Risk control of surgical site infection after cardiothoracic surgery

Valve Surgery in a Low-Volume Center in a Low- and Middle-Income Country: A Retrospective Cross-Sectional Study

Background

Valvular heart disease (VHD) has a significant prevalence and mortality rate with surgical intervention continuing to be a cornerstone of therapy. We aim to report the outcome of patients undergoing heart valve surgery (HVS) in a low-volume center (LVC) in a low- and middle-income country (LMIC).

Methods

A cross-sectional retrospective study was conducted at the Jordan University Hospital (JUH), a tertiary teaching hospital in a developing country, between April 2014 and December 2019. Patients who underwent mitral valve replacement (MVR), aortic valve replacement (AVR), tricuspid valve replacement (TVR), double valve replacement (DVR), CABG + MVR, and CABG + AVR patients were included. Thirty-day and two-year mortalities were taken as the primary and secondary outcomes, respectively.

Results

A total number of 122 patients were included, and the mean age was 54.46 ± 14.89 years. AVR was most common (42.6%). There was no significant association between STS mortality score or Euroscore II with 30-day and 2-year mortality.

Conclusion

LVC will continue to have a role in LMICs, especially during development to HICs. Further global studies are needed to assert the safety of HVS in LVC and LMICs.

Impact of Intraoperative Continuous-Infusion Versus Intermittent Dosing of Cefazolin Therapy on the Incidence of Surgical Site Infections After Coronary Artery Bypass Grafting

STUDY OBJECTIVES

To determine whether intraoperative continuous-infusion (CI) cefazolin reduces the incidence of surgical site infections (SSIs) compared with intermittent (INT) cefazolin dosing in patients undergoing coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB); safety end points and protocol adherence comparing the two dosing strategies were also explored.

DESIGN

Retrospective quasi-experimental (pre-post intervention) cohort study.

SETTING

Large academic medical center.

PATIENTS

A total of 516 adults who underwent CABG on CPB and received cefazolin intraoperatively between June 1, 2013, and December 31, 2014, were included. The INT cohort included 284 patients who underwent CABG from June 2013 to February 2014. The CI cohort included 232 patients who underwent CABG from April to December 2014, after an intraoperative CI cefazolin protocol for cardiac surgery patients undergoing CPB was adopted in March 2014.

MEASUREMENTS AND MAIN RESULTS

The primary end point was incidence of SSIs, and safety end points of renal dysfunction and seizures were evaluated. Multivariable logistic regression analysis was used to determine the impact on SSIs when controlling for other risk factors. A subgroup analysis for this study included 2 months within each time period to evaluate protocol adherence. The overall incidence of SSIs was decreased in patients receiving CI cefazolin, although this did not reach statistical significance (4.6% in the INT cohort vs 1.7% in the CI cohort, p=0.116). Superficial SSIs were significantly reduced in the CI cohort (2.8% in the INT cohort vs 0.4% in the CI cohort, p=0.039). In the regression analysis, CI cefazolin decreased the odds of SSI by 66%, although it did not reach statistical significance (p=0.077). Safety end points were not significantly different between groups. Overall protocol adherence did not differ significantly between the cohorts: 77% in the INT cohort and 67% in the CI cohort (p=0.212).

CONCLUSION

CI cefazolin significantly decreased the incidence of superficial SSIs compared with INT cefazolin in patients undergoing CABG on CPB, without increasing the risk for adverse effects. As this study was underpowered to detect a significant difference in overall SSIs, larger, randomized studies are required to validate the superiority of CI cefazolin.

[Hospital infections at the Department of Cardiovascular Surgery]

INTRODUCTION

Despite modern surgical techniques, preoperative preventive use of antibiotics and optimal treatment of operative site, patients who underwent surgical procedures are still at a risk of developing hospital infections. The aim of this paper was to estimate the frequency of hospital infections at the Department of Cardiovascular Surgery and their presence according to the anatomic localization as well as to identify the most frequent causes of hospital infections.

MATERIAL AND METHODS

During one-year period, all surgically treated patients were prospectively followed at the Department of Cardiovascular Surgery of the Institute of Cardiovascular Diseases, Vojvodina. There were 1302 patients who underwent 1396 surgical procedures during the period observed The descriptive epidemiological method was applied in the study. The following odds ratio and rates were calculated: the incidence rate of patients with hospital infections, the incidence rate of hospital infections and the incidence rate in relation to hospital stay of each patient (incidence density).

RESULTS

During that period, 36 hospital infections were recorded in 33 patients. The average incidence rate of patients with hospital infection was 2.53% and hospital infection rate was 2.58% (from 0% to 5.13%). The male-female ratio was 3.1:1. The most frequent hospital infections were surgical site infections (incidence rate 0.86%), then gastroenteritis (incidence rate 0.77%) and bloodstream infections (incidence rate 0.46%). The most common causes of hospital infections were: Staphylococcus aureus (14.8%), Acinetobacter spp (22.2%) and coagulase negative staphylococcus (11.1%).

CONCLUSION

The fact is that the incidence rate of hospital infections is relatively low, and such a trend can continue only if the continuous epidemiological control and preventive measures are implemented in the future.

Octyl-2-cyanoacrylate adhesive for skin closure and prevention of infection in plastic surgery

No complete scientific study has yet investigated the incidence of surgical-site infections in plastic surgery operations. However, it has been noted that in the case of wound infection, the aesthetic and sometimes the functional results become invalidated by delay and an alteration of the healing processes, thus necessitating surgical correction. This study aimed to evaluate the effectiveness of applying tissue adhesive on surgical wounds in plastic surgery as a protection capable of reducing the onset of infection, and to verify the existence of a statistically significant difference between treated and untreated wounds, and to determine patients' satisfaction with their cicatricial results.