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Liedl HJ, Lazenby KA, Arimoto RS, Singh A, Strelzow JA. Normothermia to Decrease Surgical Site Infection Risk: Silver Bullet or Fool's Gold? A Retrospective Cohort Study. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202406000-00008. [PMID: 38875451 PMCID: PMC11191004 DOI: 10.5435/jaaosglobal-d-23-00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE Surgical site infection (SSI) is the leading cause of nosocomial infections among surgical patients in the United States. Currently, there is compelling evidence suggesting that temperature dysregulation in surgical patients may be a risk factor for the development of SSI. We examined the relationship between perioperative hypothermia (PH) and SSI in a population of surgical patients with diabetes mellitus (DM). METHODS This retrospective cohort review was conducted on patients with a history of DM undergoing orthopaedic surgery at our institution between May 1, 2018, and April 1, 2022. Inclusion criteria were age older than 15 years, a history of DM or recent hemoglobin A1c concentration of ≥6.5%, and operation of at least 60 minutes under general anesthesia. Perioperative hypothermia was defined as an intraoperative temperature ≤ 35.5°C. Continuous variables were compared using the t-test and Wilcoxon rank-sum test. Categorical variables were compared using the chi-squared test. We constructed a multivariable logistic regression model to estimate SSI risk while controlling for demographic variables. RESULTS A total of 236 patients were included in the final analysis. The overall incidence of SSI was 5.93%. 99 patients (42%) experienced PH. No difference was observed in the risk of SSI between the normothermic and hypothermic cohorts. Among the 99 patients who experienced PH, increasing HbA1c was associated with increasing risk of SSI (OR = 2.39, 95% CI = 1.12 to 5.32, P-value = 0.0222). The multivariable logistic regression model had good discriminatory ability (c-statistic 0.74, 95% CI: 0.61 to 0.89) and good predictive accuracy (sensitivity 64%, specificity 73%). DISCUSSION PH is not an independent risk factor of SSI. However, in the presence of elevated HbA1c, PH may more than double the risk of SSI. Perioperative hypothermia may be an additive risk factor in the setting of poor glycemic control and potentially in the setting of other known risk factors.
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Affiliation(s)
- Henry J.C. Liedl
- From the Department of Orthopaedic Surgery, University of Chicago Medicine, Chicago, IL (Dr. Liedl and Dr. Strelzow), and the Pritzker School of Medicine, University of Chicago, Chicago, IL (Dr. Liedl, Dr. Lazenby, Dr. Arimoto, and Mr. Singh)
| | - Kevin A. Lazenby
- From the Department of Orthopaedic Surgery, University of Chicago Medicine, Chicago, IL (Dr. Liedl and Dr. Strelzow), and the Pritzker School of Medicine, University of Chicago, Chicago, IL (Dr. Liedl, Dr. Lazenby, Dr. Arimoto, and Mr. Singh)
| | - Ryuji S. Arimoto
- From the Department of Orthopaedic Surgery, University of Chicago Medicine, Chicago, IL (Dr. Liedl and Dr. Strelzow), and the Pritzker School of Medicine, University of Chicago, Chicago, IL (Dr. Liedl, Dr. Lazenby, Dr. Arimoto, and Mr. Singh)
| | - Armaan Singh
- From the Department of Orthopaedic Surgery, University of Chicago Medicine, Chicago, IL (Dr. Liedl and Dr. Strelzow), and the Pritzker School of Medicine, University of Chicago, Chicago, IL (Dr. Liedl, Dr. Lazenby, Dr. Arimoto, and Mr. Singh)
| | - Jason A. Strelzow
- From the Department of Orthopaedic Surgery, University of Chicago Medicine, Chicago, IL (Dr. Liedl and Dr. Strelzow), and the Pritzker School of Medicine, University of Chicago, Chicago, IL (Dr. Liedl, Dr. Lazenby, Dr. Arimoto, and Mr. Singh)
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Spatenkova V, Bradac O, Mareckova Z, Suchomel P, Hradil J, Kuriscak E, Halacova M. Incidence of surgical site infections after cervical spine surgery: results of a single-center cohort study adhering to multimodal preventive wound control protocol. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:1997-2004. [PMID: 36102993 PMCID: PMC10276122 DOI: 10.1007/s00590-022-03379-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The incidence of surgical site infections is considered a relevant indicator of perioperative and postoperative care quality. The aim of this study is to analyze and evaluate SSIs after elective cervical spine surgery under the guidance of our preventive multimodal wound protocol. METHODS A monocentric observational cohort study analyzed 797 patients who underwent cervical spine surgery from 2005 to 2010 (mean age 51.58 ± 11.74 year, male 56.09%, mean BMI 26.87 ± 4.41, ASA score 1-2 in 81.68% of patients), fulfilling the entry criteria: (1) cervical spine surgery performed by neurosurgeons (degenerative disease 85.19%, trauma 11.04%, tumor 3.76%), (2) elective surgery, (3) postoperative care in our neurointensive care unit. Our preventive wound control protocol management focused mainly on antibiotic prophylaxis, wound hygiene regime, and drainage equipment. All wound complications and surgical site infections were monitored up for 1 year after surgery. RESULTS We had only 2 (0.25%) patients with SSI after cervical spine surgery-one organ/space infection (osteomyelitis, primary due to liquorrhea) after anterior surgical approach, and one deep surgical site infection (due to dehiscence) after posterior approach. We had 17 (2.13%) patients with some wound complications (secretion 7, dehiscence 4, hematoma 1, edema 3, and liquorrhea 2) that were not classified as SSI according to the CDC guidelines. CONCLUSION Concerning our study population of patients undergoing elective cervical surgery, with ASA scores 1-2 in 81.68% of our patients, the incidence of SSI was 0.14% after anterior surgical approach, 1.4% after posterior surgical approach, and 0.25% altogether in the referred cohort.
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Affiliation(s)
- Vera Spatenkova
- Neurocenter, Neurointensive Care Unit, Regional Hospital, Husova 357/10, 46063 Liberec, Czech Republic
- Department of Anaesthesia and Intensive Care, 3 Medical Faculty, Charles University, Srobarova 50, 100 34 Prague, Czech Republic
- Institute of Physiology, First Medical Faculty, Charles University in Prague, Albertov 5, 12800 Prague 2, Czech Republic
- Faculty of Health Studies, Technical University of Liberec, Studentská 1402/2, 461 17 Liberec 1, Czech Republic
| | - Ondrej Bradac
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84/1, 150 06 Prague, Czech Republic
| | - Zuzana Mareckova
- Neurocenter, Department of Neurosurgery, Regional Hospital, Husova 357/10, 46063 Liberec, Czech Republic
| | - Petr Suchomel
- Faculty of Health Studies, Technical University of Liberec, Studentská 1402/2, 461 17 Liberec 1, Czech Republic
- Neurocenter, Department of Neurosurgery, Regional Hospital, Husova 357/10, 46063 Liberec, Czech Republic
| | - Jan Hradil
- Neurocenter, Department of Neurosurgery, Regional Hospital, Husova 357/10, 46063 Liberec, Czech Republic
| | - Eduard Kuriscak
- Institute of Physiology, First Medical Faculty, Charles University in Prague, Albertov 5, 12800 Prague 2, Czech Republic
| | - Milada Halacova
- Department of Clinical Pharmacology, Na Homolce Hospital, Roentgenova 37/2, 150 30 Prague 5, Czech Republic
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Irgang L, Barth H, Holmén M. Data-Driven Technologies as Enablers for Value Creation in the Prevention of Surgical Site Infections: a Systematic Review. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 7:1-41. [PMID: 36910913 PMCID: PMC9995622 DOI: 10.1007/s41666-023-00129-2] [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: 04/05/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Abstract
Despite the advances in modern medicine, the use of data-driven technologies (DDTs) to prevent surgical site infections (SSIs) remains a major challenge. Scholars recognise that data management is the next frontier in infection prevention, but many aspects related to the benefits and advantages of using DDTs to mitigate SSI risk factors remain unclear and underexplored in the literature. This study explores how DDTs enable value creation in the prevention of SSIs. This study follows a systematic literature review approach and the PRISMA statement to analyse peer-reviewed articles from seven databases. Fifty-nine articles were included in the review and were analysed through a descriptive and a thematic analysis. The findings suggest a growing interest in DDTs in SSI prevention in the last 5 years, and that machine learning and smartphone applications are widely used in SSI prevention. DDTs are mainly applied to prevent SSIs in clean and clean-contaminated surgeries and often used to manage patient-related data in the postoperative stage. DDTs enable the creation of nine categories of value that are classified in four dimensions: cost/sacrifice, functional/instrumental, experiential/hedonic, and symbolic/expressive. This study offers a unique and systematic overview of the value creation aspects enabled by DDT applications in SSI prevention and suggests that additional research is needed in four areas: value co-creation and product-service systems, DDTs in contaminated and dirty surgeries, data legitimation and explainability, and data-driven interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s41666-023-00129-2.
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Affiliation(s)
- Luís Irgang
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
| | - Henrik Barth
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
| | - Magnus Holmén
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
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Gaszynski R, Wong P, Gray A, Diab J, Das A, Apostolou C, Merrett N. Loop and drain technique for prevention of surgical site infection in upper gastrointestinal surgery. ANZ J Surg 2022; 92:2143-2148. [PMID: 35903966 DOI: 10.1111/ans.17923] [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: 01/30/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hepatobiliary and pancreatic surgery is frequently complicated by surgical site infections (SSI) with significant postoperative morbidity and mortality rates contributing to the economic burden on healthcare. Advancements in operative techniques to prevent SSI are gaining traction in clinical practice. This study compares the effectiveness of the 'loop and drain technique (LDT)', a combination method utilizing a continuous subcutaneous vessel loop and subcuticular suture for surgical wound closure in patients undergoing upper gastrointestinal surgery at a Metropolitan Hospital in Sydney. METHODS A retrospective review of patients who underwent an upper gastrointestinal procedure was conducted at Bankstown-Lidcombe hospital between 2017 and 2019. There were 77 patients in the LDT group and 123 patients included in the control group. The primary outcome assessed was the rate of SSI. Secondary outcomes included length of stay (LOS) and drainage of surgical site infections. RESULT Two hundred adult patients were treated for an upper gastrointestinal procedure. The most common operation was a Whipple procedure (35.0%). The rate of SSI was 12.5% with all these patients receiving intravenous antibiotics. The LDT cohort had a significantly lower rate of SSI compared to their counterparts (3.9% vs. 17.9%, P = 0.004). CONCLUSION The LDT method is associated with a decreased incidence of SSI and should be considered as a cost-effective operative technique to improve patient outcomes after upper gastrointestinal surgery.
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Affiliation(s)
- Rafael Gaszynski
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - Pearl Wong
- Liverpool Hospital, Liverpool, Australia
| | - Andrew Gray
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - Jason Diab
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - Amitabha Das
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - Christos Apostolou
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - Neil Merrett
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia.,School of Medicine, Western Sydney University, Campbelltown, Australia
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