Seasonal effect on the incidence of post-operative wound complications after trauma-related surgery of the foot, ankle and lower leg

Seasonal variation and preoperative risk factors for polymicrobial infection following open fracture

Introduction

Despite modern approaches to open fracture management, fracture-related infection (FRI) rates remain high. Recent studies demonstrated the seasonal and regional variation of causative organisms in FRI. This study aims to better understand the causative organisms and identify preoperative risk factors for the primary outcome of FRIs at a Level I trauma center.

Materials and methods

This retrospective cohort study examined all patients that underwent irrigation and debridement of an open fracture at a single Level I trauma center between 2007 and 2019. Exclusion criteria included gunshot wounds, hand injuries, and follow-up less than 3 months. Patients that developed FRI were compared by season, injury characteristics, patient demographics, initial management, and causative organisms.

Results

Among 695 patients with open fractures, 78 patients (11.2 %) developed infection, of which eight were Gustilo-Anderson (GA) Type I, 16 were GA Type II, 25 were GA Type IIIA, 26 were GA Type IIIB, and three were GA Type IIIC. Gram-positive FRIs were most common (81.1 %), followed by 56.8 % polymicrobial, 54.1 % gram-negative, and 10.1 % culture-negative infections. More than half (55.1 %) of the infections were from open tibial fractures and occurred after a motorcycle (32.1 %) or motor vehicle collision (23.1 %). Patients were more likely to have high FRI rates in the summer (12.8 %, n = 29) and fall (15.8 %, n = 32) in comparison of spring (4.7 %, n = 7) and winter (8.5 %, n = 10) (p < 0.01). Staphylococcus infections were more common in fall and winter (73.8 %, n = 31) versus spring and summer (44.4 %, n = 16) (p = 0.01). Patients that were transferred from outside hospitals had significantly higher rates of polymicrobial infection when compared to those who arrived from the field (63.6 % vs 41.2 %, p = 0.03). No differences were observed in infection causative organisms based on GA type.

Conclusions

Two preoperative risk factors for polymicrobial infection following open fracture include inter-hospital transfers and warm/humid weather. Broadening antibiotic prophylaxis during spring/summer months or for transferred patients may enhance antibiotic coverage and reduce infections.

Geographical Differences in Wound Complication Rates Following the Sinus Tarsi Approach in Displaced Intra-articular Calcaneal Fractures: A Systematic Review of the Literature

Background

The sinus tarsi approach (STA) has gained popularity for the treatment of displaced intra-articular calcaneal fractures. No large studies comparing wound complications worldwide after STA surgery are available. The aim of this systematic review was to compare postoperative wound complication (POWC) and postoperative wound infection (POWI) rates following STA surgery between continents and countries and their differences in climate.

Methods

A literature search was performed using the databases of PubMed, Embase, and the Cochrane Library. Studies published before January 1, 2000, including < 10 patients and written in a language other than English were excluded.

Results

In total, 86 studies containing 4,392 surgeries via STA from 20 different countries were included. The mean POWC was 5.9% and the mean POWI was 4.4%. The highest median POWC rate was in North America (8.5%) and the lowest in South America (2.0%). No significant differences were found in the POWC and POWI rates between countries (p = 0.178 and p = 0.570, respectively), but significant differences were found between the POWC and POWI rates between continents (p = 0.011 and p = 0.036, respectively). The number of surgeries per year and climate differences, as represented by mean local temperature, were not correlated with both the POWC/POWI rates and functional outcome scores.

Conclusions

Significant differences between the POWC and POWI rates were found between continents but not between individual countries. With a mean POWC of 5.9% and a mean POWI rate of 4.4%, STA has an intrinsic low risk for complications given the minimally invasive nature of the approach and is inevitably becoming the gold standard for calcaneal surgery.

The Association of Season of Surgery and Patient Reported Outcomes following Total Hip Arthroplasty

Background

Understanding the impact of situational variables on surgical recovery can improve outcomes in total hip arthroplasty (THA). Literature examining hospital outcomes by season remains inconclusive, with limited focus on patient experience. The aim of this study is to investigate if there are differences in hospital and patient-reported outcomes measures (PROMS) after THA depending on the season of the index procedure to improve surgeon preoperative counseling.

Methods

A retrospective chart review was performed on patients undergoing primary THA at a single large academic center between January 2013 and August 2020. Demographic, operative, hospital, and PROMs were gathered from the institutional electronic medical record and our institutional joint replacement outcomes database.

Results

6418 patients underwent primary THA and met inclusion criteria. Of this patient population, 1636 underwent surgery in winter, 1543 in spring, 1811 in summer, and 1428 in fall. PROMs were equivalent across seasons at nearly time points. The average age of patients was 65 (+/- 10) years, with an average BMI of 29.3 (+/- 6). Rates of complications including ED visits within 30 days, readmission within 90 days, unplanned readmission, dislocation, fracture, or wound infection were not significantly different by season (P > .05).

Conclusion

Our findings indicate no differences in complications and PROMs at 1 year in patients undergoing THA during 4 distinct seasons. Notably, patients had functional differences at the second follow-up visit, suggesting variation in short-term recovery. Patients could be counseled that they have similar rates of complications and postoperative recovery regardless of season.

Seasonality of mortality and in-hospital complications in hip fracture surgery: Retrospective cohort research using a nationwide inpatient database

AIM

Among older patients undergoing hip fracture surgery, previous studies have shown a seasonal variation of in-hospital surgical complications. However, little is known about seasonal effects on mortality and systemic complications after hip fracture surgery. In the present study, we evaluated whether mortality and in-hospital systemic complications are influenced by seasonal differences.

METHODS

We enrolled patients from a nationwide database who underwent hip fracture surgery between 2010 and 2018. The primary outcome was in-hospital mortality. The secondary outcomes were in-hospital systemic complications. The association between the seasonality and in-hospital outcomes was investigated using multivariable Cox, logistic regression and causal mediation analysis.

RESULTS

With 425 856 patients (mean age 83.5 years; 79% women), overall in-hospital mortality was 5324 (1.2%). Fall and winter were associated with a higher mortality than spring (hazard ratio [HR] 1.16; P < 0.001; HR 1.14; P = 0.001, respectively). Across all the seasons, there were 36 834 overall systemic complications (8.6%), with respiratory infection being the most frequent (18 637 [4.4%]). Among these complications, only respiratory infection showed seasonal variation, with a higher prevalence in fall and winter. The mediated effect of respiratory infection on mortality was significantly higher in fall and winter compared with spring (fall, HR 1.06, proportion mediated 36.7%; winter, HR 1.14, proportion mediated 55.0%; all P < 0.001).

CONCLUSIONS

We found a significantly higher mortality in fall and winter after hip fracture surgery. Specifically, in winter, the increased in-hospital death was largely attributed to the increased incidence of respiratory infection. Geriatr Gerontol Int 2021; 21: 398-403.

Complications after scrotal surgery - still a major issue?

OBJECTIVE

Gold standard treatment of symptomatic hydrocele or spermatocele is surgery. Despite a minor procedure, complications such as bleeding and infections leading to reoperations may be devastating for the patients. In autumn 2018, an accumulation of complications was seen in our department. The aim of this study was to investigate the rate and grade of complications and to identify potential means to reduce these.

MATERIALS AND METHODS

Patient records of all patients undergoing surgical repair of hydrocele or spermatocele from December 2017 to November 2018 were examined. Results were audited to identify potential causes of complications. The focus was on the perioperative hemostasis and postoperative activity restrictions. The outcome was compared to a consecutive patient series operated the following year.

RESULTS

Sixty-five men were operated on during the first period. Twenty-two patients contacted the department postoperatively due to swelling or pain, 19 patients were examined at the hospital and six patients were re-operated 1-9 times. The following year, 69 patients were operated on. Of these, 16 patients contacted the department postoperatively (p = 0.17), 13 patients were examined at the hospital, and five patients were re-operated (p = 0.68). There was the same complication rate in patients operated by specialist urologists or supervised younger doctors. However, patients preoperatively examined and informed by a specialized urologist had significantly fewer complications compared to those informed by urological residents and interns (p = 0.012).

CONCLUSION

Despite the change in patient information and increased awareness of possible complications, a high proportion of patients still were in need of unplanned contact to the department and reoperation.