The Association of Cesarean Skin Incision Length and Postoperative Wound Complications

2020 ◽  
Author(s):  
Akila Subramaniam ◽  
Victoria Jauk ◽  
George Saade ◽  
Kim Boggess ◽  
Sheri Longo ◽  
...  
Keyword(s):  
Secondary Analysis ◽  
Skin Incision ◽  
Wound Complications ◽  
Skin Closure ◽  
Double Blind ◽  
Incision Length ◽  
Postoperative Wound ◽  
Membrane Rupture ◽  
Increased Risk ◽  
Duration Of Surgery

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

scholarly journals A NEW METHOD OF TREATMENT FOR APPENDICEAL STUMP

2018 ◽  
Vol 7 (2) ◽  
pp. 129-133
Author(s):  
A. L. Charyshkin ◽  
M. M. Yartsev
Keyword(s):  
Acute Appendicitis ◽  
Standard Method ◽  
Comparison Group ◽  
Abdominal Cavity ◽  
Operation Time ◽  
Wound Complications ◽  
Group Comparison ◽  
Postoperative Wound ◽  
Duration Of Surgery ◽  
Appendiceal Stump

Background.In 30% of acute destructive appendicitis, the disease is accompanied by typhlitis, which makes it difficult to perform classical methods of appendiceal stump treatment.Aim of study.To improve the way of appendiceal stump treatment in the destructive form of acute appendicitis complicated by significant typhlitis.Material and methods.We studied 57 cases of acute destructive appendicitis complicated by typhlitis, which were divided into two groups depending on the method of treatment. The first group (comparison group) consisted of 30 patients who underwent a standard method for treating the appendiceal stump after appendectomy, such as ligation at the base and putting the stump into the cupula of the cecum and fixing it with interrupted serous-muscular sutures or with a purse and Z-shaped sutures. The second (main) group included 27 patients, who were treated by the method we proposed. The essence of the method is successive U-shaped stitching of the stump. After that, the stump curls in the form of a cochlea, peritonizes, reaching the necessary tightness without going into the cupula of the cecum. In this case, the abdominal cavity of patients in both groups was adequately sanitized and drained.Results.In the first group of patients there were technical difficulties associated with immersion of the appendiceal stump, which caused the serous damage, hematoma of the cupula of the cecum in 7 (23.3%) patients. In the second group of patients, due to the developed method of forming the appendiceal stump, technical difficulties did not arise, there were no complications. The duration of appendectomy in the first group of patients with standart treatment (interrupted serous-muscular sutures or purse and Z-shaped stiches) was 28.7±5.4 minutes, and in the second group of patients appendectomy with stump management with the suggested method lasted 20.3±6.1 minutes, p <0.05, which reduced the operation time by 8 minutes on the average. Purulent-inflammatory wound complications in the first group were detected in 7 patients (23.3%), and in 1 (3.7%) patient of the second group, which is significantly less by 19.6%.Conclusion.The proposed method is technically simple, as peritonization of the stump is performed without putting it into the cupula of the cecum. The use of this method is indicated in destructive forms of acute appendicitis complicated by severe typhlitis, which significantly reduces the operation trauma and contributes to reduction in the number of postoperative wound purulent-inflammatory complications by 19.6%. Findings The proposed method for treating the appendiceal stump during appendectomy for acute destructive appendicitis complicated by typhlitis is simple enough, reliable, characterized by low traumatism and shortens the duration of surgery by 8 minutes on the average (p <0.05). 

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

2017 ◽  
Vol 20 (4) ◽  
pp. 341-346 ◽  
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.

scholarly journals Malnutrition is not related with emergence delirium in older patients after noncardiac surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fang Zhang ◽  
Shu-Ting He ◽  
Yan Zhang ◽  
Dong-Liang Mu ◽  
Dong-Xin Wang
Keyword(s):  
Older Patients ◽  
Secondary Analysis ◽  
Noncardiac Surgery ◽  
Control Group ◽  
Clinical Trial Registry ◽  
Emergence Delirium ◽  
Link Type ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
The Relationship

Abstract Background Delirium is one of the most common complications in older surgical patients. Although previous studies reported that preoperative malnutrition was related with postoperative delirium (POD), there was lack of evidence to illustrate the relationship between malnutrition and emergency delirium (ED). The objective of this study was to investigate the relationship between preoperative malnutrition and ED in older patients undergoing noncardiac surgery. Methods The study was carried out in accordance with STROBE guidelines. This was a secondary analysis of a prospective cohort study. Older patients (65–90 years) who underwent noncardiac surgery under general anesthesia were enrolled in Peking University First Hospital. Results 915 patients were enrolled. The incidence of malnutrition was 53.6 % (490/915). The incidence of emergency delirium was 41.8 % (205/490) in malnutrition group and 31.5 % (134/425) in control group, P < 0.001. After adjusting confounding factors (i.e., age, cognitive impairment, American Society of Anesthesiologists classification (ASA), duration of surgery, pain score, low body temperature and allogeneic blood transfusion), malnutrition was not associated with increased risk of emergency delirium (OR = 1.055, 95 % CI 0.767–1.452, P = 0.742). Conclusions Malnutrition was common in older patients undergoing non-cardiac surgery, but it’s not related with emergence delirium after adjusted for confounders. Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn) (ChiCTR-OOC-17,012,734).

scholarly journals Lymphocyte counts and infection rates

2019 ◽  
Vol 6 (6) ◽  
pp. e614 ◽  
Author(s):  
Edward J. Fox ◽  
Fred D. Lublin ◽  
Jerry S. Wolinsky ◽  
Jeffrey A. Cohen ◽  
Ian M. Williams ◽  
...  
Keyword(s):  
Secondary Analysis ◽  
Absolute Lymphocyte Count ◽  
Term Treatment ◽  
Upper Respiratory Tract ◽  
Infection Rates ◽  
Double Blind ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Tract Infections

ObjectiveTo evaluate lymphocyte counts and incidences of infections in patients with primary progressive MS (PPMS) receiving fingolimod 0.5 mg/d or placebo over 5 years during the INFORMS study, to assess infection rates with longer-term treatment.MethodsINFORMS was a randomized, multicenter, double-blind, placebo-controlled, parallel-group, phase 3 study of the sphingosine 1-phosphate receptor modulator fingolimod in patients with PPMS. Lymphocyte counts and incidences of infections were compared in patients receiving fingolimod or placebo. Infection rates were assessed in patients receiving fingolimod according to nadir and mean absolute lymphocyte count (ALC).ResultsOverall, 336 patients received fingolimod 0.5 mg/d (total exposure: 908.1 patient-years), and 487 received placebo (1,423.5 patient-years). In patients receiving fingolimod, mean ALC decreased by approximately 70% in the 2 weeks following treatment initiation and remained stable throughout the study. The incidences of all infections in the fingolimod and placebo groups were similar (53.6 vs 51.9 per 100 patient-years). The most common infections in patients receiving fingolimod were urinary tract infections (5.7 per 100 patient-years), upper respiratory tract infections (4.2 per 100 patient-years), and influenza (3.2 per 100 patient-years); incidences were similar in the placebo group (5.9, 4.2, and 3.1 per 100 patient-years, respectively). There was no apparent association between nadir or mean ALC and incidence of infection-related adverse events.ConclusionsIn patients with PPMS, long-term treatment with fingolimod 0.5 mg/d for up to 5 years led to an expected decrease of approximately 70% in mean ALC and did not appear to correlate with increased risk of infection.Classification of evidenceBecause this is a secondary analysis, this study provides Class II evidence that long-term PPMS treatment with fingolimod decreased mean ALC by approximately 70%, but did not significantly increase infection risk.

Does Time of Wound Complication after Cesarean Delivery Differ by Type of Skin Closure?

2018 ◽  
Vol 36 (09) ◽  
pp. 981-984
Author(s):  
Shontreal M. Cooper ◽  
Christina T. Blanchard ◽  
Jeffery M. Szychowski ◽  
Alan T. N. Tita
Keyword(s):  
Cesarean Delivery ◽  
Hospital Discharge ◽  
Secondary Analysis ◽  
Wound Complication ◽  
Wound Complications ◽  
Skin Closure ◽  
Chi Square ◽  
Suture Closure ◽  
Care Costs

Objective A high proportion of postcesarean wound complications occur after patients have been discharged from the hospital, increasing personal and health care costs. We undertook this study to evaluate the association between skin closure methods (suture vs. staple) following a cesarean delivery and the frequency of wound complications occurring after hospital discharge. Study Design This is a secondary analysis of data from a randomized trial in which women undergoing cesarean delivery at ≥24 weeks' gestation were randomized to receive metallic staples or subcuticular suture for skin closure after surgery. Staples were removed at the time of hospital discharge on postoperative days 3 to 4 for Pfannenstiel incisions or days 7 to 10 for vertical. The primary outcome for this analysis was any wound complication occurring after hospital discharge. Wound complications were infections or any wound disruption without infection (including seromas and hematomas). Associations were examined using chi-square and Fisher's exact tests, as appropriate, and multivariable logistic regression. Results A total of 350 patients with follow-up through 4 to 6 weeks postpartum were included in the analysis: n = 171 received suture closure and n = 179 received staples. In the primary trial, wound complications occurred in 14.5% (n = 26) of individuals with staples and 5.9% (n = 10) with sutures (p = 0.008). Twenty-one (58.3%) of the 36 wound complications occurred after hospital discharge. The incidence of wound complications occurring after hospital discharge was 6.7% (n = 12) of patients receiving staples and 5.3% (n = 9) of those receiving sutures; p = 0.57; relative risk [95% confidence interval]: 1.27 [0.55–2.95]). After multivariable adjustment, type of skin closure method was not associated with wound complication after discharge from the hospital (odds ratio: 1.29; 0.52–3.17). Conclusion Although suture closure compared with staples was associated with fewer wound complications after cesarean delivery, we found no significant differences between closure types in the frequency of wound complications occurring after hospital discharge.

scholarly journals P021 OUTCOME AFTER USE OF THE STAPLED MIDLINE CLOSURE TECHNIQUE AND SELF-FIXATING MESH FOR ABDOMINAL WALL RECONSTRUCTION

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Arkadi Rapoport ◽  
Dina Ashatkin ◽  
Alexey Bukin ◽  
Seema Biswas ◽  
Igor Waksman
Keyword(s):  
Abdominal Wall ◽  
Mesh Fixation ◽  
Abdominal Wall Reconstruction ◽  
Rectus Sheath ◽  
Skin Incision ◽  
Linear Stapler ◽  
Wound Complications ◽  
Linea Alba ◽  
Lateral Abdominal Wall ◽  
Duration Of Surgery

Abstract Aim To evaluate surgical outcomes after introduction to our unit of the stapled opening and closure of the linea alba in reconstruction of the abdominal wall using the GIA linear stapler (linea alba stapling – LAS) and self-fixating mesh for medium and large defects. Material and Methods Since 2018, we have transitioned from the Rives – Stoppa (with or without component separation) (R-S) to the LAS technique for abdominal wall reconstruction. We compared our outcomes with the LAS technique with matched historic R-S controls (in terms of defect size, duration of surgery and skin related complications). Results Thirty-three cases of LAS reconstruction have been performed in our unit: 15 with defects larger than 10 cm. After exclusion of patients who underwent additional procedures such as adhesiolysis and bowel resection, the mean duration of surgery was 165 min. There were no skin related complications. Comparable cases who underwent R-S reconstruction took 213 min; and, wound infection developed in one patient and skin necrosis in two. Conclusions Provisional results indicate significantly lower operative times and incidence of wound complications (including infections and fluid collections). Notable advantages include a shorter skin incision, a small incision in the anterior rectus sheath to introduce the linear stapler rather than the standard laparotomy and lateral abdominal wall dissection (with ligation of perforators) necessary in the R-S method. Self-fixating mesh eliminates the requirement of sutured mesh fixation which may also be associated with more extensive dissection and longer operative times.

The Impact of BMI on Postpartum Infectious Morbidities and Wound Complications: A Study of Extremes

2021 ◽  
Author(s):  
Iqra Sheikh ◽  
Kylie A Fuller ◽  
Kateena Addae-Konadu ◽  
Sarah Dotters-Katz ◽  
Megan Varvoutis
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Secondary Analysis ◽  
Wound Complication ◽  
Infectious Complications ◽  
Wound Complications ◽  
Maternal Fetal Medicine ◽  
Infectious Morbidity ◽  
Increased Risk ◽  
The Impact

Background As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40kg/m2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period. Study Design The present study is a secondary analysis of women who underwent cesarean delivery and had BMI > 40 kg/m2 in the Maternal Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9kg/m2, 50-59.9kg/m2, 60-69.9kg/m2, and >70kg/m2). Results Rates of postpartum infectious morbidity increased with BMI category (11.7% body mass index 50-59.9 kg/m2; 13.7% BMI 60-69.9 kg/m2, 21.9%; and BMI >70+ kg/m2; p=0.001). Readmission for wound complications also increased with BMI (3.1% for BMI 50-59.9 kg/m2; 6.2% for BMI 60-69.9 kg/m2; and 9.4% for BMI >70+kg/m2; p=0.001). After adjusting for confounders, increased BMI 70+ kg/m2 category remained the most significant predictor of postpartum infectious complications compared to women with BMI 40-49.9 kg/m2 (aOR 6.38; 95% CI 1.37-29.7). The adjusted odds of readmission also increased with BMI (aOR 2.33 (95%CI 1.35-4.02) BMI 50-59.9kg/m2, aOR 4.91 (95% CI 2.07-11.7) BMI 60-69.9kg/m2, aOR 36.2 (7.45-176) for BMI >70kg/m2). Conclusion Women with BMI 50-70+kg/m2 are at an increased risk of postpartum wound infections and complications compared to women with BMI 40-49.9kg/m2. These data provide increased guidance for counseling women with an extremely elevated body mass index and highlight the importance of postpartum wound prevention bundles.

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