scholarly journals P032 SURGICAL SITE INFECTIONS FOLLOWING EMERGENCY HERNIA REPAIR: A SUB-STUDY FROM THE MASH PROJECT

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Victoria Proctor ◽  
Olivia Spence ◽  
Flora Burns ◽  
Susanna Green ◽  
Adele Sayers ◽  
...  
Keyword(s):  
Mesh Repair ◽  
Umbilical Hernia ◽  
Area Under The Curve ◽  
Surgical Site Infections ◽  
Roc Curves ◽  
Wound Complications ◽  
Site Infection ◽  
Health Questionnaire ◽  
Regression Modelling ◽  
Repair Technique

Abstract Aim Acutely symptomatic hernia (ASH) of the abdominal wall and groin are common presentations. Decisions related to repair technique can be driven by contamination and surgical site infection (SSI) risk. The aim of this study is to report rates of SSI following ASH repair, and assess the performance of the Bluebelle wound health questionnaire in this population. Material and Methods This study reports on the operated sub-group of the MASH study. This was a 12 week, UK-based, multi-centre, collaborative, prospective cohort study (NCT04197271) recruited adults with ASH. Hernia site, repair type, wound complications, and Bluebelle questionnaire at 30 & 90 days were captured. Performance of this score was assessed using ROC curves, and regression modelling. Results 223 patients were operated on, and 21 (9.4%) developed SSI within 90 days. Infections were most common in umbilical hernia (16.2%). No infections were seen in ‘simple’ symptomatic hernia. There was no association with either repair type. Bluebelle scores for 109 patients had an area under the curve of 0.807, showing good performance in this population. Regression modelling showed that SSI was most strongly associated with increased Bluebelle score (OR 8.54 (4.27 to 12.80, p < 0.001)). Use of a sutured repair was associated with a lower score (OR -3.79 (-7.19 to -0.39, p = 0.029)). Conclusions SSI is common after surgical treatment of ASH. Strategies to reduce this are needed. The Bluebelle score appears valid for this population; mesh repair might affect scores independent of SSI.

scholarly journals Surgical site infection prevention and management in immunocompromised patients: a systematic review of the literature

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Federico Coccolini ◽  
Mario Improta ◽  
Enrico Cicuttin ◽  
Fausto Catena ◽  
Massimo Sartelli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Site Infection ◽  
Surgical Site Infections ◽  
Sufficient Evidence ◽  
Wound Complications ◽  
Skin Closure ◽  
Immunocompromised Patients ◽  
Site Infection ◽  
Review Of The Literature ◽  
Strict Adherence

Abstract Background Immunocompromised patients are at higher risk of surgical site infection and wound complications. However, optimal management in the perioperative period is not well established. Present systematic review aims to analyse existing strategies and interventions to prevent and manage surgical site infections and other wound complications in immunocompromised patients. Methods A systematic review of the literature was conducted. Results Literature review shows that partial skin closure is effective to reduce SSI in this population. There is not sufficient evidence to definitively suggest in favour of prophylactic negative pressure wound therapy. The use of mammalian target of rapamycin (mTOR) and calcineurin inhibitors (CNI) in transplanted patient needing ad emergent or undeferrable abdominal surgical procedure must be carefully and multidisciplinary evaluated. The role of antibiotic prophylaxis in transplanted patients needs to be assessed. Conclusion Strict adherence to SSI infection preventing bundles must be implemented worldwide especially in immunocompromised patients. Lastly, it is necessary to elaborate a more widely approved definition of immunocompromised state. Without such shared definition, it will be hard to elaborate the needed methodologically correct studies for this fragile population.

scholarly journals O47 MESH-RELATED COMPLICATIONS, CHRONIC PAIN, AND ECONOMIC CLAIM COMPENSATION AFTER UMBILICAL HERNIA REPAIR

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Martin Frimand Rønnow ◽  
Mattias Hoffner ◽  
Svend Schulze ◽  
Frederik Helgstrand ◽  
Claes Hjalmarsson ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Hernia Repair ◽  
Emergency Surgery ◽  
Mesh Repair ◽  
Umbilical Hernia ◽  
Surgical Complication ◽  
Claim Data ◽  
Wound Complications ◽  
Major Complications ◽  
Umbilical Hernia Repair

Abstract Aim The risk of mesh-related surgical complications after umbilical hernia repair is not known and chronic pain has only sparsely been analysed. Economic claims may represent a surrogate for poor postoperative surgical outcomes. Thus, the present study used mesh-related complications and chronic pain as primary and secondary outcomes, respectively. Material and Methods Blinded assessment of Swedish and Danish nationwide consecutive economic claim data from 2007 –2019. The study variables and outcomes were pre-study defined. Major complications were defined as acutely life-threatening complications requiring emergency surgery, clinically important complications were defined as all complications requiring surgical intervention but not emergency surgery. Results During the 13-years study period 181 patients were eligible for analysis. There were 96 patients with a surgical complication. In 52 (54%) and 44 (46%) patients the complication was mesh- or non-mesh-related, respectively. In the group of mesh- and non-mesh-related complications, major complications were found in 14 (14,6%) vs 21 (21,9%) patients and clinically important complications were found in 38 (39,5%) vs 23 (23,9%) patients respectively (P < 0.05). Chronic pain was reported in 18%, followed by wound complications (14%) and cosmetic claim reasons (11%). After open repair, claim because of chronic pain was significantly more common after mesh repair (48%) compared with non-mesh repairs (32%), P = 0.05. The economic compensation after a mesh- and non-mesh complication was 3,488€ (291 – 188,186€) and 2,342€ (507€ - 58,437€) (P = 0.55), respectively. Conclusions Mesh-repair was related to postoperative complications and chronic pain after umbilical hernia repair

Evaluation of the clot burden score (cbs) for acute ischemic stroke (ais) in intent-to-treat patients.

2019 ◽  
Vol 1 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Sarah Yaziz ◽  
Ahmad Sobri Muda ◽  
Wan Asyraf Wan Zaidi ◽  
Nik Azuan Nik Ismail
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Treatment Decision ◽  
Roc Curves ◽  
Significant Negative Correlation ◽  
Clot Burden

Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases. Methods:  A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves. Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ?6, 6 patients (6.7%) had CBS <6, while 53 patients (59.6%) were deemed clot free. Ninety (90) days post insult, clinical assessment showed that 57 (67.6%) patients were functionally independent, 27 (30.3%) patients functionally dependent, and 5 (5.6%) patients were deceased. Data analysis reported a significant negative correlation (r= -0.611, p<0.001). ROC curves analysis showed an area under the curve of 0.81 at the cut-off point of 6.5. This showed that a CBS of more than 6 predicted a good mRS clinical outcome in AIS patients; with sensitivity of 98.2%, specificity of 53.1%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 21%. Conclusion: CBS is a useful additional variable for the management of AIS cases, and should be incorporated into the routine radiological reporting for acute ischemic stroke (AIS) cases.

Surgical Site Infections - A Hospital Havoc: Retrospective Study of Surgical Site Infections in Tertiary Health Care Centre in North East India

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
V Singh ◽  
A B Khyriem, W V Lyngdoh ◽  
C J Lyngdoh
Keyword(s):  
Surgical Site Infection ◽  
Multiple Drug Resistance ◽  
Surgical Site Infections ◽  
Multidrug Resistant ◽  
Multiple Drug ◽  
Site Infection ◽  
Retrospective Case ◽  
Acinetobacter Baumanii ◽  
Health Care Centre ◽  
North East

Objectives - Surgical site infections (SSI) has turn out to be a major problem even in hospital with most modern facilities and standard protocols of pre -operative preparation and antibiotic prophylaxis. Objective of this study is to know the prevalence of surgical site infection among the postoperative patients and to identify the relationship between SSI and etiological pathogens along with their antimicrobial susceptibility at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong. Methods - A retrospective case study conducted at NEIGRIHMS, among patients admitted to the surgical departments during the period between January 1st and December 31st 2016. Swabs from the surgical sites were collected under sterile conditions and standard bacteriological tests were performed for identification and appropriate statistical methods were employed to look for association between SSI and etiological pathogens. Results - Out of the 1284 samples included in the study, 192 samples showed evidence of SSI yielding an infection rate of 14.9%. The most commonly isolated bacteria were: Escherichia coli, Acinetobacter baumanii and Staphylococcus aureus, of the gram negative isolates 6.2% were multidrug resistant of which 19% were carbapenem resistant. Conclusion - SSI with multiple drug resistance strains and polymicrobial etiology reflects therapeutic failure. The outcome of the SSI surveillance in our hospital revealed that in order to decrease the incidence of SSI we would have to: a) incorporate a proper antibiotic stewardship  b) conduct periodic surveillance to keep a check on SSI d) educate medical staffs regarding the prevention of surgical site infection.

scholarly journals Surgical site infection in mesh repair for ventral hernia in contaminated field: A systematic review and meta-analysis

2021 ◽  
Vol 63 ◽  
pp. 102173
Author(s):  
Mohamed Maatouk ◽  
Yacine Ben Safta ◽  
Aymen Mabrouk ◽  
Ghassen Hamdi Kbir ◽  
Anis Ben Dhaou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Site Infection ◽  
Ventral Hernia ◽  
Mesh Repair ◽  
Meta Analysis ◽  
Site Infection ◽  
Contaminated Field

58 Use of Abdominal Wall or Sucutaneous Drain to Reduce the Risk of Surgical Site Infections

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Mistry ◽  
B Woolner ◽  
A John
Keyword(s):  
Surgical Site Infection ◽  
Open Cholecystectomy ◽  
Surgical Site Infections ◽  
Standard Operating Procedure ◽  
Site Infection ◽  
Infection Rates ◽  
Local Evidence ◽  
Audit Data ◽  
The Impact ◽  
To Receive

Abstract Introduction Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections. Method Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records. Results 84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures. Conclusions Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.

scholarly journals Magnetic resonance cisternography imaging findings related to the leakage of Gadolinium into the subarachnoid space

2021 ◽  
Author(s):  
Rei Nakamichi ◽  
Toshiaki Taoka ◽  
Hisashi Kawai ◽  
Tadao Yoshida ◽  
Michihiko Sone ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Subarachnoid Space ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Predictive Performance ◽  
Roc Curves ◽  
Imaging Findings ◽  
Spearman’S Rank Correlation ◽  
Sagittal Sinus ◽  
Magnetic Resonance Cisternography

Abstract Purpose To identify magnetic resonance cisternography (MRC) imaging findings related to Gadolinium-based contrast agent (GBCA) leakage into the subarachnoid space. Materials and methods The number of voxels of GBCA leakage (V-leak) on 3D-real inversion recovery images was measured in 56 patients scanned 4 h post-intravenous GBCA injection. Bridging veins (BVs) were identified on MRC. The numbers of BVs with surrounding cystic structures (BV-cyst), with arachnoid granulations protruding into the superior sagittal sinus (BV-AG-SSS) and the skull (BV-AG-skull), and including any of these factors (BV-incl) were recorded. Correlations between these variables and V-leak were examined based on the Spearman’s rank correlation coefficient. Receiver-operating characteristic (ROC) curves were generated to investigate the predictive performance of GBCA leakage. Results V-leak and the number of BV-incl were strongly correlated (r = 0.609, p < 0.0001). The numbers of BV-cyst and BV-AG-skull had weaker correlations with V-leak (r = 0.364, p = 0.006; r = 0.311, p = 0.020, respectively). The number of BV-AG-SSS was not correlated with V-leak. The ROC curve for contrast leakage exceeding 1000 voxels and the number of BV-incl had moderate accuracy, with an area under the curve of 0.871. Conclusion The number of BV-incl may be a predictor of GBCA leakage and a biomarker for waste drainage function without using GBCA.

Factors affecting progression to permanent atrial fibrillation in an unselected population of patients with non-permanent form of atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V.L Malavasi ◽  
E Fantecchi ◽  
V Tordoni ◽  
L Melara ◽  
A Barbieri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Factors Affecting ◽  
Cox Proportional Hazard ◽  
Significant Difference ◽  
History Of ◽  
Unselected Population ◽  
Cox Proportional Hazard Regression

Abstract Background Natural history of atrial fibrillation (AF) shows a progression of arrhythmia from non-permanent to permanent AF. Permanent AF was found associated with a worse prognosis than non-permanent one. Aim To assess the factors associated with progression to permanent AF in an unselected population of AF patients with non-permanent AF. Methods In this prospective study we enrolled in- as well as out-patients with non-permanent AF and age ≥18 years, with at least one episode of ECG-documented AF within 1 year. The patients were followed-up at 1 month and every 6 months thereafter. Results Out of 523 patients, 314 (60%) were in non-permanent AF (80 [25.5%] paroxysmal AF, 165 [52.5%] persistent AF, 69 [2%] first diagnosed AF), mostly male (188, 59.9%), median age 71 years (IQ range 62–77), median CHA2DS2VASc 3 (1–4), median HATCH score 1 (1–2). After a median follow-up of 701 (IQ range 437–902) days, 66 patients (21%) showed permanent AF. CHA2DS2VASc and HATCH scores were incrementally associated to progression to permanent AF (CHA2DS2VASc χ2 p=0.001; HATCH χ2 p=0.017; p for trend CHA2DS2VASc &lt;0.001, HATCH p=0.001). At multivariable Cox proportional hazard regression the following variables were significantly associated with AF progression: age (hazard ratio [HR] 1.041; 95% CI: 1.004–1.079; p=0.028), at least moderate left atrial (LA) enlargement (&gt;42 ml/m2) (HR 2.092; 95% CI: 1.132–3.866; p=0.018), antiarrhythmics drugs after the enrollment (HR 0.087; 95% CI: 0.011–0.662; p=0.018), EHRA score &gt;2 (HR 0.351; 95% CI: 0.158–0.779; p=0.010) and Valvular HD (HR 2.161; 95% CI: 1.057–4.420; p=0.035). Adding LA dilation to HATCH score (HATCH-LA) and assigning 2 points based on multivariable Cox regression, HATCH-LA was statistically better in ROC curves in prediction of AF progression vs HATCH score (area under the curve 0.695 vs 0.636; DeLong p=0.0225). Survival-free curves on freedom from permanent AF using as discriminator HATCH-LA score ≤2 vs &gt;2 led to a statistically significant difference (χ2=16.080 p&lt;0.001), but the same was not found for HATCH score (χ2 =3.099; p=0.078). Conclusions In patients without permanent AF, progression of AF was independentely related to age, LA dilation, AF symptoms severity, antiarrhythmic drugs and Valvular HD. HATCH score predicted AF progression and adding to it LA dilation (at least moderate) improved patients stratification for the risk of evolution to permanent AF. Funding Acknowledgement Type of funding source: None

Gestational Age Dependency of Umbilical Cord Serum IL-6 Levels for Detecting Fetal Inflammation

2020 ◽  
Author(s):  
Sota Iwatani ◽  
Takao Kobayashi ◽  
Sachiko Matsui ◽  
Akihiro Hirata ◽  
Miwa Yamamoto ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Gestational Age ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Significant Negative Correlation ◽  
Cord Serum ◽  
Very Preterm ◽  
Key Points ◽  
Extremely Preterm ◽  
Preterm Newborns

Objective The fetal inflammatory response syndrome (FIRS) is characterized by elevated concentrations of inflammatory cytokines in fetal blood, with preterm delivery and morbidity. Umbilical cord serum interleukin-6 (UC-s-IL-6) is an ideal marker for detecting FIRS. However, the effect of gestational age (GA) on UC-s-IL-6 levels has not been reported. This study aimed to determine the relationship between GA and UC-s-IL-6 levels, and GA-dependent cutoff values of UC-s-IL-6 levels for detecting fetal inflammation. Study Design UC-s-IL-6 concentrations were measured in 194 newborns (44 extremely preterm newborns (EPNs) at 22–27 weeks' GA, 68 very preterm newborns (VPNs) at 28–31 weeks' GA, and 82 preterm newborns (PNs) at 32–34 weeks' GA). Linear regression analyses were used to correlate GA and UC-s-IL-6 levels. Receiver operating characteristic (ROC) curves analyses were performed for detecting the presence of funisitis, as the histopathological counterpart of FIRS. Results A significant negative correlation between GA and UC-s-IL-6 levels was found in newborns with severe funisitis (r s =  − 0.427, p = 0.004) and those with mild funisitis (r s =  − 0.396, p = 0.025). ROC curve analyses revealed the area under the curve for detecting funisitis were 0.856, 0.837, and 0.622 in EPNs, VPNs, and PNs, respectively. The UC-s-IL-6 cutoff value in EPNs (28.1 pg/mL) exceeded those in VPNs and PNs (3.7 and 3.0 pg/mL, respectively). Conclusion UC-s-IL-6 levels were inversely correlated with GA especially in newborns with funisitis. Such GA dependency of UC-s-IL-6 should be considered for detecting fetal inflammation. Key Points

scholarly journals Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932110162
Author(s):  
Matthew S. Broggi ◽  
Philip O. Oladeji ◽  
Syed Tahmid ◽  
Roberto Hernandez-Irizarry ◽  
Jerad Allen
Keyword(s):  
Risk Factor ◽  
Hip Fracture ◽  
Postoperative Complications ◽  
Hip Fractures ◽  
Depressive Disorders ◽  
Surgical Site Infections ◽  
Wound Complications ◽  
Non Union ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Introduction: Intertrochanteric hip fractures are a common injury treated by orthopedic surgeons and the incidence rate is rising. Preoperative depression is a known risk factor for postoperative complications in orthopaedic surgery, however its effects on outcomes after geriatric hip fractures is relatively unknown. The purpose of this study was to investigate the relationship between preoperative depression and potential complications following open reduction internal fixation (ORIF) and intramedullary nailing (IMN) of geriatric hip fractures. Methods: In this retrospective study, the Truven Marketscan claims database was used to identify patients over age 65 who underwent ORIF or IMN for a hip fracture from January 2009 to December 2019. Patient characteristics, such as medical comorbidities, were collected and from that 2 cohorts were established (one with and one without depression). Chi-squared and multivariate analysis was performed to investigate the association between preoperative depression and common postoperative complications following intertrochanteric hip fracture surgery. Results: In total, 78,435 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds after undergoing ORIF were surgical site infections (OR 1.32; CI 1.23-1.44), ED visit for pain (OR 1.27; CI 1.16-1.39), wound complications (OR 1.26; CI 1.14-1.35), and non-union (OR 1.25; CI 1.17-1.33). In the patients with preoperative depression undergoing IMN, the complications associated with the greatest increased odds after were surgical site infections (OR 1.37; CI 1.31- 1.45), ED visit for pain (OR 1.31; CI 1.19-1.44), wound complications (OR 1.23; CI 1.10-1.39), and pneumonia (OR 1.22; CI 1.10-1.31). Conclusions: Preoperative depression in patients undergoing hip fracture surgery is associated with increased complications. Recognizing a patients’ preoperative depression diagnosis can allow physicians to adapt perioperative and postoperative surveillance protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor

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