Incidence and impact of surgical site infections on length of stay and cost of care for patients undergoing open procedures

Budget impact model of acellular tissue engineered vessel for the repair of extremity arterial trauma when autologous vein is not feasible

AIMS

To predict the budget impact of Symvess (Symvess is a trademark of Humacyte Global, Inc.) (acellular tissue engineered vessel-tyod [ATEV]) for extremity arterial trauma repair when autologous vein repair is not feasible.

MATERIALS AND METHODS

The 3-year budget impact of adding ATEV as a repair option alongside autologous vein, prosthetic graft, and "non-autologous other" grafts was evaluated from the perspectives of a Level I trauma center and third-party commercial payers. Conduit-specific complication rates were obtained from two clinical studies for ATEV and from the published literature and analysis of the PROOVIT registry for other conduits. Costs were compared pre- and post-ATEV availability. Conduit-related costs and complications included conduit infections, amputations, vein harvest site infection, surgical re-interventions, rehabilitation after amputation, and 12-month post-discharge costs. Impact on operating room (OR) time and readmissions was evaluated. A sensitivity analysis was conducted to evaluate parameter uncertainty.

RESULTS

With introduction of ATEV, there was a 29.8% reduction in amputations and a 29.5% reduction in graft infections over 3 years. From a Level I trauma center perspective, seven patients were expected to receive an ATEV over 3 years, with cumulative cost savings of $80,650 (2.3% decrease). OR time would decrease by 8.6 h, and readmission-related costs would be reduced by 16.7% with ATEV availability. From the third-party commercial payer perspective, 35 patients were expected to receive ATEV, with a budget impact showing a savings of -$0.08 per member per month after 3 years. For trauma centers, sensitivity analysis showed that cost drivers were amputation risk associated with "non-autologous other" graft types and market share of autologous vein (short ischemia time).

LIMITATIONS

Uncertainty surrounding model parameters.

CONCLUSIONS

ATEV was projected to be cost-saving over 3 years for both trauma centers and third-party payers due to reductions in the costs related to amputations and conduit infections.

Cost Analysis of Postoperative Medications in a Tertiary Care Hospital in Northeast India

BACKGROUND

Postoperative medications play a crucial role in managing physiological changes and preventing complications after surgery. However, the cost of these medications can be a significant burden for patients, particularly in low-income settings. This study aimed to estimate the cost of postoperative medications in a tertiary care hospital and simulate the financial burden on patients undergoing elective surgery.

METHODS

A prospective, hospital-based observational study was conducted at a tertiary care hospital in India. Data were collected from 109 patients undergoing elective surgery, and the cost of medications was calculated using real-world data. A gamma distribution was used to simulate 100000 data points, and the mean, median, and interquartile range of medication costs were estimated.

RESULTS

The mean medication cost was ₹9332 (around $111 USD), with a median cost of ₹4989 (around $60 USD). The interquartile range was ₹11103, indicating substantial variability in patient costs. The simulation results showed that patients would need to work for an average of 51 days to cover the mean cost of medications, with up to 104 days required for 2.5% of patients.

CONCLUSION

The financial burden of postoperative medications is significant. The findings highlight the need for flexibility in government schemes like Ayushman Bharat to accommodate the variability in costs. Policymakers should consider revising the sanctioned amounts per treatment module to keep pace with inflation and changes in medical practice.

Negative Pressure Wound Therapy in the Prevention of Surgical Site Infections Following Abdominal Surgery: A Systematic Review

Negative pressure wound therapy (NPWT) has emerged as a promising intervention for reducing surgical site infections (SSIs) across various surgical disciplines, particularly in high-risk abdominal and gastrointestinal surgeries. This systematic review aimed to evaluate the efficacy of NPWT in preventing SSIs and improving postoperative outcomes in such procedures. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library, identifying 641 studies, of which 10 high-quality randomized controlled trials (RCTs) met the inclusion criteria. Studies included a range of abdominal procedures, including emergency laparotomies, colorectal cancer surgeries, and hepatopancreatobiliary interventions. Findings indicated that NPWT significantly reduced SSI rates in high-risk populations, particularly in contaminated and emergency abdominal surgeries, with reductions in seroma formation and wound dehiscence also observed. However, some studies reported no significant benefits in lower-risk procedures, highlighting the importance of appropriate patient selection. Quality assessment revealed moderate-to-high methodological quality, though common limitations included open-label designs and sample size variability. The results support the targeted use of NPWT in high-risk abdominal surgeries, though further large-scale, multicenter trials are needed to refine patient selection criteria and optimize clinical application.

High incidence of multidrug-resistant organisms and modifiable risk factors associated with surgical site infections: a cohort study in a tertiary medical center in Kuala Lumpur, Malaysia from 2020 to 2023

BACKGROUND

Surgical site infections (SSIs) are a persistent challenge in healthcare, contributing significantly to patient morbidity, mortality, and healthcare costs. Despite advancements in preventive measures, SSIs remain prevalent, especially in countries like Malaysia where rates are higher than in high-income nations.

METHODS

A prospective, cohort study was conducted at the University Malaya Medical Center (UMMC), Malaysia, from November 2020 to May 2023. Clinical and microbiological data were collected, and logistic regression were performed to identify risk factors associated with SSIs.

RESULTS

A total of 1,815 patients undergoing orthopedic, neurosurgical, and general surgical procedures were monitored for SSIs. The incidence rate of SSIs was 3.23 per 100 procedures (n = 71) with significant associations observed between SSI occurrence and prolonged surgical duration > 100 min, extended hospitalization > 5 days, trauma-to-surgery interval > 8 days, and presence of implants. Common pathogens isolated included Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Multidrug-resistant organisms (MDROs) were identified in 42.1% of the total isolates.

CONCLUSIONS

In this study, a high rate of MDRO and risk factors for SSI were identified. It emphasises the need for ongoing surveillance to guide infection prevention strategies and antimicrobial stewardship programs. Future research should prioritize evaluating the impact of targeted interventions tailored to identified risk factors to optimize surgical patient outcomes.

Preoperative Hemoglobin Level Predicts Surgical Site Infections in Trauma Orthopedic Surgery: A Cohort Study

Background: Surgical site infections resulting from trauma orthopedic surgery increase morbidity and mortality rates and generate additional costs for the healthcare system. Preoperative and postoperative blood parameters have been described as risk predictors for surgical site infection in other surgical areas. The purpose of this study was to assess the role of preoperative and postoperative hematological parameters in predicting the risk of surgical site infections in trauma orthopedic surgery. Methods: Data on patients' demographics were collected from their medical records and the operation reports. Preoperative and postoperative blood samples were collected for a complete blood count assay. The blood cell parameters as predictors of surgical site infection after trauma orthopedic surgery were determined by the Mann-Whitney U test to assess the differences in the median between the dependent and independent variables. p value < 0.05 was considered statistically significant. Results: Out of the 210 patients who were followed postsurgery, 14 (6.7%) developed surgical site infection following trauma orthopedic surgery. The mean age of the study participants was 33.08 ± 19.23 (Mean ± SD), with a range of 86 to 0.67 years old. Low preoperative hemoglobin level was identified as a predictor of surgical site infection following trauma orthopedic surgery (p=0.019). None of the postoperative blood parameters measured was significantly associated with surgical site infections after trauma orthopedic surgery in Northern Ghana. Conclusion: In conclusion, our study demonstrates that preoperative hemoglobin level is a useful hematological parameter for predicting surgical site infection following trauma orthopedic surgery. These inexpensive and common hematological parameters could assist in guiding preventive efforts to reduce surgical site infections and improve outcomes for vulnerable patients undergoing trauma orthopedic surgery. Assessing preoperative hemoglobin levels is crucial in identifying patients at increased risk of developing surgical site infections. Preoperative optimization, including incorporating hemoglobin levels into predictive risk models can help to assess these at-risk persons better. Educate patients on the need to optimize their hemoglobin levels before surgery and discuss potential interventions, including iron supplementation or transfusion.

Comparing silicone-coated self-adhesive absorbent polyurethane films with transparent absorbent films for bilateral hip dressing: a prospective randomized controlled trial

BACKGROUND

Silicone-coated self-adhesive absorbent (SSA) and transparent films with absorbent (TFA) dressings are reportedly effective postoperative knee surgery dressings; however, there have been no direct comparative studies on these two innovative dressings over the hip areas. In this study, we aimed to compare user satisfaction and potential complications between TFA and SSA dressings for the hip area.

METHODS

This prospective randomized controlled trial was conducted at a tertiary hospital. The hip side to receive the polyurethane film with SSA dressing (Mepilex® Border Post-Op) was randomly allocated. The other side of the hip was covered with TFA (OPSITE Post-Op). Participants were scheduled for follow-ups 7 and 14 days after the initial application. Between-group outcomes were compared using a two-sample t-test or Wilcoxon signed-rank test for continuous variables and McNemar's chi-square test for categorical variables.

RESULTS

Thirty-two participants (30 - 60 years) without a history of hip surgery were included in the study. The participants were predominantly female, with a mean age of 42.8 years. Pain, difficulties in daily activities, and satisfaction scores were similar between the groups. However, moisture accumulation was significantly higher with the TFA dressing (37.9% vs. 13.8%, p < 0.01), with more dressing failures (34.5% vs. 20.7%, p = 0.016) and complications (37.9% vs. 17.2%, p = 0.012) at the 14-day follow-up than with the SSA dressing.

CONCLUSIONS

SSA dressings are preferable for hip wound care because of better moisture management, fewer dressing changes required, and fewer complications if applied for > 7 days. Both dressings offered high user satisfaction, minimal pain, and minor difficulties in daily activities.

From Guidelines to Action: Tackling Risk Factors for Surgical Site Infections

Background/Objectives: Surgical site infections are a serious public health concern, representing a significant burden on healthcare systems and society. Their occurrence is influenced by several factors, including patient demographics, healthcare facilities and the specific circumstances surrounding surgery. The use of prophylactic antibiotics in this context carries both potential benefits and risks. The aim of this study is to investigate potential risk factors that may adversely affect the development of SSIs, as well as to assess the appropriateness and adherence to perioperative antibiotic prophylaxis. Methods: This observational study was conducted from October 2023 to October 2024 at the University Hospital of Messina, Italy, a hospital performing both thoracic and vascular surgery. Data were collected using a questionnaire regarding socio-demographic data, risk factors, clinical and surgical data and details regarding the administration of antibiotics. Results: This study included 117 patients with an average age of 63 ± 12.36 SD years, 70.9% from the Thoracic Surgery Unit and 29.1% from the Vascular Surgery Unit. The most administered antibiotic was cefazolin, and antibiotic administration time was in compliance with the guidelines. Conclusions: Our data show that the implementation of evidence-based guidelines, healthcare professionals' education and correct antibiotic use can reduce the burden of SSIs by improving patient care.

Effect of preoperative hair removal vs. no removal on surgical site infections: a systematic review and meta-analysis

Background

The practice of preoperative hair removal has been debated regarding its role in Surgical Site Infection (SSI) prevention. This study aimed to compare the different hair removing modalities and investigate the effect of preoperative hair removal on SSI rates.

Methods

A systematic review and meta-analysis were conducted according to PRISMA guidelines. Three databases-PubMed, Web of Science, and Cochrane Library-were searched for relevant studies comparing preoperative hair removal to no hair removal. Studies eligible for inclusion were randomized controlled trials (RCTs) and cohort studies reporting SSI rates. Odds ratios, mean differences, and p-values were analyzed using a random effect model.

Results

Seventeen studies involving 5,407 patients were included. No statistically significant difference in SSI rates was found between the hair removal and no removal groups (OR = 1.066, 95% CI 0.646-1.758, p = 0.803). When comparing clipping to no hair removal, there was no significant difference (OR = 0.967, 95% CI 0.642-1.455, p = 0.870). Razor shaving was associated with higher skin damage and slightly increased SSI risk compared to clipping but not statistically significant (OR = 0.749, 95% CI 0.346-1.623, p = 0.464). Depilatory creams, however, were favored over razor shaving (OR = 3.235, 95% CI 1.543-6.785, p = 0.002), as they were linked to less skin damage and easier application.

Conclusion

Preoperative hair removal does not significantly impact SSI rates. Clipping appears to be a safer alternative to shaving, while depilatory creams show promise as an effective, less damaging option.

Superiority of a Silk Surgical Site Wound Closure Device over Synthetic Dressings

BACKGROUND

Silk fibroin is an emerging biomaterial with enhanced properties of cellular regeneration, growth, and proliferation. The use of a silk fibroin wound dressing has the potential to decrease the incidence of wound-healing complications and to improve patient outcomes compared with synthetic dressing alternatives.

METHODS

A randomized, single-blind clinical trial was conducted on 50 patients who were dressed with a silk fibroin dressing on 1 side of their body and 3M Steri-Strips on the contralateral side after abdominoplasty, reduction mammaplasty, or brachioplasty procedures. Data were collected over 5 postoperative visits using photographs and an investigator-administered questionnaire to monitor erythema, skin irritation, skin discomfort, need for pharmaceutical intervention, wound dehiscence, and mechanical skin injury. A comprehensive 75-patient statistical analysis was conducted, combining the results with a previously published study comparing Dermabond Prineo with the silk dressing.

RESULTS

A total of 20.8% of patients (10 of 48) were assessed by surgeons as having skin erythema (7 to 10) on the Steri-Strip control side, with 0% (0 of 48) on the silk dressing side ( P = 0.002). The frequency of breast triple-point separation in 43 cases was 30.2% (13 of 43) on the Steri-Strip side and 9.3% (4 of 43) on the silk side ( P = 0.012). A total of 75% of patients (36 of 48) had partial or total detachment of Steri-Strips, 0% (0 of 48) had total detachment of the silk dressing, and 18.8% (9 of 48) had partial detachment of the silk dressing within the first 2 weeks ( P < 0.001).

CONCLUSION

A silk fibroin wound dressing significantly reduces the incidence of wound-healing complications throughout the postoperative period.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, II.

CLINICAL RELEVANCE STATEMENT

The adoption of a silk fibroin wound dressing into clinical practice has the potential to improve patient outcomes, decrease medical adhesive-related skin injuries, and reduce the rate of wound-healing complications.

Evaluation of Modified Frailty Index for Predicting Postoperative Outcomes after Upper Extremity Replantation and Revascularization Procedures

BACKGROUND

 Upper extremity (UE) replantation and revascularization are challenging surgical procedures, with survival rates being 50 to 90%. Preoperative risk stratification is challenging yet crucial as patients with comorbid conditions face increased complications. This study assesses the predictive value of the modified 5-item frailty index (5-mFI) for postoperative complications in these procedures.

METHODS

 A retrospective study was done using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2011-2021) for UE replantation/revascularization. The 5-mFI score assigned points for comorbidities including pulmonary disease, heart failure, diabetes, hypertension, and functional status (0-5 scale; 1 point to each). 5-mFI scores stratified patients into <2 (low-risk) or ≥2 (high-risk) categories.

RESULTS

 Of 2,305 patients, the mean age and body mass index (BMI) were 53.13 years and 28.53 kg/m2, respectively. The 5-mFI ≥2 cohort experienced higher rates of all-cause complications, systemic complications, unplanned readmissions, and return to the operating room on univariate analysis. There was no significant difference in wound complication rates. Multivariable logistic regression showed that a higher 5-mFI was significantly associated with increased risks of all-cause mild and severe systemic complications. Wound complications, length of stay over 30 days, unplanned readmission, and return to the operating room were higher in high-risk patients, however not statistically significant.

CONCLUSION

 5-mFI is an effective tool for evaluating risk in UE replantation and revascularization, correlating high scores with significantly increased postoperative complications. High-risk patients with 5-mFI ≥2 also had more reoperations and readmissions. The use of 5-mFI in preoperative assessments can help personalize management, enhancing patient selection and care quality in these complex reconstructions.

Prophylactic PICO◊ dressing shortens wound dressing requirements post emergency laparotomy (EL-PICO◊ trial)

BACKGROUND

Surgical site infection (SSI) is a very common complication of emergency laparotomy and causes significant morbidity. The PICO◊ device delivers negative pressure wound therapy (NPWT) to closed incisions, with some studies suggesting a role for prevention of SSI in heterogenous surgical populations. We aimed to compare SSI rates between patients receiving PICO◊ versus conventional dressing post-emergency laparotomy. Secondary objectives were to observe seroma and dehiscence rates, length of stay, days on dressing and patients' wound experience.

METHODS

This double blinded randomized controlled trial was conducted in University Malaya Medical Centre between October 2019 and March 2022. Patients undergoing emergency laparotomy requiring incisions less than 35 cm were included. Statistical analysis was performed using χ2 test for categorical variables, independent T-test or Mann-Whitney U were used for parametric or non-parametric data respectively besides logistic regression. P values of < 0.05 were considered to be significant.

RESULTS

Ninety-six patients were analyzed (47 interventions, 49 controls). The duration on dressing was more consistent in the intervention arm (PICO◊) versus control arm [9.78 ± 10.20 vs 17.78 ± 16.46 days, P < 0.001]. There was a trend towards lower SSI [14.3 vs 4.3%, P = 0.09], dehiscence [27.1 vs 10.6%, P = 0.07] and seroma [40.8 vs 23.4%, P = 0.08] rates in the intervention arm but this did not reach statistical significance. Length of stay [9 (IQR: 6-14) vs 11 (IQR: 6-22.5) days, P = 0.18] was fairly similar between the two arms, but more patients were very satisfied with PICO◊ compared to the conventional dressing [80% vs 57.1%, P = 0.03].

CONCLUSION

The use of NPWT in emergency laparotomy improves patients wound care experience, and was associated with trends towards fewer wound related complications. Cost effectiveness needs to be explored in order to further validate its use in the emergency setting, especially for patients with additional risk for SSI. Trial registration National Medical Research Registry (NMRR): NMRR-20-1975-55222.

Polysaccharide-based chondroitin sulfate macromolecule loaded hydrogel/scaffolds in wound healing- A comprehensive review on possibilities, research gaps, and safety assessment

Wound healing is an intricate multifactorial process that may alter the extent of scarring left by the wound. A substantial portion of the global population is impacted by non-healing wounds, imposing significant financial burdens on the healthcare system. The conventional dosage forms fail to improve the condition, especially in the presence of other morbidities. Thus, there is a pressing requirement for a type of wound dressing that can safeguard the wound site and facilitate skin regeneration, ultimately expediting the healing process. In this context, Chondroitin sulfate (CS), a sulfated glycosaminoglycan material, is capable of hydrating tissues and further promoting the healing. Thus, this comprehensive review article delves into the recent advancement of CS-based hydrogel/scaffolds for wound healing management. The article initially summarizes the various physicochemical characteristics and sources of CS, followed by a brief understanding of the importance of hydrogel and CS in tissue regeneration processes. This is the first instance of such a comprehensive summarization of CS-based hydrogel/scaffolds in wound healing, focusing more on the mechanistic wound healing process, furnishing the recent innovations and toxicity profile. This contemporary review provides a profound acquaintance of strategies for contemporary challenges and future direction in CS-based hydrogel/scaffolds for wound healing.

Incidence of Surgical Site Infection Following Cesarean Section and Its Associated Factors in a Hospital of the Eastern Region, Saudi Arabia: A Retrospective Cohort Study

BACKGROUND

Surgical site infections (SSIs) following cesarean sections (CS) pose significant challenges in healthcare settings, prompting this five-year investigation in a Qatif Area general hospital. The study aimed to delineate nuances in SSI occurrences, assess yearly variations, and identify associated risk factors impacting SSI rates among CS patients.

METHODS

A retrospective analysis of 1584 cesarean sections conducted over five years was undertaken, and the reported SSI cases were examined to calculate the overall and yearly SSI rates. The impact of potential risk factors such as diabetes mellitus, hypertension, and postoperative antibiotic courses on SSI occurrence was examined.

RESULTS

The study revealed an overall SC rate of 15.4%. The SSI rate following CS was 4.7% (N = 74), with variations across years ranging from 2.2% in 2020 to a peak of 6.7% in 2022. Notably, 2021 and 2022 demonstrated increased SSI rates compared to prior years. Diabetes mellitus and a surgery duration of more than one hour exhibited a substantial association with SSI occurrence, (OR = 10.76, p = 0.038) and (OR = 3.54, p = 0.002), respectively, signifying independent risk factors.

CONCLUSIONS

The study underscores the dynamic nature of SSI rates following CS, highlighting an increasing trend in recent years. All cases were managed with the optimal hospital care. Diabetes mellitus and a surgery duration of more than one hour emerged as prominent independent risk factors for SSI, warranting heightened vigilance and tailored preventive measures in this subset of patients.

Meta-Analysis Comparing Outcomes of Two Different Closed Incision Negative Pressure Systems in Breast Surgery and Implications to Cost of Care

Background

Surgical site complication (SSC) rates in breast surgery have been reported between 2.25% and 53%. Use of incision management may help reduce the risk of SSCs. The potential of 2 closed incision negative pressure therapy (ciNPT) systems to mitigate surgical site complications (SSC) and surgical site infections (SSI) in breast surgery were assessed.

Methods

A systematic literature review for breast surgery studies was conducted comparing ciNPT use against standard of care (SOC). SSC, SSI, and dehiscence rates were examined. SSCs were defined as all surgical site complications including SSI, dehiscence, seroma, hematoma, and necrosis. Risk ratios and random effects models were used to assess the effect of ciNPT with multilayer absorbent dressing (ciNPT-MLA) and ciNPT with foam dressing (ciNPT-F) compared with SOC.

Results

Eight articles were included in the meta-analysis. No significant differences in SSC rates (P = .307) or SSI rates (P = .453) between ciNPT-MLA and SOC were observed. ciNPT-MLA use was associated with a reduction in dehiscence compared with SOC (RR = 0.499, 95% CI = 0.303, 0.822; P = .006). A significant reduction in SSC rates (RR = 0.498, 95% CI = 0.271, 0.917; P = .025) was observed with ciNPT-F use. Similarly, dehiscence rate reduction was associated with ciNPT-F use (RR = 0.349, 95% CI= 0.168, 0.725; P = .005). A trend towards reduction of SSI rates with ciNPT-F use compared with SOC was also noted (P = .053).

Conclusions

Compared with SOC, ciNPT-MLA significantly reduced rates of dehiscence, while ciNPT-F use resulted in significantly reduced SSC and dehiscence rates with a trend toward reducing SSI.

The incidence of surgical site infection following major lower limb amputation: A systematic review

Surgical site infections (SSIs) following major lower limb amputation (MLLA) in vascular patients are a major source of morbidity. The objective of this systematic review was to determine the incidence of SSI following MLLA in vascular patients. This review was prospectively registered with the International Prospective Register of Systematic Reviews (CRD42023460645). Databases were searched without date restriction using a pre-defined search strategy. The search identified 1427 articles. Four RCTs and 21 observational studies, reporting on 50 370 MLLAs, were included. Overall SSI incidence per MLLA incision was 7.2% (3628/50370). The incidence of SSI in patients undergoing through-knee amputation (12.9%) and below-knee amputation (7.5%) was higher than the incidence of SSI in patients undergoing above-knee amputation, (3.9%), p < 0.001. The incidence of SSI in studies focusing on patients with peripheral arterial disease (PAD), diabetes or including patients with both was 8.9%, 6.8% and 7.2%, respectively. SSI is a common complication following MLLA in vascular patients. There is a higher incidence of SSI associated with more distal amputation levels. The reported SSI incidence is similar between patients with underlying PAD and diabetes. Further studies are needed to understand the exact incidence of SSI in vascular patients and the factors which influence this.

Quality check: concordance between two monitoring systems for postoperative organ/space-surgical site infections in rectal cancer surgery. Linkage of data from the Catalan Cancer Plan and the VINCat infection surveillance programme

BACKGROUND

The Catalan Cancer Plan (CCP) undertakes periodic audits of cancer treatment outcomes, including organ/space surgical site infections (O/S-SSI) rates, while the Catalan Healthcare-associated Infections Surveillance Programme (VINCat) carries out standardized prospective surveillance of surgical site infections (SSI) in colorectal surgery. This cohort study aimed to assess the concordance between these two monitoring systems for O/S-SSI following primary rectal cancer surgery.

METHODS

The study compared O/S-SSI incidence data from CCP clinical audits versus the VINCat Programme in patients undergoing surgery for primary rectal cancer, in 2011-12 and 2015-16, in publicly funded centres in Spain. The main outcome variable was the incidence of O/S-SSI in the first 30 days after surgery. Concordance between the two registers was analysed using Cohen's kappa. Discordant cases were reviewed by an expert, and the main reasons for discrepancies evaluated.

RESULTS

Pooling data from both databases generated a sample of 2867 patients. Of these, O/S-SSI was detected in 414 patients-235 were common to both registry systems, with satisfactory concordance (κ = 0.69, 95% confidence interval 0.65-0.73). The rate of discordance from the CCP (positive cases in VINCat and negative in CCP) was 2.7%, and from VINCat (positive in CCP and negative in VINCat) was 3.6%. External review confirmed O/S-SSI in 66.2% of the cases in the CCP registry and 52.9% in VINCat.

CONCLUSIONS

This type of synergy shows the potential of pooling data from two different information sources with a satisfactory level of agreement as a means to improving O/S-SSI detection.

CLINICALTRIALS

gov Identifier: NCT06104579. Registered 30 November 2023.

A Quality Improvement Project to Increase Compliance With a Facility Protocol on Surgical Antimicrobial Prophylaxis

Surgical site infections (SSIs) contribute to negative outcomes for patients and health care organizations. Compliance with clinical practice guidelines likely can help prevent SSIs. An interdisciplinary team at a regional referral center in Michigan sought to reduce SSIs by improving compliance with the facility's preoperative antibiotic selection, dosing, timing, and redosing protocol. The interventions for the quality improvement project included adding the preprocedural antibiotics and doses to the master OR schedule; holding an education session for all preoperative nurses, intraoperative nurses, and anesthesia professionals; and posting a reference guide in the preoperative and intraoperative areas. Compliance with the facility's protocol for antibiotic selection, dosing, and timing significantly improved. However, SSI rates and compliance with redosing recommendations did not change significantly. The team decided to add the antibiotic order information to the master OR schedule permanently. The team plans to consider providing education sessions on administering preprocedural antibiotics outside the OR.

Antimicrobial stewardship program for gastrointestinal surgeries at a Vietnamese tertiary hospital

Background

Antimicrobial Stewardship Programs (ASP) have been applied widely in high-resource countries to prevent surgical site infections (SSI). Evidence favoring ASP interventions (ASPi) in gastrointestinal surgeries from low and middle-income countries has been limited, especially in antimicrobial prophylaxis. We aimed to investigate this gap at a Vietnamese tertiary hospital.

Methods

We conducted a retrospective cohort study on patients undergoing clean-contaminated surgeries in 2015 who received standard of care (SoC) or SoC + ASPi. Primary outcome was 30-day SSI incidence. Secondary outcomes included length of stay (LoS) after surgery (days), cost of antibiotics, and cost of treatment (USD). Results were controlled for multiplicity and reported with treatment effect and 95% confidence interval (95%CI). A predictive model was built and cross-validated to detect patients at high risk of SSI.

Results

We included 395 patients for analysis (48.1% being female, mean age 49.4 years). Compared to patients receiving SoC, those with SoC + ASPi had a lower incidence of 30-day SSI (-8.8, 95%CI: -16.0 to -1.6, p = 0.042), shorter LoS after surgery (-1.1 days, 95%CI: -1.8 to -0.4, p = 0.004), and lower cost of antibiotics (-37.3 USD, 95%CI: -59.8 to -14.8, p = 0.012) and treatment (-191.1 USD, 95%CI: -348.4 to -33.8, p = 0.042). We estimated that by detecting patients at high risk of SSI with the predictive model and providing prophylactic measures, we could save 398120.7 USD per 1,000 cases of SSI.

Conclusion

We found that ASPi were associated with a reduction in risks of SSI, hospital stays, and cost of antibiotics/treatment in a Vietnamese tertiary hospital.

A Comparative Analysis of Prophylactic Antibiotic Administration in Emergency Surgery Versus Elective Surgery: A Comprehensive Review

Surgical site infections (SSIs) contribute to increased patient morbidity, prolonged hospital stays, and substantial healthcare costs. Prophylactic antibiotics play a pivotal role in mitigating the risk of SSIs, with their administration being a standard practice before both emergency and elective surgeries. This paper provides a comprehensive review and comparative analysis of the benefits of prophylactic antibiotic administration in emergency surgery versus elective surgery. Through a systematic literature review and analysis of relevant studies identified through PubMed searches, this paper highlights the specific benefits of prophylactic antibiotics between emergency and elective surgeries. The findings underscore the importance of tailored antibiotic regimens and administration protocols to optimize patient care and promote successful surgical outcomes in diverse clinical settings. Further research is warranted to refine guidelines and enhance understanding of the relationship between prophylactic antibiotics and surgical outcomes across different surgical contexts.

The Effect of American Society of Anesthesiologists Score and Operative Time on Surgical Site Infection Rates in Major Abdominal Surgeries

BACKGROUND

The objective of this study was to evaluate the influence of two crucial variables, the American Society of Anesthesiologists (ASA) score and operative time, on the occurrence of surgical site infections (SSIs) in the context of major abdominal surgical procedures.

METHODOLOGY

A cross-sectional research study involved patients undergoing various gastrointestinal surgical procedures. Surgical details, procedure duration, and ASA score were meticulously documented. Patients were observed for surgical site infections (SSIs) during their inpatient stay until discharge. Following their discharge, patients were monitored in the outpatient department for a minimum of 30 days post-surgery, and those who underwent mesh procedures were observed for one year.

RESULTS

In the overall study population, surgical site infections were identified in 42 cases, constituting 6.7%. There was a significant association between ASA grade and the incidence of surgical site infections (p=0.001), indicating a higher prevalence of infections in cases with elevated ASA grades. Furthermore, a statistically significant association exists between the average duration of surgery and the occurrence of surgical site infections (p=0.001). The mean surgery duration for cases with infections is reported as 206.33 min, with a standard deviation of 103.73, while for cases without infections, the mean duration is 99.72 min, with a standard deviation of 79.71. In the multivariate analysis, it was found that an ASA score of 3 or higher and operative time exceeding 90 min were identified as independent factors for predicting the likelihood of surgical site infections.

CONCLUSION

 The significant associations identified between the American Society of Anesthesiologists (ASA) grade, average surgery duration, and SSIs underscore the importance of comprehensive preoperative assessment and procedural management in infection prevention.

Surgical site infection outcomes of two different closed incision negative pressure therapy systems in cardiac surgery: Systematic review and meta-analysis

Closed incision negative pressure therapy (ciNPT) system use compared with standard of care dressings (SOC) on surgical site infection (SSI) in cardiac surgery was assessed. A systematic literature review was conducted. Risk ratios (RR) and random effects models were used to assess ciNPT with foam dressing (ciNPT-F) or multilayer absorbent dressing (ciNPT-MLA) versus SOC. Health economic models were developed to assess potential per patient cost savings. Eight studies were included in the ciNPT-F analysis and four studies were included in the ciNPT-MLA analysis. For ciNPT-F, a significant reduction in SSI incidence was observed (RR: 0.507, 95% confidence interval [CI]: 0.362, 0.709; p < 0.001). High-risk study analysis reported significant SSI reduction with ciNPT-F use (RR: 0.390, 95% CI: 0.205, 0.741; p = 0.004). For ciNPT-MLA, no significant difference in SSI rates were reported (RR: 0.672, 95% CI: 0.276, 1.635; p = 0.381). Health economic modelling estimated a per patient cost savings of $554 for all patients and $3242 for the high-risk population with ciNPT-F use. Health economic modelling suggests ciNPT-F may provide a cost-effective solution for sternotomy incision management. However, limited high-quality literature exists. More high-quality evidence is needed to fully assess the impact of ciNPT use following cardiac surgery.

Shaping the Future of Antimicrobial Therapy: Harnessing the Power of Antimicrobial Peptides in Biomedical Applications

Antimicrobial peptides (AMPs) have emerged as a promising class of bioactive molecules with the potential to combat infections associated with medical implants and biomaterials. This review article aims to provide a comprehensive analysis of the role of antimicrobial peptides in medical implants and biomaterials, along with their diverse clinical applications. The incorporation of AMPs into various medical implants and biomaterials has shown immense potential in mitigating biofilm formation and preventing implant-related infections. We review the latest advancements in biomedical sciences and discuss the AMPs that were immobilized successfully to enhance their efficacy and stability within the implant environment. We also highlight successful examples of AMP coatings for the treatment of surgical site infections (SSIs), contact lenses, dental applications, AMP-incorporated bone grafts, urinary tract infections (UTIs), medical implants, etc. Additionally, we discuss the potential challenges and prospects of AMPs in medical implants, such as effectiveness, instability and implant-related complications. We also discuss strategies that can be employed to overcome the limitations of AMP-coated biomaterials for prolonged longevity in clinical settings.

Antibiotic Prophylaxis in Surgery: Current Insights and Future Directions for Surgical Site Infection Prevention

Surgical site infections (SSIs) remain a significant concern in the field of surgery, contributing to patient morbidity, prolonged hospital stays, and increased healthcare costs. Antibiotic prophylaxis, the administration of antibiotics before surgery, has been a cornerstone in preventing SSIs for decades. This review explores the current state of antibiotic prophylaxis in surgery, offering insights into its effectiveness, challenges, and emerging trends. In this comprehensive analysis, we delve into the historical development of antibiotic prophylaxis, examining its evolution from early practices to modern guidelines. We explore the various classes of antibiotics commonly used, their dosing regimens, and the importance of timing in optimizing prophylactic interventions. Additionally, we investigate the role of patient-specific factors, such as comorbidities and allergies, in tailoring antibiotic prophylaxis to individual needs. While antibiotic prophylaxis has undeniably reduced the incidence of SSIs, concerns about antimicrobial resistance and adverse effects necessitate a reevaluation of current practices. This review presents a critical assessment of the challenges posed by the overuse and misuse of antibiotics in surgery and highlights the urgent need for judicious antibiotic stewardship. Moreover, the future of antibiotic prophylaxis holds promise with the emergence of innovative strategies such as antimicrobial coatings, probiotics, and immunomodulatory agents. We discuss these novel approaches and their potential to enhance SSI prevention while minimizing antibiotic-related risks. In conclusion, antibiotic prophylaxis in surgery has been instrumental in reducing SSIs, but its continued effectiveness requires a multifaceted approach. By addressing current challenges, promoting antibiotic stewardship, and embracing innovative strategies, we can advance the field of SSI prevention and improve patient outcomes in the years to come. This review provides valuable insights and direction for clinicians, researchers, and policymakers as they navigate the evolving landscape of surgical prophylaxis.

Association of predictive factors and neurosurgical postoperative infections: A retrospective analysis

OBJECTIVE

To identify the factors that predispose neurosurgical patients to surgical site infections (SSI) as well as assess the risk factors attached to infection by a specific microorganism.

METHODOLOGY

A retrospective case-control study was conducted at University College of Medical Sciences and G.T.B. Hospital, Delhi. Adult patients (>18 years) undergoing a neurosurgical procedure with a diagnosis of SSI in the year 2021 having a minimum follow up of 30 days postoperatively or until death if they survived less than 30 days were included. Statistical analysis was performed using the SPSS 16 software with level of significance at 0.05.

RESULTS

An incidence of 3.15% was observed at our center. Mean age of the study population was 39.2 ± 13.07 years (range 22-70 years) with a male: female ratio of 3:1. Having an underlying infection (p = 0.024), ASA score> 2 (p = 0.041), duration of surgery> 4 h (p = 0.025), diabetes (p = 0.027) and preoperative stay at the hospital (p = 0.036) were found to be statistically significant risk factors in the prediction of SSI in neurosurgical patients which were utilised to create a regression model with an accuracy of 70% and AUC of 0.833. Deep infections were found to have a significant association with positive culture on the collected samples (p = 0.035).

CONCLUSIONS

This study is a starting point to identify which factors could predict the presence of a particular organism isolated from the site of infection in neurosurgical patients, thereby minimizing AMR.

Incidence and impact of surgical site complications on length of stay and cost of care for patients undergoing open procedures

Background

Surgical site complications (SSCs) can have serious and life-threatening consequences for patients; however, their frequency and impact on healthcare utilization across surgical procedures, particularly for non-infectious SSCs, are unknown. This study examined incidence of overall SSCs and non-infectious SSCs in patients undergoing open surgical procedures in the United States and their effect on length of stay (LOS) and costs.

Methods

This retrospective study utilizing 2019-2020 data from Medicare and Premier Health Database identified patients with SSCs during hospitalization or within 90 days of discharge. Propensity score matching was used to calculate incremental LOS and costs attributable to SSCs. Mean LOS and costs attributable to SSCs for the index admission, readmissions, and outpatient visits were summed by procedure and Charlson Comorbidity Index score to estimate the overall impact of an SSC on LOS and costs across healthcare settings.

Results

Overall and non-infectious SSC rates were 7.3 % and 5.3 % respectively for 2,696,986 Medicare and 6.7 % and 5.0 % for 1,846,254 Premier open surgeries. Total incremental LOS and cost per SSC were 7.8 days and $15,339 for Medicare patients and 6.2 days and $17,196 for Premier patients. Incremental LOS and cost attributable to non-infectious SSCs were 6.5 days and $12,703 and 5.2 days and $14,477 for Medicare and Premier patients respectively.

Conclusions

This study utilizing two large national databases provides strong evidence that SSCs, particularly non-infectious SSCs, are not uncommon in open surgeries and result in increased healthcare utilization and costs. These findings demonstrate the need for increased adoption of evidence-based interventions that can reduce SSC rates.