radical surgery for urinary tumors and TV-NOSES were analyzed retrospectively. The basic clinical data, perioperative-related data, postoperative complications, and related indexes of postoperative functional evaluation were analyzed and evaluated. Results: All 57 operations were successfully performed according to the original plan. One patient developed mild vaginal infection after operation, which was cured after symptomatic treatment. The visual analog scale scores at 24 and 48 hours after operation were 2.5 (1-4) and 1.1 (0-2), respectively. Patient scar assessment questionnaire scores at 3 months after operation were 37.1 (32-48). Pelvic floor distress inventory-short form 20 scores at preoperative and postoperative 3 months were 5.9 (3-9) and 6.3 (3-9), respectively, and the difference was not statistically significant (P = .48). There was no significant difference in female sexual function index scores between preoperative and postoperative 3 months (P = .82). Conclusions: TV-NOSES in urological surgery is feasible and practical. In addition, this technique further reduces wound pain and wound-related complications without affecting postoperative sexual function and pelvic floor function. The successful development of this technique has laid a solid foundation for further clinical application and promotion. Clinical Trial Registration number: 22/141-3342.
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Affiliation(s)
- Qinxin Zhao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyuan Wu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feiya Yang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sujun Han
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nianzeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Urology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Shanxi, China
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Huang T, Liu T, Shang M, Han G. Clinical application of improved VSD and VSD in the treatment of SSI after abdominal surgery: A retrospective randomized clinical study. Medicine (Baltimore) 2023; 102:e32785. [PMID: 36820532 PMCID: PMC9907897 DOI: 10.1097/md.0000000000032785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
By comparing the efficacy and cost of improved vacuum-sealing drainage devices and vacuum-sealing drainage (VSD) devices in the treatment of postoperative abdominal surgical site infection, the clinical applicability and promotion of improved vacuum-sealing drainage devices were assessed. In our institution, between October 2019 and December 2021, 55 patients with surgical site infection after abdominal surgery were retrospectively analyzed, including 30 patients treated with improved VSD and 25 patients treated with VSD. The efficacy of wound healing, total dressing change cost throughout therapy, total hospital costs, hospital days, and bacterial culture results of wound secretions before and after treatment were compared between the 2 groups. Both groups achieved wound healing following vacuum sealing-drainage treatment, with no significant differences in wound healing time or secondary suture rate. However, the total hospitalization and dressing change costs in the improved VSD group were significantly lower than those in the VSD group. Similar to VSD, improved VSD is effective in the treatment of surgical site infections after abdominal surgery. Compared with VSD, the improved VSD device has lower dressing change costs and total hospitalization costs during the treatment process. The improved VSD has a wide range of applications and is suitable for clinical use and promotion.
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Affiliation(s)
- Tao Huang
- Department of Gastrointestinal Surgery, Wuhan Puren Hospital, Qingshan District, Wuhan, Hubei, China
| | - Tong Liu
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Nanguan District, Changchun, Jilin, China
| | - Mei Shang
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Nanguan District, Changchun, Jilin, China
| | - Gang Han
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Nanguan District, Changchun, Jilin, China
- * Correspondence: Gang Han, Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, No.218, Ziqiang street, Nanguan District, Changchun, Jilin, China (e-mail: )
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Prophylactic effect of negative‐pressure wound therapy and delayed sutures against incisional‐surgical site infection after emergency laparotomy for colorectal perforation: A multicenter retrospective cohort study. Ann Gastroenterol Surg 2022; 7:441-449. [PMID: 37152783 PMCID: PMC10154815 DOI: 10.1002/ags3.12643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/15/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
Aim The prophylactic effect of negative-pressure wound therapy against incisional surgical site infection after highly contaminated laparotomies has not been sufficiently explored. This study aimed to evaluate the prophylactic effect of negative-pressure wound therapy against incisional surgical site infection after emergency surgery for colorectal perforation. Methods This nationwide, multicenter, retrospective cohort study analyzed data from the 48 emergency hospitals certificated by the Japanese Society for Abdominal Emergency Medicine. Patients who underwent an emergency laparotomy for colorectal perforation between April 2015 and March 2020 were included in this study. Outcomes, including the incidence of incisional surgical site infection, were compared between patients who were treated with prophylactic negative-pressure wound therapy and delayed sutures (i.e., negative-pressure wound therapy group) and patients who were treated with regular wound management (i.e., control group) using 1:4 propensity score matching analysis. Results The negative-pressure wound therapy group comprised 88 patients, whereas the control group consisted of 1535 patients. Of them, 82 propensity score-matched pairs (negative-pressure wound therapy group: 82; control group: 328) were evaluated. The negative-pressure wound therapy group showed a lower incidence of incisional surgical site infection [18 (22.0%) in the negative-pressure wound therapy group and 115 (35.0%) in the control group, odds ratio, 0.52; 95% confidence interval, 0.30 to 0.92; p = 0.026]. Conclusions The prophylactic use of negative-pressure wound therapy with delayed sutures was associated with a lower incidence of incisional surgical site infection after emergency surgery for colorectal perforation.
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An S, Kim K, Kim MH, Jung JH, Kim Y. Perioperative Probiotics Application for Preventing Postoperative Complications in Patients with Colorectal Cancer: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1644. [PMID: 36422183 PMCID: PMC9699544 DOI: 10.3390/medicina58111644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 05/23/2024]
Abstract
Background and Objectives: Perioperative probiotic administration in patients who undergo gastrointestinal surgery can reduce postoperative infectious complications. This systematic review and meta-analysis aimed to evaluate the effect of probiotics on postoperative outcomes in patients who underwent colorectal cancer surgery. Materials and Methods: For this study, we followed the protocol published by PROSPERO (registration number: CRD42021247277). We included studies on patients undergoing open, laparoscopic, or robotic colorectal cancer surgery for curative intent. We conducted a comprehensive search with online databases (trial registries and ClinicalTrials.gov), other literature sources, and conference proceedings, with no language restriction, up until 12 August 2022. We assessed risk of bias, extracted data, and conducted statistical analyses by using a random-effects model and interpreted the results based on the Cochrane Handbook for Systematic Reviews of Interventions. We rated the certainty of evidence (CoR) according to the GRADE approach. Results: We identified 20 published full-text studies. The use of probiotics probably results in little to no difference in perioperative mortality (risk ratio (RR): 0.17, 95% CI: 0.02 to 1.38; I2 = 0%; moderate CoE) and may result in reducing the overall postoperative infectious complications (RR: 0.45, 95% CI: 0.27 to 0.76; I2 = 38%; low CoE) after colorectal cancer surgery. Probiotics may result in little to no difference in probiotics-related adverse events (RR: 0.73, 95% CI: 0.45 to 1.19; I2 = 0%; low CoE). While probiotics may result in reducing the overall postoperative complications (RR: 0.47, 95% CI: 0.30 to 0.74; I2 = 8%; low CoE), it may result in little to no difference in hospital length of stay (LOS) (MD: -1.06, 95% CI: -1.64 to -0.47; I2 = 8%; low CoE) and postoperative quality of life (QOL) (MD: +5.64, 95% CI: 0.98 to 10.3; low CoE). Conclusions: Perioperative probiotic administration may reduce complications, including overall infectious complications, in patients undergoing colorectal cancer surgery without any additional adverse effects. In addition, probiotics may have similar effects on perioperative mortality; procedure-related complications such as anastomotic leakage, and hospital LOS; or improve the QOL. Thus, probiotics may be considered a beneficial supplement to routine perioperative care for colorectal cancer surgery.
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Affiliation(s)
- Sanghyun An
- Department of Surgery, College of Medicine, Yonsei University Wonju, Wonju 26426, Korea
| | - Kwangmin Kim
- Department of Surgery, College of Medicine, Yonsei University Wonju, Wonju 26426, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Korea
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, College of Medicine, Yonsei University Wonju, Wonju 26426, Korea
| | - Jae Hung Jung
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Korea
- Department of Urology, College of Medicine, Yonsei University Wonju, Wonju 26426, Korea
| | - Youngwan Kim
- Department of Surgery, College of Medicine, Yonsei University Wonju, Wonju 26426, Korea
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Turcotte JJ, Allen RS, Klune JR, Feather CB. Open and Closed Approaches to Skin Closure After Nonelective Open Colorectal Operations. Am Surg 2022:31348221101578. [PMID: 35580356 DOI: 10.1177/00031348221101578] [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: 11/16/2022]
Abstract
INTRODUCTION Optimal wound management strategies to reduce surgical site infections (SSIs) in nonelective open colorectal surgery (NOCS) remain controversial and variable. Our aim is to describe SSI and other 30-day outcome measures among patients with varying wound management techniques undergoing NOCS. METHODS All NOCS patients were extracted from the 2016 to 2018 ACS-NSQIP database. Outcomes of patients managed with all layers closed (ALC) were compared to patients managed with skin open (SO), using propensity score matching (PSM) to control for significant confounding risk factors for SSI. RESULTS A total of 40,820 patients were included; 4622 patients managed with SO and 36,198 managed with ALC. Patients in the SO group were more likely to have a history of hypertension, renal failure, chronic obstructive pulmonary disease, smoking, obesity, and sepsis on presentation (P < .001). After PSM, no differences in risk factors remained; 4622 and 4344 patients were included in the SO and ALC cohorts, respectively. While ALC patients experienced a higher rate of superficial SSI (1.4% vs 7.3%, P < .001) and any wound complications (6.8% vs 10.8%, P < .001), the SO group had higher wound dehiscence (4.4% vs 2.8%, P < .001). There were no significant differences in deep wound infection. The SO group had longer average length of stay (14.7 vs 13.1 days, P < .001), higher non-wound-related complications, discharge to SNF, and in-hospital mortality. DISCUSSION Significant differences in SSI rates among NOCS patients with differing wound management techniques were observed. More notably, other important quality measures, such as length of stay, disposition, mortality, and non-wound-related complications were also significantly impacted by wound management strategy.
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Affiliation(s)
- Justin J Turcotte
- Department of Surgery, 1267Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - Rebecca S Allen
- Department of Surgery, 1267Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - J Robert Klune
- Department of Surgery, 1267Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - Cristina B Feather
- Department of Surgery, 1267Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
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11
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Xu Z, Qu H, Gong Z, Kanani G, Zhang F, Ren Y, Shao S, Chen X, Chen X. Risk factors for surgical site infection in patients undergoing colorectal surgery: A meta-analysis of observational studies. PLoS One 2021; 16:e0259107. [PMID: 34710197 PMCID: PMC8553052 DOI: 10.1371/journal.pone.0259107] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/12/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Surgical site infection (SSI) is the second most prevalent hospital-based infection and affects the surgical therapeutic outcomes. However, the factors of SSI are not uniform. The main purpose of this study was to understand the risk factors for the different types of SSI in patients undergoing colorectal surgery (CRS). METHODS PubMed, EMBASE, and Cochrane Library databases were searched using the relevant search terms. The data extraction was independently performed by two investigators using a standardized format, following the pre-agreed criteria. Meta-analysis for the risk factors of SSI in CRS patients was carried out using Review Manager 5.3 (RevMan 5.3) and Stata 15.1 software. The quality of evidence was evaluated using total sample size, Egger's P-value, and intergroup heterogeneity, which contained three levels: high-quality (Class I), moderate-quality (Class II/III), and low-quality (Class IV). The publication bias of the included studies was assessed using funnel plots, Begg's test, and Egger's test. RESULTS Of the 2660 potentially eligible studies, a total of 31 studies (22 retrospective and 9 prospective cohort studies) were included in the final analysis. Eventually, the high-quality evidence confirmed that SSI was correlated with obesity (RR = 1.60, 95% confidence interval (CI): 1.47-1.74), ASA score ≥3 (RR = 1.34, 95% CI: 1.19-1.51), and emergent surgery (RR = 1.36, 95% CI: 1.19-1.55). The moderate-quality evidence showed the correlation of SSI with male sex (RR = 1.30, 95% CI: 1.14-1.49), diabetes mellitus (RR = 1.65, 95% CI: 1.24-2.20), inflammatory bowel disease (RR = 2.12, 95% CI: 1.24-3.61), wound classification >2 (RR = 2.65, 95% CI: 1.52-4.61), surgery duration ≥180 min (RR = 1.88, 95% CI: 1.49-2.36), cigarette smoking (RR = 1.38, 95% CI: 1.14-1.67), open surgery (RR = 1.81, 95% CI: 1.57-2.10), stoma formation (RR = 1.89, 95% CI: 1.28-2.78), and blood transfusion (RR = 2.03, 95% CI:1.34-3.06). Moderate-quality evidence suggested no association with respiratory comorbidity (RR = 2.62, 95% CI:0.84-8.13) and neoplasm (RR = 1.24, 95% CI:0.58-2.26). Meanwhile, the moderate-quality evidence showed that the obesity (RR = 1.28, 95% CI: 1.24-1.32) and blood transfusion (RR = 2.32, 95% CI: 1.26-4.29) were independent risk factors for organ/space SSI (OS-SSI). The high-quality evidence showed that no correlation of OS-SSI with ASA score ≥3 and stoma formation. Furthermore, the moderate-quality evidence showed that no association of OS-SSI with open surgery (RR = 1.37, 95% CI: 0.62-3.04). The high-quality evidence demonstrated that I-SSI was correlated with stoma formation (RR = 2.55, 95% CI: 1.87-3.47). There were some certain publication bias in 2 parameters based on asymmetric graphs, including diabetes mellitus and wound classification >2. The situation was corrected using the trim and fill method. CONCLUSIONS The understanding of these factors might make it possible to detect and treat the different types of SSI more effectively in the earlier phase and might even improve the patient's clinical prognosis. Evidence should be continuously followed up and updated, eliminating the potential publication bias. In the future, additional high-level evidence is required to verify these findings.
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Affiliation(s)
- ZhaoHui Xu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Dalian Medical University, Dalian, China
| | - Hui Qu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Dalian Medical University, Dalian, China
| | - ZeZhong Gong
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Dalian Medical University, Dalian, China
| | - George Kanani
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Dalian Medical University, Dalian, China
| | - Fan Zhang
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - YanYing Ren
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Shuai Shao
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - XiaoLiang Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Xin Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
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12
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Zhao Q, Yang F, Wu L, Han S, Xing N. A new and practical surgical technique of transvaginal natural orifice specimen extraction surgery (NOSES) in laparoscopic nephroureterectomy-an initial clinical experience. J Surg Oncol 2021; 124:1200-1206. [PMID: 34270098 DOI: 10.1002/jso.26608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/07/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore the safety, feasibility and clinical effect of transvaginal natural orifice specimen extraction surgery (NOSES) in 3D laparoscopic nephroureterectomy (LNU) for upper tract urothelial carcinoma (UTUC). METHODS A retrospective analysis was made of 16 female patients who underwent 3D LNU and NOSES in the Department of Urology, Cancer Hospital, Chinese Academy of Medical Sciences from June 2019 to December 2020. The basic clinical data, perioperative related data, perioperative complications, visual analogue pain score (VAS), postoperative scar assessment questionnaire (PSAQ) at 3 months, female pelvic floor dysfunction questionnaire (PFDI-20) and female sexual function index questionnaire (FSFI) at preoperative and postoperative 3 months were analyzed and evaluated. RESULTS The surgery was successfully completed in all 16 patients, and none of them was converted to open surgery. No postoperative complications, such as abdominal incision-related infection. No cases of local recurrence and distant metastasis were observed during follow-up of 3 to 21 months. The VAS scores at 24 h and 48 h after operation were 2.9 ± 0.7, 1.3 ± 0.6, respectively. PSAQ scores at 3 months after operation were 34.3 ± 3.3. PFDI-20 scores of women preoperative and postoperative 3 months were 6.25 ± 1.75, 6.3 ± 1.8, respectively, and the difference was not statistically significant (p = 0.924). There was no significant difference in FSFI scores between preoperative and postoperative 3 months (p = 0.892). CONCLUSION Transvaginal NOSES in 3D LNU for UTUC is safe, feasible and practical. The successful development of this technique has laid a solid foundation for further clinical application and promotion.
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Affiliation(s)
- Qinxin Zhao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feiya Yang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyuan Wu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sujun Han
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nianzeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Bislenghi G, Vanhaverbeke A, Fieuws S, de Buck van Overstraeten A, D’Hoore A, Schuermans A, Wolthuis AM. Risk factors for surgical site infection after colorectal resection: a prospective single centre study. An analysis on 287 consecutive elective and urgent procedures within an institutional quality improvement project. Acta Chir Belg 2021; 121:86-93. [PMID: 31577178 DOI: 10.1080/00015458.2019.1675969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To determine the incidence and to investigate risk factors for surgical site infections (SSIs) in a cohort of patients undergoing colorectal surgery. MATERIAL & METHODS Data from all consecutive patients operated at our department in an elective or in an urgent setting over a 4-month period were prospectively collected and analysed. The updated Centres for Disease Control and Prevention guidelines were used to define and to score SSIs during weekly meetings. Multivariate analysis was performed considering a list of 20 potential perioperative risk factors. RESULTS A total of 287 patients (mean age 56.9 ± 16.8 years, 51.2% male) were included. Thirty-five patients (12.2%) developed SSI. Independent risk factors for SSI were BMI <20 kg/m2 (OR 3.70; p = .022), cancer (OR 0.33; p = .046), respiratory comorbidity (OR 3.15; p = .035), presence of a preoperative stoma (OR 3.74; p = .003), and operative time ≥3 hours (OR 2.93; p = .014). CONCLUSION Identified incidence and risk factors for the development of SSI after colorectal surgery were consistent with those already reported in the literature. The possibility to develop a validated prediction model for SSIs warrants further investigation, in order to target specific preventive measures on high-risk population.
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Affiliation(s)
- Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Steffen Fieuws
- Interuniversity Center for Biostatistics and Statistical Bioinformatics, KU Leuven, University of Leuven and University of Hasselt, Leuven, Belgium
| | | | - André D’Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Annette Schuermans
- Department of Public Health and Primary Care, University Hospitals Leuven, Leuven, Belgium
| | - Albert M. Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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14
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van der Klauw AL, Voogt ELK, Frouws MA, Baeten CIM, Snijders HS. Is sterile exposure in perianal procedures necessary? A single-institution experience and results from a national survey. Tech Coloproctol 2021; 25:539-548. [PMID: 33665747 DOI: 10.1007/s10151-021-02422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Surgical site infections (SSI) are the most common postoperative complications. To minimize the risk of SSI, there is a strict asepsis policy in the operating theatre. The aim of this study was to evaluate the risk and cost-saving benefit of performing perianal surgery in a non-sterile setting. METHODS All patients who had perianal surgery at our institution between January 2014 and December 2017 in a sterile (S) or non-sterile (NS) setting for an infectious or non-infectious cause were included. The primary outcome was the 30-day SSI rate. The secondary outcome was the reintervention rate. A questionnaire was sent to surgeons in the Netherlands to assess current policy with regard to asepsis in perianal procedures. Finally, a cost analysis was performed. RESULTS In total, 376 patients were included. The rate of SSI in infectious procedures was 13% (S) versus 14% (NS, p = 0.853) and 5.1% (S) versus 0.9% (NS) in non-infectious procedures (p = 0.071). Reintervention rates in infectious procedures were 3.4% (S) versus 8.6% (NS, p = 0.187) and 1.3% (S) versus 0.0% (NS) in non-infectious procedures (p = 0.227). The questionnaire revealed that most surgeons perform perianal surgery in a sterile setting although they did not consider this useful. The potential national cost-saving benefit of a non-sterile setting is €124.61 per patient. CONCLUSIONS This study suggests that it is safe to perform perianal surgery in a non-sterile setting with regard to the SSI and reintervention rate. Adjustment of the current practice will contribute to a reduction in healthcare expenses.
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Affiliation(s)
- A L van der Klauw
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.
| | - E L K Voogt
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - M A Frouws
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands
| | - C I M Baeten
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands
| | - H S Snijders
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands
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15
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Johnson BH, Rai P, Jang SR, Johnston SS, Chen BPH. Real-World Outcomes of Patients Undergoing Open Colorectal Surgery with Wound Closure Incorporating Triclosan-Coated Barbed Sutures: A Multi-Institution, Retrospective Database Study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:65-75. [PMID: 33658869 PMCID: PMC7917355 DOI: 10.2147/mder.s297671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Open colorectal surgery is associated with a high rate of postoperative wound complications. This is a single-arm study of real-world outcomes of triclosan-coated barbed suture (Ethicon's STRATAFIXTM Symmetric PDSTM Plus Knotless Tissue Control Device [SSPP]) used in open colorectal surgery. Methods Retrospective cohort study using the Premier Healthcare Database. The study included patients who underwent an inpatient open colorectal surgery with wound closure using SSPP (size 0 or 1 to increase the likelihood the suture was used in fascia) between October 2015-September 2019 (N=593). Wound complications, hospital length of stay, total hospital costs (2019 US$), and all-cause readmissions post-discharge were measured. Post-hoc multivariable analyses compared wound complications between non-elective admissions and elective. Results The overall incidence of wound complications within 30-days post-procedure was 7.1%, with the majority of those being surgical site infections (SSI) (6.0%). Mean operation time was 190 (standard deviation [SD]=64.4) mins, postoperative length of stay was 8.1 (SD=11.9) days, 30-day readmission rate was 11.8%, and total hospital costs were $31,693 (SD=$40,076). As compared with published literature on the rate of SSI in colorectal surgery, the 30-day rate of SSI in the present study (6.0%) fell within the range of 5.4% to 18.2% for open colorectal surgery and from 4.3% to 21.5% for combined open and minimally invasive procedures. Multivariable-adjusted incidence proportions of wound complications were slightly lower for non-elective admissions and did not differ significantly from those of elective admissions. Conclusion The rate of wound complications observed in the present study falls within the range of rates previously reported in the literature, suggesting a safe and effective role for SSPP in open colorectal surgery. In post hoc analyses, the adjusted rate of wound complications was similar between non-elective and elective admissions. Head-to-head studies are required to determine comparative advantages or disadvantages for SSPP versus other sutures.
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Affiliation(s)
- Barbara H Johnson
- Real World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Pragya Rai
- Real World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Se Ryeong Jang
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephen S Johnston
- Real World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Brian Po-Han Chen
- Health Economics and Market Access, Ethicon Inc., Somerville, NJ, USA
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16
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Caputo D, Coppola A, Farolfi T, La Vaccara V, Angeletti S, Cascone C, Ciccozzi M, Coppola R. The use of an implemented infection prevention bundle reduces the incidence of surgical site infections after colorectal surgery: a retrospective single center analysis. Updates Surg 2021; 73:2113-2124. [PMID: 33400250 DOI: 10.1007/s13304-020-00960-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical-site infections (SSIs) represent the most common complications after colorectal surgery (CS). Role of preoperative administration of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP), alone or in combination, in the prevention of SSIs after CS is debated. Aim of this study was to assess the effect of the introduction of an Implemented Infection Prevention Bundle (IIPB) in preventing SSIs in CS. METHODS A group of 251 patients (Group 1) who underwent CS receiving only preoperative intravenous antibiotic prophylaxis (IAP) was compared to a Group of 107 patients (Group 2) who also received the IIPB. The IIPB consisted of the combination of oral administrations of three doses of Rifaximin 400 mg and MBP the day before surgery and in the administration of a cleansing enema the day of the surgical procedure. RESULTS At the univariate analysis, Group 2 showed significant lower rates of wound infection (WI) (2.8% vs. 9.9%; p = 0.021) and anastomotic leakage (AL) (2.8% vs. 14.7%; p = 0.001) with shorter hospital stay (5 vs. 6 days; p < 0.0001). The probability of postoperative AL was lower in Group 2; patients in this Group resulted protected from AL; a statistically significant Odds ratio of 0.16 (CI 0.05-0.55 p = 0.0034) was found. In diabetic patients, that were at higher risk of WI (OR 3.53, CI 1.49-8.35 p = 0.002), despite having any impact on anastomotic dehiscence, the use of IIPB significantly reduced the rate of WI (0% vs 28.1%; p = 0.01). CONCLUSION The use of an IIPB significantly reduces rates of SSIs and post-operative hospital stay after CS.
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Affiliation(s)
- Damiano Caputo
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Alessandro Coppola
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Tommaso Farolfi
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Vincenzo La Vaccara
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Chiara Cascone
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistic and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Roberto Coppola
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
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Zhang X, Wang Z, Chen J, Wang P, Luo S, Xu X, Mai W, Li G, Wang G, Wu X, Ren J. Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study. BMC Infect Dis 2020; 20:837. [PMID: 33183253 PMCID: PMC7663877 DOI: 10.1186/s12879-020-05567-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022] Open
Abstract
Purposes Surgical site infection (SSI) after colorectal surgery is a frequent complication associated with the increase in morbidity, medical expenses, and mortality. To date, there is no nationwide large-scale database of SSI after colorectal surgery in China. The aim of this study was to determine the incidence of SSI after colorectal surgery in China and to further evaluate the related risk factors. Methods Two multicenter, prospective, cross-sectional studies covering 55 hospitals in China and enrolling adult patients undergoing colorectal surgery were conducted from May 1 to June 30 of 2018 and the same time of 2019. The demographic and perioperative characteristics were collected, and the main outcome was SSI within postoperative 30 days. Multivariable logistic regressions were conducted to predict risk factors of SSI after colorectal surgery. Results In total, 1046 patients were enrolled and SSI occurred in 74 patients (7.1%). In the multivariate analysis with adjustments, significant factors associated with SSI were the prior diagnosis of hypertension (OR, 1.903; 95% confidence interval [CI], 1.088–3.327, P = 0.025), national nosocomial infection surveillance risk index score of 2 or 3 (OR, 3.840; 95% CI, 1.926–7.658, P < 0.001), laparoscopic or robotic surgery (OR, 0.363; 95% CI, 0.200–0.659, P < 0.001), and adhesive incise drapes (OR, 0.400; 95% CI, 0.187–0.855, P = 0.018). In addition, SSI group had remarkably increased length of postoperative stays (median, 15.0 d versus 9.0d, P < 0.001), medical expenses (median, 74,620 yuan versus 57,827 yuan, P < 0.001), and the mortality (4.1% versus 0.3%, P = 0.006), compared with those of non-SSI group. Conclusion This study provides the newest data of SSI after colorectal surgery in China and finds some predictors of SSI. The data presented in our study can be a tool to develop optimal preventive measures and improve surgical quality in China. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05567-6.
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Affiliation(s)
- Xufei Zhang
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, People's Republic of China
| | - Zhiwei Wang
- Department of Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, People's Republic of China
| | - Jun Chen
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People's Republic of China
| | - Peige Wang
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, People's Republic of China
| | - Suming Luo
- Department of Emergency Trauma Surgery, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, People's Republic of China
| | - Xinjian Xu
- Department of General Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People's Republic of China
| | - Wei Mai
- Department of Gastrointestinal Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Guangyi Li
- Department of Gastrointestinal Surgery, The People's Hospital of Hunan, Changsha, 410005, People's Republic of China
| | - Gefei Wang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People's Republic of China
| | - Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People's Republic of China
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, People's Republic of China. .,Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People's Republic of China.
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Ghuman A, Kasteel N, Brown CJ, Karimuddin AA, Raval MJ, Wexner SD, Phang PT. Surgical site infection in elective colonic and rectal resections: effect of oral antibiotics and mechanical bowel preparation compared with mechanical bowel preparation only. Colorectal Dis 2020; 22:1686-1693. [PMID: 32441804 DOI: 10.1111/codi.15153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/30/2020] [Indexed: 12/08/2022]
Abstract
AIM Surgical site infections are disproportionately common after colorectal surgery and may be largely preventable. The objective of this retrospective cohort study was to determine the effect of oral antibiotics and mechanical bowel preparation on surgical site infections. METHOD A retrospective study of a consecutive series of elective colonic and rectal resections following an Enhanced Recovery After Surgery pathway, which also included mechanical bowel preparation, from 1 September 2014 to 30 September 2017. The addition of oral antibiotics (neomycin and metronidazole) to the mechanical bowel preparation procedure was assessed. Development of surgical site infections within 30 days was the main outcome measured. The secondary outcome was assessment of possible surgical site infection predictors. RESULTS Seven-hundred thirty-two patients were included: 313 (43%) preintervention (mechanical bowel preparation only); and 419 (57%) postintervention (mechanical bowel preparation plus oral antibiotics). Surgical site infection rates preintervention and. postintervention were: overall, 20.8% vs 10.5%, P < 0.001; superficial, 10.9% vs 4.3%, P < 0.001; and organ space, 9.9% vs 6.2%, P = 0.03. Subgroup analysis of colonic resections revealed a significant reduction in overall (17.1% vs 6.8%), superficial (10.7% vs 4.3%) and organ space (6.4% vs. 2.6%) infections. Rectal resections had significant reduction in overall (26.2% vs 15.3%) and superficial (11.1% vs 4.4%) infection rates but not in organ space infections (15.1% vs 10.9%). Multivariate regression analysis revealed open vs minimally invasive surgery (P < 0.001) and omission of oral antibiotics (P = 0.004) as independent predictors of surgical site infections. CONCLUSION Administration of oral antibiotics resulted in significant reduction of superficial and organ space infections after colonic resection; after rectal resection, significant reduction only of superficial infections was found.
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Affiliation(s)
- A Ghuman
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - N Kasteel
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - C J Brown
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - A A Karimuddin
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - M J Raval
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - S D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - P T Phang
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
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He J, Yao HB, Wang CJ, Yang QY, Qiu JM, Chen JM, Shen Z, Yang GG. Meta-analysis of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) versus abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectal tumors. World J Surg Oncol 2020; 18:215. [PMID: 32814583 PMCID: PMC7439723 DOI: 10.1186/s12957-020-01982-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/31/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Natural orifice specimen extraction surgery is a novel technique of minimally invasive surgery. The purpose of this study was to compare the safety of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) and abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectum tumors. METHODS MEDLINE (PubMed), Embase, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus, and ClinicalTrials databases were systematically searched for related articles up to August 2019. The primary outcomes included postoperative complications (overall postoperative complication, incision-related complication, anastomotic fistula, and severe complication) and pathologic results (lymph nodes harvested, proximal resection margin, and distal resection edge). The statistical analysis was performed on STATA 12.0 software. RESULTS Ten studies comprising 1787 patients were used for meta-analysis. Compared with AISE-LAR, NOSE-LAR had more advantages in terms of overall postoperative complication (odds ratio (OR) = 0.65 (95% CI, 0.46 to 0.90; P = 0.01)), incision-related complication (OR = 0.13 (95% CI, 0.05 to 0.35; P < 0.01)), distal resection edge (weighted mean difference (WMD) = 0.17 cm (95% CI, 0.02 to 0.33 cm; P = 0.02)), recovery of gastrointestinal function (WMD = - 0.38 day (95% CI, - 0.70 to - 0.06 day; P = 0.02 )), pain scores in postoperative day 1 (WMD = - 1.64 (95% CI, - 2.31 to - 0.98; P < 0.01)), additional analgesics usage (OR = 0.21 (95% CI, 0.11 to 0.40; P < 0.01)) and hospital stay (WMD = - 0.71 day (95% CI, - 1.10 to - 0.32 day; P < 0.01)), while the operation time of NOSE-LAR was prolonged (WMD = 7.4 min (95% CI, 0.17 to 14.64 min; P = 0.04)). The anastomotic fistula, severe complication, lymph nodes harvested, proximal resection margin, intraoperative blood loss, and long-term outcomes in NOSE-LAR were comparable with AISE-LAR. CONCLUSIONS The safety of NOSE-LAR was demonstrated, and it could be an alternative to conventional surgery in laparoscopic anterior resection for sigmoid and rectal tumors. However, further randomized and multi-center trials are required.
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Affiliation(s)
- Jun He
- Department of Colorectal Surgery, Hangzhou Third Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Hai-Bo Yao
- Departments of Gastroenterology & Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Chang-Jian Wang
- Department of Colorectal Surgery, Hangzhou Third Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Qin-Yan Yang
- Department of Colorectal Surgery, Hangzhou Third Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Jian-Ming Qiu
- Department of Colorectal Surgery, Hangzhou Third Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Jin-Ming Chen
- Department of Colorectal Surgery, Hangzhou Third Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Zhong Shen
- Department of Colorectal Surgery, Hangzhou Third Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Guan-Gen Yang
- Department of Colorectal Surgery, Hangzhou Third Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China.
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Gao G, Chen L, Luo R, Tang B, Li T. Short- and long-term outcomes for transvaginal specimen extraction versus minilaparotomy after robotic anterior resection for colorectal cancer: a mono-institution retrospective study. World J Surg Oncol 2020; 18:190. [PMID: 32727478 PMCID: PMC7392672 DOI: 10.1186/s12957-020-01967-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Colorectal cancer resection surgery with transvaginal specimen extraction is becoming increasingly accepted and used by surgeons. However, few publications on robotic anterior sigmoid colon and rectal cancer resection with transvaginal specimen extraction (TVSE) have been reported, and a clinical outcome comparison between conventional robotic minilaparotomy (LAP) and transvaginal specimen extraction in anterior sigmoid colon and rectal cancer resection has not been performed. The current study compared the short- and long-term outcomes of TVSE and LAP for sigmoid colon cancer and rectal cancer in a mono-institution. METHODS From December 2014 to October 2018, 45 patients who underwent TVSE and 45 patients who underwent LAP matched by tumor location, tumor stage, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, gender, and age at the same period were included in the current study. The short- and long-term outcomes of TVSE and LAP were discussed. RESULTS No significant differences were found in patient characteristics. For the short-term outcomes, the operative time in the TVSE group was longer than that in the LAP group, and the postoperative pain and additional analgesia were lower in the TVSE group. Patients in the TVSE group required slightly less time to pass first flatus. There were no significant differences in overall complications, time to regular diet, length of hospital stay after surgery, estimated blood loss, or pathological outcomes. For long-term outcomes, the 3-year overall survival (94.9% vs. 91.7%, p = 0.702) and 3-year disease-free survival (88.4% vs. 86.2%, p = 0.758) were comparable between the two groups. CONCLUSION The robotic TVSE is safe and feasible in selected sigmoid/upper rectal cancer patients with tumor diameter < 5 cm. This approach has slightly better short-term outcomes in terms of less postoperative pain and less analgesic requirements without any significant difference in long-term outcomes.
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Affiliation(s)
- Gengmei Gao
- Medical College of Nanchang University, Nanchang, 330000, China
| | - Lan Chen
- Gannan Medical University, Ganzhou, 341000, China
| | - Rui Luo
- Medical College of Nanchang University, Nanchang, 330000, China
| | - Bo Tang
- Medical College of Nanchang University, Nanchang, 330000, China
| | - Taiyuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China.
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Wassef M, Mukhtar A, Nabil A, Ezzelarab M, Ghaith D. Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt. Infect Drug Resist 2020; 13:229-236. [PMID: 32095080 PMCID: PMC6995287 DOI: 10.2147/idr.s236814] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/14/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Surgical site infections (SSIs) are one of the most frequently reported hospital acquired infections associated with significant spread of antibiotic resistance. Purpose We aimed to evaluate a bundle-based approach in reducing SSI at acute surgical intensive care unit of the Emergency Hospital of Cairo University. Patients and Methods Our prospective study ran from March 2018 to February 2019 and used risk assessment. The study was divided into three phases. Phase I: (pre-bundle phase) for 5 months; data collection, active surveillance of the SSIs, screening for OXA-48 producing Enterobacteriaceae and multidrug resistant Acinetobacter baumannii colonizers using Chrom agars were carried out. Phase II: (bundle-implementation) a 6-S bundle approach included education, training and postoperative bathing with Chlorhexidine Gluconate in collaboration with the infection control team. Finally, Phase III: (post-implementation) for estimation of compliance, rates of colonization, and infection. Results Phase I encompassed 177 patients, while Phase III included 93 patients. A significant reduction of colonization from 24% to 15% (p<0.001) was observed. Similarly, a decrease of SSI from 27% to 15% (p=0.02) was noticed. A logistic regression was performed to adjust for confounding in the implementation of the bundle and we found a 70% reduction of SSI odd's ratio (OR's ratio = 0.3) confidence interval (95% CI 0.14-0.6) with significant Apache II (p=0.04), type of wound; type II (p=0.002), type III (p=0.001) and duration of surgery (p=0.04) as independent risk factors for SSI. Klebsiella pneumoniae was the most prevalent organism during phase I (34.7%). On the other hand, A. baumannii was the commonest organism to be isolated during phase III with (38.5%) preceding K. pneumoniae (30%). Conclusion Our study demonstrated that the implementation of a multidisciplinary bundle containing evidence-based interventions was associated with a significant reduction of colonization and SSIs and was met with staff approval and acceptable compliance.
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Affiliation(s)
- Mona Wassef
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Mukhtar
- Department of Anesthesia and Critical Care, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Nabil
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Moushira Ezzelarab
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Ghaith
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Maleknejad A, Dastyar N, Badakhsh M, Balouchi A, Rafiemanesh H, Al Rawajfah O, Rezaie Keikhaie K, Sheyback M. Surgical site infections in Eastern Mediterranean region: a systematic review and meta-analysis. Infect Dis (Lond) 2019; 51:719-729. [PMID: 31361182 DOI: 10.1080/23744235.2019.1642513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Surgical site infections (SSIs) are the most common and costly type of hospital-acquired infections (HAIs) worldwide. Despite individual studies, there is also no clear statistics on the SSI prevalence rate in the East Mediterranean region. The aim of this study was to investigate the prevalence of SSI in the Eastern Mediterranean region. Methods: This systematic review and meta-analysis were performed by searching three international databases (Web of Science, PubMed and Scopus) from 1 January 2001 to 31 December 2018. The keywords used included 'Prevalence' OR 'incidence' OR 'surgical site infection' OR 'wound infection' OR 'Postoperative Wound Infections' and 'Middle east'. The Hoy et al.'s tool was used to evaluate the quality of the articles. Result: Out of 889 initial studies, 40 studies from 12 countries of the Eastern Mediterranean region were included in the final stage of the study. Based on the results of random effect method, the overall prevalence of SSI in 137,452 patients was 7.9% (95% Confidence Interval (CI): 7.1, 8.8; I2=96.7%). The prevalence of SSI in cardiac surgery and general surgery wards was 10 and 9.2%, respectively. The prevalence of SSI was lower in women than in males, although this difference was related to caesarean section. Conclusions: Considering the high prevalence of SSI in the Eastern Mediterranean region, timely diagnosis, proper prevention and postoperative control are necessary in the region using the same international guides in all countries.
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Affiliation(s)
- Abdulbaset Maleknejad
- Department of General Surgery, Clinical Immunology Research Center, Ali-Ebne Abitaleb Hospital, Zahedan University of Medical Sciences , Zahedan , Iran
| | - Neda Dastyar
- Department of Midwifery, Jiroft University of Medical Sciences , Jiroft , Iran
| | - Mahin Badakhsh
- Department of Midwifery, School of Nursing and Midwifery, Zabol University of Medical Sciences , Zabol , Iran
| | - Abbas Balouchi
- Student Research Committee, Nursing and Midwifery School, Iran University of Medical Sciences , Tehran , Iran
| | - Hosein Rafiemanesh
- Department of Epidemiology, Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections. Hernia 2019; 24:839-843. [PMID: 31254134 DOI: 10.1007/s10029-019-01995-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/20/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Small steps wound closure of midline laparotomy has been reported to decrease the incidence of incisional hernia development in two randomized controlled trials. The aim of the present study was to evaluate the effect of implementing the small steps wound closure technique in clinical practice with regards to the development of incisional ventral hernia (IVH) and surgical site infections (SSI) in clinical practice. METHODS Implementation of the small steps wound closure technique using the small tissue bites technique as the standard closure technique for abdominal midline incisions in our clinical practice was done in March 2015. For this study, all patients from June 2013 until June 2016 with a midline laparotomy, either long or small in case of specimen extraction in laparoscopic surgery, in either elective or emergency setting were included. Conventional large bite wound closure was compared to small steps wound closure with regards to the development of SSI, IVH as well as burst abdomen. RESULTS A total of 327 patients were included. The small steps suture technique was used in 136 (42%) of the patients, whereas the conventional large bites suture technique was used in 191 patients (58%). A total of 54 patients in the large bites group developed SSI (28%) compared to 23 (17%) patients in the small steps group (p = 0.02). A total number of 10 patients (7%) developed IVH in the small steps group compared to 27 patients (14%) in the large bites group (p = 0.08). CONCLUSION Implementation of small bites wound closure of abdominal midline incisions in clinical practice was correlated with a reduction in surgical site infections.
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Liu Z, Efetov S, Guan X, Zhou H, Tulina I, Wang G, Tsarkov P, Wang X. A Multicenter Study Evaluating Natural Orifice Specimen Extraction Surgery for Rectal Cancer. J Surg Res 2019; 243:236-241. [PMID: 31229790 DOI: 10.1016/j.jss.2019.05.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/23/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Low anterior resections are increasingly performed laparoscopically for rectal cancer. Recently, natural orifice specimen extraction surgery (NOSES) has been reported as an alternative approach without additional incisions or extensions. In this study, we aimed to evaluate the safety and feasibility of NOSES by comparing the short-term outcomes with those of conventional laparoscopic resection (CLR) in a multicenter retrospective study from China and Russia. METHODS The retrospective multicenter study was conducted at three centers between January 2015 and December 2017. Relevant collected data included patient demographics, operative parameters, and postoperative complications. All procedures were performed using either a NOSES or a CLR approach. RESULTS The data of a total of 768 consecutive patients with rectal cancer were retrospectively analyzed, including 412 CLR and 356 NOSES cases. The two groups were comparable for all demographics and characteristics except for the median tumor size (P = 0.038). No difference was found in the operative time and number of retrieved lymph nodes. Intraoperative complications and positive resection margins were nil in both groups. No difference was found in the time to first flatus (P = 0.150), time to first defecation (P = 0.084), length of postoperative hospital stay (P = 0.152), anastomotic leakage (P = 0.377), and intra-abdominal abscess (P = NA). The CLR group but not the NOSES group had incisional hernia or wound infection events, although the difference between groups was not significant (P = 0.253). CONCLUSIONS The NOSES procedure is a well-established strategy and may be considered as an alternative procedure to CLR for rectal cancer. However, the long-term benefits of this approach require further evaluation.
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Affiliation(s)
- Zheng Liu
- Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sergey Efetov
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Inna Tulina
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Guiyu Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Petr Tsarkov
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Wang Z, Chen J, Wang P, Jie Z, Jin W, Wang G, Li J, Ren J. Surgical Site Infection After Gastrointestinal Surgery in China: A Multicenter Prospective Study. J Surg Res 2019; 240:206-218. [PMID: 30986636 DOI: 10.1016/j.jss.2019.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND There is no nationwide database of information on surgical site infection (SSI) after gastrointestinal surgery in China. This study aimed to determine the incidence of SSI after gastrointestinal surgery in China and evaluate the related risk factors. MATERIALS AND METHODS The multicenter, prospective, observational study enrolled adult patients who underwent gastrointestinal surgery from May 1, 2018 to June 30, 2018 in 30 hospitals in China. The demographic and perioperative characteristics were collected, and the primary outcome was 30-d SSI. Predictors of SSI were determined by multivariable logistic regressions. Subgroup analysis was performed to determine the predictors of SSI in different surgeries. RESULTS A total of 1290 patients were enrolled and SSI occurred in 68 patients (5.2%). Multivariate analysis with adjustments revealed that normal body mass index, normal blood glucose level, low national nosocomial infection surveillance risk index score, noncolon surgery, laparoscopic or robotic surgery, and use of mechanical bowel preparation were associated with reduced SSI in gastrointestinal surgery. Subgroup analysis revealed diverse predictors of SSI in diverse surgeries. National nosocomial infection surveillance risk index score of 2 and a high blood glucose level increased the incidence of SSI in colorectal and noncolorectal surgery, respectively. Besides, mechanical bowel preparation and laparoscopic or robotic surgery were protective factors for SSI in colorectal and noncolorectal surgery, respectively. CONCLUSIONS This study provides the newest data of SSI after gastrointestinal surgery in China and revealed some predictors of SSI in diverse surgeries, which can be a tool to look for areas to target quality improvement initiatives.
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Affiliation(s)
- Zhiwei Wang
- Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, P.R. China
| | - Jun Chen
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Peige Wang
- Department of Emergency General Surgery, The affiliated hospital of Qingdao University, Qingdao, P.R. China
| | - Zhigang Jie
- Department of General Surgery, Wuhan General Hospital of Guangzhou Military, Wuhan, P.R. China
| | - Weidong Jin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, P.R. China
| | - Gefei Wang
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Jieshou Li
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Jianan Ren
- Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, P.R. China; Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China.
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Guzman-Pruneda FA, Husain SG, Jones CD, Beal EW, Porter E, Grove M, Moffatt-Bruce S, Schmidt CR. Compliance with preoperative care measures reduces surgical site infection after colorectal operation. J Surg Oncol 2018; 119:497-502. [PMID: 30582613 DOI: 10.1002/jso.25346] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 12/07/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are a major cause of morbidity complicating colorectal operations. Several evidence-based preoperative strategies are associated with decreased SSI rates. We hypothesize that compliance with multiple strategies is associated with lower incidence of SSI after the elective colorectal operation. METHODS Preoperative care measure compliance before colorectal operations were assessed. Measures included antiseptic wash the night before and day of operation, oral antibiotic, and mechanical bowel preparation, antibiotic prophylaxis, Chloraprep skin preparation, and hair clipping. Rates of SSI after colectomy and other pertinent outcomes were stratified by full and partial compliance with preoperative measures. Exclusion criteria included bowel perforation, ischemia, complete obstruction, intra-abdominal abscess, and no intraoperative skin closure. RESULTS Eight hundred twenty-six subjects underwent colectomy between 2010 and 2016; 469 met inclusion criteria. Compliance with all measures occurred in 214 (46%) and was independently associated with lower postoperative infection rates (odds ratio [OR], 0.37; confidence interval [CI], 0.16-0.85; P = 0.02). SSI occurred in 51 (11%): was superficial in 35 (7%); deep in 5 (1%); and organ space in 11 (2%). SSI rates were reduced from 16% (partial or no compliance group) to 5% (full compliance group). No stand-alone intervention was independently associated with decreased SSI rate. Multivariate analysis found the following factors associated with a lower risk of SSI: full compliance with all five process measures, lower BMI, nonsmoker, and minimally invasive operation. DISCUSSION AND CONCLUSION Compliance with preoperative care strategies reduces rates of SSI after colectomy with a cumulative effect more pronounced than any single intervention reinforcing the need for protocol-driven and evidence-based care for patients undergoing colorectal operations.
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Affiliation(s)
- Francisco A Guzman-Pruneda
- Department of Surgery, Division of Surgical Oncology, Wexner Medical Center, James Cancer Hospital, Solove Research Institute, The Ohio State University, Columbus, Ohio
| | - Syed G Husain
- Department of Surgery, Division of Colorectal Surgery, Wexner Medical Center, James Cancer Hospital, Solove Research Institute, The Ohio State University, Columbus, Ohio
| | - Christian D Jones
- Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Eliza W Beal
- Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Erica Porter
- Department of Quality and Patient Safety, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Michele Grove
- Department of Quality and Patient Safety, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Susan Moffatt-Bruce
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Carl R Schmidt
- Department of Surgery, Division of Surgical Oncology, Wexner Medical Center, James Cancer Hospital, Solove Research Institute, The Ohio State University, Columbus, Ohio
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Timing, diagnosis, and treatment of surgical site infections after colonic surgery: prospective surveillance of 1263 patients. J Hosp Infect 2018; 100:393-399. [DOI: 10.1016/j.jhin.2018.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/19/2018] [Indexed: 01/09/2023]
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Yilmaz HO, Babazade R, Leung S, Zimmerman NM, Makarova N, Saasouh W, Stocchi L, Gorgun E, Sessler DI, Turan A. Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery. Anesth Analg 2018; 127:1129-1136. [DOI: 10.1213/ane.0000000000003666] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Shaw E, Gomila A, Piriz M, Perez R, Cuquet J, Vazquez A, Badia JM, Lérida A, Fraccalvieri D, Marron A, Freixas N, Castro A, Cruz A, Limón E, Gudiol F, Biondo S, Carratalà J, Pujol M. Multistate modelling to estimate excess length of stay and risk of death associated with organ/space infection after elective colorectal surgery. J Hosp Infect 2018; 100:400-405. [PMID: 30125586 DOI: 10.1016/j.jhin.2018.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/10/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Accounting for time-dependency and competing events are strongly recommended to estimate excess length of stay (LOS) and risk of death associated with healthcare-associated infections. AIM To assess the effect of organ/space (OS) surgical site infection (SSI) on excess LOS and in-hospital mortality in patients undergoing elective colorectal surgery (ECS). METHODS A multicentre prospective adult cohort undergoing ECS, January 2012 to December 2014, at 10 Spanish hospitals was used. SSI was considered the time-varying exposure and defined as incisional (superficial and deep) or OS. Discharge alive and death were the study endpoints. The mean excess LOS was estimated using a multistate model which provided a weighted average based on the states patients passed through. Multivariate Cox regression models were used to assess the effect of OS-SSI on risk of discharge alive or in-hospital mortality. FINDINGS Of 2778 patients, 343 (12.3%) developed SSI: 194 (7%) OS-SSI and 149 (5.3%) incisional SSI. Compared to incisional SSI or no infection, OS-SSI prolonged LOS by 4.2 days (95% confidence interval (CI): 4.1-4.3) and 9 days (8.9-9.1), respectively, reduced the risk of discharge alive (adjusted hazard ratio (aHR): 0.36 (95% CI: 0.28-0.47) and aHR: 0.17 (0.14-0.21), respectively), and increased the risk of in-hospital mortality (aHR: 8.02 (1.03-62.9) and aHR: 10.7 (3.7-30.9), respectively). CONCLUSION OS-SSI substantially extended LOS and increased risk of death in patients undergoing ECS. These results reinforce OS-SSI as the SSI with the highest health burden in ECS.
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Affiliation(s)
- E Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain.
| | - A Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain
| | - M Piriz
- VINCat Programme, Barcelona, Spain; Infection Control, Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - R Perez
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Fundació Althaia de Manresa, Barcelona, Spain
| | - J Cuquet
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital General de Granollers, Barcelona, Spain
| | - A Vazquez
- Servei d'Estadística Aplicada, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M Badia
- VINCat Programme, Barcelona, Spain; Department of General Surgery, Hospital General de Granollers, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain
| | - A Lérida
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain
| | - D Fraccalvieri
- VINCat Programme, Barcelona, Spain; Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Marron
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain
| | - N Freixas
- VINCat Programme, Barcelona, Spain; Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - A Castro
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - A Cruz
- VINCat Programme, Barcelona, Spain; Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain
| | - E Limón
- VINCat Programme, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - F Gudiol
- VINCat Programme, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - S Biondo
- VINCat Programme, Barcelona, Spain; Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain
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Impact of Preoperative Anemia on Perioperative Outcomes in Patients Undergoing Elective Colorectal Surgery. Gastroenterol Res Pract 2018; 2018:2417028. [PMID: 29853859 PMCID: PMC5964567 DOI: 10.1155/2018/2417028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/13/2017] [Indexed: 01/12/2023] Open
Abstract
Aim To evaluate the impact of preoperative anemia (POA) on perioperative outcomes in patients undergoing elective surgery for colorectal cancer (CRC). Methods A total of 326 CRC patients were enrolled. POA was defined as a hemoglobin (Hb) concentration ≤ 12 g/dl. Univariable and multivariable analyses were performed to assess the impact of POA on the risks of postoperative complications like surgical site infection (SSI). Results Patients with colon cancer presented higher rate of POA than patients with rectal cancer (60% versus 40% for colon cancer versus rectal cancer). In addition, female patients and patients with large tumor mass (>4 cm) had a higher rate of POA than male patients and patients with small tumor (≤4 cm), respectively. Upon univariable analysis, CRC patients with POA had a higher rate of incisional SSI than patients without POA (12% versus 6%, P = 0.04). However, POA was not associated with other postoperative complications, like anastomotic leak, organ space SSI, and bleeding. Upon multivariable analysis, POA and stoma formation were identified as two independent risk factors for incisional SSI (OR (95%CI): 2.44 (1.09–5.49) for POA versus no POA and 2.64 (1.20–5.81) for stoma formation versus no stoma formation). Conclusions POA was an independent risk factor for incisional surgical site infection after colorectal resection for CRC, and correcting POA should be considered before elective surgery.
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Elia-Guedea M, Cordoba-Diaz de Laspra E, Echazarreta-Gallego E, Valero-Lazaro MI, Ramirez-Rodriguez JM, Aguilella-Diago V. Colorectal surgery and surgical site infection: is a change of attitude necessary? Int J Colorectal Dis 2017; 32:967-974. [PMID: 28364211 DOI: 10.1007/s00384-017-2801-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Surgical site infection (SSI) can be as high as 30% in patients undergoing colorectal surgery and is associated with an increase in morbidity and mortality. The aim of this study is to evaluate the impact of a set of simple preventive measures that have resulted in a reduction in surgical site infection in colorectal surgery. APPLIED METHOD Prospective study with two groups of patients treated in the colorectal unit of the "Clinico Universitario Lozano Blesa" hospital in Zaragoza. One group was subject to our measures from February to May 2015. The control group was given conventional treatment within a time period of 3 months before the set of measures were implemented. RESULTS One hundred forty-nine patients underwent a major colorectal surgical procedure. Seventy (47%) belonged to the control group and were compared to the remaining 79 patients (53% of the total), who were subject to our treatment bundle in the period tested. Comparing the two groups revealed that our set of measures led to a general reduction in SSI (31.4 vs. 13.6%, p = 0.010) and in superficial site infection (17.1 vs. 2.5%, p = 0.002). As a consequence, the postoperative hospital stay was shortened (10.0 vs. 8.0 days, p = 0.048). However, it did not, the number of readmissions nor the re-operation rate. SSI was clearly related to open surgery. CONCLUSIONS The preventive set of measures applied in colorectal surgery led to a significant reduction of the SSI and of the length of hospital stay.
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Affiliation(s)
- Manuela Elia-Guedea
- Colorectal Department, University Hospital of Zaragoza, San Juan Bosco Avenue, 15, 50009, Zaragoza, Spain.,Instituto de Investigaciones Sanitarias de Aragon (IIS), Zaragoza, Spain
| | - Elena Cordoba-Diaz de Laspra
- Colorectal Department, University Hospital of Zaragoza, San Juan Bosco Avenue, 15, 50009, Zaragoza, Spain.,Instituto de Investigaciones Sanitarias de Aragon (IIS), Zaragoza, Spain
| | - Estibaliz Echazarreta-Gallego
- Colorectal Department, University Hospital of Zaragoza, San Juan Bosco Avenue, 15, 50009, Zaragoza, Spain. .,Instituto de Investigaciones Sanitarias de Aragon (IIS), Zaragoza, Spain.
| | - María Isabel Valero-Lazaro
- Colorectal Department, University Hospital of Zaragoza, San Juan Bosco Avenue, 15, 50009, Zaragoza, Spain
| | - Jose Manuel Ramirez-Rodriguez
- Colorectal Department, University Hospital of Zaragoza, San Juan Bosco Avenue, 15, 50009, Zaragoza, Spain.,Instituto de Investigaciones Sanitarias de Aragon (IIS), Zaragoza, Spain
| | - Vicente Aguilella-Diago
- Colorectal Department, University Hospital of Zaragoza, San Juan Bosco Avenue, 15, 50009, Zaragoza, Spain.,Instituto de Investigaciones Sanitarias de Aragon (IIS), Zaragoza, Spain
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Leaper D, Wilson P, Assadian O, Edmiston C, Kiernan M, Miller A, Bond-Smith G, Yap J. The role of antimicrobial sutures in preventing surgical site infection. Ann R Coll Surg Engl 2017; 99:439-443. [PMID: 28660816 PMCID: PMC5696981 DOI: 10.1308/rcsann.2017.0071] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Healthcare associated infections (HCAIs) are falling following widespread and enforced introduction of guidelines, particularly those that have addressed antibiotic resistant pathogens such as methicillin resistant Staphylococcus aureus or emergent pathogens such as Clostridium difficile, but no such decline has been seen in the incidence of surgical site infection (SSI), either in the UK, the EU or the US. SSI is one of the HCAIs, which are all avoidable complications of a surgical patient's pathway through both nosocomial and community care. METHODS This report is based on a meeting held at The Royal College of Surgeons of England on 21 July 2016. Using PubMed, members of the panel reviewed the current use of antiseptics and antimicrobial sutures in their specialties to prevent SSI. FINDINGS The group agreed that wider use of antiseptics in surgical practice may help in reducing reliance on antibiotics in infection prevention and control, especially in the perioperative period of open elective colorectal, hepatobiliary and cardiac operative procedures. The wider use of antiseptics includes preoperative showering, promotion of hand hygiene, (including the appropriate use of surgical gloves), preoperative skin preparation (including management of hair removal), antimicrobial sutures and the management of dehisced surgical wounds after infection. The meeting placed emphasis on the level I evidence that supports the use of antimicrobial sutures, particularly in surgical procedures after which the SSI rate is high (colorectal and hepatobiliary surgery) or when a SSI can be life threatening even when the rate of SSI is low (cardiac surgery).
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Affiliation(s)
- D Leaper
- University of Newcastle upon Tyne , UK
| | - P Wilson
- University College of London Hospitals NHS Foundation Trust , UK
| | | | | | | | - A Miller
- University Hospitals of Leicester NHS Trust , UK
| | | | - J Yap
- Barts Health NHS Trust , UK
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Gomila A, Carratalà J, Camprubí D, Shaw E, Badia JM, Cruz A, Aguilar F, Nicolás C, Marrón A, Mora L, Perez R, Martin L, Vázquez R, Lopez AF, Limón E, Gudiol F, Pujol M. Risk factors and outcomes of organ-space surgical site infections after elective colon and rectal surgery. Antimicrob Resist Infect Control 2017; 6:40. [PMID: 28439408 PMCID: PMC5401556 DOI: 10.1186/s13756-017-0198-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/18/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Organ-space surgical site infections (SSI) are the most serious and costly infections after colorectal surgery. Most previous studies of risk factors for SSI have analysed colon and rectal procedures together. The aim of the study was to determine whether colon and rectal procedures have different risk factors and outcomes for organ-space SSI. METHODS A multicentre observational prospective cohort study of adults undergoing elective colon and rectal procedures at 10 Spanish hospitals from 2011 to 2014. Patients were followed up until 30 days post-surgery. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Oral antibiotic prophylaxis (OAP) was considered as the administration of oral antibiotics the day before surgery combined with systemic intravenous antibiotic prophylaxis. RESULTS Of 3,701 patients, 2,518 (68%) underwent colon surgery and 1,183 (32%) rectal surgery. In colon surgery, the overall SSI rate was 16.4% and the organ-space SSI rate was 7.9%, while in rectal surgery the rates were 21.6% and 11.5% respectively (p < 0.001). Independent risk factors for organ-space SSI in colon surgery were male sex (Odds ratio -OR-: 1.57, 95% CI: 1.14-2.15) and ostomy creation (OR: 2.65, 95% CI: 1.8-3.92) while laparoscopy (OR: 0.5, 95% CI: 0.38-0.69) and OAP combined with intravenous antibiotic prophylaxis (OR: 0.7, 95% CI: 0.51-0.97) were protective factors. In rectal surgery, independent risk factors for organ-space SSI were male sex (OR: 2.11, 95% CI: 1.34-3.31) and longer surgery (OR: 1.49, 95% CI: 1.03-2.15), whereas OAP with intravenous antibiotic prophylaxis (OR: 0.49, 95% CI: 0.32-0.73) was a protective factor. Among patients with organ-space SSI, we found a significant difference in the overall 30-day mortality, being higher in colon surgery than in rectal surgery (11.5% vs 5.1%, p = 0.04). CONCLUSIONS Organ-space SSI in colon and rectal surgery has some differences in terms of incidence, risk factors and outcomes. These differences could be considered for surveillance purposes and for the implementation of preventive strategies. Administration of OAP would be an important measure to reduce the OS-SSI rate in both colon and rectal surgeries.
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Affiliation(s)
- Aina Gomila
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.,VINCat program, Catalonia, Spain
| | - Jordi Carratalà
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.,VINCat program, Catalonia, Spain.,University of Barcelona, Barcelona, Spain
| | - Daniel Camprubí
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.,VINCat program, Catalonia, Spain
| | - Evelyn Shaw
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.,VINCat program, Catalonia, Spain
| | - Josep Mª Badia
- VINCat program, Catalonia, Spain.,Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Antoni Cruz
- VINCat program, Catalonia, Spain.,Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain
| | - Francesc Aguilar
- VINCat program, Catalonia, Spain.,Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Carmen Nicolás
- VINCat program, Catalonia, Spain.,Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Anna Marrón
- VINCat program, Catalonia, Spain.,Consorci Sanitari de l'Anoia, Barcelona, Spain
| | - Laura Mora
- VINCat program, Catalonia, Spain.,Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - Rafel Perez
- VINCat program, Catalonia, Spain.,Fundació Althaia, Barcelona, Spain
| | - Lydia Martin
- VINCat program, Catalonia, Spain.,Hospital de Viladecans, Barcelona, Spain
| | - Rosa Vázquez
- VINCat program, Catalonia, Spain.,Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ana Felisa Lopez
- VINCat program, Catalonia, Spain.,Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - Enric Limón
- VINCat program, Catalonia, Spain.,University of Barcelona, Barcelona, Spain
| | - Francesc Gudiol
- VINCat program, Catalonia, Spain.,University of Barcelona, Barcelona, Spain
| | - Miquel Pujol
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.,VINCat program, Catalonia, Spain.,Infectious Diseases Department, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
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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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Gomila A, Badia JM, Carratalà J, Serra-Aracil X, Shaw E, Diaz-Brito V, Castro A, Espejo E, Nicolás C, Piriz M, Brugués M, Obradors J, Lérida A, Cuquet J, Limón E, Gudiol F, Pujol M. Current outcomes and predictors of treatment failure in patients with surgical site infection after elective colorectal surgery. A multicentre prospective cohort study. J Infect 2017; 74:555-563. [PMID: 28315721 DOI: 10.1016/j.jinf.2017.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/27/2017] [Accepted: 03/08/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine current outcomes and predictors of treatment failure among patients with surgical site infection (SSI) after colorectal surgery. METHODS A multicentre observational prospective cohort study of adults undergoing elective colorectal surgery in 10 Spanish hospitals (2011-2014). Treatment failure was defined as persistence of signs/symptoms of SSI or death at 30 days post-surgery. RESULTS Of 3701 patients, 669 (18.1%) developed SSI; 336 (9.1%) were organ-space infections. Among patients with organ-space SSI, 81.2% required source control: 60.4% reoperation and 20.8% percutaneous/transrectal drainage. Overall treatment failure rate was 21.7%: 9% in incisional SSIs and 34.2% in organ-space SSIs (p < 0.001). Median length of stay was 15 days (IQR 9-22) for incisional SSIs and 24 days (IQR 17-35) for organ-space SSIs (p < 0.001). One hundred and twenty-seven patients (19%) required readmission and 35 patients died (5.2%). Risk factors for treatment failure among patients with organ-space SSI were age ≥65 years (OR 1.83, 95% CI: 1.07-1.83), laparoscopy (OR 1.7, 95% CI: 1.06-2.77), and reoperation (OR 2.8, 95% CI: 1.7-4.6). CONCLUSIONS Rates of SSI and treatment failure in organ-space SSI after elective colorectal surgery are notably high. Careful attention should be paid to older patients with previous laparoscopy requiring reoperation for organ-space SSI, so that treatment failure can be identified early.
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Affiliation(s)
- Aina Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
| | - Josep Ma Badia
- Department of General Surgery, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain; VINCat Program, Spain.
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain; University of Barcelona, Barcelona, Spain.
| | - Xavier Serra-Aracil
- Department of Surgery and Infection Control Team, Corporació Sanitària Parc Taulí, Barcelona, Spain; VINCat Program, Spain.
| | - Evelyn Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
| | - Vicens Diaz-Brito
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain.
| | - Antoni Castro
- Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain; VINCat Program, Spain.
| | - Elena Espejo
- Department of Infectious Diseases, Consorci Sanitari de Terrassa, Barcelona, Spain; VINCat Program, Spain.
| | - Carmen Nicolás
- Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; VINCat Program, Spain.
| | - Marta Piriz
- Department of Surgery and Infection Control Team, Corporació Sanitària Parc Taulí, Barcelona, Spain; VINCat Program, Spain.
| | - Montserrat Brugués
- Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain; VINCat Program, Spain.
| | - Josefina Obradors
- Department of Internal Medicine, Fundació Althaia, Barcelona, Spain; VINCat Program, Spain.
| | - Ana Lérida
- Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain; VINCat Program, Spain.
| | - Jordi Cuquet
- Department of General Surgery, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain; VINCat Program, Spain.
| | | | - Francesc Gudiol
- VINCat Program, Spain; University of Barcelona, Barcelona, Spain.
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
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Yang W, Liu Y, Zhang Y, Zhao QH, He SF. Effect of intra-operative high inspired oxygen fraction on surgical site infection: a meta-analysis of randomized controlled trials. J Hosp Infect 2016; 93:329-38. [DOI: 10.1016/j.jhin.2016.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/03/2016] [Indexed: 02/01/2023]
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