BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical i...BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical impact in abdominal surgery remains unclear.AIM To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis.METHODS The database search used PubMed,MEDLINE,and the Cochrane Library.The following inclusion criteria were set for the systematic review:(1)Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains;and(2)Studies that described clinical outcomes,such as SSIs,seroma formation,the length of hospital stays,and mortality.RESULTS Eight studies were included in this meta-analysis.The rate of total SSIs was significantly lower in the drained group(54/771,7.0%)than in the control group(89/759,11.7%),particularly in gastrointestinal surgery.Furthermore,the rate of superficial SSIs was slightly lower in the drained group(31/517,6.0%)than in the control group(49/521,9.4%).No significant differences were observed in seroma formation between the groups.Hospital stays were shorter in the drained group than in the control group.CONCLUSION Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation.The timing of drain removal needs to be reconsidered in future studies.展开更多
Background: Operative site infections (ISO) are typically nosocomial. According to the WHO the incidence of ISO varies from 0.5% to 15% and exceeds 25% in developing countries. They result from the combined action of ...Background: Operative site infections (ISO) are typically nosocomial. According to the WHO the incidence of ISO varies from 0.5% to 15% and exceeds 25% in developing countries. They result from the combined action of several factors and represent a concern for public health. To study the contributing factors of surgical site infections in patients operated at the University Clinic of Orthopedic Traumatology of CNHU-HKM of Cotonou. Method: This was an analytical cross-sectional study that involved 35 operated patients and ten nurses. Were included in our study: 1) All patients, without distinction of sex or age, having been operated on in the university clinic of orthopedic traumatology, during the survey period;2) Patients hospitalized for post-operative care during the survey period;3) The nursing staff on duty during our study period. The usual statistical measures were used according to the type of variables: means, standard deviations, percentages. Data analysis first involved calculating percentages for the qualitative variables and means followed by their standard deviations for the quantitative variables. Next, the Pearson Chi-square test was used to test the association between the dependent variable and the independent variables of interest. The significance level is set at p Results: The prevalence of surgical site infections was 28.58%. The main factors contributing to the occurrence of SSIs that were found were the patient’s level of education (p = 0.003) and the reuse of bandages used for dressing (p = 0.004). Other potential factors such as the economic status of the patient, the poor quality of technical dressings, and the preoperative stay were also highlighted. Conclusion: Surgical site infections remain a global concern. Risk factors were found on both the patient and nurse sides. It is urgent to address these various factors to minimize the occurrence of surgical site infections.展开更多
Background: Surgical site infections (SSIs) remain a challenging medical problem, especially in cardiac surgery patients. There is a lack of studies evaluating the rate of and outcomes of SSIs following cardiac surger...Background: Surgical site infections (SSIs) remain a challenging medical problem, especially in cardiac surgery patients. There is a lack of studies evaluating the rate of and outcomes of SSIs following cardiac surgeries in Saudi Arabia. Aims: This study aimed to determine the incidence of SSIs after adult cardiac surgeries that were done in Madinah Cardiac Center, Saudi Arabia. Further, to identify the outcomes and risk factors contributing to death among surgical site infection patients. Methods: This was a 6-year, single-center, retrospective cohort study that included 93 consecutive patients who underwent adult cardiac surgery between August 2016 and August 2022. All adult patients aged 18 years or older who had clinical evidence of postoperative surgical wound infection were included. Preoperative, operative, and postoperative data (early and late) were collected from medical records. Microbiological culture reports and clinical outcomes were also recorded. Results: The study revealed a 9.1% (93/1021) incidence rate of SSIs. Of the 93 patients with SSIs, 60 had superficial incisional infections and 33 had deep infections with incidence rates of 5.9% and 3.2%, respectively. In-hospital mortality due to SSI was recorded in 4 out of 93 patients with an incidence rate of 4.3%. There was a significant association between the in-hospital mortality and the type of SSIs (p = 0.014). All non-survivors had deep SSIs. The type of cardiac surgery also showed a significant association with the in-hospital mortality (p = 0.017). Furthermore, the median duration of antibiotic administration was significantly longer in the non-survivors than in the survivors (72.5 vs 17, respectively, p Conclusions: In conclusion, the incidence of surgical wound infections following cardiac surgery is not low (9.1%);of which 3.2% were deep infections. The in-hospital mortality rate after treatment of SSIs was fortunately low (4.3%), and all non-survivors had deep SSIs. The non- survivors showed a significantly longer duration of antibiotics administration than survivors. Combined CABG and valve procedures showed a higher mortality rate (75%) than the isolated procedures.展开更多
Background: Surgical site infections (SSIs) are considered as result of the healthcare quality in hospitals. Objective: to study SSI at Saint Jean de Dieu Hospital Tanguieta (SJDHT), prior to the implementation of a p...Background: Surgical site infections (SSIs) are considered as result of the healthcare quality in hospitals. Objective: to study SSI at Saint Jean de Dieu Hospital Tanguieta (SJDHT), prior to the implementation of a permanent monitoring system. Method: transversal, and descriptive study with prospective data collection was performed from 1 July to 31 janvier 2017 in the department of general surgery of SJDHT. The hospital lacks in a microbiology unit. All patients who underwent surgery during this period were included and the monitoring lasted one month. SSIs diagnostic was carried out according to WHO criteria as described in the Practical Guide for the Prevention of Nosocomial Infections published in 2002. Statistical tests (χ-square and Student’s t-test) were applied and p 0.05 were statistically significant. Results: Of 343 patients recorded, 105 (30.6%) had SSI. Their age averaged 40.3 years and the sex-ratio (men/women) was 2.8. The emergency surgery resulted in a 50.0% rate of SSI (p = 0.00). The SSI rate for clean and clean-contaminated surgery was 6.3% against 94.6% for infected surgery (p = 0.00). The SSI rates were 100% and 66.7% for NNISS = 2 and NNISS = 1 (p = 0.00), respectively. Superficial SSI rate was 13.3%, while deep SSI and organ/space SSI were 46.7% and 40%, respectively. The hospital stay of patients with SSI was three times longer than the length of patients without SSI (p = 0.00). Conclusion: SSIs are real burden at SJDHT. Appropriate measures must be adopted to reduce its prevalence.展开更多
Introduction: A caesarean section (CS) is one of the most frequently performed obstetric surgeries in the world and its use has increased dramatically in recent years. The number of caesarean section cases worldwide h...Introduction: A caesarean section (CS) is one of the most frequently performed obstetric surgeries in the world and its use has increased dramatically in recent years. The number of caesarean section cases worldwide has been increasing each year, and the World Health Organization (WHO) reported an excess of 10% - 15% of CS procedures for all births. However, some women experience surgical site infections (SSIs) after undergoing CS delivery. This study investigated the prescribing patterns of antibiotics in CS deliveries and the prevalence of SSIs at two tertiary hospitals in Lusaka, Zambia. Materials and Methods: A retrospective cross-sectional study was conducted from January 2020 to December 2020 at the Women and Newborn University Teaching Hospital (UTH) and the Levy Mwanawasa University Teaching Hospital, in Lusaka, Zambia. Results: Of a total of 838 women who delivered via CS, more than half were aged between 21 and 25 years (n = 461, 55.0%), 56.3% were from low-cost residential areas, and 57% had emergency CS delivery. The prevalence of SSIs was 6.0%, with the level of education (OR 0.377, 95% CI 0.150 - 0.946), type of caesarean section (OR 6.253, 95% CI 2.833 - 13.803), and oral antibiotics post-caesarean (OR 0.218, 95% CI 0.049 - 0.963). The duration of IV antibiotic treatment significantly predicted SSI (p Conclusion: This study found that the third-generation cephalosporin (cefotaxime) and triple combination therapy (benzylpenicillin, gentamicin, and metronidazole) were the most frequently prescribed antibiotics before and after CS. The level of education, type of CS, oral antibiotics post-CS, facility, and duration of administering IV antibiotics were all predictors of SSIs.展开更多
Wound irrigation(i.e.washing out a wound before wound closure)aims to reduce the microbial burden by removing tissue debris,metabolic waste,and tissue exudate from the surgical field before site closure.Although it is...Wound irrigation(i.e.washing out a wound before wound closure)aims to reduce the microbial burden by removing tissue debris,metabolic waste,and tissue exudate from the surgical field before site closure.Although it is a popular procedure in every day surgical practice,the lack of procedure standardization,leads to studies with high heterogeneity and often controversial results.Thus,there are studies that advocate its use,while others discourage its implementation in clinical practice to reduce the risk of surgical site infection.The present article reviews the current literature on wound irrigation for preventing surgical site infections.Several irrigants are presented.Chlorexidine is generally considered to be less effective than povidone-iodine,while antibiotics are not that common nowadays,as they require prolonged exposure with the target to act.Hydrogen peroxide has several potential complications,which eliminate its use.Any differences in the incidence of surgical site infections between different irrigants,especially between antibacterial and non-bacterial ones,should be viewed sceptically.More randomized controlled studies are needed to provide better quality of evidence regarding the irrigants'effectiveness and safety.展开更多
BACKGROUND Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy for hepatocellular carcinoma (HCC).AIM To identify the risk factors associated with SSI,and develop a nomogram to predict S...BACKGROUND Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy for hepatocellular carcinoma (HCC).AIM To identify the risk factors associated with SSI,and develop a nomogram to predict SSI among patients undergoing hepatectomy.METHODS We retrospectively reviewed the data of patients diagnosed with HCC undergoing hepatectomy at two academic institutions in China,and evaluated the occurrence of SSI.Independent risk factors for SSI were identified using univariate and multivariate analyses.Based on these independent risk factors,a nomogram was established using the data of patients in the first institution,and was validated using data from an external independent cohort from the second institution.RESULTS The nomogram was established using data from 309 patients,whereas the validation cohort used data from 331 patients.The operation duration,serum albumin level,repeat hepatectomy,and ASA score were identified as independent risk factors.The concordance index (C-index) of the nomogram for SSI prediction in the training cohort was 0.86;this nomogram also performed well in the external validation cohort,with a C-index of 0.84.Accordingly,we stratified patients into three groups,with a distinct risk range based on the nomogram prediction,to guide clinical practice.CONCLUSION Our novel nomogram offers good preoperative prediction for SSIs in patients undergoing hepatectomy.展开更多
AIM: To investigate whether a subcutaneous penrose drain would decrease the superficial surgical site infection (s-SSI) rate in elective colorectal surgery. METHODS: This is a comparative study of the historical contr...AIM: To investigate whether a subcutaneous penrose drain would decrease the superficial surgical site infection (s-SSI) rate in elective colorectal surgery. METHODS: This is a comparative study of the historical control type. Intervention consisted of the use of penrose drain in elective open colorectal surgical wounds. The outcome was an incidence of s-SSI. The patients were risk stratified according to the depth of subcutaneous tissue.RESULTS: There were 131 patients (40 patients with high s-SSI risk) in the prior period (from July 2008 to June 2009, when no penrose drains were inserted) and 151 patients (75 patients with high s-SSI risk) in the latter period (from June 2010 to November 2011, when penrose drains were inserted). The overall s-SSI rate was 6.1% and 5.3% during the two periods (P = 0.770), and the s-SSI rate in the high s-SSI risk group was 15.0% and 8.0% (P = 0.242).CONCLUSION: Although penrose drain was not observed to significantly reduce s-SSI, there tended to be a reduced risk of s-SSI in the high s-SSI risk group.展开更多
Aim: To evaluate the incidence of surgical site infection in the Urology Department of Brazzaville teaching hospital. Methods: This was a prospective study performed in the Urology Department and operating room of the...Aim: To evaluate the incidence of surgical site infection in the Urology Department of Brazzaville teaching hospital. Methods: This was a prospective study performed in the Urology Department and operating room of the Brazzaville teaching hospital during six months from February 2nd to July 2nd 2017. The study concerned all patients who had undergone surgery, selected during the operating program and those who had been in emergency and then hospitalized in the urology department. These patients were followed for one month after the intervention date. Results: 209 patients were operated on of whom 48 had surgical site infection, a cumulative incidence of 22.96%. The average age of infected patients was 58.3 years ± 17.73 ds (extremes from 13 to 85 years). 43.75% infected patients had co-morbidity factors. The SSI rate was 70% in patients with positive urine culture. Urinary catheters were found in 33.33% of patients. The average length of preoperative hospital stay was two days. The rate of SSI in patients classified Asa I was 10.41%, Asa II 37.5% and Asa III 52.09%. The SSI rate was respectively 5.21%, 56.76% and 38.03%. The infected patients operated first in the operative program accounted for 10.42%. The group of patients who underwent prostatic surgery accounted for 42.58% of patients with an SSI rate of 47.91%. The practice of aseptic measures by staff was found in 70% of cases. The infection rate in patients with drain was 73.23%. The infection rate in patients with catheters was 54.26%. The SSI was superficial in 66.67% of cases, deep in 25% of cases and organ in 8.33% of cases. Escherichia coli was the most frequently isolated germ 50%. Conclusion: Surgical site infection (ISO) is a common feature in our practice. The advanced age of patients and comorbidity factors are associated with a high risk of occurrence of SSI. These infections were not inevitable, their incidence can be greatly reduced by specific preventive measures.展开更多
Background: Surgical Site Infection (SSI) is one of the most common healthcare-associated infections, its account for up to 16% of all healthcare-associated infections worldwide. The SSIs can contribute to post-operat...Background: Surgical Site Infection (SSI) is one of the most common healthcare-associated infections, its account for up to 16% of all healthcare-associated infections worldwide. The SSIs can contribute to post-operative morbidity, prolonged recovery, delayed discharge and increasing cost. Nurses’ knowledge of the evidence-based recommendations is necessary to provide high-quality nursing care. Aims: To assess the level of Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs, to describe the relationship between nurses’ knowledge and selected sociodemographics, to examine the differences in nurses’ knowledge with respect to selected dichotomized variables, and to identify the most significant predictors of Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs. Design: Cross-sectional design. Sample: Two hundred registered nurses at four targeted hospitals were recruited conveniently. Results: The mean of the total knowledge scores of the sample was 3.28 out of nine (SD = 1.72, range = 0 - 7), the median was 3 out of nine. There were a statistically significant correlation between all tested continuous sociodemographics variables and the total knowledge score (p > 0.05). There is a significant difference in nurses’ knowledge between those who are attending to special surgical related training course and who are not. The most significant predictors of Jordanian nurses’ knowledge were: the number of credit hours attended by nurses for surgical-related training courses and the total years of work experience in nursing. These variables explained 16.7% of variance. Conclusion: The results of this study shed light on the obstacles that hampers the Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs in acute care settings. However, the successful implementation of infection control measures, particularly SSIs prevention measures, and well-structured continuing education programs are considered as a substantial element that would improve nurses’ knowledge.展开更多
Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbi...Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients;small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.展开更多
Surgical treatment can decrease the pain burden of patients, as well as improve their quality of life and social satisfaction. However, postoperative infection and other complications may harm patients and may even ca...Surgical treatment can decrease the pain burden of patients, as well as improve their quality of life and social satisfaction. However, postoperative infection and other complications may harm patients and may even cause surgical failure and death. This review describes the definition, classification, and status of surgical site infection(SSI). In addition, this review provides an analysis of the relevant risk factors that result in SSI, and proposes the corresponding preventative and control measures for each different risk factor.展开更多
Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used thro...Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.展开更多
BACKGROUND Surgical site infection(SSI)is a common complication of colorectal surgery.Minimally invasive surgery notably reduces the incidence of SSI.This study aimed to compare the incidences of SSI after robot-assis...BACKGROUND Surgical site infection(SSI)is a common complication of colorectal surgery.Minimally invasive surgery notably reduces the incidence of SSI.This study aimed to compare the incidences of SSI after robot-assisted colorectal surgery(RACS)vs that after laparoscopic assisted colorectal surgery(LACS)and to analyze associated risk factors for SSI in minimally invasive colorectal surgery.AIM To compare the incidences of SSI after RACS and LACS,and to analyze the risk factors associated with SSI after minimally invasive colorectal surgery.METHODS Clinical data derived from patients who underwent minimally invasive colorectal surgery between October 2020 and October 2022 at the First Affiliated Hospital of Soochow University were collated.Differences in clinical characteristics and surgeryrelated information associated with RACS and LACS were compared,and possible risk factors for SSI were identified.RESULTS A total of 246 patients(112 LACS and 134 RACS)were included in the study.Fortythree(17.5%)developed SSI.The proportions of patients who developed SSI were similar in the two groups(17.9%vs 17.2%,P=0.887).Diabetes mellitus,intraoperative blood loss≥100 mL,and incision length were independent risk factors for SSI.Possible additional risk factors included neoadjuvant therapy,lesion site,and operation time.CONCLUSION There was no difference in SSI incidence in the RACS and LACS groups.Diabetes mellitus,intraoperative blood loss≥100 mL,and incision length were independent risk factors for postoperative SSI.展开更多
Background: The optimal time to closure of a newborn with a myelomeningocele has been the focus of a number of evaluations. The Timing of primary surgery has received significant attention due to its relationship to r...Background: The optimal time to closure of a newborn with a myelomeningocele has been the focus of a number of evaluations. The Timing of primary surgery has received significant attention due to its relationship to repair-site infection that can lead to increased morbidity and prolonged hospital stays. It is on this basis that recommendations have utilized 48 - 72 hours post birth as ideal time of closure. This is not only prevent infection at the site but also prevent ventriculitis and neural structure damage. We therefore, hypothesized an increase in wound infection rates in those patients with delays in myelomeningocele repair. Methods: We retrospectively reviewed the records of 103 children with myelomeningocele treated between 2016 and 2023. At discharge the patients were followed up at the post-operative clinic visit 2 weeks later. Children were assigned to 1 of 2 groups, those who underwent primary neurosurgical repair within 72 hours of delivery (Group 1) and those undergoing repair after 72 hours (Group 2). We compared the infection rates. Results: 103 children who underwent myelomeningocele repair were identified, with a median time from birth to treatment of 1 day. Eight (7.8 %) patients were noted to have post-repair surgical site complications. There was no significant difference in rates of infection between Group 1 and Group 2 repair times. The presence of infection was associated increased length of stay when compared to neonates without infection. Conclusion: In children with myelomeningocele, the timing of primary neurosurgical repair appears not to have a significant impact on surgical site infection. Closure of the spinal lesion within the first 72 hours of life may be more favorable for neural damage prevention. These results suggest that early myelomeningocele repair may not impart significantly on the rate of wound-site infection.展开更多
BACKGROUND Surgical site infections(SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challengin...BACKGROUND Surgical site infections(SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challenging to predict, with most models having poor predictability. Therefore, we developed a prediction model for SSI after elective abdominal surgery by identifying risk factors.AIM To analyse the data on inpatients undergoing elective abdominal surgery to identify risk factors and develop predictive models that will help clinicians assess patients preoperatively.METHODS We retrospectively analysed the inpatient records of Shaanxi Provincial People’s Hospital from January 1, 2018 to January 1, 2021. We included the demographic data of the patients and their haematological test results in our analysis. The attending physicians provided the Nutritional Risk Screening 2002(NRS 2002)scores. The surgeons and anaesthesiologists manually calculated the National Nosocomial Infections Surveillance(NNIS) scores. Inpatient SSI risk factors were evaluated using univariate analysis and multivariate logistic regression. Nomograms were used in the predictive models. The receiver operating characteristic and area under the curve values were used to measure the specificity and accuracy of the model.RESULTS A total of 3018 patients met the inclusion criteria. The surgical sites included the uterus(42.2%), the liver(27.6%), the gastrointestinal tract(19.1%), the appendix(5.9%), the kidney(3.7%), and the groin area(1.4%). SSI occurred in 5% of the patients(n = 150). The risk factors associated with SSI were as follows: Age;gender;marital status;place of residence;history of diabetes;surgical season;surgical site;NRS 2002 score;preoperative white blood cell, procalcitonin(PCT), albumin, and low-density lipoprotein cholesterol(LDL) levels;preoperative antibiotic use;anaesthesia method;incision grade;NNIS score;intraoperative blood loss;intraoperative drainage tube placement;surgical operation items. Multivariate logistic regression revealed the following independent risk factors: A history of diabetes [odds ratio(OR) = 5.698, 95% confidence interval(CI): 3.305-9.825, P = 0.001], antibiotic use(OR = 14.977, 95%CI: 2.865-78.299, P = 0.001), an NRS 2002 score of ≥ 3(OR = 2.426, 95%CI: 1.199-4.909, P = 0.014), general anaesthesia(OR = 3.334, 95%CI: 1.134-9.806, P = 0.029), an NNIS score of ≥ 2(OR = 2.362, 95%CI: 1.019-5.476, P = 0.045), PCT ≥ 0.05 μg/L(OR = 1.687, 95%CI: 1.056-2.695, P = 0.029), LDL < 3.37 mmol/L(OR = 1.719, 95%CI: 1.039-2.842, P = 0.035), intraoperative blood loss ≥ 200 mL(OR = 29.026, 95%CI: 13.751-61.266, P < 0.001), surgical season(P < 0.05), surgical site(P < 0.05), and incision grade I or Ⅲ(P < 0.05). The overall area under the receiver operating characteristic curve of the predictive model was 0.926, which is significantly higher than the NNIS score(0.662).CONCLUSION The patient’s condition and haematological test indicators form the bases of our prediction model. It is a novel, efficient, and highly accurate predictive model for preventing postoperative SSI, thereby improving the prognosis in patients undergoing abdominal surgery.展开更多
Abdominal surgical site infections(SSIs)are infections that occur after abdominal surgery.They can be superficial,involving the skin tissue only,or more profound,involving deeper skin tissues including organs and impl...Abdominal surgical site infections(SSIs)are infections that occur after abdominal surgery.They can be superficial,involving the skin tissue only,or more profound,involving deeper skin tissues including organs and implanted materials.Currently,SSIs are large global health problem with an incidence that varies significantly depending on the United Nations’Human Development Index.The purpose of this review is to provide a practical update on the latest available literature on SSIs,focusing on causative pathogens and treatment with an overview of the ongoing studies of new therapeutic strategies.展开更多
BACKGROUND Surgical site infection(SSI)is one of the most common complications after gastric cancer(GC)surgery.The occurrence of SSI can lead to a prolonged postoperative hospital stay and increased medical expenses,a...BACKGROUND Surgical site infection(SSI)is one of the most common complications after gastric cancer(GC)surgery.The occurrence of SSI can lead to a prolonged postoperative hospital stay and increased medical expenses,and it can also affect postoperative rehabilitation and the quality of life of patients.Subcutaneous fat thickness(SFT)and abdominal depth(AD)can be used as predictors of SSI in patients undergoing radical resection of GC.AIM To explore the potential relationship between SFT or AD and SSI in patients undergoing elective radical resection of GC.METHODS Demographic,clinical,and pre-and intraoperative information of 355 patients who had undergone elective radical resection of GC were retrospectively collected from hospital electronic medical records.Univariate analysis was performed to screen out the significant parameters,which were subsequently analyzed using binary logistic regression and receiver-operating characteristic curve analysis.RESULTS The prevalence of SSI was 11.27%(40/355).Multivariate analyses revealed that SFT[odds ratio(OR)=1.150;95%confidence interval(95%CI):1.090-1.214;P<0.001],AD(OR=1.024;95%CI:1.009-1.040;P=0.002),laparoscopic-assisted surgery(OR=0.286;95%CI:0.030-0.797;P=0.017),and operation time(OR=1.008;95%CI:1.001-1.015;P=0.030)were independently associated with the incidence of SSI after elective radical resection of GC.In addition,the product of SFT and AD was a better potential predictor of SSI in these patients than either SFT or AD alone.CONCLUSION SFT and AD are independent risk factors and can be used as predictors of SSI in patients undergoing radical resection of GC.展开更多
Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical s...Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection(SSI).Although several effor ts are being under taken to determine the proper means to reduce such complications,there is still a high incidence of SSI worldwide.Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site.This study tested the effectiveness of an operating room(OR)bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.Methods:A quasi-experimental pretest and posttest design was utilized to determine its effectiveness.The study was composed of 60 par ticipants divided into two groups:30 subjects were selected to receive the OR bundle of care,while the other 30 subjects received the usual care.The groupings were determined through a systematic random sampling technique.The OR bundle of care had three interventions,namely:(1)maintaining perioperative normothermia,(2)no pre-operative surgical site hair removal,and(3)changing gloves before abdominal wall closure.These patients were evaluated using the standard instrument,Bates–Jensen Wound Assessment Tool(BWAT)in the post-intervention phases of the wound healing process,which are as follows:hemostasis,inflammatory,and proliferative phases.To describe the difference in the patients’wound status after implementation of the OR bundle of care in each post-intervention phase,Friedman’s test was used.To describe the difference in the patients’wound status in both groups after implementation of the OR bundle of care,the Mann–Whitney U test was used.Results:The patient’s wound status was lower,indicating a more healing process.Differences between the wound status of the control and the experimental group were observed on the third postoperative day.This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring.A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed.Conclusions:The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital,if there is uniform and consistent implementation of the said intervention.展开更多
基金Supported by Grants-in-Aid from JSPS KAKENHI,No.JP 21K10715 and No.JP 20K10404Northern Advancement Center for Science&Technology,No.T-2-2+9 种基金the Yasuda Medical Foundation,No.31010316the Okawa Foundation for Information and Telecommunications,No.41111042Taiju Life Social Welfare Foundation,No.50811490Japan Keirin Autorace Foundation,No.2023M-378Project Mirai Cancer Research Grants,No.31010269Takahashi Industrial and Economic Research Foundation,No.50411278Sapporo Doto Hospital,No.50311211Noguchi Hospital,No.40310551Doki-kai Tomakomai Hospital,No.40710739Tsuchida Hospital,No.50811478.
文摘BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical impact in abdominal surgery remains unclear.AIM To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis.METHODS The database search used PubMed,MEDLINE,and the Cochrane Library.The following inclusion criteria were set for the systematic review:(1)Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains;and(2)Studies that described clinical outcomes,such as SSIs,seroma formation,the length of hospital stays,and mortality.RESULTS Eight studies were included in this meta-analysis.The rate of total SSIs was significantly lower in the drained group(54/771,7.0%)than in the control group(89/759,11.7%),particularly in gastrointestinal surgery.Furthermore,the rate of superficial SSIs was slightly lower in the drained group(31/517,6.0%)than in the control group(49/521,9.4%).No significant differences were observed in seroma formation between the groups.Hospital stays were shorter in the drained group than in the control group.CONCLUSION Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation.The timing of drain removal needs to be reconsidered in future studies.
文摘Background: Operative site infections (ISO) are typically nosocomial. According to the WHO the incidence of ISO varies from 0.5% to 15% and exceeds 25% in developing countries. They result from the combined action of several factors and represent a concern for public health. To study the contributing factors of surgical site infections in patients operated at the University Clinic of Orthopedic Traumatology of CNHU-HKM of Cotonou. Method: This was an analytical cross-sectional study that involved 35 operated patients and ten nurses. Were included in our study: 1) All patients, without distinction of sex or age, having been operated on in the university clinic of orthopedic traumatology, during the survey period;2) Patients hospitalized for post-operative care during the survey period;3) The nursing staff on duty during our study period. The usual statistical measures were used according to the type of variables: means, standard deviations, percentages. Data analysis first involved calculating percentages for the qualitative variables and means followed by their standard deviations for the quantitative variables. Next, the Pearson Chi-square test was used to test the association between the dependent variable and the independent variables of interest. The significance level is set at p Results: The prevalence of surgical site infections was 28.58%. The main factors contributing to the occurrence of SSIs that were found were the patient’s level of education (p = 0.003) and the reuse of bandages used for dressing (p = 0.004). Other potential factors such as the economic status of the patient, the poor quality of technical dressings, and the preoperative stay were also highlighted. Conclusion: Surgical site infections remain a global concern. Risk factors were found on both the patient and nurse sides. It is urgent to address these various factors to minimize the occurrence of surgical site infections.
文摘Background: Surgical site infections (SSIs) remain a challenging medical problem, especially in cardiac surgery patients. There is a lack of studies evaluating the rate of and outcomes of SSIs following cardiac surgeries in Saudi Arabia. Aims: This study aimed to determine the incidence of SSIs after adult cardiac surgeries that were done in Madinah Cardiac Center, Saudi Arabia. Further, to identify the outcomes and risk factors contributing to death among surgical site infection patients. Methods: This was a 6-year, single-center, retrospective cohort study that included 93 consecutive patients who underwent adult cardiac surgery between August 2016 and August 2022. All adult patients aged 18 years or older who had clinical evidence of postoperative surgical wound infection were included. Preoperative, operative, and postoperative data (early and late) were collected from medical records. Microbiological culture reports and clinical outcomes were also recorded. Results: The study revealed a 9.1% (93/1021) incidence rate of SSIs. Of the 93 patients with SSIs, 60 had superficial incisional infections and 33 had deep infections with incidence rates of 5.9% and 3.2%, respectively. In-hospital mortality due to SSI was recorded in 4 out of 93 patients with an incidence rate of 4.3%. There was a significant association between the in-hospital mortality and the type of SSIs (p = 0.014). All non-survivors had deep SSIs. The type of cardiac surgery also showed a significant association with the in-hospital mortality (p = 0.017). Furthermore, the median duration of antibiotic administration was significantly longer in the non-survivors than in the survivors (72.5 vs 17, respectively, p Conclusions: In conclusion, the incidence of surgical wound infections following cardiac surgery is not low (9.1%);of which 3.2% were deep infections. The in-hospital mortality rate after treatment of SSIs was fortunately low (4.3%), and all non-survivors had deep SSIs. The non- survivors showed a significantly longer duration of antibiotics administration than survivors. Combined CABG and valve procedures showed a higher mortality rate (75%) than the isolated procedures.
文摘Background: Surgical site infections (SSIs) are considered as result of the healthcare quality in hospitals. Objective: to study SSI at Saint Jean de Dieu Hospital Tanguieta (SJDHT), prior to the implementation of a permanent monitoring system. Method: transversal, and descriptive study with prospective data collection was performed from 1 July to 31 janvier 2017 in the department of general surgery of SJDHT. The hospital lacks in a microbiology unit. All patients who underwent surgery during this period were included and the monitoring lasted one month. SSIs diagnostic was carried out according to WHO criteria as described in the Practical Guide for the Prevention of Nosocomial Infections published in 2002. Statistical tests (χ-square and Student’s t-test) were applied and p 0.05 were statistically significant. Results: Of 343 patients recorded, 105 (30.6%) had SSI. Their age averaged 40.3 years and the sex-ratio (men/women) was 2.8. The emergency surgery resulted in a 50.0% rate of SSI (p = 0.00). The SSI rate for clean and clean-contaminated surgery was 6.3% against 94.6% for infected surgery (p = 0.00). The SSI rates were 100% and 66.7% for NNISS = 2 and NNISS = 1 (p = 0.00), respectively. Superficial SSI rate was 13.3%, while deep SSI and organ/space SSI were 46.7% and 40%, respectively. The hospital stay of patients with SSI was three times longer than the length of patients without SSI (p = 0.00). Conclusion: SSIs are real burden at SJDHT. Appropriate measures must be adopted to reduce its prevalence.
文摘Introduction: A caesarean section (CS) is one of the most frequently performed obstetric surgeries in the world and its use has increased dramatically in recent years. The number of caesarean section cases worldwide has been increasing each year, and the World Health Organization (WHO) reported an excess of 10% - 15% of CS procedures for all births. However, some women experience surgical site infections (SSIs) after undergoing CS delivery. This study investigated the prescribing patterns of antibiotics in CS deliveries and the prevalence of SSIs at two tertiary hospitals in Lusaka, Zambia. Materials and Methods: A retrospective cross-sectional study was conducted from January 2020 to December 2020 at the Women and Newborn University Teaching Hospital (UTH) and the Levy Mwanawasa University Teaching Hospital, in Lusaka, Zambia. Results: Of a total of 838 women who delivered via CS, more than half were aged between 21 and 25 years (n = 461, 55.0%), 56.3% were from low-cost residential areas, and 57% had emergency CS delivery. The prevalence of SSIs was 6.0%, with the level of education (OR 0.377, 95% CI 0.150 - 0.946), type of caesarean section (OR 6.253, 95% CI 2.833 - 13.803), and oral antibiotics post-caesarean (OR 0.218, 95% CI 0.049 - 0.963). The duration of IV antibiotic treatment significantly predicted SSI (p Conclusion: This study found that the third-generation cephalosporin (cefotaxime) and triple combination therapy (benzylpenicillin, gentamicin, and metronidazole) were the most frequently prescribed antibiotics before and after CS. The level of education, type of CS, oral antibiotics post-CS, facility, and duration of administering IV antibiotics were all predictors of SSIs.
文摘Wound irrigation(i.e.washing out a wound before wound closure)aims to reduce the microbial burden by removing tissue debris,metabolic waste,and tissue exudate from the surgical field before site closure.Although it is a popular procedure in every day surgical practice,the lack of procedure standardization,leads to studies with high heterogeneity and often controversial results.Thus,there are studies that advocate its use,while others discourage its implementation in clinical practice to reduce the risk of surgical site infection.The present article reviews the current literature on wound irrigation for preventing surgical site infections.Several irrigants are presented.Chlorexidine is generally considered to be less effective than povidone-iodine,while antibiotics are not that common nowadays,as they require prolonged exposure with the target to act.Hydrogen peroxide has several potential complications,which eliminate its use.Any differences in the incidence of surgical site infections between different irrigants,especially between antibacterial and non-bacterial ones,should be viewed sceptically.More randomized controlled studies are needed to provide better quality of evidence regarding the irrigants'effectiveness and safety.
文摘BACKGROUND Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy for hepatocellular carcinoma (HCC).AIM To identify the risk factors associated with SSI,and develop a nomogram to predict SSI among patients undergoing hepatectomy.METHODS We retrospectively reviewed the data of patients diagnosed with HCC undergoing hepatectomy at two academic institutions in China,and evaluated the occurrence of SSI.Independent risk factors for SSI were identified using univariate and multivariate analyses.Based on these independent risk factors,a nomogram was established using the data of patients in the first institution,and was validated using data from an external independent cohort from the second institution.RESULTS The nomogram was established using data from 309 patients,whereas the validation cohort used data from 331 patients.The operation duration,serum albumin level,repeat hepatectomy,and ASA score were identified as independent risk factors.The concordance index (C-index) of the nomogram for SSI prediction in the training cohort was 0.86;this nomogram also performed well in the external validation cohort,with a C-index of 0.84.Accordingly,we stratified patients into three groups,with a distinct risk range based on the nomogram prediction,to guide clinical practice.CONCLUSION Our novel nomogram offers good preoperative prediction for SSIs in patients undergoing hepatectomy.
基金Supported by Osaka Medical Center for Cancer and Cardiovascular Diseases
文摘AIM: To investigate whether a subcutaneous penrose drain would decrease the superficial surgical site infection (s-SSI) rate in elective colorectal surgery. METHODS: This is a comparative study of the historical control type. Intervention consisted of the use of penrose drain in elective open colorectal surgical wounds. The outcome was an incidence of s-SSI. The patients were risk stratified according to the depth of subcutaneous tissue.RESULTS: There were 131 patients (40 patients with high s-SSI risk) in the prior period (from July 2008 to June 2009, when no penrose drains were inserted) and 151 patients (75 patients with high s-SSI risk) in the latter period (from June 2010 to November 2011, when penrose drains were inserted). The overall s-SSI rate was 6.1% and 5.3% during the two periods (P = 0.770), and the s-SSI rate in the high s-SSI risk group was 15.0% and 8.0% (P = 0.242).CONCLUSION: Although penrose drain was not observed to significantly reduce s-SSI, there tended to be a reduced risk of s-SSI in the high s-SSI risk group.
文摘Aim: To evaluate the incidence of surgical site infection in the Urology Department of Brazzaville teaching hospital. Methods: This was a prospective study performed in the Urology Department and operating room of the Brazzaville teaching hospital during six months from February 2nd to July 2nd 2017. The study concerned all patients who had undergone surgery, selected during the operating program and those who had been in emergency and then hospitalized in the urology department. These patients were followed for one month after the intervention date. Results: 209 patients were operated on of whom 48 had surgical site infection, a cumulative incidence of 22.96%. The average age of infected patients was 58.3 years ± 17.73 ds (extremes from 13 to 85 years). 43.75% infected patients had co-morbidity factors. The SSI rate was 70% in patients with positive urine culture. Urinary catheters were found in 33.33% of patients. The average length of preoperative hospital stay was two days. The rate of SSI in patients classified Asa I was 10.41%, Asa II 37.5% and Asa III 52.09%. The SSI rate was respectively 5.21%, 56.76% and 38.03%. The infected patients operated first in the operative program accounted for 10.42%. The group of patients who underwent prostatic surgery accounted for 42.58% of patients with an SSI rate of 47.91%. The practice of aseptic measures by staff was found in 70% of cases. The infection rate in patients with drain was 73.23%. The infection rate in patients with catheters was 54.26%. The SSI was superficial in 66.67% of cases, deep in 25% of cases and organ in 8.33% of cases. Escherichia coli was the most frequently isolated germ 50%. Conclusion: Surgical site infection (ISO) is a common feature in our practice. The advanced age of patients and comorbidity factors are associated with a high risk of occurrence of SSI. These infections were not inevitable, their incidence can be greatly reduced by specific preventive measures.
文摘Background: Surgical Site Infection (SSI) is one of the most common healthcare-associated infections, its account for up to 16% of all healthcare-associated infections worldwide. The SSIs can contribute to post-operative morbidity, prolonged recovery, delayed discharge and increasing cost. Nurses’ knowledge of the evidence-based recommendations is necessary to provide high-quality nursing care. Aims: To assess the level of Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs, to describe the relationship between nurses’ knowledge and selected sociodemographics, to examine the differences in nurses’ knowledge with respect to selected dichotomized variables, and to identify the most significant predictors of Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs. Design: Cross-sectional design. Sample: Two hundred registered nurses at four targeted hospitals were recruited conveniently. Results: The mean of the total knowledge scores of the sample was 3.28 out of nine (SD = 1.72, range = 0 - 7), the median was 3 out of nine. There were a statistically significant correlation between all tested continuous sociodemographics variables and the total knowledge score (p > 0.05). There is a significant difference in nurses’ knowledge between those who are attending to special surgical related training course and who are not. The most significant predictors of Jordanian nurses’ knowledge were: the number of credit hours attended by nurses for surgical-related training courses and the total years of work experience in nursing. These variables explained 16.7% of variance. Conclusion: The results of this study shed light on the obstacles that hampers the Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs in acute care settings. However, the successful implementation of infection control measures, particularly SSIs prevention measures, and well-structured continuing education programs are considered as a substantial element that would improve nurses’ knowledge.
文摘Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients;small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.
文摘Surgical treatment can decrease the pain burden of patients, as well as improve their quality of life and social satisfaction. However, postoperative infection and other complications may harm patients and may even cause surgical failure and death. This review describes the definition, classification, and status of surgical site infection(SSI). In addition, this review provides an analysis of the relevant risk factors that result in SSI, and proposes the corresponding preventative and control measures for each different risk factor.
文摘Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.
文摘BACKGROUND Surgical site infection(SSI)is a common complication of colorectal surgery.Minimally invasive surgery notably reduces the incidence of SSI.This study aimed to compare the incidences of SSI after robot-assisted colorectal surgery(RACS)vs that after laparoscopic assisted colorectal surgery(LACS)and to analyze associated risk factors for SSI in minimally invasive colorectal surgery.AIM To compare the incidences of SSI after RACS and LACS,and to analyze the risk factors associated with SSI after minimally invasive colorectal surgery.METHODS Clinical data derived from patients who underwent minimally invasive colorectal surgery between October 2020 and October 2022 at the First Affiliated Hospital of Soochow University were collated.Differences in clinical characteristics and surgeryrelated information associated with RACS and LACS were compared,and possible risk factors for SSI were identified.RESULTS A total of 246 patients(112 LACS and 134 RACS)were included in the study.Fortythree(17.5%)developed SSI.The proportions of patients who developed SSI were similar in the two groups(17.9%vs 17.2%,P=0.887).Diabetes mellitus,intraoperative blood loss≥100 mL,and incision length were independent risk factors for SSI.Possible additional risk factors included neoadjuvant therapy,lesion site,and operation time.CONCLUSION There was no difference in SSI incidence in the RACS and LACS groups.Diabetes mellitus,intraoperative blood loss≥100 mL,and incision length were independent risk factors for postoperative SSI.
文摘Background: The optimal time to closure of a newborn with a myelomeningocele has been the focus of a number of evaluations. The Timing of primary surgery has received significant attention due to its relationship to repair-site infection that can lead to increased morbidity and prolonged hospital stays. It is on this basis that recommendations have utilized 48 - 72 hours post birth as ideal time of closure. This is not only prevent infection at the site but also prevent ventriculitis and neural structure damage. We therefore, hypothesized an increase in wound infection rates in those patients with delays in myelomeningocele repair. Methods: We retrospectively reviewed the records of 103 children with myelomeningocele treated between 2016 and 2023. At discharge the patients were followed up at the post-operative clinic visit 2 weeks later. Children were assigned to 1 of 2 groups, those who underwent primary neurosurgical repair within 72 hours of delivery (Group 1) and those undergoing repair after 72 hours (Group 2). We compared the infection rates. Results: 103 children who underwent myelomeningocele repair were identified, with a median time from birth to treatment of 1 day. Eight (7.8 %) patients were noted to have post-repair surgical site complications. There was no significant difference in rates of infection between Group 1 and Group 2 repair times. The presence of infection was associated increased length of stay when compared to neonates without infection. Conclusion: In children with myelomeningocele, the timing of primary neurosurgical repair appears not to have a significant impact on surgical site infection. Closure of the spinal lesion within the first 72 hours of life may be more favorable for neural damage prevention. These results suggest that early myelomeningocele repair may not impart significantly on the rate of wound-site infection.
基金Supported by Key Research and Development Program of Shaanxi,No.2020GXLH-Y-019 and 2022KXJ-141Innovation Capability Support Program of Shaanxi,No.2019GHJD-14 and 2021TD-40+1 种基金Science and Technology Talent Support Program of Shaanxi Provincial People's Hospital,No.2021LJ-052023 Natural Science Basic Research Foundation of Shaanxi Province,No.2023-JC-YB-739.
文摘BACKGROUND Surgical site infections(SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challenging to predict, with most models having poor predictability. Therefore, we developed a prediction model for SSI after elective abdominal surgery by identifying risk factors.AIM To analyse the data on inpatients undergoing elective abdominal surgery to identify risk factors and develop predictive models that will help clinicians assess patients preoperatively.METHODS We retrospectively analysed the inpatient records of Shaanxi Provincial People’s Hospital from January 1, 2018 to January 1, 2021. We included the demographic data of the patients and their haematological test results in our analysis. The attending physicians provided the Nutritional Risk Screening 2002(NRS 2002)scores. The surgeons and anaesthesiologists manually calculated the National Nosocomial Infections Surveillance(NNIS) scores. Inpatient SSI risk factors were evaluated using univariate analysis and multivariate logistic regression. Nomograms were used in the predictive models. The receiver operating characteristic and area under the curve values were used to measure the specificity and accuracy of the model.RESULTS A total of 3018 patients met the inclusion criteria. The surgical sites included the uterus(42.2%), the liver(27.6%), the gastrointestinal tract(19.1%), the appendix(5.9%), the kidney(3.7%), and the groin area(1.4%). SSI occurred in 5% of the patients(n = 150). The risk factors associated with SSI were as follows: Age;gender;marital status;place of residence;history of diabetes;surgical season;surgical site;NRS 2002 score;preoperative white blood cell, procalcitonin(PCT), albumin, and low-density lipoprotein cholesterol(LDL) levels;preoperative antibiotic use;anaesthesia method;incision grade;NNIS score;intraoperative blood loss;intraoperative drainage tube placement;surgical operation items. Multivariate logistic regression revealed the following independent risk factors: A history of diabetes [odds ratio(OR) = 5.698, 95% confidence interval(CI): 3.305-9.825, P = 0.001], antibiotic use(OR = 14.977, 95%CI: 2.865-78.299, P = 0.001), an NRS 2002 score of ≥ 3(OR = 2.426, 95%CI: 1.199-4.909, P = 0.014), general anaesthesia(OR = 3.334, 95%CI: 1.134-9.806, P = 0.029), an NNIS score of ≥ 2(OR = 2.362, 95%CI: 1.019-5.476, P = 0.045), PCT ≥ 0.05 μg/L(OR = 1.687, 95%CI: 1.056-2.695, P = 0.029), LDL < 3.37 mmol/L(OR = 1.719, 95%CI: 1.039-2.842, P = 0.035), intraoperative blood loss ≥ 200 mL(OR = 29.026, 95%CI: 13.751-61.266, P < 0.001), surgical season(P < 0.05), surgical site(P < 0.05), and incision grade I or Ⅲ(P < 0.05). The overall area under the receiver operating characteristic curve of the predictive model was 0.926, which is significantly higher than the NNIS score(0.662).CONCLUSION The patient’s condition and haematological test indicators form the bases of our prediction model. It is a novel, efficient, and highly accurate predictive model for preventing postoperative SSI, thereby improving the prognosis in patients undergoing abdominal surgery.
文摘Abdominal surgical site infections(SSIs)are infections that occur after abdominal surgery.They can be superficial,involving the skin tissue only,or more profound,involving deeper skin tissues including organs and implanted materials.Currently,SSIs are large global health problem with an incidence that varies significantly depending on the United Nations’Human Development Index.The purpose of this review is to provide a practical update on the latest available literature on SSIs,focusing on causative pathogens and treatment with an overview of the ongoing studies of new therapeutic strategies.
基金The Nanjing Health Science and Technology Development Fund Project,No.YKK18241.
文摘BACKGROUND Surgical site infection(SSI)is one of the most common complications after gastric cancer(GC)surgery.The occurrence of SSI can lead to a prolonged postoperative hospital stay and increased medical expenses,and it can also affect postoperative rehabilitation and the quality of life of patients.Subcutaneous fat thickness(SFT)and abdominal depth(AD)can be used as predictors of SSI in patients undergoing radical resection of GC.AIM To explore the potential relationship between SFT or AD and SSI in patients undergoing elective radical resection of GC.METHODS Demographic,clinical,and pre-and intraoperative information of 355 patients who had undergone elective radical resection of GC were retrospectively collected from hospital electronic medical records.Univariate analysis was performed to screen out the significant parameters,which were subsequently analyzed using binary logistic regression and receiver-operating characteristic curve analysis.RESULTS The prevalence of SSI was 11.27%(40/355).Multivariate analyses revealed that SFT[odds ratio(OR)=1.150;95%confidence interval(95%CI):1.090-1.214;P<0.001],AD(OR=1.024;95%CI:1.009-1.040;P=0.002),laparoscopic-assisted surgery(OR=0.286;95%CI:0.030-0.797;P=0.017),and operation time(OR=1.008;95%CI:1.001-1.015;P=0.030)were independently associated with the incidence of SSI after elective radical resection of GC.In addition,the product of SFT and AD was a better potential predictor of SSI in these patients than either SFT or AD alone.CONCLUSION SFT and AD are independent risk factors and can be used as predictors of SSI in patients undergoing radical resection of GC.
文摘Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection(SSI).Although several effor ts are being under taken to determine the proper means to reduce such complications,there is still a high incidence of SSI worldwide.Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site.This study tested the effectiveness of an operating room(OR)bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.Methods:A quasi-experimental pretest and posttest design was utilized to determine its effectiveness.The study was composed of 60 par ticipants divided into two groups:30 subjects were selected to receive the OR bundle of care,while the other 30 subjects received the usual care.The groupings were determined through a systematic random sampling technique.The OR bundle of care had three interventions,namely:(1)maintaining perioperative normothermia,(2)no pre-operative surgical site hair removal,and(3)changing gloves before abdominal wall closure.These patients were evaluated using the standard instrument,Bates–Jensen Wound Assessment Tool(BWAT)in the post-intervention phases of the wound healing process,which are as follows:hemostasis,inflammatory,and proliferative phases.To describe the difference in the patients’wound status after implementation of the OR bundle of care in each post-intervention phase,Friedman’s test was used.To describe the difference in the patients’wound status in both groups after implementation of the OR bundle of care,the Mann–Whitney U test was used.Results:The patient’s wound status was lower,indicating a more healing process.Differences between the wound status of the control and the experimental group were observed on the third postoperative day.This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring.A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed.Conclusions:The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital,if there is uniform and consistent implementation of the said intervention.
