Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

2020 ◽  
pp. 000348942096213
Author(s):  
Khodayar Goshtasbi ◽  
Sunil P. Verma
Keyword(s):  
Adverse Events ◽  
Surgical Complications ◽  
Smoking Status ◽  
Operation Time ◽  
Medical Complications ◽  
Improvement Program ◽  
Level Of Evidence ◽  
Vein Thrombosis ◽  
Hypopharyngeal Diverticulum ◽  
American Society

Objective: To describe rates of short-term morbidity following transcervical surgical treatment of hypopharyngeal diverticulum (HD) and analyze predictors of adverse events. Methods: The 2005 to 2017 National Surgical Quality Improvement Program database was queried to identify patients diagnosed with HD undergoing open transcervical diverticulectomy. Results: A total of 597 patients with a mean age of 71.4 ± 12.3 years were included. Thirty-day adverse events were experienced by 63 (10.6%) subjects, including 6.5% unplanned reoperations, 4.2% surgical complications, 4.4% medical complications, 2.7% readmissions, and 0.7% deaths. Medical complications notably included pneumonia (2.0%), reintubation (1.2%), sepsis (1.2%), intubation >48 hours (0.5%), urinary tract infection (0.5%), or deep vein thrombosis (0.5%), while surgical complications included organ/space infection (2.0%) and superficial (1.3%) or deep (1.0%) surgical site infection. Gender, race, functional status, diabetes, dyspnea, hypertension, steroid use, and recent weight loss were not associated with adverse events. Length of operation and hospitalization were both higher among those with adverse events (127.4 ± 107.9 vs 95.7 ± 59.8 minutes, P = 0.027, and 7.4 ± 7.4 vs 2.8 ± 3.6 days, P < 0.001). On multivariable logistic regression, high American Society of Anesthesiologists (ASA) class (OR = 2.02, P = 0.017), smoking (OR = 2.10, P = 0.044), and operation time (OR = 1.01; P = 0.005) were independent predictors of adverse events. Obesity was not associated with length of stay, readmission/reoperation, or complications. However, increased age was associated with shorter operations ( P = 0.020), higher length of hospitalization ( P < 0.001), and higher mortality ( P = 0.027) and readmission rates ( P = 0.023). Conclusion: Understanding clinical factors associated with complications following open surgery for HD such as ASA score, smoking status, length of operation, and age can help optimize surgical outcomes for at-risk patients. Level of Evidence: NA

Postoperative Complications Predict 30-Day Readmission in Geriatric General Surgery Patients

2017 ◽  
Vol 83 (4) ◽  
pp. 365-370 ◽  
Author(s):  
James D. Dieterich ◽  
Celia M. Divino
Keyword(s):  
Venous Thromboembolism ◽  
General Surgery ◽  
Cox Regression ◽  
Operation Time ◽  
Unplanned Readmission ◽  
Improvement Program ◽  
Vein Thrombosis ◽  
American Society ◽  
Patient Readmissions ◽  
American Society Of Anesthesiologists

The Affordable Care Act has placed unplanned patient readmissions under more scrutiny than ever. Geriatric patients, in particular, suffer a disproportionate amount of complications from any kind of hospitalization, including readmissions. This study seeks to identify risk factors in this population that predispose them to an unplanned readmission within 30 days after index surgery. The National Surgical Quality Improvement Program database was used to select patients 65 years and older, who underwent general surgery procedures in 2012. Patient demographics, comorbidities, complications, and readmissions were analyzed. A Cox regression survivorship model was used for multivariate analysis. A total of 7712 patients were reviewed; 617 patients (8.0%) had an unplanned readmission within 30 days of their operation. Cox regression revealed five different independent predictors of unplanned readmission within 30 days. They are age [P = 0.009, hazard ratio (HR) = 1.016, 95% confidence interval (CI) = 1.01–1.03], American Society of Anesthesiologists Class >2 (P = 0.037, HR = 1.22, CI = 1.024–1.475), operation time (minutes) (P = 0.001, HR = 1.001, CI = 1.00–1.002), any complication (P = 0.03, HR = 1.449, CI = 1.33–1.852), and deep vein thrombosis (P = 0.03, HR = 1.87, CI = 1.31–3.85). Using Cox regression to adjust for patient length of stay, age, American Society of Anesthesiologists class, any complication, operation time, and venous thromboembolism all independently increased the rate of unplanned readmissions. Patients who suffer any complication or a venous thromboembolism postoperatively are at a particularly high risk of readmission. These patients should be targeted for increased inpatient monitoring and included in preventable readmission programs after discharge.

Single- vs 2-Screw Lag Fixation of the Medial Malleolus in Unstable Ankle Fractures

2019 ◽  
Vol 40 (7) ◽  
pp. 790-796 ◽  
Author(s):  
Jessica Mandel ◽  
Omar Behery ◽  
Rajkishen Narayanan ◽  
Sanjit R. Konda ◽  
Kenneth A. Egol
Keyword(s):  
Ankle Fracture ◽  
Fragment Size ◽  
Smoking Status ◽  
Medial Malleolus ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Initial Injury ◽  
American Society ◽  
Fixation Points ◽  
American Society Of Anesthesiologists

Background: The purpose of this study was to determine the efficacy of medial malleolar fixation with 1 vs 2 screws. Methods: Between April 2013 and February 2017, 196 patients who presented at 2 hospitals within one academic institution with an unstable rotational ankle fracture with a medial fracture and were treated operatively by a trained orthopedic surgeon were identified. These patients’ charts were reviewed and their injury, radiographic, surgical, and follow-up data recorded. Medial malleolus fragment size was assessed on the anteroposterior (AP) and lateral views of the initial injury radiograph. Functional outcome was assessed using Maryland Foot Score (MFS). Patients were grouped based upon the number of screws utilized to fox the medial malleolar fragment. Data were assessed using Fisher exact tests and independent t tests with SPSS, version 23. Results: Out of the 196 patients who met inclusion criteria, 47 patients (24%) were fixed with 1 medial malleolar screw and 149 patients (76%) were fixed with 2 screws. There were no differences among patients who received 1 vs 2 screws with regard to age, gender, body mass index, American Society of Anesthesiologists grade, or smoking status. The average malleolar fragment size was smaller in those treated with 1 screw on both the AP and lateral radiographic views than those with 2 screws ( P = .009, P = .001, respectively). There was no difference between groups in ankle dorsiflexion or plantarflexion at 1 year postoperation ( P = .451, P = .581). Patients who received 1 screw did not differ from those who received 2 screws with respect to Maryland Foot Scores ( P = .924). There was no difference in rate of revision surgery or need for hardware removal between groups ( P = .093). Furthermore, time to healing and postoperative complication rate did not differ between groups. Conclusion: The use of a single screw for medial malleolar fixation provided stable fixation to allow ankle fracture healing, without an increase in complications. This information is especially important in situations when the fragment is too small to accommodate multiple fixation points. Level of Evidence: Level III, retrospective case-control study.

Timing of Complications following Hand Surgery

2020 ◽  
Author(s):  
Nitin Goyal ◽  
Daniel D. Bohl ◽  
Robert W. Wysocki
Keyword(s):  
Myocardial Infarction ◽  
Adverse Event ◽  
Adverse Events ◽  
Proportional Hazards ◽  
Kidney Injury ◽  
Hand Surgery ◽  
Cox Proportional Hazards ◽  
Improvement Program ◽  
Level Of Evidence ◽  
Event Timing

Abstract Introduction Our purposes were to (1) characterize the timeline of eight postoperative complications following hand surgery, (2) assess complication timing for the procedures that account for the majority of adverse events, and (3) determine any differences in complication timing between outpatient and inpatient procedures. Materials and Methods Patients undergoing hand, wrist, and forearm procedures from 2005 to 2016 were identified in the National Surgical Quality Improvement Program database. Timing of eight adverse events was characterized. Cox proportional hazards modeling was used to compare adverse event timing between inpatient and outpatient procedures. Results A total of 59,040 patients were included. The median postoperative day of diagnosis for each adverse event was as follows: myocardial infarction 1, pulmonary embolism 2, acute kidney injury 3, pneumonia 8, deep vein thrombosis 9, sepsis 13, urinary tract infection 15, and surgical site infection 16. Amputations, fasciotomies, and distal radius open reduction internal fixation accounted for the majority of adverse events. Complication timing was significantly earlier in inpatients compared with outpatients for myocardial infarction. Conclusion This study characterizes postoperative adverse event timing following hand surgery. Surgeons should have the lowest threshold for testing for each complication during the time period of greatest risk. Level of Evidence This is a therapeutic, Level III study.

Symptomatic Epidural Hematoma After Elective Cervical Spine Surgery: Incidence, Timing, Risk Factors, and Associated Complications

2021 ◽  
Author(s):  
Matthew V Abola ◽  
Jerry Y Du ◽  
Charles C Lin ◽  
William Schreiber-Stainthorp ◽  
Peter G Passias
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Spine Surgery ◽  
International Classification Of Diseases ◽  
Improvement Program ◽  
Cervical Spine Surgery ◽  
Vein Thrombosis ◽  
Postoperative Hematoma ◽  
Classification Of Diseases ◽  
American Society

Abstract BACKGROUND As the rate of elective cervical spine surgery increases, studies of complications may improve quality of care. Symptomatic postoperative cervical epidural hematomas (PCEH) are rare but result in significant morbidity. Because of their low incidence, the risk factors and complications associated with symptomatic PCEH remain unclear. OBJECTIVE To clarify the prevalence, timing, variables, and complications associated with PCEH following elective cervical spine surgery. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database, cervical spine surgeries performed between 2012 and 2016 were identified using Current Procedural Terminology codes. Symptomatic PCEH was defined as readmission or reoperation events specifically associated with International Classification of Diseases code diagnoses of postoperative hematoma within 30 d of index surgery. Multivariate models were created to assess the independent association of symptomatic PCEH with other postoperative complications. RESULTS There were 53233 patients included for analysis. The overall incidence of symptomatic PCEH was 0.4% (n = 198). Reoperation occurred in 158 cases (78.8%), of which 2 required a second reoperation (1.3%). The majority (91.8%) of hematomas occurred within 15 d of surgery. Multivariate analysis identified male gender, American Society of Anesthesiologists classes 3 to 5, bleeding disorder, increasing number of operative levels, revision surgery, dural repair, and perioperative transfusion as independent factors associated with PCEH. Upon controlling for those confounders, PCEH was independently associated with cardiac arrest, stroke, deep vein thrombosis, surgical site infection, and pneumonia. CONCLUSION Postoperative epidural hematomas requiring readmission or reoperation following elective cervical spine surgery occurred at an incidence of 0.4%. Symptomatic PCEHs are associated with increased rates of numerous major morbidities.

scholarly journals A Propensity Score Matched Analysis Comparing Outpatient and Short-Stay Hospitalization to Standard Inpatient Hospitalization Following Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0006
Author(s):  
Mark A. Plantz ◽  
Alain E. Sherman ◽  
Anish R. Kadakia
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Surgical Complications ◽  
Unplanned Readmission ◽  
Short Stay ◽  
Short Term ◽  
Improvement Program ◽  
Inpatient Hospitalization ◽  
Area Of Interest ◽  
American Society

Category: Ankle Introduction/Purpose: The number of total ankle arthroplasties (TAAs) performed annually has continued to increase over the last two decades. Given the current challenges of healthcare cost-control, the trend towards minimizing hospitalization and length of stay (LOS) after various procedures, including joint replacement, has become an area of interest. Currently, there are no large sample, propensity score matched analyses to assess the safety of ‘short-stay’ versus standard inpatient hospitalization following TAA. Methods: The American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP) was used to identify 1,141 patients who underwent primary and revision TAA between 2007 and 2017. Propensity score matching was used to compare the risk of 30-day unplanned readmission, reoperation, mortality, discharge destination, and several medical and surgical complications in patients with outpatient or short-stay inpatient hospitalization (LOS <= 1 day) versus standard inpatient hospitalization (LOS > 1 day). Patients were matched in a 1:1 ratio based on several factors, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and several comorbidities (diabetes, smoking, COPD, congestive heart failure, hypertension, dialysis, and chronic steroid use). The incidence of various 30-day complications were compared between the two propensity score matched groups to assess for any differences in short-term outcomes after controlling for confounding risk factors. Results: A total of 892 patients were included in the propensity-score matched analysis, with 446 patients per group. The shorter LOS group had a significantly lower rate of medical complications (0.2% vs. 2.8%, p = 0.004) and non-home discharge (1.3% vs. 12.1%, <0.001). Additionally, the shorter LOS group had lower rates of unplanned readmission (0.4% vs. 1.1%, p = 0.256), reoperation (0.2% vs. 0.4%, p = 0.564), return to the OR (0.2% vs. 0.9%, p = 0.179), and surgical complications (0.4% vs. 2.0%, p = 0.057), although these results were not statistically significant. Conclusion: Propensity score matched comparative analysis demonstrated that outpatient and short-stay inpatient hospitalization can be just as safe as standard inpatient hospitalization after TAA. Length of stay should be dictated by the overall risk of complication. Outpatient or short-stay TAA should be considered for patients with low risk of short-term complications. [Table: see text]

scholarly journals Timing of Adverse Events Following Open Reduction and Internal Fixation of the Ankle

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0016
Author(s):  
Daniel Bohl ◽  
Simon Lee ◽  
Kamran Hamid ◽  
Johnny Lin ◽  
George Holmes
Keyword(s):  
Myocardial Infarction ◽  
Adverse Events ◽  
Internal Fixation ◽  
Open Reduction ◽  
Kidney Injury ◽  
Interquartile Range ◽  
Improvement Program ◽  
Orthopaedic Surgeons ◽  
Vein Thrombosis ◽  
Malleolar Fractures

Category: Ankle Introduction/Purpose: There is increasing interest in the early identification and treatment of adverse medical events following orthopaedic procedures. The purpose of this study is to characterize the timing of adverse events following open reduction and internal fixation of closed fractures of the ankle. Methods: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program. A total of 17,318 patients undergoing open reduction and internal fixation of closed ankle fractures were identified. For each of eight different adverse events, the median postoperative day of diagnosis, interquartile range for day of diagnosis, and middle 80% for day of diagnosis were determined. Timing was compared between uni-malleolar and bi-/tri-malleolar fractures. Results: The median day of diagnosis (and interquartile range; middle 80%) for myocardial infarction was 2 (1-5; 0-17), pneumonia 3 (2-7; 1-19), acute kidney injury 6.5 (2-18; 2-20), urinary tract infection 7 (2-14; 0-24), pulmonary embolism 10 (3-21; 0-27), sepsis 15 (4-22; 1-28), deep vein thrombosis 17 (10-22; 3-27), and surgical site infection 19 (14-25; 8-28; Figure 1). Myocardial infarction occured earlier in patients with bi-/tri-malleolar fractures than in patients with uni-malleolar fractures (median postoperative day 2 versus 10, p=0.041). Similarly, sepsis occured earlier in patients with bi-/tri-malleolar fractures than in patients with uni-malleolar fractures (median day 10 versus 20.5, p=0.022). For the other 6 adverse events, there was no difference in timing between patients with uni-malleolar and patients with bi-/tri-malleolar fractures (p>0.05 for each). Conclusion: These precisely described time periods for occurrence of specific adverse events enable heightened awareness amongst orthopaedic surgeons during the first month following open reduction and internal fixation of the ankle. Orthopaedic surgeons should have the lowest threshold for testing for each adverse event during the time period of greatest risk.

scholarly journals Assessing the Feasibility and Effects of Introducing the USA National Surgical Quality Improvement Program on Clinical Outcomes and Cost in Saudi Arabia: An Observational Study

2020 ◽  
Vol 3 (1) ◽  
pp. 14-21
Author(s):  
Shahenaz Najjar ◽  
Adel F. Almutairi ◽  
Rashad Massoud ◽  
Khaled Al-Surimi ◽  
Sami Boghdadly
Keyword(s):  
Saudi Arabia ◽  
Quality Improvement ◽  
Adverse Events ◽  
Surgical Complications ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Clinical Registry ◽  
Surgical Quality ◽  
Additional Costs ◽  
Surgical Adverse Events

Abstract Introduction: This study aimed at introducing a systematic clinical registry to assess the outcomes of surgical performances and the associated costs of surgical complications in hospitals of Saudi Arabia. Materials and Methods: This was an observational retrospective cohort study. Three large Saudi public hospitals from different regions participated in the study. A systematic sample consisting of 2077 medical records was retrospectively reviewed after being received from the hospitals' surgical wards. The inclusion criteria of the study were inpatients of the surgical cases, patients older than 18 years, and those who underwent major surgery under general anesthesia. The occurrence of adverse events in surgical wards and the direct costs associated with these surgical adverse events were estimated. Results were reported in terms of odds ratio and 95% confidence interval. A value of p &lt; 0.05 was considered statistically significant. Results: Introducing the systematic clinical registry to assess surgical outcomes and complications across multiple hospital sites is feasible. The findings of the study suggest that some areas are exemplary and others need improvement, such as sepsis cases, renal failure, ventilator use for more than 48 h, urinary tract infection, surgical site infection (SSI), length of stay after colorectal surgery, and rehospitalization. Additional costs from surgical complications in Riyadh only were approximately 0.5 million Saudi Arabian Riyal (127,764.40 USD) during that year. Most of the additional costs were due to sepsis and SSI. Conclusion: Empirical evidence derived from the idea of introducing a National Surgical Quality Improvement Program might be generally applicable to other countries in the region and worldwide, and can be used to measure surgical adverse events and track interventions over time. As a result, quality improvement initiatives could be identified to be implemented immediately focusing on preventing several surgical adverse events. A future study is needed to explore the underlying factors that contribute to the occurrence of surgical adverse events to be prevented and/or mitigated.

scholarly journals Resident Involvement in Shoulder Arthroscopy Is Not Associated With Short-term Risk to Patients

2018 ◽  
Vol 6 (12) ◽  
pp. 232596711881629 ◽  
Author(s):  
Bryce A. Basques ◽  
Bryan M. Saltzman ◽  
Erik N. Mayer ◽  
Bernard R. Bach ◽  
Anthony A. Romeo ◽  
...  
Keyword(s):  
Adverse Events ◽  
Operative Time ◽  
Shoulder Arthroscopy ◽  
Error Variance ◽  
Improvement Program ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Resident Involvement ◽  
American College Of Surgeons ◽  
Perioperative Risks

Background: Shoulder arthroscopy is a commonly performed, critical component of orthopaedic residency training. However, it is unclear whether there are additional risks to patients in cases associated with resident involvement. Purpose: To compare shoulder arthroscopy cases with and without resident involvement via a large, prospectively maintained national surgical registry to characterize perioperative risks. Study Design: Cohort study; Level of evidence, 3. Methods: The prospectively maintained American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent 1 of 12 shoulder arthroscopy procedures from 2005 through 2012. Multivariate Poisson regression with robust error variance was used to compare the rates of postoperative adverse events and readmission within 30 days between cases with and without resident involvement. Multivariate linear regression was used to compare operative time between cohorts. Results: A total of 15,774 patients with shoulder arthroscopy were included in the study, and 12.3% of these had a resident involved with the case. The overall rate of adverse events was 1.09%. On multivariate analysis, resident involvement was not associated with increased rates of any aggregate or individual adverse event. There was also no association between resident involvement and risk of readmission within 30 days. Resident involvement was not associated with any difference in operative time ( P = .219). Conclusion: Resident involvement in shoulder arthroscopy was not associated with increased risk of adverse events, increased operative time, or readmission within 30 days. The results of this study suggest that resident involvement in shoulder arthroscopy cases is a safe method for trainees to learn these procedures.

scholarly journals Short-Term Morbidity and Predictors of Adverse Events Following Esthesioneuroblastoma Surgery

2020 ◽  
pp. 194589242097046
Author(s):  
Khodayar Goshtasbi ◽  
Jack L. Birkenbeuel ◽  
Mehdi Abouzari ◽  
Brandon M. Lehrich ◽  
Tyler M. Yasaka ◽  
...  
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Operation Time ◽  
Complication Rates ◽  
Short Term ◽  
Improvement Program ◽  
Asa Score ◽  
Operative Outcomes

Introduction The short-term adverse events and predictors of morbidity in surgical resection of esthesioneuroblastoma (ENB) are largely unknown, and investigating these variables can help direct planning for at-risk patients. Methods The 2005–2017 National Surgical Quality Improvement Program database was queried to identify patients with a diagnosis of ENB undergoing skull base surgery for tumor resection. Information regarding demographics, patient morbidity score, pre-operative and intra-operative data, and post-operative outcomes were extracted. Cox proportional hazard analysis was utilized to assess complication and readmission/reoperation rates. Results A total of 95 patients undergoing skull base surgery for resection of ENB were included. Mean age, BMI, operation time, and post-operative length of stay (LOS) of the cohort were 53.6 ± 16.2 years, 29.1 ± 6.5, 392.0 ± 204.6 minutes, and 5.8 ± 4.6 days, respectively. In total, 31 patients (32.6%) experienced at least one 30-day adverse event, which included blood transfusion intra-operatively or within 72 hours from the operation (22.1%), readmission (10.7%), intubation >48 hours (7.4%), reintubation (4.2%), organ or space infection (4.2%), reoperation (4.0%), superficial or deep surgical site infection (2.1%), sepsis (2.1%), pulmonary embolism (1.1%), and myocardial infarction (1.1%). Patients who experienced at least one adverse event had significantly higher operation time (486.8 ± 230.4 vs. 347.5 ± 176.2 minutes, p = 0.002), LOS (9.2 ± 5.6 days vs. 4.2 ± 3.0, p < 0.001), and lower hematocrit (37.3 ± 5.9 vs. 41.2 ± 3.8, p < 0.001) and albumin levels (3.8 ± 0.6 vs. 4.2 ± 0.3, p = 0.009). Patients with a higher American Society of Anesthesiologists (ASA) score (HR = 2.39; p = 0.047) or longer operation time (HR = 1.004; p = 0.001) had a significantly higher risk for experiencing adverse events. Obesity was not associated with different intra- or post-operative outcomes, but older patients had shorter operations ( p = 0.002) and LOS ( p = 0.0014). Conclusion Longer operation time and lower pre-operative hematocrit and albumin levels may all increase complication rates in ENB resection. Patients with high ASA score or more advanced age may have different short-term outcomes.

Predisposing Factors for 30-Day Complications Following Leg Amputation

2021 ◽  
pp. 193864002110019
Author(s):  
Joseph V. Villarreal ◽  
Doha G. Hussien ◽  
Vinod K. Panchbhavi ◽  
Daniel C. Jupiter
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Improvement Program ◽  
Level Of Evidence ◽  
Surgical Infection ◽  
Vein Thrombosis ◽  
Total Length ◽  
Infected Wounds ◽  
Additional Service ◽  
The Impact

Background Although amputation rates, morbidity, and mortality have been established for select populations, the impact of general demographic factors on postoperative surgical complications remains little studied. Methods The American College of Surgeons’ National Surgical Quality Improvement Program database was searched for leg amputations from 2012 to 2017 using CPT codes 27881, 27882, 27884, and 27886, identifying 4162 patients. A total of 29 demographic variables with 4 complications (surgical infection, additional service, and deep-vein thrombosis [DVT], and sepsis) were analyzed. Results Preoperative open, contaminated, or dirty/infected wounds; longer intraoperative times; development of sepsis prior to surgery; and admission of patients from home or another hospital influenced postoperative infection rates. Preoperative open, infected, or dirty/infected wounds; height; weight; total length of hospital stay; and ethnicity affected postoperative additional service incidence. Preoperative congestive heart failure, large decreases in body weight, and total length of hospital stay influenced postoperative DVT rates. Preoperative functional heath status, total length of hospital stay, amputations conducted as emergency cases, preoperative acute renal failure, open or infected wounds, sepsis, and contaminated or dirty/infected wounds affected postoperative sepsis rates. Background Conclusion. Understanding these risk factors may allow providers to anticipate and address higher rates of complications in certain patient populations. Level of evidence: Level III: Prognostic

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