Increased Risk of Postoperative Wound Complications Among Obesity Classes II & III After ALIF in 10-year ACS-NSQIP Analysis of 10,934 Cases

Objective This study was aimed to evaluate the relationship between cesarean skin incision length and wound complications. Study Design Planned secondary analysis of a multicenter double-blind randomized trial of adjunctive azithromycin versus placebo (in addition to standard cefazolin) in women ≥24 weeks undergoing cesarean delivery during labor or ≥4 hours after membrane rupture. Skin incision length (cm) was measured just prior to skin closure. The primary outcome was a composite of wound complications (wound infection, separation, seroma, hematoma, or dehiscence) up to 6 weeks of postpartum. Individual components of the composite were examined as secondary outcomes. Outcomes were compared between groups defined by the lowest (≤25th), middle (25–75th) and highest (>75th) incision length quartiles. Logistic regression was used to adjust for potential confounding variables. Results Of the 2,013 women enrolled in the primary trial, 1,916 had recorded incision lengths and were included in this secondary analysis. The overall rate of composite wound complications was 7.8%. Median incision length was 15.0 cm (interquartile range: 14.0–16.5) with the lowest quartile defined as ≤14, middle as >14 to ≤16.5, and highest as >16.5 cm. Mean BMI, parity, use of staples, and duration of surgery differed significantly between the three incision length groups. In unadjusted analysis, the longest incision lengths were associated with an increased risk of the wound composite and wound infections (odds ratio [OR] = 2.27, 95% confidence interval [CI]: 1.43–3.60 and OR = 2.30, 95% CI: 1.27–4.15, respectively) compared with the shortest incision lengths. However, after multivariable adjustments, these associations were nullified. Additional analyses considering incision length as a continuous variable and using 10th/90th percentile cut-offs still did not suggest any associations with outcomes. Conclusion Increasing skin incision length is not independently associated with an increased risk of postoperative wound complications. Key Points

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Jackson-Pratt drainage in pediatric craniofacial reconstructive surgery: is it helping or hurting?

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.5.peds17101 ◽

2017 ◽

Vol 20 (4) ◽

pp. 341-346 ◽

Cited By ~ 3

Author(s):

Kumar Vasudevan ◽

Ahyuda Oh ◽

R. Shane Tubbs ◽

David Garcia ◽

Andrew Reisner ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Reconstructive Surgery ◽

Pediatric Patients ◽

Emergency Department Visits ◽

Wound Complications ◽

Postoperative Wound ◽

Icu Length Of Stay ◽

Perioperative Blood Loss ◽

Increased Risk

OBJECTIVEJackson-Pratt drains (JPDs) are commonly employed in pediatric craniofacial reconstructive surgery (CRFS) to reduce postoperative wound complications, but their risk profile remains unknown. Perioperative blood loss and volume shifts are major risks of CFRS. The goal of this study was to evaluate the risks of JPD usage in CFRS, particularly with regard to perioperative blood loss, hyponatremia, intensive care unit (ICU) length of stay, and postoperative wound complications.METHODSThe authors performed a retrospective review of data obtained in pediatric patients who underwent CFRS at a single institution, as performed by multiple surgeons between January 2010 and December 2014. Data were gathered from patients who did and did not receive JPDs at the time of surgery. Outcome measures were compared between the JPD and no-JPD groups.RESULTSThe overall population 179 pediatric patients: 128 who received JPDs and 51 who did not. In their analysis, the authors found no significant differences in baseline patient characteristics between the two groups. The average JPD output over the first 48 hours was 222 ± 142 ml. When examining the immediate preoperative to immediate postoperative time period, no significant differences were noted between the groups with regard to the need for blood transfusion or changes in hemoglobin, hematocrit, or serum sodium levels. These differences were also not significant when examining the 48-hour postoperative period. Finally, no significant differences in hospital length of stay, ICU length of stay, or emergency department visits at 60 days were noted between the two groups.CONCLUSIONSIn this retrospective study, the use of JPDs in pediatric CFRS was not associated with an increased risk of serious perioperative complications, although the benefits of this practice remain unclear.

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Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

Anesthesiology ◽

10.1097/aln.0b013e3182054d06 ◽

2011 ◽

Vol 114 (2) ◽

pp. 283-292 ◽

Cited By ~ 312

Author(s):

Laurent G. Glance ◽

Andrew W. Dick ◽

Dana B. Mukamel ◽

Fergal J. Fleming ◽

Raymond A. Zollo ◽

...

Keyword(s):

Blood Transfusion ◽

Noncardiac Surgery ◽

Pulmonary Complications ◽

Wound Complications ◽

Severe Anemia ◽

Thromboembolic Complications ◽

Mortality And Morbidity ◽

Risk Of Death ◽

Increased Risk ◽

The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

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Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01580-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jef Van den Eynde ◽

Abel Van Vlasselaer ◽

Annoushka Laenen ◽

Delphine Szecel ◽

Bart Meuris ◽

...

Keyword(s):

Retrospective Study ◽

Hemoglobin A1c ◽

Clinical Decision Making ◽

Artery Bypass ◽

Clinical Decision ◽

Wound Complications ◽

Minimal Risk ◽

Off Pump ◽

Increased Risk ◽

Diabetes Patients

Abstract Background Poor glycemic control has been associated with an increased risk of wound complications after various types of operations. However, it remains unclear how hemoglobin A1c (HbA1c) and preoperative glycemia can be used in clinical decision-making to prevent sternal wound complications (SWC) following off-pump coronary artery bypass grafting (OPCAB). Methods We conducted a retrospective study of 1774 consecutive patients who underwent OPCAB surgery between January 2010 and November 2016. A new four-grade classification for SWC was used. The associations of HbA1c and preoperative glycemia with incidence and grade of SWC were analysed using logistic regression analysis and proportional odds models, respectively. Results During a median follow-up of 326 days (interquartile range (IQR) 21–1261 days), SWC occurred in 133/1316 (10%) of non-diabetes and 82/458 (18%) of diabetes patients (p < 0.001). Higher HbA1c was significantly associated with a higher incidence of SWC (odds ratio, OR 1.24 per 1% increase, 95% confidence interval, CI 1.04;1.48, p = 0.016) as well as a higher grade of SWC (OR 1.25, 95% CI 1.06;1.48, p = 0.010). There was no association between glycemia and incidence (p = 0.539) nor grade (p = 0.607) of SWC. Significant modifiers of these effects were found: HbA1c was associated with SWC in diabetes patients younger than 70 years (OR 1.41, 95% CI 1.17;1.71, p < 0.001), whereas it was not in those older than 70 years. Glycemia was associated with SWC in patients who underwent non-urgent surgery (OR 2.48, 95% CI 1.26;4.88, p = 0.009), in diabetes patients who received skeletonised grafts (OR 4.83, 95% CI 1.28;18.17, p = 0.020), and in diabetes patients with a BMI < 30 (OR 2.19, 95% CI 1.01;4.76, p = 0.047), whereas it was not in the counterparts of these groups. Conclusions Under certain conditions, HbA1c and glycemia are associated SWC following OPCAB. These findings are helpful in planning the procedure with minimal risk of SWC.

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The Effect of Obesity on Achilles Rupture Repair

Foot & Ankle Specialist ◽

10.1177/1938640018816376 ◽

2018 ◽

Vol 12 (6) ◽

pp. 503-512 ◽

Cited By ~ 1

Author(s):

Jeffery S. Hillam ◽

Neil Mohile ◽

Niall Smyth ◽

Jonathan Kaplan ◽

Amiethab Aiyer

Keyword(s):

Achilles Tendon ◽

Tendon Repair ◽

Wound Dehiscence ◽

Comorbid Conditions ◽

Improvement Program ◽

Acs Nsqip ◽

Achilles Tendon Repair ◽

Increased Risk ◽

American College Of Surgeons ◽

Tendon Ruptures

Introduction. Obesity is an increasingly common comorbidity that may negatively affect outcomes following orthopaedic surgery. It is valuable to determine whether obese patients are vulnerable for postoperative complications. The purpose of this study was to analyze data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to determine the effect of obesity on surgical treatment of Achilles tendon ruptures. Methods. Patients who underwent a surgical repair of the Achilles tendon were retrospectively identified through the ACS NSQIP. The patients were divided into 2 cohorts (obese and nonobese), then perioperative and postoperative factors were evaluated for association with obesity. Results. A total of 2128 patients were identified, of whom 887 (41.7%) were classified as obese. Obesity correlated with an increased operative time, 60.9 versus 56.1 minutes. The only postoperative complication associated with obesity was wound dehiscence. Logistic regression adjusted for comorbid conditions demonstrated that obesity was not associated with an increased risk of wound dehiscence. Conclusion. A large segment of the patient population undergoing Achilles tendon repair is obese. Obesity was found to have an increased association with wound dehiscence, likely related to comorbid conditions, following Achilles tendon repair. Obesity was not significantly associated with any other complication. Levels of Evidence: III, Retrospective Cohort Study

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Wound-Healing Issues Following Rotational Ankle Fracture Surgery: Predictors and Local Management Options

Foot & Ankle Specialist ◽

10.1177/1938640018810422 ◽

2018 ◽

Vol 12 (5) ◽

pp. 409-417 ◽

Cited By ~ 1

Author(s):

Hesham Saleh ◽

Sanjit Konda ◽

Adam Driesman ◽

John Stranix ◽

Catherine Ly ◽

...

Keyword(s):

Wound Healing ◽

Ankle Fracture ◽

Wound Complications ◽

Management Options ◽

Original Cohort ◽

Surgical Interventions ◽

Postoperative Wound ◽

Trimalleolar Fractures ◽

Medical Histories ◽

Fracture Surgery

Background. The incidence and risk factors of wound-healing complications following rotational ankle fracture surgery are well documented in the literature. However, there is a paucity regarding management options following these complications. The goal of this study was to provide a descriptive analysis of one surgeon’s experience managing wound complications in patients who have undergone ankle fracture surgery. Methods. A total of 215 patients who were operatively treated for an unstable ankle were retrospectively identified. Patient demographics, medical histories, initial injury characteristics, surgical interventions, and clinical follow-up were collected. Twenty-five of these patients developed postoperative wound problems. Results. Of the original cohort of 215 patients, 25 (11.6%) developed wound-healing complications. Their average age was 53.6 ± 18.0 years; there were 12 males (48.0%). Connective tissue/inflammatory disease (odds ratio [OR] 3.9), cardiovascular disease (OR 3.6), and active smoking (OR 3.3) were associated with an increased likelihood of developing postoperative wound complications. With regard to injuries, open fractures (OR 17.9) had the highest likelihood of developing postoperative complications, followed by type 44-C (OR 2.8) and trimalleolar fractures (OR 2.0). Conclusion. Wound complications following open treatment of ankle fractures occurred with an incidence of 11.6% in this series, of which only about half required operative intervention. A third of wounds were managed by orthopaedics in conjunction with plastic surgery. Levels of Evidence: Level III: Retrospective comparative study

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Contralateral Abdominal Pocketing in Salvation of Replanted Fingertips with Compromised Circulation

The Scientific World JOURNAL ◽

10.1155/2014/548687 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Hyung-Sup Shim ◽

Dong-Hwi Kim ◽

Ho Kwon ◽

Sung-No Jung

Keyword(s):

Range Of Motion ◽

Chart Review ◽

Patient Comfort ◽

Wound Complications ◽

Dash Score ◽

Postoperative Wound ◽

Medical Chart Review ◽

Lower Abdominal Quadrant ◽

The Mean ◽

Abdominal Quadrant

Abdominal pocketing is one of the most useful methods in salvation of compromised replanted fingertips. Abdominal pocketing has generally been performed in the ipsilateral lower abdominal quadrant, but we have also performed contralateral pocketing at our institute. To determine which approach is more beneficial, a total of 40 patients underwent an abdominal pocketing procedure in either the ipsilateral or contralateral lower abdominal quadrant after fingertip replantation. Dates of abdominal pocketing after initial replantation, detachment after abdominal pocketing, range of motion (ROM) before abdominal pocketing, and sequential ROM after the detachment operation and date of full ROM recovery and Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) score were recorded through medical chart review. Mean detachment date, mean abduction of shoulder after the detachment operation, and mean days to return to full ROM were not significantly different between the ipsilateral and contralateral pocketing groups. However, the mean DASH score was significantly lower in the contralateral group than the ipsilateral group. There were also fewer postoperative wound complications in the contralateral group than in the ipsilateral group. We, therefore, recommend contralateral abdominal pocketing rather than ipsilateral abdominal pocketing to increase patient comfort and reduce pain and complications.

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Impact of Primary Tracheoesophageal Puncture on Outcomes after Total Laryngectomy

Otolaryngology ◽

10.1177/0194599817722938 ◽

2017 ◽

Vol 158 (1) ◽

pp. 103-109 ◽

Cited By ~ 2

Author(s):

Aru Panwar ◽

Oleg Militsakh ◽

Robert Lindau ◽

Andrew Coughlin ◽

Harlan Sayles ◽

...

Keyword(s):

Total Laryngectomy ◽

Attributable Risk ◽

Wound Complications ◽

Medical Complications ◽

Improvement Program ◽

Data Set ◽

Surgical Quality ◽

Postoperative Wound ◽

Tracheoesophageal Puncture ◽

Length Of Hospitalization

Objectives To identify differences in postoperative wound complications associated with a primary tracheoesophageal puncture (TEP) at the time of laryngectomy versus no TEP. Study Design Retrospective review of large national data set. Setting Academic and nonacademic health care facilities in United States, contributing de-identified, risk-adjusted clinical data to the American College of Surgeons National Surgical Quality Improvement Program. Subjects and Methods The National Surgical Quality Improvement Program data set for years 2006 to 2012 identified 430 patients who underwent total laryngectomy with or without a primary TEP. Patients who underwent a TEP at the time of laryngectomy (n = 68) were compared with patients who underwent laryngectomy without a TEP (n = 362). Postoperative wound complications and secondary outcomes, including medical complications and length of hospitalization, were compared between the groups. Results The incidence of “superficial” and “deep or organ space” surgical site infection, medical complications, return to the operating room, and length of hospitalization were similar between the groups. Patients in the TEP group had a higher overall wound complication rate (relative risk, 2.02; 95% CI = 1.06-3.84; attributable risk, 8.17%; number needed to harm, 12). Conclusions Performance of a primary TEP concurrent to total laryngectomy contributed to a small increase in attributable risk for overall wound complications but did not add substantial risk for “superficial” or “deep or organ space” surgical site infection, medical complications, or increased burden for resource utilization. These data may help inform patient choice and physician recommendations for primary alaryngeal speech rehabilitation.

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