Surgical Site Infections latest literature update March 2019

Need full text? Contact us at: Dunhill.library@wsht.nhs.uk or library.worthing@wsht.nhs.uk

Comments/suggestions/mailing on this update to: Sally.Reynolds@wsht.nhs.uk

Clinical Librarian

Latest new papers on surgical site infections.

1. Risk factors for Staphylococcus aureus colonization in a presurgical orthopedic populationAuthor(s): Kent S.E.; Schneider G.B.; Vlad S.C.; Hollenbeck B.L.Source: American Journal of Infection Control; 2019Publication Date: 2019Publication Type(s): ArticleAvailable at American Journal of Infection Control - from ClinicalKey

Abstract:Background: Preoperative colonization with Staphylococcus aureus (SA) increases risk of surgical site infection. Screening for SA followed by skin and nasal decolonization can help to reduce the risk of postoperative infections. Risk factors for colonization are, however, not completely understood. Method(s): A case-control study using questionnaires and patient demographics specifically designed to observe SA colonization risk factors in a presurgical orthopedic population. A total of 115 subjects with a positive preoperative screen for SA nasal colonization prior to orthopedic surgery completed a questionnaire to assess for SA risk factors: these subjects served as our cases. An additional 476 controls completed similar questionnaires. Data collected included demographic, health, and lifestyle information. Multivariable logistic regression was used to generate odds ratios (OR) for risk of SA colonization. Result(s): Several risk factors were identified. Male sex (OR 2.3; 95% confidence interval [CI], [1.4-3.8]) and diabetes (OR 3.8 [1.8-7.8]) significantly increased the risk of SA colonization. Older age, visiting public places (OR 0.2 [0.1-0.3]), recent antibiotic use (OR 0.2 [0.1-0.6]), and the presence of facial hair (OR 0.3 [0.1-0.6]) significantly lowered the risk of SA colonization. Conclusion(s): By identifying patients who may be at greater risk of SA colonization, we can better streamline our presurgical techniques to help reduce risk of surgical site infections and improve patient outcomes.Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Database: EMBASE

2. The Effectiveness of Sterile Wound Drapes in the Prevention of Surgical Site Infection in Thoracic SurgeryAuthor(s): Karapinar K.; Kocaturk C.I.Source: BioMed Research International; 2019; vol. 2019Publication Date: 2019Publication Type(s): ArticlePubMedID: 30886857Available at BioMed Research International - from Europe PubMed Central - Open Access Available at BioMed Research International - from Hindawi Open Access Journals

Abstract:Background. The rate of surgical site infections (SSIs) has decreased in parallel to advances in sterilization techniques. Such infections increase morbidity and hospitalization costs. The use of iodine-impregnated sterile wound drapes (SWDs) is recommended to prevent or reduce the incidence of these infections. However, there is a paucity of data regarding their use in thoracic surgical procedures. The aim of the present study was to evaluate the effectiveness of sterile wound drapes in the prevention of these infections and the effects on hospitalization costs. Methods. Perioperative iodine-impregnated SWDs have been used since January 2015 in the Thoracic Surgery Clinic of our hospital. A retrospective evaluation was made of patients who underwent anatomic pulmonary resection via thoracotomy with SWD in the period January 2015-2017, compared with a control group who underwent the same surgery without SWD in the 2-year period before January 2015. Factors that may have increased the risk of surgical site infection were documented and the occurrence of SSI was recorded from postoperative follow-up data. The cost analysis was performed as an important criterion to investigate the benefits of SWD. Results. Evaluation was made of 654 patients in the study group (n:380) using SWD, the operation time was significantly longer, and perioperative blood transfusion was significantly higher, whereas treatment costs (p=0.0001) and wound culture positivity (p=0.004) were significantly lower and less surgical wound debridement was performed (p=0.002). Conclusion. The findings suggest that the use of sterile wound draping in thoracic surgery procedures reduces surgical site infections and hospitalization costs.Copyright © 2019 Kemal Karapinar and Celalettin Ibrahim Kocaturk.Database: EMBASE

3. The Effects of Preoperative Steroid Therapy on Perioperative Complications After Elective Anterior Lumbar Fusion

Author(s): White S.J.W.; Carrillo O.; Cheung Z.B.; Ranson W.A.; Cho S.K.-W.Source: World Neurosurgery; 2019Publication Date: 2019Publication Type(s): ArticleAvailable at World Neurosurgery - from ClinicalKey

Abstract:Objective: To examine the effects of chronic preoperative steroid therapy on 30-day perioperative complications after anterior lumbar fusion (ALF). Method(s): We retrospectively analyzed data from the American College of Surgeons National Surgical Quality Improvement Program between 2008 and 2015. Adult patients who underwent ALF were included and divided into 2 groups: steroids and no steroids. We compared baseline patient demographics, comorbidities, and operative variables between these 2 groups and then performed a multivariate regression analysis to determine complications that were independently associated with chronic steroid therapy. We also performed a subgroup analysis of the steroid group to identify additional risk factors that further predispose these patients to postoperative complications. Result(s): A total of 9483 patients were included, of whom 289 (3.0%) were on chronic steroid therapy. Univariate analysis showed that chronic steroid use was independently associated with 4 perioperative complications, including deep surgical site infection (odds ratio [OR], 2.78; confidence interval [CI], 1.09-7.10; P = 0.033), pulmonary complications (OR, 1.98; CI, 1.02-3.86; P = 0.044), blood transfusion (OR, 1.60; CI, 1.15-2.23; P = 0.005), and extended length of stay (OR, 1.58; CI, 1.17-2.16; P = 0.003). In patients on chronic steroid therapy, pulmonary comorbidity and extended operative time were additional risk factors that further predisposed to perioperative complications, including deep surgical site infection, blood transfusion, and extended length of stay. Conclusion(s): Chronic preoperative steroid therapy is associated with perioperative complications after ALF. Decisions about the discontinuing or holding steroid therapy preoperatively should be determined through an interdisciplinary approach between the medical and surgical teams.Copyright © 2019 Elsevier Inc.Database: EMBASE

4. History of surgical site infection increases the odds for a new infection after open incisional hernia repairAuthor(s): Tastaldi L.; Petro C.C.; Krpata D.M.; Alkhatib H.; Fafaj A.; Rosenblatt S.; Prabhu A.S.; Rosen M.J.; Tu C.; Poulose B.K.Source: Surgery (United States); 2019Publication Date: 2019Publication Type(s): ArticleAvailable at Surgery (United States) - from ClinicalKey Available at Surgery (United States) - from ScienceDirect

Abstract:Background: It is unclear whether a history of surgical site infection is associated with developing a new infection after subsequent operations. We aim to investigate the impact of an earlier abdominal wall surgical site infection on future 30-day infectious wound complications after open incisional hernia repair with mesh. Method(s): Patients undergoing elective, clean open incisional hernia repair were identified within the Americas Hernia Society Quality Collaborative and were divided into

those with and without a history of a surgical site infection. Predictors of a surgical site infection and a surgical site infection requiring a procedural intervention were investigated using logistic regression and propensity-matched analysis. A subgroup analysis was done to investigate whether an earlier methicillin-resistant Staphylococcus aureus surgical site infection specifically increases odds for infectious complications. Result(s): Of 3,168 identified patients, 589 had a history of a surgical site infection and experienced higher rates of postoperative surgical site infection (6.5% vs 2.9%, P <.001) and surgical site infections requiring procedural intervention (5.3% vs 1.9%, P <.001). After adjusting for identified confounders, a previous surgical site infection was independently associated with developing another surgical site infection (odds ratio 2.04, 95% confidence interval 1.32-3.10, P <.001) and a surgical site infection requiring procedural intervention (odds ratio 2.2, 95% confidence interval 1.35-3.55, P =.001). Propensity-matched analysis controlling for additional confounders confirmed the association of an earlier surgical site infection with the outcomes of interest (odds ratio 2.1 and 2.8, respectively). A subgroup analysis found that an earlier methicillin-resistant Staphylococcus aureus infection specifically did not incur higher rates of surgical site infection when compared with non-methicillin-resistant Staphylococcus aureus pathogens. Conclusion(s): History of a surgical site infection increases the odds for new infectious complications after open incisional hernia repair in a clean wound. Investigations on perioperative interventions to ameliorate the negative impact of such association are necessary.Copyright © 2019 Elsevier Inc.Database: EMBASE

5. Single versus multi-drug antimicrobial surgical infection prophylaxis for left ventricular assist devices: A systematic review and meta-analysisAuthor(s): Patel S.; Choi J.H.; Rizvi S.S.A.; Maynes E.J.; Samuels L.E.; Morris R.J.; Massey H.T.; Tchantchaleishvili V.; Moncho Escriva E.; Luc J.G.Y.; Aburjania N.Source: Artificial Organs; 2019Publication Date: 2019Publication Type(s): ArticleAvailable at Artificial Organs - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS

Abstract:Infection remains the Achilles heel of left ventricular assist device (LVAD) therapy. However, an optimal antimicrobial surgical infection prophylaxis (SIP) regimen has not been established. This study evaluated the efficacy of a single-drug SIP compared to a multi-drug SIP on clinical outcomes in patients undergoing continuous-flow LVAD (CF-LVAD) and pulsatile LVAD (P-LVAD) implantation. An electronic search was performed to identify studies in the English literature on SIP regimens in patients undergoing LVAD implantation. Identified articles were assessed for inclusion and exclusion criteria. Fourteen articles with 1,311 (CF-LVAD: 888; P-LVAD: 423) patients were analyzed. Overall, 501 (38.0%) patients received single-drug SIP, whereas 810 (62.0%) received multi-drug SIP. Time to infection was comparable between groups. There was no significant difference in overall incidence of LVAD-specific infections [single-drug: 18.7% vs. multi-drug: 24.8%, P = 0.49] including driveline infections [single-drug:

14.1% vs. multi-drug: 20.8%, P = 0.37]. Compared to single-drug SIP, patients who received multi-drug SIP had a significantly lower survival rate [single-drug: 90.0% vs. multi-drug: 76.0%, P = 0.01] and infection-free survival rate [single-drug: 88.4% vs. multi-drug: 77.3%, P = 0.04] at 90 days. However, there were no significant differences in 1-year survival and 1-year infection-free survival between groups. No survival differences were observed in the CF-LVAD subset as well. This study demonstrated no additional advantage of a multi-drug compared to a single-drug regimen for SIP. Although there was a modest advantage in early survival among CF-LVAD and P-LVAD patients who received single-drug SIP, there were no significant differences in the 1-year survival and 1-year infection-free survival.Copyright © 2019 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.Database: EMBASE

6. Malpractice litigation in cardiac surgery: Alleged injury mechanisms and outcomesAuthor(s): Eltorai A.S.Source: Journal of Cardiac Surgery; 2019Publication Date: 2019Publication Type(s): ArticleAvailable at Journal of Cardiac Surgery - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS

Abstract:Background and Aim: The feared prospect of involvement in malpractice litigation ultimately becomes a reality for many physicians in high-risk specialties such as cardiothoracic surgery. This study systematically analyzes malpractice claims by procedure type and alleged injury mechanism. Method(s): An extensive nation-wide database of medical malpractice claims was searched, and 140 involving cardiac procedures were identified. The primary reason for the lawsuit was classified as a periprocedural injury, postoperative mismanagement, failure to operate in a timely manner or at all, performing an unnecessary procedure, performing a procedure too soon, lack of informed consent, or patient abandonment. Result(s): Cardiac surgeons were defendants in 47.8% of cases and cardiologists in 56.4%. Forty percent of cases involved coronary artery bypass grafting, valvular surgery, or both; 50% of these received defendant verdicts. The most common reason for the lawsuit was periprocedural injury, most frequently due to poor prosthetic valve fit/securement (23.1%) or surgical site infection (15.4%). For congenital cases, most lawsuits alleged periprocedural injury, with perfusion-related issues (cooling during circulatory arrest, failure to inform surgeon about poor oxygenation) cited in 37.5%. Cardiologists and cardiothoracic or vascular surgeons were codefendants in 14.3% of cases, most commonly coronary artery bypass grafting (40%) or cardiac catheterizations (25%). In all catheterization cases, the allegation against the surgeon was a failure to diagnose/treat the complication in a proper or timely manner. In postoperative mismanagement cases, bleeding/tamponade was the most common allegation category (31.8%). Conclusion(s): A careful review of cardiac surgical malpractice litigation can identify common contributory factors to adverse patient outcomes and catalyze practice improvement.Copyright © 2019 Wiley Periodicals, Inc.

Database: EMBASE

7. Health state utilities associated with post-surgical Staphylococcus aureus infectionsAuthor(s): Matza L.S.; Kim K.J.; Yu H.; Belden K.A.; Chen A.F.; Kurd M.; Lee B.Y.; Webb J.Source: European Journal of Health Economics; 2019Publication Date: 2019Publication Type(s): ArticlePubMedID: 30887157

Abstract:Introduction: Surgical site infections (SSIs) are among the most common and potentially serious complications after surgery. Staphylococcus aureus is a virulent pathogen frequently identified as a cause of SSI. As vaccines and other infection control measures are developed to reduce SSI risk, cost-utility analyses (CUA) of these interventions are needed to inform resource allocation decisions. A recent systematic review found that available SSI utilities are of "questionable quality." Therefore, the purpose of this study was to estimate the disutility (i.e., utility decrease) associated with SSIs. Method(s): In time trade-off interviews, general population participants in the UK (London, Edinburgh) valued health states drafted based on literature and clinician interviews. Health states described either joint or spine surgery, with or without an SSI. The utility difference between otherwise identical health states with and without the SSI represented the disutility associated with the SSI. Result(s): A total of 201 participants completed interviews (50.2% female; mean age = 46.2 years). Mean (SD) utilities of health states describing joint and spine surgery without infections were 0.79 (0.23) and 0.78 (0.23). Disutilities of SSIs ranged from - 0.03 to - 0.32, depending on severity of the infection and subsequent medical interventions. All differences between corresponding health with and without SSIs were statistically significant (all p < 0.001). Conclusion(s): The preference-based SSI disutilities derived in this study may be used to represent mild and serious SSIs in CUAs assessing and comparing the value of vaccinations that may reduce the risk of SSIs.Copyright © 2019, The Author(s).Database: EMBASE

8. Short report: Post-operative wound infections after the gentle caesarean sectionAuthor(s): Bronsgeest K.; Wolters V.E.R.A.; Boers K.E.; Freeman L.M.; te Pas A.B.; Kreijen-Meinesz J.H.Source: European Journal of Obstetrics Gynecology and Reproductive Biology; 2019Publication Date: 2019Publication Type(s): ArticlePubMedID: 30879842Available at European journal of obstetrics, gynecology, and reproductive biology - from ClinicalKey

Abstract:Objectives: Worldwide, the caesarean section (CS) is the most performed type of surgery and numbers are still rising. The gentle CS has become a more common procedure as it allows the parents to experience birth. Early and continuous skin-to-skin contact between the mother and her newborn is pursued. Parents are not separated from their newborns and stay with their child in the operation theatre and recovery room. However, data are limited on the incidence of surgical site infections (SSI) after

gentle CS. The aim of our study was to examine the risk of postoperative wound infections after gentle CS. Secondary outcomes included other maternal complications and neonatal outcomes. Study design: In this multicenter prospective cohort study, all women who underwent an elective gentle CS between January 2015 and January 2017 were eligible. Demographics, per procedural data, maternal complications and neonatal outcomes were collected. The follow-up lasted until six weeks post partum. Result(s): Of the 243 performed CSs, two (0.8%) SSIs occurred; one superficial and one deep wound infection. One patient (0.4%) was readmitted for treatment of endometritis. In total, 20 (8.2%) maternal complications were identified. Median time to skin-to-skin contact was 3 minutes (IQR 2-4.25) with a median neonatal oxygen saturation 10 minutes after birth of 95% (IQR 92-98). Mean gestational age was 274 +/- 4.1 days (39 + 1 weeks) and mean neonatal pH was 7.28 (+/-SD 0.07). All children had Apgar scores >7 at 5 minutes after birth. Neonatal admission occurred in 19 cases (7.8%) and neonatal readmission in 10 cases (4.1%). Conclusion(s): The gentle CS seems to be a safe procedure for both mother and child and is not associated with an increased risk of surgical site infections or direct suboptimal neonatal outcomes. Therefore, more intensive mother-child interaction during CS is allowed.Copyright © 2019Database: EMBASE

9. Prognostic Impact of Postoperative Complications on Overall Survival in 287 Patients With Oral Cancer: A Retrospective Single-Institution StudyAuthor(s): Zhang C.; Xi M.Y.; Zeng J.; Li Y.; Yu C.Source: Journal of Oral and Maxillofacial Surgery; 2019Publication Date: 2019Publication Type(s): ArticlePubMedID: 30790530Available at Journal of Oral and Maxillofacial Surgery - from ClinicalKey

Abstract:Purpose: To investigate the relation between postoperative complications and long-term survival in patients with oral cancer after surgery and to explore the methods that improve survival rate through analyzing risk factors for postoperative complications. Material(s) and Method(s): This is a retrospective single-institution study of a cohort of 287 patients with oral cancer who underwent surgery at the Stomatological Hospital of the Chongqing Medical University (Chongqing, China) from January 1, 2007 through December 31, 2012. Result(s): Postoperative complications occurred in 80 patients (27.9%). Patients with pulmonary complications or delirium had worse overall survival than those without these complications, whereas other postoperative complications, such as surgical site infection, postoperative bleeding, salivary fistula, and chylothorax, were not associated with overall survival. American Society of Anesthesiologists (ASA) status and tracheostomy were risk factors for postoperative pulmonary complications according to the Pearson chi2 test or multivariate analysis. Using the Pearson chi2 test, age, comorbidity, and ASA status were risk factors for the incidence of postoperative delirium. However, in multivariate analysis, only comorbidity and ASA status were identified as risk factors. Conclusion(s): Postoperative pulmonary complications and postoperative delirium could

be independent predictors of poorer long-term survival in patients with oral cancer. The risk factors for postoperative pulmonary complications and postoperative delirium could help identify patients who are at high risk and help clinicians take some actions to prevent them.Copyright © 2019 American Association of Oral and Maxillofacial SurgeonsDatabase: EMBASE

10. Supratentorial Craniotomies with or without Dural Closure-A ComparisonAuthor(s): Alwadei A.; Almubarak A.O.; Bafaquh M.; Qoqandi O.; Alobaid A.; Alsubaie F.; Almalki S.; Alyamani M.; Orz Y.; Alzahrani A.S.; Alyahya N.M.Source: World Neurosurgery; 2019Publication Date: 2019Publication Type(s): ArticlePubMedID: 30780042Available at World Neurosurgery - from ClinicalKey

Abstract:Background: Dural closure is a routine surgical step in neurosurgery. The benefit of suturing the dura to achieve watertight closure-with or without the use of dural substitutes-has been questioned in supratentorial craniotomy. We performed a retrospective study to examine the possible benefits and harms of suturing the dura compared with no dural closure and the occurrence of postoperative infection, cerebrospinal fluid (CSF) leak, and postcraniotomy headaches. Method(s): We performed a retrospective study to compare the incidence of CSF leak, infection, surgical site swelling, and postcraniotomy headaches between patients with watertight dural closure (closed group) and patients without watertight dural closure (open group). Any method used to close the dura and to achieve watertight closure was included, whether primary or secondary closure (with or without using suturable dural substitute). Result(s): Overall, 216 patients were included in the present study, with 112 patients in the open group and 114 in the closed group. The open group experienced a greater incidence of infection and CSF leak (6 in the open group vs. 2 in the closed group), but without statistical significance (P = 0.15). We found no difference in surgical site swelling (P = 0.29). However, the closed group showed a greater association with the development of postcraniotomy headaches (P = 0.001). Conclusion(s): We found no difference in the occurrence of CSF leak, infection, or surgical site swelling between the closed and open groups. The incidence of postcraniotomy headaches was greater in the closed group, and the difference was statistically significant.Copyright © 2019 Elsevier Inc.Database: EMBASE

11. Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: risk factors and clinical outcomesAuthor(s): de Jong L.; van Rijckevorsel V.A.J.I.M.; Raats J.W.; Roukema G.R.; Klem T.M.A.L.; Kuijper T.M.Source: Clinical interventions in aging; 2019; vol. 14 ; p. 427-435Publication Date: 2019Publication Type(s): ArticlePubMedID: 30880924

Available at Clinical interventions in aging - from Europe PubMed Central - Open Access

Abstract:Background: The primary aim of the present study was to verify the potential risk factors for developing a delirium after hip fracture surgery. The secondary aim of this study was to examine the related clinical outcomes after a delirium developed post-hip fracture surgery. Patients and Methods: Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records. A total of 463 patients undergoing hip fracture (hip hemiarthroplasty) surgery in a level II trauma teaching hospital between January 2011 and May 2016 were included. Delirium was measured using the Delirium Observation Screening Scale, the confusion assessment method, and an observatory judgment by geriatric medicine specialists. Result(s): The results showed that 26% of the patients (n=121) developed a delirium during hospital stay with a median duration during admission of 5 days (IQR 3-7). The multivariable model showed that the development of delirium was significantly explained by dementia (OR 2.75, P=0.001), age (OR 1.06, P=0.005), and an infection during admission (pneumonia, deep surgical site infection, or urinary tract infection) (OR 1.23, P=0.046). After 1 year of follow-up, patients who developed delirium after hip fracture surgery were significantly more discharged to (semi-independent) nursing homes (P<0.001) and had a significantly higher mortality rate (P<0.001) compared to patients without delirium after hip fracture surgery. Conclusion(s): The results showed that 26% of the patients undergoing hip fracture surgery developed a delirium. The risk factors including age, dementia, and infection during admission significantly predicted the development of the delirium. No association was confirmed between delirium and time of admission or time to surgery. The development of delirium after hip fracture surgery was subsequently found to be a significant predictor of admission to a nursing home and mortality after 1 year.Database: EMBASE

12. When is the right time to remove staples after an elective cesarean delivery?: a randomized control trialAuthor(s): Miremberg H.; Barber E.; Tamayev L.; Ganer Herman H.; Bar J.; Kovo M.Source: Journal of Maternal-Fetal and Neonatal Medicine; 2019Publication Date: 2019Publication Type(s): Article

Abstract:Objective: To determine if there are differences in scar healing and cosmetic outcome between early and late metal staples removal after cesarean delivery. Study design: Randomized controlled trial, in which patients undergoing a scheduled nonemergent cesarean delivery were randomly assigned to early staples removal versus late staples removal. Outcome assessors were blinded to group allocation. Scars were evaluated 8 weeks after cesarean delivery. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) scores. Secondary outcome measures included surgical site infection, wound disruption, hematoma, or seroma. Result(s): During the study period, 104 patients were randomized. There were no between-group differences in maternal demographics. Both

groups had similar indications for cesarean delivery and similar rate of previous one or more cesarean delivery. Patient and Observer Scar Assessment Scale were similar for patients (p =.932) and for physician observer (p =.529). No significant differences were demonstrated between the groups in the rate of surgical site infection or wound disruption. Conclusion(s): Removal of stainless steel staples on postoperative 4 versus postoperative 8 after cesarean delivery showed similar outcome without significant effect on incision healing. Therefore, timing of removal staples after cesarean delivery could be performed based on patients and surgeon preference.Copyright © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.Database: EMBASE

13. Single-Dose Perioperative Antibiotics Do Not Increase the Risk of Surgical Site Infection in Unicompartmental Knee ArthroplastyAuthor(s): Wyles C.C.; Vargas-Hernandez J.S.; Carlson S.W.; Carlson B.C.; Sierra R.J.Source: Journal of Arthroplasty; 2019Publication Date: 2019Publication Type(s): ArticleAvailable at Journal of Arthroplasty - from ClinicalKey Available at Journal of Arthroplasty - from ScienceDirect

Abstract:Background: Unicompartmental knee arthroplasty (UKA) is commonly performed as an outpatient procedure. To facilitate this process, a single-dose intravenous (IV) perioperative antibiotic administration is required compared to 24-hour IV antibiotic dosing schedules that are typical of most inpatient arthroplasty procedures. There is a paucity of literature to guide surgeons on the safety of single-dose perioperative antibiotic administration for arthroplasty procedures, particularly those that will be performed in the outpatient setting. The purpose of this study is to evaluate a large series of UKA performed with single-dose vs 24-hour IV antibiotic coverage to determine the impact on risk for surgical site infection (SSI). Method(s): All UKA cases were evaluated from 2007 to 2017 performed by a single surgeon at an academic institution. There were 296 UKAs in the cohort: 40 were outpatient procedures receiving single-dose antibiotics and 256 were inpatient procedures receiving 24-hour antibiotics. No patients were prescribed adjuvant oral antibiotics. Mean age was 64 years, 50% were female, mean body mass index was 32 kg/m2, and mean follow-up was 4.1 years (range 1.0-10.4). Perioperative antibiotic regimen was evaluated and SSI, defined as occurring within 1 year of surgery, was abstracted through a prospective total joint registry and manual chart review. Result(s): SSI occurred in 2 of 296 cases (0.7%) in the entire cohort, 2 of 256 inpatient UKAs (0.8%), and 0 of 40 outpatient UKAs (0%) (P = 1.00). One SSI was a deep infection occurring 6 weeks postoperatively that required 2-stage exchange and conversion to total knee arthroplasty. The other was a superficial infection treated with 2 weeks of oral antibiotics. Conclusion(s): This study demonstrates a low SSI risk (0.8% or less) following UKA with both single-dose and 24-hour IV antibiotics. Administering single-dose perioperative antibiotics is safe for UKA, which should alleviate that potential concern for outpatient surgery. Level of Evidence: Level III, Therapeutic.Copyright © 2019 Elsevier Inc.

Database: EMBASE

14. The cost of surgical site infections after colorectal surgery in the United States from 2001 to 2012: A longitudinal analysisAuthor(s): Gantz O.; Zagadailov P.; Merchant A.M.Source: American Surgeon; 2019; vol. 85 (no. 2); p. 142-149Publication Date: 2019Publication Type(s): ArticlePubMedID: 30819289Available at American Surgeon - from Proquest_New_Platform

Abstract:Surgical site infections (SSIs) are among the most common types of postoperative complications in the United States and are associated with significant prevalence of morbidity and mortality in patients undergoing surgical interventions, especially in colorectal surgery (CRS) where SSI rates are significantly higher than those of similar operative sites. SSIs were identified from the National Inpatient Sample-Healthcare Cost and Utilization Project database from 2001 to 2012 based on the specification of an ICD-9 code. Propensity score matching was used to compare costs associated with SSI cases with those of non-SSI controls among elective and nonelective admissions. Results were projected nationally using Healthcare Cost and Utilization Project sampling methodology to evaluate the incidence of SSIs and ascertain the national cost burden retrospectively. Among 4,851,359 sample-weighted hospitalizations, 4.2 per cent (203,597) experienced SSI. Elective admissions associated with SSI-stayed hospitalized for an average of 7.8 days longer and cost $18,410 more than their counterparts who did not experience an SSI. Nonelective admissions that experienced an SSI had an 8.5-day longer hospital stay and cost $20,890 more than counterparts without perioperative infections. This represents a 3 per cent annual growth in costs for SSIs and seems to be largely driven by cost increases in treatment of SSIs for elective surgeries. Current efforts of SSI management after CRS focused on compliance with guidelines and tracking of infection rates would benefit from some improvements. Considering the growing costs and increase in resource utilization associated with SSIs from 2001 to 2012, further research on costs associated with management of SSIs specific to CRS is necessary.Copyright © 2019 Southeastern Surgical Congress. All Rights Reserved.Database: EMBASE

15. Extended Postoperative Antibiotics Versus No Postoperative Antibiotics in Patients Undergoing Emergency Cholecystectomy for Acute Calculous Cholecystitis: A Systematic Review and Meta-AnalysisAuthor(s): Hajibandeh S.; Popova P.; Rehman S.Source: Surgical Innovation; 2019Publication Date: 2019Publication Type(s): ReviewAvailable at Surgical Innovation - from SAGE Premier Health Sciences - 2019

Abstract:Objectives. To compare the outcomes of extended postoperative antibiotics versus no postoperative antibiotics in patients with acute calculous cholecystitis undergoing emergency cholecystectomy. Methods. We

performed a systematic review and conducted a search of electronic information sources to identify all randomized controlled trials comparing outcomes of extended postoperative antibiotics versus no postoperative antibiotics in patients with acute calculous cholecystitis undergoing emergency cholecystectomy. Postoperative infectious complications and surgical site infections were primary outcome measures. The secondary outcome measures included postoperative morbidity, postoperative noninfectious complications, urinary tract infections, pneumonia, length of hospital stay, postoperative mortality, and need for readmission. Random or fixed effects modeling was applied to calculate pooled outcome data. Results. Four randomized controlled trials enrolling 953 patients were identified. The included populations in the extended antibiotic group and no antibiotic group were comparable in terms of baseline characteristics. There was no difference between the 2 groups in terms of postoperative infectious complications (odds ratio [OR] =0.94, P =.79), surgical site infections (OR = 1.13, P =.72), postoperative morbidity (OR = 0.93, P =.70), postoperative noninfectious complications (OR = 0.85, P =.57), urinary tract infections (OR = 0.69, P =.55), pneumonia (OR = 0.33, P =.14), length of hospital stay (mean difference = 0.78, P =.25), postoperative mortality (risk difference = -0.00, P =.65), and need for readmission (OR = 0.87, P =.70). Conclusions. Our results suggest that extended postoperative antibiotic therapy does not improve postoperative infectious or noninfectious outcomes in patients with mild or moderate acute calculous cholecystitis undergoing emergency cholecystectomy. Postoperative antibiotics should not be routinely used and should be preserved only for selected cases.Copyright © The Author(s) 2019.Database: EMBASE

16. Prophylactic incisional negative pressure wound therapy shows promising results in prevention of wound complications following inguinal lymph node dissection for Melanoma: A retrospective case-control seriesAuthor(s): Jorgensen M.G.; Thomsen J.B.; Sorensen J.A.; Toyserkani N.M.Source: Journal of Plastic, Reconstructive and Aesthetic Surgery; 2019Publication Date: 2019Publication Type(s): ArticleAvailable at Journal of Plastic, Reconstructive and Aesthetic Surgery - from ClinicalKey Available at Journal of Plastic, Reconstructive and Aesthetic Surgery - from ScienceDirect

Abstract:Background: Inguinal lymphadenectomy (ILND) for melanoma is associated with a number of complications including seroma, surgical site infection (SSI), and lymphedema. Incisional negative pressure wound therapy (iNPWT) has shown promising results in preventing postoperative morbidity across a wide variety of surgical procedures, but these results are yet to be investigated in patients undergoing ILND for melanoma. Method(s): In this study, we reviewed the data of 55 melanoma patients treated with ILND between January 2015 and January 2017 at Odense University Hospital. Patients were followed up until April 2018 for the occurrence of seroma, SSI, and

lymphedema. We used prophylactic iNPWT after ILND in 14 patients and compared their morbidity outcomes with the 41 patients receiving standard postoperative wound care in the same period. Result(s): The iNPWT intervention significantly reduced seroma compared to the control group (28.6% vs. 90.3%, p < 0.001) and had a trending impact on wound infection (42.9% vs. 65.9%, p = 0.13). The effect was not significant for the prevention of lymphedema (35.7% vs. 51.2%, p = 0.33). Because the iNPWT group had relatively fewer incidences of seroma, SSI, and lymphedema, the iNPWT intervention was more cost-effective than conventional wound care (US$911.2 vs. US$2542.7, p < 0.05). Conclusion(s): The use of prophylactic iNPWT significantly reduced seroma formation following ILND. These promising results, however, need to be confirmed in a future prospective randomized trial.Copyright © 2019 Elsevier LtdDatabase: EMBASE

17. Risks and complications of thyroglossal duct cyst removalAuthor(s): Anderson J.L.; Vu K.; Haidar Y.M.; Kuan E.C.; Tjoa T.Source: Laryngoscope; 2019Publication Date: 2019Publication Type(s): ArticleAvailable at Laryngoscope - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS

Abstract:Objectives/Hypothesis: Thyroglossal duct cysts (TGDCs) are the most common congenital neck cyst and typically present in childhood or adolescence, although a subset remains asymptomatic until adulthood. Although treatment involves surgical excision, few large-scale studies exist regarding the risks of surgical treatment of TGDCs in adults. This study aims to describe the characteristics of adult patients undergoing TGDC excision and to analyze risk factors associated with reoperation or other postoperative complications. Study Design: Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Method(s): Patients age >= 18 years in the NSQIP database who underwent TGDC removal from 2005 to 2014 were included. Covariates included patient demographics, comorbidities, preoperative variables, and intraoperative variables. Outcomes included reoperation, complications, and length of hospital stay. Result(s): A total of 793 cases met inclusion criteria. Patients were predominantly female (57.0%) and white (64.3%), with a mean age of 44.3 years. Thirty-day mortality did not occur in this cohort, but 3.0% of patients experienced at least one complication. Forty-eight patients (6.1%) underwent reoperation. Wound infection rates were higher in revision operations compared with primary operations (8.3% and 0.9%, respectively; P =.003). Low preoperative sodium was associated with reoperation (P =.047). Additionally, length of hospital stay was associated with increased total operative time (P =.02). Conclusion(s): TGDC excision is a safe and well-tolerated procedure in the adult population, with low complication rates. However, the risk of reoperation, surgical-site infections, and medical complications should be taken into consideration during preoperative planning. Level of Evidence: NA Laryngoscope, 2019.Copyright © 2019 The

American Laryngological, Rhinological and Otological Society, Inc.Database: EMBASE

18. A pilot feasibility randomised clinical trial comparing dialkylcarbamoylchloride-coated dressings versus standard care for the primary prevention of surgical site infectionAuthor(s): Totty J.P.; Hitchman L.H.; Cai P.L.; Harwood A.E.; Wallace T.; Carradice D.; Smith G.E.; Chetter I.C.Source: International Wound Journal; 2019Publication Date: 2019Publication Type(s): ArticleAvailable at International Wound Journal - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS

Abstract:A surgical site infection (SSI) may occur in up to 30% of procedures and results in significant morbidity and mortality. We aimed to assess the feasibility of conducting a randomised controlled trial (RCT) examining the use of dialkylcarbamoylchloride (DACC)-impregnated dressings, which bind bacteria at the wound bed, in the prevention of SSI in primarily closed incisional wounds. This pilot RCT recruited patients undergoing clean or clean-contaminated vascular surgery. Participants were randomised intraoperatively on a 1:1 basis to either a DACC-coated dressing or a control dressing. Outcomes were divided into feasibility and clinical outcomes. The primary clinical outcome was SSI at 30 days (assessed using Centers for Disease Control criteria and Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of the deep tissues, Isolation of bacteria and duration of inpatient Stay scoring methods). This study recruited 144 patients in 12 months at a median rate of 10 per month. Eligibility was 73% and recruitment 60%. At 30 days, there was a 36.9% relative risk reduction in the DACC-coated arm (16.22% versus 25.71%, odds ratio 0.559, P = 0.161). The number needed to treat was 11 patients. A large-scale RCT is both achievable and desirable given the relative risk reduction shown in this study. Further work is needed to improve the study protocol and involve more centres in a full-scale RCT.Copyright © 2019 Medicalhelplines.com Inc and John Wiley & Sons LtdDatabase: EMBASE

19. A diagnostic algorithm for the surveillance of deep surgical site infections after colorectal surgeryAuthor(s): Mulder T.; Kluytmans-Van Den Bergh M.F.Q.; Bonten M.J.M.; Kluytmans J.A.J.W.; Romme J.; Van Mourik M.S.M.; Crolla R.M.P.H.Source: Infection Control and Hospital Epidemiology; 2019 ; p. 1-5Publication Date: 2019Publication Type(s): Article

Abstract:Objective:Surveillance of surgical site infections (SSIs) is important for infection control and is usually performed through retrospective manual chart review. The aim of this study was to develop an algorithm for the surveillance of deep SSIs based on clinical variables to enhance efficiency of surveillance. Design(s):Retrospective cohort study (2012-2015). Setting(s):A Dutch teaching hospital. Participant(s):We included all consecutive patients who underwent colorectal surgery excluding those with

contaminated wounds at the time of surgery. All patients were evaluated for deep SSIs through manual chart review, using the Centers for Disease Control and Prevention (CDC) criteria as the reference standard.Analysis:We used logistic regression modeling to identify predictors that contributed to the estimation of diagnostic probability. Bootstrapping was applied to increase generalizability, followed by assessment of statistical performance and clinical implications. Result(s):In total, 1,606 patients were included, of whom 129 (8.0%) acquired a deep SSI. The final model included postoperative length of stay, wound class, readmission, reoperation, and 30-day mortality. The model achieved 68.7% specificity and 98.5% sensitivity and an area under the receiver operator characteristic (ROC) curve (AUC) of 0.950 (95% CI, 0.932-0.969). Positive and negative predictive values were 21.5% and 99.8%, respectively. Applying the algorithm resulted in a 63.4% reduction in the number of records requiring full manual review (from 1,606 to 590). Conclusion(s):This 5-parameter model identified 98.5% of patients with a deep SSI. The model can be used to develop semiautomatic surveillance of deep SSIs after colorectal surgery, which may further improve efficiency and quality of SSI surveillance.Copyright © 2019 by The Society for Healthcare Epidemiology of America.Database: EMBASE

20. Mode of anesthesia and major perioperative outcomes associated with vaginal surgeryAuthor(s): Smith P.E.; Pandya L.K.; Hundley A.F.; Hudson C.O.; Hade E.M.; Tan Y.Source: International Urogynecology Journal; 2019Publication Date: 2019Publication Type(s): Article

Abstract:Introduction and hypothesis: The primary aim was to compare the incidence of major perioperative complications in women undergoing vaginal reconstructive surgery with general, regional, and monitored anesthesia care using a national database. The secondary aim was to compare length of hospital stay, 30-day readmission rates, urinary tract infections, and reoperation rates between anesthesia types. Material(s) and Method(s): The National Surgical Quality Improvement Program database was used to study women undergoing vaginal surgery for pelvic floor disorders from 2006 to 2015 via Current Procedural Terminology codes. Demographic and clinical variables were abstracted. The incidence of major perioperative complications was defined as the occurrence of any of the following within 30 days of surgery: death, surgical-site infection, pneumonia, venous thromboembolism, intensive care unit admission, stroke, transfusion, sepsis, and myocardial infarction. Regression analysis was used to estimate the relative risks (RR) associated with anesthesia type for each outcome. Result(s): From the database, we gathered data on 37,426 women who underwent vaginal reconstructive surgery between 2006 and 2015; 87.2% (n = 32,623) underwent general, 6.9% (n = 2565) regional, and 5.9% (n = 2238) monitored anesthesia care. Major perioperative complications occurred in 560 women (1.5%). Relative to general anesthesia, the adjusted risk of major perioperative complications was not significantly different in those receiving monitored or regional anesthesia [monitored vs. general, adjusted RR 0.74, 95% confidence

interval (CI) 0.45-1.20; regional vs. general, adjusted RR 1.23, 95% CI 0.92-1.65]. Discussion(s): Major perioperative complications in vaginal reconstructive surgery were uncommon, and no differences were observed between monitored, regional, and general anesthesia outcomes.Copyright © 2019, The International Urogynecological Association.Database: EMBASE

21. Prevalence and predictors of surgical site infections after bowel resection for Crohn's disease: the role of dual-ring wound protectorAuthor(s): Ge X.; Tang S.; Qi W.; Liu W.; Lv J.; Zhou W.; Cai X.; Cao Q.Source: International Journal of Colorectal Disease; 2019Publication Date: 2019Publication Type(s): Article

Abstract:Purpose: Surgical site infections (SSIs) have become a leading cause of preventable morbidity and mortality in surgery. The aim was to evaluate the efficacy of a dual-ring wound protector to prevent the SSIs in Crohn's disease (CD) after bowel resection. Method(s): This retrospective observational study included all CD patients undergoing bowel resection at the Inflammatory Bowel Disease Center between January 2015 and June 2018 at Sir Run Run Shaw Hospital. Risk factors of SSIs were evaluated by assessing preoperative clinical characteristics and perioperative treatments in univariate and multivariate analyses. Outcomes for CD patients with and without the wound protector were compared. Result(s): Three hundred forty-four CD patients were enrolled in this study, 121 (35.2%) patients had postoperative complications, of whom, 72 (20.9%) patients developed SSIs (12.8% patients with incisional SSI and 8.1% patients with organ/space SSI). There was a significant reduction in the incidence of incisional SSI in the wound protector group (8.1% vs 16.8%, p < 0.05). No significant differences were identified in organ/space SSI between groups with and without wound protector (6.3% vs 9.8%, p = 0.232). Incisional SSI correlated with preoperative albumin, C-reactive protein, white blood cell, age (<= 16), penetrating disease behavior, surgical history, open surgery, stoma creation, estimated blood loss, infliximab, and wound protector (p < 0.05). Multivariate analysis identified the wound protector to be one of independent factors for preventing incisional SSIs (OR 0.357, 95% CI 0.161-0.793, p < 0.05). Conclusion(s): Among the CD patients with bowel resection, the use of a dual-ring wound protector during surgery significantly reduced the risk of incisional SSI.Copyright © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.Database: EMBASE

22. Operating Room Hand Preparation: To Scrub or to Rub?Author(s): Fry D.E.Source: Surgical Infections; 2019; vol. 20 (no. 2); p. 129-134Publication Date: 2019Publication Type(s): ArticlePubMedID: 30657416

Abstract:Background: The alcohol rub has been proposed as an alternative to the traditional surgical scrub in preparing the hands for surgical procedures. Few reviews

have examined critically the evidence that favors or discredits the use of the alcohol rub instead of the traditional scrub. Method(s): A review of available published literature was undertaken to define the evidence for the best methods for hand preparation before surgical procedures. The focus of this literature review was to compare the bacteriologic and clinical outcomes of conventional surgical scrubbing of the hands compared with alcohol rubs. Result(s): The bacteriologic studies of the hands after the conventional scrub versus the alcohol rub demonstrated consistently comparable or superior reductions in bacterial presence on the hand with the alcohol rub. Only four clinical studies were identified that compared the scrub versus the rub in the frequency of surgical site infections. No difference in surgical site infections were identified. Conclusion(s): The alcohol rub appears to have comparable results to the surgical scrub and is a reasonable alternative in preparation of the hands for surgical procedures.Copyright © 2019, Mary Ann Liebert, Inc., publishers.Database: EMBASE

23. Laminar Air Flow Handling Systems in the Operating RoomAuthor(s): Jain S.; Reed M.Source: Surgical Infections; 2019; vol. 20 (no. 2); p. 151-158Publication Date: 2019Publication Type(s): ArticlePubMedID: 30596534

Abstract:Background: Surgical site infection is associated with a substantial healthcare burden and remains one of the most challenging complications to treat. Airborne particles carrying contaminating micro-organisms are responsible for the majority of these infections. Method(s): Various operating theater ventilatory systems have been developed to prevent direct airborne bacterial inoculation of the surgical wound. Laminar air flow uses positive pressure air currents through filtration units to direct air streams away from the operative field in order to create an ultraclean zone around the operative site. Discussion(s): Early studies reported lower infection rates with laminar air flow and therefore it became the accepted standard for implant-related surgery. However, more recent evidence has questioned its clinical importance. The purpose of this article is to review contemporary laminar air flow handling systems and the current evidence behind their use.Copyright © 2019, Mary Ann Liebert, Inc., publishers.Database: EMBASE

24. Operating Room Foot Traffic: A Risk Factor for Surgical Site InfectionsAuthor(s): Alizo G.; Sciarretta J.D.; Onayemi A.; Davis J.M.Source: Surgical Infections; 2019; vol. 20 (no. 2); p. 146-150Publication Date: 2019Publication Type(s): ArticlePubMedID: 30648925

Abstract:Extensive studies on foot traffic in the operating room (OR) have shown little correlation between surgical site infections (SSIs) and traffic of OR personnel in and out of the OR. While evidence supports the relation between foot traffic in the OR, airborne bacteria, and subsequent SSIs in orthopedic surgical procedures, the studies were

conducted over four years and in more than 8,000 patients. The direct relation this finding has to general surgery patients has yet to be proven; however, protocols to reduce foot traffic may have a beneficial effect for the OR team.Copyright © 2019, Mary Ann Liebert, Inc., publishers.Database: EMBASE

25. Prevention of Surgical Infections: Building or Renovating a New Intensive Care UnitAuthor(s): Golob J.F.; Kreiner L.A.Source: Surgical Infections; 2019; vol. 20 (no. 2); p. 107-110Publication Date: 2019Publication Type(s): ArticlePubMedID: 30489217

Abstract:Background: Renovating or building a new intensive care unit (ICU) can be a challenging project. Planning the renovation or rebuild as a quality improvement project will help break down the process into manageable pieces with clear goals. Method(s): Literature was reviewed with regards to ICU design and renovation, with specific attention to patient quality improvement, process and structural change, healthcare systems engineering, emerging technology, and infection control. Result(s): In any quality improvement initiative, a first step is to create a multidisciplinary change team charged with leading the rebuild process. This team should include frontline providers, administration, architects, infection prevention specialists, and healthcare system engineers. Healthcare system engineers (HSEs) are specialized system and human factors engineers who can assist with data analysis, create mathematical models to anticipate areas of difficulty, and perform simulations to assist with the actual structural changes as well as the process changes aimed at eliminating nosocomial infections. Every aspect of creating a new ICU space should begin with infection control standards of practice ranging from selection of furniture and computer keyboards, to identifying the best location of the soiled utility rooms. There are many infection control products that may be considered during the building process such as tele-tracking hand hygiene stations and heavy-metal-coated surfaces aimed at decreasing surface colonization and subsequent infections. Conclusion(s): This article offers suggestions on renovating or rebuilding an ICU aimed at eliminating the preventable harm associated with hospital acquired infections.Copyright © 2019, Mary Ann Liebert, Inc., publishers.Database: EMBASE

26. Motion-capture system to assess intraoperative staff movements and door openings: Impact on surrogates of the infectious risk in surgeryAuthor(s): Birgand G.; Rukly S.; Timsit J.-F.; Lucet J.-C.; Toupet G.; Azevedo C.; Pissard-Gibollet R.Source: Infection Control and Hospital Epidemiology; 2019Publication Date: 2019Publication Type(s): Article

Abstract:Objectives:We longitudinally observed and assessed the impact of the operating room (OR) staff movements and door openings on surrogates of the exogenous infectious risk using a new technology system.Design and setting:This multicenter observational study included 13 ORs from 10 hospitals, performing

planned cardiac and orthopedic surgery (total hip or knee replacement). Door openings during the surgical procedure were obtained from data collected by inertial sensors fixed on the doors. Intraoperative staff movements were captured by a network of 8 infrared cameras. For each surgical procedure, 3 microbiological air counts, longitudinal particles counts, and 1 bacteriological sample of the wound before skin closure were performed. Statistics were performed using a linear mixed model for longitudinal data. Result(s):We included 34 orthopedic and 25 cardiac procedures. The median frequency of door openings from incision to closure was independently associated with an increased log10 0.3 mum particle (s, 0.03; standard deviation [SD], 0.01; P =.01) and air microbial count (s, 0.07; SD, 0.03; P =.03) but was not significantly correlated with the wound contamination before closure (r = 0.13; P =.32). The number of persons (s, -0.08; SD, 0.03; P <.01), and the cumulated movements by the surgical team (s, 0.0004; SD, 0.0005; P <.01) were associated with log10 0.3 mum particle counts. Conclusion(s):This study has demonstrated a previously missing association between intraoperative staff movements and surrogates of the exogenous risk of surgical site infection. Restriction of staff movements and door openings should be considered for the control of the intraoperative exogenous infectious risk.Copyright © 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.Database: EMBASE

27. Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015Author(s): Niitsuma T.; Kusachi S.; Asai K.; Watanabe M.; Takesue Y.; Mikamo H.Source: Annals of Gastroenterological Surgery; 2019Publication Date: 2019Publication Type(s): Article

Abstract:Aim: To survey postoperative infections (PI) after digestive surgery. Method(s): This survey, conducted by the Japan Society of Surgical Infection, included patients undergoing digestive surgery at 28 centers between September 2015 and March 2016. Data collected included patient background characteristics, type of surgery, contamination status, and type of PI, including surgical site infection (SSI), remote infection (RI), and antimicrobial-resistant (AMR) bacterial infections and colonization. Result(s): Postoperative infections occurred in 10.7% of 6582 patients who underwent digestive surgery (6.8% for endoscopic surgery and 18.7% for open surgery). SSI and RI, including respiratory tract infection, urinary tract infection, antibiotic-associated diarrhea, drain infection, and catheter-related bloodstream infection, occurred in 8.9% and 3.7% of patients, respectively. Among all PI, 13.2% were overlapping infections. The most common overlapping infections were incisional and organ/space SSI, which occurred in 4.2% of patients. AMR bacterial infections occurred in 1.2% of patients after digestive surgery and comprised 11.5% of all PI. Rate of AMR bacterial colonization after digestive surgery was only 0.3%. Conclusion(s): Periodic surveillance of PI, including AMR bacteria, is necessary for a detailed evaluation of nosocomial infections.Copyright © 2019 The Authors.

Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological SurgeryDatabase: EMBASE

28. Maximizing Interpretability and Cost-Effectiveness of Surgical Site Infection (SSI) Predictive Models Using Feature-Specific Regularized Logistic Regression on Preoperative Temporal DataAuthor(s): Kocbek P.; Fijacko N.; Povalej Brzan P.; Stiglic G.; Soguero-Ruiz C.; Mikalsen K.O.; Jenssen R.; Skrovseth S.O.; Maver U.; Stozer A.Source: Computational and Mathematical Methods in Medicine; 2019; vol. 2019Publication Date: 2019Publication Type(s): ArticleAvailable at Computational and Mathematical Methods in Medicine - from Europe PubMed Central - Open Access Available at Computational and Mathematical Methods in Medicine - from Hindawi Open Access Journals

Abstract:This study describes a novel approach to solve the surgical site infection (SSI) classification problem. Feature engineering has traditionally been one of the most important steps in solving complex classification problems, especially in cases with temporal data. The described novel approach is based on abstraction of temporal data recorded in three temporal windows. Maximum likelihood L1-norm (lasso) regularization was used in penalized logistic regression to predict the onset of surgical site infection occurrence based on available patient blood testing results up to the day of surgery. Prior knowledge of predictors (blood tests) was integrated in the modelling by introduction of penalty factors depending on blood test prices and an early stopping parameter limiting the maximum number of selected features used in predictive modelling. Finally, solutions resulting in higher interpretability and cost-effectiveness were demonstrated. Using repeated holdout cross-validation, the baseline C-reactive protein (CRP) classifier achieved a mean AUC of 0.801, whereas our best full lasso model achieved a mean AUC of 0.956. Best model testing results were achieved for full lasso model with maximum number of features limited at 20 features with an AUC of 0.967. Presented models showed the potential to not only support domain experts in their decision making but could also prove invaluable for improvement in prediction of SSI occurrence, which may even help setting new guidelines in the field of preoperative SSI prevention and surveillance.Copyright © 2019 Primoz Kocbek et al.Database: EMBASE

29. 2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patientsAuthor(s): Sartelli M.; Trana C.; Di Bella S.; McFarland L.V.; Khanna S.; Furuya-Kanamori L.; Abuzeid N.; Abu-Zidan F.M.; Ansaloni L.; Coccolini F.; Augustin G.; Bala M.; Ben-Ishay O.; Kluger Y.; Biffl W.L.; Brecher S.M.; Camacho-Ortiz A.; Cainzos M.A.; Chan S.; Cherry-Bukowiec J.R.; Clanton J.; Cocuz M.E.; Coimbra R.; Cortese F.; Cui Y.; Czepiel J.; Demetrashvili Z.; Di Carlo I.; Di Saverio S.; Dumitru I.M.; Eckmann C.; Eiland E.H.; Forrester J.D.; Fraga G.P.; Frossard

J.L.; Fry D.E.; Galeiras R.; Ghnnam W.; Gomes C.A.; Griffiths E.A.; Guirao X.; Ahmed M.H.; Herzog T.; Kim J.I.; Iqbal T.; Isik A.; Itani K.M.F.; Labricciosa F.M.; Lee Y.Y.; Juang P.; Karamarkovic A.; Kim P.K.; Leppaniemi A.; Lohsiriwat V.; Machain G.M.; Segovia-Lohse H.; Marwah S.; Mazuski J.E.; Metan G.; Moore E.E.; Moore F.A.; Ordonez C.A.; Pagani L.; Petrosillo N.; Portela F.; Rasa K.; Rems M.; Sakakushev B.E.; Sganga G.; Shelat V.G.; Spigaglia P.; Tattevin P.; Urbanek L.; Ulrych J.; Viale P.; Baiocchi G.L.; Catena F.Source: World journal of emergency surgery : WJES; 2019; vol. 14 ; p. 8Publication Date: 2019Publication Type(s): ReviewPubMedID: 30858872Available at World journal of emergency surgery : WJES - from BioMed Central Available at World journal of emergency surgery : WJES - from Europe PubMed Central - Open Access Available at World journal of emergency surgery : WJES - from Proquest_New_Platform

Abstract:In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.Database: EMBASE

30. Clinical Outcome and Surgical Technique of Laparoscopic Posterior Rectopexy Using the Mesh with Anti-adhesion CoatingAuthor(s): Matsuda Y.; Nishikawa M.; Nishizawa S.; Yane Y.; Ushijima H.; Tokuhara T.Source: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques; 2019Publication Date: 2019Publication Type(s): Article

Abstract:We herein present an innovative technique of laparoscopic posterior mesh rectopexy (LPMR) for full-thickness rectal prolapse and report the clinical outcomes in our institution. Ten consecutive patients who were treated with our latest LPMR technique using mesh with an anti-adhesion coating from June 2014 to May 2017 were retrospectively analyzed. All patients were women with a mean age of 63.6 years (range, 39 to 82 y). The median operative time and blood loss volume were 197.5 minutes (range, 156 to 285 min) and 0 mL (range, 0 to 152 mL), respectively. No perioperative complications occurred, including surgical site infection, pneumonia, urinary dysfunction, and intestinal obstruction. The median follow-up duration was 768 days (range, 396 to 1150 d). During the follow-up, the cumulative incidence of full-thickness rectal prolapse and any mesh-related complications was 0. It may be possible to eliminate retroperitoneal closure using a mesh with an anti-adhesion coating. Our LPMR

technique appears safe and acceptable.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.Database: EMBASE

31. Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy-a systematic review with meta-analysisAuthor(s): Schorn S.; Demir I.E.; Vogel T.; Schirren R.; Reim D.; Wilhelm D.; Friess H.; Ceyhan G.O.Source: Langenbeck's Archives of Surgery; 2019Publication Date: 2019Publication Type(s): ReviewPubMedID: 30820662

Abstract:Background: Pancreaticoduodenectomy/PD is a technically demanding pancreatic resection. Options of surgical reconstruction include (1) the child reconstruction defined as pancreatojejunostomy/PJ followed by hepaticojejunostomy/HJ and the gastrojejunostomy/GJ "the standard/s-Child," (2) the s-child reconstruction with an additional Braun enteroenterostomy "BE-Child," or (3) Isolated-Roux-En-Y-pancreaticojejunostomy "Iso-Roux-En-Y," in which the pancreas anastomosis is reconstructed in a separate loop after the GJ. Yet, the impact of these reconstruction methods on patients' outcome has not been sufficiently compared in a systematic manner. Method(s): A systematic review and meta-analysis were conducted according to the Preferred-Reporting-Items-for-Systematic-review-and-Meta-Analysis/PRISMA-guidelines by screening Pubmed/Medline, Scopus, Cochrane Library and Web-of-Science. Articles meeting predefined criteria were extracted and meta-analysis was performed. Result(s): Nineteen studies were identified comparing BE-Child or Isolated-Roux-En-Y vs. s-Child. Compared to s-Child neither BE-Child (p = 0.43) nor Iso-Roux-En-Y (p = 0.94) displayed an impact on postoperative mortality, whereas BE-Child showed less postoperative complications (p = 0.02). BE-Child (p = 0.15) and Iso-Roux-En-Y (p = 0.61) did not affect postoperative pancreatic fistula/POPF in general, but BE-Child was associated with a decrease of clinically relevant POPF (p = 0.005), clinically relevant delayed gastric emptying/DGE B/C (p = 0.004), bile leaks (p = 0.01), and hospital stay (p = 0.06). BE-Child entailed also an increased operation time (p = 0.0002) with no impact on DGE A/B/C, hemorrhage, surgical site infections and pulmonary complications. Conclusion(s): BE-Child is associated with a decreased risk for postoperative complications, particularly a decreased risk for clinically relevant DGE, POPF, and bile leaks, whereas Iso-Roux-En-Y does not seem to affect the clinical course after PD. Therefore, BE seems to be a valuable surgical method to improve patients' outcome after PD.Copyright © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.Database: EMBASE

32. Induction of Labor versus Scheduled Cesarean in Morbidly Obese Women: A Cost-Effectiveness AnalysisAuthor(s): Hopkins M.K.; Grotegut C.A.; Swamy G.K.; Myers E.R.; Havrilesky L.J.Source: American Journal of Perinatology; 2019; vol. 36 (no. 4); p. 399-405Publication Date: 2019

Publication Type(s): ArticlePubMedID: 30130822

Abstract:Objective To assess the costs, complication rates, and harm-benefit tradeoffs of induction of labor (IOL) compared to scheduled cesarean delivery (CD) in women with class III obesity. Study Design We conducted a cost analysis of IOL versus scheduled CD in nulliparous morbidly obese women. Primary outcomes were surgical site infection (SSI), chorioamnionitis, venous thromboembolism, blood transfusion, and readmission. Model outcomes were mean cost of each strategy, cost per complication avoided, and complication tradeoffs. We assessed the costs, complication rates, and harm-benefit tradeoffs of IOL compared with scheduled CD in women with class III obesity. Results A total of 110 patients underwent scheduled CD and 114 underwent IOL, of whom 61 (54%) delivered via cesarean. The group delivering vaginally experienced fewer complications. SSI occurred in 0% in the vaginal delivery group, 13% following scheduled cesarean, and 16% following induction then cesarean. In the decision model, the mean cost of induction was $13,349 compared with $14,575 for scheduled CD. Scheduled CD costs $9,699 per case of chorioamnionitis avoided, resulted in 18 cases of chorioamnionitis avoided per additional SSI and 3 cases of chorioamnionitis avoided per additional hospital readmission. In sensitivity analysis, IOL is cost saving compared with scheduled CD unless the cesarean rate following induction exceeds 70%. Conclusion In morbidly obese women, induction of labor remains cost-saving until the rate of cesarean following induction exceeds 70%.Copyright © 2019 by Thieme Medical Publishers, Inc.Database: EMBASE

33. A systematic review and meta-analysis of antibiotic prophylaxis in skin graft surgery: A protocolAuthor(s): Borrelli M.R.; Sinha V.; Landin M.L.; Chicco M.; Echlin K.; Agha R.A.; Ross A.M.Source: International Journal of Surgery Protocols; 2019; vol. 14 ; p. 14-18Publication Date: 2019Publication Type(s): Article

Abstract:Introduction: There is little evidence-based guidance on the use of prophylactic antibiotics in skin surgery; whilst antibiotics may protect against surgical site infections (SSI), they have associated side effects, increase the risk of adverse events, and can propagate antibiotic resistance. We present a protocol for a systematic review to establish whether the benefit of prophylactic antibiotics overrides the risk, for patients undergoing autograft surgery. Method(s): The systematic review will be registered a priori on researchregistry.com and will be conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A search strategy will be devised to investigate 'skin graft surgery and use of antibiotics'. The following electronic databases will be searched, 1979-2018: PubMed, MEDLINE EMBASE, SCOPUS, CINAHL, PsychINFO, SciELO, The Cochrane Library, including the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effect (DARE), the Cochrane Methodology Register, Health Technology Assessment Database, the NHS Economic Evaluation Databases and Cochrane Groups,

ClinicalTrials.gov, Current Controlled Trials Database, the World Health Organisation (WHO) International Clinical Trials Registry Platform, UpToDate.com, NHS Evidence and the York Centre for Reviews and Dissemination. Grey literature will be searched. All comparative study designs reporting on the use of antibiotics in skin graft surgery will be considered for inclusion, namely randomized controlled trials (RCTs). Two trained independent teams will screen all titles and abstracts, followed by relevant full texts, for eligibility. Data will be extracted under standardized extraction fields into a preformatted database. Note will be made of the indication for skin graft surgery (traumatic, congenital, malignant, benign), the graft site (head & neck, trunk, upper extremities, lower extremities), type of skin graft (split thickness, full-thickness). The primary outcome will be occurrence of SSI at the donor and/or recipient sites. Secondary outcomes, if reported, will include: length of hospital stay, revision surgery required, cost of medical care, time to wound healing and cosmetic outcome. Ethics and dissemination: The systematic review will be published in a peer-reviewed journal and presented at national and international meetings within fields of plastic, reconstructive, and aesthetic surgery. The work will be disseminated electronically and in print. Brief reports of the review and findings will be disseminated to interested parties through email and direct communication. The review aims to guide healthcare practice and policy.Copyright © 2019Database: EMBASE

34. Primary Versus Delayed Primary Incision Closure in Contaminated Abdominal Surgery: A Meta-AnalysisAuthor(s): Tang S.; Hu L.; Zhou J.; Hu W.Source: Journal of Surgical Research; Jul 2019; vol. 239 ; p. 22-30Publication Date: Jul 2019Publication Type(s): ArticlePubMedID: 30782543Available at Journal of Surgical Research - from ClinicalKey

Abstract:Background: Debates still exist whether delayed primary incision closure (DPC) could bring more benefits to patients suffering contaminated abdominal surgery. So, we want to determine whether DPC has advantage over primary incision closure (PC) in contaminated abdominal surgery. Method(s): Embase, Medline, and the Cochrane Library databases were searched for eligible studies from January 1, 1980 to August 6, 2017. Bibliographies of potential eligibility were also retrieved. The primary outcome was the rate of surgical site infection (SSI) and the second outcome was length of hospital stay (LOS). A systematic review and meta-analysis of RCTs were performed. Result(s): Twelve studies were included in the final quantitative synthesis. Of the 12 studies included, five were from third world countries (i.e., India and Pakistan), and all of these demonstrated an improvement in SSI rate with DPC. When the fixed-effect model used, compared with PC, SSI was significantly reduced in DPC with a risk ratio of 0.64 (0.51-0.79) (P < 0.0001), and a significant difference in LOS between DPC and PC was also identified with a mean difference of 0.39 (0.17-0.60) (P = 0.0004). Although the random-effect model was used, no significant difference in SSI between DPC and PC was observed with a

risk ratio of 0.65 (0.38-1.12) (P = 0.12), and no significant difference in LOS between DPC and PC was found with a mean difference of 1.19 (-1.03 to 3.41) (P = 0.29). Conclusion(s): DPC may be the preferable choice in contaminated abdominal surgeries, especially in patients with high risk of infection, and particularly in resource constrained environments. In addition, more high-quality studies with well design are needed to provide clear evidence.Copyright © 2019 Elsevier Inc.Database: EMBASE

35. The role of exclusive enteral nutrition in the preoperative optimization of laparoscopic surgery for patients with Crohn's disease: A cohort studyAuthor(s): Ge X.; Tang S.; Yang X.; Liu W.; Yu W.; Xu H.; Zhou W.; Cai X.; Ye L.; Cao Q.Source: International Journal of Surgery; May 2019; vol. 65 ; p. 39-44Publication Date: May 2019Publication Type(s): ArticleAvailable at International Journal of Surgery - from ClinicalKey

Abstract:Background: Growing evidence has shown that there are significant advantages associated with the use of laparoscopic surgery for Crohn's disease (CD). However, the impact of preoperative exclusive enteral nutrition (EEN) on postoperative complications and CD recurrence following laparoscopic surgery have not been investigated. Method(s): A total of 120 CD patients undergoing bowel resection with laparoscopic surgery were eligible for this study. Patient data were collected from a prospectively maintained database. Before laparoscopic surgery, 45 CD patients received EEN for at least 4 weeks, and 75 CD patients had no EEN. Postoperative complications, and endoscopic and clinical recurrence were subsequently measured and compared after laparoscopic surgery and during follow-up assessments. Result(s): Patients who received EEN had significant improvements in their nutritional (albumin, prognostic nutritional index (PNI), and hemoglobin) and inflammatory (C-reactive protein) status after the EEN treatment prior to surgery (P < 0.05). Patients who received EEN also experienced fewer postoperative complications, decreased surgical site infections, and a lower comprehensive complication index (P < 0.05). The endoscopic recurrence rates 6 months after surgery were also decreased significantly in patients who received EEN (P < 0.05). However, the incidence of clinical recurrence was similar in the 2 groups at 1-year follow-up. Endoscopic recurrence was correlated with ileocolonic disease, EEN before surgery, and PNI (P < 0.05). PNI remained independently associated with endoscopic recurrence after surgery. Conclusion(s): Preoperative EEN for at least 4 weeks improved CD patients' nutritional and inflammatory status, which in turn reduced postoperative complications following laparoscopic surgery and endoscopic recurrence on follow-up.Copyright © 2019Database: EMBASE

36. Systematic review of the use of cyanoacrylate glue in addition to standard wound closure in the prevention of surgical site infection

Author(s): Machin M.; Liu C.; Coupland A.; Davies A.H.; Thapar A.Source: International Wound Journal; Apr 2019; vol. 16 (no. 2); p. 387-393Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30515975Available at International Wound Journal - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS

Abstract:Surgical site infection (SSI) is associated with increased morbidity, length of stay, and cost. Cyanoacrylate glue is a low-cost, fluid-proof, antimicrobial barrier. The aim of this systematic review is to assess the use of cyanoacrylate glue after standard wound closure versus dressings in the reduction of SSI. Medline, Embase, Cochrane Library, and clinical trial registries were searched with no restrictions in accordance with PRISMA guidelines. Eligibility criteria were prospective studies comparing glue versus dressings after standardised wound closure. Two reviewers independently screened articles and utilised GRADE for quality assessment. Meta-analysis was not performed because of the heterogeneity of the data. Three articles were included in the review. Study quality was uniformly low. Incidence of SSI was low, between 0% and 4%. No significant differences were reported in the single randomised controlled trial. A single non-randomised parallel group trial reported a significant reduction in the incidence of SSI in the cyanoacrylate group. There was no consistent evidence demonstrating reduction in SSI as a result of the use of cyanoacrylate glue. Future studies should assess the use of cyanoacrylate in procedures with a higher rate of SSI, for example, lower limb bypass.Copyright © 2018 Medicalhelplines.com Inc and John Wiley & Sons LtdDatabase: EMBASE

37. Incidence and risk factors for surgical site infection after open reduction and internal fixation of intra-articular fractures of distal femur: A multicentre studyAuthor(s): Lu K.; Liu H.; Yin L.; Wang H.; You X.; Qu Q.; Zhang J.; Cheng J.; Yang C.Source: International Wound Journal; Apr 2019; vol. 16 (no. 2); p. 473-478Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30588735Available at International Wound Journal - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS

Abstract:There remains a lack of data on the epidemiological characteristics of surgical site infection (SSI) following the open reduction and internal fixation (ORIF) of intra-articular fractures of distal femur, and the aim of this study was to solve this key clinical issue. The electronic medical records (EMRs) of patients who underwent ORIF for distal femoral fracture from January 2013 to December 2017 were reviewed to identify those who developed a SSI. Then, we conducted univariate Chi-square analyses and used a multivariate logistic regression analysis model to determine the adjusted risk factors associated with SSI. A total of 724 patients who underwent ORIF of intra-articular fractures of the distal femur were studied retrospectively, and 29 patients had postoperative SSIs. The overall

incidence of SSIs was 4.0% (29/724), with deep SSIs being 1.5% (11/724), and superficial SSIs being 2.5% (18/724). Staphylococcus aureus was the most common causative pathogen (8, 42.1%), followed by mixed bacterial pathogens (5, 26.3%). Open fracture, obesity, smoking, and diabetes mellitus were identified as the adjusted risk factors associated with SSIs. Although modification of these risk factors may be difficult, patients and families should be counselled regarding their increased risk of SSI because these patients potentially benefit from focused perioperative medical optimisation.Copyright © 2018 Medicalhelplines.com Inc and John Wiley & Sons LtdDatabase: EMBASE

38. Risk of Surgical Site Infection and Mortality Following Lumbar Fusion Surgery in Patients With Chronic Steroid Usage and Chronic Methicillin-Resistant Staphylococcus aureus InfectionAuthor(s): Singla A.; Qureshi R.; Chen D.Q.; Hassanzadeh H.; Shimer A.L.; Shen F.H.; Nourbakhsh A.Source: Spine; Apr 2019; vol. 44 (no. 7)Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30889145

Abstract:STUDY DESIGN: A retrospective database analysis among Medicare beneficiaries OBJECTIVE.: The aim of this study was to determine the effect of chronic steroid use and chronic methicillin-resistant Staphylococcus aureus (MRSA) infection on rates of surgical site infection (SSI) and mortality in patients 65 years of age and older who were treated with lumbar spine fusion. SUMMARY OF BACKGROUND DATA: Systemic immunosuppression and infection focus elsewhere in the body are considered risk factors for SSI. Chronic steroid use and previous MRSA infection have been associated with an increased risk of SSI in some surgical procedures, but their impact on the risk of infection and mortality after lumbar fusion surgery has not been studied in detail. METHOD(S): The PearlDiver insurance-based database (2005-2012) was queried to identify 360,005 patients over 65 years of age who had undergone lumbar spine fusion. Of these patients, those who had been taking oral glucocorticoids chronically and those with a history of chronic MRSA infection were identified. The rates of SSI and mortality in these two cohorts were compared with an age- and risk-factor matched control cohort and odds ratio (OR) was calculated. RESULT(S): Chronic oral steroid use was associated with a significantly increased risk of 1-year mortality [OR = 2.06, 95% confidence interval (95% CI) 1.13-3.78, P = 0.018] and significantly increased risk of SSI at 90 days (OR = 1.74, 95% CI 1.33-1.92, P < 0.001) and 1 year (OR = 1.88, 95% CI 1.41-2.01, P < 0.001). Chronic MRSA infection was associated with a significantly increased risk of SSI at 90 days (OR = 6.99, 95% CI 5.61-9.91, P < 0.001) and 1 year (OR = 24.0, 95%CI 22.20-28.46, P < 0.001) but did not significantly impact mortality. CONCLUSION(S): Patients over 65 years of age who are on chronic oral steroids or have a history of chronic MRSA infection are at a significantly increased risk of SSI following lumbar spine fusion.3.Database: EMBASE

39. Readmission after surgery for oropharyngeal cancer: An analysis of rates, causes, and risk factorsAuthor(s): Goel A.N.; Badran K.W.; Mendelsohn A.H.; Chhetri D.K.; Sercarz J.A.; Blackwell K.E.; John M.A.S.; Long J.L.Source: Laryngoscope; Apr 2019; vol. 129 (no. 4); p. 910-918Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30229931Available at Laryngoscope - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS

Abstract:Objectives/Hypothesis: Determine the rate, diagnoses, and risk factors associated with 30-day nonelective readmissions for patients undergoing surgery for oropharyngeal cancer. Study Design: Retrospective cohort study. Method(s): We analyzed the Nationwide Readmissions Database for patients who underwent oropharyngeal cancer surgery between 2010 and 2014. Rates and causes of 30-day readmissions were determined. Multivariate logistic regression was used to identify risk factors for readmission. Result(s): Among 16,902 identified cases, the 30-day, nonelective readmission rate was 10.2%, with an average cost per readmission of $14,170. The most common readmission diagnoses were postoperative bleeding (14.1%) and wound complications (12.6%) (surgical site infection [8.6%], dehiscence [2.3%], and fistula [1.7%]). On multivariate regression, significant risk factors for readmission were major ablative surgery (which included total glossectomy, pharyngectomy, and mandibulectomy) (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.06-1.60), advanced Charlson/Deyo comorbidity (OR: 2.00, 95% CI: 1.43-2.79), history of radiation (OR: 1.58, 95% CI: 1.15-2.17), Medicare (OR: 1.34, 95% CI: 1.06-1.69) or Medicaid (OR: 1.82, 95% CI: 1.32-2.50) payer status, index admission from the emergency department (OR: 1.19, 95% CI: 1.02-1.40), and length of stay >=6 days (OR: 1.57, 95% CI: 1.19-2.08). Conclusion(s): In this large database analysis, we found that approximately one in 10 patients undergoing surgery for oropharyngeal cancer is readmitted within 30 days. Procedural complexity, insurance status, and advanced comorbidity are independent risk factors, whereas postoperative bleeding and wound complications are the most common reasons for readmission. Level of Evidence: 4. Laryngoscope, 129:910-918, 2019.Copyright © 2018 The American Laryngological, Rhinological and Otological Society, Inc.Database: EMBASE

40. Surgical Site Infection after Primary Closure of High-Risk Surgical Wounds in Emergency General Surgery Laparotomy and Closed Negative-Pressure Wound TherapyAuthor(s): Hall C.; Regner J.; Abernathy S.; Isbell C.; Isbell T.; Kurek S.; Smith R.; Frazee R.Source: Journal of the American College of Surgeons; Apr 2019; vol. 228 (no. 4); p. 393-397Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30586643Available at Journal of the American College of Surgeons - from ClinicalKey

Available at Journal of the American College of Surgeons - from ScienceDirect

Abstract:Background: We hypothesized that the universal adoption of closed wounds with negative pressure wound therapy (NPWT) in emergency general surgery patients would result in low superficial surgical infection (SSI) rates. Study Design: We performed a retrospective observational study using primary wound closure with external NPWT, from May 2017 to May 2018. Patients with active soft tissue infection of the abdominal wall were excluded. Data were analyzed by Fisher's exact tests and Wilcoxon-Mann-Whitney tests, with significance is set at a value of p < 0.05. Result(s): Eighty-five patients (53% female) with a median age of 65 years (range 19 to 98 years) underwent laparotomies. Four patients were excluded for active soft tissue infection. Wounds were classified as dirty (n = 18), contaminated (n = 52), and clean contaminated (n = 11). Median BMI was 27 kg/m2 (interquartile range [IQR] 23.4 to 33.0 kg/m2). Median antibiotic therapy was 4 days (IQR 1 to 7 days). Twenty-six patients had open abdomen management. Patient follow-up was a median of 20 days (range 14 to 120 days). Six patients (7%) developed superficial SSI requiring conversion to open wound management. No patients developed fascial dehiscence. There were no statistically significant associations between SSI and wound class (p = 0.072), antibiotic duration (p = 0.702), open abdomen management, or preoperative risk factors (p < 0.1). Overall morbidity was 38% and mortality was 6%. Conclusion(s): Primary closure of high risk incisions combined with NPWT is associated with acceptably low SSI rates. Due to the low morbidity and decreased cost associated with this technique, primary closure with NPWT should replace open wound management in the emergency general surgery population.Copyright © 2018 American College of SurgeonsDatabase: EMBASE

41. Cefuroxime plasma and tissue concentrations in patients undergoing elective cardiac surgery: Continuous vs bolus application. A pilot studyAuthor(s): Skhirtladze-Dworschak K.; Hutschala D.; Bartunek A.; Dworschak M.; Tschernko E.M.; Reining G.; Dittrich P.Source: British Journal of Clinical Pharmacology; Apr 2019; vol. 85 (no. 4); p. 818-826Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30636060Available at British Journal of Clinical Pharmacology - from Wiley

Abstract:Aims: Surgical site infections contribute to morbidity and mortality after surgery. The authors hypothesized that higher antibiotic tissue concentrations can be reached for a prolonged time span by continuous administration of prophylactic cefuroxime compared to bolus administration. Method(s): Twelve patients undergoing elective cardiac surgery were investigated. Group A received 1.5 g cefuroxime as bolus infusions before surgery, and 12 and 24 hours thereafter. In group B, a continuous infusion of 3.0 g cefuroxime was started after a bolus of 1.5 g. Cefuroxim levels were determined in blood and tissue (microdialysis). T-test, Wilcoxon signed rank test

and chi2 test were used for statistical analysis. Result(s): The area under the curve (AUC) of plasma cefuroxime concentrations was greater in group B (399 [333-518]) as compared to group A (257 [177-297] h mg L-1, [median and interquartile range], P =.026). Furthermore, a significantly longer percentage of time > minimal inhibitory concentrations of 2 mg L-1 (100% vs 50%), 4 mg L-1 (100% vs 42%), 8 mg L-1 (100% vs 17%) and 16 mg L-1 (83% vs 8%) was found for free plasma cefuroxime in group B. In group B, area under the curve in subcutaneous tissue (78 [61-113] h mg L-1) and median peak concentration (33 [26-38] mg L-1) were markedly higher compared to group A (P = 0.041 and P =.026, respectively). Conclusion(s): Higher cefuroxime concentrations were measured in plasma and subcutaneously over a prolonged period of time when cefuroxime was administered continuously. The clinical implication of this finding still has to be elucidated.Copyright © 2019 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.Database: EMBASE

42. Length of Stay and Opioid Dose Requirement with Transversus Abdominis Plane Block vs Epidural Analgesia for Ventral Hernia RepairAuthor(s): Warren J.A.; Carbonell A.M.; Cobb W.S.; Mcguire A.; Hand W.R.; Cancellaro V.A.; Jones L.K.; Ewing J.A.Source: Journal of the American College of Surgeons; Apr 2019; vol. 228 (no. 4); p. 680-686Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30630088Available at Journal of the American College of Surgeons - from ClinicalKey Available at Journal of the American College of Surgeons - from ScienceDirect

Abstract:Background: Major abdominal operations often requires postoperative opioid analgesia. However, there is growing recognition of the potential for abuse. We previously reported a significant reduction in opioid consumption after implementation of an Enhanced Recovery after Surgery protocol after ventral hernia repair focusing on opioid reduction. Epidural use was routine for postoperative pain control in this protocol. Recently, we have transitioned to transversus abdominis plane (TAP) block instead of epidural analgesia. We hypothesize that this modification reduces length of stay and lowers opioid use in ventral hernia repair. Method(s): All patients undergoing open ventral hernia repair were recorded prospectively in the Americas Hernia Society Quality Collaborative database. All patients receiving either TAP or epidural between February 2015 and March 2018 were identified. Additional review was performed to quantify opioid use in morphine milligram equivalents (MMEs). Primary outcomes were length of stay and opioid use. Result(s): Epidural was used in 172 patients and TAP block in 74. There were no significant comorbidity differences between groups. The TAP group had a slightly higher BMI (33.6 kg/m2 vs 28.3 kg/m2) and slightly smaller hernias (8.8 cm vs 10.8 cm). There was no difference in 30-day surgical site infections. Hospital length of stay was significantly shorter with TAP block (2.4 vs 4.5 days; p < 0.001). Total

MME requirements for patients receiving TAP block were lower than those with epidural during postoperative days 1 and 2 (mean 40 vs 54.1 MMEs; p = 0.033 and 36.1 vs 52.5 MMEs; p = 0.018). Conclusion(s): Use of TAP block significantly reduces length of stay and decreases opioid dose requirements in the early postoperative period compared with epidural analgesia.Copyright © 2019 American College of SurgeonsDatabase: EMBASE

43. Perioperative Bundle to Reduce Surgical Site Infection after Pancreaticoduodenectomy: A Prospective Cohort StudyAuthor(s): Lawrence S.A.; McIntyre C.A.; Pulvirenti A.; Chou Y.; Balachandran V.P.; Kingham T.P.; D'Angelica M.I.; Drebin J.A.; Jarnagin W.R.; Allen P.J.; Seier K.; Gonen M.Source: Journal of the American College of Surgeons; Apr 2019; vol. 228 (no. 4); p. 595-601Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30630087Available at Journal of the American College of Surgeons - from ClinicalKey Available at Journal of the American College of Surgeons - from ScienceDirect

Abstract:Background: Pancreaticoduodenectomy is historically associated with incisional surgical site infection (iSSI) rates between 15% and 20%. Prospective studies have been mixed with respect to the benefit of individual interventions directed at decreasing iSSI. We hypothesized that the application of a perioperative bundle during pancreaticoduodenectomy would decrease the rate of iSSIs significantly. Method(s): An initial cohort of 150 consecutive post-pancreaticoduodenectomy patients were assessed within 2 to 4 weeks of operation to determine baseline iSSI rates. The CDC definition of iSSI was used. A 4-part perioperative bundle was then instituted for the second cohort of 150 patients. This bundle consisted of a double-ring wound protector, gown/glove and drape change before fascial closure, irrigation of the wound with bacitracin solution, and a negative-pressure wound dressing that was left in place until postoperative day 7 or day of discharge. Three-hundred patients provided 80% power to detect a 50% risk reduction in iSSIs. Result(s): Cohorts 1 and 2 were similar with respect to age (68 vs 69 years; p = 0.918), sex (male, 51% vs 55%; p = 0.644), BMI (26 vs 26 kg/m2; p = 0.928), use of neoadjuvant therapy (21% vs 17%; p = 0.377), median operative time (222 vs 215 minutes; p = 0.366), and presence of a preoperative stent (53% vs 41%; p = 0.064). The iSSI rate was 22.3% in the initial cohort. This rate was higher than both our institutional database (13%) and NSQIP reporting (11%). Within the second cohort, the iSSI rate decreased significantly to 10.7% (n = 16; p = 0.012). All 4 components of the bundle were used in 91% of cohort 2 patients. Conclusion(s): In this cohort study of 300 consecutive patients who underwent pancreaticoduodenectomy, the implementation of a 4-part bundle decreased iSSI rate from 22% to 11%.Copyright © 2019 American College of SurgeonsDatabase: EMBASE

44. Robotic Pancreaticoduodenectomy Is the Future: Here and NowAuthor(s): Rosemurgy A.; Ross S.; Bourdeau T.; Craigg D.; Spence J.; Alvior J.; Sucandy I.Source: Journal of the American College of Surgeons; Apr 2019; vol. 228 (no. 4); p. 613-624Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30682410Available at Journal of the American College of Surgeons - from ClinicalKey Available at Journal of the American College of Surgeons - from ScienceDirect

Abstract:Background: This study was undertaken to examine our outcomes after robotic pancreaticoduodenectomy and to compare our outcomes with predicted outcomes using the American College of Surgeons (ACS) NSQIP Surgical Risk Calculator and with outcomes reported through ACS NSQIP. Method(s): We prospectively followed 155 patients undergoing robotic pancreaticoduodenectomy. Outcomes were compared with predicted outcomes calculated using the ACS NSQIP Surgical Risk Calculator and with outcomes documented in ACS NSQIP for pancreaticoduodenectomy from 2012 to 2017. Median data are presented. Result(s): Eighty-eight percent of our robotic pancreaticoduodenectomies were performed in 2015 to 2018. Predicted outcomes were like those reported in ACS NSQIP. Actual outcomes were superior to predicted outcomes and outcomes reported in ACS NSQIP for overall complications, serious complications, returned to operating room, surgical site infections, deep vein thrombosis, and length of stay. Seventeen percent had conversions to open operations, generally due to failure to progress or need for major vascular reconstruction; only 3 (3.5%) of the last 80 operations were converted to open. Robotic operations took 423 minutes; estimated blood loss was 200 mL. Biliary fistulas occurred in 5% and pancreatic fistulas occurred in 5%. Six percent of patients died perioperatively; 5 patients died due to cardiac deterioration and 4 (3.1%) patients died after pancreaticoduodenectomy completed robotically. Conclusion(s): Our patients were not a select group, they were like those reported in ACS NSQIP. Their outcomes after robotic pancreaticoduodenectomy were like or better than predicted outcomes or national data. Our mortality was high because of preoperative ill health (eg renal failure) and cardiac risk. Although we believe our results will continue to improve, our current data document the salutary benefits of minimally invasive robotic pancreaticoduodenectomy.Copyright © 2019Database: EMBASE

45. Evaluating the Impact of Technique and Mesh Type in Complicated Ventral Hernia Repair: A Prospective Randomized Multicenter Controlled TrialAuthor(s): Bochicchio G.V.; Bochicchio K.; Sato B.; Reese S.; Ilahi O.; Zhang Q.; Horn C.; Garcia A.; Kaufman J.Source: Journal of the American College of Surgeons; Apr 2019; vol. 228 (no. 4); p. 377-390Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30707935

Available at Journal of the American College of Surgeons - from ClinicalKey Available at Journal of the American College of Surgeons - from ScienceDirect

Abstract:Background: To our knowledge, there is an absence of prospective randomized multicenter controlled trials evaluating both the impact of technique and mesh type on outcomes in complicated ventral hernia repair. Study Design: A prospective randomized multicenter controlled trial of 120 patients at 3 sites was conducted in which patients were randomized to either overlay (anterior component separation) or underlay mesh placement (posterior component separation) and mesh type (human acellular dermis [HADM] vs porcine acellular dermis [PADM]). Key inclusion criteria included hernia size (>200 cm2), BMI < 40 kg/m2, hemoglobin A1C < 7%, tobacco free > 6 weeks and primary fascial closure. Primary outcome was hernia recurrence at 1 year, determined by independent examiner/imaging. Secondary outcomes included complications and patient satisfaction (short form [SF]-36v2). Standardized investigator training included a porcine model followed by a proctored first case by the lead investigator. Result(s): There were no significant differences in demographics between the 4 groups (age 60 +/-12 years, BMI 32 +/- 5 kg/m2, 51% female). The overall 1-year recurrence rate was 10.8%. There was no significant difference in recurrence rate by location of mesh placement (overlay 9.8%, underlay 11.9%) or mesh type (HADM 10.3%, PADM 11.3%). Overlay patients had a significantly lower surgical site infection rate (1.6% vs 11.9% p = 0.03), reported better physical functioning (p = 0.001) and role limitation scores (p = 0.04) in the early postoperative period, and achieved the highest physical functioning score during the 12-month period (p < 0.03). Conclusion(s): Recurrence rates were not affected by either anatomic location or type of mesh used. To our knowledge, this represents the first prospective randomized multicenter controlled trial that demonstrates similar clinical outcomes using HADM vs PADM (not inferiority, contrary to previously published literature), with several advantages identified using the overlay technique.Copyright © 2019 American College of SurgeonsDatabase: EMBASE

46. DiscussionAuthor(s): anonymousSource: Journal of the American College of Surgeons; Apr 2019; vol. 228 (no. 4); p. 601-604Publication Date: Apr 2019Publication Type(s): NotePubMedID: 30885485Available at Journal of the American College of Surgeons - from ClinicalKey Available at Journal of the American College of Surgeons - from ScienceDirect Database: EMBASE

47. Poor glycemic control is a strong predictor of postoperative morbidity and mortality in patients undergoing vascular surgeryAuthor(s): Long C.A.; Fang Z.B.; Hu F.Y.; Arya S.; Brewster L.P.; Duwayri Y.; Duggan E.

Source: Journal of Vascular Surgery; Apr 2019; vol. 69 (no. 4); p. 1219-1226Publication Date: Apr 2019Publication Type(s): ArticleAvailable at Journal of Vascular Surgery - from ClinicalKey

Abstract:Objective: Hyperglycemia is a common occurrence in patients undergoing cardiovascular surgery. It has been identified in several surgical cohorts that improved perioperative glycemic control reduced postoperative morbidity and mortality. A significant portion of the population with peripheral arterial disease suffers from the sequelae of diabetes or metabolic syndrome. A paucity of data exists regarding the relationship between perioperative glycemic control and postoperative outcomes in vascular surgery patients. The objective of this study was to better understand this relationship and to determine which negative perioperative outcomes could be abated with improved glycemic control. Method(s): This is a retrospective review of a vascular patient database at a large academic center from 2009 to 2013. Eligible procedures included carotid endarterectomy and stenting, endovascular and open aortic aneurysm repair, and all open bypass revascularization procedures. Data collected included standard demographics, outcome parameters, and glucose levels in the perioperative period. Perioperative hyperglycemia was defined as at least one glucose value >180 mg/dL within 72 hours of surgery. The primary outcome was 30-day mortality, with secondary outcomes of complications, need to return to the operating room, and readmission. Result(s): Of the total 1051 patients reviewed, 366 (34.8%) were found to have perioperative hyperglycemia. Hyperglycemic patients had a higher 30-day mortality (5.7% vs 0.7%; P <.01) and increased rates of acute renal failure (4.9% vs 0.9%; P <.01), postoperative stroke (3.0% vs 0.7%; P <.01), and surgical site infections (5.7% vs 2.6%; P =.01). In addition, these patients were also more likely to undergo readmission (12.3% vs 7.9%; P =.02) and reoperation (6.3% vs 1.8%; P <.01). Furthermore, multivariable logistic regression demonstrated that perioperative hyperglycemia had a strong association with increased 30-day mortality and multiple negative postoperative outcomes, including myocardial infarction, stroke, renal failure, and wound complications. Conclusion(s): This study demonstrates a strong association between perioperative glucose control and 30-day mortality in addition to multiple other postoperative outcomes after vascular surgery.Copyright © 2018Database: EMBASE

48. Risk of readmission for infection after surgical intervention for intracerebral hemorrhageAuthor(s): Kaur G.; Stein L.K.; Liang J.W.; Tuhrim S.; Dhamoon M.S.; Boehme A.; Mocco J.Source: Journal of the Neurological Sciences; Apr 2019; vol. 399 ; p. 161-166Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30818077Available at Journal of the Neurological Sciences - from ClinicalKey

Abstract:Background: Several operative interventions are performed to reduce the mortality and morbidity of

Intracerebral hemorrhage (ICH) in the acute setting, including: craniotomy or craniectomy, placement of an external ventricular drain (EVD), placement of a ventriculo-peritoneal shunt (VPS) and stereotactic craniotomy. Infections are a major source of readmissions following ICH. We explored the association between operative interventions for ICH and 30-day readmissions for infection-related causes. Method(s): The Nationwide Readmissions Database contains >14 million discharges for all payers and uninsured in 2013. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify index cases of ICH, intracranial procedures, and comorbidities. We summarized demographics and comorbidities during index admission, stratified by receipt of operative interventions. We calculated differences in means (using t-tests) and frequencies (using chi-square) by group (any intervention versus none). Top 5 causes of 30-day readmission and top 5 causes for infectious readmissions were identified. Cox regression analysis was performed for time to readmission for infectious causes. Result(s): There were 27,739 index admissions with ICH, 13% had operative interventions. In the operative group, 45.5% underwent craniotomy, 65.4% had EVD placement and 7.6% had VPS placement. Acute cerebrovascular disease was the top cause of readmission followed by infection in the entire cohort and those with interventions. Among infectious causes of readmissions, septicemia was the largest in the intervention group (65%). In both adjusted and unadjusted models, there was significant association between ICH intervention and risk of readmission for infectious causes. Among those with operative interventions for ICH, risk of readmission with infection is double the risk in the non-intervention group. Cumulative risk of readmission was higher for infection following ICH, starting after approximately 50 days, in the intervention group (log-rank p-value <.0001). Conclusion(s): Infections and cerebrovascular complications contribute to most readmissions after ICH. There is a dose-response relationship between number of interventions and risk of infectious readmission, and this risk significantly increases after approximately 50-days.Copyright © 2019 Elsevier B.V.Database: EMBASE

49. Perioperative complications of anterior decompression with fusion versus laminoplasty for the treatment of cervical ossification of the posterior longitudinal ligament: propensity score matching analysis using a nation-wide inpatient databaseAuthor(s): Morishita S.; Yoshii T.; Okawa A.; Fushimi K.; Fujiwara T.Source: Spine Journal; Apr 2019; vol. 19 (no. 4); p. 610-616Publication Date: Apr 2019Publication Type(s): ArticleAvailable at Spine Journal - from ClinicalKey

Abstract:BACKGROUND CONTEXT: Surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) has a high risk of various complications. Anterior decompression with fusion (ADF) and laminoplasty (LAMP) are the most representative surgical procedures. However, few studies have compared the two procedures in terms of perioperative surgical complications. PURPOSE: To compare the perioperative complications post-ADF and LAMP for

cervical OPLL using a large national inpatient database. STUDY DESIGN: A retrospective cohort study with propensity score matching analysis. PATIENT SAMPLE: Overall, 8,718 (ADF/LAMP:1,333/7,485) patients who underwent surgery for cervical OPLL from April 1, 2010 to March 31, 2016 in hospitals using the diagnosis procedure combination were analyzed. OUTCOME MEASURES: The occurrence of postoperative complications during hospitalization. METHOD(S): We compared the perioperative systemic and local complications, reoperation rates, and costs between ADF and LAMP using propensity score matching analysis. RESULT(S): One-to-one matching resulted in 1,192 pairs of patients who underwent ADF and LAMP. The postoperative cardiovascular event rate was significantly higher (ADF/LAMP=1.9/0.8%, p=.013) in the ADF group. The incidence rates of dysphagia (similarly, 2.4/0.2%, p<.001), pneumonia (1.0/0.3%, p=.045), and spinal fluid leakage (2.4/0.4%, p<.001) were also higher in the ADF group, even after matching. The costs were also higher in the ADF group. However, surgical site infection (2.0/3.4%, p=.033) was significantly lower in the ADF group. No significant difference in the reoperation rates was found between the groups. CONCLUSION(S): The present study, using a large nationwide database, demonstrated that perioperative complications were more common in the ADF group, but that surgical site infection (SSI) was more frequently observed in the LAMP group.Copyright © 2018 Elsevier Inc.Database: EMBASE

50. Body mass index and the risk of deep surgical site infection following posterior cervical instrumented fusionAuthor(s): Cheng C.W.; Cizik A.M.; Dagal A.H.C.; Bellabarba C.; Bransford R.J.; Zhou H.; Lewis L.; Lynch J.Source: Spine Journal; Apr 2019; vol. 19 (no. 4); p. 602-609Publication Date: Apr 2019Publication Type(s): ArticleAvailable at Spine Journal - from ClinicalKey

Abstract:BACKGROUND: Surgical site infection (SSI) following spine surgery is associated with increased morbidity, reoperation rates, hospital readmissions, and cost. The incidence of SSI following posterior cervical spine surgery is higher than anterior cervical spine surgery, with rates from 4.5% to 18%. It is well documented that higher body mass index (BMI) is associated with increased risk of SSI after spine surgery. There are only a few studies that examine the correlation of BMI and SSI after posterior cervical instrumented fusion (PCIF) using national databases, however, none that compare trauma and nontraumatic patients. PURPOSE: The purpose of this study is to determine the odds of developing SSI with increasing BMI after PCIF, and to determine the risk of SSI in both trauma and nontraumatic adult patients. STUDY DESIGN: This is a retrospective cohort study of a prospective surgical database collected at one academic institution. PATIENT SAMPLE: The patient sample is from a prospectively collected surgical registry from one institution, which includes patients who underwent PCIF from April 2011 to October 2017. OUTCOME MEASURES: A SSI that required return to the operating room for surgical debridement. METHOD(S): This is a retrospective cohort study using a prospectively collected database of all spine surgeries

performed at our institution from April 2011 to October 2017. We identified 1,406 patients, who underwent PCIF for both traumatic injuries and nontraumatic pathologies using International Classification of Diseases 9 and 10 procedural codes. Thirty-day readmission data were obtained. Patient's demographics, BMI, presence of diabetes, preoperative diagnosis, and surgical procedures performed were identified. Using logistic regression analysis, the risk of SSI associated with every one-unit increase in BMI was determined. This study received no funding. All the authors in this study report no conflict of interests relevant to this study. RESULT(S): Of the 1,406 patients identified, 1,143 met our inclusion criteria. Of those patients, 688 had PCIF for traumatic injuries and 454 for nontraumatic pathologies. The incidence of SSI for all patients, who underwent PCIF was 3.9%. There was no significant difference in the rate of SSI between our trauma group and nontraumatic group. There was a higher rate of infection in patients, who were diabetic and with BMI>=30 kg/m2. The presence of both diabetes and BMI>=30 kg/m2 had an added effect on the risk of developing SSI in all patients, who underwent PCIF. Additionally, logistic regression analysis showed that there was a positive difference measure between BMI and SSI. Our results demonstrate that for one-unit increase in BMI, the odds of having a SSI is 1.048 (95% CI: 1.007-1.092, p=.023). CONCLUSION(S): Our study demonstrates that our rate of SSI after PCIF is within the range of what is cited in the literature. Interestingly, we did not see a statistically significant difference in the rate of infection between our trauma and nontrauma group. Overall, diabetes and elevated BMI are associated with increased risk of SSI in all patients, who underwent PCIF with even a higher risk in patient, who are both diabetic and obese. Obese patients should be counseled on elevated SSI risk after PCIF, and those with diabetes should be medically optimized before and after surgery when possible to minimize SSI.Copyright © 2018 Elsevier Inc.Database: EMBASE

51. A multicenter point prevalence survey of healthcare-associated infections in Pakistan: Findings and implicationsAuthor(s): Saleem Z.; Hassali M.A.; Godman B.; Hashmi F.K.; Saleem F.Source: American Journal of Infection Control; Apr 2019; vol. 47 (no. 4); p. 421-424Publication Date: Apr 2019Publication Type(s): ArticleAvailable at American Journal of Infection Control - from ClinicalKey

Abstract:Background: Healthcare-associated infections (HAIs) are seen as a global public health threat, leading to increased mortality and morbidity as well as costs. However, little is currently known about the prevalence of HAIs in Pakistan. Consequently, this multicenter prevalence survey of HAIs was conducted to assess the prevalence of HAIs in Pakistan. Method(s): We used the methodology employed by the European Centre for Disease Prevention and Control to assess the prevalence of HAIs in Punjab Province, Pakistan. Data were collected from 13 hospitals using a structured data collection tool. Result(s): Out of

1,553 hospitalized patients, 130 (8.4%) had symptoms of HAIs. The most common HAI was surgical site infection (40.0%), followed by bloodstream infection (21.5%), and lower respiratory tract infection (14.6%). The prevalence of HAI was higher in private sector hospitals (25.0%) and among neonates (23.8%) and patients admitted to intensive care units (33.3%). Patients without HAIs were admitted mainly to public sector hospitals and adult medical and surgical wards. Conclusion(s): The study found a high rate of HAIs among hospitals in Pakistan, especially surgical site infections, bloodstream infections, and lower respiratory tract infections. This needs to be addressed to reduce morbidity, mortality, and costs in the future, and further research is planned.Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc.Database: EMBASE

52. The relationship between body mass index, sex, and postoperative outcomes in patients undergoing potentially curative surgery for colorectal cancerAuthor(s): Almasaudi A.S.; McSorley S.T.; Horgan P.G.; McMillan D.C.; Edwards C.A.Source: Clinical Nutrition ESPEN; Apr 2019; vol. 30 ; p. 185-189Publication Date: Apr 2019Publication Type(s): ArticleAvailable at Clinical Nutrition ESPEN - from ClinicalKey

Abstract:Background: There is increasing evidence that an increased BMI is associated with increased complications after surgery for colorectal cancer (CRC). However, the basis of this relationship is not clear. Since men and women have different fat distribution, with men more likely to have excess visceral fat in BMI defined obesity, there may be a sex difference in the surgical site infection (SSIs) rate in the obese. Therefore, the aim of this study was to examine the relationship between sex, BMI, clinic-pathological characteristics and the development of postoperative infective complications after surgery for CRC and to establish whether there were gender differences in complication following surgery for CRC. Design(s): Data were recorded prospectively for patients undergoing potentially curative surgery for CRC in a single centre between 1997 and 2016. Patient characteristics were recorded and complications were classified as either infective or non-infective. The relationship between sex, BMI, associated clinicopathological characteristics and presences of complications were examined by Chi-square test for linear association and multivariate binary logistic regression model. Result(s): A total of 1039 patients were included. There were significant differences in the presence of complications between male and female (p <= 0.001), the rate of complication was higher in obese male (44%); in particular SSIs, wound infection and anastomotic leak (p <= 0.05). The rate of surgical site infection was 12% in male patients with normal BMI compared with 26% in those with a BMI >=30 (p <= 0.001), while the rate of SSIs in female patients was 10% in those with normal BMI and those with a BMI >=30. In males, BMI remained significantly associated with SSI on multivariate analysis [(OR = 1.42, 95% CI 1.13-1.78) P = 0,002]. Conclusion(s): Obesity prior to surgery for CRC increases the risk of infective complications in both male and female. Increased BMI in male patients was

associated greater risk of SSIs and wound infection compared to female patients. Male obese patients should be considered at high risk of developing post-operative infective complications.Copyright © 2018 European Society for Clinical Nutrition and MetabolismDatabase: EMBASE

53. Letter to editor: Surgical-site infection following lymph node excision indicates susceptibility for lymphedema: A retrospective cohort study of malignant melanoma patientsAuthor(s): Elia R.; Clemente E.T.; Vestita M.; Nacchiero E.Source: Journal of Plastic, Reconstructive and Aesthetic Surgery; Apr 2019; vol. 72 (no. 4); p. 685-710Publication Date: Apr 2019Publication Type(s): LetterAvailable at Journal of Plastic, Reconstructive and Aesthetic Surgery - from ClinicalKey Available at Journal of Plastic, Reconstructive and Aesthetic Surgery - from ScienceDirect

Abstract:Following the reading of the original article "Surgical-site infection following lymph node excision indicates susceptibility for lymphedema: A retrospective cohort study of malignant melanoma patients" the authors reviewed the literature for the discussed therapeutic value of complete lymph node dissection (CLND), the major complications and the current treatment for lymphedema. The authors also share their experience and protocol for CLND, and treating lymphedema using lymph node flap transfer and multiple lymphatic-venous anastomoses.Copyright © 2019Database: EMBASE

54. Universal staphylococcal decolonization for elective surgeries: The patient perspectiveAuthor(s): Masroor N.; Ferretti-Gallon J.; Cooper K.; Elgin K.; Sanogo K.; Nguyen H.J.; Doll M.; Stevens M.P.; Bearman G.Source: American Journal of Infection Control; Apr 2019; vol. 47 (no. 4); p. 391-393Publication Date: Apr 2019Publication Type(s): ArticleAvailable at American Journal of Infection Control - from ClinicalKey

Abstract:Background: Staphylococcal decolonization decreases the risk of Staphylococcus aureus surgical site infection. This study evaluates patient perceptions and barriers to a universal Staphylococcal decolonization (USD) protocol. Method(s): In October 2013, a protocol for the decolonization of Staphylococcal aureus in elective orthopedic, neurosurgical, and cardiac surgeries was implemented in an effort to further decrease post-operative infections rates. We surveyed patients undergoing these procedures between November 2014 and April 2015 using an anonymous, voluntary, Likert-scale survey; survey questions targeted compliance with the protocol as well as barriers to protocol completion. Result(s): A sample of 546 patients (n=1289, 42%) undergoing elective neurosurgical and orthopedic surgeries completed surveys. Respondents had 85% compliance with USD. Insufficient time prior to the procedure to complete the protocol was the largest barrier to USD completion.

Conclusion(s): This study provides evidence that USD is acceptable to patients, and that the biggest barriers are logistical.Copyright © 2018Database: EMBASE

55. Long-term assessment of surgical and quality-of-life outcomes between lightweight and standard (heavyweight) three-dimensional contoured mesh in laparoscopic inguinal hernia repairAuthor(s): Arnold M.R.; Coakley K.M.; Fromke E.J.; Groene S.A.; Prasad T.; Colavita P.D.; Augenstein V.A.; Kercher K.W.; Heniford B.T.Source: Surgery (United States); Apr 2019; vol. 165 (no. 4); p. 820-824Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30449696Available at Surgery (United States) - from ClinicalKey Available at Surgery (United States) - from ScienceDirect

Abstract:Background: Mesh weight is a possible contributor to quality-of-life outcomes after inguinal hernia repair. This study compares lightweight mesh versus heavyweight mesh in laparoscopic inguinal hernia repair. Method(s): A prospective, single-center, hernia-specific database was queried for all adult laparoscopic inguinal hernia repair with three-dimensional contoured mesh (3-D Max, Bard, Inc, New Providence, NJ) from 1999 to June 2016. Demographics and outcomes were analyzed. Quality of life was evaluated preoperatively and after 2 weeks, 4 weeks, 6 months, 12 months, and 24 months, using the Carolinas Comfort Scale. Univariate analysis and multivariate logistic regression were performed. Result(s): A total of 1,424 laparoscopic inguinal hernia repair were performed with three-dimensional contoured mesh, with 804 patients receiving lightweight mesh and 620 receiving heavyweight mesh. Patients receiving lightweight mesh were somewhat younger (52.6 +/- 14.8 years vs 56.3 +/- 13.7 years, P <.0001), with slightly lower body mass indices (26.4 +/- 9.9 vs 27.1 +/- 4.3, P <.0001). Lightweight mesh was used less often in incarcerated hernias (12.5% vs 16.8%, P =.02). There were a total of 3 surgical site infections. There were no differences in complications between groups except for seroma. Although on univariate analysis, seromas appeared to occur more frequently with heavyweight mesh (21.5% vs 7.9%). On multivariate analysis, heavyweight mesh was not independently associated with seroma formation. Average follow-up was 20 months. Recurrence rates were similar between lightweight mesh and heavyweight mesh (0.7 vs 0.6% P >.05). At all points of follow-up (4 week to 3 years), quality-of-life outcomes of discomfort, mesh sensation, and movement limitation scores were similar between lightweight mesh and heavyweight mesh. Conclusion(s): Contoured lightweight mesh and heavyweight mesh in laparoscopic inguinal hernia repair yield excellent recurrence rates and no difference in postoperative complications or quality of life. Considering the lack of outcome difference with long-term follow-up, heavyweight mesh may be considered for use in laparoscopic inguinal hernia repair patients.Copyright © 2018Database: EMBASE

56. Physician Engagement: A Key Concept in the Journey for Quality ImprovementAuthor(s): Mcgonigal M.; Bauer M.; Post C.Source: Critical Care Nursing Quarterly; Apr 2019; vol. 42 (no. 2); p. 215-219Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30807349

Abstract:In the 2001 Institute of Medicine report on patient outcomes in the United States, one of the key concepts was the importance of collaboration within the health care team by using quality improvement methodologies as a foundation and using data to drive change and improve patient outcomes and ultimately the health of the nation. Ensuring that all health care providers have a voice at the table on key initiatives has been a challenge to implement, especially when attempting to involve frontline staff including physicians and nurses. In regard to the particular organization to be discussed, it was important to have an understanding of what issues resonated with physicians and the health care team as a whole in order to successfully integrate their expertise into committee work and practice changes that were priorities for the organization. As a starting point, a review of physician engagement strategies was completed and priorities were matched according to physician specialty and interest. Due to the increasing external pressure to examine and improve outcomes in hospital-acquired infections and in particular, reduction of central line-associated blood stream infections, catheter-associated urinary tract infections, surgical site infections, and Clostridium difficile infections, these areas were the focus of the initial physician-led teams. The positive outcomes in both physician engagement and satisfaction as well as patient outcomes were evidence to pursue additional team approaches in complication reviews, employee injury teams, and mortality risk reduction.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.Database: EMBASE

57. Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and AccuracyAuthor(s): Tucker A.; Kajimoto Y.; Ohmura T.; Ikeda N.; Furuse M.; Nonoguchi N.; Kawabata S.; Kuroiwa T.Source: Operative neurosurgery (Hagerstown, Md.); Apr 2019; vol. 16 (no. 4); p. 471-477Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30011016

Abstract:BACKGROUND: Spinal catheter insertion in lumboperitoneal (LP) shunt surgery for idiopathic normal pressure hydrocephalus (iNPH) is frequently associated with technical difficulties especially in patients with obesity and elderly patients with vertebral deformities. OBJECTIVE(S): To elucidate the accuracy and safety of image-guided spinal catheter placement using a paramedian approach (PMA). METHOD(S): We retrospectively analyzed 39 consecutive iNPH patients treated by LP shunting with spinal catheter insertion via the PMA. The success rate of catheter placement and the number of changes in puncture location were evaluated.

Accuracy of catheter insertion was assessed by measuring both vertical and horizontal deviations in the point of catheter dural penetration from the center of the interlaminar space. RESULT(S): The success rate of catheter placement was 100% (39/39). The difficulty rate for catheter insertion, measured by the number of changes in puncture location, was 2.6% (1/39). No bloody punctures or surgical infections were observed. Accuracy of catheter insertion, measured as the degree of deviation, was 0.5 +/- 1.9 mm horizontally and 0.0 +/- 2.4 mm vertically. The rates of minor complications, including caudal catheter insertion, transient low-pressure headache, and root pain, were 5.1% (2/39), 10.4% (4/39), and 0% (0/43), respectively. Subdural hematoma requiring surgical intervention occurred in 1 case (2.6%). During the mean follow-up period of 36 mo, spinal catheter rupture at the level of the spinous processes was not observed. CONCLUSION(S): Fluoroscopic-guided spinal catheter placement via the PMA was safe, accurate, and reliable, even for use in geriatric and obese patients.Copyright © Congress of Neurological Surgeons 2017.Database: EMBASE

58. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: infection and sepsisAuthor(s): Barnes J.; Hunter J.; Mythen M.G.; Harris S.; Shankar-Hari M.; Diouf E.; Jammer I.; Kalkman C.; Klein A.A.; Corcoran T.; Dieleman S.; Grocott M.P.W.; Myles P.; Gan T.J.; Kurz A.; Peyton P.; Sessler D.; Tramer M.; Cyna A.; De Oliveira G.S.; Wu C.; Jensen M.; Kehlet H.; Botti M.; Boney O.; Haller G.; Grocott M.; Cook T.; Fleisher L.; Neuman M.; Story D.; Gruen R.; Bampoe S.; Evered L.; Scott D.; Silbert B.; van Dijk D.; Chan M.; Grocott H.; Eckenhoff R.; Rasmussen L.; Eriksson L.; Beattie S.; Wijeysundera D.; Landoni G.; Leslie K.; Biccard B.; Howell S.; Nagele P.; Richards T.; Lamy A.; Lalu M.; Pearse R.; Mythen M.; Canet J.; Moller A.; Gin T.; Schultz M.; Pelosi P.; Gabreu M.; Futier E.; Creagh-Brown B.; Fowler A.; Abbott T.; Klein A.; Cooper D.J.; McIlroy D.; Bellomo R.; Shaw A.; Prowle J.; Karkouti K.; Billings J.; Mazer D.; Jayarajah M.; Murphy M.; Bartoszko J.; Sneyd R.; Morris S.; George R.; Moonesinghe R.; Shulman M.; Lane-Fall M.; Nilsson U.; Stevenson N.; Cooper J.D.; van Klei W.; Cabrini L.; Miller T.; Pace N.; Jackson S.; Buggy D.; Short T.; Riedel B.; Gottumukkala V.; Alkhaffaf B.; Johnson M.Source: British Journal of Anaesthesia; Apr 2019; vol. 122 (no. 4); p. 500-508Publication Date: Apr 2019Publication Type(s): ReviewPubMedID: 30857606Available at British Journal of Anaesthesia - from ScienceDirect Available at British Journal of Anaesthesia - from Worthing Hospital Health Sciences Library (lib327445) Local Print Collection [location] : Worthing Hospital Health Sciences Library.

Abstract:Background: Perioperative infection and sepsis are of fundamental concern to perioperative clinicians. However, standardised endpoints are either poorly defined or not routinely implemented. The Standardised Endpoints in Perioperative Medicine (StEP) initiative was established to derive a set of standardised endpoints for use in

perioperative clinical trials. Method(s): We undertook a systematic review to identify measures of infection and sepsis used in the perioperative literature. A multi-round Delphi consensus process that included more than 60 clinician researchers was then used to refine a recommended list of outcome measures. Result(s): A literature search yielded 1857 titles of which 255 met inclusion criteria for endpoint extraction. A long list of endpoints, with definitions and timescales, was generated and those potentially relevant to infection and sepsis circulated to the theme subgroup and then the wider StEP-COMPAC working group, undergoing a three-stage Delphi process. The response rates for Delphi rounds 1, 3, and 3 were 89% (n=8), 67% (n=62), and 80% (n=8), respectively. A set of 13 endpoints including fever, surgical site, and organ-specific infections as defined by the US Centres for Disease Control and Sepsis-3 are proposed for future use. Conclusion(s): We defined a consensus list of standardised endpoints related to infection and sepsis for perioperative trials using an established and rigorous approach. Each endpoint was evaluated with respect to validity, reliability, feasibility, and patient centredness. One or more of these should be considered for inclusion in future perioperative clinical trials assessing infection, sepsis, or both, thereby permitting synthesis and comparison of future results.Copyright © 2019 British Journal of AnaesthesiaDatabase: EMBASE

59. Endoscopic Retrograde Biliary Drainage Causes Intra-Abdominal Abscess in Pancreaticoduodenectomy Patients: An Important But Neglected Risk FactorAuthor(s): Wu J.-M.; Ho T.-W.; Yen H.-H.; Wu C.-H.; Kuo T.-C.; Yang C.-Y.; Tien Y.-W.Source: Annals of Surgical Oncology; Apr 2019; vol. 26 (no. 4); p. 1086-1092Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30675700

Abstract:Background: Patients with periampullary cancer frequently suffer obstructive jaundice and commonly require preoperative biliary drainage (PBD) for relief and to avoid related complications. Although research has established a correlation between PBD and surgical wound infection, the impact of PBD on major infectious complications (intra-abdominal abscess [IAA]) and overall mortality remains debatable. We hypothesized that PBD could lead to IAA and mortality, and evaluated their correlation in patients undergoing pancreaticoduodenectomy (PD). Method(s): We enrolled patients undergoing PD at an Asian academic medical center between 2007 and 2016. The types of PBD included endoscopic retrograde biliary drainage (ERBD) and percutaneous transhepatic cholangiography and drainage (PTCD). The primary outcome was IAA, defined as the presence of pus or infected fluid inside the abdominal cavity and with documented infectious pathogens. Result(s): There was one (0.1%) 30-day mortality and eight (0.9%) 90-day mortalities among 899 consecutive patients examined. More than one-quarter of patients had PBD (n = 237, 26.4%; 165 ERBD, 72 PTCD). In the ERBD, PTCD, and non-PBD groups, the IAA rates were 37.0%, 16.7%, and 10.6%, respectively. On multivariate analysis, ERBD (odds

ratio 3.67; 95% confidence interval 2.22-6.06; p < 0.001) was the only significant factor associated with IAA. No significant factor was found to analyze variables associated with mortality. Conclusion(s): ERBD, but not PTCD, is associated with an increased risk of IAA in patients undergoing PD, which suggests that ERBD should be avoided whenever possible to prevent IAA. Further randomized clinical trials should be conducted to validate this relationship.Copyright © 2019, Society of Surgical Oncology.Database: EMBASE

60. Value of procalcitonin as a marker of surgical site infection following spinal surgeryAuthor(s): Aljabi Y.; Manca A.; Ryan J.; Elshawarby A.Source: The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland; Apr 2019; vol. 17 (no. 2); p. 97-101Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30055952Available at The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland - from ClinicalKey

Abstract:AIM: To compare the value of Procalcitonin (PCT) as a marker of surgical site infection to other inflammatory markers, including C-Reactive Protein (CRP), White Cell Count (WCC) and Erythrocyte Sedimentation Rate (ESR) in patients undergoing a number of spinal procedures. This study also aims to describe the biokinetic profile of the above-named markers in patients developing surgical site infection and those remaining infection-free post-operatively. METHOD(S): 200 patients undergoing four routine elective spinal procedures were included for analysis. All patients had blood specimens taken at baseline, day 1, 2, 3, 4 and 5 post-operatively for analysis of PCT, CRP, ESR and WCC levels. All patients were monitored for early surgical site infection. Patients with other sources of infection in the early postoperative period were excluded. RESULT(S): Procalcitonin was the most sensitive and specific marker for the detection of surgical site infection in the immediate post-operative period with sensitivity and specificity of 100% and 95.2% respectively. Although Procalcitonin is an inflammatory marker, extent of surgical physiological insult did not alter its biokinetics as opposed to the other inflammatory markers making it a valuable marker of infection. CONCLUSION(S): Procalcitonin was found to be superior to the other inflammatory markers investigated in this study as a marker for early surgical site infection in patients undergoing spinal surgery.Copyright © 2018 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.Database: EMBASE

61. The Use of Regional or Local Anesthesia for Carotid Endarterectomies May Reduce Blood Loss and Pulmonary ComplicationsAuthor(s): Malik O.S.; Brovman E.Y.; Urman R.D.Source: Journal of Cardiothoracic and Vascular Anesthesia; Apr 2019; vol. 33 (no. 4); p. 935-942Publication Date: Apr 2019

Publication Type(s): ArticlePubMedID: 30243870Available at Journal of Cardiothoracic and Vascular Anesthesia - from ClinicalKey

Abstract:Objective: Over 150,000 carotid endarterectomy (CEA) procedures are performed each year. Perioperative anesthetic management may be complex due to multiple patient and procedure-related risk factors. The authorsaimed to determine whether the use of general anesthesia (GA), when compared with regional anesthesia (RA), would be associated with reduced perioperative morbidity and mortality in patients undergoing a CEA. Design(s): Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Setting(s): The authors evaluated patients undergoing a CEA at multiple university- and community-based settings. Participant(s): A total of 43,463 patients were identified; 22,845 patients were propensity matched after excluding for missing data. Intervention(s): The study population was divided into 2 groups: patients undergoing RA or GA. The RA group included regional anesthesia performed by the anesthesiologist or surgeon, monitored anesthesia care, and local infiltration. Method(s): The primary endpoint was 30-day mortality. Secondary endpoints included surgical site infection, pulmonary complications, return to the operating room, acute kidney injury, cardiac arrest, urinary tract infection, myocardial infarction, thromboembolism, perioperative transfusion, sepsis, and days to discharge. Measurements and Main Results: Younger age, Hispanic ethnicity, body mass index <18.5, dyspnea, chronic obstructive pulmonary disease, and smoking history were associated with receiving GA. Patients with low hematocrit and low platelets were more likely to get RA. There was no mortality difference. GA was associated with a significantly higher rate of perioperative transfusions (p = 0.037) and perioperative pneumonia (p = 0.027). Conclusion(s): The use of RA over GA in CEA is associated with decreased risk of postoperative pneumonia and a reduced need for perioperative blood transfusions.Copyright © 2018 Elsevier Inc.Database: EMBASE

62. A cross-sectional evaluation of outcomes of pediatric branchial cleft cyst excisionAuthor(s): Mattioni J.; Azari S.; Hoover T.; Weaver D.; Chennupati S.K.Source: International Journal of Pediatric Otorhinolaryngology; Apr 2019; vol. 119 ; p. 171-176Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 30735909Available at International Journal of Pediatric Otorhinolaryngology - from ClinicalKey

Abstract:Objective: To examine complications following pediatric branchial cleft cyst excision by surgical specialty, demographics, and comorbid conditions. Method(s): A retrospective review of the National Surgical Quality Improvement Program database was performed. Pediatric cases from January 1, 2015 through May 1, 2017 with a current procedural terminology code of 42810 (excision branchial cleft cyst or vestige, confined to skin and

subcutaneous tissues) or 42815 (excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into the pharynx) were included. Statistical analysis was performed to assess associations between complications and surgical specialty, demographics, and comorbidities. Result(s): Of the 895 cases that met inclusion criteria, the median age was two years and there was an approximately equal number of males (46.8%) and females (53.2%). Forty-five patients (5.0%) experienced at least one 30-day complication, the most predominant of which was superficial surgical site infection. There was no statistically significant difference between complications and surgical specialty, complications and patient demographics, or complications and depth of excision. There was a statistically significant difference (p = 0.05) in the percentage of patients with a past medical history of developmental delay between those with at least one complication (11.1%) compared to those without any complications (4.2%). Conclusion and relevance: Branchial cleft excision is a generally safe procedure across surgical specialties and patient demographics. There is an association between a history of developmental delay and 30-day postoperative complications.Copyright © 2019 Elsevier B.V.Database: EMBASE

63. The Role of Bowel Preparation in Colorectal Surgery: Results of the 2012-2015 ACS-NSQIP DataAuthor(s): Klinger A.L.; Green H.; Beck D.; Kann B.; Vargas H.D.; Whitlow C.; Margolin D.; Monlezun D.J.Source: Annals of surgery; Apr 2019; vol. 269 (no. 4); p. 671-677Publication Date: Apr 2019Publication Type(s): ArticlePubMedID: 29064902

Abstract:OBJECTIVE: To analyze potential benefits with regards to infectious complications with combined use of mechanical bowel preparation (MBP) and ABP in elective colorectal resections. BACKGROUND: Despite recent literature suggesting that MBP does not reduce infection rate, it still is commonly used. The use of oral antibiotic bowel preparation (ABP) has been practiced for decades but its use is also controversial. METHOD(S): Patients undergoing elective colorectal resection in the 2012 to 2015 American College of Surgeons National Surgical Quality Improvement Program cohorts were selected. Doubly robust propensity score-adjusted multivariable regression was conducted for infectious and other postoperative complications. RESULT(S): A total of 27,804 subjects were analyzed; 5471 (23.46%) received no preparation, 7617 (32.67%) received MBP only, 1374 (5.89%) received ABP only, and 8855 (37.98%) received both preparations. Compared to patients receiving no preparation, those receiving dual preparation had less surgical site infection (SSI) [odds ratio (OR) = 0.39, P < 0.001], organ space infection (OR = 0.56, P <= 0.001), wound dehiscence (OR = 0.43, P = 0.001), and anastomotic leak (OR = 0.53, P < 0.001). ABP alone compared to no prep resulted in significantly lower rates of surgical site infection (OR = 0.63, P = 0.001), organ space infection (OR = 0.59, P = 0.005), anastomotic leak (OR = 0.53, P = 0.002). MBP showed no significant benefit to infectious complications

when used as monotherapy. CONCLUSION(S): Combined MBP/ABP results in significantly lower rates of SSI, organ space infection, wound dehiscence, and anastomotic leak than no preparation and a lower rate of SSI than ABP alone. Combined bowel preparation significantly reduces the rates of infectious complications in colon and rectal procedures without increased risk of Clostridium difficile infection. For patients undergoing elective colon or rectal resection we recommend bowel preparation with both mechanical agents and oral antibiotics whenever feasible.Database: EMBASE

64. Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial.Author(s): Hyldig, N; Vinter, C A; Kruse, M; Mogensen, O; Bille, C; Sorensen, J A; Lamont, R F; Wu, C; Heidemann, L N; Ibsen, M H; Laursen, J B; Ovesen, P G; Rorbye, C; Tanvig, M; Joergensen, J SSource: BJOG : an international journal of obstetrics and gynaecology; Apr 2019; vol. 126 (no. 5); p. 628-635Publication Date: Apr 2019Publication Type(s): Randomized Controlled Trial Pragmatic Clinical Trial Journal ArticlePubMedID: 30066454Available at BJOG : an international journal of obstetrics and gynaecology - from Wiley Available at BJOG : an international journal of obstetrics and gynaecology - from Worthing Hospital Health Sciences Library (lib327445) Local Print Collection [location] : Worthing Hospital Health Sciences Library.

Abstract:OBJECTIVETo evaluate the reduction of surgical site infections by prophylactic incisional negative pressure wound therapy compared with standard postoperative dressings in obese women giving birth by caesarean section.DESIGNMulticentre randomised controlled trial.SETTINGFive hospitals in Denmark.POPULATIONObese women (prepregnancy body mass index (BMI) ≥30 kg/m2 ) undergoing elective or emergency caesarean section.METHODThe participants were randomly assigned to incisional negative pressure wound therapy or a standard dressing after caesarean section and analysed by intention-to-treat. Blinding was not possible due to the nature of the intervention.MAIN OUTCOME MEASURESThe primary outcome was surgical site infection requiring antibiotic treatment within the first 30 days after surgery. Secondary outcomes included wound exudate, dehiscence and health-related quality of life.RESULTSIncisional negative pressure wound therapy was applied to 432 women and 444 women had a standard dressing. Demographics were similar between groups. Surgical site infection occurred in 20 (4.6%) women treated with incisional negative pressure wound therapy and in 41 (9.2%) women treated with a standard dressing (relative risk 0.50, 95% CI 0.30-0.84; number needed to treat 22; P = 0.007). The effect remained statistically significant when adjusted for BMI and other potential risk factors. Incisional negative pressure wound therapy significantly reduced wound exudate whereas no difference was found for dehiscence and quality of life between the two groups.CONCLUSIONProphylactic use of incisional negative pressure wound therapy reduced the

risk of surgical site infection in obese women giving birth by caesarean section.TWEETABLE ABSTRACTRCT: prophylactic incisional NPWT versus standard dressings postcaesarean in 876 women significantly reduces the risk of SSI.Database: Medline

65. Cost-effectiveness of incisional negative pressure wound therapy compared with standard care after caesarean section in obese women: a trial-based economic evaluation.Author(s): Hyldig, N; Joergensen, J S; Wu, C; Bille, C; Vinter, C A; Sorensen, J A; Mogensen, O; Lamont, R F; Möller, S; Kruse, MSource: BJOG : an international journal of obstetrics and gynaecology; Apr 2019; vol. 126 (no. 5); p. 619-627Publication Date: Apr 2019Publication Type(s): Randomized Controlled Trial Journal ArticlePubMedID: 30507022Available at BJOG : an international journal of obstetrics and gynaecology - from Wiley Available at BJOG : an international journal of obstetrics and gynaecology - from Worthing Hospital Health Sciences Library (lib327445) Local Print Collection [location] : Worthing Hospital Health Sciences Library.

Abstract:OBJECTIVETo evaluate the cost-effectiveness of incisional negative pressure wound therapy (iNPWT) in preventing surgical site infection in obese women after caesarean section.DESIGNA cost-effectiveness analysis conducted alongside a clinical trial.SETTINGFive obstetric departments in Denmark.POPULATIONWomen with a pregestational body mass index (BMI) ≥30 kg/m2 .METHODWe used data from a randomised controlled trial of 876 obese women who underwent elective or emergency caesarean section and were subsequently treated with iNPWT (n = 432) or a standard dressing (n = 444). Costs were estimated using data from four Danish National Databases and analysed from a healthcare perspective with a time horizon of 3 months after birth.MAIN OUTCOME MEASURESCost-effectiveness based on incremental cost per surgical site infection avoided and per quality-adjusted life-year (QALY) gained.RESULTSThe total healthcare costs per woman were €5793.60 for iNPWT and €5840.89 for standard dressings. Incisional NPWT was the dominant strategy because it was both less expensive and more effective; however, no statistically significant difference was found for costs or QALYs. At a willingness-to-pay threshold of €30,000, the probability of the intervention being cost-effective was 92.8%. A subgroup analysis stratifying by BMI shows that the cost saving of the intervention was mainly driven by the benefit to women with a pre-pregnancy BMI ≥35 kg/m2 .CONCLUSIONIncisional NPWT appears to be cost saving compared with standard dressings but this finding is not statistically significant. The cost savings were primarily found in women with a pre-pregnancy BMI ≥35 kg/m2 .TWEETABLE ABSTRACTProphylactic incisional NPWT reduces the risk of SSI after caesarean section and is probably dominant compared with standard dressings #healtheconomics.Database: Medline

66. Biofilm contamination of high-touched surfaces in intensive care units: epidemiology and potential impacts.Author(s): Costa DM; Johani K; Melo DS; Lopes LKO; Lopes Lima LKO; Tipple AFV; Hu H; Vickery KSource: Letters in applied microbiology; Apr 2019; vol. 68 (no. 4); p. 269-276Publication Date: Apr 2019Publication Type(s): Journal ArticlePubMedID: 30758060

Abstract:The aim of this study was to determine the epidemiology (location, microbial load, microbiome, presence/absence of biofilm and pathogens, including ESKAPE-Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species, and antimicrobial susceptibility profiles) of the bacterial contamination on intensive care units (ICUs) surfaces. Fifty-seven high-touched surfaces were collected from adult, paediatric and neonatal ICUs from two large public Brazilian hospitals from central and north regions. Samples (c. 4 cm2 ) were subjected to culture (qualitative), qPCR targeting 16s rRNA gene (microbial load-bacteria per cm2 ), 16s rRNA amplicon sequencing (microbiome analysis) and scanning electron (SEM) or confocal laser scanning microscopy (CLSM) (biofilm presence). Multidrug resistant organisms (MROs) were detected using specific chromogenic agar. The average bacterial load was 1·32 × 104 bacteria per cm2 , container for newborn feeding bottles, stretcher mattress, humidicrib mattress filling and computer keyboards presented the higher bioburden. However, only 45·6% (26/57) were culture-positive, including 4/26 with MROs. ESKAPE organisms were detected in 51·8% of the samples subjected to next-generation sequencing. Viability staining and CLSM demonstrated live bacteria on 76·7% of culture-negative samples. Biofilm was present on all surfaces subjected to microscopy (n = 56), demonstrating that current cleaning practices are suboptimal and reinforcing that MROs are incorporated into hospital surfaces biofilm. SIGNIFICANCE AND IMPACT OF THE STUDY: Contamination of healthcare facilities surfaces has been shown to play a major role in transmission of pathogens. The findings of this study show that dry surface biofilms are widespread and can incorporate pathogens and multidrug-resistant organisms (MROs). Biofilms on highly touched surfaces pose a risk to patients, as dry surface biofilms persist for long period and micro-organisms within biofilm have been shown to be transmitted. This study also provides a better understanding of microbial populations in hospital environments, reinforcing that pathogens and MROs are found incorporated into biofilm, which impacts the difficulty in cleaning/disinfection.Database: PubMed

67. PACMAN trial protocol, Perioperative Administration of Corticotherapy on Morbidity and mortality after Non-cardiac major surgery: A randomised, multicentre, double-blind, superiority studyAuthor(s): Asehnoune K.; Futier E.; Feuillet F.; Roquilly A.Source: BMJ Open; Mar 2019; vol. 9 (no. 3)Publication Date: Mar 2019Publication Type(s): Review

Available at BMJ Open - from Europe PubMed Central - Open Access Available at BMJ Open - from HighWire - Free Full Text

Abstract:Introduction Postoperative complications are major healthcare problems and are associated with a reduced short-Term and long-Term survival after surgery. An excessive postoperative inflammatory response participates to the development of postoperative infection and mortality. The aim of the Perioperative Administration of Corticotherapy on Morbidity and mortality After Non-cardiac surgery (PACMAN) study is to assess the effectiveness of perioperative administration of corticosteroid to reduce postoperative morbidity and mortality in patients undergoing major non-cardiac surgery. Methods and analysis The PACMAN is a multicentre, randomised, controlled, double-blind, superiority, two-Arm trial of 1222 high-risk patients aged 50 years or older undergoing major non-cardiac surgery at 32 acute care hospital in France. Patients are randomly assigned to dexamethasone (0.2 mg/kg at the end of the surgical procedure and at day +1, n=611) or to placebo (n=611). The primary outcome is a composite of predefined 14-day major pulmonary complications and mortality. Secondary outcomes are surgical complications, infections, organ failures, critical care-free days, length of hospital stay and all-cause mortality at 28 days. Ethics and dissemination The PACMAN trial protocol has been approved by the ethics committee of Sud Mediterranee V, and will be carried out according to the Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. The PACMAN trial is a randomised controlled trial powered to investigate whether perioperative administration of corticosteroids in patients undergoing non-cardiac major surgery reduces postoperative complications. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. Trial registration number NCT03218553; Pre-results.Copyright © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Database: EMBASE

68. Outcome of no oral antibiotic prophylaxis and bowel preparation in Crohn's diseases surgeryAuthor(s): Unger L.W.; Riss S.; Argeny S.; Bergmann M.; Bachleitner-Hofmann T.; Stift A.; Herbst F.Source: Wiener Klinische Wochenschrift; Mar 2019; vol. 131 (no. 5); p. 113-119Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30840131

Abstract:Background: Recent studies support the use of mechanical bowel preparation and/or oral antibiotic prophylaxis in patients operated on for Crohn's disease (CD); however, data are scarce, especially for laparoscopic surgery. Therefore, this study was carried out to investigate the effect of laparoscopic surgery on complication rates in patients not undergoing standardized bowel preparation but single shot antibiotics. Method(s): In this study 255 consecutive patients who underwent a laparoscopic intestinal resection for CD at a tertiary referral center between 1997 and 2014 were retrospectively analyzed.

Superficial surgical site infections (SSI), organ/space infections and ileus were recorded and grouped according to the type of resection (colorectal vs. small intestine+/- ileocecal). Result(s): The baseline characteristics of the groups were comparable. Colorectal resections showed a significantly increased risk of organ/space infection (4.6% in small intestine+/- ileocecal vs. 14.3% in colorectal resections p= 0.039). The superficial SSI rate was low in both groups (1.8% in small intestine+/- ileocecal resection vs. 0% in colorectal resections, p= 1.000). Univariate binary logistic regression analysis revealed a statistically significant influence of duration of surgery (p= 0.001) and type of resection (p= 0.031) on organ/space infection. In multivariate analysis, only duration of surgery (OR 1.111, 95% CI 1.026-1.203 for every 10min, p= 0.009) remained significant for postoperative organ/space infections. Conclusion(s): Single-shot antibiotic therapy without bowel preparation is safe in patients undergoing minimally invasive surgery and was associated with a low number of complications; however, organ/space infections were more common if colorectal resections were performed. Therefore, combined bowel preparation might be beneficial when the (sigmoid) colon or rectum are involved.Copyright © 2019, The Author(s).Database: EMBASE

69. Errors in packaging surgical instruments based on a surgical instrument tracking system: an observational studyAuthor(s): Zhu X.; Yuan L.; Li T.; Cheng P.Source: BMC health services research; Mar 2019; vol. 19 (no. 1); p. 176Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30890128Available at BMC health services research - from BioMed Central Available at BMC health services research - from Europe PubMed Central - Open Access Available at BMC health services research - from Proquest_New_Platform

Abstract:BACKGROUND: Surgical instrument processing is important for improving the safety of surgical care in hospitals. However, it has been rarely studied to date. Errors in surgical instrument processing may increase operative times and costs, and increase the risk of surgical infections and perioperative morbidity. We aimed to investigate the errors occurred in packaging surgical instruments. METHOD(S): Surgical instrument tracking system in a central sterile supply department (CSSD) was used to collect the packaging data during January-August 2016 in the First Affiliated Hospital of Soochow University, Suzhou City, China. RESULT(S): Data on 33,839 surgical instrument packages were collected. A total of 398 (1.18%) errors occurred, including incomplete packages (n=70), instrument missing (n=77), instrument malfunction (n=27), instrument in wrong specification (n=175), wrong packaging tag (n=8), box and cover mismatched (n=14), wrong packing material (n=15), indicator card missing (n=6), and wrong count of instruments (n=6). The highest error rates were observed among least experienced nurses (N1 level) and during the 16:00-20:00 time period (both p<0.05). A

relatively high error rate was detected in the Department of Orthopedics as well as in the Department of Gynecology and Obstetrics. CONCLUSION(S): Wrong instrument specifications were the primary packing error identified in the current study. Further effort is needed to standardize the packing procedure for instruments under the same category and more effort is required to reduce the error rate during high risk times, or in the surgery department.Database: EMBASE

70. Risk factors for surgical site infections in neurosurgeryAuthor(s): Patel S.; Thompson D.; Narbad V.; Selway R.; Barkas K.; Innocent S.Source: Annals of the Royal College of Surgeons of England; Mar 2019; vol. 101 (no. 3); p. 220-225Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30698457

Abstract:INTRODUCTION: Surgical site infections (SSIs) are of profound significance in neurosurgical departments, resulting in high morbidity and mortality. There are limited public data regarding the incidence of SSIs in neurosurgery. The aim of this study was to determine the rate of SSIs (particularly those requiring reoperation) over a seven-year period and identify factors leading to an increased risk. METHOD(S): An age matched retrospective analysis was undertaken of a series of 16,513 patients at a single centre. All patients who required reoperation for suspected SSIs within a 7-year period were identified. Exclusion criteria comprised absence of infective material intraoperatively and patients presenting with primary infections. Clinical notes were reviewed to confirm presence or absence of suspected risk factors. RESULT(S): Of the 16,513 patients in the study, 1.20% required at least one further operation to treat a SSI. Wound leak (odds ratio [OR]: 27.41), dexamethasone use (OR: 3.55), instrumentation (OR: 2.74) and operative duration >180 minutes (OR: 1.85) were statistically significant risk factors for reoperation. CONCLUSION(S): This is the first UK study of such a duration that has documented a SSI reoperation rate in a cohort of this size. Various risk factors are associated with the development of SSIs, making it essential to have robust auditing and monitoring of high risk patients to ensure excellent standards of healthcare. Departmental and public registers to record all SSIs may be beneficial, particularly for those treated solely by general practitioners, allowing units to address potential risk factors prior to surgical intervention.Database: EMBASE

71. Suture choice to reduce occurrence of surgical site infection, hernia, wound dehiscence and sinus/fistula: a network meta-analysisAuthor(s): Zucker B.E.; Simillis C.; Tekkis P.; Kontovounisios C.Source: Annals of the Royal College of Surgeons of England; Mar 2019; vol. 101 (no. 3); p. 150-161Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30286645

Abstract:BACKGROUND: There are many options and little guiding evidence when choosing suture types with which to

close the abdominal wall fascia. This network meta-analysis investigated the effect of suture materials on surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence after abdominal surgery. The aim was to provide clarity on whether previous recommendations on suture choice could be followed with confidence. METHODS AND METHODS: In February 2017, the Cochrane Central Register of Controlled Trials, Medline, EMBASE and Science Citation Index Expanded were searched for randomised controlled trials investigating the effect of suture choice on these four complications in closing the abdomen. A reference search of identified trials was performed. Prisma guidelines and the Cochrane risk of bias tool were followed in the data extraction and synthesis. Two review authors screened titles and abstracts of trials identified. A random effect model was used for the surgical site infection network based on the deviance information criterion statistics. RESULT(S): Thirty-one trials were included (11,533 participants). No suture material reached the predetermined 90% probability threshold for determination of 'best treatment' for any outcome. Pairwise comparisons largely showed no differences between suture types for all outcomes measured. However, nylon demonstrated a reduction in the occurrence of incisional hernias with respect to two commonly used absorbable sutures: polyglycolic acid (odds ratio, OR 1.91; 95% confidence interval, CI, 1.01-3.63) and polyglyconate (OR 2.18; 95% CI 1.17-4.07). CONCLUSION(S): No suture type can be considered the 'best treatment' for the prevention of surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence.Database: EMBASE

72. Beyond Death and Graft Survival - Variation in Outcomes after Liver Transplant. Results from the NSQIP Transplant Beta PhaseAuthor(s): Parekh J.R.; Greenstein S.; Sudan D.L.; Grieco A.; Cohen M.E.; Hall B.L.; Ko C.Y.; Hirose R.Source: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons; Mar 2019Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30887634Available at American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons - from Wiley

Abstract:The National Surgical Quality Program (NSQIP) Transplant program was designed by transplant surgeons from the ground up to track post-transplant outcomes beyond basic recipient and graft survival. After an initial pilot phase, the program has expanded to 29 participating sites and enrolled more than 4300 recipient-donor pairs into the database, including 1444 completed liver transplant cases. In this analysis, surgical site infection (SSI), urinary tract infection (UTI) and unplanned re-operation/intervention after liver transplantation were evaluated. We observed impressive variation in the crude incidence between sites for SSI (0-29%), UTI (0-10%) and re-operation/intervention (0-57%). After adjustment for donor and recipient factors; at least one site was identified as an outlier for each of the analyzed outcomes. For the first

time, the field of transplantation has data which demonstrates variation in liver recipient outcomes beyond death and graft survival between sites. More importantly, NSQIP Transplant provides a powerful platform to improve care beyond basic patient and graft survival. This article is protected by copyright. All rights reserved.Database: EMBASE

73. Surgical Site Infections in Aesthetic SurgeryAuthor(s): Kaoutzanis C.; Kumar N.G.; Winocour J.; Higdon K.K.; Hood K.Source: Aesthetic surgery journal; Mar 2019Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30892625

Abstract:Surgical site infections represent one of the most common postoperative complications in patients undergoing aesthetic surgery. As with other postoperative complications, the incidence of these infections may be influenced by many factors, and varies depending on the specific operation performed. Understanding of the risk factors for the development of these infections is critical since careful patient selection and appropriate perioperative counselling will set the right expectations, and can ultimately improve patient outcomes and satisfaction. Various perioperative prevention measures may also be employed to minimize the incidence of these infections. Once the infection occurs, prompt diagnosis will allow management of the infection and any associated complications in a timely manner to ensure patient safety, optimize the postoperative course and avoid long-term sequelae.Copyright © 2019 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.Database: EMBASE

74. Gender Disparity in Surgery: An Evaluation of Surgical SocietiesAuthor(s): Lyons N.B.; Bernardi K.; Huang L.; Holihan J.L.; Cherla D.; Martin A.C.; Milton A.; Ko T.C.; Liang M.K.; Loor M.; Hydo L.Source: Surgical infections; Mar 2019Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30892131

Abstract:BACKGROUND: The percentage of female surgeons and surgery residents has increased slowly to 24% and 35%, respectively. However, women remain under-represented in surgical leadership positions (<20%). Society awards and leadership positions are used for hiring and promoting surgeons. We hypothesized that within the Surgical Infection Society (SIS), females are under-represented. METHOD(S): The SIS website and databases were consulted for the number of female members, awardees, and leaders. Representation was divided into four time periods: 2000-2005, 2006-2010, 2011-2015, and 2016-2017 and compared for changes over time utilizing a X2 test. In addition, we reviewed the council members of five other surgical societies and compared the percentage of female representation in leadership positions. RESULT(S): Since the SIS was founded, there have been 587 members of whom only 135 (23%) are female. There has been an

increase in female membership over time (p<0.001). The number of female awardees rose from 37% during the first two study periods to more than 50% in the last two periods (p=0.002). However, female representation in leadership positions decreased from 26% in 2000-2005 to less than 15% in the last three study periods (p=0.234). Similar disparities emerged when comparing the SIS with other surgical societies: Women have represented only 24% (range 8%-42%) of leaders and 4% (range 0-11%) of society presidents. CONCLUSION(S): Female surgeons are under-represented in the SIS membership and leadership positions. Whereas the number of female surgeons and residents has increased, these trends have not occurred with council membership and leadership within the SIS. There is a need to address this gender disparity.Database: EMBASE

75. Evaluation of antibiotic prophylaxis for gastrointestinal surgeries in a teaching hospital: An interventional pre-post studyAuthor(s): Elyasi S.; Atamanesh A.; Fattahi Masum A.; Abdollahi A.; Bahreyni A.; Samani S.S.; Mousavi M.Source: Journal of perioperative practice; Mar 2019Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30888937

Abstract:Surgical site infections are related to a high morbidity, mortality and healthcare costs. Despite ample evidence demonstrating the effectiveness of antimicrobials to prevent surgical site infections, inappropriate timing, antibiotic selection and excessive continuation of antibiotics are common in practice. In this study, we compare the appropriateness of antibiotic prophylaxis in gastrointestinal surgery, before and after an evidence-based guideline implementation. One hundred patients were evaluated in each group. The implementation of the guideline resulted in significant reduction of incorrect use of antibiotics from 55% to 18% (P=0.002). It also reduced duration of prophylactic antibiotics (43% vs. 23%, P=0.025). Inappropriate doses diminished but not significantly (8% vs. 5%, P=0.321). Based on our results, in more than half of of these cases patients received incorrect antibiotic prophylaxis regimens for gastrointestinal surgery in this hospital. Local guideline implementation can result in reduction of antibiotic use, dose and duration errors.Database: EMBASE

76. Temperature-responsive PNDJ hydrogels provide high and sustained antimicrobial concentrations in surgical sitesAuthor(s): Overstreet D.J.; Badha V.S.; Heffernan J.M.; Childers E.P.; Moore R.C.; McLaren A.C.; Vernon B.L.Source: Drug delivery and translational research; Mar 2019Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30891707

Abstract:Local antimicrobial delivery is a promising strategy for improving treatment of deep surgical site infections (SSIs) by eradicating bacteria that remain in the wound or around its margins after surgical debridement. Eradication of biofilm bacteria can require sustained exposure to high antimicrobial concentrations (we estimate 100-1000

mug/mL sustained for 24 h) which are far in excess of what can be provided by systemic administration. We have previously reported the development of temperature-responsive hydrogels based on poly(N-isopropylacrylamide-co-dimethylbutyrolactone acrylate-co-Jeffamine M-1000 acrylamide) (PNDJ) that provide sustained antimicrobial release in vitro and are effective in treating a rabbit model of osteomyelitis when instilled after surgical debridement. In this work, we sought to measure in vivo antimicrobial release from PNDJ hydrogels and the antimicrobial concentrations provided in adjacent tissues. PNDJ hydrogels containing tobramycin and vancomycin were administered in four dosing sites in rabbits (intramedullary in the femoral canal, soft tissue defect in the quadriceps, intramuscular injection in the hamstrings, and intra-articular injection in the knee). Gel and tissue were collected up to 72 h after dosing and drug levels were analyzed. In vivo antimicrobial release (43-95% after 72 h) was markedly faster than in vitro release. Drug levels varied significantly depending on the dosing site but not between polymer formulations tested. Notably, total antimicrobial concentrations in adjacent tissue in all dosing sites were sustained at estimated biofilm-eradicating levels for at least 24 h (461-3161 mug/mL at 24 h). These results suggest that antimicrobial-loaded PNDJ hydrogels are promising for improving the treatment of biofilm-based SSIs.Database: EMBASE

77. The cost-effectiveness of ertapenem for the treatment of chorioamnionitis after cesarean deliveryAuthor(s): Lim S.L.; Havrilesky L.J.; Heine R.P.; Dotters-Katz S.Source: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians; Mar 2019 ; p. 1-11Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30885073

Abstract:BACKGROUND: Chorioamnionitis affects 1-4% of pregnancies, and patients who undergo cesarean delivery in the setting of chorioamnionitis have an increased risk of endometritis and surgical site infection. The standard treatment for chorioamnionitis after cesarean delivery is a combination regimen of intravenous ampicillin, gentamicin, and clindamycin with variable duration (single dose to 24 hours). However, newer evidence suggests that ertapenem may decrease the risk of postoperative infectious morbidity with the added benefit of a single postpartum dose, compared to between 3-10 doses of AGC. Concerns regarding the cost of ertapenem have been cited as a deterrent for this regimen. OBJECTIVE(S): The objective of this study was to investigate the cost-effectiveness of single dose ertapenem compared to existing standard regimens. METHOD(S): A decision analytic cost-effectiveness model was designed from a hospital perspective to compare four strategies for the postpartum management of chorioamnionitis after cesarean delivery: (1) No antibiotics; (2) a one-time intravenous dose of ampicillin, gentamicin, and clindamycin (AGC-1); (3) 24-hour coverage with intravenous ampicillin, gentamicin, and clindamycin (AGC-

24); (4) intravenous ertapenem, 1 dose. Medical costs, rates of surgical site infection (SSI) and endometritis following cesarean delivery, and costs of postcesarean infection (SSI or endometritis) were abstracted from the literature. Antibiotic drug costs were obtained from the pharmacy department at a private academic hospital. The cost of each regimen was calculated as costs to the hospital and included antibiotics (no antibiotics $0, AGC-1 $66, ertapenem $140, and AGC-24 $208), administration, and labor costs. Effectiveness was quantified as percentage of patients who avoided postcesarean infectious morbidity (endometritis or SSI). RESULT(S): The base case cost of each strategy was: AGC-1 $704, ertapenem $733, AGC-24 $846, and no antibiotics $971. Ertapenem had an effectiveness of 88%, AGC-1 and AGC-24 were 87% each, and no antibiotics was 81%. No antibiotics and AGC-24 were more costly and equally or less effective than comparators (dominated strategies). Ertapenem was more costly, but more effective than AGC-1, with an incremental cost-effectiveness ratio of $3738 per infection avoided. In a sensitivity analysis comparing ertapenem to the most commonly used strategy of ACG-24, the ertapenem strategy remained less costly if the rate of endometritis with ertapenem was less than 11% (base case estimate 8%) or the rate of SSI with ertapenem was less than 7% (base case estimate 4%). CONCLUSION(S): Ertapenem is a cost saving alternative to 24-hour AGC treatment for chorioamnionitis in the setting of cesarean delivery, and may be considered a cost-effective treatment when compared to a one time dose of AGC depending on infection rates.Database: EMBASE

78. Modifiable Factors as Current Smoking, Hypoalbumin, and Elevated Fasting Blood Glucose Level Increased the SSI Risk Following Elderly Hip Fracture SurgeryAuthor(s): Ma T.; Lu K.; Song L.; Wang D.; Ning S.; Chen Z.; Wu Z.Source: Journal of investigative surgery : the official journal of the Academy of Surgical Research; Mar 2019 ; p. 1-9Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30885013

Abstract:OBJECTIVE: Surgical site infection (SSI) following hip fractures represents an important complication. This study aimed to investigate the incidence rate after surgery of hip fractures in the elderly and to identify the associated risk factors. PATIENTS: Patients' demographic, injury, and surgery-related data and biochemical indexes were retrospectively reviewed and recorded during their hospitalization, between July 2015 and June 2017. After their discharge from hospital, patients were prospectively followed up at postoperative 1, 3, 6, and 12months. SSIs were identified by review of patients' medical records and post-discharge telephone follow-up. Univariate and multivariate analyses were performed to determine the independent risk factors associated with SSI. RESULT(S): A total of 611 patients undergoing surgery for hip fractures with complete data were included for analysis. During the postoperative one year, 27 SSIs (19 superficial and 8 deep SSIs) developed, indicating the cumulative incidence of 4.4% (95%CI, 2.8-6.0%). Of them, 21 (77.8%) SSIs were detected during patients' hospitalization, and the 6 (22.2%)

cases were confirmed via telephone during the post-discharge follow-up. After adjustment of multiple variables, BMI, current smoking, surgical duration, preoperative hospital stay, ASA class of III-IV, ALB <35g/L, and FBG > 110mg/dL were identified as independent risk factors for SSI. CONCLUSION(S): Three modifiable factors as smoking, preoperative ALB <35g/L, and FBG > 110mg/dL should be optimized preoperatively to reduce the SSIs. Other factors, although not modifiable, could be used for screening of at-risk patients, patient risk stratification, or for counseling of patients.Database: EMBASE

79. Immunosuppressed Patients with Crohn's Disease Are at Increased Risk of Postoperative Complications: Results from the ACS-NSQIP DatabaseAuthor(s): Abou Khalil M.; Vasilevsky C.-A.; Morin N.; Ghitulescu G.; Boutros M.; Abou-Khalil J.; Motter J.Source: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract; Mar 2019Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30887300

Abstract:BACKGROUND: The impact of immunosuppressants on postoperative complications following colon resections for Crohn's disease remains controversial. This study aimed to compare postoperative outcomes between immunosuppressed and immunocompetent patients with Crohn's disease undergoing elective colon resection. METHOD(S): Analysis of 30-day outcomes using a cohort from the American College of Surgeons National Surgical Quality Improvement Program colectomy-specific database was performed. The database is populated by trained clinical reviewers who collect 30-day postoperative outcomes for patients treated at participating North-American institutions. Adult patients who underwent an elective colectomy between 2011 and 2015 were included. Immunosuppression for Crohn's disease was predefined as use of regular corticosteroids or immunosuppressants within 30 days of the operation. Patients who received chemotherapy within 90 days of surgery, and patients who had disseminated cancer, preoperative shock, or emergency surgery were excluded. Primary outcome was infectious complications. RESULT(S): Three thousand eight hundred sixty patients with Crohn's disease required elective colon resection and met the inclusion criteria. Of these, 2483 were immunosuppressed and 1377 were immunocompetent. On multivariate analysis, the odds of infectious complications [OR 1.25; 95% CI (1.033-1.523)], overall surgical site infection [1.40; (1.128-1.742)], organ space surgical site infection [1.47; (1.094-1.984)], and anastomotic leak [1.51; (1.018-2.250)] were significantly higher for immunosuppressed compared to immunocompetent patients with Crohn's disease. CONCLUSION(S): Patients with Crohn's disease who were on immunosuppressant medications within 30 days of elective colectomy had significantly increased rates of infectious complications, overall surgical site infection, organ space surgical site infection, and anastomotic leak compared to patients who were not on immunosuppressive agents.Database: EMBASE

80. Update on Prevention of Surgical Site InfectionsAuthor(s): Schulz J.T.Source: Current Trauma Reports; Mar 2019; vol. 5 (no. 1)Publication Date: Mar 2019Publication Type(s): Review

Abstract:Purpose of Review: This review summarizes recent surgical site infection (SSI) prevention guidelines/guideline updates that are relevant to surgery and wound care after injury and reviews a sample of recent literature relevant to SSI. Recent Findings: The quality of evidence supporting guidelines/guideline updates is quite variable. The strongest support is for appropriately timed preoperative antibiotics when indicated and for alcohol-based skin preparation before incision when feasible. Summary: New guidelines for SSI prevention are available from the American College of Surgeons, the Centers for Disease Control, and the World Health Organization. There are recommendations common to all three reports that trauma/acute care surgeons should be aware of.Copyright © 2019, Springer Nature Switzerland AG.Database: EMBASE

81. Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: A multi-center, retrospective cohort study 11 Medical and Health Sciences 1117 Public Health and Health ServicesAuthor(s): Branch-Elliman W.; Abdulkerim H.; Rosen A.K.; Charns M.P.; Mull H.J.; Gold H.S.; Itani K.M.F.; Pizer S.D.; Dasinger E.A.; Hawn M.T.Source: Antimicrobial Resistance and Infection Control; Mar 2019; vol. 8 (no. 1)Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30886702Available at Antimicrobial Resistance and Infection Control - from BioMed Central Available at Antimicrobial Resistance and Infection Control - from Europe PubMed Central - Open Access Available at Antimicrobial Resistance and Infection Control - from Proquest_New_Platform

Abstract:Background: Guidelines recommend discontinuation of antimicrobial prophylaxis within 24 h after incision closure in uninfected patients. However, how facility and surgical specialty factors affect the implementation of these evidence-based surgical prophylaxis guidelines in outpatient surgery is unknown. Thus, we sought to measure how facility complexity, including ambulatory surgical center (ASC) status and availability of ancillary services, impact adherence to guidelines for timely discontinuation of antimicrobial prophylaxis after outpatient surgery. A secondary aim was to measure the association between surgical specialty and guideline compliance. Method(s): A multi-center, national Veterans Health Administration retrospective cohort from 10/1/2015-9/30/2017 including any Veteran undergoing an outpatient surgical procedure in any of five specialties (general surgery, urology, ophthalmology, ENT, orthopedics) was created. The primary outcome was the association between facility complexity and proportion of surgeries not compliant with discontinuation of

antimicrobials within 24 h of incision closure. Data were analyzed using logistic regression with adjustments for patient and procedural factors. Result(s): Among 153,097 outpatient surgeries, 7712 (5.0%) received antimicrobial prophylaxis lasting > 24 h after surgery; rates ranged from 0.4% (eye surgeries) to 13.7% (genitourinary surgeries). Cystoscopies and cystoureteroscopy with lithotripsy procedures had the highest rates (16 and 20%), while hernia repair, cataract surgeries, and laparoscopic cholecystectomies had the lowest (0.2-0.3%). In an adjusted logistic regression model, lower complexity ASC and hospital outpatient departments had higher odds of prolonged antimicrobial prophylaxis compared to complex hospitals (OR ASC, 1.3, 95% CI: 1.2-1.5). Patient factors associated with higher odds of noncompliance with antimicrobial discontinuation included younger age, female sex, and white race. Genitourinary and ear/nose/throat surgeries were associated with the highest odds of prolonged antimicrobial prophylaxis. Conclusion(s): Facility complexity appears to play a role in adherence to surgical infection prevention guidelines. Lower complexity facilities with limited infection prevention and antimicrobial stewardship resources may be important targets for quality improvement. Such interventions may be especially useful for genitourinary and ear/nose/throat surgical subspecialties. Increasing pharmacy, antimicrobial stewardship and/or infection prevention resources to promote more evidence-based care may support surgical providers in lower complexity ambulatory surgery centers and hospital outpatient departments in their efforts to improve this facet of patient safety.Copyright © 2019 The Author(s).Database: EMBASE

82. Early hospital readmission after kidney transplantation under a public health care systemAuthor(s): Tavares M.G.; Cristelli M.P.; Ivani de Paula M.; Viana L.; Felipe C.R.; Proenca H.; Aguiar W.; Wagner Santos D.; Tedesco-Silva Junior H.; Medina Pestana J.O.Source: Clinical Transplantation; Mar 2019; vol. 33 (no. 3)Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30580452Available at Clinical Transplantation - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS

Abstract:Early hospital readmission (EHR) is associated with increased mortality after kidney transplantation. This is influenced by population demographics and the comprehensiveness of the healthcare system. We investigated the incidence and risk factors associated with EHR and 1-year patient and graft survivals. Method(s): We included all recipients of kidney transplant between 2011 and 2012. We excluded recipients younger than 18 years, retransplants and who died or lost the graft during the index hospital admission. Result(s): Among 1175 recipients, the incidence of EHR was 26.6%. The main reasons for EHR were infection (67%), surgical complications (14%), and metabolic disturbances (11%). Independent risk factors associated with EHR were recipient age (OR = 1.95, 95% CI 1.46-2.63, P < 0.001), CMV serology negative (OR = 2.2, 95% CI 1.31-3.65, P = 0.003), use of rabbit anti-thymocyte globulin (OR = 2.06, 95% CI 1.33-3.13, P < 0.001), treatment

for acute rejection during index hospitalization (OR = 1.68, 95% CI 1.15-2.47, P = 0.008), and length of stay (OR = 1.72, 95% CI 1.18-2.5, P = 0.005). Patient (88.8% vs 97.6%, P < 0.001) and death-censored graft (97.4% vs 99.0%, P < 0.001) survivals were inferior comparing patients with and without EHR. Conclusion EHR was independently associated with mortality (OR 4.01, 95% CI 2.13-7.54, P < 0.001), but its incidence and causes are directly related to the local characteristics of the population and healthcare system.Copyright © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons LtdDatabase: EMBASE

83. Implementation strategies to reduce surgical site infections: A systematic reviewAuthor(s): Ariyo P.; Latif A.; Berenholtz S.; Zayed B.; Riese V.; Anton B.; Kilpatrick C.; Allegranzi B.Source: Infection Control and Hospital Epidemiology; Mar 2019; vol. 40 (no. 3); p. 287-300Publication Date: Mar 2019Publication Type(s): ReviewPubMedID: 30786946

Abstract:Background: Surgical site infections (SSIs) portend high patient morbidity and mortality. Although evidence-based clinical interventions can reduce SSIs, they are not reliably delivered in practice, and data are limited on the best approach to improve adherence. Objective(s): To summarize implementation strategies aimed at improving adherence to evidence-based interventions that reduce SSIs. Design(s): Systematic reviewMethods: We searched PubMed, Embase, CINAHL, the Cochrane Library, the WHO Regional databases, AFROLIB, and Africa-Wide for studies published between January 1990 and December 2015. The Effective Practice and Organization Care (EPOC) criteria were used to identify an acceptable-quality study design. We used structured forms to extract data on implementation strategies and grouped them into an implementation model called the Four Es framework (ie, engage, educate, execute, and evaluate). Result(s): In total, 125 studies met our inclusion criteria, but only 8 studies met the EPOC criteria, which limited our ability to identify best practices. Most studies used multifaceted strategies to improve adherence with evidence-based interventions. Engagement strategies included multidisciplinary work and strong leadership involvement. Education strategies included various approaches to introduce evidence-based practices to clinicians and patients. Execution strategies standardized the interventions into simple tasks to facilitate uptake. Evaluation strategies assessed adherence with evidence-based interventions and patient outcomes, providing feedback of performance to providers. Conclusion(s): Multifaceted implementation strategies represent the most common approach to facilitating the adoption of evidence-based practices. We believe that this summary of implementation strategies complements existing clinical guidelines and may accelerate efforts to reduce SSIs.Copyright © 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.Database: EMBASE

84. Purse-string approximation vs. primary closure with a drain for stoma reversal surgery: results of a randomized clinical trialAuthor(s): Amamo K.; Ishida H.; Kumamoto K.; Okada N.; Hatano S.; Chika N.; Tajima Y.; Ohsawa T.; Yokoyama M.; Ishibashi K.; Mochiki E.Source: Surgery Today; Mar 2019; vol. 49 (no. 3); p. 231-237Publication Date: Mar 2019Publication Type(s): Article

Abstract:Purpose: Stoma reversal carries a risk of surgical site infection (SSI). Purse-string approximation (PSA) has been reported as an attractive alternative to conventional primary wound closure for stoma reversal, but its efficacy is still under debate. Method(s): Patients undergoing elective stoma reversal were randomized to undergo PSA or primary closure with a drain (PCD). All patients received preoperative bowel cleansing and antimicrobial prophylaxis. The primary endpoint was the incidence of wound healing at the stoma site 30 days after surgery. The secondary endpoint was the 30-day SSI rate after surgery. Result(s): A total of 159 patients (PCD group, n = 79; PSA group, n = 80) were eligible for this study. The incidence of wound healing at the stoma site was 92.4% in the PCD group and 62.5% in the PSA group [difference (95% confidence interval - 29.9% (- 42.9 to - 16.9%)]. The 30-day SSI rate at the stoma site, as the secondary endpoint, was 8.9% in the PCD group and 5.0% in the PSA group (P = 0.35). Conclusion(s): These results suggest that PCD may remain the standard procedure for stoma reversal surgery.Copyright © 2018, Springer Nature Singapore Pte Ltd.Database: EMBASE

85. Clinical application of dual-phase F-18 sodium-fluoride bone PET/CT for diagnosing surgical site infection following orthopedic surgeryAuthor(s): Lee J.W.; Yu S.N.; Jeon M.H.; Chang S.-H.; Yoo I.D.; Lee S.M.; Hong C.-H.; Shim J.-J.Source: Medicine; Mar 2019; vol. 98 (no. 11)Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30882648Available at Medicine - from Europe PubMed Central - Open Access Available at Medicine - from IngentaConnect - Open Access Available at Medicine - from Ovid (Journals @ Ovid) - Remote Access

Abstract:F-18 sodium-fluoride (NaF) bone positron emission tomography (PET/CT) has been used for diagnosing various bone and joint diseases, and, with using dual-phase scan protocol, it could give the same information obtained by the 3-phase bone scintigraphy. The present study aimed to evaluate the diagnostic ability of dual-phase F-18 NaF bone PET/CT in detecting surgical site infection after orthopedic surgery.Twenty-three patients who underwent dual-phase F-18 NaF bone PET/CT under clinical suspicion of surgical site infection of the bone following orthopedic surgery were enrolled in this study. Dual-phase bone PET/CT consisted of an early phase scan performed immediately after radiotracer injection and a

conventional bone-phase scan. All dual-phase PET/CT images were visually assessed, and, for quantitative analysis, 6 parameters of dual-phase PET/CT (lesion-to-blood pool uptake ratio, lesion-to-bone uptake ratio, and lesion-to-muscle uptake ratio on both early phase and bone-phase scans) were measured.Surgical site infection was diagnosed in 14 patients of the 23 patients. The sensitivity, specificity, and accuracy of visual analysis of dual-phase F-18 NaF bone PET/CT for diagnosing surgical site infection of the bone were 92.9%, 100.0%, and 95.7%, respectively. Among the 6 parameters, the lesion-to-blood pool uptake ratio on early phase scan showed the highest area under the receiver operating characteristic curve value (0.857, 95% confidence interval, 0.649-0.966), with the cut-off value of 0.88 showing sensitivity, specificity, and accuracy of 85.7%, 88.9%, and 87.0%, respectively.Our study showed the high diagnostic ability of dual-phase F-18 NaF bone PET/CT for detecting surgical site infection following orthopedic surgery. Further studies are needed to compare the diagnostic ability of dual-phase bone PET/CT with other imaging modalities.Database: EMBASE

86. Incidence and risk of surgical site infection after adult femoral neck fractures treated by surgery: A retrospective case-control studyAuthor(s): Ji C.; Zhu Y.; Liu S.; Li J.; Zhang F.; Chen W.; Zhang Y.Source: Medicine; Mar 2019; vol. 98 (no. 11)Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30882697Available at Medicine - from Europe PubMed Central - Open Access Available at Medicine - from IngentaConnect - Open Access Available at Medicine - from Ovid (Journals @ Ovid) - Remote Access

Abstract:Surgical site infections (SSI) are devastating complications after surgery for femoral neck fractures. There are a lot of literature have shown a strong association between diabetic patients and SSI. This study aimed to identify diabetes as an independent risk factor of SSI, focusing on femoral neck fractures, and to investigate the other potential risk factors for SSI.We retrospectively collected data from patients who underwent surgery for femoral neck fractures through the medical record management system at a single level 1 hospital between January 2015 and June 2016. Demographic and clinical patient factors and characteristics of SSI were recorded. The case group was defined as patients with SSI and the control group was defined as patients without SSI. Univariate and multivariate analyses were performed to determine the risk factors for SSI.Data were provided for 692 patients, among whom 26 had SSI, representing an incidence rate of 3.67%. In the SSI group, 24 (3.47%) patients had superficial infection and 2 (0.29%) had deep infection. On multivariate analysis, diabetes (P < .001) was determined an independent risk factor of SSI, so were surgery performed between May and September (P = .04), body mass index (P = .031), corticosteroid therapy (P = .003), anemia (P = .041), and low preoperative

hemoglobin levels.Our results suggest that clinicians should recognize patients with these factors, particularly diabetes. And taking management optimally in the preoperative period will prevent the SSI after femoral neck fracture.Database: EMBASE

87. Major intraoperative bleeding during pancreatoduodenectomy - preoperative biliary drainage is the only modifiable risk factorAuthor(s): Rystedt J.; Tingstedt B.; Andersson B.; Ansorge C.; Nilsson J.Source: HPB; Mar 2019; vol. 21 (no. 3); p. 268-274Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30170978Available at HPB - from ClinicalKey Available at HPB - from Europe PubMed Central - Open Access

Abstract:Background: Pancreatoduodenectomy is associated with a high risk of complications. The aim was to identify preoperative risk factors for major intraoperative bleeding. Method(s): Patients registered for pancreatoduodenectomy in the Swedish National Pancreatic and Periampullary Cancer Registry, 2011 to 2016, were included. Major intraoperative bleeding was defined as >=1000 ml. Univariable and multivariable analysis of preoperative parameters were performed. Result(s): In total, 1864 patients were included. The median blood loss was 600 ml, and 502 patients (27%) had registered bleeding of >=1000 ml. Preoperative independent risk factors associated with major bleeding were male sex (p < 0.001), body mass index (BMI) >=25 kg/m2 (p < 0.001), preoperative biliary drainage (PBD) (p < 0.001), C-reactive protein (CRP) >=12 mg/L (p = 0.006) and neo-adjuvant chemotherapy treatment (NAT) (p = 0.002). Postoperative intensive care (p < 0.001), reoperation (p = 0.035), surgical infections (p = 0.036), and bile leakage (p = 0.045) were more common in the group with major bleeding, and the 30-day mortality was higher (4.9% vs 1.6%; p < 0.001). Conclusion(s): Most predictive parameters for major intraoperative bleeding are not modifiable. PBD is an independent predictor for major intraoperative bleeding and to reduce the risk, patients with resectable periampullary tumors should, if possible, be subject to surgery without preoperative biliary drainage.Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc.Database: EMBASE

88. The Difficult Abdominal Wound: Management TipsAuthor(s): Mendoza A.E.Source: Current Trauma Reports; Mar 2019; vol. 5 (no. 1); p. 6-11Publication Date: Mar 2019Publication Type(s): Review

Abstract:Purpose of Review: This review aims to summarize therapeutic options for the management of complex surgical wounds of the abdomen especially in regard to emergency surgery and trauma patients. Recent Findings: Wounds in emergency surgery and trauma patients are complex and have an elevated risk for surgical site infection and hernia. In addition, the open abdomen (OA) and

damage control laparotomy (DCL) are techniques being increasingly used not just in trauma patients but in critically ill surgical patients as well. Although these techniques can be lifesaving, they can be complicated and difficult to manage especially in a patient that requires multiple takebacks and those with delayed closures requiring ongoing resuscitation. Summary: This review article discusses the management options that facilitate wound closure and reduce wound complications in an emergency surgery and trauma patient. The article aims to provide a range of options that can be used regardless of resources and surgical expertise.Copyright © 2019, Springer Nature Switzerland AG.Database: EMBASE

89. A Postoperative Care Bundle Reduces Surgical Site Infections in Pediatric Patients Undergoing Cardiac SurgeriesAuthor(s): Caruso T.J.; Wang E.Y.; Schwenk H.; Marquez J.L.S.; Cahn J.; Loh L.; Shaffer J.; Chen K.; Wood M.; Sharek P.J.Source: Joint Commission Journal on Quality and Patient Safety; Mar 2019; vol. 45 (no. 3); p. 156-163Publication Date: Mar 2019Publication Type(s): Article

Abstract:Background: Pediatric patients undergoing cardiac surgeries are at an increased surgical site infection (SSI) risk, given prolonged cardiopulmonary bypasses and delayed sternal closures. At one institution, the majority of cardiac patients developed SSIs during prolonged recoveries in the cardiovascular intensive care unit (CVICU). Although guidelines have been published to reduce SSIs in the perioperative period, there have been few guidelines to reduce the risk during prolonged hospital recoveries. The aim of this project was to study a postoperative SSI reduction care bundle, with a goal of reducing cardiac SSIs by 50%, from 3.4 to 1.7 per 100 procedures. Method(s): This project was conducted at a quaternary, pediatric academic center with a 20-bed CVICU. Historical control data were recorded from January 2013 through May 2015 and intervention/sustainment data from June 2015 through March 2017. A multidisciplinary SSI reduction team developed five key drivers that led to implementation of 11 postoperative SSI reduction care elements. Statistical process control charts were used to measure process compliance, and Pearson's chi-square test was used to determine differences in SSI rates. Result(s): Prior to implementation, there were 27 SSIs in 799 pediatric cardiac surgeries (3.4 SSIs per 100 surgeries). After the intervention, SSIs significantly decreased to 5 in 570 procedures (0.9 SSIs per 100 surgeries; p = 0.0045). Conclusion(s): This project describes five key drivers and 11 elements that were dedicated to reducing the risk of SSI during prolonged CVICU recoveries from pediatric cardiac surgery, with demonstrated sustainability.Copyright © 2018 The Joint CommissionDatabase: EMBASE

90. Impact of a preventive bundle to reduce surgical site infections in gynecologic oncologyAuthor(s): Nguyen J.M.V.; Sadeghi M.; Gien L.T.; Covens A.; Kupets R.; Vicus D.; Nathens A.B.

Source: Gynecologic Oncology; Mar 2019; vol. 152 (no. 3); p. 480-485Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30876492Available at Gynecologic Oncology - from ClinicalKey

Abstract:Objective: To assess the impact of a surgical site infection (SSI) prevention bundle for Gynecologic Oncology patients at a large academic tertiary centre in Toronto, Canada. Method(s): A SSI prevention bundle was implemented in February 2017 including: preoperative chlorhexidine shower, prophylactic antibiotics, glycemic control, normothermia, and separate closing tray. Data were collected prospectively using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) institutional data, and chart review of surgeries between January 2016 and September 2017 was performed. The primary outcome was rate of SSIs, secondary outcomes were: superficial, deep and organ space SSIs, sepsis, wound disruption, length of stay, 30-day readmission and reoperation. Logistic regression analysis was conducted to identify predictors of SSIs. Result(s): 339 baseline and 224 post-intervention patients were included. 53 incurred one or more SSIs: 43 superficial, 6 deep, and 14 organ-space. The bundle decreased overall SSIs by 55% (12.1% to 5.4%, p = 0.008) and superficial SSIs by 54% (9.7% to 4.5%, p = 0.023). Improvement was sustained for 6 quarters. No significant difference was found in other secondary outcomes. On multivariable analysis, surgery in the pre-bundle period, BMI >=30, laparotomies and longer operative duration were independent risk factors for overall SSIs (OR 2.23, 95% CI 1.06-5.06, -OR 3.01, 95% CI 1.57 - 5.87, OR 3.70, 95% CI 1.56 - 10.18 and - OR 2.16, 95% 1.11 - 4.19, respectively). Conclusion(s): This prevention bundle successfully decreased SSIs in patients undergoing gynecologic cancer surgery. We recommend improving quality of care by wide implementation of SSI prevention bundles in Gynecologic Oncology patients.Copyright © 2018 Elsevier Inc.Database: EMBASE

91. Adherence to preoperative hand hygiene and sterile gowning technique among consultant surgeons, surgical residents, and nurses: A pilot study at an academic medical center in IndonesiaAuthor(s): Handaya A.Y.; Werdana V.A.P.Source: Patient Safety in Surgery; Mar 2019; vol. 13 (no. 1)Publication Date: Mar 2019Publication Type(s): ArticleAvailable at Patient Safety in Surgery - from BioMed Central Available at Patient Safety in Surgery - from Europe PubMed Central - Open Access Available at Patient Safety in Surgery - from ProQuest (Health Research Premium) - NHS Version

Abstract:Background: Healthcare-associated infections (HAI) is a major problem for patient safety and surgical site infection (SSI) is a type of HAI and the most common form of infection related to surgical health care. Transmission of microorganisms can be minimized by aseptic procedures. The main objective of this study is to compare adherence to preoperative sterile gowning and hand hygiene technique

among consultant surgeons, surgical residents, and nurses. Method(s): This research was conducted by observing the implementation of the pre-operative sterile gowning and hand hygiene technique of abdominal surgery by consultant surgeons, surgical residents, and nurses using aseptic instrument tests of the Objective Structured Clinical Examination (OSCE) Faculty of Medicine Universitas Gadjah Mada from August 10, 2018 to September 10, 2018. Observations were made when participants performed hand scrubbing, gowning, and donning the gloves procedures. The observer completed mobile online forms, so that the medical personnel under observation did not know that they were being observed. Result(s): Twelve consultant surgeons, 16 surgical residents, and 12 nurses were observed. All of the medical personnel showed a good score with total percentage mean 83.58%. The highest total mean score was achieved by consultant surgeons (86.39%), but mean score did not vary significantly between medical personnel (p =.091). In the hand scrubbing procedure, scrub the nail and palm using brush side and the skin of hand and arm using sponge side, in both hands had the lowest mean score (1.82 +/- 1.152 of the maximum score of 4). While in the gowning procedure, taking and unfolding the sterile gown had the lowest mean score (1.97 +/-.158 of the maximum score of 2). In the donning the glove procedure, grasping left glove with right hand and putting the glove over the left hand in opposite direction procedure had the lowest mean score (1.97 +/-.158 of the maximum score of 2). Conclusion(s): The mean score of each group of health personnel in each section showed good results. Comparison of hand hygiene and gowning procedure performance between groups of health personnel did not show significant differences. However, larger scale research is needed after this pilot study.Copyright © 2019 The Author(s).Database: EMBASE

92. Extracranial Internal Carotid Aneurysm in a 10-Year-Old Boy Diagnosed via UltrasoundAuthor(s): Sosa P.A.; Gross I.T.; Matar P.Source: Pediatric Emergency Care; Mar 2019; vol. 35 (no. 3)Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30768565

Abstract:Background Extracranial carotid aneurysms in children are extremely rare but carry a high mortality and morbidity. For pediatric patients, they are often complications of pharyngeal infections and surgical trauma but can also arise from congenital and inflammatory diseases. They have a wide range of presentation from an asymptomatic mass to a rapidly fatal hemorrhage. Case A 10-year-old boy presented to the emergency department with complaints of a neck mass and residual cough from a recent upper respiratory infection. Ultrasound revealed a carotid aneurysm that was further characterized by magnetic resonance angiography as a 3-cm aneurysm of the internal carotid artery. The patient was taken for surgery where he underwent resection and placement of an interposition graft. The procedure was well tolerated and the boy recovered fully. Discussion Carotid aneurysms in children can present with 1 or more of the following: a pulsatile neck mass, hematemesis, epistaxis, neurologic

symptoms, and symptoms of airway compression. Although ultrasound is the preferred initial test, the choice of additional imaging for further characterization will depend most on the patient age, hemodynamic stability, airway status, and availability of pediatric anesthesia. Hemodynamic and neurologic status should be monitored closely, and clinicians must also be prepared for a potentially complicated airway. Surgery is indicated for children owing to high risk of neurologic complications. Conclusions Although these lesions are rare, it is crucial that physicians recognize when there is a need for further evaluation so that these children have the most favorable outcomes possible.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.Database: EMBASE

93. Epidemiology of Surgical Site Infections and Non-Surgical Infections in Neurosurgical Polish Patients-Substantial Changes in 2003-2017Author(s): Kolpa M.; Walaszek M.; Rozanska A.; Wolak Z.; Wojkowska-Mach J.Source: International journal of environmental research and public health; Mar 2019; vol. 16 (no. 6)Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30871283Available at International journal of environmental research and public health - from Europe PubMed Central - Open Access Available at International journal of environmental research and public health - from Proquest_New_Platform

Abstract:Introduction: The objective of the analysis was to determine the epidemiology of healthcare-associated infections (HAIs) in neurosurgical patients, paying special attention to two time points, 2003 and 2017, in order to evaluate the effectiveness of a surveillance program introduced in 2003 and efforts to reduce infection rates. Material(s) and Method(s): Continuous surveillance during 2003-2017 carried out using the HAI-Net methodology allowed us to detect 476 cases of HAIs among 10,332 patients staying in a 42-bed neurosurgery unit. The intervention in this before-after study (2003-2017) comprised standardized HAI surveillance with regular analysis and feedback. Result(s): The HAI incidence during the whole study was 4.6%. Surgical site infections (SSIs) accounted for 33% of all HAIs with an incidence rate of 1.5%. The remaining infections were pneumonia (1.1%) and bloodstream infections (0.9%). The highest SSI incidence concerned spinal fusion (FUSN, 2.2%), craniotomy (1.9%), and ventricular shunt (5.1%) while the associated total HAI incidence rates were 4.1%, 8.0%, and 18.6%, respectively. A significant reduction was found in HAI incidence between 2003 and 2017 in regard to the most common surgery types: laminectomy (4.5% vs. 0.8%); FUSN (11.8% vs. 0.8%); and craniotomy (10.1% vs. 0.4%). Significant changes were also achieved in selected elements of the unit's work: pre-hospitalization duration, hospital stay, and surgery length reductions. Simultaneously, the general condition of patients became significantly worse: there was an increase in patients' age and decreases in their general condition as expressed by ASA scores (The American Society of Anesthesiologists physical status classification system).

Conclusion(s): HAI epidemiology changed substantially during the study period. Among the main types of HAI, SSIs were slightly predominant, but non-surgical HAIs accounted for almost two thirds of all infections; this indicates the need for surveillance of infection types other than SSIs in surgical patients. The implementation of active surveillance based on regular analysis and feedback led to a significant reduction in HAI incidence.Database: EMBASE

94. Analysis of risk factors for multiantibiotic-resistant infections among surgical patients at a children's hospitalAuthor(s): Sun L.; Liu S.; Wang J.; Wang L.Source: Microbial Drug Resistance; Mar 2019; vol. 25 (no. 2); p. 297-303Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30676248

Abstract:Background: To identify the potential risk factors for multiantibiotic-resistant infections and provide sufficient evidence for multiantibiotic resistance prevention and control. Material(s) and Method(s): We conducted a retrospective study of all patients in pediatric orthopedics, pediatric heart surgery, and pediatric general surgery at a level 3, grade A children's hospital from January to December 2016. The clinical laboratory information monitoring system and the medical record system were used to collect patient information regarding age, surgery type, preoperative length of stay, admission season, incision type, preoperative infection, intraoperative blood loss, postoperative use of invasive equipment, duration of catheter drainage, and timepoint of intraoperative prophylactic antibiotics administration. We used logistic univariate and multivariate regression analysis to analyze the potential risk factors for multiantibiotic-resistant infections among pediatric surgical patients. SPSS 21.0 and Excel software packages were used for the statistical analysis. Result(s): In total, 2,973 patients met the inclusion criteria: 1,247 patients in pediatric orthopedics, 1,089 patients in pediatric heart surgery, and 637 patients in pediatric general surgery. At the end of the study, 113 patients were multiantibiotic-resistant infection cases; the rate of multiantibiotic-resistant infections was 3.80%, and the detection rate was 84.79%. Multivariate analysis indicated that the multiantibiotic-resistant infection cases were influenced by age, department, admission season, incision type, preoperative infection, and duration of catheter drainage. Conclusion(s): Age, department, admission season, incision type, preoperative infection, and duration of catheter drainage may provide possible evidence for prevention and control strategies of multiantibiotic-resistant infections.Copyright © Lixin Sun et al., 2019; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons LicenseDatabase: EMBASE

95. Impact of pharmacist-led antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis in obstetric and gynecologic surgeries in NigeriaAuthor(s): Abubakar U.; Sulaiman S.A.S.; Adesiyun A.G.

Source: PLoS ONE; Mar 2019; vol. 14 (no. 3)Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 30845240Available at PLoS ONE - from Europe PubMed Central - Open Access Available at PLoS ONE - from Public Library of Science (PLoS)

Abstract:Background Inappropriate and excessive use of surgical antibiotic prophylaxis are associated with the emergence of antibiotic resistance. Antibiotic prophylaxis malpractices are common in obstetrics and gynecology settings and antibiotic stewardship is used to correct such malpractice. Objective To evaluate the impact of antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis practice in obstetrics and gynecology surgeries. Method A prospective pre- and post-intervention study was conducted in two tertiary hospitals between May and December 2016. The duration of the each period was 3 months. Antibiotic stewardship interventions including development of a protocol, educational meeting and audit and feedback were implemented. Data were collected using the patient records and analyzed with SPSS version 23. Results A total of 226 and 238 surgical procedures were included in the pre- and post-intervention periods respectively. Age, length of stay and estimated blood loss were similar between the two groups. However, specialty and surgical procedures varied significantly. There was a significant increase in compliance with timing (from 14.2% to 43.3%) and duration (from 0% to 21.8%) of surgical antibiotic prophylaxis after the interventions. The interventions significantly reduced the prescription of third generation cephalosporin (-8.6%), redundant antibiotic (-19.1%), antibiotic utilization (-3.8 DDD/procedure) and cost of antibiotic prophylaxis (-$4.2/procedure). There was no significant difference in the rate of surgical site infection between the two periods. Post-intervention group (OR: 5.60; 95% CI: 3.31-9.47), elective surgery (OR: 4.62; 95% CI: 2.51-8.47) and hospital attended (OR: 9.89; 95% CI: 5.66-17.26) were significant predictors of compliance with timing while elective surgery (OR: 12.49; 95% CI: 2.85-54.71) and compliance with timing (OR: 58.55; 95% CI: 12.66-270.75) were significantly associated with compliance to duration of surgical antibiotic prophylaxis. Conclusion The interventions improve compliance with surgical antibiotic prophylaxis and reduce antibiotic utilization and cost. However, there is opportunity for further improvement, particularly in non-elective surgical procedures.Copyright © 2019 Abubakar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Database: EMBASE

96. Pre-operative screening for asymptomatic bacteriuria and associations with post-operative outcomes in patients with spinal cord injuryAuthor(s): Fitzpatrick M.A.; Suda K.J.; Poggensee L.; Ramanathan S.; Evans C.T.; Burns S.P.Source: Journal of Spinal Cord Medicine; Mar 2019; vol. 42 (no. 2); p. 255-259

Publication Date: Mar 2019Publication Type(s): ArticlePubMedID: 29578382

Abstract:Context: Screening for asymptomatic bacteriuria (ASB) before non-urologic surgery is common but of unclear benefit. Our aim was to describe pre-operative ASB screening and post-operative outcomes in patients with neurogenic bladder due to spinal cord injury (SCI). Method(s): This was a descriptive retrospective cohort study of adults with SCI undergoing neurosurgical spine or orthopedic lower limb surgery from 10/1/2012-9/30/2014 at Veterans Affairs (VA) medical centers. National VA datasets and medical record review was used to describe frequency of pre-operative ASB screening, presence of ASB, and association with post-operative surgical site infection, urinary tract infection, and hospital readmission. Result(s): 175 patients were included. Although over half of patients had pre-operative ASB screening, only 30.8% actually had pre-operative ASB. 15.2% of patients screened were treated for ASB with antibiotics before surgery. Post-operative urinary tract infection (UTI) or surgical site infection (SSI) occurred in 10 (5.7%) patients, and 20 patients (11.4%) were readmitted within 30 days. Neither ASB screening nor the presence of pre-operative ASB were associated with these post-op outcomes (p > 0.2 for all). Conclusion(s): Pre-operative ASB screening is common in patients with SCI undergoing elective spine and lower limb surgery, although ASB occurs in less than 1/3rd of cases. There were no associations between pre-operative ASB and outcomes. Further studies evaluating the clinical benefit of this practice in patients with SCI should be performed.Copyright ©, This work was authored as part of the Contributor's official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law.Database: EMBASE

97. Shenfu Injection Attenuates Bile Duct Injury in Rats with Acute Obstructive Cholangitis.Author(s): Tan HY; Li PZ; Gong JP; Yang KSource: Surgical infections; Mar 2019Publication Date: Mar 2019Publication Type(s): Journal ArticlePubMedID: 30925118

Abstract:BACKGROUND: We investigated the effect of Shenfu injection (SFI) in Wistar rats with acute obstructive cholangitis (AOC) and considered the possible molecular mechanisms of the effects.METHODS: The 96 rats were divided randomly into three groups. In one group, the common bile duct was subjected to ligation (BDL), and 0.2 mL of saline was injected into the proximal bile ducts. To create AOC, again, the common bile duct was ligated, and 0.2 mL of lipopolysaccharide (LPS)) (2 mg/mL) was injected into the proximal ducts. In the Shenfu injection (SFI) group, the material (10 mg/kg) was injected into the tail vein 2 hours before induction of AOC. The hepatic histopathologic changes were observed under a light microscope. The endotoxin, tumor necrosis factor-α (TNF-α), alanine transaminase (ALT), and total bilirubin (TB) concentrations in the serum were measured at different time points (0, 4,

8, and 16 hours) after ligation. The expression of nuclear transcription factor-κB (NF-κB) and CD14 in Kupffer cells also was analyzed at different times by Western blotting.RESULTS: The TNF-α, ALT, and TB concentrations in the serum and the expression of CD14 and NF-κB in Kupffer cells were significantly higher in the SFI group than in the BDL group, but all were significantly lower than in the AOC group. Compared with the AOC group, the edema of cholangiocytes was alleviated in the SFI group, and the infiltration of inflammatory cells around cholangiocytes was reduced.CONCLUSION: Shenfu injection significantly alleviated bile duct injury. The potential mechanism may be associated with inhibition of CD14 expression and prevention of NF-κB activation in Kupffer cells.Database: PubMed

98. Characterization of agr Groups of Staphylococcus pseudintermedius Isolates from Dogs in Texas.Author(s): Little SV; Bryan LK; Hillhouse AE; Cohen ND; Lawhon SDSource: mSphere; Mar 2019; vol. 4 (no. 2)Publication Date: Mar 2019Publication Type(s): Journal ArticlePubMedID: 30918056Available at mSphere - from Europe PubMed Central - Open Access

Abstract:Staphylococcus pseudintermedius is an important canine pathogen implicated in an increasing number of human infections. Along with rising levels of methicillin and multidrug resistance, staphylococcal biofilms are a complicating factor for treatment and contribute to device, implant, and surgical infections. Staphylococcal virulence, including biofilm formation, is regulated in part by the quorum sensing accessory gene regulator system (agr). The signal molecule for agr, known as the autoinducing peptide molecule, contains polymorphisms that result in the formation of distinct groups. In S. pseudintermedius, 4 groups (i.e., groups I, II, III, and IV) have been identified but not comprehensively examined for associations with infection type, virulence factor carriage, or phylogenetic relationships-all of which have been found to be significant in S. aureus In this study, 160 clinical canine isolates from Texas, including isolates from healthy dogs (n = 40) and 3 different infection groups (pyoderma, urinary tract, and surgical, n = 40 each), were sequenced. The agr group, biofilm-producing capabilities, toxin gene carriage, antimicrobial resistance, and sequence type (ST) were identified for all isolates. While no significant associations were discovered among the clinical infection types and agr groups, agr II isolates were significantly less common than any other group in diseased dogs. Furthermore, agr II isolates were less likely than other agr groups to be multidrug resistant and to carry toxin genes expA and sec-canine Fifty-two (33%) of the 160 isolates were methicillin resistant, and the main sequence types (ST64, ST68, ST71, ST84, ST150, and ST155) of methicillin-resistant strains of S. pseudintermedius (MRSP) were identified for the geographic region.IMPORTANCEStaphylococcus pseudintermedius is an important disease-causing bacterium in dogs and is recognized as a growing threat to human health. Due to increasing multidrug resistance, discovery of alternative methods for treatment of these

infections is vital. Interference with one target for alternative treatment, the quorum sensing system agr, has demonstrated clinical improvement of infections in S. aureus animal models. In this study, we sequenced and characterized 160 clinical S. pseudintermedius isolates and their agr systems in order to increase understanding of the epidemiology of the agr group and clarify its associations with types of infection and antimicrobial resistance. We found that isolates with agr type II were significantly less common than other agr types in diseased dogs. This provides valuable information to veterinary clinical microbiologists and clinicians, especially as less research has been performed on infection associations of agr and its therapeutic potential in S. pseudintermedius than in S. aureus.Database: PubMed

99. Reactivation of Latent Cytomegalovirus Infection after Major Surgery: Risk Factors and Outcomes.Author(s): Gardiner BJ; Herrick KW; Bailey RC; Chow JK; Snydman DRSource: Surgical infections; Mar 2019Publication Date: Mar 2019Publication Type(s): Journal ArticlePubMedID: 30912706

Abstract:BACKGROUND: Reactivation of latent cytomegalovirus (CMV) infection occurs in previously immunocompetent critically ill individuals and may be associated with increased morbidity and mortality. Our aim was to explore risk factors for and outcomes after CMV reactivation in patients undergoing major surgery.PATIENTS AND METHODS: We performed a retrospective case control study of patients without underlying immunocompromise who developed post-operative CMV reactivation from 2004-2016. Cases included patients testing positive for CMV by viral load, culture, or histopathology. Controls were matched by age, gender, type, and year of surgery.RESULTS: Sixteen CMV cases were matched to 32 controls. Median age was 65 and median time from surgery to CMV diagnosis was 32 days. Symptoms included fever (94%), hepatitis (75%), myelosuppression (56%), and diarrhea (38%). Despite similar baseline comorbidities, cases were more likely to return to surgery (odds ratio [OR] 6.31; 95% confidence interval [CI], 1.29-30.74), require renal replacement therapy (OR 18.54; 95% CI, 2.36-145.6), total parenteral nutrition (OR 33.0; 95% CI, 6.60-262.37) and corticosteroids (OR 18.78; 95% CI, 4.5-103.9). Length of stay was increased (median 51 vs. 8 days, p = 0.005), co-infections were more common (OR 15.10; 95% CI, 1.89-120.8), and mortality was higher (38% vs. 0%, p < 0.01).CONCLUSIONS: Cytomegalovirus reactivation occurs in previously immunocomptent patients post-operatively and is associated with poor outcomes including other infections and mortality. Potential risk factors include prolonged length of stay, surgical complications, and corticosteroid use. It is not clear from our study whether CMV reactivation is a surrogate marker of severe illness and post-operative complications or if CMV reactivation plays a causative role in the development of these adverse outcomes.Database: PubMed

100. Evaluation of Rectal Vancomycin Irrigation for Treatment of Clostridioides difficile Infection in Patients Post-Colectomy for Toxic Colitis.Author(s): Feeney ME; Thompson M; Gerlach AT; Rushing A; Evans DC; Eiferman DS; Murphy CVSource: Surgical infections; Mar 2019Publication Date: Mar 2019Publication Type(s): Journal ArticlePubMedID: 30900947

Abstract:BACKGROUND: Clostridioides difficile infection (CDI) accounts for as many as 25% of episodes of antibiotic-associated diarrhea and is the most common cause of healthcare-associated diarrhea. Rectal vancomycin irrigation is a therapy option; however, evidence is limited for its value post-colectomy. The objective of this study was to describe outcomes of patients who underwent total colectomy for fulminant C. difficile colitis and received rectal vancomycin post-operatively.METHODS: This was a single-center retrospective chart review of adult patients who underwent total colectomy for fulminant CDI. Efficacy outcomes were all-cause in-hospital death, intensive care unit (ICU) and hospital length of stay, ventilator-free days at day 28 post-procedure, development of proctitis or pseudomembranes, need for re-initiation of CDI therapy, and normalization of infectious signs and symptoms at completion of CDI therapy. The primary safety outcome was the incidence of rectal stump blowout.RESULTS: Of the 50 patients included, 38 (76%) received treatment with rectal vancomycin at the discretion of the surgeon. The Sequential Organ Failure Assessment score on the day of the procedure was higher in the rectal vancomycin group; however, this difference did not reach statistical significance. No difference was observed between the groups in the primary outcome of all-cause death. There was no significant difference between the groups for hospital length of stay, but there was a trend toward longer ICU length of stay for patients who received rectal vancomycin (9.5 days vs. 2.5 days; p = 0.05). No differences in the remaining secondary efficacy outcomes were observed. No episodes of rectal stump blowout were observed in either group.CONCLUSIONS: This study aimed to add to the limited data on the use of rectal vancomycin irrigation post-colectomy for toxic C. difficile colitis. Although our results do not support routine use of rectal vancomycin irrigation, they suggest that this therapy is not harmful if providers are considering its use for severe infections refractory to alternative treatment.Database: PubMed

101. The Heroin Epidemic in America: A Surgeon's Perspective.Author(s): Bauman ZM; Morizio K; Singer M; Hood CR; Feliciano DV; Vercruysse GASource: Surgical infections; Mar 2019Publication Date: Mar 2019Publication Type(s): Journal ArticlePubMedID: 30900946

Abstract:BACKGROUND: The United States is currently experiencing a heroin epidemic. Recent reports have demonstrated a three-fold increase in heroin use among Americans since 2007 with a shift in demographics to more women and white Americans. Furthermore, there has been

a correlation between the recent opioid epidemic and an increase in heroin abuse. Much has been written about epidemiology and prevention of heroin abuse, but little has been dedicated to the surgical implications, complications, and resource utilization.DISCUSSION: This article focuses on the surgical problems encountered from heroin abuse and how to manage them in a constant effort to improve morbidity and mortality for these heroin abusers.Database: PubMed

102. Comparative Effectiveness of Ceftriaxone plus Metronidazole versus Anti-Pseudomonal Antibiotics for Perforated Appendicitis in Children.Author(s): Hamdy RF; Handy LK; Spyridakis E; Dona D; Bryan M; Collins JL; Gerber JSSource: Surgical infections; Mar 2019Publication Date: Mar 2019Publication Type(s): Journal ArticlePubMedID: 30874482

Abstract:BACKGROUND: Appendicitis is the most common pediatric surgical emergency and one of the most common indications for antibiotic use in hospitalized children. The antibiotic choice differs widely across children's hospitals, and the optimal regimen for perforated appendicitis remains unclear.METHODS: We conducted a retrospective cohort study comparing initial antibiotic regimens for perforated appendicitis at a large tertiary-care children's hospital. Children hospitalized between January 2011 and March 2015 who underwent surgery for perforated appendicitis were identified by ICD-9 codes with confirmation by chart review. Patients were excluded if they had been admitted ≥48 hours prior to diagnosis, had a history of appendicitis, received inotropic agents, were immunocompromised, or were given an antibiotic regimen other than ceftriaxone plus metronidazole (CTX/MTZ) or an anti-pseudomonal drug (cefepime, piperacillin/tazobactam, ciprofloxacin, imipenem, or meropenem) within the first two days after diagnosis. The primary outcome of interest was post-operative complications, defined as development of an incisional infection or abscess within six weeks of hospital discharge.RESULTS: Of the 353 children who met the inclusion criteria, 252 (71%) received CTX/MTZ and the others received an anti-pseudomonal regimen. A post-operative complication occurred in 37 (14.7%) of the CTX/MTZ group versus 18 (17.8%) of the anti-pseudomonal group. Antibiotic-related complications occurred in 4.4% of children on CTX/MTZ and 6.9% of children on anti-pseudomonal antibiotics (p = 0.32). In a multivariable logistic regression model adjusting for sex, age, ethnicity, and duration of symptoms prior to presentation, the adjusted odds ratio for post-operative complications in children receiving anti-pseudomonal antibiotics was 1.25 (95% confidence interval 0.66-2.40).CONCLUSION: Post-operative complication rates did not differ for children treated with CTX/MTZ versus a broader-spectrum regimen.Database: PubMed

103. Commonly Encountered Skin Biome-Derived Pathogens after Orthopedic Surgery.Author(s): Garcia DR; Deckey D; Haglin JM; Emanuel T; Mayfield C; Eltorai AEM; Spake CS; Jarrell JD; Born CTSource: Surgical infections; Mar 2019

Publication Date: Mar 2019Publication Type(s): Journal ArticlePubMedID: 30839243

Abstract:BACKGROUND: Normal skin microbiota influence susceptibility to surgical infections. The distribution of skin bacteria differs by anatomic site, and given the right conditions, almost any of these bacteria can become an opportunistic pathogen.METHODS: This paper provides a thorough review of the most commonly encountered bacteria in various regions of the body and their isolation from operative incisions at those locations. These data may be useful in optimizing targeted antibiotic therapy for surgical site infections and provide a better understanding of the skin biome distribution at specific surgical sites.CONCLUSION: Typical skin-borne flora, surgical site infections, orthopedic infections by body part, and drug-resistant pathogens are reviewed.Database: PubMed

104. Use of Topical Antibiotics before Primary Incision Closure to Prevent Surgical Site Infection: A Meta-Analysis.Author(s): López-Cano M; Kraft M; Curell A; Puig-Asensio M; Balibrea J; Armengol-Carrasco M; García-Alamino JMSource: Surgical infections; Mar 2019Publication Date: Mar 2019Publication Type(s): Journal ArticlePubMedID: 30839242

Abstract:BACKGROUND: Surgical site infections (SSIs) remains a concern for surgeons because of the negative impact on outcomes and health care costs. Our purpose was to assess whether topical antibiotics before primary incision closure reduced the rate of SSIs.METHODS: Systematic review of MEDLINE/PubMed, Scopus, CINAHL, and Web of Science databases from inception to January 2017. Only randomized controlled trials (RCTs) were retrieved. The primary outcome was the SSI rate. Meta-analysis was complemented with trial sequential analysis (TSA).RESULTS: Thirty-five RCTs (10,870 patients) were included. Only β-lactams and aminoglycosides were used. A substantial reduction of the incidence of SSIs with the application of antibiotic agents before incision closure (risk ratio [RR] 0.49, 95% confidence interval [CI] 0.37-0.64) was found, which remained in the analysis of 12 RCTs after removal of studies of uncertain quality. The use of β-lactams was effective to reduce SSI in elective surgery only (RR 0.33, 95% CI 0.13-0.85). In clean-contaminated fields and as an irrigation solution, β-lactams did not reduce the risk of SSI. Aminoglycosides were not effective (RR 0.74, 95% CI 0.49-1.10). After TSA, the evidence accumulated was far below the optimal information size. The heterogeneity of studies was high and methodological quality of most RCTs included in the meta-analysis was uncertain.CONCLUSIONS: Results of this meta-analysis show the data present in the literature are not sufficiently robust and, therefore, the use of topical β-lactams or aminoglycosides before incision closure to reduce SSI cannot be recommended or excluded.Database: PubMed

105. Understanding the microbiome of diabetic foot osteomyelitis: insights from molecular and microscopic approaches.Author(s): Johani K; Fritz BG; Bjarnsholt T; Lipsky BA; Jensen SO; Yang M; Dean A; Hu H; Vickery K; Malone MSource: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases; Mar 2019; vol. 25 (no. 3); p. 332-339Publication Date: Mar 2019Publication Type(s): Journal ArticlePubMedID: 29787888

Abstract:OBJECTIVES: Rigorous visual evidence on whether or not biofilms are involved in diabetic foot osteomyelitis (DFO) is lacking. We employed a suite of molecular and microscopic approaches to investigate the microbiome, and phenotypic state of microorganisms involved in DFO.METHODS: In 20 consecutive subjects with suspected DFO, we collected intraoperative bone specimens. To explore the microbial diversity present in infected bone we performed next generation DNA sequencing. We used scanning electron microscopy (SEM) and peptide nucleic acid fluorescent in situ hybridization (PNA-FISH) with confocal microscopy to visualize and confirm the presence of biofilms.RESULTS: In 19 of 20 (95%) studied patients presenting with DFO, it was associated with an infected diabetic foot ulcer. By DNA sequencing of infected bone, Corynebacterium sp. was the most commonly identified microorganism, followed by Finegoldia sp., Staphylococcus sp., Streptococcus sp., Porphyromonas sp., and Anaerococcus sp. Six of 20 bone samples (30%) contained only one or two pathogens, while the remaining 14 (70%) had polymicrobial communities. Using a combination of SEM and PNA-FISH, we identified microbial aggregates in biofilms in 16 (80%) bone specimens and found that they were typically coccoid or rod-shaped aggregates.CONCLUSIONS: The presence of biofilms in DFO may explain why non-surgical treatment of DFO, relying on systemic antibiotic therapy, may not resolve some chronic infections caused by biofilm-producing strains.Database: PubMed

106. Does Piezosurgery Influence the Severity of Neurosensory Disturbance Following Bilateral Sagittal Split Osteotomy?Author(s): D'Agostino A; Favero V; Lanaro L; Zanini M; Nocini PF; Trevisiol LSource: The Journal of craniofacial surgery; Mar 2019Publication Date: Mar 2019Publication Type(s): Journal ArticlePubMedID: 30839457

Abstract:The present paper aims to evaluate the long-term incidence and severity of the neurosensory disturbance (NSD) of the inferior alveolar nerve following bilateral sagittal split osteotomy (BSSO) of the mandibular ramus performed with piezosurgery. A retrospective study on patients referred to the Maxillofacial Surgery and Dentistry Clinic of the University of Verona for orthognathic surgery between March 2013 and October 2015 was performed. Inclusion criteria were having undergone BSSO with piezosurgery and follow-up lasting at least 24 months. Exclusion criteria were history of surgical infection,

osteosynthesis failure or re-do surgery. The extent of mandibular repositioning movements was retrieved and patients underwent 4 clinical neurosensory tests. Descriptive statistical analysis was performed. 52 patients met the inclusion criteria. Average follow-up was 40 months (range 24-75). 83% of the nerves examined have no or slightly altered sensitivity. Seventy-one percent of patients perceive a moderate to none discomfort and none describes the discomfort as serious (Visual Analogue Scale [VAS] >7). The extent of mandibular repositioning did not have significant influence on the development and severity of the NSD. Resulting data led the Authors to infer that using piezosurgery in BSSO, the severity of the NSD of inferior alveolar nerve is reduced, but the incidence of permanent nerve lesions remains unchanged, compared to historical controls.Database: PubMed

107. Surgical Protocol for Infections, Nonhealing Wound Prophylaxis, and Analgesia: Development and Implementation for Posterior Spinal Fusions.Author(s): Belykh E; Carotenuto A; Kalinin AA; Akshulakov SK; Kerimbayev T; Borisov VE; Aliyev MA; Nakaji P; Preul MC; Byvaltsev VASource: World neurosurgery; Mar 2019; vol. 123 ; p. 390-401.e2Publication Date: Mar 2019Publication Type(s): Journal ArticlePubMedID: 30481624Available at World neurosurgery - from ClinicalKey

Abstract:OBJECTIVE: To analyze the effects of a surgical protocol for infections, nonhealing wound prophylaxis, and analgesia among patients who underwent posterior spinal fusion at a single tertiary-care neurosurgical center.METHODS: This prospective study was conducted in the neurosurgery department of a tertiary-care neurosurgical center and compared a control group of patients who had posterior spinal fusion within 3 months before implementation of a surgical protocol with a study group of patients enrolled within 1 year after protocol implementation. The protocol included a surgical safety checklist, control of modifiable risks associated with surgical site infection, administration of intrawound vancomycin and local analgesia, and standard closure. Postoperative pain, demand for analgesics, and postoperative surgical site infections were assessed among patients before and after the introduction of the protocol.RESULTS: The control group (n = 35; 30 women; median age, 40 years [interquartile range, 31-54 years]) experienced a higher-than-predicted rate of minor surgical infections and nonhealing wounds (12 patients; 34%). In the study group (n = 113; 74 women; median age, 45 years [interquartile range, 37-54 years]), 11 patients (10%) had minor surgical infections and nonhealing wounds. Introduction of the protocol was associated with a 24% absolute risk reduction for minor surgical site infection and a significant decrease in pain on postoperative days 1 and 2 (P < 0.01 for both). Interpersonal communication improved among specialists involved in patient management.CONCLUSIONS: The protocol was effective in reducing postoperative pain and the rate of surgical site infection among patients with posterior spinal surgeries.

Database: PubMed

108. Surgical Site Infection in Endometriosis Surgery Is a Rare Complication: Results of a Single Center's Prospective Surveillance of Eight Hundred Ninety-Six Procedures.Author(s): Balayé P; Josset V; Mias S; Perrier MA; Lebaron C; Roman H; Merle VSource: Surgical infections; Feb 2019Publication Date: Feb 2019Publication Type(s): Journal ArticlePubMedID: 30817227

Abstract:BACKGROUND: There are no studies reporting the rate of surgical site infection (SSI) after surgery for endometriosis, although this information is valuable when discussing the most appropriate treatment strategy with the patient.METHODS: We conducted a prospective cohort study in a university hospital and regional reference center for endometriosis. We sought to measure the rate of SSI after endometriosis surgery using prospective SSI post-discharge surveillance data and the hospital information system via an ad hoc algorithm using both diagnosis and procedure code classifications.RESULTS: Among 896 consecutive endometriosis surgical procedures, we identified 365 procedures with involvement of the gastrointestinal tract, defined as the deep invasive procedure (DIP) group, 107 procedures with involvement of an ovary, and 424 other procedures. Twelve SSI (all organ/space infections) were observed, all in the DIP group, corresponding to an overall SSI incidence of 1.3% 95% confidence interval (CI) 0.7-2.3, and an SSI incidence in the DIP group of 2.8%, 95% CI 1.5-4.9. The median delay between the procedure and the SSI was 6.5 days (range, 3-23). At least one micro-organism was found in 10 patients (four Escherichia coli, four Enterobacter cloacae, three Enteroccus faecalis, two Bacteroides fragilis, one Pseudomonas aeruginosa, one Candida albicans).CONCLUSION: A low overall rate of SSI after surgery for endometriosis was observed. Nevertheless, procedures with involvement of the intestinal tract were at risk of SSI.Database: PubMed

109. Infections by OXA-48-like-producing Klebsiella pneumoniae non-co-producing extended spectrum beta-lactamase: can they be treated successfully with cephalosporins?Author(s): Escolà-Vergé L; Larrosa N; Los-Arcos I; Viñado B; González-López JJ; Pigrau C; Almirante B; Len OSource: Journal of global antimicrobial resistance; Feb 2019Publication Date: Feb 2019Publication Type(s): Journal ArticlePubMedID: 30825700

Abstract:BACKGROUND: OXA-48 is an Ambler class D β-lactamase that hydrolyzes penicillin and imipenem but has low hydrolytic activity against cephalosporins. However, very few clinical experiences of treating ESBL-negative OXA-48 producers with cephalosporins has been published.OBJECTIVES: The aim of this study is to report our clinical experience of infections due to ESBL-negative OXA-48-producing Klebsiella pneumoniae treated with cephalosporins.PATIENTS AND METHODS: We performed a retrospective study at Vall d'Hebron University Hospital, in

Barcelona (Spain). We reviewed all microbiologic isolates of OXA-48-producers that did not co-produce ESBL from May 2014 to May 2017, and we included only clinical strains of patients treated with a cephalosporin during ≥ 72 hour.RESULTS: From the 75 isolations of OXA-48 producers, there were 17 isolations of ESBL-negative OXA-48-producing K. pneumoniae. Three patients were treated with cephalosporins with successful outcome: a pneumonia in a neutropenic patient treated with cefepime and amikacin, an acute focal nephritis of the renal graft treated with ceftriaxone, and an intrabdominal post-surgical infection treated with cefepime in combination with tigecycline at the beginning and ciprofloxacin afterwards.CONCLUSIONS: Cephalosporins could be an alternative treatment in selected patients with ESBL-negative OXA-48-producing K. pneumoniae infections, especially to avoid carbapenem use, although if they should be given in combination remains unknown.Database: PubMed

110. Clinical Outcome and Risk Factors for Emergency Department Adult Patients with Thoracic Empyema after Video-Assisted Thoracic Surgical Procedure.Author(s): Tsai YM; Lin YL; Chang H; Lee SC; Huang TWSource: Surgical infections; Feb 2019Publication Date: Feb 2019Publication Type(s): Journal ArticlePubMedID: 30810495

Abstract:BACKGROUND: Empyema is a purulent infection of the pleural cavity that is most relevant to parapneumonia effusion. Video-assisted thoracoscopic surgery (VATS) is an option for stage 2 (fibrinopurulent) and stage 3 (organizational). Surgeons may see critically ill patients with pleural empyema who present to the emergency department (ED). The purpose of this work is to investigate the outcomes of ED adult patients with thoracic empyema undergoing a thoracoscopic surgical procedure and to identify possible risk factors for death.METHODS: We reviewed retrospectively the clinical characteristics and treatment outcomes of patients with thoracic empyema who received this diagnosis at our center from January 2012 to June 2014. Patients <20 years old were excluded from this study. The prognostic values of age, sex, comorbidities, clinical presentations, location, stage, and laboratory examinations were evaluated. Uni-variable analysis and multi-variable modeling were performed to determine significant risk factors for post-operative death.RESULTS: Seventeen of 160 patients died post-operatively. Two groups (survivors and non-survivors) significantly differed in age (p = 0.013), sex (p = 0.026), comorbidity (p = 0.017), cough (p = 0.024), chest pain (p = 0.016), serum hemoglobin (p = 0.001), and potassium (p = 0.004) levels. Further logistic regression analysis showed statistically significant differences in age, hemoglobin levels, and potassium levels.CONCLUSION: Among the ED patients with thoracic empyema, older age, lower hemoglobin levels, and higher potassium levels are associated with post-operative death after VATS. These findings underline the importance of careful peri-operative treatment in older patients with signs of empyema when they present to the ED.Database: PubMed

111. Two-Layer Wound Sealing before Surgical Hand Washing for Surgeons with a Minor Cut Injury on the Hand.Author(s): Yoon C; Gong HS; Park J; Seok HS; Park JW; Baek GHSource: Surgical infections; Feb 2019Publication Date: Feb 2019Publication Type(s): Journal ArticlePubMedID: 30810481

Abstract:BACKGROUND: There is a lack of evidence-based recommendations for surgical hand washing when there is a minor cut on the hand. We sought to evaluate whether two-layer wound sealing functions as a barrier to prevent the spread of micro-organisms.METHODS: We randomly categorized 20 surgeons into subjects with either a right- or left-hand injury. Each subject was assumed to have a minor injury on the assigned hand and the other hand was used as a control. Subjects applied a waterproof topical dressing as a first layer, then protected the injured area with a second layer using an antimicrobial drape, and finally performed surgical hand rubbing. Subjects stamped each hand onto an agar plate. The injured hands were checked by an investigator to confirm the wounded area remained properly sealed after hand rubbing. Colonies were counted and the micro-organisms were identified after 48 hours of incubation.RESULTS: There was no leak found from two-layer wound sealing after hand washing. Mean number of the colonies was 0.2 on the injured hand and 0.25 on the uninjured hand (p = 0.772). The micro-organisms cultured from both the injured and uninjured hands were coagulase-negative staphylococci.CONCLUSIONS: Using a model for a minor cut injury on the hand this study demonstrated that two-layer wound sealing is an effective barrier not only to prevent the spread of micro-organisms but also to protect surgeons.Database: PubMed

Need to refresh your Openthens account?

https://www.openathens.net/nhs_users.php

Negative pressure wound therapy for surgical wounds healing by primary closureCochrane Systematic Review - Intervention Version published: 26 March 2019 see what's new

Joan Webster, Zhenmi Liu, Gill Norman, Jo C Dumville, Laura Chiverton, Paul Scuffham, Monica Stankiewicz, Wendy P Chaboyer

Abstract

BackgroundIndications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). While existing evidence for the effectiveness of NPWT remains uncertain, new trials necessitated an updated review of the evidence for the effects of NPWT on postoperative wounds healing by primary closure.ObjectivesTo assess the effects of negative pressure wound therapy for preventing surgical site infection in wounds healing through primary closure.Search methodsWe searched the Cochrane Wounds Specialised Register, CENTRAL, Ovid MEDLINE (including In‐Process & Other Non Indexed Citations), Ovid ‐Embase, and EBSCO CINAHL Plus in February 2018. We also searched clinical trials registries for ongoing and unpublished studies, and checked reference lists of relevant included studies as well as reviews, meta‐analyses, and health technology reports to identify additional studies. There were no restrictions on language, publication date, or setting.Selection criteriaWe included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another type of NPWT.Data collection and analysisFour review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, 'Risk of bias' assessment using the Cochrane 'Risk of bias' tool, and quality assessment according to GRADE methodology.

Main resultsIn this second update we added 25 intervention trials, resulting in a total of 30 intervention trials (2957 participants), and two economic studies nested in trials. Surgeries included abdominal and colorectal (n = 5); caesarean section (n = 5); knee or hip arthroplasties (n = 5); groin surgery (n = 5); fractures (n = 5); laparotomy (n = 1); vascular surgery (n = 1); sternotomy (n = 1); breast reduction mammoplasty (n = 1); and mixed (n = 1). In three key domains four studies were at low risk of bias; six studies were at high risk of bias; and 20 studies were at unclear risk of bias. We judged the evidence to be of low or very low certainty for all outcomes, downgrading the level of the evidence on the basis of risk of bias and imprecision.

Primary outcomesThree studies reported mortality (416 participants; follow up 30 to 90 days or unspecified). It is uncertain ‐whether NPWT has an impact on risk of death compared with standard dressings (risk ratio (RR) 0.63, 95% confidence interval (CI) 0.25 to 1.56; very low certainty evidence, downgraded once for serious ‐risk of bias and twice for very serious imprecision).Twenty five studies reported on SSI. The evidence ‐from 23 studies (2533 participants; 2547 wounds; follow up 30 days to 12 months or unspecified) ‐showed that NPWT may reduce the rate of SSIs (RR 0.67, 95% CI 0.53 to 0.85; low certainty evidence, ‐downgraded twice for very serious risk of bias).Fourteen studies reported dehiscence. We combined results from 12 studies (1507 wounds; 1475 participants; follow up 30 days to an average of 113 ‐days or unspecified) that compared NPWT with standard dressings. It is uncertain whether NPWT reduces the risk of wound dehiscence compared with standard dressings (RR 0.80, 95% CI 0.55 to 1.18; very low certainty evidence, downgraded twice for very ‐serious risk of bias and once for serious imprecision).

Secondary outcomesWe are uncertain whether NPWT increases or decreases reoperation rates when compared with a standard dressing (RR 1.09, 95% CI 0.73 to 1.63; 6 trials; 1021 participants; very low certainty evidence, ‐downgraded for very serious risk of bias and serious imprecision) or if there is any clinical benefit associated with NPWT for reducing wound related ‐readmission to hospital within 30 days (RR 0.86, 95% CI 0.47 to 1.57; 7 studies; 1271 participants; very low‐certainty evidence, downgraded for very serious risk of bias and serious imprecision). It is also uncertain

whether NPWT reduces incidence of seroma compared with standard dressings (RR 0.67, 95% CI 0.45 to 1.00; 6 studies; 568 participants; very low‐certainty evidence, downgraded twice for very serious risk of bias and once for serious imprecision). It is uncertain if NPWT reduces or increases the risk of haematoma when compared with a standard dressing (RR 1.05, 95% CI 0.32 to 3.42; 6 trials; 831 participants; very low certainty evidence, ‐downgraded twice for very serious risk of bias and twice for very serious imprecision. It is uncertain if there is a higher risk of developing blisters when NPWT is compared with a standard dressing (RR 6.64, 95% CI 3.16 to 13.95; 6 studies; 597 participants; very low certainty evidence, downgraded twice for very ‐serious risk of bias and twice for very serious imprecision).Quality of life was not reported separately by group but was used in two economic evaluations to calculate quality adjusted life years (QALYs). There was no clear‐ difference in incremental QALYs for NPWT relative to standard dressing when results from the two trials were combined (mean difference 0.00, 95% CI −0.00 to 0.00; moderate certainty evidence).‐One trial concluded that NPWT may be more cost‐effective than standard care, estimating an incremental cost effectiveness ratio (ICER) value of ‐GBP 20.65 per QALY gained. A second cost‐effectiveness study estimated that when compared with standard dressings NPWT was cost saving and improved QALYs. We rated the overall quality of the reports as very good; we did not grade the evidence beyond this as it was based on modelling assumptions.

Authors' conclusionsDespite the addition of 25 trials, results are consistent with our earlier review, with the evidence judged to be of low or very low certainty for all outcomes. Consequently, uncertainty remains about whether NPWT compared with a standard dressing reduces or increases the incidence of important outcomes such as mortality, dehiscence, seroma, or if it increases costs. Given the cost and widespread use of NPWT for SSI prophylaxis, there is an urgent need for larger, well designed and well conducted trials to evaluate ‐ ‐the effects of newer NPWT products designed for use on clean, closed surgical incisions. Such trials should initially focus on wounds that may be difficult to heal, such as sternal wounds or incisions on obese patients.