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Kim JY, Ma IZ, Hong KY. Unveiling the Potential of Drain Tip Cultures: Impact on Surgical Site Infections in Implant-Based Breast Reconstruction. J Breast Cancer 2024; 27:248-259. [PMID: 39069783 PMCID: PMC11377939 DOI: 10.4048/jbc.2024.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/25/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
PURPOSE Surgical site infections (SSIs) remain a concern after implant-based breast reconstruction, despite preventive measures. These infections can have serious consequences. This study evaluated the correlation between drain tip culture results and SSIs in this patient population. METHODS We analyzed data from patients who underwent implant-based breast reconstruction between July 2021 and May 2023. Drain tip cultures were collected, and any SSIs occurring within one month of surgery were documented. We then compared clinical data with the culture results. RESULTS A total of 263 drain tip cultures were included. Notably, none of the 61 patients who underwent tissue expander removal and implant insertion had positive cultures. However, among the 202 patients who received tissue expanders or direct-to-implant procedures, 11 (5.45%) had positive cultures, with a total of 12 SSIs identified. Importantly, five of the 11 culture-positive wounds developed SSIs. Multivariate analysis revealed a significant two-way association between infection and positive drain tip cultures. For Staphylococcus aureus specifically, drain tip cultures showed excellent predictive value: sensitivity (33.33%), specificity (100%), positive predictive value (100%), and negative predictive value (95.96%). CONCLUSION Drain tip cultures from immediate implant-based breast reconstructions significantly correlated with SSIs. Close monitoring is crucial, especially when S. aureus is identified in the culture.
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Affiliation(s)
- Ji-Young Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Plastic and Reconstructive Surgery, Hanyang University Medical Center, Seoul, Korea
| | - I Zhen Ma
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Zhan B, Fang S, Lv X, Xie X, Wang X. Effect of drain placement in short-level spinal surgery on postoperative wound infection: A meta-analysis. Int Wound J 2024; 21:e14508. [PMID: 38037852 PMCID: PMC10898379 DOI: 10.1111/iwj.14508] [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: 10/25/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023] Open
Abstract
In the meta-analysis, we evaluated the efficacy of placing drainage channels following single- or double-level spine surgery in order to decrease the incidence of postoperative injury. We conducted the analysis with the help of four databases: PubMed, Embase, Cochrane Library and Web of Science. A review of related studies was carried out after evaluating the quality of the literature against the classification and exclusion criteria set for the trial. Calculation of 95% CI, OR and MD was performed with fixed-effect models. A meta-analysis of the data was carried out with RevMan 5.3. Meta-analyses of randomized controlled trial (RCT) did not indicate that there were a statistically significantly different incidence of postoperative wound infections among those who received drainage compared to those who did not receive drainage (OR, 2.29; 95% CI, 0.50, 10.41 p = 0.28). Moreover, there were no statistically significant differences in post-operation hematoma (OR, 1.20; 95% CI, 0.27, 5.28 p = 0.81) and visual analogue scale score (MD, -0.01; 95% CI, -1.34, 1.33 p = 0.99). Thus, placing drainage in short-levels of spine operation did not significantly influence the outcome of postoperative wound complications. Nevertheless, because of the limited sample size chosen for this meta-analysis, caution should be exercised when treating these data. More high-quality RCT trials with a large number of samples are required to confirm the findings.
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Affiliation(s)
- Baoming Zhan
- Department of Spinal SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Shiqiang Fang
- Department of Spinal SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Xiuhong Lv
- Department of Spinal SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Xuesheng Xie
- Department of Spinal SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Xing Wang
- Department of Trauma and OrthopedicsPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
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Kwon H, Lee S, Lee SH, Kim ES. Dural rupture and subsequent spinal cord herniation due to closed wound suction drainage after spinal surgery. Br J Neurosurg 2023; 37:1171-1175. [PMID: 33576692 DOI: 10.1080/02688697.2021.1885623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
Closed wound suction drains are commonly used in spinal surgery. Severe neurological complications related to their use are rare. Here, we report a case of a dural rupture and subsequent spinal cord herniation related to the use of closed suction drains after posterior decompression and fixation surgery for spinal metastasis.
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Affiliation(s)
- Hyukjun Kwon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sungjoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Schnake KJ, Pumberger M, Rappert D, Götz A, Zolotoverkh O, Waligora R, Scheyerer MJ. Closed-suction drainage in thoracolumbar spinal surgery-clinical routine without evidence? a systematic review. 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; 31:614-622. [PMID: 35092451 DOI: 10.1007/s00586-021-07079-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The considered benefit of surgical drain use after spinal surgery is to prevent local accumulation of a haematoma by decompressing the closed space in the approach of the surgical site. In this context, the aim of the present systematic review was to prove the benefit of the routine use of closed-suction drains. METHODS We conducted a comprehensive systematic review of the literature according to the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist and algorithm. RESULTS Following the literature search, 401 potentially eligible investigations were identified. Eventually, a total of 24 studies with 8579 participants were included. Negative suction drainage led to a significantly higher volume of drainage fluid. Drainage duration longer than 72 h may be associated with a higher incidence of Surgical side infections (SSI); however, accompanying antibiotic treatment is unnecessary. Regarding postoperative haematoma and neurological complications, no evidence exists concerning their prevention. Hospital stay length and related costs may be elevated in patients with drainage but appear to depend on surgery type. CONCLUSIONS With regard to the existing literature, the use of closed-suction drainage in elective thoracolumbar spinal surgery is not associated with any proven benefit for patients and cannot decrease postoperative complications.
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Affiliation(s)
- Klaus John Schnake
- Center for Spine and Scoliosis Therapy, Malteser Waldkrankenhaus St.,Marien, Erlangen, Germany.,Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Matthias Pumberger
- Spine Department, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Denis Rappert
- Center for Spine and Scoliosis Therapy, Malteser Waldkrankenhaus St.,Marien, Erlangen, Germany
| | - Achim Götz
- Center for Spine and Scoliosis Therapy, Malteser Waldkrankenhaus St.,Marien, Erlangen, Germany
| | - Oleksandr Zolotoverkh
- Center for Spine and Scoliosis Therapy, Malteser Waldkrankenhaus St.,Marien, Erlangen, Germany
| | - Rita Waligora
- Spine Department, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Max Joseph Scheyerer
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
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van Schelt M, Jenniskens K, Rentenaar RJ, Bronsveld I. Diagnostic value of routine chest tube tip culture in surgery for noninfectious lung disease. J Cardiothorac Surg 2021; 16:329. [PMID: 34758852 PMCID: PMC8582142 DOI: 10.1186/s13019-021-01713-6] [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: 08/17/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluation of the diagnostic value of routine chest tube tip culture for detection of postoperative infection after surgery for noninfectious lung disease. METHODS Included subjects were patients who underwent lung surgery between January 1st 2013 and January 1st 2018 in University Medical Centre Utrecht and of whom a chest tube tip was cultured. Postoperative outcomes included pneumonia, surgical site infection, and empyema within 30 days after surgery. Univariable analysis for diagnostic accuracy of chest tube tip culture results predicting these postoperative outcomes was performed, as well as multivariable analysis using penalized firth logistic regression. RESULTS Patients developed one or more postoperative infections in 42 out of 210 (20%) lung surgeries. Pneumonia, surgical site infection, and empyema were found in 36 (17%), 8 (4%), and 2 (1%) cases respectively. Chest tube tip culture had a sensitivity of 31%, a specificity of 83%, a positive predictive value of 32%, and a negative predictive value of 83% for postoperative infections. In the subgroup of patients who did not have evidence of postoperative infection at the time of chest tube removal, the drain tip culture's positive and negative predictive value changed to 18% and 92% respectively. Adding additional variables to chest tube tip culture in a prediction model resulting in only limited improvement in diagnostic performance. CONCLUSIONS We found insufficient diagnostic performance to support the practice of routine chest tube tip culture after surgery for noninfectious lung disease. Therefore, routine chest tube tip culture is not advisable and should be omitted to unburden the healthcare process and prevent low value care together with extra costs.
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Affiliation(s)
- Martijn van Schelt
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Kevin Jenniskens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rob J Rentenaar
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inez Bronsveld
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
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Prolonged Post-surgical Drain Retention Increases Risk for Deep Wound Infection After Spine Surgery. World Neurosurg 2019; 130:e846-e853. [DOI: 10.1016/j.wneu.2019.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 01/25/2023]
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Bacterial profile of suction drains and the relationship thereof to surgical-site infections in prosthetic breast reconstruction. Arch Plast Surg 2018; 45:542-549. [PMID: 30466234 PMCID: PMC6258990 DOI: 10.5999/aps.2018.00437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/05/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite the increasing popularity of prosthetic breast reconstruction, scant data exist on the microbiological profile of drainage fluid from closed-suction drains and the relationship thereof to surgical-site infections (SSIs) in breast reconstruction surgery. This study aimed to determine whether bacteria isolated from drainage fluid were associated with the development of SSIs, and whether the bacterial profile of drainage fluid could be a clinically useful predictor of SSIs. METHODS We performed a retrospective chart review of 61 women who underwent tissue expander/implant or direct-to-implant reconstructions. Patient demographics and culture studies of drainage fluid from suction drains collected on postoperative day 7 were evaluated. RESULTS Sixteen patients (26.23%) were culture-positive, and 45 patients (73.77%) were culture-negative. The most frequently isolated bacteria were coagulase-negative staphylococci, followed by Staphylococcus aureus. SSIs were diagnosed in seven patients and were mostly resolved by systemic antibiotics; however, the tissue expander or implant was explanted in two patients. Positive culture of drainage fluid from closed-suction drains was significantly associated with the development of SSIs (P<0.05). The positive predictive value was 37.50%, and the negative predictive value was 97.78%. CONCLUSIONS To our knowledge, this study is the first to demonstrate a significant association between the microbiological profile of drainage fluid from closed-suction drains and the development of SSIs in patients with prosthetic breast reconstructions. The high negative predictive value suggests that microbial testing of drainage fluid from closed-suction drains may have clinical utility. Further prospective studies with larger sample sizes are required to confirm our findings.
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Methicillin-Resistant Staphylococcus aureus Nasal Swab and Suction Drain Tip Cultures in 4573 Spinal Surgeries: Efficacy in Management of Surgical Site Infections. Spine (Phila Pa 1976) 2018; 43:E430-E435. [PMID: 28767628 DOI: 10.1097/brs.0000000000002360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective single-center study. OBJECTIVE To assess the diagnostic value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab and suction drain tip cultures. SUMMARY OF BACKGROUND DATA The prognostic value of MRSA nasal swab and suction drain tip cultures has not been firmly established in spinal surgery. METHODS This study retrospectively included 4573 consecutive patients who underwent spinal surgery between January 2008 and December 2014. Patients diagnosed with infectious disease were excluded. Prophylactic antibiotics were administered intraoperatively and postoperatively for 48 hours. MRSA nasal swab cultures were taken from all patients before surgery. Drains were removed when the volume of postoperative fluid drainage was less than 50 mL in the preceding 24 hours and cultures were made. Surgical site infection (SSI) was defined according to Centers for Disease Control and Prevention criteria. RESULTS SSI was identified in 94 cases (2.1%) and bacteria were isolated in 87 cases (92.6%). Positive MRSA nasal swab cultures were identified in 49 cases (1.1%). There was no significant difference in the SSI positivity rate between the MRSA nasal swab culture (+) and (-) groups. Positive drain tip cultures were found in 382 cases (8.4%), 28 of which developed SSI. There was a significant difference in the SSI positivity rate between the drain tip culture (+) and (-) groups. The sensitivity of drain tip culture was 29.8% and the specificity was 92.1%. In 16 of the 28 patients in the SSI (+) group with positive drain cultures, the same bacteria were isolated from the surgical site, giving a bacteria matching rate of 57.1%. CONCLUSION MRSA nasal swab and drain tip cultures were not useful for predicting SSI. However, drain tip culture had a high positivity rate in the SSI group and the coincidence rate for the causative pathogen was relatively high. LEVEL OF EVIDENCE 4.
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Kobayashi K, Ando K, Ito K, Tsushima M, Morozumi M, Tanaka S, Machino M, Ota K, Ishiguro N, Imagama S. Prediction of surgical site infection in spine surgery from tests of nasal MRSA colonization and drain tip culture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1053-1057. [PMID: 29470651 DOI: 10.1007/s00590-018-2163-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/09/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE MRSA is an organism that is a possible risk factor for postoperative SSI. The purpose of the study was to examine relationships among surgical site infection (SSI) after spinal surgery, nasal methicillin-resistant staphylococcus aureus (MRSA) colonization, and wound drain culture results. METHODS The subjects were 132 patients who underwent spinal instrumentation surgery. A preoperative nasal swab was used to check for the presence of MRSA colonization, and a wound drain tip culture was performed for detection of SSI. Data from culture studies using nasal samples and those from the distal tip of the wound drain were used for analysis. RESULTS Five patients (3.8%) had nasal MRSA, 17 (13%) had positive drain tip cultures, 15 (11%) had SSIs, and 10 (8%) had SSIs with MRSA. Patients with nasal MRSA had a higher rate of detection of bacteria in the drain tip culture (40 vs. 19%, p = 0.065), and the SSI rate was significantly higher in patients with a positive drain tip culture (33 vs. 10%, p = 0.012). The total SSI rate differed significantly between patients with and without nasal MRSA (40 vs. 10%, p = 0.039); however, the SSI with MRSA rate did not differ significantly between these groups. CONCLUSION MRSA carriers were not necessarily associated with MRSA infection, but were related to a positive drain tip culture and SSI, which might be due to endogenous skin bacteria. Therefore, possible SSI should be considered in patients with nasal MRSA colonization or bacteria detected in a drain tip culture.
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Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya, 466-8550, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya, 466-8550, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya, 466-8550, Japan
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya, 466-8550, Japan
| | - Masayoshi Morozumi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya, 466-8550, Japan
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya, 466-8550, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya, 466-8550, Japan
| | - Kyotaro Ota
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya, 466-8550, Japan.
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Ishioka K, Hokuto D, Nomi T, Yasuda S, Yoshikawa T, Matsuo Y, Akahori T, Nishiwada S, Nakagawa K, Nagai M, Nakamura K, Ikeda N, Sho M. Significance of bacterial culturing of prophylactic drainage fluid in the early postoperative period after liver resection for predicting the development of surgical site infections. Surg Today 2018; 48:625-631. [PMID: 29380135 DOI: 10.1007/s00595-018-1629-8] [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: 10/10/2017] [Accepted: 01/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSES The relationship between the results of bacterial drainage fluid cultures in the early postoperative period after liver resection and the development of surgical site infections (SSIs) is unclear. We evaluated the diagnostic value of bacterial cultures of drainage fluid obtained on postoperative day (POD) 1 after liver resection. METHODS The cases of all consecutive patients who underwent elective liver resection from January 2014 to December 2016 were analyzed. The association between a positive culture result and the development of SSIs was analyzed. RESULTS A total of 195 consecutive patients were studied. Positive drainage fluid cultures were obtained in 6 patients (3.1%). A multivariate analysis revealed that a positive drainage fluid culture was an independent risk factor for SSIs (odds ratio: 8.04, P = 0.035), and combined resection of the gastrointestinal tract was a risk factor for a positive drainage fluid culture (P = 0.006). Among the patients who did not undergo procedures involving the gastrointestinal tract, there was no association between drainage fluid culture positivity and SSIs. CONCLUSIONS The detection of positive culture results for drainage fluid collected on POD 1 after liver resection was associated with SSIs. However, among patients who did not undergo procedures involving the gastrointestinal tract, it was not a predictor of SSIs.
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Affiliation(s)
- Kohei Ishioka
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Daisuke Hokuto
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Takeo Nomi
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Satoshi Yasuda
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Takahiro Yoshikawa
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yasuko Matsuo
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Takahiro Akahori
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Satoshi Nishiwada
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kenji Nakagawa
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Minako Nagai
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kota Nakamura
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Naoya Ikeda
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Hida T, Ando K, Kobayashi K, Ito K, Tsushima M, Matsumoto A, Morozumi M, Tanaka S, Machino M, Ota K, Kanbara S, Ito S, Nishida Y, Ishiguro N, Imagama S. Intrawound Vancomycin powder as the prophylaxis of surgical site infection after invasive spine surgery with a high risk of infection. NAGOYA JOURNAL OF MEDICAL SCIENCE 2017; 79:545-550. [PMID: 29238110 PMCID: PMC5719213 DOI: 10.18999/nagjms.79.4.545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Surgical site infections (SSIs) are one of the most serious complications in spine surgery. We investigated the efficacy of locally administered vancomycin (VCM) powder for prophylaxis on SSI after invasive spine surgery. We retrospectively studied 174 consecutive patients who underwent spine surgery. In patients of the VCM group (n = 81), VCM powder was administered in the wound before closing wound. Patients who did not receive VCM treatment were set as a control group (n = 93). We compared the patients’ background, operation time, intraoperative blood loss, usage of implants, presence of deep SSI, and side effects between the two groups. There were no significant differences between the groups in age, gender, and BMI. The operation time and the intraoperative blood loss were longer and greater in the VCM group than in the control group (P < 0.005, P < 0.001, respectively). Implants were used in 85% of the VCM group, and in 31% of the control group (P < 0.001). Deep SSI was not observed in the VCM group, whereas it was observed in 4 patients in the control group. No side effects were observed in any of the cases. In conclusion, surgeons applied VCM for cases which were invasive or had a high risk of infection. However, deep SSI was not observed in anyone in the VCM group. The intrawound administration of VCM might be effective to prevent SSI in cases with high risks of infection.
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Affiliation(s)
- Tetsuro Hida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akiyuki Matsumoto
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayoshi Morozumi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyotaro Ota
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Kanbara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Choi HS, Lee SG, Kim WK, Son S, Jeong TS. Is Surgical Drain Useful for Lumbar Disc Surgery? KOREAN JOURNAL OF SPINE 2016; 13:20-3. [PMID: 27123026 PMCID: PMC4844656 DOI: 10.14245/kjs.2016.13.1.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 11/19/2022]
Abstract
Objective Surgical drains are commonly used after the spine surgeries for minimizing hematoma formation, which can delay wound healing and may become a source of fibrosis, infection, and pain. The drain, however, may provide a direct route for infection if it is contaminated. Our objective was to survey the relationship between surgical drains and infection. Methods The 70 patients who had undergone single-level lumbar discectomy from April 2011 to March 2012 were retrospectively analyzed. Each patient's medical chart and magnetic resonance image were thoroughly reviewed after all the patients had been divided into the drainage and the nondrainage groups. The amounts and durations of the surgical drains in the drainage group were analyzed. Additionally, the levels of C-reactive protein, rates of infection, scores of preoperative and postoperative visual analog scale (VAS), and lengths of hospital stay after operation were compared between the 2 groups. Results In this study, 70 patients were retrospectively analyzed; out of which, 42 and 28 patients were included in the drainage and the nondrainage groups, respectively. Two of the postoperative infection cases in the nondrainage group required to undergo repeated operations. The frequency of the postoperative infection cases was higher in the nondrainage group than in the drainage group; however, there was no significant statistical difference between the 2 groups (p=0.157). Conclusion Surgical drains did not elevate postoperative infection. Furthermore, drain tip cultures allowed us to detect postoperative infection at an early stage, and it led to faster initiation of antibiotics treatment.
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Affiliation(s)
- Ho Seok Choi
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Sang Gu Lee
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong Son
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Tae Seok Jeong
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
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