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Barry IP, Turley LP, Gwilym BL, Bosanquet DC, Richards T. Impact of closed-incision negative pressure wound dressings on surgical site infection following groin incisions in vascular surgery; a single-centre experience. Vascular 2023; 31:1128-1133. [PMID: 35759405 DOI: 10.1177/17085381221111007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Surgical site infection (SSI) is a common complication in vascular surgery, and is associated with increased patient morbidity, readmission and reintervention. The aim of this study was to assess the impact of closed-incision negative pressure wound therapy (CiNPWT) upon rate of SSI and length of hospital stay. METHODS This study was reported in line with the STROBE guidelines. We assessed the baseline incidence of SSI from a 12-month retrospective cohort and, following a change in practice intervention with CiNPWT, compared to a 6-month prospective cohort. The primary endpoint was incidence of SSI (according to CDC-NHSN guidelines) while secondary endpoints included length of hospital stay, readmission, reintervention and Days Alive and Out of Hospital (DAOH) to 90-days. RESULTS A total of 127 groin incisions were performed: 76 (65 patients) within the retrospective analysis and 51 (42 patients) within the prospective analysis (of whom 69% received CiNPWT). The primary endpoint of SSI was seen in 21.1% of the retrospective cohort and 9.8% of the prospective cohort (p = .099). Readmission was found to be significantly associated with the retrospective cohort (p = .016) while total admission (inclusive of re-admission) was significantly longer in those in the retrospective cohort (p = .013). DAOH-90 was 83 days (77-85) following introduction of the CiNPWT protocol as compared to the retrospective cohort (77 days (64-83), p = .04). CONCLUSION Introduction of CiNPWT was associated with a reduced length of hospital stay and improved DAOH-90. Further trials on CINPWT should include patient-centred outcomes and healthcare cost analysis.
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Affiliation(s)
- Ian Patrick Barry
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, WA, Australia
| | - Luke P Turley
- Department of General Surgery, Sir Charles Gardiner Hospital, Nedlands, WA, Australia
| | - Brenig L Gwilym
- Department of Vascular Surgery, Aneurin Bevan University Health Board, Newport, UK
| | - David C Bosanquet
- Department of Vascular Surgery, Aneurin Bevan University Health Board, Newport, UK
| | - Toby Richards
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
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Gwilym BL, Maheswaran R, Edwards A, Thomas-Jones E, Michaels J, Bosanquet DC. Income Deprivation and Groin Wound Surgical Site Infection: Cross-Sectional Analysis from the Groin Wound Infection after Vascular Exposure Multicenter Cohort Study. Surg Infect (Larchmt) 2021; 23:73-83. [PMID: 34698562 DOI: 10.1089/sur.2021.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Living in deprived areas is associated with poorer outcomes after certain vascular procedures and surgical site infection in other specialties. Our primary objective was to determine whether living in more income-deprived areas was associated with groin wound surgical site infection after arterial intervention. Secondary objectives were to determine whether living in more income-deprived areas was associated with mortality and clinical consequences of surgical site infection. Methods: Postal code data for patients from the United Kingdom who were included in the Groin Wound Infection after Vascular Exposure (GIVE) multicenter cohort study was used to determine income deprivation, based on index of multiple deprivation (IMD) data. Patients were divided into three IMD groups for descriptive analysis. Income deprivation score was integrated into the final multivariable model for predicting surgical site infection. Results: Only patients from England had sufficient postal code data, analysis included 772 groin incisions (624 patients from 22 centers). Surgical site infection occurred in 9.7% incisions (10.3% of patients). Surgical site infection was equivalent between income deprivation tertiles (tertile 1 = 9.5%; tertile 2 = 10.3%; tertile 3 = 8.6%; p = 0.828) as were the clinical consequences of surgical site infection and mortality. Income deprivation was not associated with surgical site infection in multivariable regression analysis (odds ratio [OR], 0.574; 95% confidence interval [CI], 0.038-8.747; p = 0.689). Median age at time of procedure was lower for patients living in more income-deprived areas (tertile 1 = 68 years; tertile 2 = 72 years; tertile 3 = 74 years; p < 0.001). Conclusions: We found no association between living in an income-deprived area and groin wound surgical site infection, clinical consequences of surgical site infection and mortality after arterial intervention. Patients living in more income-deprived areas presented for operative intervention at a younger age, with similar rates of comorbidities to patients living in less income-deprived areas.
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Affiliation(s)
| | - Ravi Maheswaran
- School of Health and Related Research, University of Sheffield, United Kingdom
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, United Kingdom
| | | | - Jonathan Michaels
- School of Health and Related Research, University of Sheffield, United Kingdom
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Gwilym BL, Ambler GK, Saratzis A, Bosanquet DC. Groin Wound Infection after Vascular Exposure (GIVE) Risk Prediction Models: Development, Internal Validation, and Comparison with Existing Risk Prediction Models Identified in a Systematic Literature Review. Eur J Vasc Endovasc Surg 2021; 62:258-266. [PMID: 34246547 DOI: 10.1016/j.ejvs.2021.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/29/2021] [Accepted: 05/08/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to develop and internally validate risk prediction models for predicting groin wound surgical site infections (SSIs) following arterial intervention and to evaluate the utility of existing risk prediction models for this outcome. METHODS Data from the Groin wound Infection after Vascular Exposure (GIVE) multicentre cohort study were used. The GIVE study prospectively enrolled 1 039 consecutive patients undergoing an arterial procedure through 1 339 groin incisions. An overall SSI rate of 8.6% per groin incision, and a deep/organ space SSI rate of 3.8%, were reported. Eight independent predictors of all SSIs, and four independent predictors of deep/organ space SSIs were included in the development and internal validation of two risk prediction models. A systematic search of the literature was conducted to identify relevant risk prediction models for their evaluation. RESULTS The "GIVE SSI risk prediction model" ("GIVE SSI model") and the "GIVE deep/organ space SSI risk prediction model" ("deep SSI model") had adequate discrimination (C statistic 0.735 and 0.720, respectively). Three other groin incision SSI risk prediction models were identified; both GIVE risk prediction models significantly outperformed these other risk models in this cohort (C statistic 0.618 - 0.629; p < .050 for inferior discrimination in all cases). CONCLUSION Two models were created and internally validated that performed acceptably in predicting "all" and "deep" groin SSIs, outperforming current existing risk prediction models in this cohort. Future studies should aim to externally validate the GIVE models.
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Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Royal Gwent Hospital, Newport, UK.
| | - Graeme K Ambler
- Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Athanasios Saratzis
- NIHR Leicester Biomedical Research Centre, University of Leicester Department of Cardiovascular Sciences, Leicester, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Royal Gwent Hospital, Newport, UK
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- Vascular and Endovascular Research Network (VERN), UK
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Dattani N, Shalhoub J, Nandhra S, Lane T, Abu-Own A, Elbasty A, Jones A, Duncan A, Garnham A, Thapar A, Murray A, Baig A, Saratzis A, Sharif A, Huasen B, Dawkins C, Nesbitt C, Carradice D, Morrow D, Bosanquet D, Kavanagh E, Shaikh F, Gosi G, Ambler G, Fulton G, Singh G, Travers H, Moore H, Olivier J, Hitchman L, O’Donohoe M, Popplewell M, Medani M, Jenkins M, Goh MA, Lyons O, McBride O, Moxey P, Stather P, Burns P, Forsythe R, Sam R, Brar R, Brightwell R, Benson R, Onida S, Paravastu S, Lambracos S, Vallabhaneni SR, Walsh S, Aktar T, Moloney T, Mzimba Z, Nyamekye I. Reducing the risk of venous thromboembolism following superficial endovenous treatment: A UK and Republic of Ireland consensus study. Phlebology 2020; 35:706-714. [DOI: 10.1177/0268355520936420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives Venous thromboembolism is a potentially fatal complication of superficial endovenous treatment. Proper risk assessment and thromboprophylaxis could mitigate this hazard; however, there are currently no evidence-based or consensus guidelines. This study surveyed UK and Republic of Ireland vascular consultants to determine areas of consensus. Methods A 32-item survey was sent to vascular consultants via the Vascular and Endovascular Research Network (phase 1). These results generated 10 consensus statements which were redistributed (phase 2). ‘Good’ and ‘very good’ consensus were defined as endorsement/rejection of statements by >67% and >85% of respondents, respectively. Results Forty-two consultants completed phase 1. This generated seven statements regarding risk factors mandating peri-procedural pharmacoprophylaxis and three statements regarding specific pharmacoprophylaxis regimes. Forty-seven consultants completed phase 2. Regarding venous thromboembolism risk factors mandating pharmacoprophylaxis, ‘good’ and ‘very good’ consensus was achieved for 5/7 and 2/7 statements, respectively. Regarding specific regimens, ‘very good’ consensus was achieved for 3/3 statements. Conclusions The main findings from this study were that there was ‘good’ or ‘very good’ consensus that patients with any of the seven surveyed risk factors should be given pharmacoprophylaxis with low-molecular-weight heparin. High-risk patients should receive one to two weeks of pharmacoprophylaxis rather than a single dose.
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Affiliation(s)
- Nikesh Dattani
- Worcestershire Acute Hospitals NHS Trust, The Vascular Surgery Unit, Worcester, Worcestershire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Joseph Shalhoub
- Imperial College Healthcare NHS Trust, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Sandip Nandhra
- Northern Vascular Centre, Freeman Hospital, Newcastle University, Newcastle Upon Tyne, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Tristan Lane
- Department of Surgery and Cancer, Imperial College London, Academic Section of Vascular Surgery, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Abdulsalam Abu-Own
- Colchester Hospital University NHS Foundation Trust, Colchester, Essex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ahmed Elbasty
- Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Aled Jones
- Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Andrew Duncan
- University Hospitals of Leicester NHS Trust, Leicester, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Andrew Garnham
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ankur Thapar
- Imperial College London, Academic Section of Vascular Surgery, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Anna Murray
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Anzar Baig
- Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Athanasios Saratzis
- University Hospitals of Leicester NHS Trust, Leicester, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Atif Sharif
- Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Bella Huasen
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Claire Dawkins
- Sunderland Royal Hospital, Sunderland, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Craig Nesbitt
- Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Daniel Carradice
- Hull Royal Infirmary, Hull, Kingston upon Hull, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Darren Morrow
- Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - David Bosanquet
- Southmead Hospital, Bristol, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Eamon Kavanagh
- University of Limerick Hospitals Group, Vascular Surgery, Limerick, Ireland
- University of Limerick Graduate Entry Medical School, Limerick, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Faisal Shaikh
- Heartlands Hospital, Birmingham, West Midlands, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Gergely Gosi
- University Hospital Waterford, Vascular Surgery, Waterford, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Graeme Ambler
- Royal Gwent Hospital, Newport, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Gregory Fulton
- Cork University Hospital Group, Cork, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Gurdas Singh
- Guy’s Hospital, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Hannah Travers
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Hayley Moore
- Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - James Olivier
- Musgrove Park Hospital, Taunton, Somerset, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Louise Hitchman
- Hull Royal Infirmary, Hull, Kingston upon Hull, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Martin O’Donohoe
- Mater Misericordiae University Hospital, Dublin, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Matthew Popplewell
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Mekki Medani
- Beaumont Hospital, Dublin, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Michael Jenkins
- Imperial College Healthcare NHS Trust, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Mingzheng A Goh
- Basildon University Hospital, Basildon, Essex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Oliver Lyons
- Basildon University Hospital, Basildon, Essex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Olivia McBride
- Edinburgh Royal Infirmary, Edinburgh, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Paul Moxey
- St George’s Hospital, Vascular Surgery, London, Tooting, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Philip Stather
- Addenbrooke’s Hospital, Cambridge, Cambridgeshire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Phillipa Burns
- Edinburgh Royal Infirmary, Edinburgh, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Rachel Forsythe
- Royal Infirmary of Edinburgh, Edinburgh, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Rachel Sam
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ranjeet Brar
- Royal Free London NHS Foundation Trust, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Robert Brightwell
- Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ruth Benson
- University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Sarah Onida
- Imperial College London, Academic Section of Vascular Surgery, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Sharath Paravastu
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Simon Lambracos
- Western Sussex Hospitals NHS Trust, Worthing, West Sussex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Srinivasa R Vallabhaneni
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Stewart Walsh
- Lambe Institute for Translational Discipline of Surgery, National University of Ireland, Galway, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Tasleem Aktar
- Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Tony Moloney
- University of Limerick Hospitals Group, Dooradoyle, Limerick, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Zola Mzimba
- Altnagelvin Hospitals Health and Social Services Trust, Londonderry, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Isaac Nyamekye
- Worcestershire Acute Hospitals NHS Trust, The Vascular Surgery Unit, Worcester, Worcestershire, UK
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