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Jahangir F, Haghdoost A, Moameri H, Okhovati M. Incidence and Risk Factors of Surgical Site Infection in Abdominal Surgeries: A Scoping Review of Cohort and Case-Control Studies. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:402-412. [PMID: 39114633 PMCID: PMC11300942 DOI: 10.30476/ijms.2024.100819.3338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 08/10/2024]
Abstract
Background Abdominal surgery is considered a high-risk procedure for the development of surgical site infection (SSI). Few studies have evaluated the relative importance of surgical site infection risk factors in terms of consistency in abdominal surgery. Therefore, this comprehensive review article mapped and summarized the evidence aimed to determine the relative importance of the risk factors and incidence of SSIs in abdominal surgery. Methods A literature review was conducted using electronic databases and search engines such as Scopus, PubMed, and Web of Science up to March 16, 2023. There was no language restriction for the papers to be included in the study. The relative consistency of the risk factors was measured and evaluated using the methodology of the Joanna Briggs Institute. Original peer-reviewed cohort and case-control studies were included if all types of SSIs were included. Meta-analysis was performed to determine the pooled estimates of SSI incidences. Results Of 14,237 identified records, 107 articles were included in the review. The pooled incidence of SSI was 10.6% (95% CI: 9.02-12.55%, χ2=12986.44, P<0.001). Operative time and higher wound class were both significant consistent risk factors for SSI incidence. Patients' educational status, malnutrition, functional status, and history of neurological/psychiatric disorders were all candidates for consistent risk factors, with insufficient evidence. Conclusion The findings of the present study indicated that SSI in abdominal surgery was a multifactorial phenomenon with a considerable risk and had different risk factors with various relative importance. Determining the relative importance of the risk factors for the prevention and control of SSI is strongly recommended.This manuscript has been released as a preprint at the research square: (https://doi.org/10.21203/rs.3.rs-3219597/v1).
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Affiliation(s)
- Fereidoun Jahangir
- Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Nursing, Hazrat Zahra (P.B.U.H) Abadeh School of Nursing, Shiraz University of Medical Sciences, Shiraz, Iran
| | - AliAkbar Haghdoost
- Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hossein Moameri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Okhovati
- Department of Health Management, Policy and Economics, School of Medical Management and Information, Kerman University of Medical Sciences, Kerman, Iran
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Adapa AR, Linzey JR, Moriguchi F, Daou BJ, Khalsa SSS, Ponnaluri-Wears S, Thompson BG, Park P, Pandey AS. Risk factors and morbidity associated with surgical site infection subtypes following adult neurosurgical procedures. Br J Neurosurg 2024; 38:503-509. [PMID: 33779461 DOI: 10.1080/02688697.2021.1905773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Studies on surgical site infection (SSI) in adult neurosurgery have presented all subtypes of SSIs as the general 'SSI'. Given that SSIs constitute a broad range of infections, we hypothesized that clinical outcomes and management vary based on SSI subtype. METHODS A retrospective analysis of all neurosurgical SSI from 2012-2019 was conducted at a tertiary care institution. SSI subtypes were categorized as deep and superficial incisional SSI, brain, dural or spinal abscesses, meningitis or ventriculitis, and osteomyelitis. RESULTS 9620 craniotomy, shunt, and fusion procedures were studied. 147 procedures (1.5%) resulted in postoperative SSI. 87 (59.2%) of these were associated with craniotomy, 36 (24.5%) with spinal fusion, and 24 (16.3%) with ventricular shunting. Compared with superficial incisional primary SSI, rates of reoperation to treat SSI were highest for deep incisional primary SSI (91.2% vs 38.9% for superficial, p < 0.001) and second-highest for intracranial SSI (90.9% vs 38.9%, p = 0.0001). Postoperative meningitis was associated with the highest mortality rate (14.9%). Compared with superficial incisional SSI, the rate of readmission for intracranial SSI was highest (57.6% vs 16.7%, p = 0.022). CONCLUSION Deep incisional and organ space SSI demonstrate a greater association with morbidity relative to superficial incisional SSI. Future studies should assess subtypes of SSI given these differences.
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Affiliation(s)
- Arjun R Adapa
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Joseph R Linzey
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Badih J Daou
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | | | | | - Paul Park
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
- Department of Orthopedic Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Aditya S Pandey
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
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Zaboli Mahdiabadi M, Farhadi B, Shahroudi P, Mohammadi M, Omrani A, Mohammadi M, Hekmati Pour N, Hojjati H, Najafi M, Majd Teimoori Z, Farzan R, Salehi R. Prevalence of surgical site infection and risk factors in patients after knee surgery: A systematic review and meta-analysis. Int Wound J 2024; 21:e14765. [PMID: 38351472 PMCID: PMC10864688 DOI: 10.1111/iwj.14765] [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: 01/09/2024] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/16/2024] Open
Abstract
The present systematic review and meta-analysis aimed to determine the prevalence of surgical site infection (SSI) and risk factors in patients after knee surgery. A comprehensive and systematic search was carried out across various international electronic databases, including Scopus, PubMed and Web of Science, as well as Persian electronic databases like Iranmedex and the Scientific Information Database (SID). This search involved the utilization of keywords derived from Medical Subject Headings, such as 'Prevalence', 'Surgical wound infection', 'Surgical site infection' and 'Orthopaedics', spanning from the earliest records up to 1 October 2023. To assess the quality of the included studies, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was utilized. The study encompassed a combined participant pool of 11 028 individuals who underwent knee surgery across seven selected studies. The collective prevalence of SSI in patients who underwent knee surgery, as reported in the seven included studies, was determined to be 3.0% (95% CI: 1.2% to 7.5%; I2 = 96.612%; p < 0.001). The combined prevalence of SSI in patients with DM, as reported in six studies, was 5.1% (95% CI: 1.7% to 14.5%; I2 = 79.054%; p < 0.001). Similarly, the pooled prevalence of SSI in patients with HTN, drawn from four studies, was 1.8% (95% CI: 0.7% to 4.5%; I2 = 63.996%; p = 0.040). Additionally, the collective prevalence of SSI in patients with a history of tobacco use, based on findings from six studies, was 4.8% (95% CI: 1.4% to 15.2%; I2 = 93.358%; p < 0.001). Subgroup analysis was conducted within six studies, categorizing them by two countries, namely China and the USA. These analyses revealed that the prevalence of SSI following knee surgery was 3.0% in China and 2.0% in the USA. It is noteworthy that variations in SSI prevalence across different studies may be attributed to a multitude of factors, particularly varying risk factors among patient populations. To address this issue and mitigate the impact of SSI on knee surgery patients, it is advisable to develop tailored interventions.
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Affiliation(s)
| | - Bahar Farhadi
- School of MedicineIslamic Azad University, Mashhad BranchMashhadIran
| | - Parinaz Shahroudi
- Department of Surgical TechnologyGuilan University of Medical SciencesRashtIran
| | - Mohsen Mohammadi
- Department of Medical Surgical NursingGuilan University of Medical SciencesRashtIran
| | - Amin Omrani
- Department of Physical Therapy, School of MedicineTehran University of Medical SciencesTehranIran
| | - Maryam Mohammadi
- Department of Physical Therapy, School of MedicineUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | - Nafiseh Hekmati Pour
- Department of NursingAliabad Katoul Branch, Islamic Azad UniversityAliabad KatoulIran
| | - Hamid Hojjati
- Nursing Research Center, Golestan University of Medical SciencesGorganIran
| | - Masoomeh Najafi
- Student Research Committee, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Zahra Majd Teimoori
- Shahid Beheshti School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Reza Salehi
- Department of Anesthesiology, School of MedicineIran University of Medical SciencesTehranIran
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Jin JY, Yu M, Xu RF, Sun Y, Li BH, Zhou FF. Risk Factors for Cerebrospinal Fluid Leakage After Extradural Spine Surgery: A Meta-Analysis and Systematic Review. World Neurosurg 2023; 179:e269-e280. [PMID: 37625633 DOI: 10.1016/j.wneu.2023.08.075] [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: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage is 1 of the common complications of spine surgery and is largely caused by intraoperative or postoperative dural tears. Associations of different factors with postoperative CSF leakage have not been consistent. In this study we aimed to identify demographic, disease-related, and surgical risk factors for CSF leakage after extradural spine surgery in a systematic review and meta-anlysis. METHODS The PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Wanfang data, Chinese Weipu Database, and SinoMed databases were searched from inception until October 24, 2022. Fixed-effects or random-effects models were used to calculate odds ratios and 95% confidence intervals. The quality of observational studies was evaluated using the Newcastle-Ottawa scale instrument. RESULTS A total of 15 observational studies with 1,719,923 participants were included in this systematic review. All studies had a Newcastle-Ottawa scale score greater than or equal to 6. Age older than 70 years, smoking, ossification of the posterior longitudinal ligament, adhesion of spinal dura, spinal canal stenosis, cervical fracture, spondylolisthesis, revision surgery, and multiple surgical segments were all related to CSF leakage in the pooled analysis. Obesity and disease duration>1 year were not associated with the leakage of CSF. CONCLUSIONS This study will provide a reference for the identification of patients at high risk of developing CSF leakage, which suggests clinicians to strengthen the observation of drainage fluid in high-risk groups.
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Affiliation(s)
- Ji-Yan Jin
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China
| | - Miao Yu
- Department of Nursing, Peking University Third Hospital, Beijing, PR China
| | - Rui-Feng Xu
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China
| | - Yu Sun
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China
| | - Bao-Hua Li
- Department of Neurology, Peking University Third Hospital, Beijing, PR China
| | - Fei-Fei Zhou
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China.
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White CA, Dominy CL, Tang JE, Pitaro NL, Patel AV, Wang KC, Kim JS, Cho SK, Cagle PJ. Impact of tobacco usage on readmission and complication rates following shoulder replacement surgery: A study of 164,527 patients. Shoulder Elbow 2023; 15:71-79. [PMID: 37692876 PMCID: PMC10492530 DOI: 10.1177/17585732221102393] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 09/12/2023]
Abstract
Background Tobacco carcinogens have adverse effects on bone health and are associated with inferior outcomes following orthopedic procedures. The purpose of this study was to assess the impact tobacco use has on readmission and complication rates following shoulder arthroplasty. Methods The 2016-2018 National Readmissions Database was queried to identify patients who underwent anatomical, reverse, and hemi-shoulder arthroplasty. ICD-10 codes Z72.0 × (tobacco use disorder) and F17.2 × (nicotine dependence) were used to define "tobacco-users." Demographic, 30-/90-day readmission, surgical complication, and medical complication data were collected. Inferential statistics were used to analyze complications for both the cohort as a whole and for each procedure separately (i.e. anatomical, reverse, and hemiarthroplasty). Results 164,527 patients were identified (92% nontobacco users). Tobacco users necessitated replacement seven years sooner than nonusers (p < 0.01) and were more likely to be male (52% vs. 43%; p < 0.01). Univariate analysis showed that tobacco users had higher rates of readmission, revisions, shoulder complications, and medical complications overall. In the multivariate analysis for the entire cohort, readmission, revision, and complication rates did not differ based on tobacco usage; however, smokers who underwent reverse shoulder arthroplasty in particular were found to have higher 90-day readmission, dislocation, and prosthetic complication rates compared to nonsmokers. Conclusion Comparatively, tobacco users required surgical correction earlier in life and had higher rates of readmission, revision, and complications in the short term following their shoulder replacement. However, when controlling for tobacco usage as an independent predictor of adverse outcomes, these aforementioned findings were lost for the cohort as a whole. Overall, these findings indicate that shoulder replacement in general is a viable treatment option regardless of patient tobacco usage at short-term follow-up, but this conclusion may vary depending on the replacement type used.
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Affiliation(s)
- Christopher A White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Calista L Dominy
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Justin E Tang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Nicholas L Pitaro
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Akshar V Patel
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Kevin C Wang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jun S Kim
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Samuel K Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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6
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Dastagirzada Y, Benjamin C, Bevilacqua J, Gurewitz J, Sen C, Golfinos JG, Placantonakis D, Jafar JJ, Lieberman S, Lebowitz R, Lewis A, Pacione D. Discontinuation of Postoperative Prophylactic Antibiotics for Endoscopic Endonasal Skull Base Surgery. J Neurol Surg B Skull Base 2023; 84:157-163. [PMID: 36895810 PMCID: PMC9991524 DOI: 10.1055/a-1771-0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022] Open
Abstract
Background Postoperative prophylactic antibiotic usage for endoscopic skull base surgery varies based on the institution as evidence-based guidelines are lacking. The purpose of this study is to determine whether discontinuing postoperative prophylactic antibiotics in endoscopic endonasal cases led to a difference in central nervous system (CNS) infections, multi-drug resistant organism (MDRO) infections, or other postoperative infections. Methods This quality improvement study compared outcomes between a retrospective cohort (from September 2013 to March 2019) and a prospective cohort (April 2019 to June 2019) after adopting a protocol to discontinue prophylactic postoperative antibiotics in patients who underwent endoscopic endonasal approaches (EEAs). Our primary end points of the study included the presence of postoperative CNS infection, Clostridium difficile ( C. diff ), and MDRO infections. Results A total of 388 patients were analyzed, 313 in the pre-protocol group and 75 in the post-protocol group. There were similar rates of intraoperative cerebrospinal fluid leak (56.9 vs. 61.3%, p = 0.946). There was a statistically significant decrease in the proportion of patients receiving IV antibiotics during their postoperative course ( p = 0.001) and those discharged on antibiotics ( p = 0.001). There was no significant increase in the rate of CNS infections in the post-protocol group despite the discontinuation of postoperative antibiotics (3.5 vs. 2.7%, p = 0.714). There was no statistically significant difference in postoperative C. diff (0 vs. 0%, p = 0.488) or development of MDRO infections (0.3 vs 0%, p = 0.624). Conclusion Discontinuation of postoperative antibiotics after EEA at our institution did not change the frequency of CNS infections. It appears that discontinuation of antibiotics after EEA is safe.
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Affiliation(s)
- Yosef Dastagirzada
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Carolina Benjamin
- Department of Neurosurgery, University of Miami, Miami, Florida, United States
| | - Julia Bevilacqua
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Jason Gurewitz
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | | | - Jafar J Jafar
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Seth Lieberman
- Department of Otolaryngology, NYU Langone Health, New York, New York, United States
| | - Rich Lebowitz
- Department of Otolaryngology, NYU Langone Health, New York, New York, United States
| | - Ariane Lewis
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States.,Department of Neurology, NYU Langone Health, New York, New York, United States
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
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7
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Geere JH, Swamy GN, Hunter PR, Geere JAL, Lutchman LN, Cook AJ, Rai AS. Incidence and risk factors for five-year recurrent disc herniation after primary single-level lumbar discectomy. Bone Joint J 2023; 105-B:315-322. [PMID: 36854329 DOI: 10.1302/0301-620x.105b3.bjj-2022-1005.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation. A retrospective study was conducted using prospectively collected data and patient-reported outcome measures, including the Oswestry Disability Index (ODI), between 2008 and 2019. Postoperative sRDH was identified from clinical notes and the centre's MRI database, with all imaging providers in the region checked for missing events. The Kaplan-Meier method was used to calculate five-year sRDH incidence. Cox proportional hazards model was used to identify independent variables predictive of sRDH, with any variable not significant at the p < 0.1 level removed. Hazard ratios (HRs) were calculated with 95% confidence intervals (CIs). Complete baseline data capture was available for 733 of 754 (97.2%) consecutive patients. Median follow-up time for censored patients was 2.2 years (interquartile range (IQR) 1.0 to 5.0). sRDH occurred in 63 patients at a median 0.8 years (IQR 0.5 to 1.7) after surgery. The five-year Kaplan-Meier estimate for sRDH was 12.1% (95% CI 9.5 to 15.4), sRDH reoperation was 7.5% (95% CI 5.5 to 10.2), and any-procedure reoperation was 14.1% (95% CI 11.1 to 17.5). Current smoker (HR 2.12 (95% CI 1.26 to 3.56)) and higher preoperative ODI (HR 1.02 (95% CI 1.00 to 1.03)) were independent risk factors associated with sRDH. Current smoker (HR 2.15 (95% CI 1.12 to 4.09)) was an independent risk factor for sRDH reoperation. This is one of the largest series to date which has identified current smoker and higher preoperative disability as independent risk factors for sRDH. Current smoker was an independent risk factor for sRDH reoperation. These findings are important for spinal surgeons and rehabilitation specialists in risk assessment, consenting patients, and perioperative management.
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Affiliation(s)
| | | | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jo-Anne L Geere
- School of Health Sciences, University of East Anglia, Norwich, UK
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White CA, Patel AV, Wang KC, Cirino CM, Parsons BO, Flatow EL, Cagle PJ. The impact of tobacco use on clinical outcomes and long-term survivorship after anatomic total shoulder arthroplasty. J Orthop 2023; 36:99-105. [PMID: 36659901 PMCID: PMC9842961 DOI: 10.1016/j.jor.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/13/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Introduction Postoperative outcomes following total shoulder arthroplasty can be affected by preoperative health factors such as tobacco usage. Methods The charts of patients who underwent anatomic total shoulder arthroplasty were retrospectively analyzed and stratified based on smoking status. The primary data included range of motion and patient reported outcomes. Additionally, demographic, radiographic, and survivorship analyses were conducted. All data were analyzed using statistical inference. Results There were 78, 49, and 16 non-smoker, former smoker, and current smoker shoulders respectively with no significant differences in sex, American Society of Anesthesiologists status, body mass index, or mean follow-up time (average: 10.7 yrs). Smokers (51.5 ± 10.4 years) were younger than both non-smokers (64.9 ± 8.1 years; p < 0.01) and former smokers (65.1 ± 9.1years; p < 0.01) at the time of surgery. For non-smokers and former smokers, all range of motion and patient reported outcome scores significantly improved. Smokers reported significant improvements in all patient reported outcomes and external and internal rotation. Visual Analog Scale, American Shoulder and Elbow, and Simple Shoulder Test scores were lower for smokers comparatively, but these differences did not reach significance. Forward elevation was higher postoperatively for non-smokers (149.7o ± 17.2o) and former smokers (147.1o ± 26.0o) compared to current smokers (130.9o ± 41.2o; p = 0.017). No differences between the cohorts were found in the radiographic analysis. Revision rates were lower in the non-smoking cohort (7.7%) compared to both former (20.4%; p = 0.036) and current smokers (37.5%; p < 0.01). Survival curves showed that non-smoker implants lasted longer than those of current smokers. Conclusion After a decade, patients generally had improved shoulder range of motion, functionality, and pain regardless of smoking status. However, current smokers required shoulder replacements sooner and revision surgery more frequently.
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Affiliation(s)
- Christopher A. White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Akshar V. Patel
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Kevin C. Wang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Carl M. Cirino
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Bradford O. Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Evan L. Flatow
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Paul J. Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
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Chen KJ, Huang YC, Yao YC, Yang TC, Lin HH, Wang ST, Chang MC, Chou PH. Investigation of preoperative asymptomatic bacteriuria as a risk factor for postvertebroplasty infection. J Chin Med Assoc 2023; 86:233-239. [PMID: 36652570 DOI: 10.1097/jcma.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Postvertebroplasty infection (PVI) is a catastrophic complication after vertebroplasty (VP). Although the urinary tract has been considered as a source of infectious pathogens, whether asymptomatic bacteriuria (ASB) is a risk factors for PVI remains unknown. METHODS This retrospective study included 716 patients (207 males; 509 females) treated with VP for osteoporotic vertebral fractures in a single medical center between May 2015 and December 2019. Clinical symptoms, urinalysis results, and culture data were collected preoperatively to identify patients with ASB. The primary outcome was PVI at the index level during follow-up. Demographic data and laboratory test results were compared between the PVI and non-PVI groups. RESULTS The mean age of the cohort was 78.6 ± 9.6 (range, 63-106). The prevalence of ASB was 14.1%, with female predominance (63.4%). The overall PVI rate was 1.26% (9/716). The PVI group had more patients with ASB (4/9, 44.4%) than did the non-PVI group (97/707, 13.7%) (p = 0.027). The rate of ASB treatment was similar between the PVI and non-PVI groups (25% vs. 23.7%, respectively). No case of PVI was caused by the urine culture pathogen. Multivariate analysis identified the following risk factors for PVI: ASB (odds ratio [OR], 5.61; 95% CI, 1.14-27.66; p = 0.034), smoking (OR, 16.26; 95% CI, 2.58-102.65; p = 0.003), and malignancy (OR 7.27; 95% CI, 1.31-40.31; p = 0.023). CONCLUSION ASB was not uncommon among patients admitted for VP and should be considered a marker of relatively poor host immunity. Preoperative ASB, a history of malignancy, and smoking were identified as significant risk factors for PVI.
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Affiliation(s)
- Kuan-Jung Chen
- Department of Orthopedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yen-Chun Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Cheng Yao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Cheng Yang
- Department of Orthopedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsi-Hsien Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Tien Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chau Chang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Po-Hsin Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Tfaily MA, Ghanem P, Farran SH, Dabdoub F, Kanafani ZA. The role of preoperative albumin and white blood cell count in surgical site infections following whipple surgery. Sci Rep 2022; 12:19184. [PMID: 36357432 PMCID: PMC9649662 DOI: 10.1038/s41598-022-21849-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
Whipple surgery is associated with a high risk of surgical sites infections (SSIs). Nutritional deficiency has been associated with an increased risk of wound infections. This study aims at exploring the role of preoperative albumin levels in predicting the risk of SSIs following Whipple surgery. A total of 23,808 individuals were identified from the ACS-NSQIP database from years 2011 to 2017. The primary exposure was pre-operative albumin while the secondary exposure was white blood cell (WBC) count. The primary outcome was divided into superficial and deep surgical site infections (S/D SSI) and organ-space SSI. All statistical analyses were conducted using IBM Statistical Package for Social Sciences version 26. Levels of pre-operative serum albumin less than 3.73 g/L, dirty and contaminated wounds and longer operative time were associated with increased odds for developing S/D SSIs (OR = 1.14, OR = 1.17, OR = 1.06, respectively, p-value < 0.05). Pre-operative WBC level (/L) was associated with a risk of developing an organ-space SSI but not S/D SSI (OR = 1.02, p-value 0.003). This study demonstrates the predictive role of pre-operative albumin in developing S/D SSIs and highlights the need to develop therapeutic strategies to optimize the pre-operative nutritional health status of patients undergoing Whipple surgery.
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Affiliation(s)
- Mohamad Ali Tfaily
- grid.189967.80000 0001 0941 6502Department of Internal Medicine, Emory University, Atlanta, GA USA ,grid.411654.30000 0004 0581 3406Department of Internal Medicine, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon
| | - Paola Ghanem
- grid.21107.350000 0001 2171 9311Department of Medical Oncology, Johns Hopkins University, Baltimore, MD USA
| | - Sarah H. Farran
- grid.22903.3a0000 0004 1936 9801Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - Fatema Dabdoub
- grid.411654.30000 0004 0581 3406Department of Internal Medicine, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon
| | - Zeina A. Kanafani
- grid.411654.30000 0004 0581 3406Department of Internal Medicine, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon
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Oberhuber-Kurth LM, Angeli R, Lippmann N, Notov D, Osterhoff G, Frank K, Langer S, Kohler L. Pathogens and Shift of Resistance in Early Infections after Operative Fracture Fixation. Surg Infect (Larchmt) 2022; 23:583-589. [PMID: 35917386 DOI: 10.1089/sur.2022.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Surgical site infections (SSIs) remain a challenge for the healthcare system. During the last 30 years, the literature has shown an increase of gram-negative bacterial strains in multiple infectious sites and that cephalosporins have replaced penicillin as the gold standard in peri-operative antibiotic prophylaxis. This study aims to examine the recent bacterial spectrum in orthopedic early SSIs and to compare it with a historical cohort. Patients and Methods: Patients in a level 1 trauma center with an SSI within six weeks after open fixation of a fracture were analyzed in two adjacent periods from 2007 to 2012 (data pool 1; DP1) and 2013 to 2017 (data pool 2; DP2), retrospectively. The detected microbiologic pathogens and the associated resistograms from both time periods were compared. Results: Six hundred eighty-one smear tests and respective pathogens from the wounds of 463 patients (mean age, 62.6 ± 20 years) with SSIs were analyzed. The following pathogens were found most frequent: Staphylococcus epidermidis (DP1, 20.6%; DP2, 26.3%), Staphylococcus aureus (DP1, 27.1%; DP2, 16.5%), Enterococcus faecalis (DP1, 13.7%; DP2, 11.1%), Bacillus sp. (DP1, 3.0%; DP2, 5.3%), Escherichia coli (DP1, 5.1%; DP2, 4.1%), Pseudomonas aeruginosa (DP1, 3.7%; DP2, 2.5%). In DP2, there were lower primary early infection rates with Staphylococcus aureus than in DP1 (p = 0.002). In DP2, Staphylococcus epidermidis showed an oxacillin resistance in 90.6% and an increased resistance (79.8%; p = 0.069) to several classes of antibiotic agents compared to DP1. Conclusions: No bacterial shift toward gram-negative species was observed in this investigation. However, Staphylococcus epidermidis showed an increased antibiotic resistance in the more recent patient cohort. The incidence of SSIs with Staphylococcus aureus decreased substantially.
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Affiliation(s)
| | - Rico Angeli
- Department of Anaesthesiology and Critical Care Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Dmitry Notov
- Department of Orthopaedics, Trauma, and Plastic Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma, and Plastic Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Konstantin Frank
- Division of Hand, Plastic, and Aesthetic Surgery, Munich University Hospital, LMU, Munich, Germany
| | - Stefan Langer
- Department of Orthopaedics, Trauma, and Plastic Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Lukas Kohler
- Division of Hand, Plastic, and Aesthetic Surgery, Munich University Hospital, LMU, Munich, Germany
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12
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Connor M, Briggs RG, Bonney PA, Lamorie-Foote K, Shkirkova K, Min E, Ding L, Mack WJ, Attenello FJ, Liu JC. Tobacco Use Is Associated With Increased 90-Day Readmission Among Patients Undergoing Surgery for Degenerative Spine Disease. Global Spine J 2022; 12:787-794. [PMID: 33030060 PMCID: PMC9344509 DOI: 10.1177/2192568220964032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
STUDY DESIGN Retrospective database study. OBJECTIVE Tobacco use is associated with complications after surgical procedures, including poor wound healing, surgical site infections, and cardiovascular events. We used the Nationwide Readmissions Database (NRD) to determine if tobacco use is associated with increased 30- and 90-day readmission among patients undergoing surgery for degenerative spine disorders. METHODS Patients who underwent elective spine surgery were identified in the NRD from 2010 to 2014. The study population included patients with degenerative spine disorders treated with discectomy, fusion, or decompression. Descriptive and multivariate logistic regression analyses were performed to identify patient and hospital factors associated with 30- and 90-day readmission, with significance set at P value <.001. RESULTS Within 30 days, 4.8% of patients were readmitted at a median time of 9 days. The most common reasons for 30-day readmission were postoperative infection (12.5%), septicemia (3.5%), and postoperative pain (3.0%). Within 90 days, 7.3% were readmitted at a median time of 18 days. The most common reasons for 90-day readmission were postoperative infection (9.6%), septicemia (3.5%), and pneumonia (2.3%). After adjustment for patient and hospital characteristics, tobacco use was independently associated with readmission at 90 days (odds ratio 1.05, 95% confidence interval 1.03-1.07, P < .0001) but not 30 days (odds ratio 1.02, 95% confidence interval 1.00-1.05, P = .045). CONCLUSIONS Tobacco use is associated with readmission within 90 days after cervical and thoracolumbar spine surgery for degenerative disease. Tobacco use is a known risk factor for adverse health events and therefore should be considered when selecting patients for spine surgery.
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Affiliation(s)
| | | | | | | | | | - Elliot Min
- University of Southern
California, Los Angeles, CA, USA
| | - Li Ding
- University of Southern
California, Los Angeles, CA, USA
| | | | | | - John C. Liu
- University of Southern
California, Los Angeles, CA, USA
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Halvachizadeh S, Klingebiel FKL, Pfeifer R, Gosteli M, Schuerle S, Cinelli P, Zelle BA, Pape HC. The local soft tissue status and the prediction of local complications following fractures of the ankle region. Injury 2022; 53:1789-1795. [PMID: 35382943 DOI: 10.1016/j.injury.2022.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Well-known risk factors (RF) for soft tissue complications following surgical treatment of fracture of the ankle region include diabetes, smoking, and the local soft tissue status. A weighted analysis might provide a risk profile that guides the surgical treatment strategy. The aim of this meta-analysis was to provide a risk profile for soft tissue complications following closed fractures of the ankle region. METHODS This review provides a meta-analysis of studies that investigate potential risk factors for complications in fractures of the ankle region. INCLUSION CRITERIA Original articles that were published between 2000 and 2020 in English or German language that calculated odds ratios (OR) of RF for soft tissue complications. Further, this study only includes articles that investigated fractures of the ankle region including pilon fracture, calcaneal fractures, and fractures of the malleoli. This study excluded articles that provide exploratory analyses, narrative reviews, and case reports. RF were stratified as patient specific systemic RF (PSS), patient specific local RF (PSL), and non-patient specific RF (NPS). PSS RF includes comorbidities, American society of anaesthesiology (ASA), requirement of medication, additional injuries, and smoking or substance abuse. PSL RF includes soft tissue status, wounds, and associated complications. NPS RF includes duration of surgery, staged procedure, or time to definitive surgery. Random effect (RE) models were utilized to summarize the effect measure (OR) for each group or specific RF. RESULTS Out of 1352 unique articles, 34 were included for quantitative analyses. Out of 370 complications, the most commonly assessed RF were comorbidities (34.6%). Local soft tissue status accounted for 7.5% of all complications. The overall rate for complication was 10.9% (standard deviation, SD 8.7%). PSS RF had an OR of 1.04 (95%CI 1.01 to 1.06, p = 0.006), PSL an OR of 1.79 (95% 1.28 to 2.49, p = 0.0006), and NPS RF an OR of 1.01 (95%CI 0.97 to 1.05, p = 0.595). Additional injuries did not predict complications (OR 1.23, 95%CI 0.44 to 3.45, p = 0.516). The most predictive RF were open fracture (OR 3.47, 95%CI 1.64 to 7.34, p < 0.001), followed by local tissue damage (OR 3.05, 95%CI 1.23 to 40.92, p = 0.04), and diabetes (OR 2.3, 95%CI 1.1 to 4.79, p = 0.26). CONCLUSION Among all RFs for regional soft tissue complications, the most predictive is the local soft tissue status, while additional injuries or NPS RF were less predictive. The soft tissue damage can be quantified and outweighs the cofactors described in previous publications. The soft tissue status appears to have a more important role in the decision making of the treatment strategy when compared with comorbidities such as diabetes.
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Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland.
| | - Felix Karl Ludwig Klingebiel
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Martina Gosteli
- Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Simone Schuerle
- Institute for translational medicine, Department of Health Science & Technology, ETH Zurich, Rämistrasse 101, Zürich 8092, Switzerland
| | - Paolo Cinelli
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Boris A Zelle
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas TX 78229, United States
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
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14
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Wound Closure Following Intervention for Closed Orthopedic Trauma. Injury 2022; 53:313-322. [PMID: 34865820 DOI: 10.1016/j.injury.2021.11.062] [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: 09/28/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Abstract
The method of skin closure and post-operative wound management has always been important in orthopedic surgery and plays an even larger role now that surgical site infection (SSI) is a national healthcare metric for both surgeons and hospitals. Wound related issues remain some of the most feared complications following orthopedic trauma procedures and are associated with significant morbidity. In order to minimize the risk of surgical site complications, surgeons must be familiar with the physiology of wound healing as well as the patient and surgical factors affecting healing potential. The goal of all skin closure techniques is to promote rapid healing with acceptable cosmesis, all while minimizing risk of infection and dehiscence. Knowledge of the types of closure material, techniques of wound closure, surgical dressings, negative pressure wound therapy, and other local modalities is important to optimize wound healing. There is no consensus in the literature as to which closure method is superior but the available data can be used to make informed choices. Although often left to less experienced members of the surgical team, the process of wound closure and dressing the wound should not be an afterthought, and instead must be part of the surgical plan. Wounds that are in direct communication with bony fractures are particularly at risk due to local tissue trauma, resultant swelling, hematoma formation, and injured vasculature.
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15
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Salimi S, Khayat Kashani HR, Azhari S, Sadeghi S, Sheikhghomy S, Paryan P, KhayatKashani M. Local vancomycin therapy to reduce surgical site infection in adult spine surgery: a randomized prospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:454-460. [PMID: 34750670 DOI: 10.1007/s00586-021-07050-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/07/2021] [Accepted: 10/28/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE This prospective randomized controlled trial hypothesizes that intra wound vancomycin reduces postoperative infection. METHODS In this RCT study, the patients were randomly divided into two groups of treatment and control. In the treatment group, 1-2 g of intra wound vancomycin was used, and no drug was used for the control group. SSI and the type of microorganism causing postoperative infection were assessed at a three-month follow-up. Factors affecting postoperative infection such as age, sex, site of operation, surgical levels, and risk factors affecting postoperative infection, such as diabetes, blood pressure, ischemic heart disease, smoking, blood transfusion, BMI, neurologic deficit, CSF leakage, UTI, COPD and surgery time were examined in two groups. RESULTS In this study, 375 patients, including 187patients in the treatment group and 188 patients in the control group, were studied. Among the patients, 228 had surgery without instrumentation, and 147 had surgery with instrumentation. There were 12 cases of SSI in the treatment group and 11 in the control group, and there was no statistically significant difference between the two groups. There was no difference between the two groups with and without instrumentation in the evaluation of postoperative infection. In the subgroups with and without instruments, there was no significant difference between treatment and control groups. Due to the microorganism causing the infection, gram-negative bacteria were more common in the treatment group. CONCLUSION Intra-wound vancomycin has no effect on SSI; in addition, it can increase the rate of gram-negative infections.
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Affiliation(s)
- Sohrab Salimi
- Clinical Research and Development Unit, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Khayat Kashani
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani street, Tehran, Iran.
| | - Shirzad Azhari
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani street, Tehran, Iran
| | - Sohrab Sadeghi
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani street, Tehran, Iran
| | - Siavash Sheikhghomy
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani street, Tehran, Iran
| | - Poorya Paryan
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani street, Tehran, Iran
| | - Maryam KhayatKashani
- Clinical Research and Development Unit, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Hoang H, Sharfman Z, Gelfand Y, Ramos RLG, Gomez J, Krystal J, Kramer D, Yassari R. Cigarette smoking and complications in elective thoracolumbar fusions surgery: An analysis of 58,304 procedures. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:169-174. [PMID: 35837438 PMCID: PMC9274679 DOI: 10.4103/jcvjs.jcvjs_15_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/01/2022] [Indexed: 11/04/2022] Open
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17
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Quiroga-Centeno AC, Quiroga-Centeno CA, Guerrero-Macías S, Navas-Quintero O, Gómez-Ochoa SA. Systematic review and meta-analysis of risk factors for Mesh infection following Abdominal Wall Hernia Repair Surgery. Am J Surg 2021; 224:239-246. [PMID: 34969506 DOI: 10.1016/j.amjsurg.2021.12.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical Mesh Infection (SMI) after Abdominal Wall Hernia Repair (AWHR) represents a catastrophic complication. We performed a systematic review and meta-analysis to analyze the risk factors for SMI in the context of AWHR. METHODS PubMed, Embase, Scielo, and LILACS were searched without language or time restrictions from inception until June 2021. Articles evaluating the association between demographic, clinical, laboratory and surgical characteristics with SMI in AWHR were included. RESULTS 23 studies were evaluated, comprising a total of 118,790 patients (98% males; mean age 56.5 years) with a mesh infection pooled prevalence of 4%. Significant risk factors for SMI were type 2 diabetes mellitus, obesity, smoking history, steroids use, ASA III/IV, laparotomy vs laparoscopy, emergency surgery, duration of surgery and onlay mesh position vs sublay. The quality of evidence was regarded as very low-moderate. CONCLUSION Several factors, highlighting sociodemographic characteristics, comorbidities, and the clinical scenario, may increase the risk of developing mesh infections in AWHR. The recognition and mitigation of these may significantly reduce mesh infection rates in this context.
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Affiliation(s)
| | | | | | | | - Sergio Alejandro Gómez-Ochoa
- Member Grupo de Investigación en Cirugía y Especialidades Quirúrgicas (GRICES-UIS), Universidad Industrial de Santander, Bucaramanga, Colombia; Research Division, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
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Zhu AC, Tram J, Waterman R, Wallace M, Chakravarthy K. Recommendations for anesthetic management for intraoperative neuromodulation cases. Pain Manag 2021; 12:557-567. [PMID: 34886683 DOI: 10.2217/pmt-2020-0109] [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: 11/21/2022] Open
Abstract
This paper performs a review of current literature as well as uses our single-center experience to discuss pre-operative, intra-operative and, briefly, postoperative management for dorsal column stimulators (DCSs), dorsal root ganglion (DRG) stimulators, peripheral nerve stimulators (PNSs) and intrathecal pumps. Generally, pre-operative antibiotics are recommended with discontinuation within 24 h postoperatively. For dorsal column and DRG stimulation, monitored anesthesia care or general anesthesia with intra-operative neuromonitoring is recommended; for peripheral nerve stimulation and intrathecal pump implementation, monitored anesthesia care is preferred. There is little information on appropriate anesthetic management during these forms of neuromodulation. More research is necessary to articulate specific pre-operative, intra-operative and postoperative management guidelines and recommendations for dorsal column stimulator, DRG stimulation, PNS and intrathecal pump implantation.
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Affiliation(s)
- Alyssa C Zhu
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, 9400 Campus Point Dr, La Jolla, CA 92037, USA
| | - Jennifer Tram
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, 9400 Campus Point Dr, La Jolla, CA 92037, USA
| | - Ruth Waterman
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, 9400 Campus Point Dr, La Jolla, CA 92037, USA
| | - Mark Wallace
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, 9400 Campus Point Dr, La Jolla, CA 92037, USA
| | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, 9400 Campus Point Dr, La Jolla, CA 92037, USA.,VA San Diego Health Care, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
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Inose H, Kobayashi Y, Morishita S, Matsukura Y, Yuasa M, Hirai T, Yoshii T, Okawa A. Application of an index derived from the area under a neutrophil curve as a predictor of surgical site infection after spinal surgery. BMC Surg 2021; 21:354. [PMID: 34579693 PMCID: PMC8477575 DOI: 10.1186/s12893-021-01345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background Patients with prolonged and intense neutrophilia after spinal surgery are at high risk of developing surgical site infection (SSI). To date, there is no standard method for the objective assessment of the intensity and duration of neutrophilia. Thus, this retrospective observational study aimed to test a new index (I-index), developed by combining the duration and intensity of neutrophilia, as a predictor of SSI. Methods I-index was calculated based on the postoperative neutrophil percentage. A total of 17 patients with SSI were enrolled as cases, and 51 patients without SSI were selected as controls. The groups were matched at a ratio of 1:3 by age, sex, and surgery type. The differences in the I-index were compared between the groups. Moreover, we checked the cumulative I-index (c-I-index), which we defined as the area under the neutrophil curve from postoperative day 1 until the first clinical manifestation of SSI in each case. Furthermore, a cutoff for SSI was defined using the receiver operating characteristic curve. Results The median I-index-7, I-index-14, and c-I-index were significantly higher in the SSI group than those in the control group. For a cutoff point of 42.1 of the I-index-7, the sensitivity and specificity were 0.706 and 0.882, respectively. For a cutoff point of 45.95 of the I-index-14, the sensitivity and specificity were 0.824 and 0.804, respectively. For a cutoff point of 45.95 of the c-I-index, the sensitivity and specificity were 0.824 and 0.804, respectively. Conclusion We devised a new indicator of infection, i.e., the I-Index and c-I-index, and confirmed its usefulness in predicting SSI.
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Affiliation(s)
- Hiroyuki Inose
- Department of Orthopaedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yutaka Kobayashi
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Shingo Morishita
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yu Matsukura
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masato Yuasa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Atsushi Okawa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Goyal DKC, Divi SN, Bowles DR, Mujica VE, Kaye ID, Kurd MF, Woods BI, Radcliff KE, Rihn JA, Anderson DG, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Does Smoking Affect Short-Term Patient-Reported Outcomes After Lumbar Decompression? Global Spine J 2021; 11:727-732. [PMID: 32875911 PMCID: PMC8165909 DOI: 10.1177/2192568220925791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The goal of this study was to determine how smoking status influences patient-reported outcome measurements (PROMs) in patients undergoing lumbar decompression surgery. METHODS Patients undergoing lumbar decompression between 1 to 3 levels at a single-center, academic hospital were retrospectively identified. Patients <18 years old, and those undergoing surgery for infection, trauma, tumor, or revision, with less than 12 months of follow-up were excluded. Patients were divided into 3 groups: (1) never smokers (NSs); (2) current smokers (CSs); and (3) former smokers (FSs). PROMs analyzed included the Physical Component Score and Mental Component Score of the Short Form-12 Health Survey, the Oswestry Disability Index, and Visual Analogue Scale Back and Leg pain scores. One-way ANOVA was used to compare preoperative and postoperative scores between smoking groups, and multiple linear regression analysis was performed to determine whether smoking status predicted change in each outcome score, controlling for factors such as age, sex, body mass index, and other clinical variables. A P value <.05 was considered to be significant. RESULTS A total of 195 patients were included in the final cohort, with 121 (62.1%) patients in the NS group, 22 (11.3%) in the CS group, and 52 (26.6%) in the FS group. There were no significant differences between groups at baseline or postoperatively. Smoking status was also not a significant predictor of change in any outcome scores over time on multivariate analysis. CONCLUSION These results suggest that smoking status does not significantly affect short-term complications or outcomes in patients undergoing lumbar decompression surgery.
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Affiliation(s)
- Dhruv K. C. Goyal
- Thomas Jefferson University, Philadelphia, PA, USA,Dhruv K. C. Goyal, Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
| | | | | | | | | | - Mark F. Kurd
- Thomas Jefferson University, Philadelphia, PA, USA
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Debono B, Wainwright TW, Wang MY, Sigmundsson FG, Yang MMH, Smid-Nanninga H, Bonnal A, Le Huec JC, Fawcett WJ, Ljungqvist O, Lonjon G, de Boer HD. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Spine J 2021; 21:729-752. [PMID: 33444664 DOI: 10.1016/j.spinee.2021.01.001] [Citation(s) in RCA: 150] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care have led to improvements in outcomes in numerous surgical areas, through multimodal optimization of patient pathway, reduction of complications, improved patient experience and reduction in the length of stay. ERAS represent a relatively new paradigm in spine surgery. PURPOSE This multidisciplinary consensus review summarizes the literature and proposes recommendations for the perioperative care of patients undergoing lumbar fusion surgery with an ERAS program. STUDY DESIGN This is a review article. METHODS Under the impetus of the ERAS® society, a multidisciplinary guideline development group was constituted by bringing together international experts involved in the practice of ERAS and spine surgery. This group identified 22 ERAS items for lumbar fusion. A systematic search in the English language was performed in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Systematic reviews, randomized controlled trials, and cohort studies were included, and the evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Consensus recommendation was reached by the group after a critical appraisal of the literature. RESULTS Two hundred fifty-six articles were included to develop the consensus statements for 22 ERAS items; one ERAS item (prehabilitation) was excluded from the final summary due to very poor quality and conflicting evidence in lumbar spinal fusion. From these remaining 21 ERAS items, 28 recommendations were included. All recommendations on ERAS protocol items are based on the best available evidence. These included nine preoperative, eleven intraoperative, and six postoperative recommendations. They span topics from preoperative patient education and nutritional evaluation, intraoperative anesthetic and surgical techniques, and postoperative multimodal analgesic strategies. The level of evidence for the use of each recommendation is presented. CONCLUSION Based on the best evidence available for each ERAS item within the multidisciplinary perioperative care pathways, the ERAS® Society presents this comprehensive consensus review for perioperative care in lumbar fusion.
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Affiliation(s)
- Bertrand Debono
- Paris-Versailles Spine Center (Centre Francilien du Dos), Paris, France; Ramsay Santé-Hôpital Privé de Versailles, Versailles, France.
| | - Thomas W Wainwright
- Research Institute, Bournemouth University, Bournemouth, UK; The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Bournemouth, UK
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Freyr G Sigmundsson
- Department of Orthopedic Surgery, Örebro University Hospital, Södra Grev Rosengatan, Örebro, Sweden
| | - Michael M H Yang
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Aurélien Bonnal
- Department of Anesthesiology, Clinique St-Jean- Sud de France, Santécité Group. St Jean de Vedas, Montpellier Metropole, France
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery - Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - William J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - Guillaume Lonjon
- Department of Orthopedic Surgery, Orthosud, Clinique St-Jean- Sud de France, SantéCité Group. St Jean de Vedas, Montpellier Metropole, France
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, the Netherlands
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Khurana VG. Adverse impact of smoking on the spine and spinal surgery. Surg Neurol Int 2021; 12:118. [PMID: 33880223 PMCID: PMC8053459 DOI: 10.25259/sni_6_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/24/2021] [Indexed: 12/15/2022] Open
Abstract
Background Tobacco smokers and companies are well aware that smoking increases the risks for cancers, vascular morbidity, and early mortality. This is a review of the plethora of adverse effects chronic smoking has on spinal tissues and spinal surgery. Methods Medline (PubMed) and Google Scholar databases were searched for pertinent literature through keywords related to smoking, spondylosis, and spinal surgery. Results Smoking accelerates spondylosis by impairing spinal tissue vascular supply through atherosclerosis and thrombosis, while inducing local hypoxia, inflammation, proteolysis, and cell loss. It, thus, compromises disc, cartilage, synovium, bone, and blood vessels. It can lead to early surgery, delayed wound healing, increased surgical site infection, failed fusion, more re-operations, and chronic spinal pain. Conclusion There is ample evidence to support surgeons' declining to operate on chronic smokers. The need for immediate and permanent smoking cessation and its potential benefits should be emphasized for the patient considering or who has undergone spinal surgery.
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Affiliation(s)
- Vini G Khurana
- CNS Neurosurgery, Woolloomooloo, New South Wales, Australia
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Konovalov NA, Stepanov IA, Beloborodov VA, Korolishin VA, Brinyuk ES. [Smoking as a risk factor of advanced heterotopic ossification in patients after lumbar total disk arthroplasty]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:19-27. [PMID: 33560617 DOI: 10.17116/neiro20218501119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Smoking is an obvious risk factor of adverse events in early and long-term postoperative period after spine surgery including lumbar total disk arthroplasty. Objective. To study the effect of smoking on clinical and radiological outcomes after lumbar total disk arthroplasty. MATERIAL AND METHODS A single-center retrospective observational cohort study was performed. We have analyzed medical records of patients who underwent single-level lumbar total disk arthroplasty for degenerative disease. RESULTS The study included 57 medical records of respondents. The examined medical records were divided into two groups - smokers (n=26) and non-smokers (n=31). There were no significant between-group differences in clinical outcomes. Incidence of adverse events was similar too. Kaplan-Meier event-free survival was similar in both groups. There were no significant between-group differences in X-ray data. Development of heterotopic ossification after lumbar total disk arthroplasty was more active in smokers. CONCLUSION Smoking has no significant effect on clinical and radiological outcomes in patients after single-level after lumbar total disk arthroplasty. On the other hand, smoking significantly increases formation of heterotopic ossification after lumbar total disk arthroplasty.
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Affiliation(s)
| | - I A Stepanov
- Irkutsk State Medical University, Irkutsk, Russia.,Kharlampiev Clinic LLC, Irkutsk, Russia
| | | | | | - E S Brinyuk
- Burdenko Neurosurgery Center, Moscow, Russia
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Kantzanou M, Korfias S, Panourias I, Sakas DE, Karalexi MA. Deep Brain Stimulation-Related Surgical Site Infections: A Systematic Review and Meta-Analysis. Neuromodulation 2021; 24:197-211. [PMID: 33462954 DOI: 10.1111/ner.13354] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/23/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Over the last decades, the increased use of deep brain stimulation (DBS) has raised concerns about the potential adverse health effects of the treatment. Surgical site infections (SSIs) following an elective surgery remain a major challenge for neurosurgeons. Few studies have examined the prevalence and risk factors of DBS-related complications, particularly focusing on SSIs. OBJECTIVES We systematically searched published literature, up to June 2020, with no language restrictions. MATERIALS AND METHODS Eligible were studies that examined the prevalence of DBS-related SSIs, as well as studies that examined risk and preventive factors in relation to SSIs. We extracted information on study characteristics, follow-up, exposure and outcome assessment, effect estimate and sample size. Summary odds ratios (sOR) and 95% confidence intervals (CI) were calculated from random-effects meta-analyses; heterogeneity and small-study effects were also assessed. RESULTS We identified 66 eligible studies that included 12,258 participants from 27 countries. The summary prevalence of SSIs was estimated at 5.0% (95% CI: 4.0%-6.0%) with higher rates for dystonia (6.5%), as well as for newer indications of DBS, such as epilepsy (9.5%), Tourette syndrome (5.9%) and OCD (4.5%). Similar prevalence rates were found between early-onset and late-onset hardware infections. Among risk and preventive factors, the perioperative implementation of intra-wound vancomycin was associated with statistically significantly lower risk of SSIs (sOR: 0.26, 95% CI: 0.09-0.74). Heterogeneity was nonsignificant in most meta-analyses. CONCLUSION The present study confirms the still high prevalence of SSIs, especially for newer indications of DBS and provides evidence that preventive measures, such as the implementation of topical vancomycin, seem promising in reducing the risk of DBS-related SSIs. Large clinical trials are needed to confirm the efficacy and safety of such measures.
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Affiliation(s)
- Maria Kantzanou
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Korfias
- Department of Neurosurgery, School of Medicine Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Panourias
- Department of Neurosurgery, Korgialenio and Mpenakio General Hospital of Athens, Red Cross, Athens, Greece
| | - Damianos E Sakas
- Department of Neurosurgery, School of Medicine Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria A Karalexi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Thapa B, Sutanto E, Bhandari R. Thickness of subcutaneous fat is a risk factor for incisional surgical site infection in acute appendicitis surgery: a prospective study. BMC Surg 2021; 21:6. [PMID: 33397364 PMCID: PMC7784256 DOI: 10.1186/s12893-020-01029-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Incisional surgical site infection (SSI) is a significant source of postoperative morbidity resulting in increased length of stay and cost. In this study, our aim was to evaluate the association between thickness of subcutaneous fat (TSF) and incisional SSI among patients undergoing open appendectomy in low-resource settings. METHODS 90 patients with acute uncomplicated appendicitis who underwent emergency open appendectomy from December 2017 to August 2018 were included in this prospective study. TSF was measured preoperatively using ultrasound. TSF and other possible predictors of incisional SSI, including body mass index and other clinical characteristics, were assessed by univariate and multivariable logistic regression analysis. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of TSF and the optimum cut-off value for TSF was determined using the Youden index. RESULTS The prevalence of incisional SSI was 13.3% (12/90). TSF was independently associated with incisional SSI (P < 0.001). Additionally, history of smoking (P = 0.048) was also associated with incisional SSI. A model of incisional SSI using a cut-off of 23.0 mm for TSF was moderately accurate (area under curve 0.83, confidence interval 0.70-0.97; sensitivity 83.3%; specificity 76.9%). CONCLUSIONS The study demonstrated that TSF, as evaluated by ultrasound, is a predictor in the development of incisional SSI in patients with acute appendicitis undergoing open appendectomy. These findings suggest that ultrasound is useful both for the evaluation of TSF and the prediction of incisional SSI risk factor in low-resource settings.
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Affiliation(s)
- Bikas Thapa
- Department of General and Gastrointestinal Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Maharajgung, Kathmandu, Nepal
| | - Edward Sutanto
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Raju Bhandari
- Department of General and Gastrointestinal Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Maharajgung, Kathmandu, Nepal.
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Tavares-Júnior MCM, Cabrera GED, Teixeira WGJ, Narazaki DK, Ghilardi CS, Marcon RM, Cristante AF, de Barros-Filho TEP. Risk Factors Associated with Postoperative Infection in Cancer Patients Undergoing Spine Surgery. Clinics (Sao Paulo) 2021; 76:e2741. [PMID: 34008773 PMCID: PMC8101687 DOI: 10.6061/clinics/2021/e2741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine the rate of and main risk factors for postoperative infection in cancer patients who underwent spine surgery in the last 5 years in order to determine whether there is an association between postoperative infection and increased mortality during hospitalization. METHODS All cancer patients who underwent surgical procedures between January 2015 and December 2019 at a single hospital specializing in spine cancer surgery were analyzed. The primary outcome of interest was postoperative infection. Bivariate logistic regression was used to estimate the odds ratio and 95% confidence interval for each variable in relation to the occurrence of infection. RESULTS We evaluated 324 patients, including 176 men (54.3%) and 148 women (45.7%) with a mean age of 56 years. The incidence of postoperative infection was 20.37%. Of the 324 patients, 39 died during hospitalization (12%). CONCLUSIONS Surgical time greater than 4 hours, surgical instrumented levels greater than 6, and an Eastern Cooperative Oncology Group of 3 or 4 were associated with an increased risk of postoperative infection, but these factors did not lead to an increase in mortality during hospitalization.
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Affiliation(s)
- Mauro Costa Morais Tavares-Júnior
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Gabriela Estefania Delgado Cabrera
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - William Gemio Jacobsen Teixeira
- Cirurgia de Coluna, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Douglas Kenji Narazaki
- Cirurgia de Coluna, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Cesar Salge Ghilardi
- Cirurgia de Coluna, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Raphael Martus Marcon
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alexandre Fogaça Cristante
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tarcisio Eloy Pessoa de Barros-Filho
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Adapa AR, Linzey JR, Daou BJ, Mehta UV, Patel T, Ponnaluri-Wears S, Washer LL, Thompson BG, Park P, Pandey AS. Evaluating the role of methicillin-resistant Staphylococcus aureus (MRSA)-specific antibiotic prophylaxis for neurosurgical patients. Clin Neurol Neurosurg 2020; 200:106353. [PMID: 33168331 DOI: 10.1016/j.clineuro.2020.106353] [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: 09/12/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Surgical site infection (SSI) in neurosurgical patients increases morbidity. Despite the rise of methicillin-resistant Staphylococcus aureus (MRSA) colonization, there is little consensus regarding antibiotic prophylaxis for SSI in MRSA-colonized neurosurgical patients. Our objective was to examine the incidence of SSI in MRSA-colonized neurosurgical patients and interrogate whether MRSA-specific antibiotic prophylaxis reduces SSIs. METHODS We performed a retrospective analysis of adult patients undergoing neurosurgical procedures between 2013 and 2018. The primary outcome was SSI in patients with MRSA colonization receiving MRSA-specific antibiotics. Secondary outcomes included predictors of SSI, including whether broad use of MRSA-specific antibiotics affects SSI rate. RESULTS Of 9739 procedures, 376 had SSI (3.9 %). Seven hundred forty-four procedures (7.6 %) were performed on patients screened preoperatively for MRSA, including 54 procedures on MRSA-colonized patients. MRSA-colonized patients were more likely than MRSA-non-colonized patients to receive MRSA-specific antibiotics (35.2 % vs. 17.8 %, p = 0.002) for prophylaxis. Nevertheless, MRSA-colonized patients had higher SSI rates compared to MRSA-non-colonized patients (22.2 % vs. 6.4 %, p = 0.00002). MRSA-colonization led to 3.49 greater odds (95 % CI 1.52-7.65, p = 0.002) of SSI relative to MRSA-non-colonization. MRSA-colonized patients receiving MRSA-specific antibiotics, compared to those receiving non-MRSA-specific antibiotics, had lower SSI rates, but this difference was not statistically significant (15.8 % vs. 25.7 %, p = 0.40). In the non-screened population, those receiving MRSA-specific antibiotics, compared to those receiving non-MRSA-specific antibiotics, had significantly higher SSI rates (6.9 % vs. 3.0 %, p = 0.00001). The use of MRSA-specific antibiotic prophylaxis in the non-screened population increased the odds of SSI (OR 1.90, 95 % CI 1.45-2.46, p = 0.0001). CONCLUSION MRSA-colonized neurosurgical patients had a higher SSI rate compared to MRSA-non-colonized patients. While MRSA-specific antibiotics may benefit those with MRSA colonization, the difference in SSI rate between MRSA-colonized patients receiving MRSA-specific antibiotics vs. non-specific antibiotics requires further investigation. The broader use of MRSA-specific antibiotics may paradoxically confer an increased risk of SSI in a non-screened neurosurgical population.
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Affiliation(s)
- Arjun Rohit Adapa
- University of Michigan Medical School, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Badih Junior Daou
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Unnati Vikram Mehta
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Twisha Patel
- Department of Pharmacy Services, University of Michigan, Ann Arbor, MI, USA
| | | | - Laraine Lynn Washer
- Division of Infectious Disease, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA; Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Pennington Z, Ehresman J, Westbroek EM, Lubelski D, Cottrill E, Sciubba DM. Interventions to minimize blood loss and transfusion risk in spine surgery: A narrative review. Clin Neurol Neurosurg 2020; 196:106004. [DOI: 10.1016/j.clineuro.2020.106004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 12/26/2022]
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Teitelbaum JI, Grasse C, Quan D, Abi Hachem R, Goldstein BJ, Hua X, Jang DW. General Complications after Endoscopic Sinus Surgery in Smokers: A 2005-2016 NSQIP Analysis. Ann Otol Rhinol Laryngol 2020; 130:350-355. [PMID: 32819161 DOI: 10.1177/0003489420952481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Exposure to cigarette smoke has been associated with a higher incidence of postoperative complications across a variety of surgical specialties. However, it is unclear if smoking increases this risk after endoscopic sinus surgery (ESS). Because complication rates after ESS are relatively low, a large national database allows for a statistically meaningful study of this topic. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset from 2005 to 2016 was analyzed. Patients who underwent ESS were identified. Thirty-day postoperative complication rates between smokers and nonsmokers were compared. Complications included infection, thromboembolic events, reintubation, readmission, acute renal failure, and cardiovascular events. RESULTS 921 patients who underwent ESS were identified. 182 (20%) were smokers and 739 (80%) were nonsmokers. 609 patients underwent outpatient ESS, while 312 patients underwent inpatient ESS. A total of 12 patients experienced postoperative surgical site infections involving the deeper tissues beyond the wound (organ/space SSI). On univariate analysis, smoking was associated with a higher incidence of organ/space SSI (P = .0067) and pulmonary embolism (P = .0321) after ESS. On multivariate logistic regression, smoking was associated with increased odds (4.495, 1.11- 8.17, P = .0347) of organ/space SSI after ESS. CONCLUSIONS This study demonstrates an association between exposure to cigarette smoke and potentially serious surgical site infections in the 30-day postoperative period after ESS. Our findings may help when counseling smokers who are considering ESS. Further study is required to understand the nature of these infections and ways to prevent them.Level of Evidence: 2c ("health outcomes").
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Affiliation(s)
- Jordan I Teitelbaum
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Catie Grasse
- Department of Computer Science, Duke University, Durham, NC, USA
| | - Dennis Quan
- Department of Computer Science, Duke University, Durham, NC, USA
| | - Ralph Abi Hachem
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Bradley J Goldstein
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Xiaoyang Hua
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - David W Jang
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA
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Fiani B, Cathel A, Sarhadi KJ, Cohen J, Siddiqi J. Neurosurgical Post-Operative Wound Infections: A retrospective study on surgical site infections for quality improvement. Int Wound J 2020; 17:1039-1046. [PMID: 32315121 DOI: 10.1111/iwj.13367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022] Open
Abstract
Despite efforts to maintain a meticulous aseptic environment, wound infection is one of the most common complications following surgery and may be related to dehiscence, haemorrhage, infection, and/or poor surgical technique. With the appearance of new wound closure techniques and suture materials, we felt compelled to perform a retrospective study on our institution's neurosurgical population to determine how our institution compared to others in terms of incidence of surgical site infection (SSI). A retrospective analysis was performed at our single institution for all patients that had cranial or spine surgery by a neurosurgeon for the past 15 years. The data were extracted via Crimson Continuum of Care software program and analysed using χ2 and relative risk. The data retrieval software program collected a total of 1184 cranial and spinal surgeries. Of these 1184 cases, 12 resulted in post-operative wound infections. Using these collected values, we compared the results with published values in the literature. Prior studies have shown that up to 33% of surgical cases have post-operative infections. Using this reported value in comparison with our data, χ2 testing equals 547.893 with 1 df, P = .0001 (confidence interval = 0.05), which demonstrated statistical significance when compared with surgical literature. The results from this retrospective analysis demonstrated that the rate of neurosurgical post-operative SSI falls within the range consistent with the literature, which has shown rates of infection from <1% up to 15% depending on the type of surgery, surgical technique, and patient characteristics. SSIs can be an unfortunate and costly post-operative complication. Risks factors in the past have been studied, but introspection by each institution is an important metric to ensure accountability and provide optimal patient care in comparison with established data and guidelines. No deviation from current techniques is deemed necessary at our institution based on the results.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | - Alessandra Cathel
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | - Kasra J Sarhadi
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jordan Cohen
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Javed Siddiqi
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
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Atesok K, Papavassiliou E, Heffernan MJ, Tunmire D, Sitnikov I, Tanaka N, Rajaram S, Pittman J, Gokaslan ZL, Vaccaro A, Theiss S. Current Strategies in Prevention of Postoperative Infections in Spine Surgery. Global Spine J 2020; 10:183-194. [PMID: 32206518 PMCID: PMC7076595 DOI: 10.1177/2192568218819817] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES Postoperative surgical site infections (SSIs) are among the most common acute complications in spine surgery and have a devastating impact on outcomes. They can lead to increased morbidity and mortality as well as greater economic burden. Hence, preventive strategies to reduce the rate of SSIs after spine surgery have become vitally important. The purpose of this article was to summarize and critically analyze the available evidence related to current strategies in the prevention of SSIs after spine surgery. METHODS A literature search utilizing Medline database was performed. Relevant studies from all the evidence levels have been included. Recommendations to decrease the risk of SSIs have been provided based on the results from studies with the highest level of evidence. RESULTS SSI prevention occurs at each phase of care including the preoperative, intraoperative, and postoperative periods. Meticulous patient selection, tight glycemic control in diabetics, smoking cessation, and screening/eradication of Staphylococcus aureus are some of the main preoperative patient-related preventive strategies. Currently used intraoperative measures include alcohol-based skin preparation, topical vancomycin powder, and betadine irrigation of the surgical site before closure. Postoperative infection prophylaxis can be performed by administration of silver-impregnated or vacuum dressings, extended intravenous antibiotics, and supplemental oxygen therapy. CONCLUSIONS Although preventive strategies are already in use alone or in combination, further high-level research is required to prove their efficacy in reducing the rate of SSIs in spine surgery before evidence-based standard infection prophylaxis guidelines can be built.
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Affiliation(s)
- Kivanc Atesok
- University of Alabama at Birmingham, AL, USA,Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA,Kivanc Atesok, Department of Neurosurgery Spine Program, Beth Israel Deaconess Medical Center, Harvard University, 110 Francis Street, Boston, MA 02215, USA.
| | | | - Michael J. Heffernan
- Children’s Hospital of New Orleans, LSU Health Science Center, New Orleans, LA, USA
| | | | - Irina Sitnikov
- International Center for Minimally Invasive Spine Surgery, Wyckoff, NJ, USA
| | | | | | | | - Ziya L. Gokaslan
- Brown University, Providence, RI, USA,Rhode Island Hospital, Providence, RI, USA
| | - Alexander Vaccaro
- Thomas Jefferson University, The Rothman Institute, Philadelphia, PA, USA
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Aubé M, Chua M, DeLong J, McCammon K, Tonkin J, Gilbert D, Virasoro R. Predictors of surgical complications and evaluation of outcomes after surgical correction of adult-acquired buried penis. Int Urol Nephrol 2019; 52:687-692. [PMID: 31797250 DOI: 10.1007/s11255-019-02347-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/24/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine predictors for surgical complications and assess patient satisfaction after surgical treatment of Adult-Acquired Buried Penis (AABP). METHODS A retrospective review was performed on all patients diagnosed with AABP who underwent surgical treatment at a single institution from January 2013-December 2017. Patient demographics and peri-operative data were extracted. Univariate and multivariate regression analyses were performed to identify predictors for surgical complications. Patients' post-operative satisfaction was likewise assessed for factors such as successful outcome, post-operative erection quality, and complications related to the surgery. RESULT Twenty-four patients of median age 61.5 years (IQR 54-67) with median follow-up of 12 months (IQR 3.25-29) were included. Overall success was 87.5% (21/24). Complications occurred in 15 (62.5%) patients with 7 (29%) Clavien-Dindo category ≥ 3. Based on regression analyses, body mass index (BMI) ≥ 40 (HR 25; 95% CI 1.45-431.81) and tobacco smoking (HR 14.6; 95% CI 1.15-199.98) were identified as independent predictors of overall complications. Concomitant performance of abdominal panniculectomy was associated with Clavien-Dindo category ≥ 3 (HR 28; 95% CI 2.4-326.74) complications. Patient satisfaction was associated with surgical success (p < 0.0001), post-operative erection (p < 0.027), and absence of surgical morbidity that needed further surgical intervention (p = 0.032). CONCLUSION Surgical management of AABP following an individualized algorithm results in a high success rate but also in relatively high procedure-related morbidity. Peri-operative BMI ≥ 40 and tobacco smoking have higher odds for overall complication occurrence, while concomitant abdominal panniculectomy results in more occurrence of Clavien-Dindo category ≥ 3 morbidities. Patient's eventual satisfaction correlates well with surgical success, post-procedural erection condition, and lack of Clavien-Dindo ≥ 3 morbidity.
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Affiliation(s)
- Mélanie Aubé
- Department of Urology, McGill University Health Center, Montreal, QC, Canada
| | - Michael Chua
- Department of Urology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jessica DeLong
- Department of Urology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Kurt McCammon
- Department of Urology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jeremy Tonkin
- Department of Urology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - David Gilbert
- Department of Plastic Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Ramón Virasoro
- Department of Urology, Eastern Virginia Medical School, Norfolk, VA, USA.
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Antonelli B, Chen AF. Reducing the risk of infection after total joint arthroplasty: preoperative optimization. ARTHROPLASTY 2019; 1:4. [PMID: 35240760 PMCID: PMC8787890 DOI: 10.1186/s42836-019-0003-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/20/2019] [Indexed: 12/13/2022] Open
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Lucasti CJ, Dworkin M, Radcliff KE, Nicholson K, Lucasti CJ, Woods BI. What Factors Predict Failure of Nonsurgical Management of a Lumbar Surgical Site Infection? Int J Spine Surg 2019; 13:239-244. [PMID: 31328087 DOI: 10.14444/6032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background One of the most frequent complications of invasive lumbar spine surgery is postoperative surgical site infections (SSIs). Although there are absolute criteria for surgical intervention (progressive neurologic deficit, sepsis, failure of medical management), the treatment of routine, uncomplicated SSIs remains somewhat unclear. The purpose of this study was to evaluate the outcome of a series of patients with postoperative surgical site infections who were treated with or without surgical intervention. The primary clinical outcome was the assessment of whether medical management alone would be sufficient to eradicate the infection. Methods A retrospective review of consecutive patients who underwent lumbar surgery complicated by spine infection between 2011 and 2017 was performed in order to determine what factors, if any, resulted in the need for additional surgical management. Medical records were reviewed for various demographic (e.g., age), clinical (e.g., organism), and surgical (e.g., presence of instrumentation) factors. A regression analysis was performed to identify what variables significantly increased the risk for SSI. Results During the 6-year period studied, a total of 74 patients met the inclusion criteria and were included in the study. There were 13 patients who failed medical management and required additional surgical management, which included irrigation and debridement. Thus, overall, medical management alone was effective in 82% of patients. In the final multivariate logistic regression analysis model, revision primary surgery had the strongest association with SSI that would require a washout. In addition, diabetes had a strong association with the occurrence of an infection. Conclusions Identification of risk factors associated with the need for additional surgical management may benefit from aggressive antibiotic therapy to reduce the likelihood of reoperation. Clinicians should be aware of the identified risk factors, which may help with postoperative management in at-risk individuals.
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Affiliation(s)
- Christopher J Lucasti
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Orthopaedic Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, Pennsylvania
| | - Myles Dworkin
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Orthopaedic Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, Pennsylvania
| | - Kris E Radcliff
- Department of Orthopaedic Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, Pennsylvania
| | - Kristen Nicholson
- Department of Orthopaedic Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, Pennsylvania
| | | | - Barrett I Woods
- Department of Orthopaedic Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, Pennsylvania
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Sun Z, Wang W, Fan C. Tobacco use predicts poorer clinical outcomes and higher post-operative complication rates after open elbow arthrolysis. Arch Orthop Trauma Surg 2019; 139:883-891. [PMID: 30610418 DOI: 10.1007/s00402-018-03109-z] [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] [Received: 05/23/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tobacco use is a worldwide public health problem, and has been found to be a predisposing factor for adverse functional outcomes and increased postoperative complication rates after various orthopedic operations. The purpose of this study was to determine the potential impact of tobacco use on open arthrolysis for post-traumatic elbow stiffness. MATERIALS AND METHODS A database search identified 145 patients with open arthrolysis performed for post-traumatic elbow stiffness; these were divided into three groups: current tobacco users (37), former users (28), and nonusers (80). All surgeries were performed using the same technique by the same doctor. General patient data, functional performance, and complications were documented and analyzed. RESULTS Demographic data and disease characteristics were comparable at baseline. Postoperatively, significant differences were found among the three groups in terms of range of motion (P < 0.001), Mayo Elbow Performance Score (P = 0.006), visual analog scale score for pain (P = 0.015), Dellon classification for ulnar nerve symptoms (P = 0.013), and total complication rates (P < 0.001). The current tobacco users group had the poorest clinical outcomes and highest complication rates, while no significant differences were found between former users and nonusers. CONCLUSIONS Current tobacco users reported increased risk of poorer clinical outcomes and higher postoperative complication rates after open arthrolysis. Former users were found to have outcomes similar to those of nonusers. This study underlines the importance of discontinuing tobacco use for patients with post-traumatic elbow stiffness who are considering open arthrolysis. LEVEL OF EVIDENCE Level III; Retrospective Cohort Design; Therapeutic Study.
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Affiliation(s)
- Ziyang Sun
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui, Shanghai, 200233, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui, Shanghai, 200233, People's Republic of China.,Department of Orthopedics, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, 222 Third Huanhu Road West, Pudong, Shanghai, 201306, People's Republic of China
| | - Cunyi Fan
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui, Shanghai, 200233, People's Republic of China. .,Department of Orthopedics, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, 222 Third Huanhu Road West, Pudong, Shanghai, 201306, People's Republic of China.
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Khan ES, Kow RY, Arifin KBBM, Komahen C, Low CL, Lim BC. Factors Associated with Deep Surgical Site Infection Following Spinal Surgery: A Pilot Study. Cureus 2019; 11:e4377. [PMID: 31218142 PMCID: PMC6553666 DOI: 10.7759/cureus.4377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Surgical site infection (SSI) is the most common healthcare-related infection in surgical patients. Patients who have undergone spinal surgeries and have contracted postoperative SSI face increased morbidity and mortality, which invariably leads to additional burden on the healthcare system and higher costs. The risk factors for the increase in SSI in patients who have undergone spinal surgery have been investigated in numerous studies but no studies have been performed in Malaysia. The aim of this pilot study is to determine the incidence and factors associated with deep SSIs in patients that have undergone spinal surgeries. Methods This retrospective study includes all patients who underwent spinal surgeries at Tengku Ampuan Afzan Hospital, Kuantan, from 1 January 2016 to 31 December 2017. Patients with an active spinal infection, polytrauma, and open fractures were excluded from this study. Patient characteristics and laboratory investigations were extracted to determine the risk factors for deep SSI events. Associations between SSI and risk factors were analyzed with SPSS V21.0 (IBM, Armonk, NY). Results The univariate analysis indicated that fracture dislocation at the thoraco-lumbar junction (p=0.008) and a history of preoperative blood product transfusion (p=0.003) were associated with deep SSI. Other factors such as age (p=0.162), gender (p=0.262), body mass index (p=0.215), smoking status (0.272), number of vertebrae involved in the surgery (p=0.837), spinal cord involvement (p=0.259), postoperative hemoglobin reduction (p=0.816), and preoperative white blood cell count (p=0.278) were not associated with deep SSI. Conclusions This pilot study highlights the factors associated with deep SSI in spinal surgeries. A larger study is needed to further confirm these findings.
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Affiliation(s)
- Ed S Khan
- Orthopaedics, International Islamic University Malaysia, Kuantan, MYS
| | - Ren Yi Kow
- Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan, MYS
| | | | - Colin Komahen
- Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan, MYS
| | | | - Bee Chiu Lim
- Clinical Research, Hospital Tengku Ampuan Afzan, Kuantan, MYS
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Makwana M, Taylor PN, Stew BT, Shone G, Hayhurst C. Smoking and Obesity are Risk Factors for Thirty-Day Readmissions Following Skull Base Surgery. J Neurol Surg B Skull Base 2019; 81:206-212. [PMID: 32206541 DOI: 10.1055/s-0039-1684034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022] Open
Abstract
Background Thirty-day readmission has become a significant health care metric reflecting the quality of care and on the cost of service delivery. There is little data on the impact of complications following skull base surgery (SBS) on emergency readmission. Identifying modifiable risk factors for readmission may improve care and reduce cost. Design The study was designed as a single-center retrospective cohort study. Methods Records for a consecutive series of 165 patients who underwent open or endoscopic SBS by a single surgeon reviewed. Patients with pituitary adenoma were excluded. The diagnosis, procedure, complications, length of stay (LOS), body mass index (BMI), and smoking status were recorded. Readmission to the neurosurgical department or regional hospitals was either noted prospectively or the patient contacted. Cause and length of readmission was documented. Results Of the 165 cases, 14 (8.5%) were readmitted within 30 days. Causes for readmission included cerebrospinal fluid (CSF) leak in 5/14 or 35.7% (overall rate for readmission for this complication in the series is 3.1%), infection in 4/14 (28.6%), hyponatraemia in 2/14 (14.3%), vascular: sinus thrombosis in 1/14 (7.1%), seizures in 1/14 (7.1%), and epistaxis in 1/14 (7.1%). Initial and readmission LOS was 6 and 14 days, respectively. BMI was higher in those readmitted within 30 days (33.2 kg/m 2 ) versus no readmission (27.1 kg/m 2 ). In addition, of those readmitted within 30 days, 35.7% were smokers compared with 20.8% in those not readmitted. Conclusion In this series, smoking and raised BMI may be indicators for within 30-day readmission and complications in this population, raising the question of risk factor modification prior to elective intervention.
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Affiliation(s)
- Milan Makwana
- Department of Neurosurgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Benjamin T Stew
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Geoffrey Shone
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Caroline Hayhurst
- Department of Neurosurgery, University Hospital of Wales, Cardiff, United Kingdom
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Durand WM, DePasse JM, Bokshan SL, Eltorai AE, Daniels AH. Tobacco Use and Complications Following Spinal Fusion: A Comparison of the National Surgical Quality Improvement Program and National Inpatient Sample Datasets. World Neurosurg 2019; 123:e393-e407. [DOI: 10.1016/j.wneu.2018.11.180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 12/15/2022]
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Risk Factors for Surgical Site Infection After Spinal Surgery: A Systematic Review and Meta-Analysis Based on Twenty-Seven Studies. World Neurosurg 2019; 123:e318-e329. [DOI: 10.1016/j.wneu.2018.11.158] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 11/18/2022]
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Madsbu MA, Salvesen Ø, Werner DAT, Franssen E, Weber C, Nygaard ØP, Solberg TK, Gulati S. Surgery for Herniated Lumbar Disc in Daily Tobacco Smokers: A Multicenter Observational Study. World Neurosurg 2017; 109:e581-e587. [PMID: 29045852 DOI: 10.1016/j.wneu.2017.10.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare clinical outcomes at 1 year following single-level lumbar microdiscectomy in daily tobacco smokers and nonsmokers. METHODS Data were collected through the Norwegian Registry for Spine Surgery. The primary endpoint was a change in the Oswestry Disability Index (ODI) at 1 year. Secondary endpoints were change in quality of life measured with EuroQol 5 Dimensions (EQ-5D), leg and back pain measured with a numerical rating scale (NRS), and rates of surgical complications. RESULTS A total of 5514 patients were enrolled, including 3907 nonsmokers and 1607 smokers. A significant improvement in ODI was observed for the entire cohort (mean, 31.1 points; 95% confidence interval [CI], 30.4-31.8; P < 0.001). Nonsmokers experienced a greater improvement in ODI at 1 year compared with smokers (mean, 4.1 points; 95% CI, 2.5-5.7; P < 0.001). Nonsmokers were more likely to achieve a minimal important change (MIC), defined as an ODI improvement of ≥10 points, compared with smokers (85.5% vs. 79.5%; P < 0.001). Nonsmokers experienced greater improvements in EQ-5D (mean difference, 0.068; 95% CI, 0.04-0.09; P < 0.001), back pain NRS (mean difference, 0.44; 95% CI, 0.21-0.66; P < 0.001), and leg pain NRS (mean difference, 0.54; 95% CI, 0.31-0.77; P < 0.001). There was no difference between smokers and nonsmokers in the overall complication rate (6.2% vs. 6.7%; P = 0.512). Smoking was identified as a negative predictor for ODI change in a multiple regression analysis (P < 0.001). CONCLUSIONS Nonsmokers reported a greater improvement in ODI at 1 year following microdiscectomy, and smokers were less likely to experience an MIC. Nonetheless, significant improvement was also found among smokers.
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Affiliation(s)
- Mattis A Madsbu
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Øyvind Salvesen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - David A T Werner
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway; Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Eric Franssen
- Department of Orthopedic Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
| | - Øystein P Nygaard
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; National Advisory Unit on Spinal Surgery, St. Olavs University Hospital, Trondheim, Norway; Norwegian National Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Tore K Solberg
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway; Department of Clinical Medicine, University of Tromsø, Tromsø, Norway; Norwegian National Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; National Advisory Unit on Spinal Surgery, St. Olavs University Hospital, Trondheim, Norway
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Barie PS. Atypical Wound Pathogens. Surg Infect (Larchmt) 2017; 18:455-460. [PMID: 28541806 DOI: 10.1089/sur.2017.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atypical wound pathogens may be so described because they are uncommon pathogens of soft tissue among human beings, or because they may be fastidious and difficult to recover/isolate in the laboratory. METHODS A review of pertinent English-language literature was performed. RESULTS These wound pathogens are a diverse lot, including aerobic and anaerobic gram-positive and gram-negative bacilli, non-tuberculous mycobacteria, and bacteria that cannot be characterized conventionally because they lack a cell wall (the Mycoplasmataceae). They are diverse with respect to their virulence, but many are opportunistic pathogens. CONCLUSIONS Among these atypical pathogens, clinical reports are most common of wound infections caused by Mycoplasma/Ureaplasma (sometimes as co-infecting agents), and the so-called rapidly growing non-tuberculous mycobacteria (Runyon Type IV; e.g., M. chelonae).
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Affiliation(s)
- Philip S Barie
- Departments of Surgery and Medicine, Weill Cornell Medicine , New York, New York
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