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Turan MI, Ozturk Durmaz S, Celik M, Akgul N. Current Practices in Antibiotic Prophylaxis for Transoral Endoscopic Thyroid and Parathyroid Surgery: A Comparative Study. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:939. [PMID: 40428897 PMCID: PMC12113538 DOI: 10.3390/medicina61050939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2025] [Revised: 05/17/2025] [Accepted: 05/20/2025] [Indexed: 05/29/2025]
Abstract
Background and Objectives: The transoral endoscopic thyroidectomy-vestibular approach (TOETVA) and parathyroidectomy-vestibular approach (TOEPVA) are scar-free alternatives to conventional surgery but are classified as clean-contaminated due to the oral incision, raising concerns about surgical site infections (SSIs). This study evaluates whether perioperative antibiotic prophylaxis (pABX) alone is sufficient compared to extended antibiotic prophylaxis (eABX) in preventing SSIs in TOET/PVA, particularly considering the surgical learning curve. Materials and Methods: A retrospective study analyzed 162 patients undergoing TOET/PVA at a single center from January 2018 to June 2024. Patients were divided into two groups: 82 received eABX (intravenous cefazolin preoperatively plus 7 days of oral amoxicillin/clavulanate), and 80 received pABX alone (intravenous cefazolin). The inclusion criteria included complete postoperative hemogram and C-reactive protein (CRP) records; exclusions comprised other surgical approaches or missing data. Outcomes included postoperative white blood cell (WBC) count, CRP levels, and complications (seroma, cellulitis, and flap perforation), defined using Centers for Disease Control and Prevention (CDC) guidelines. The statistical analysis comprised t-tests, chi-square tests, and logistic regression, adjusting for confounders like age and sex. Results: The postoperative WBC and CRP levels were significantly higher in the pABX group (p = 0.001), but all values remained within the laboratory normal limits. Complications were observed in 14 patients: seroma in 11, cellulitis in 2, and flap perforation in 1. Complications occurred more frequently in the eABX group but without statistical significance (p = 0.103). The duration of surgery was longer in the eABX group (117.93 ± 52.35 vs. 72.44 ± 22.54 min, p = 0.001) and was an independent predictor of complications (OR = 1.018, 95% CI: 1.006-1.031, p = 0.004). Conclusions: Perioperative antibiotic prophylaxis alone does not increase the risk of SSIs compared to extended prophylaxis in TOETVA. However, eABX may be prudent during the learning curve due to longer operative times and higher complication risks. Future prospective, randomized trials are needed to standardize prophylaxis regimens.
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Affiliation(s)
- Mehmet Ilker Turan
- Department of General Surgery, Kepez State Hospital, 07320 Antalya, Turkey
| | - Senay Ozturk Durmaz
- Department of Infectious Diseases and Clinical Microbiology, Kepez State Hospital, 07320 Antalya, Turkey;
| | - Mehmet Celik
- Department of Endocrinology and Metabolism, Medical Faculty, Trakya University, 22000 Edirne, Turkey;
| | - Nedim Akgul
- Department of General Surgery, Antalya Training and Research Hospital, University of Health Sciences, 07070 Antalya, Turkey;
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Hong PKW, Pathak A, Shirali AS. Predictors of postoperative complications following thyroidectomy: A systematic review. SURGERY IN PRACTICE AND SCIENCE 2024; 18:100252. [PMID: 39845428 PMCID: PMC11749984 DOI: 10.1016/j.sipas.2024.100252] [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: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 01/24/2025] Open
Abstract
Introduction Thyroidectomy is considered a relatively safe procedure with a low risk of postoperative complications, making it challenging to identify predictors of complications to improve shared decision making. Recent advancements in clinical bioinformatics and surgical decision-making tools have the potential to improve patient outcomes. This systematic review aimed to assess the current understanding of factors predicting such complications following thyroidectomy. Methods We searched PubMed/MEDLINE, Web of Science, and EMBASE for studies published between 2010 and October 2023, investigating predictors of postoperative complications after thyroidectomy. Studies were included if they investigated predictors of hypocalcemia, hypoparathyroidism, vocal cord paresis (VCP), hematoma, or other postoperative complications. Studies solely reliant on univariate and ROC analyses were excluded. Independent predictors of each postoperative complication were evaluated and categorized as biochemical, surgical, and patient/disease specific. Results Forty-five studies were included. Biochemical hypocalcemia and transient hypoparathyroidism were the most investigated complications, with reported rates ranging from 15.7 % to 76.7 % and 12.9 % to 53.8 %, respectively. The majority of studies (n = 35, 77 %) focused on these complications. Biochemical markers (e.g., serum calcium, parathyroid hormone) were the most frequent predictors identified for these complications. Surgical factors (inadvertent parathyroidectomy) were frequently studied for all complications. Age, gender, and thyroid pathology were common patient/disease-specific predictors. Conclusion This review highlights the disparity in research on complication predictors. Most studies focused on hypocalcemia and hypoparathyroidism, with fewer examining VCP, hematoma, and mortality. Notably, a lack of high-quality evidence exists due to the scarcity of prospective and randomized controlled trials. Future research should explore incorporating a wider range of independent predictors, especially surgical factors, into comprehensive predictive models. This review can serve as a foundation for developing such models to improve risk prediction for a broader spectrum of thyroidectomy complications.
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Affiliation(s)
- Philip KW Hong
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Aman Pathak
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Aditya S Shirali
- Department of Surgery, Division of Surgical Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
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Zhang D, Sun H, Kim HY, Chai YJ, Tufano RP, Wu CW, Pino A, Anuwong A, Dionigi G. Bacterial Colonization on Endoscopic Materials and Surgical Field Without Infections After Transoral Endoscopic Thyroidectomy. Surg Laparosc Endosc Percutan Tech 2024; 34:248-258. [PMID: 38767568 DOI: 10.1097/sle.0000000000001067] [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: 08/10/2021] [Accepted: 01/27/2022] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Our aim was to determine whether bacteria contamination occurred within the surgical field or on endoscopic equipment during surgery using the transoral endoscopic thyroidectomy vestibular approach (TOETVA). MATERIALS AND METHODS Participants were recruited from patients planned for TOETVA between May 2017 and December 2019. Bacterial samples were taken before and at the conclusion of the TOETVA procedure. The preoperative and postoperative samples were taken from the endoscopic materials and inferior oral vestibulum using a sterile flocked swab. RESULTS The study resulted in 480 samples (80 TOETVAs). No vestibular, port site, or neck infections occurred in any of the patients. Three (3.7%) out of 80 patients developed postoperative fever. Our results show different microbial communities during TOETVA. The most prevalent species detected were S treptococcus species. Multivariate logistic regression analyses revealed that the degree of contamination depended on the sampling site (inferior vestibulum > equipment) ( P =0.03). In addition, the abundance of bacteria was affected by operative time ( P =0.013). There were no significant differences observed in isolation frequencies of bacteria in malignancy ( P =0.34). CONCLUSIONS TOETVA surgery is categorized as a "clean-contaminated" operation. A swab identified the common colonizers of oral microbiota on the endoscopic equipment and within the surgical field.
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Affiliation(s)
- Daqi Zhang
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Sun
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hoon Yub Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital
| | - Young Jun Chai
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Che-Wei Wu
- Department of Otorhinolaryngology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Antonella Pino
- Division of General Surgery, Endocrine Surgery Section, Istituto Auxologico Italiano IRCCS
| | - Angoon Anuwong
- Department of Surgery, Minimally Invasive and Endocrine Surgery Division, Police General Hospital, Bangkok, Thailand
| | - Gianlorenzo Dionigi
- Division of General Surgery, Endocrine Surgery Section, Istituto Auxologico Italiano IRCCS
- Department of Pathophysiology and Transplantation, University of Milan, Italy
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Polistena A, Prete FP, Avenia S, Cavallaro G, Di Meo G, Pasculli A, Rondelli F, Sanguinetti A, Sgaramella LI, Avenia N, Testini M, Gurrado A. Effect of Antibiotic Prophylaxis on Surgical Site Infection in Thyroid and Parathyroid Surgery: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:290. [PMID: 35326753 PMCID: PMC8944446 DOI: 10.3390/antibiotics11030290] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 02/04/2023] Open
Abstract
Thyroid and parathyroid surgery are considered clean procedures, with an incidence of surgical site infection (SSI) after thyroidectomy ranging from 0.09% to 2.9%. International guidelines do not recommend routine antibiotic prophylaxis (AP), while AP seems to be employed commonly in clinical practice. The purpose of this systematic review is analyzing whether the postoperative SSI rate in thyroid and parathyroid surgery is altered by the practice of AP. We searched Pubmed, Scopus, the Cochrane Library, and Web of Science (WOS) for studies comparing AP to no preoperative antibiotics up to October 2021. Data on the SSI rate was evaluated and summarized as relative risks (RR) with 95% confidence intervals (95% CI). Risk of bias of studies were assessed with standard methods. Nine studies (4 RCTs and 5 nRCTs), including 8710 participants, were eligible for quantitative analysis. A meta-analysis showed that the SSI rate was not significantly different between AP and no preoperative antibiotics (SSI rate: 0.6% in AP vs. 2.4% in control group; RR 0.69, 0.43-1.10 95% CI, p = 0.13, I2 = 0%). A sensitivity analysis and subgroup analysis on RCTs were consistent with the main findings. Evidence of low quality supports that AP in thyroid and parathyroid surgery produce similar SSI rates as to the absence of perioperative antibiotics.
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Affiliation(s)
- Andrea Polistena
- Oncologic and Laparoscopic Surgery, Department of Surgery Pietro Valdoni, Sapienza University of Rome, Policlinico Umberto I, 00161 Roma, Italy;
- General and Endocrine Surgery, School of Medical, University of Perugia, S. Maria University Hospital, 05100 Terni, Italy; (S.A.); (F.R.); (A.S.); (N.A.)
| | - Francesco Paolo Prete
- Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy; (F.P.P.); (G.D.M.); (A.P.); (L.I.S.); (M.T.); (A.G.)
| | - Stefano Avenia
- General and Endocrine Surgery, School of Medical, University of Perugia, S. Maria University Hospital, 05100 Terni, Italy; (S.A.); (F.R.); (A.S.); (N.A.)
| | - Giuseppe Cavallaro
- Oncologic and Laparoscopic Surgery, Department of Surgery Pietro Valdoni, Sapienza University of Rome, Policlinico Umberto I, 00161 Roma, Italy;
| | - Giovanna Di Meo
- Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy; (F.P.P.); (G.D.M.); (A.P.); (L.I.S.); (M.T.); (A.G.)
| | - Alessandro Pasculli
- Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy; (F.P.P.); (G.D.M.); (A.P.); (L.I.S.); (M.T.); (A.G.)
| | - Fabio Rondelli
- General and Endocrine Surgery, School of Medical, University of Perugia, S. Maria University Hospital, 05100 Terni, Italy; (S.A.); (F.R.); (A.S.); (N.A.)
| | - Alessandro Sanguinetti
- General and Endocrine Surgery, School of Medical, University of Perugia, S. Maria University Hospital, 05100 Terni, Italy; (S.A.); (F.R.); (A.S.); (N.A.)
| | - Lucia Ilaria Sgaramella
- Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy; (F.P.P.); (G.D.M.); (A.P.); (L.I.S.); (M.T.); (A.G.)
| | - Nicola Avenia
- General and Endocrine Surgery, School of Medical, University of Perugia, S. Maria University Hospital, 05100 Terni, Italy; (S.A.); (F.R.); (A.S.); (N.A.)
| | - Mario Testini
- Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy; (F.P.P.); (G.D.M.); (A.P.); (L.I.S.); (M.T.); (A.G.)
| | - Angela Gurrado
- Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy; (F.P.P.); (G.D.M.); (A.P.); (L.I.S.); (M.T.); (A.G.)
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Karakas E, Klein G, Michlmayr L, Schardey M, Schopf S. Transoral thyroid surgery vestibular approach: is there an increased risk of surgical site infections? Updates Surg 2021; 74:303-308. [PMID: 34671926 PMCID: PMC8827351 DOI: 10.1007/s13304-021-01191-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is an upcoming surgical technique with the aim to optimize cosmetic outcome avoiding visible scars in the neck. However, the transoral access bears the risk of contamination and microbial allocation from the mouth into the thyroid region. Therefore, some authors recommend extended antibiotic therapy up to 7 days after surgery. Our aim was to evaluate infection rates and parameters before and after transoral surgery and to suggest a viable and safe routine in transoral surgery. Prospectively collected data of patients who were eligible for transoral surgery in Austria and Germany between June 2017 and July 2020 were retrospectively evaluated focussing on clinical and laboratory infection signs pre and postoperatively. White blood cell count (WBC) and C-reactive protein levels (CRP) were estimated before and after surgery. Patients` characteristics, surgical outcome and complications were also determined and compared to the current results reported in the literature. 113 transoral operations were performed in 108 patients. In 37 of 108 (36%) patients an additional retroauricular incision in the hairline and in two patients a submental skin incision was performed to extract thyroid specimen of more than 40 ml. Intravenous antibiotic prophylaxis and enoral mucosal disinfection were used in all patients before surgery. WBC and CRP levels were available in 75 patients. Median WBC was 5800/µl (range 3500–10,500/µl) before and significantly higher (median 8900/µl, range 4500–18,800 µl; p < 0.01) at day one after surgery. WBC returned to normal range (4500–11,500/µl) in all patients within the first 7 days postoperatively (median 5300/µl, range 3400–8700/µl). CRP levels were normal before (< 0.5 mg/dl) and slightly elevated within the first two days after surgery (Median 2.0 mg/dl, range 0.5–6.4 mg/dl, n.s.). In one patient oral antibiotic therapy was necessary due to transient erythema in the chin region which occurred 10 days after surgery and resolved completely without surgical intervention. Despite a transient increase in WBC transoral thyroid and parathyroid surgery via the vestibular approach does not seem to be associated with a significant number of wound infections in our patients. Intravenous antibiotic prophylaxis and enoral mucosal disinfection might be reasonable procedures to avoid microbial allocation from the mouth into the thyroid region. However, further investigations are required to finally estimate the need of antibiotics in transoral surgery.
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Affiliation(s)
- Elias Karakas
- Department of General-, Abdominal- and Endocrine Surgery, Hospital Maria Hilf, Alexianer GmbH, 470805, Krefeld, Germany.
| | - Günther Klein
- Department of General Surgery, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Linda Michlmayr
- Department of General Surgery, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Martin Schardey
- Department of General-, Abdominal and Vascular Surgery, Hospital Agatharied, Hausham, Germany
| | - Stefan Schopf
- Department of General-, Abdominal- and Endocrine Surgery, RoMed Hospital, Bad Aibling, Germany
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6
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Medas F, Canu GL, Cappellacci F, Romano G, Amato G, Erdas E, Calò PG. Antibiotic Prophylaxis for Thyroid and Parathyroid Surgery: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 164:482-488. [DOI: 10.1177/0194599820947700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective Although thyroid and parathyroid surgery is considered a clean procedure with a low incidence of surgical site infections (SSIs), a great number of endocrine surgeons use antibiotic prophylaxis (AP). The aim of this study was to assess whether AP is significantly effective in reducing the incidence of SSIs in this kind of surgery. Data Sources A systematic literature search was performed with PubMed, Scopus, and ISI–Web of Science. Studies addressing the efficacy of AP in reducing the incidence of SSIs in thyroid and parathyroid surgery were included in the systematic review and meta-analysis. Review Methods The random effects model was assumed to account for different sources of variation among studies. The overall effect size was computed through the inverse variance method. Heterogeneity across studies, possible outlier studies, and publication bias were evaluated. Results A total of 6 studies with 4428 patients were included in the quantitative analysis. The incidence of SSI was 0.6% in the case group and 0.4% in the control group (odds ratio, 1.07; 95% CI, 0.3-3.81; P = .915). There was no evidence of heterogeneity among the studies ( Q = 8.36, P = .138; I2 = 40.17). The analysis of several continuous moderators, including age, use of drain, and duration of surgery, did not generate any significant result. Conclusion AP is not effective in reducing the incidence of SSI in thyroid and parathyroid surgery and should be avoided, notwithstanding the negative impact on social costs and the risk of development of antibiotic resistance.
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Giorgio Romano
- Department of Surgical, Oncological, and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Palermo, Italy
| | - Giuseppe Amato
- Postgraduate School of General Surgery, University of Cagliari, Cagliari, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Zhang H, Lu J, Wu Q, Wu B, Xu C, Fan Y, Zhou Q. A Perioperative Small Dose of Dexamethasone Enhances Postoperative Recovery by Reducing Volume and Inflammatory Contents in Wound Drainage After Thyroid Surgery: A Double-Blinded, Randomized, Prospective Study. World J Surg 2019; 43:1721-1727. [PMID: 30963205 DOI: 10.1007/s00268-019-04986-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aims of this study were to assess the effect of perioperative dexamethasone on postoperative thyroid surgery recovery using measures of wound drainage volume and C-reactive protein (CRP) levels and leukocyte counts. MATERIALS AND METHODS From January to September 2014, healthy patients, aged between 18 and 65 years, had elective thyroid surgery in the tertiary hospital. Eligible patients were randomized into either group D (dexamethasone 0.1 mg/kg IV) or group S (saline IV) after anesthesia induction. At the end of surgery, a drainage tube was placed at the thyroid bed with a negative pressure ball connected outside the wound. Drainage fluids were collected after thyroid surgery. The fluid volume and the levels of C-reactive protein and leukocyte counts inside were analyzed. All patients were followed up for 1 month. RESULTS The median total drainage in group D (n = 103) was 43 ml (IQR: 21-83 ml), and 68 ml (IQR: 35-104 ml) in group S (n = 111), P = 0.002. More patients in group D were discharged on postoperative day 2 (74.8% vs. 54.1%, P = 0.002). The CRP levels and leukocyte counts were much less in group D than in group S (P = 0.002 and P < 0.001, respectively). Two patients (one in each group) had wound infections 1 week after surgery that healed one additional week later. CONCLUSIONS One perioperative small dose of dexamethasone reduced wound drainage volume and inflammatory content after thyroid surgery, thereby possibly contributing to early recovery. The effects of dexamethasone have never been evaluated before under these conditions. REGISTRATION NUMBER NCT02304250 ( http://www.clinicaltrials.gov ).
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Affiliation(s)
- Huiwen Zhang
- Department of Anaesthesiology, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China.,Department of Anaesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jie Lu
- Department of Anaesthesiology, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China
| | - Qiang Wu
- Department of Anaesthesiology, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China
| | - Bo Wu
- Department of Surgery, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China
| | - Cheng Xu
- Department of Anaesthesiology, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China
| | - Youben Fan
- Department of Surgery, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China.
| | - Quanhong Zhou
- Department of Anaesthesiology, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China.
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Myssiorek D, Ahmed Y, Parsikia A, Castaldi M, McNelis J. Factors predictive of the development of surgical site infection in thyroidectomy – An analysis of NSQIP database. Int J Surg 2018; 60:273-278. [DOI: 10.1016/j.ijsu.2018.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 10/29/2018] [Accepted: 11/12/2018] [Indexed: 01/19/2023]
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Salem FA, Almquist M, Nordenström E, Dahlberg J, Hessman O, Lundgren CI, Bergenfelz A. A Nested Case-Control Study on the Risk of Surgical Site Infection After Thyroid Surgery. World J Surg 2018; 42:2454-2461. [PMID: 29470699 PMCID: PMC6060833 DOI: 10.1007/s00268-018-4492-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction It is unclear if antibiotic prophylaxis reduces the risk of surgical site infection (SSI) in thyroid surgery. This study assessed risk factors for SSI and antibiotic prophylaxis in subgroups of patients. Method and design A nested case–control study on patients registered in the Swedish National Register for Endocrine Surgery was performed. Patients with SSI were matched 1:1 by age and gender to controls. Additional information on patients with SSI and controls was queried from attending surgeons using a questionnaire. Risk factors for SSI were evaluated by logistic regression analysis and presented as odds ratio (OR) with 95% confidence interval (CI). Results There were 9494 operations; 109 (1.2%) patients had SSI. Patients with SSI were older (median 53 vs. 49 years) than patients without SSI p = 0.01 and more often had a cancer diagnosis 23 (21.1%) versus 1137 (12.1%) p = 0.01. In the analysis of patients with SSI versus controls, patients with SSI more often had post-operative drainage 68 (62.4%) versus 46 (42.2%) p = 0.01 and lymph node surgery 40 (36.7%) versus 14 (13.0%) p < 0.01, and both were independent risk factors for SSI, drain OR 1.82 (CI 1.04–3.18) and lymph node dissection, OR 3.22 (95% CI 1.32–7.82). A higher number of 26(62%) patients with independent risk factors for SSI and diagnosed with SSI did not receive antibiotic prophylaxis. Data were missing for 8 (31%) patients. Conclusion Lymph node dissection and drain are independent risk factors for SSI after thyroidectomy. Antibiotic prophylaxis might be considered in patients with these risk factors.
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Affiliation(s)
- F A Salem
- Department of Clinical Sciences, Lund University, Lund, Sweden. .,Skåne University Hospital, 221 85, Lund, Sweden.
| | - M Almquist
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - E Nordenström
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - J Dahlberg
- Department of Endocrine Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - O Hessman
- Department of Endocrine Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - C I Lundgren
- Department of Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - A Bergenfelz
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Moskalenko M, Asai M, Beem K, Pezzi TA, Brophy CL, Noonan K, Pezzi CM. Incidence of Surgical Site Infections after Thyroid and Parathyroid Surgery: No Role for Antimicrobial Prophylaxis. Am Surg 2018. [DOI: 10.1177/000313481808400638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To better define the value of antimicrobial prophylaxis (AMP) and antiseptic skin preparation (ASP) in thyroid and parathyroid surgery, we examined the rate of surgical site infections (SSIs) with and without AMP. Retrospective analysis was performed using the National Surgical Quality Improvement Program database at a single institution. Patients undergoing thyroid or parathyroid surgery with data entered into the National Surgical Quality Improvement Program database at our institution between November 2007 and June 2015 were studied, including patient demographics, wound classification, other risk factors for SSI, and wound outcome. Charts were retrospectively reviewed for AMP, ASP, and use of drains. Of the 534 patients who underwent thyroid (n = 358) or parathyroid (n = 176) surgery, 58 (10.9%) were diabetic, 54 (10.1%) used tobacco, and 14 (2.6%) were on steroids. Most wounds were classified as “clean” (99.6%). Betadine was used for ASP in 96 per cent. AMP was given to 141 patients (26%) using cefazolin, vancomycin, or clindamycin. The remaining 393 patients (74%) received no AMP. Zero infections occurred in the group who did not receive AMP. One (0.7%) superficial, nonpurulent SSI occurred in the group that received AMP which was not statistically significantly different (P = 0.319). The rates of SSI after thyroid and parathyroid surgery are extremely low, around two per 1000 cases, and do not decrease with AMP. Therefore, AMP is not necessary in thyroid and parathyroid surgery and should be avoided to reduce costs, adverse reactions, and antibiotic resistance.
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Affiliation(s)
| | - Megumi Asai
- Department of Surgery, Abington Hospital—Jefferson Health, Abington, Pennsylvania
| | - Karen Beem
- Department of Surgery, Abington Hospital—Jefferson Health, Abington, Pennsylvania
| | | | - Cynthia L. Brophy
- Department of Surgery, Abington Hospital—Jefferson Health, Abington, Pennsylvania
| | - Kristin Noonan
- Department of Surgery, Abington Hospital—Jefferson Health, Abington, Pennsylvania
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Patel PN, Jayawardena ADL, Walden RL, Penn EB, Francis DO. Evidence-Based Use of Perioperative Antibiotics in Otolaryngology. Otolaryngol Head Neck Surg 2018; 158:783-800. [DOI: 10.1177/0194599817753610] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Priyesh N. Patel
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Rachel L. Walden
- Annette and Irwin Eskind Biomedical Library, Vanderbilt University, Nashville, Tennessee, USA
| | - Edward B. Penn
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David O. Francis
- Division of Otolaryngology, Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
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Fachinetti A, Chiappa C, Arlant V, Kim HY, Liu X, Sun H, Dionigi G, Rovera F. Antibiotic prophylaxis in thyroid surgery. Gland Surg 2017; 6:525-529. [PMID: 29142844 DOI: 10.21037/gs.2017.07.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Use of antibiotic prophylactic (AP) in clean surgery is still controversial. We reviewed the literature of the last 10 years to identify the best way to approach the use of prophylactic antibiotic in thyroid surgery. In thyroid surgery, it is a highly controversial topic primarily due to the lack of evidence in "support" of or "against" antibiotic use. In this review, the authors analyze the literature on the use of AP in thyroid surgery in order to evaluate if the available data support or contradict this use routinely.
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Affiliation(s)
- Anna Fachinetti
- 1st Division of Surgery, Senology Research Center, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), Varese, Italy
| | - Corrado Chiappa
- 1st Division of Surgery, Senology Research Center, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), Varese, Italy
| | - Veronica Arlant
- 1st Division of Surgery, Senology Research Center, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), Varese, Italy
| | - Hoon Yub Kim
- KUMC Thyroid Center, Korea University, Anam Hospital, Seoul, Korea
| | - Xiaoli Liu
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, China-Japan Union Hospital of Jilin University, Changchun 130031, China
| | - Hui Sun
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, China-Japan Union Hospital of Jilin University, Changchun 130031, China
| | - Gianlorenzo Dionigi
- 1st Division of Surgery, Senology Research Center, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), Varese, Italy
| | - Francesca Rovera
- 1st Division of Surgery, Senology Research Center, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), Varese, Italy
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13
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Dionigi G, Kim HY, Wu CW, Lavazza M, Materazzi G, Lombardi CP, Anuwong A, Tufano RP. Neuromonitoring in endoscopic and robotic thyroidectomy. Updates Surg 2017; 69:171-179. [DOI: 10.1007/s13304-017-0442-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/01/2017] [Indexed: 12/01/2022]
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14
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Borgia G, Maraolo AE, Foggia M, Buonomo AR, Gentile I. Fecal microbiota transplantation for Clostridium difficile infection: back to the future. Expert Opin Biol Ther 2016; 15:1001-14. [PMID: 26063385 DOI: 10.1517/14712598.2015.1045872] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Clostridium difficile infection (CDI) is a leading cause of diarrhea in the industrialized world. The estimated costs of this infection are impressive: over 3.2 billion dollars annually in the US. The introduction of fecal microbiota transplantation (FMT) to clinical practice can be considered a Copernican Revolution. The rationale of this approach consists of correcting the imbalance of the organisms dwelling in the gut by reintroducing a normal flora. AREAS COVERED This review focuses on the indication for FMT in CDI; it examines in-depth the most relevant aspects of the techniques used, and the safety and efficacy of this new 'old' therapy. EXPERT OPINION Authoritative guidelines about the management of CDI strongly recommend FMT for multiple recurrent episodes of infection by C. difficile unresponsive to repeated antibiotic treatment. The cure rates are about 90%, with no serious adverse events having been reported. The main concerns are the long-term outcomes, lack of a standardized procedure for the delivery of donor material, and a cultural barrier to the transplantation of fecal microbiota. A promising solution to some of these problems could be the use of a more acceptable administration route of fecal material, namely, oral capsules.
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Affiliation(s)
- Guglielmo Borgia
- University of Naples "Federico II", Department of Clinical Medicine and Surgery, Section of Infectious Diseases, Naples , Italy +39(0)81 7463178 ; +39(0)81 7463190 ;
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15
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Abstract
BACKGROUND The extent, magnitude and technical equipment used for thyroid surgery has changed considerably in Germany during the last decade. The number of thyroidectomies due to benign goiter have decreased while the extent of thyroidectomy, nowadays preferentially total thyroidectomy, has increased. Due to an increased awareness of surgical complications the number of malpractice claims is increasing. OBJECTIVES In contrast to surgical databases the frequency of complications in malpractice claims reflects the individual impact of complications on the quality of life. In contrast to surgical databases unilateral and bilateral vocal fold palsy are therefore at the forefront of malpractice claims. As guidelines are often not applicable for the individual surgical expert review, the question arises which are the relevant criteria for the professional expert witness assessing the severity of the individual complication. RESULTS While in surgical databases major complications after thyroidectomy, such as vocal fold palsy, hypoparathyroidism, hemorrhage and infections are equally frequent (1-3 %), in malpractice claims vocal fold palsy is significantly more frequent (50 %) compared to hypoparathyroidism (15 %), hemorrhage and infections (about 5 % each). To avoid bilateral nerve palsy intraoperative nerve monitoring has become of utmost importance for surgical strategy and malpractice suits alike. For surgical expert review documentation of individual risk-oriented indications, the surgical approach and postoperative management are highly important. CONCLUSION Guidelines only define the treatment corridors of good clinical practice. Surgical expert reviews in malpractice suits concerning quality of care and causality between surgical management, complications and sequelae of complications are therefore highly dependent on the grounds and documentation of risk-oriented indications for thyroidectomy, intraoperative and postoperative surgical management.
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Affiliation(s)
- H Dralle
- Universitätsklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Medizinische Fakultät, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland,
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16
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Dionigi G, Lombardi D, Lombardi CP, Carcoforo P, Boniardi M, Innaro N, Chiofalo MG, Cavicchi O, Biondi A, Basile F, Zaccaroni A, Mangano A, Leotta A, Lavazza M, Calò PG, Nicolosi A, Castelnuovo P, Nicolai P, Pezzullo L, De Toma G, Bellantone R, Sacco R. Intraoperative neuromonitoring in thyroid surgery: a point prevalence survey on utilization, management, and documentation in Italy. Updates Surg 2014; 66:269-76. [DOI: 10.1007/s13304-014-0275-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/26/2014] [Indexed: 12/11/2022]
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17
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Valdez TA, Marvin K, Bennett NJ, Lerer T, Nolder AR, Buchinsky FJ. Current trends in perioperative antibiotic use: a survey of otolaryngologists. Otolaryngol Head Neck Surg 2014; 152:63-6. [PMID: 25305267 DOI: 10.1177/0194599814554551] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This study describes the patterns of perioperative antimicrobial use by otolaryngologists during common otolaryngologic surgical procedures. Through the American Academy of Otolaryngology--Head and Neck Surgery Infectious Diseases Committee, a survey was developed to assess the current practice patterns regarding the use of perioperative antibiotics in otolaryngology. A total of 6903 surveys were sent out; 458 were fully or partially completed, and a total of 442 responses were included in the final analysis. Most physicians reported routinely prescribing antibiotics either preoperatively or postoperatively for 12 of the 17 procedures included in the questionnaire despite providers agreeing that there is not enough evidence to support their use. The most common procedure for which antibiotics were prescribed was laryngectomy (91.1%). Antibiotic use is a common practice during the perioperative period for otolaryngologic procedures; however, there is a discrepancy between utilization and evidence of benefit.
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Affiliation(s)
- Tulio A Valdez
- Department of Otolaryngology, Connecticut Children's Medical Center, Hartford, Connecticut, USA Infectious Disease Committee, American Academy of Otolaryngology, Alexandria, Virginia, USA
| | - Kastley Marvin
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Nicholas J Bennett
- Department of Pediatrics, Division of Infectious Diseases, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Trudy Lerer
- Department of Research, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Abby R Nolder
- Infectious Disease Committee, American Academy of Otolaryngology, Alexandria, Virginia, USA Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Farrel J Buchinsky
- Infectious Disease Committee, American Academy of Otolaryngology, Alexandria, Virginia, USA Division of Pediatric Otolaryngology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Dralle H, Nguyen Thanh P. [Total thyroidectomy with lymph node dissection of the central compartment for node-positive, capsular invasive papillary thyroid cancer: video contribution]. Chirurg 2014; 85:895-903. [PMID: 25294049 DOI: 10.1007/s00104-014-2802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of radical oncological surgery for nodal metastasized papillary thyroid cancer is, as for other oncological interventions in visceral surgery, the anatomy-related implementation of the concept of en bloc (no touch) resection of the organ bearing the primary tumor together with the first lymph node station, while the structures of the aerodigestive tract, the recurrent laryngeal nerves and parathyroid glands are preserved. The surgical technique is demonstrated in detail with the help of a video of the operation and which is available on-line, the advantages and disadvantages of the technique are discussed.
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Affiliation(s)
- H Dralle
- Universitätsklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland,
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19
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Lu Q, Xie SQ, Chen SY, Chen LJ, Qin Q. Experience of 1166 thyroidectomy without use of prophylactic antibiotic. BIOMED RESEARCH INTERNATIONAL 2014; 2014:758432. [PMID: 24900986 PMCID: PMC4037569 DOI: 10.1155/2014/758432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 02/23/2014] [Accepted: 03/22/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although the procedure requires a small surgical incision and a short duration, incision infection rate is very low in thyroidectomy; however, doctors still have misgivings about infection events. AIM We retrospectively analyzed the prevention of incision infection without perioperative use of antibacterial medications following thyroidectomy. MATERIALS AND METHODS 1166 patients of thyroidectomy were not administered perioperative antibiotics. Unilateral total lobectomy or partial thyroidectomy was performed in 68.0% patients with single-side nodular goiter or thyroid adenoma. Bilateral partial thyroidectomy was performed in 25.5% patients with nodular goiter or Graves' disease. The mean time of operation was 80.6 ± 4.87 (range: 25-390) min. RESULTS Resuturing was performed in two patients of secondary hemorrhage from residual thyroid following bilateral partial thyroidectomy. Temporally recurrent nerve paralysis was reported following right-side total lobectomy and left-side subtotal lobectomy in a nodular goiter patient. One case had suppurative infection in neck incision 5 days after bilateral partial thyroidectomy. CONCLUSIONS Thyroidectomy, which is a clean incision, involves a small incision, short duration, and minor hemorrhage. If the operation is performed under strict conditions of sterility and hemostasis, antibacterial medications may not be required to prevent incision infection, which reduces cost and discourages the excessive use of antibiotics.
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Affiliation(s)
- Qiang Lu
- Department of General Surgery, TungWah Affiliated Hospital of Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Shu-Qin Xie
- Department of General Surgery, TungWah Affiliated Hospital of Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Si-Yuan Chen
- Department of Surgical Oncology, Tung Wah Affiliated Hospital of Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Li-Ju Chen
- Operating Room Tung Wah, Tung Wah Affiliated Hospital of Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Qian Qin
- Department of General Surgery, TungWah Affiliated Hospital of Sun Yat-sen University, Dongguan, Guangdong 523110, China
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20
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Elfenbein DM, Schneider DF, Chen H, Sippel RS. Surgical site infection after thyroidectomy: a rare but significant complication. J Surg Res 2014; 190:170-6. [PMID: 24739508 DOI: 10.1016/j.jss.2014.03.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/06/2014] [Accepted: 03/12/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) after thyroidectomy are rare but can have significant consequences. Thyroidectomy is a clean case, and the patterns for use of prophylactic antibiotics vary. We hypothesized that patient and operative characteristics may predict a higher risk of SSI, and that SSI are associated with other complications leading to increased resource utilization. METHODS Data from the American College of Surgeons National Surgical Quality Improvement Program dataset for patients who underwent thyroidectomy through cervical incisions from 2005-2011 were included. Bivariate analysis using t-tests and chi-square tests were performed, and variables with P<0.2 were considered for inclusion in a multivariate logistic regression model. RESULTS A total of 49,326 patients underwent thyroidectomy from 2005-2011 and 179 (0.36%) had an SSI. On multivariate analysis, the strongest predictors of SSI were operative time (P<0.001) and wound classification clean-contaminated (odds ratio 6.1; 95% confidence interval, 3.6, 10.3). Preoperative factors associated with SSI on multivariate analysis had lower magnitudes of influence on SSI risk but included obesity, alcohol use, and nonindependent functional status. Patients with SSI were more likely to have a wound dehiscence, renal insufficiency, bleeding requiring transfusion, and return to the operating room on a multivariate model of outcomes. CONCLUSIONS Although rare, SSI after thyroidectomy are associated with other postoperative complications. We have identified preoperative and intraoperative factors that are associated with SSI, and this may help identify high-risk patients who may benefit from selective use of antibiotics.
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Affiliation(s)
- Dawn M Elfenbein
- Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
| | - David F Schneider
- Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Herbert Chen
- Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Rebecca S Sippel
- Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin
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