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Reischies FMJ, Tiefenbacher F, Holzer-Geissler JCJ, Wolfsberger C, Eylert G, Mischitz M, Pregartner G, Meikl T, Winter R, Kamolz LP, Lumenta DB. BMI and Revision Surgery for Abdominoplasties: Complication Definitions Revisited Using the Clavien-Dindo Classification. Plast Reconstr Surg Glob Open 2023; 11:e4411. [PMID: 36798721 PMCID: PMC9925103 DOI: 10.1097/gox.0000000000004411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/12/2022] [Indexed: 02/15/2023]
Abstract
After body contouring surgery of the lower trunk (CSLT), the definition, rate (4%-70%), and documentation of complications vary. Objectives We analyzed the effect of risk factors on the outcome based on the Clavien-Dindo classification (CDC) after CSLT surgery and polled postoperative satisfaction among patients. Methods All patients undergoing CSLT from 2001 to 2016 were included and were classified according to the CDC for postoperative events. Statistical analysis included proportional odds logistic regression analysis. We polled patients to grade their satisfaction with the postoperative result and whether they would have the operation performed again. Results A total of 265 patients were included: 60 (22.6%), 25 (9.4%), 28 (10.6%), and 21 (7.9%) were in CDC grades I, II, IIIa, and IIIb, respectively. A high preoperative body mass index significantly increased the odds for a postoperative event requiring revision surgery under general anesthesia (CDC grade IIIb, odds ratio 0.93, 95% confidence interval 0.89-0.97, P = 0.001). One-hundred twenty-eight patients (48.3%) participated in the poll: 101 (78.9%) were either happy or content with the postoperative results, and 117 (91.4%) would have the procedure performed again, including all nine patients with CDC grade IIIb. Conclusions Our results confirm that a high body mass index is a statistically significant risk factor for requiring major revision surgery after CSLT. Despite being a complication prone intervention, postoperative satisfaction after CSLT was ranked favorably in our sample. We recommend that the CDC be used in all surgical specialties to evaluate complications and permit future comparability of pooled data.
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Affiliation(s)
- Frederike M. J. Reischies
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Fabian Tiefenbacher
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Judith C. J. Holzer-Geissler
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria,COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Christina Wolfsberger
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria,Division of Neonatology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Gertraud Eylert
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Madeleine Mischitz
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics und Documentation, Medical University of Graz, Graz, Austriaand
| | - Tobias Meikl
- Department of Surgery, St John of God Hospital, Graz, Austria
| | - Raimund Winter
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lars-Peter Kamolz
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria,COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - David B. Lumenta
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Reischies FMJ, Krause R, Holzer J, Tiefenbacher F, Winter R, Eylert G, Meikl T, Tuca A, Köfer MJ, Kamolz LP, Lumenta DB. What can we learn from sonication results of breast implants? PLoS One 2017; 12:e0182267. [PMID: 28797044 PMCID: PMC5552211 DOI: 10.1371/journal.pone.0182267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 07/14/2017] [Indexed: 11/17/2022] Open
Abstract
Background Different research groups have identified microorganisms on breast implants by sonication with significant correlation to the rate of capsular contracture. This substantiated the hypothesis of an infectious etiology of capsular contracture. However, no clinical consequence has been drawn from these results yet. Aim of this study was to review sonication results from breast implants and to evaluate the current preoperative antibiotic regime for breast-implant surgery. Methods We compared breast implant sonication culture results from published reports and our own database. Current perioperative antibiotic recommendations were compared with the susceptibility profile of the found organisms. Results We found Coagulase-negative staphylococci and Propionibacteria to be the main group of microorganism found by sonication on explanted breast implants. Most guidelines recommend cephalosporins for preoperative antibiotical prophylaxis for breast-implant surgery. Conclusion There is a discrepancy between antibiotic activity of commonly used antibiotics for preoperative prophylaxis of surgical site infections, and microorganisms found by sonication on breast implants, suspected to trigger the formation of capsular contracture. A targeted antibiotic prophylaxis for breast implant surgery with glycopeptides (e.g. Vancomycin) should be considered for the prevention of capsular contracture.
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Affiliation(s)
- Frederike M J Reischies
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Judith Holzer
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Fabian Tiefenbacher
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Raimund Winter
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Gertraud Eylert
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Tobias Meikl
- Department of Surgery, Landeskrankenhaus Feldbach/Fürstenfeld, Feldbach, Austria
| | - Alexandru Tuca
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Martin J Köfer
- Institute for Hospital Hygiene and Microbiology, Medical University of Graz, Graz, Austria
| | - Lars P Kamolz
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - David B Lumenta
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
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Winter R, Haug I, Lebo P, Grohmann M, Reischies FMJ, Cambiaso-Daniel J, Tuca A, Rienmüller T, Friedl H, Spendel S, Forbes AA, Wurzer P, Kamolz LP. Standardizing the complication rate after breast reduction using the Clavien-Dindo classification. Surgery 2016; 161:1430-1435. [PMID: 28043695 DOI: 10.1016/j.surg.2016.11.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Published complication rates for breast reduction surgery, also known as reduction mammaplasty, vary between 4% and 54%. This wide range of complication rates could be attributable to the lack of a standardized classification of complications in plastic surgery. The aim of this study was to analyze our single-center complication rates after reduction mammaplasty using the Clavien-Dindo classification. METHODS We performed a retrospective chart review studying 804 patients between the ages of 18 and 81 years old who underwent breast reduction between 2005 and 2015 at our institution. Patients with a history of breast cancer, a previous breast operation, who did not undergo bilateral reduction mammaplasty, or who required systemic immunodeficiency/immunosuppressive drugs were excluded from our analysis. Complications were classified according to the Clavien-Dindo classification from Grades I to V. RESULTS A total of 486 patients met the inclusion criteria for the analysis. Patients had an age (mean ± standard deviation) of 39 ± 13 years and a body mass index of 26 ± 4 kg/m2. Median follow-up was 274 days (interquartile range: 90.5-378). The overall rate of complications of reduction mammaplasty was 63%, with the majority of those being Grades I (48%) and II (9%), comprising 92% of all the complications. Operative revisions were required in 6% (1% Grade IIIA and 5% Grade IIIB). There were no complications graded in categories IV and V. CONCLUSION Although complications occurred in more than half of the cases, the majority did not require operative reintervention. The Clavien-Dindo classification can classify the severity of complications and serve as a benchmark to compare complication rates between different practices. We believe that grading of complications should distinguish between those that do and do not require operative reinterventions.
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Affiliation(s)
- Raimund Winter
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria.
| | - Isabella Haug
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Patricia Lebo
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Martin Grohmann
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Frederike M J Reischies
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Janos Cambiaso-Daniel
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Alexandru Tuca
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Theresa Rienmüller
- Institute of Health Care Engineering with European Notified Body of Medical Devices, Graz University of Technology, Graz, Austria
| | - Herwig Friedl
- Institute of Statistics, Graz University of Technology, Graz, Austria
| | - Stephan Spendel
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Abigail A Forbes
- University of Texas Medical Branch, School of Medicine, Galveston, TX
| | - Paul Wurzer
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Lars-P Kamolz
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria; Research Unit for Safety in Health, Medical University of Graz, Graz, Austria
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Reischies FMJ, Prattes J, Woelfler A, Eigl S, Hoenigl M. Diagnostic performance of 1,3-beta-D-glucan serum screening in patients receiving hematopoietic stem cell transplantation. Transpl Infect Dis 2016; 18:466-70. [PMID: 26992092 DOI: 10.1111/tid.12527] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/08/2016] [Accepted: 01/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The polysaccharide cell wall component, 1,3-beta-D-glucan (BDG), is used as a serum biomarker for invasive fungal infection (IFI). Patients receiving hematopoietic stem cell transplantation (HSCT) are considered a highly vulnerable group for IFI development. We evaluated the diagnostic performance of serum BDG screening in HSCT recipients. METHODS HSCT recipients were prospectively enrolled in this study between September 2014 and August 2015. Routine serum BDG screening was performed 2-3 times weekly by using the Fungitell(®) assay. All samples were classified according to the 2008 EORTC/MSG criteria, with serum BDG results not being considered for classification. The diagnostic performance of BDG testing for IFI was calculated. BDG values ≥80 pg/mL were considered positive. RESULTS A total of 308 serum samples were collected in 45 patients. The majority of 172 samples (55.8%) were obtained at the early phase (within 30 days) after allogeneic HSCT. BDG levels were significantly higher in 16 possible/probable IFI samples when compared to no evidence for IFI samples (median 170 pg/mL, interquartile range [IQR] 100-274 pg/mL vs. median 15 pg/mL, IQR 15-15 pg/mL; P < 0.001, Mann-Whitney U-test). Diagnostic performance of serum BDG screening for possible IFI/probable invasive pulmonary aspergillosis vs. no evidence for IFI was as follows: sensitivity 81%, specificity 98%, positive predictive value 65%, negative predictive value (NPV) 99%, and diagnostic odds ratio 176 (95% confidence interval 41-761). CONCLUSIONS Our data suggest that serum BDG testing in HSCT patients may be highly specific and associated with a very high NPV of >99%. Therefore, serum BDG may be a helpful tool to rule out IFI in HSCT patients.
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Affiliation(s)
- F M J Reischies
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - J Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine, Graz, Austria
| | - A Woelfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - S Eigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - M Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine, Graz, Austria.,Division of Pulmonology, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California-San Diego, San Diego, CA, USA
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Reischies FMJ, Prattes J, Prüller F, Eigl S, List A, Wölfler A, Buzina W, Zollner-Schwetz I, Valentin T, Rabensteiner J, Flick H, Krause R, Raggam RB, Hoenigl M. Prognostic potential of 1,3-beta-d-glucan levels in bronchoalveolar lavage fluid samples. J Infect 2015; 72:29-35. [PMID: 26416472 DOI: 10.1016/j.jinf.2015.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/20/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The objective of this study was to investigate the prognostic potential of 1,3-beta-d-glucan (BDG) testing in bronchoalveolar lavage fluid (BALF) samples. METHODS A total of 300 BALF samples from 252 patients were investigated for BDG (Fungitell(®) assay). Prognostic potential of BALF BDG was evaluated by using: i.) Kaplan-Meier analysis, and ii.) multivariable Cox hazard regression analyses. RESULTS BALF BDG levels were found to be significantly higher in samples with Candida spp. colonization (p < 0.001). A total of 61/252 patients (24.2%) died within 90-days of BALF sampling (18.1% of patients with BALF BDG <200 pg/mL, 32.4% with BALF BDG ≥200 pg/mL). Kaplan-Meier analysis revealed that overall cumulative 90-day mortality was significantly higher in those with BALF BDG levels ≥200 pg/mL when compared to those with levels <200 pg/mL (log-rank p = 0.006, Breslow p = 0.005 and Tarone-Ware p = 0.005). The multivariable Cox regression analysis showed that BALF BDG levels were a strong predictor of 90-day overall mortality, with a hazard ratio of 1.048 (per 100 pg/mL increase of BALF BDG). CONCLUSION False positive BALF BDG results in the presence of Candida spp. colonization of the lower respiratory tract may explain the limited diagnostic potential of BALF BDG testing. In contrast, prognostic potential of BALF BDG may be promising.
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Affiliation(s)
- Frederike M J Reischies
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Susanne Eigl
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Agnes List
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Albert Wölfler
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Walter Buzina
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reinhard B Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Division of Infectious Diseases, Department of Medicine, University of California, San Diego, USA.
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