scholarly journals Surgical site infection in paediatric posterior fossa surgery: does pathology matter?

2021 ◽  
Author(s):  
Malik Zaben ◽  
Alexandra Richards ◽  
Joseph Merola ◽  
Chirag Patel ◽  
Paul Leach
Keyword(s):  
Surgical Site Infection ◽  
Posterior Fossa ◽  
Csf Leak ◽  
Tumour Resection ◽  
Posterior Fossa Surgery ◽  
Site Infection ◽  
Significant Difference ◽  
Paediatric Age ◽  
Postoperative Hydrocephalus ◽  
Brain Tumour Surgery

Abstract Objectives The aim of this study was to explore the rates and potential risks of surgical site infection (SSI) after posterior fossa surgery for tumour resection in children. Methods We retrospectively reviewed our local paediatric (age < 16 years) database for all cases of posterior fossa (PF) brain tumour surgery between November 2008 and November 2019. We collected patient demographics, tumour histology/location, and the event of postoperative surgical site infection. Results Overall, 22.1% (n=15) developed SSI out of sixty-eight children undergoing PF surgery for resection of brain tumours; 73.3% of them had a confirmed diagnosis of medulloblastoma. There was no statistically significant difference in the age (5.1 ± 0.60 vs. 6.2 ± 0.97 years; p=0.47) and duration of operation (262 vs. 253 min; p = 0.7655) between the medulloblastoma group and other tumours. Although the rate of postoperative hydrocephalus was higher in the medulloblastoma group (12.9% vs. 0%), this was not associated with increased SSI. Rates of CSF leak between the 2 groups were not different. Conclusion Medulloblastoma as a pathological entity seems to carry higher risk of postoperative surgical site infection compared to other types of paediatric posterior fossa tumours. Further larger studies are required to look into this causal relationship and other risk factors that might be involved.

scholarly journals DuraSeal Exact Is a Safe Adjunctive Treatment for Durotomy in Spine: Postapproval Study

2018 ◽  
Vol 9 (3) ◽  
pp. 272-278 ◽  
Author(s):  
Kee D. Kim ◽  
Dinesh Ramanathan ◽  
Jason Highsmith ◽  
William Lavelle ◽  
Peter Gerszten ◽  
...  
Keyword(s):  
Adverse Events ◽  
Surgical Site Infection ◽  
The United States ◽  
Csf Leak ◽  
Site Infection ◽  
Serious Adverse Events ◽  
Dural Repair ◽  
Significant Difference ◽  
Csf Leakage ◽  
Deep Surgical Site Infection

Study Design: A nonrandomized, two-armed prospective study. Objective: Water-tight dural closure is paramount to the prevention of cerebrospinal fluid (CSF) leakage and associated complications. Synthetic polyethylene glycol (PEG) hydrogel has been used as an adjunct to sutured dural repair; however, its expansion postoperatively is a concern for neurological complications. A low-swell formulation of PEG sealant was introduced as DuraSeal Exact Spine Sealant System (DESS). A Post-Approval Study was performed primarily to evaluate the safety and efficacy of DESS for spinal dural repair compared to current alternatives, in a large patient population, reflecting a real-world practice. Methods: A total of 36 sites in the United States enrolled 429 patients treated with DESS as an adjunct to dural repair in the spinal sealant group and 406 patients treated with all other modalities in the control arm, from October 2011 to June 2016. The primary endpoint was the incidence of CSF leak within 90 days of operation. The secondary endpoints evaluated were deep surgical site infection and neurological serious adverse events. Results: The CSF leakage in the DESS group (6.6%) was not significantly different from the control group (6.5%) ( p = .83), and there was no significant difference in the time to first leak. The two groups had no significant differences in deep surgical site infection (1.6% versus control 2.1%, p = .61) or proportion of subjects with neurological serious adverse events (2.9% versus control 1.6%, p = .516). Conclusions: DuraSeal Exact Spinal Sealant is safe when compared to current alternatives for spinal dural repair.

Chlorhexidine Showers are Associated With a Reduction in Surgical Site Infection Following Spine Surgery: An Analysis of 4266 Consecutive Surgeries

Neurosurgery ◽  
2018 ◽  
Vol 85 (6) ◽  
pp. 817-826 ◽  
Author(s):  
Andrew K Chan ◽  
Simon G Ammanuel ◽  
Alvin Y Chan ◽  
Taemin Oh ◽  
Henry C Skrehot ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Subgroup Analysis ◽  
Spinal Surgery ◽  
Site Infection ◽  
Safe Patient Care ◽  
Significant Difference ◽  
Additional Costs ◽  
Procedure Type

Abstract BACKGROUND Surgical site infection (SSI) is a common complication following spinal surgery. Prevention is critical to maintaining safe patient care and reducing additional costs associated with treatment. OBJECTIVE To determine the efficacy of preoperative chlorhexidine (CHG) showers on SSI rates following fusion and nonfusion spine surgery. METHODS A mandatory preoperative CHG shower protocol was implemented at our institution in November 2013. A cohort comparison of 4266 consecutive patients assessed differences in SSI rates for the pre- and postimplementation periods. Subgroup analysis was performed on the type of spinal surgery (eg, fusion vs nonfusion). Data represent all spine surgeries performed between April 2012 and April 2016. RESULTS The overall mean SSI rate was 0.4%. There was no significant difference between the pre- (0.7%) and postimplementation periods (0.2%; P = .08). Subgroup analysis stratified by procedure type showed that the SSI rate for the nonfusion patients was significantly lower in the post- (0.1%) than the preimplementation group (0.7%; P = .02). There was no significant difference between SSI rates for the pre- (0.8%) and postimplementation groups (0.3%) for the fusion cohort (P = .21). In multivariate analysis, the implementation of preoperative CHG showers were associated with significantly decreased odds of SSI (odds ratio = 0.15, 95% confidence interval [0.03-0.55], P &lt; .01). CONCLUSION This is the largest study investigating the efficacy of preoperative CHG showers on SSI following spinal surgery. In adjusted multivariate analysis, CHG showering was associated with a significant decrease in SSI following spinal surgery.

The incidence of complications in elective cranial neurosurgery associated with dural closure material

2014 ◽  
Vol 120 (1) ◽  
pp. 278-284 ◽  
Author(s):  
Brian P. Walcott ◽  
Jonathan B. Neal ◽  
Sameer A. Sheth ◽  
Kristopher T. Kahle ◽  
Emad N. Eskandar ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Corticosteroid Treatment ◽  
Csf Leak ◽  
Site Infection ◽  
Exclusion Criteria ◽  
Dural Closure ◽  
Estimated Blood Loss ◽  
Dural Graft ◽  
Synthetic Grafts

Object Dural closure with synthetic grafts has been suggested to contribute to the incidence of infection and CSF leak. The objective of this study was to assess the contribution of choice of dural closure material, as well as other factors, to the incidence of infection and CSF leak. Methods A retrospective, consecutive cohort study of adult patients undergoing elective craniotomy was established between April 2010 and March 2011 at a single center. Exclusion criteria consisted of trauma, bur hole placement alone, and temporary CSF fluid diversion. Results Three hundred ninety-nine patients were included (mean follow-up 396.6 days). Nonautologous (synthetic) dural substitute was more likely to be used (n = 106) in cases of reoperation (p = 0.001). Seventeen patients developed a surgical site infection and 12 patients developed a CSF leak. Multivariate logistic regression modeling identified estimated blood loss (OR 1.002, 95% CI 1.001–1.003; p < 0.001) and cigarette smoking (OR 2.198, 95% CI 1.109–4.238; p = 0.019) as significant predictors of infection. Synthetic dural graft was not a predictor of infection in multivariate analysis. Infratentorial surgery (OR 4.348, 95% CI 1.234–16.722; p = 0.024) and more than 8 days of postoperative corticosteroid treatment (OR 3.886, 95% CI 1.052–16.607; p = 0.048) were significant predictors for the development of CSF leak. Synthetic dural graft was associated with a lower likelihood of CSF leak (OR 0.072, 95% CI 0.003–0.552; p = 0.036). Conclusions The use of synthetic dural closure material is not associated with surgical site infection and is associated with a reduced incidence of CSF leak. Modifiable risk factors exist for craniotomy complications that warrant vigilance and further study.

scholarly journals The Use of Oral Antibiotics to Prevent Surgical Site Infection on Postoperative Modified Radical Mastectomy Patients in Dr. Soetomo General Hospital, Surabaya

2021 ◽  
Vol 56 (1) ◽  
pp. 36
Author(s):  
Norman Hadi ◽  
Hantoro Ishardyanto
Keyword(s):  
Single Dose ◽  
Surgical Site Infection ◽  
General Hospital ◽  
Radical Mastectomy ◽  
Antibiotic Use ◽  
Prophylactic Antibiotics ◽  
Site Infection ◽  
Oral Antibiotics ◽  
Modified Radical Mastectomy ◽  
Significant Difference

Surgical operations on modified radical mastectomy are considered clean procedures by the Centers for Disease Control and Prevention (CDC) wound classification system. Despite this, higher than expected Surgical Site Infection (SSI) rates are reported, varying from 1 % to 26 % across the literature. Some surgeons also prescribe postoperative prophylaxis for postoperative modified radical mastectomy patients to prevent infection despite its lack of proven efficacy. The aim of this study is to analyze the use of oral antibiotics to prevent Surgical Site Infection (SSI) on postoperative modified radical mastectomy patients in Dr. Soetomo General Hospital. This study was double-blinded randomized control trial of 60 postoperative modified radical mastectomy patients (2 groups) during the period of December 2017 to March 2018. Samples were prospectively divided into two groups (random sampling), in group A (n=30) patients received single dose prophylactic antibiotics and continued with oral antibiotics postoperative (Cefadroxil 2 x 500 mg) during 7 days and in group B (n=30) patients received single dose prophylactic antibiotics and continued without postoperative antibiotics (placebo). Both groups were evaluated clinically for surgical site infection up to 30 days. There was no statistically significant difference in both groups {p=1 (p>0.05)}. There was no incidence of surgical site infection in both groups during the 30-day follow-up period (days 3, 7, 14 and 30). There was no difference in the surgical site infection rate among those who received oral postoperative antibiotics prophylactic and without antibiotics (placebo) on postoperative modified radical mastectomy patients in Dr. Soetomo General Hospital. Because of the potential adverse events associated with antibiotic use, further evaluation of this practice is required.

scholarly journals The Incidence of Surgical Site Infection in Acute Non Perforated Appendicitis

2019 ◽  
Vol 9 (2) ◽  
pp. 11-14
Author(s):  
Suraj Raj Bhattarai ◽  
Kishor Kumar Tamrakar
Keyword(s):  
Single Dose ◽  
Surgical Site Infection ◽  
Perforated Appendicitis ◽  
College Teaching ◽  
Cross Sectional Study ◽  
Age Group ◽  
Site Infection ◽  
Cross Sectional ◽  
Significant Difference ◽  
Group Sex

Background: Appendectomy is the most commonly performed emergency  surgical procedure and has significant morbidity of surgical site infection (SSIs). Regarding this, there are conflicting reports and dilemma on use of optimal duration of antibiotics. The aim of this study was to evaluate the incidence of SSIs after three doses of perioperative prophylactic antibiot­ics (single dose before surgery and two doses postoperatively) after ap­pendectomy in acute non- perforated appendicitis (NPA). Methods: This cross sectional study was conducted in the department of General surgery, Chitwan Medical College Teaching Hospital, from May 2018 to April 2019. All the cases received single dose of antibiotics (cef­triaxone and metronidazole) during the induction of anesthesia and two doses of the same antibiotics postoperatively within 24 hours. SSIs was assessed on 2nd and followed up till 7th postoperative day. The data col­lected was analyzed using SPSS version 16. Results: In the study of 100 patients, who received perioperative three doses of antibiotics, the overall frequency of SSIs on 2nd and 3rd post-operative day were 2% (p=.840) and 6% (p=.539) respectively, which was statistically not significant. In follow up after 3rd postoperative day, there was no evidence of SSIs. Statistically there was no significant difference in the incidence and grade of SSIs between age group, sex and duration of operation. Conclusions: A combined three doses of perioperative antibiotics was ad­equate for SSIs prevention in patients of any age group and sex with acute NPA after appendectomy in usual operative time.

Surgical Site Infection Rate Drops to 0% Using a Vacuum-Assisted Closure in Contaminated/ Dirty Infected Laparotomy Wounds

2017 ◽  
Vol 83 (5) ◽  
pp. 512-514 ◽  
Author(s):  
Gerardo Lozano-Balderas ◽  
Alejandro Ruiz-Velasco-Santacruz ◽  
Jose Antonio Diaz-Elizondo ◽  
Juan Antonio Gomez-Navarro ◽  
Eduardo Flores-Villalba
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Primary Closure ◽  
Statistical Significance ◽  
Site Infection ◽  
Class Iii ◽  
Infection Rates ◽  
Vacuum Assisted Closure ◽  
Significant Difference ◽  
Delayed Closure

Wound site infections increase costs, hospital stay, morbidity, and mortality. Techniques used for wounds management after laparotomy are primary, delayed primary, and vacuum-assisted closures. The objective of this study is to compare infection rates between those techniques in contaminated and dirty/ infected wounds. Eighty-one laparotomized patients with Class III or IV surgical wounds were enrolled in a three-arm randomized prospective study. Patients were allocated to each group with the software Research Randomizer® (Urbaniak, G. C, & Plous, S., Version 4.0). Presence of infection was determined by a certified board physician according to Centers for Disease Control's Criteria for Defining a Surgical Site Infection. Twenty-seven patients received primary closure, 29 delayed primary closure, and 25 vacuum-assisted closure, with no exclusions for analysis. Surgical site infection was present in 10 (37%) patients treated with primary closure, 5 (17%) with primary delayed closure, and 0 (0%) patients receiving vacuum-assisted closure. Statistical significance was found between infection rates of the vacuum-assisted group and the other two groups. No significant difference was found between the primary and primary delayed closure groups. The infection rate in contaminated/dirty-infected laparotomy wounds decreases from 37 and 17 per cent with a primary and delayed primary closures, respectively, to 0 per cent with vacuum-assisted systems.

scholarly journals Perioperative Prophylactic Antibiotics in Orthopaedic Surgery

2013 ◽  
Vol 3 (1) ◽  
pp. 5-10
Author(s):  
Bikram Prasad Shrestha ◽  
Surya Raj Niraula ◽  
Parvin Nepal ◽  
Guru Prasad Khanal ◽  
Navin Karn ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Orthopaedic Surgery ◽  
Controlled Trial ◽  
Prophylactic Antibiotics ◽  
Drug Resistant ◽  
Site Infection ◽  
Oral Antibiotics ◽  
Randomized Controlled ◽  
Orthopaedic Patients ◽  
Significant Difference

Introduction: In our country, various institutes have different protocols for postoperative antibiotics. Many western literature have mentioned that administration of prophylactic antibiotics for longer than 24 hours has no advantage and may actually lead to superinfection with drug-resistant organisms. Because of environmental and theater condition most of the surgeon here are very reluctant to use prophylactic antibiotics for only 24 hours. The objective of the study was to find out the effect of duration of prophylactic antibiotics on the rate of surgical site infection in clean elective orthopaedic surgeries. Methods: This was a randomized controlled trial involving 207 clean elective orthopaedic patients undergoing surgery. The patients were divided into three groups which received intravenous prophylactic antibiotics for 24 hours, 48 hours and 48 hours followed by 7 days of oral antibiotics respectively. The patients were followed up for three months postoperatively. Result: There was no significant difference in the rate of surgical site infection among the three groups. Conclusion: We conclude that there is no benefit in prolonging prophylactic antibiotics beyond 24 hours. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9318   Nepal Orthopedic Association Journal 2013 Vol.3(1): 5-10

Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan

2020 ◽  
pp. 1-9
Author(s):  
Ali Faisal Saleem ◽  
Huma Faiz Halepota ◽  
Hasaan Omar ◽  
Areeba Zain ◽  
Muhammad Arif Mateen Khan
Keyword(s):  
Abdominal Surgery ◽  
Surgical Site Infection ◽  
Tertiary Care ◽  
Stable Condition ◽  
University Hospital ◽  
P Value ◽  
Care Hospital ◽  
Site Infection ◽  
Significant Difference ◽  
Pathogen Occurrence

Abstract A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the post-operative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chi-square and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and post-surgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). Continuous...  

Sitting Prone Position for the Posterior Surgical Approach to the Spine and Posterior Fossa

Neurosurgery ◽  
1982 ◽  
Vol 10 (2) ◽  
pp. 232-235 ◽  
Author(s):  
Albert W. Cook ◽  
Tariq S. Siddiqi ◽  
Florence Nidzgorski ◽  
Hadley A. Clarke
Keyword(s):  
Central Venous Pressure ◽  
Prone Position ◽  
Posterior Fossa ◽  
Surgical Approach ◽  
Airway Pressure ◽  
Venous Pressure ◽  
Posterior Fossa Surgery ◽  
Comparative Efficacy ◽  
Central Venous ◽  
Significant Difference

Abstract The sitting prone position is compared with the standard laminectomy prone position and the sitting up position for posterior fossa surgery. We measured central venous pressure and airway pressure with the patient in different positions to determine the comparative efficacy of the sitting prone position. On a linear average, the central venous pressure increased by 6.83 cm H2O and the airway pressure increased by 3.16 cm H2O when the patient was changed from the supine to the standard prone position under general anesthesia; with a change from the standard prone position to the sitting prone position, the central venous pressure decreased by 10.45 cm H2O and the airway pressure decreased by 3.66 cm H2O. However, comparing the sitting prone position for posterior fossa surgery with the sitting up position, there was no statistically significant difference in central venous or airway pressure.

Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients

2011 ◽  
Vol 14 (6) ◽  
pp. 771-778 ◽  
Author(s):  
Matthew J. McGirt ◽  
Scott L. Parker ◽  
Jason Lerner ◽  
Luella Engelhart ◽  
Tyler Knight ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Site Infection ◽  
Direct Cost ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Site Infection ◽  
Patient Morbidity ◽  
Significant Difference ◽  
Level Fusion

Object Surgical site infection (SSI) after lumbar fusion results in significant patient morbidity and associated medical resource utilization. Minimally invasive (MI) techniques for posterior/transforaminal lumbar interbody fusion (P/TLIF) were introduced with the goals of smaller wounds, less tissue trauma, reduced blood loss, and quicker postoperative recovery, while maintaining comparable surgical results. Studies with sufficient power to directly compare the incidence of SSI following MI versus open P/TLIF procedures have been lacking. Furthermore, the direct medical cost associated with the treatment of SSI following the P/TLIF procedure is poorly understood and has not been adequately assessed. Thus, the aim in the present study was to determine the incidence of perioperative SSI in patients undergoing MI versus open P/TLIF and the direct hospital cost associated with the diagnosis and management of SSI after P/TLIF as reported in a large administrative database. Methods The authors retrospectively reviewed hospital discharge and billing records from the Premier Perspective Database for 2003 to 2009 to identify patients undergoing 1- or 2-level MI or open P/TLIF for lumbar spondylotic disease, disc degeneration, or spondylolisthesis. The ICD-9-CM procedure codes were used to identify patients undergoing P/TLIF and those experiencing SSI. Infection-related costs were obtained from the total costs incurred by the hospital for SSI-related care provided during inpatient or hospital outpatient encounters. Results Five thousand one hundred seventy patients undergoing P/TLIF were identified. Demographic profiles, including the Charlson Comorbidity Index, were similar between MI and open cohorts. Overall, 292 patients (5.6%) experienced an SSI with a mean direct cost of $15,817 per SSI. For 1-level MI versus open P/TLIF, the incidence of SSI (38 [4.5%] vs 77 [4.8%], p = 0.77) and the mean SSI-associated cost per P/TLIF ($684 vs $724, p = 0.680) were similar. For 2-level MI versus open P/TLIF, the incidence of SSI (27 [4.6%] vs 150 [7.0%], p = 0.037) and mean SSI-associated cost per P/TLIF ($756 vs $1140, p = 0.030) were both significantly lower among MI-treated patients. In a multivariate model that accounted for differences in demographics and patient severity, open fusion was associated with a strong trend of increased incidence of SSI as compared with MI fusion (OR 1.469, 95% CI 0.959–2.250). Conclusions In this multihospital study, the MI technique was associated with a decreased incidence of perioperative SSI and a direct cost savings of $38,400 per 100 P/TLIF procedure when used in 2-level fusion. There was no significant difference in the incidence of SSIs between the open and MI cohorts for 1-level fusion procedures. The results of this study provide further evidence of the reduced patient morbidity and health care costs associated with MI P/TLIF.

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