Incidence and Risk Factors for Pin Site Infection of Exposed Kirschner Wires Following Elective Forefoot Surgery

2019 ◽  
Vol 40 (10) ◽  
pp. 1154-1159 ◽  
Author(s):  
James C. McKenzie ◽  
Ryan G. Rogero ◽  
Sultan Khawam ◽  
Elizabeth L. McDonald ◽  
Kristen Nicholson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Case Series ◽  
Current Smoker ◽  
Site Infection ◽  
Kirschner Wires ◽  
Forefoot Surgery ◽  
Pin Site ◽  
Male Sex ◽  
K Wires

Background: Kirschner wires (K-wires) are commonly utilized for temporary metatarsal and phalangeal fixation following forefoot procedures. K-wires can remain in place for up to 6 weeks postoperatively and are at risk for complications. This study investigated the incidence of infectious complications of exposed K-wires after forefoot surgery and identifies risk factors for these complications. Methods: A single-surgeon retrospective chart review of forefoot surgeries from 2007 to 2017 was undertaken. Inclusion criteria were adult patients (≥18 years) undergoing elective forefoot surgery with the use of exposed K-wires. Incidence of pin site infectious complication, defined as cellulitis, or pin site drainage and/or migration/loosening of the pin was noted. Patient demographic and perioperative data were analyzed, along with the number of K-wires placed per procedure. Mann-Whitney U and chi-square tests were performed to determine predictive factors related to pin site infection rates, with a multivariable model with significant factors subsequently performed. Two-thousand seventeen K-wires in 1237 patients were analyzed. Results: There were 35 pin site infections for a rate of 1.74%. Combined forefoot procedures (507 pins in 229 patients) had a pin site infection rate of 4.93% (N = 25), followed by lesser metatarsal osteotomies (667 pins in 446 patients) at 1.05% (N = 7), then hammertoe corrections (694 pins in 421 patients) at 0.43% (N = 3), and no pin site infections with chevron osteotomies (149 pins in 141 patients). Male sex, body mass index (BMI), current smoker, and number of pins were significant risk factors ( P ≤ .05). Additionally, there were 23 non–infection-related K-wire complications. No long-term sequelae were encountered based on any complications. Conclusion: K-wires are commonly used for temporary immobilization of the smaller bones of the forefoot following deformity correction. Male sex, BMI, current smoker, and number of pins were significant risk factors for pin site infection, with a higher rate of infection with 2 or more pins placed. Level of Evidence: Level IV, case series.

Perioperative risk factors for surgical site infection in tibial tuberosity advancement: 224 stifles

2015 ◽  
Vol 28 (03) ◽  
pp. 199-206 ◽  
Author(s):  
F. W. Yap ◽  
K.D. Smith ◽  
T. Parkin ◽  
I. Calvo
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Antimicrobial Therapy ◽  
Significant Risk ◽  
Case Series ◽  
Tibial Tuberosity ◽  
Sample Population ◽  
Site Infection ◽  
Retrospective Case ◽  
Surgical Time

SummaryObjective: To examine perioperative factors affecting surgical site infection (SSI) rate following tibial tuberosity advancement (TTA).Study design: Retrospective case series.Sample population: 224 stifles in 186 dogs.Methods: Medical records of dogs that underwent TTA in a single institution were reviewed. Information on signalment anaesthetic and surgical parameters, as well as occurrence of SSI was recorded. Dogs were followed for a minimum of three months postoperatively. The association between perioperative factors and SSI was assessed usingChi-squared tests and binary logistic regression.Results: The prevalence of SSI was 5.3% (12/224 TTA). Surgical time (p = 0.02) and anaesthesia time (p = 0.03) were significantly associated with SSI. For every minute increase in surgical time and anaesthesia time, the likelihood of developing SSI increased by seven percent and four percent respectively. The use of postoperative antimicrobial therapy was not significantly associated with lower SSI (p = 0.719). Implants were removed in 1.3% of cases (3/224 TTA).Conclusions: The findings of this study suggest that increased surgical and anaesthesia times are significant risk factors for SSI in TTA, and that there is no evidence that postoperative prophylactic antimicrobial therapy is associated with SSI rate.

scholarly journals Incidence and Risk Factors for Complications of Exposed Kirschner Wires Following Elective Forefoot Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0034
Author(s):  
James McKenzie ◽  
Ryan Rogero ◽  
Elizabeth McDonald ◽  
Kristen Nicholson ◽  
Rachel Shakked ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prophylactic Antibiotics ◽  
Wound Complications ◽  
Kirschner Wires ◽  
Tourniquet Time ◽  
Early Removal ◽  
Forefoot Surgery ◽  
Increased Risk ◽  
History Of ◽  
K Wires

Category: Midfoot/Forefoot Introduction/Purpose: Kirschner wires (K-wires) are commonly utilized for temporary metatarsal and phalangeal fixation following forefoot corrective osteotomies. K-wires can remain in place for up to 6 weeks postoperatively and are at risk for wound complications. Their exposure to the outside environment and direct osseous communication makes infection an important concern for the clinician. Early removal, prophylactic antibiotics, and re-operation are potential sequelae of infected K-wires and can affect outcomes. The purpose of this study is to evaluate the incidence of complications of exposed K-wires after forefoot surgery and identify patient or perioperative risk factors for these complications. Methods: A single surgeon retrospective chart review of forefoot surgeries over the past 10 years was undertaken. Inclusion criteria were any adult undergoing elective forefoot surgery with the use of exposed K-wires. Incidence of wound complication defined as cellulitis, pin site drainage, or migration/loosening of the pin requiring prophylactic antibiotics or early removal was noted. Patient demographic data such as age, BMI, comorbidities, and smoking status were recorded. Perioperative data such as tourniquet time, type of anesthesia, and perioperative antibiotics was also recorded. Univariate analysis was performed via Mann-Whitney test for continuous variables and Chi square test for categorical variables. Multivariate analysis was performed for statistically significant risk factors. Results: 1,217 Patients (2,018 K-wires) were analyzed. There was a 10% complication rate requiring prophylactic antibiotics or early removal (N=123). 40 patients required early pin removal, 54 patients were given oral antibiotics, and 29 patients required both. Female gender (p<0.001), BMI over 28 (p<0.001), general anesthesia (p=0.025), increased tourniquet time (p=0.003) and history of rheumatoid arthritis (p=0.047) were significantly associated with complications. Both male gender [OR 2.62] and tourniquet time [OR 1.01] remained significant on multivariate regression analysis. There was no increased risk of complications with a history of smoking or diabetes. Conclusion: The K-wire is an important modality for providing temporary immobilization of the smaller bones of the forefoot following deformity correction. Male gender, elevated BMI, history of rheumatoid arthritis, general anesthesia, and longer tourniquet time are associated with increased risk of pin infection requiring early removal and/or antibiotics. Further study is needed to determine whether optimizing inflammatory disease, using efficient perioperative technique, and utilizing local anesthesia may limit the risk of wound complications with K-wires in forefoot surgery.

Kirschner wire pin site infection in hand and wrist fractures: incidence rate and risk factors

2016 ◽  
Vol 41 (9) ◽  
pp. 990-994 ◽  
Author(s):  
W. F. van Leeuwen ◽  
B. T. J. A. van Hoorn ◽  
N. Chen ◽  
D. Ring
Keyword(s):  
Risk Factors ◽  
Kirschner Wire ◽  
Multivariable Logistic Regression Analysis ◽  
Site Infection ◽  
Kirschner Wires ◽  
Level Of Evidence ◽  
Wrist Fractures ◽  
Kirschner Wire Fixation ◽  
Number Of Patients ◽  
Pin Site

Kirschner wires are widely used for skeletal fixation of unstable fractures, but the pin tracks create a potential pathway through the skin and into the bone for bacteria to cause an infection. We tested the null hypothesis that there are no demographic, patient-related, injury, or treatment variables independently associated with the occurrence of pin site infection after percutaneous fixation of hand and wrist fractures using Kirschner wires. A retrospective review of 1213 patients with one or more fractures of the hand and wrist treated with percutaneous Kirschner wire fixation identified 85 patients (7%) who had additional treatment with oral antibiotics, early pin removal, or reoperation related to a pin site infection. We found no factors were independently associated with higher or lower risks of pin site infection in multivariable logistic regression analysis. Pin site infections – most benign – occur in a notable number of patients and we could not identify any modifiable risk factors. Level of Evidence: III

Post-thyroidectomy bleeding: analysis of risk factors from a national registry

2021 ◽  
Author(s):  
H E Doran ◽  
S M Wiseman ◽  
F F Palazzo ◽  
D Chadwick ◽  
S Aspinall
Keyword(s):  
Risk Factors ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Bleeding Risk ◽  
Redo Surgery ◽  
Day Case ◽  
Increased Risk ◽  
Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

scholarly journals Incidence and Risk Factors of Recipient Surgical Site Infection in Oral and Maxillofacial Reconstruction with Vascularized Fibular Bone Grafts

2020 ◽  
pp. 231
Author(s):  
Pichai Vittayakittipong ◽  
Sarocha Makmanee
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Significant Risk ◽  
Bone Grafts ◽  
Class Ii ◽  
P Value ◽  
Site Infection ◽  
Physical Status ◽  
Recipient Site ◽  
Maxillofacial Reconstruction

Objective: To determine the incidence and risk factors of recipient surgical site infection (RSSI) after oral and maxillofacial reconstruction with vascularized fibular bone grafts (VFBG).Material and Methods: This retrospective study was performed in patients who underwent oral and maxillofacial reconstructive surgery, with VFBG, at the Dental Hospital, Faculty of Dentistry, Prince of Songkla University. Demographic, preoperative, intraoperative and postoperative data were recorded. Any infection at the recipient site occurring within 30 days post-operatively, by criteria from the Center of Disease Control, was defined as RSSI. Statistical analysis was performed by chi-square test, Student's t-test and Pearson’s correlation coefficient with statistical significance was set at 0.05.Results: There were twenty-one patients who met the eligibility criteria. The incidence of RSSI after oral and maxillofacial reconstruction with VFBG was 47.6% (10/21 patients), and the success rate of VFBG was 95.2%. American Society of Anesthetics (ASA) physical status class II and oral contamination were significant risk factors for RSSI (p-value=0.004 and p-value=0.031, respectively). Length of hospital stay was significantly higher in the RSSI group (p-value<0.001).Conclusion: The incidence of RSSI after oral and maxillofacial reconstruction with VFBG was high, and ASA physical status class II and oral contamination were significant risk factors for RSSI.

scholarly journals Bone fractures in patients with type 2 diabetes mellitus: prevalence and risk factors

2017 ◽  
Vol 20 (4) ◽  
pp. 4-10
Author(s):  
Tatiana Olegovna Yalochkina ◽  
Janna Evgen'evna Belaya ◽  
Lyudmila Yakovlevna Rozhinskaya ◽  
Michail Borisovich Antsiferov ◽  
Larisa Konstantinovna Dzeranova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Outpatient Clinic ◽  
Bone Fractures ◽  
Significant Risk ◽  
History Of ◽  
Male Sex

Aim. To estimate the prevalence of and risk factors for low-traumatic fractures in patients with type 2 diabetes mellitus (T2DM).Materials and methods. We questioned 214 patients with T2DM from a single outpatient clinic located in Moscow to evaluate the prevalence of and risk factors for low-traumatic fractures, the duration of and complications from TD2M and HbA1c levels.Results. Of 214 patients, 65 reported low-traumatic bone fractures. Patients with a history of low-traumatic fractures reported falls in the previous year (28%), whereas only 13% of patients without fractures reported falls. The difference was statistically significant, with an odds ratio of 2.34 (1,144,76), P=0,022. Men reported fractures more frequently than women (43.3% vs. 24.7%, respectively, P = 0.01). Patients with bone fractures had a lower body mass index (P = 0.022); however, a multivariate analysis revealed that a history of falls and male sex were the most significant risk factors for fracture.Conclusion. Around 30% of patients with T2DM from a Moscow outpatient clinic reported bone fractures. The most significant risk factors for fracture were a history of falls in the previous year and male sex. The article is the RePrint from the original article inDiabetes Mellitus (2016); 19(5) pp. 359-365. doi: 10.14341/DM7796

scholarly journals Risk Factors for Long-term Hip Osteoarthritis in Patients With Femoroacetabular Impingement Without Surgical Intervention

2020 ◽  
Vol 48 (12) ◽  
pp. 2881-2886
Author(s):  
Heath P. Melugin ◽  
Rena F. Hale ◽  
Jun Zhou ◽  
Matthew LaPrade ◽  
Christopher Bernard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoroacetabular Impingement ◽  
Mixed Type ◽  
Surgical Intervention ◽  
Significant Risk ◽  
Hip Osteoarthritis ◽  
Hip Pain ◽  
Male Sex ◽  
Time Of Presentation

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain and a known risk factor for hip osteoarthritis (OA) and total hip arthroplasty (THA) at a young age. Unfortunately, little is known about the specific factors associated with an increased risk of OA. Purpose: To (1) report the overall rate of symptomatic hip OA and/or THA in patients with FAI without surgical intervention and (2) identify radiographic features and patient characteristics associated with hip OA. Study Design: Case-control study; Level of evidence, 3. Methods: A geographic database was used to identify all patients with hip pain and radiographs between 2000 and 2016. Chart review was performed to identify patients with FAI. Patient medical records were reviewed to obtain demographic information, clinical history, physical examination findings, imaging details, and treatment details. Kaplan-Meier analysis was used to determine the rate of hip OA. Univariate and multivariate proportional hazard regression models were performed to determine risk factors for OA. Results: The study included 952 patients (649 female; 303 male; 1104 total hips) with FAI. The majority of hips had mixed type (n = 785; 71.1%), 211 (19.1%) had pincer type, and 108 (9.8%) had cam type. Mean age at time of presentation was 27.6 ± 8.7 years. Mean follow-up time was 24.7 ± 12.5 years. The rate of OA was 13.5%. THA was performed in 4% of patients. Male sex, body mass index (BMI) greater than 29, and increased age were risk factors for OA (male sex: hazard ratio [HR], 2.28; P < .01; BMI >29: HR, 2.11; P < .01; per year of increased age: HR, 1.11; P < .01.). Smoking and diabetes mellitus were not significant risk factors. No radiographic morphological features were found to be significant risk factors for OA. Conclusion: At mean follow-up of 24.7 years, 14% of hips had symptomatic OA and 4% underwent THA. BMI greater than 29, male sex, and increased age at the time of presentation with hip pain were risk factors for hip OA. The cohort consisted of a large percentage of mixed-type FAI morphologies, and no specific radiographic risk factors for OA were identified.

Nonunion and Reoperation Following Proximal Interphalangeal Joint Arthrodesis and Associated Patient Factors

Hand ◽  
2020 ◽  
pp. 155894472093919
Author(s):  
Haroon M. Hussain ◽  
Alexander L. Roth ◽  
Assem A. Sultan ◽  
Hiba K. Anis ◽  
Peter J. Stern
Keyword(s):  
Risk Factors ◽  
Corrective Osteotomy ◽  
Significant Risk ◽  
Final Analysis ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Adverse Outcomes ◽  
Patient Specific ◽  
Community Practice ◽  
Male Sex

Background Proximal interphalangeal joint (PIPJ) arthrodesis can provide reliable pain relief and restore hand function in patients with PIPJ arthritis. However, there is a paucity of literature on patient-specific preoperative risk factors that are associated with adverse outcomes after PIPJ arthrodeses. Therefore, the primary purpose of this study was to assess preoperative predictors of nonunion and reoperation after PIPJ arthrodesis. Methods This study identified all patients who underwent PIPJ arthrodesis at a single community practice between 1987 and 2013. The final analysis included 415 PIPJs treated with arthrodesis. The mean follow-up was 1.3 years. Data on preoperative diagnosis, demographics, comorbidities, and operative techniques were recorded, as well as the occurrence of nonunions and reoperations. Logistic regression models were used to identify independent risk factors of nonunion and reoperation. Results There were 40 nonunions (10%) and 62 reoperations (15%). Of the reoperations, there were 39 incidences of isolated hardware removal, 9 irrigation and debridement, 8 amputations, 5 revision arthrodeses, and 1 corrective osteotomy. The highest number of nonunions occurred in the traumatic diagnosis group (37%), followed by the rheumatoid group (23%) and the scleroderma group (15%). The highest number of reoperations occurred within the traumatic joint disorder group (40%), followed by the rheumatoid group (24%) and the scleroderma group (11%). Multivariate analysis revealed that male sex ( P < .01) and hepatic disease ( P = .03) were significant risk factors of nonunion. Male sex was also significantly associated with increased reoperation risk ( P < .01). Conclusion Risks of nonunions and reoperations after PIPJ arthrodeses are low; however, these findings may guide clinicians and patients in the preoperative decision-making process and help with targeted postoperative surveillance to mitigate these risks.

scholarly journals The Association between ADHD and the Severity of COVID-19 Infection

2021 ◽  
pp. 108705472110036
Author(s):  
Eugene Merzon ◽  
Margaret D. Weiss ◽  
Samuele Cortese ◽  
Ann Rotem ◽  
Tzipporah Schneider ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Health Services ◽  
Logistic Regression Analysis ◽  
Significant Risk ◽  
Increased Risk ◽  
Dependent Variables ◽  
Male Sex ◽  
Analysis Models

Objective: Patients with ADHD are at increased risk of acquiring COVID-19. The present study assessed the possibility that ADHD also increases the risk of severe COVID-19 infection. Method: We assessed 1,870 COVID-19 positive patients, aged 5 to 60 years, registered in the database of Leumit Health Services (LHS, Israel), February to -June 2020, of whom 231 with ADHD. Logistic regression analysis models evaluated the association between ADHD and the dependent variables of being symptomatic/referral to hospitalization, controlling for demographic and medical variables. Results: Age, male sex, and BMI were confirmed to be significant risk factors for increased COVID-19 severity. ADHD was found to be associated with increased severity of COVID-19 symptoms ( OR = 1.81, 95% CI [1.29, 2.52], p < .05) and referral to hospitalization ( OR =1.93, 95% CI [1.06, 3.51], p = .03). Conclusion: ADHD is associated with poorer outcomes in COVID-19 infection.

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