Surgical Site Infection after Gastrointestinal and Hepatobiliary Surgeries- A Retrospective Evaluation from a Single Center of Western India

Western India ◽

Site Infection ◽

Prolonged Hospital Stay ◽

Hepatobiliary Surgery ◽

Aim: Aim of our study to evaluate various factors responsible for surgical site infection after gastrointestinal and hepatobiliary surgeries. Material and Methods: Patient who underwent gastrointestinal and hepatobiliary surgery in our department were evaluated retrospectively. Various factors associated with surgical site infection were evaluated using univariate and multivariate analysis. Surgical site infection was defined as any culture positive discharge from the wound within 30 days of surgery.Statistical analysis was done using SPSS version 23. Results: We evaluated total 331 patients operated between April 2018 to March 2020. 14 patients were lost to follow up after discharge and before completing post operative day 30. 18 patients expired before 30 days without developing SSI and were excluded from the study as per exclusion criteria. 299 patient included in the study. Total 20 patients developed surgical site infection. It showed SSI rate in our study population was 6.68%. On univariate analysis prolonged hospital stay, more blood product used, higher cdc grade of surgery, higher ASA grade, more operative time, open surgeries,colorectal and HPB surgeries were associated with surgical site infections. On multivariate analysis only prolonged hospital stay independently predicted Surgical Site Infectins. (p=0.014,0dds ratio 1.223, 95% confidence interal 1.042-1.435). Conclusion: Prolonged hospital stay independently predicts surgical site infections after gastrointestinal and hepatobiliary surgery.

Surgical site Infection after gastrointestinal and hepatobiliary surgeries- A retrospective evaluation from a single center of western India

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v23i2.35802 ◽

2020 ◽

Vol 23 (2) ◽

pp. 31-35

Author(s):

Bhavin Vasavada ◽

Hardik Patel

Keyword(s):

Multivariate Analysis ◽

Surgical Site Infection ◽

Hospital Stay ◽

Univariate Analysis ◽

Western India ◽

Site Infection ◽

Prolonged Hospital Stay ◽

Hepatobiliary Surgery ◽

Introduction: Aim of our study to evaluate various factors responsible for surgical site infection after gastrointestinal and hepatobiliary surgeries. Methods: Patients who underwent gastrointestinal and hepatobiliary surgery in our department were evaluated retrospectively. Various factors associated with surgical site infection were evaluated using univariate and multivariate analysis. Surgical site infection was defined as any culture positive discharge from the wound within 30 days of surgery. Results: We evaluated a total of 331 patients operated between April 2018 and March 2020. 14 patients were lost to follow up after discharge and before completing post operative day 30. Eighteen patients expired before 30 days without developing SSI and were excluded from the study as per exclusion criteria. 299 patients were included in the study. Twenty patients developed surgical site infection. It showed SSI rate in our study population was 6.68%. On univariate analysis prolonged hospital stay, more blood product used, higher CDC grade of surgery, higher ASA grade, more operative time, open surgeries, colorectal and HPB surgeries were associated with surgical site infections. On multivariate analysis only prolonged hospital stay independently predicted SSI. (p=0.014, Odds ratio 1.223, 95% confidence interval 1.042-1.435.). Conclusion: Prolonged hospital stay independently predicts surgical site infections after gastrointestinal and hepatobiliary surgery.

Prolonged Hospital Stay is Associated with Increase Surgical Site Infection, Gastrointestinal and Hepatobiliary Surgery – A propensity Matched Analysis

10.20944/preprints202009.0356.v1 ◽

2020 ◽

Author(s):

Bhavin Vasavada ◽

Hardik Patel

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Malignant Disease ◽

Site Infection ◽

Prolonged Hospital Stay ◽

Hepatobiliary Surgery ◽

Small Intestinal ◽

Prolonged Hospital ◽

Upper Gastrointestinal

Aims: Primary AIM of the study was to evaluate effect of prolonged hospital stay on Surgical site infections We also evaluated effect of prolonged hospital stay on overall morbidity in Gastrointestinal and Hepatobiliary Surgery as secondary outcome. Methods: We retrospectively analysed all the patients who underwent gastrointestinal and hepatobiliary surgery between April 2017 to March 2020. On our analysis we found mean hospital stay in patient who did not develop SSI and/or morbidity was 4 days (Total hospital stay) vs 6 days who developed morbidity (hospital stay before diagnosis of SSI or diagnosis or morbid event). Based on this to avoid selection bias, we did 1:1 propensity score analysis between patients who had 4 or less than hospital stay vs patients who had 5 or more hospital stay before diagnosis of surgical site infection and/or morbid event. We took all the preoperative and intraoperative factors like Age, sex, malignant disease, ASA score, CDC grade of surgery, open or laparoscopic surgery, HPB surgeries, colorectal surgeries, Upper Gastrointestinal surgeries and small intestinal surgeries as covariates. We used nearest neighbor matching protocol with a calipher of 0.2. Cases were not reusable after matching. Statistical analysis was done using SPSS version 23. Results: We included 348 patients operated between April 2017 and March 2020 in our analysis. After 1:1 propensity score matching 58 patients included in study arm (prevent hospital stay more than 4 days) and 56 patients in control arm. Both groups were comparable with regard to Age, Sex, Surgery for malignant disease, ASA score, CDC grade of surgery, HPB surgeries, Small intestinal surgeries, Colorectal surgeries, upper gastrointestinal surgeries, intraoperative blood product requirement, intraoperative hypotension or any other event, operative time. Prolonged hospital stay (> 4 days) was significantly associated with surgical site infections (p<0.0001), morbidity (p=0.001). Open surgeries were associated with prolonged hospital stay. (p=0.032). Conclusion: Prolonged Hospital stay is associated with increase surgical site infection and morbidity in Gastrointestinal and Hepatobiliary Surgery.

Assessment of prolonged hospital stay attributable to surgical site infections using appropriateness evaluation protocol

American Journal of Infection Control ◽

10.1067/mic.2000.102353 ◽

2000 ◽

Vol 28 (2) ◽

pp. 109-115 ◽

Cited By ~ 30

Author(s):

Veronique Merle ◽

Jeanne-Marie Germain ◽

Pierre Chamouni ◽

Herve Daubert ◽

Loetizia Froment ◽

...

Keyword(s):

Hospital Stay ◽

Prolonged Hospital Stay ◽

Appropriateness Evaluation Protocol ◽

Evaluation Protocol ◽

Prolonged Hospital Stay and Surgical-Site Infections

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700042636 ◽

2000 ◽

Vol 21 (6) ◽

pp. 426-427

Author(s):

Gina Pugliese ◽

Martin S. Favero

Keyword(s):

Hospital Stay ◽

Prolonged Hospital Stay ◽

Effect of duration of pre-operative admission on surgical site infection in major abdominal surgeries: an observational study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192422 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2306

Author(s):

Alka Shantiprakash Gupta ◽

Arthika Shetty

Keyword(s):

Surgical Site Infection ◽

Surgical Patient ◽

P Value ◽

Site Infection ◽

Admission Time ◽

Long Run ◽

Skin Flora ◽

Significant Difference ◽

Background: Surgical site infection (SSI) are second most common cause of mortality in surgical patient, situation has been further complicated by emergence of drug resistant strains. The importance of preventing surgical site infections is well recognized since they lead to increased morbidity, prolonged hospital stays, need for readmission, high end antibiotic treatment and re-surgery. The study was done to see if incidence of SSI is decreased with decreased pre-operative admission time. Others factors associated with SSI were analysed including the microbiological spectrum.Methods: The study was an analytical, observational, case control study. Sixty (60) cases each of gynaecology and obstetrical post-operative patients who developed SSI within 30 days were taken as cases and who did not develop SSI were taken as controls and preoperative admission time was analysed in both cases and controls to observe if risk of surgical site infections decreases due to decreased exposure to nosocomial pathogens when the pre-operative admission time was less than 48 hours.Results: Author found that there was statistically significant difference in the time between surgery and admission in the gynaecological surgeries with p value 0.023, as compared to the obstetrics surgeries where there was no statistically significant difference. Common organism isolated was E. coli sensitive to gentamicin.Conclusions: From this study, it seems to be a good policy to evaluate the patient on OPD basis and admit them about 24 to 48 hours prior to the surgery rather them keeping them admitted for prolonged duration in wards for diagnostic evaluation. This prevents nosocomial contamination in the patient’s skin flora thereby preventing SSI. This practice not only conserves the hospital resources but also makes the patient turn over faster. Further this might in the long run reduce the antibiotic resistant hospital flora.

Prevalence of surgical site infections and their sensitivity patterns in elective abdominal surgeries in King George Hospital, Visakhapatnam

International Surgery Journal ◽

10.18203/2349-2902.isj20202830 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2247

Author(s):

Pratha Anantha Ramani ◽

Simhadri Uday Kiran ◽

Murali Manohar Deevi ◽

Ginni Vijay Sainath Reddy ◽

Ginjupalli Saichand ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Wound Dressings ◽

Site Infection ◽

Antibiotic Resistant ◽

Clean Contaminated ◽

King George Hospital ◽

A Prospective Study ◽

Background: Surgical site infections are one of the most common complications in the postoperative period leading to increased morbidity, prolonged hospital stay and reduced quality of life. The present study aims to identify the incidence of surgical site infection (SSI), risk factors, causative organisms, and their sensitivity patterns in patients who have undergone elective abdominal surgeries.Methods: A prospective study containing 200 patients who have undergone elective abdominal surgeries from May 2018 to January 2020 were evaluated. A thorough history was taken in all the patients. A detailed clinical examination and routine investigations were done. Parameters such as body mass index (BMI), diabetic status, type of surgery, wound grading, culture, and sensitivity patterns were considered. The patients underwent treatment based on their investigatory reports.Results: In the present study, 54 patients developed surgical site infection, and among them, 22 are diabetics. Only ten patients with normal BMI developed SSI, whereas the other 44 patients who developed SSI had abnormal BMI. The incidence of SSI was higher in clean-contaminated surgeries comprising up to 89% of cases. Staphylococcus aureus was the most commonly isolated organism, and cefoperazone plus sulbactam was the most sensitive on antibiogram.Conclusions: The surgical site infections are on rising trend due to the emergence of antibiotic-resistant microorganisms. Treatment of the underlying risk factors, regular wound dressings, and antibiotics, according to sensitivity patterns, are the mainstay.

Intraoperative subcutaneous culture as a predictor of surgical site infection in open gynecological surgery

PLoS ONE ◽

10.1371/journal.pone.0244551 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244551

Author(s):

Ricardo Sainz de la Cuesta ◽

Rosa Mohedano ◽

Sylvia Sainz de la Cuesta ◽

Belen Guzman ◽

Alicia Serrera ◽

...

Keyword(s):

Surgical Site Infection ◽

Univariate Analysis ◽

Colon Resection ◽

Skin Closure ◽

Microbiological Analysis ◽

Gynecological Surgery ◽

Site Infection ◽

Positive Skin ◽

Observational Cohort

Purpose To analyze the relationship between intraoperative cultures and the development of surgical site infection (SSI) in women undergoing laparotomy for gynecological surgery. Methods Prospective observational cohort study. Over a six-year period, women who underwent elective laparotomy at our hospital were included. Patients’ demographics, underlying co-morbidities, surgical variables, type and etiology of postoperative surgical site infections were collected. Skin and subcutaneous samples were taken just prior to skin closure and processed for microbiological analysis. Univariate and multivariate analyses (logistic regression model) were conducted to explore the association of the studied variables with SSIs. Results 284 patients were included in our study, of which 20 (7%) developed surgical site infection, including 11 (55%) superficial and nine (45%) organ-space. At univariate analysis, length of surgery, colon resection, transfusion and positive intraoperative culture were associated with surgical site infection occurrence. Skin and subcutaneous cultures were positive in 25 (8.8%) and 20 (7%) patients, respectively. SSI occurred in 35% of women with positive subcutaneous culture and in 20% of those with positive skin cultures. Using multivariate analysis, the only independent factor associated with surgical site infection was a positive subcutaneous culture (OR 10.4; 95% CI 3.5–30.4; P<0.001). Conclusion Intraoperative subcutaneous cultures before skin closure may help early prediction of surgical site infection in open gynecological procedures.

Evaluation of various pre and postoperative parameters associated with types of surgical site infections in abdominal surgeries

International Surgery Journal ◽

10.18203/2349-2902.isj20190016 ◽

2019 ◽

Vol 6 (2) ◽

pp. 432

Author(s):

Shabi Ahmad ◽

Abhinav Agrawal ◽

Shivam Madeshiya ◽

Roshni Khan ◽

Pradeep Kumar Singh

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Signs And Symptoms ◽

Site Infection ◽

Case Scenario ◽

Average Hospital ◽

E Coli ◽

Control And Prevention ◽

Clean Contaminated

Background: Surgical Site Infections (SSIs) contributing to substantial rate of mortality, significant morbidity, considerable prolongation in length of hospitalization and added treatment expenses. The Centers for Disease Control and Prevention (CDC) has classified Surgical site infections (SSI) into superficial, deep, or organ/space SSIs. The objective of study was to evaluate pattern of surgical site infection in various abdominal surgeries.Methods: All patients who admitted in surgical OPD/emergency and undergoing abdominal surgical procedures were included in study. Patients were observed in wards and during follow up to assess signs and symptoms of surgical site infection.Results: Result were analysed in terms of etiology, distribution of cases based on case scenario, wound type, clinical features, number of re-explorations done after development of SSI, type of surgery (laparoscopic v/s open), type of organisms cultured, mortality, co-morbid condition, number of extra days in hospital after SSI and average amount spent after SSI.Conclusions: Surgical site infection is associated with high incidence of morbidity in terms of treatment cost and hospital stay. Average hospital stay, expenditure, co-morbidities and mortality were more in organ/space SSI. Superficial SSI is most common in both laparoscopy and open procedures. Deep and organ/space SSI not seen with laparoscopy. Superficial SSI were more common in clean and clean contaminated cases while superficial SSI was more common in contaminated and dirty cases. In superficial and deep SSI staphylococcus aureus was more common whereas in organ/space SSI E. coli and pseudomonas were common bacterial isolates.

Nonconcordance with Surgical Site Infection Prevention Guidelines and Rates of Surgical Site Infections for General Surgical, Neurological, and Orthopedic Procedures

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00562-11 ◽

2011 ◽

Vol 55 (10) ◽

pp. 4659-4663 ◽

Cited By ~ 36

Author(s):

Barnaby Young ◽

Tat Ming Ng ◽

Christine Teng ◽

Brenda Ang ◽

Hwei Yee Tai ◽

...

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Univariate Analysis ◽

Orthopedic Procedures ◽

Site Infection ◽

Chi Square ◽

Chi Square Test ◽

Prevention Guidelines ◽

Complication Of Surgery

ABSTRACTSurgical site infection (SSI) is a common and preventable complication of surgery, but the relative importance of individual measures recommended by guidelines has not been determined. Elective general surgical, neurological, and orthopedic procedures requiring antibiotic prophylaxis from a 3-month period were retrospectively studied to determine concordance with SSI prevention guidelines and to identify factors which predicted the development of SSIs. A total of 216 surgeries were reviewed, with 18 SSIs (8.3%). A mean of 1.4 antibiotic prophylaxis errors per surgery were identified, with correct antibiotic type identified for 64%, antibiotic timing for 83%, supplemental antibiotic dosing for 34%, and antibiotic duration of less than 24 h for 44%. Normothermia was present in 79% of surgeries, and normoglycemia was present in 17%. Univariate analysis of the SSI rate identified four significant factors. Antibiotic prophylaxis for less than 24 h postoperatively (odds ratio [OR], 0.213; 95% confidence interval [95% CI]0.060 to 0.757) and neurosurgery (OR, 0.118; 95% CI, 0.15 to 0.903) correlated with a reduced risk of SSI. The mean number of prophylaxis errors (OR, 1.6; 95% CI, 1.02 to 2.4) and a duration of surgical drainage for more than 3 days (OR, 2.679; 95% CI, 1.009 to 7.113) predicted SSI. By multivariate analysis, errors in individual antibiotic prophylaxis measures were not significantly associated with SSI; however, the presence of more than two errors was significant (OR, 4.030; 95% CI, 1.018 to 15.96). A strong correlation was identified between the degree of concordance to SSI prevention guidelines and the SSI rate (P= 0.001, Mantel-Haenszel linear-by-linear association chi-square test).

ROLE OF SUBCUTANEOUS NEGATIVE-PRESSURE DRAIN IN CASES OF EMERGENCY LAPAROTOMIES

10.36106/gjra/0612545 ◽

2021 ◽

pp. 116-118

Author(s):

Anshoo S. Gandhi ◽

Viraj C. Shinde ◽

Rizwanuddin M. Khwaja

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Negative Pressure ◽

Antibiotic Use ◽

Purulent Discharge ◽

Site Infection ◽

Cost Of Treatment ◽

Prolonged Hospital ◽

Early Healing

Surgical Site infection is one of the common complications in patients who underwent emergency laparotomies, leading to postoperative complications, purulent discharge, prolonged hospital stay, increased cost of treatment, increased morbidity etc. Even after culture sensitivity -based antibiotic use and judicious irrigation of wound with saline, it has remained a major concern.(1) Aims and objectives: 1. To evaluate the role of subcutaneous Negative-pressure Drain in reduction of postoperative Surgical Site infection in cases of Emergency laparotomies when compared to laparotomy wounds without subcutaneous Negative-pressure drain. 2. To evaluate whether Subcutaneous Negative-pressure Drain is effective in reducing the hospital stays. 3. To evaluate whether Subcutaneous Negative-pressure Drain is effective in reducing the cost of treatment. 4. To evaluate whether Subcutaneous Negative-pressure Drain helps in early healing of wound and removal of sutures. Materials and methods: This study is conducted on patients who underwent emergency laparotomies and we divided it into two groups: one with Subcutaneous Negative-pressure Drain in and other without it. Conclusion: Subcutaneous Negative-pressure Drain prevented postoperative wound infection signicantly, reduces hospital stay, reduces cost of treatment, and helped in early healing of wound and removal of sutures.