Addressing an increase in surgical site infections during the COVID-19 pandemic-Identifying opportunities during a chaotic time

Trends in surgical site infection and periprosthetic joint infection after primary total hip arthroplasty in two national health registers 2013-2022

BACKGROUND

This study aimed to assess trends in surgical site infection (SSI), re-operations for SSI, and re-operations for periprosthetic joint infection (PJI) following primary total hip arthroplasty (THA) in Norway from 2013 to 2022. Two national health registers were used to compare their abilities as surveillance tools for PJI after primary THA.

METHODS

The Norwegian Surveillance System for Healthcare-Associated Infections (NOIS) was evaluated for 30-day incidence and risk of SSI and reoperations for SSI after THA. Reporting to NOIS is mandatory. The Norwegian Arthroplasty Register (NAR) was assessed for 30-day and 1-year incidence and risk of re-operation due to PJI after THA. Reporting to NAR is based on patient consent. Descriptive statistics and adjusted Cox regression analyses, accounting for sex, age and American Society of Anesthesiology class, were performed.

RESULTS

A total of 87,923 primary THAs were included in NOIS, with 1393 (1.6%) reported as 30-day SSIs. The 30-day re-operation rate for SSI in NOIS was 0.9% (N = 765), with 96% completeness of 30-day follow-up. In NAR, out of 91,194 THAs, the 30-day re-operation rate for PJI was 0.8% (N = 725) and the 1-year rate was 1.2% (N = 1019). The completeness of 30-day re-operation for PJI in NAR compared with re-operation for SSI in NOIS was 95%. Annual risk factors were similar across registers. There was a corresponding decline in SSI [adjusted hazard rate ratio (aHRR) 0.92, 95% confidence interval (CI) 0.90-0.93] and reoperations for SSI (aHRR 0.95, 95% CI 0.92-0.97) in NOIS, and reoperations for PJI (30 days: aHRR 0.96, 95% CI 0.94-0.99; 1 year: aHRR 0.95, 95% CI 0.95-0.99) in NAR.

CONCLUSION

There has been a corresponding decline in SSI and re-operation for PJI between 2013 and 2022. The 95% completeness of 30-day re-operation for PJI in the patient-consent-based NAR, compared with the mandatory NOIS, is considered excellent. The findings indicate a genuine reduction in the incidence of SSI and PJI after primary THA.

Safety and Racial Implications of Same-Day Discharge in Alloplastic Breast Reconstruction Following the COVID-19 Pandemic

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic was an unprecedented period that fundamentally reshaped healthcare delivery worldwide. Among the significant changes was a shift toward same-day discharge (SDD) across all surgical specialties. This study focuses on immediate alloplastic reconstruction, with the objectives to quantify the increase in SDDs, evaluate the associated safety outcomes, and investigate racial disparities resulting from these changes.

METHODS

Using data from the National Surgical Quality Improvement Program (NSQIP) database, we conducted a retrospective analysis of patients who underwent mastectomies with immediate alloplastic reconstructions from 2018 to 2022. Patients were categorized by length of stay as SDD (0 day) or inpatient (≥1 day) and divided into pre-COVID (2018-2019) and post-COVID (2020-2022) phases. To assess patient safety, we compared complication rates between SDD and inpatient cases as well as across pre- and post-COVID periods. To evaluate racial disparities, we performed unmatched and matched comparisons of outcomes between Caucasian and Black patients. Limited statistical power precluded analysis of other racial groups.

RESULTS

A total of 31,458 patients were identified. The proportion of SDD cases increased from 9.3% pre-COVID to 31.9% post-COVID, representing a 3.43-fold rise. In this study, SDD was found to be as safe as, if not safer than, inpatient procedures, with significantly lower rates of reoperation (5.5% vs 8.6%), readmission (3.9% vs 4.9%), and postoperative transfusions (0.1% vs 1.0%) (P < 0.001). Post-COVID SDD outcomes were also comparable to pre-COVID benchmarks. Following the pandemic, racial disparities persisted in the inpatient setting, with Black patients experiencing significantly higher rates of wound dehiscence and postoperative transfusions than Caucasian patients. In contrast, among SDD cases, complication rates were similar across racial groups in the unmatched analysis, while the matched analysis revealed lower rates of surgical site complications and reoperations in Black patients.

CONCLUSIONS

Since the onset of COVID-19, SDD in immediate alloplastic reconstruction has increased by 22.6%. Despite this rapid transition, SDD has demonstrated promising outcomes, upholding both safety and equity considerations.

Exploring the impact and challenges of tele-ICU: A qualitative study on nursing perspectives

AIM

The primary objectives of this study were to explore ICU and Tele-ICU nurses' perceptions of Tele-ICU, focusing on its perceived benefits, challenges, and implications for integration into critical care settings.

BACKGROUND

Tele-Intensive Care Unit (Tele-ICU) services are reshaping critical care by enabling remote monitoring and enhancing patient outcomes. This study investigates the experiences of nurses transitioning from bedside ICU to Tele-ICU roles, focusing on the impact on patient care, organizational benefits, and implementation challenges.

METHODS

A qualitative approach was used, involving semi-structured interviews with ICU nurses who transitioned to Tele-ICU roles. An interview guide was developed to explore key topics, including the benefits, challenges, and future implications of TeleICU. Thematic analysis was applied to identify recurring themes and subthemes.

RESULTS

Participants highlighted several benefits of Tele-ICU, including continuous patient monitoring, improved infection control, and enhanced resource utilization. Organizational advantages included reduced length of stay, lower readmission rates, and improved post-discharge planning. However, significant barriers were identified, such as technological infrastructure issues, financial constraints, resistance to workflow changes, and gaps in training. Cultural preferences for in-person care and regulatory challenges were also noted.

CONCLUSIONS

Tele-ICU presents significant opportunities to improve critical care delivery, but its success depends on addressing implementation barriers. Investments in technology, comprehensive training, and supportive policies are essential for maximizing its potential and facilitating broader adoption in healthcare settings.

Assessing the impact of enhanced hygiene precautions during the COVID-19 pandemic on surgical site infection risk in abdominal surgeries

BACKGROUND

A surgical site infection (SSI) is a postoperative infection that occurs at or near the surgical incision. SSIs significantly increase morbidity, mortality, length of hospital stay, and healthcare costs. The World Health Organization (WHO) has established hospital hygiene precaution guidelines for the prevention of SSIs, which were enhanced during the COVID-19 pandemic. The current study aims to explore the effect of the COVID-19 pandemic on SSI incidence among initially uninfected postoperative patients. We hypothesize that these enhanced precautions would reduce the incidence of SSIs.

MATERIALS AND METHODS

A retrospective study comparing surgical outcomes before and during the pandemic. Patients who had abdominal surgery between June and December 2019 (Non-COVID-19) or between February and June 2020 (COVID-19) were included. The two groups were matched in a 1:1 ratio based on age, Sex, acuity (elective or emergent), surgical approach, and comorbidities. Electronic medical records were reviewed to identify SSIs and hospital readmissions within 30 days after surgery. Pearson's chi-square test and Fisher's exact test were used.

RESULTS

Data was collected and analyzed from 976 patients who had surgery before the COVID-19 pandemic (non-COVID group) and 377 patients who had surgery during the pandemic (COVID group). After matching, there were 377 patients in each group. In our study, we found 23 surgical site infections (SSIs) in both laparoscopic and open surgeries. The incidence of SSIs was significantly higher in the non-COVID period compared to the COVID period [17 cases (4.5%) vs. 6 cases (1.6%), respectively, p = 0.032], especially in non-COVID open surgeries. The incidence of SSIs in laparoscopic surgeries was also higher during the non-COVID period, but not statistically significant.

CONCLUSIONS

Enhanced hygiene precautions during the COVID -19 pandemic may have reduced SSIs rates following abdominal surgery.

Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Surgical Site Infection in Patients with Inflammatory Bowel Disease-A Monocentric, Retrospective Cohort Study

(1) Background: Surgical site infections (SSIs) are a relevant problem with a 25% incidence rate after elective laparotomy due to inflammatory bowel disease (IBD). The aim of this study was to evaluate whether stricter hygienic measures during the COVID-19 pandemic influenced the rate of SSI. (2) Methods: This is a monocentric, retrospective cohort study comparing the rate of SSI in patients with bowel resection due to IBD during COVID-19 (1 March 2020-15 December 2021) to a cohort pre-COVID-19 (1 February 2015-25 May 2018). (3) Results: The rate of SSI in IBD patients with bowel resection was 25.8% during the COVID-19 pandemic compared to 31.8% pre-COVID-19 (OR 0.94; 95% CI 0.40-2.20; p = 0.881). There were seventeen (17.5%) superficial and four (4.1%) deep incisional and organ/space SSIs, respectively, during the COVID-19 pandemic (p = 0.216). There were more postoperative intra-abdominal abscesses during COVID-19 (7.2% vs. 0.9%; p = 0.021). The strictness of hygienic measures (mild, medium, strict) had no influence on the rate of SSI (p = 0.553). (4) Conclusions: Hygienic regulations in hospitals during COVID-19 did not significantly reduce the rate of SSI in patients with bowel resection due to IBD. A ban on surgery, whereby only emergency surgery was allowed, was likely to delay surgery and exacerbate the disease, which probably contributed to more SSIs and postoperative complications.