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Results for “Surgical site occurrence”

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At least 19 recordsLinked to original sources

PubMed2005

Rates of surgical-site infection: an international comparison.

OBJECTIVES: To quantify the occurrence of surgical-site infections (SSIs) in an Italian region and to estimate the proportion of potentially avoidable infections through benchmarking comparison. DESIGN: Prospective study during 1 month based on a convenience sample of surgical patients admitted to 31 public hospitals. All of the patients undergoing an intervention included among the 44 operative procedures of the National Nosocomial Infections Surveillance (NNIS) System were enrolled. Ninety-five percent of the patients were actively observed after discharge for up to 30 days for all of the operations and for up to 1 year for operations involving implantation. RESULTS: Among the 6,167 operative procedures studied, 290 infections were recorded (4.7 per 100 procedures), 206 (71%) of which were SSIs (3.3 per 100 procedures; 95% confidence interval, 2.9-3.9). One hundred thirty-five SSIs (65.5%) were superficial infections, 53 (25.7%) were deep infections, and 12 (5.8%) were organ-space infections; in 6 cases (2.9%), the type of SSI was not recorded. The frequency of SSIs observed in this study was significantly higher for several procedures than that expected when the NNIS System rates (standardized infection ratio [SIR] ranging from 1.77 to 6.42) or the Hungarian rates (SIR ranging from 1.28 to 3.04) were applied to the study population. CONCLUSIONS: The high intensity of postdischarge surveillance can in part explain the differences observed. To allow for meaningful benchmarking comparison, in addition to intrinsic patient risk, data on the intensity of postdischarge surveillance should be included in published reports.

Adult↗

PubMedDate not supplied

[Suitability of the Hospital Infection National Surveillance System (NNISS) risk index for the prediction of the incidence of surgical site infection at a university hospital in Florianopolis, South Brazil].

BACKGROUND: The NNIS risk index has been largely recommended because it consists of a simple additive scale. Nevertheless, it has been seldom validated in populations other than the NNIS participating hospitals OBJECTIVES: To investigate the occurrence of Surgical Site Infection ( SSI ) using the traditional variables of the NNIS Index, and to approach the suitability of this methodology when applied to a smaller public university hospital (HU/UFSC) in Florianópolis, South Brazil. METHODS: A retrospective chart review of 9322 patients undergoing surgical procedures in the period of January 1993 to December 1998. RESULTS: The composite index showed to be a better predictor of SSI than Surgical Wound class (SWc) and presented a predictive power comparable to the ASA index. ASA together with length of surgery seemed to be the main contributors for the final performance of the composite index. CONCLUSIONS: The composite index using the variables of the traditional NNIS system showed to adequately predict the risk of SSI in our university hospital. Larger samples using different hospitals with similar characteristics are needed to approach the risk of SSI associated to specific surgical procedures.

Brazil↗

PubMed2001

Suitability of the NNIS index for estimating surgical-site infection risk at a small university hospital in Brazil.

OBJECTIVES: To detect the occurrence of surgical-site infection (SSI) in our study sample, using the traditional variables of the National Nosocomial Infection Surveillance (NNIS) index with a locally modified cut-off point for the "T time" defining length of surgical procedure; to compare the modified and the traditional NNIS index under the hypothesis that a cut-off point discriminating procedures of short and long duration, based upon the actual experience of the study sample, can adequately predict the risk of SSI. DESIGN: A retrospective chart review of 9,322 patients undergoing surgical procedures in the period January 1993 to December 1998. SETING: A small university hospital (UH) in southern Brazil. RESULTS: The composite index using the local sample procedure-duration cut-off point (UH-index) performed better than any of the individual components of the composite index (anesthesia risk index and surgical-wound class [SWC]). The UH-index also predicted adequately the risk of SSI when compared to the traditional NNIS index, particularly when stratifying by SWC. CONCLUSIONS: A modified NNIS index, using the sample cut-off point, can adequately predict the risk of SSI in a given population. Further studies are needed to compare and validate the NNIS index of risk for populations other than those of the NNIS-participating hospitals. Larger samples using different hospitals with similar characteristics are needed to investigate the risk of SSI associated with specific operations.

Brazil↗

PubMed2005

Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair.

Adult umbilical hernia is a common surgical condition mainly encountered in the fifth and sixth decade of life. Despite the high frequency of the umbilical hernia repair procedure, disappointingly high recurrence rates, up to 54% for simple suture repair, are reported. Since both mesh and suture techniques are used in our clinic we set out to investigate the respective recurrence rates and associated complications, retrospectively. Patients who were treated between January 1998 and December 2002 were identified from our hospital database and invited to attend the outpatient department for an extra follow-up, history taking and physical examination. The use of prosthetic material, occurrence of surgical site infection, body mass and height as well as recurrence were recorded at the time of this survey. In total, 131 consecutive patients underwent operative repair of an umbilical hernia. Twenty-eight percent of the patients were female (n = 37). In 12 patients (11%) umbilical hernia repair was achieved with mesh implantation. Fourteen umbilical hernia recurrences were noted (13%); none had been repaired using mesh. No relationship was found between wound infection or obesity and umbilical hernia recurrence. In the light of these results it is necessary to re-evaluate our clinical "guidelines" on mesh placement in umbilical hernia repair: apparently not every umbilical fascial defect needs mesh repair. Research should focus on establishing risk factors for hernia recurrence.

Adult↗

PubMed2026

Hybrid robotic transversus abdominis release (hrTAR) for complex ventral hernias: a systematic review and preliminary synthesis.

Hybrid robotic transversus abdominis release (hrTAR) combines robotic posterior component separation with a planned limited open phase. Evidence supporting this strategy is sparse. Following PRISMA 2020, we searched PubMed, Embase, Scopus, and the Cochrane Library and registered the protocol in PROSPERO (CRD420261303285). Eligible studies reported hrTAR outcomes for ventral or incisional hernia repair. Findings were synthesized narratively; no pooled effect estimates were calculated. Three reports contained 85 hrTAR cohort entries. Because two reports came from the same institution and overlap could not be excluded, this total should not be interpreted as a unique-patient count. Surgical-site outcomes were heterogeneous: two reports used SSO endpoints (4% and 5%), whereas another reported surgical-site events in 25% of patients, including seroma and wound infection. Mean length of stay ranged from 1.8 to 3.7 days; the sample-size-weighted mean across studies reporting means was 2.9 days. One propensity-matched comparison reported shorter hospitalization and lower 30-day SSO with hrTAR than open TAR. No perioperative deaths or recurrences were reported during limited follow-up. hrTAR appears feasible in selected patients, but available evidence is exploratory. Standardized prospective multicenter studies with non-overlapping cohorts and longer follow-up are needed before comparative effectiveness, economic value, or wider adoption can be supported.

Humans↗

PubMed2005

Primary facial skin cancer: clinical characteristics and surgical outcome in Chungbuk Province, Korea.

Clinical features of facial skin cancer in Asian population including Korean are not readily available. In the present study, we analyzed the clinical characteristics and the surgical results of primary facial skin cancer in Chungbuk Province, Korea. Eighty-six cases of primary facial skin cancer collected during a 10-yr period (1994-2003) were retrospectively reviewed about the clinical characteristics including age, sex, annual diagnostic rate, types of tumor, specific sites of occurrence, and the surgical results. The average age at the diagnosis was 67 and male to female ratio was 1 to 1.05. The average annual diagnostic rate was 0.73% and the rate surged during the period 2001-2003 compared with the period 1994 to 2000. Basal cell carcinoma was the most common tumor and the nose was the most frequent site. Traditional surgical excision with immediate reconstruction was performed in 81 cases. During the 23 months of average follow-up, three patients had recurrences (3.7%) and three patients had secondary skin cancers. Facial skin cancer is increasing in the province and basal cell carcinoma is most frequent. Traditional surgical excision and immediate reconstruction with local flap are a good therapeutic modality with an acceptable recurrence rate.

Adult↗

PubMed2000

Perioperative antibiotic use in high-risk penetrating hollow viscus injury: a prospective randomized, double-blind, placebo-control trial of 24 hours versus 5 days.

BACKGROUND: The purpose of this study was to compare the safety and therapeutic efficacy of a 24-hour versus 5-day course of ampicillin/sulbactam for the prevention of postoperative infections in high-risk patients sustaining hollow viscus injury from penetrating abdominal trauma. METHODS: A total of 317 patients from four Level I trauma centers with penetrating abdominal injuries and at least one hollow viscus perforation each received one preoperative and three postoperative doses of ampicillin/sulbactam 3 g intravenously. After receiving 24 hours of unblinded ampicillin/sulbactam, patients were then randomized into one of two groups. Group 1 received 4 additional days of blinded ampicillin/sulbactam (5 days total of antibiotic), and Group 2 received 4 days of placebo (24 hours of antibiotic). Patients were assessed postoperatively for occurrence of deep surgical-site infections (intra-abdominal abscess, fasciitis, and peritonitis) and superficial (wound) surgical-site infections. Development of nonsurgical-site infections (e.g., pneumonia, urinary tract infection, phlebitis, and cellulitis) was also recorded. Continuous variables were analyzed by analysis of variance and discrete variables by the Cochran-Mantel-Haenszel chi2 test. Multivariate logistic regression analyses were also performed to identify independent risk factors for postoperative infection. RESULTS: A total of 159 patients were randomized into Group 1, and 158 patients were randomized into Group 2. The Injury Severity Score and penetrating abdominal trauma index were 18+/-8 and 21+/-13, respectively, for Group 1 and 18+/-9 and 20+/-15, respectively, for Group 2. A total of 162 (51%) patients sustained one or more colon injuries (82 in Group 1 and 80 in Group 2). There were 16 (10%) surgical-site infections in Group 1 and 13 (8%) surgical-site infections in Group 2 (p = 0.74). Group 1 patients experienced 17 (11%) nonsurgical-site infections, whereas Group 2 had 32 (20%) nonsurgical-site infections. This difference, however, was not statistically significant (p = 0.16). Only the total number of blood units transfused and the presence of a PATI score greater than or equal to 25 were found to be independently associated with the development of a postoperative surgical- and nonsurgical-site infections (p = 0.001 and p = 0.003, respectively). Of note, the presence of a colon injury was not found to be an independent risk factor (p = 0.11) for either surgical or nonsurgical site postoperative infection in our study. CONCLUSION: High-risk patients with colon or other hollow viscus injuries from penetrating abdominal trauma are at no greater risk for surgical-site or nonsurgical-site infection when treated with only a 24-hour course of a broad-spectrum antibiotic.

Adult↗

PubMedDate not supplied

Iris prolapse at the surgical site: a late complication of nonpenetrating deep sclerectomy.

To investigate the occurrence and management of late-onset iris prolapse through the surgical wound after nonpenetrating deep sclerectomy. Two cases of iris prolapse that presented 8 and 10 months, respectively, after surgery for glaucoma were reviewed. One of the cases was associated with mild trauma. The postoperative follow-up was 5 and 24 months, respectively. The iris tissue bulge did not progress and there were no other complications. The visual acuity was not affected and the intraocular pressure was controlled with medical therapy. These cases demonstrate that the eye is weaker than normal at the surgical site after nonpenetrating deep sclerectomy, allowing iris protrusion. Iris prolapse should be added to the list of late postoperative complications of nonpenetrating deep sclerectomy.

Aged↗

PubMed2002

[Prevention of port-site metastasis after laparoscopy].

Port-site metastasis is a major complication of surgical laparoscopy for gynaecologic oncology. Aetiology of port-site metastases is multifactorial. Surgical conditions and laparoscopic environment were determinant. Several means of prevention were evaluated to prevent occurrence of port-site metastases. Aim of this review is to report optimal surgical conditions, laparoscopic environment and means of prevention to decrease risk of port-site metastases.

Animals↗

PubMed2000

Pyoderma gangrenosum occurring in a lower limb fasciocutaneous flap--a lesson to learn.

Pyoderma gangrenosum is a destructive cutaneous disease characterised by progressive painful ulceration. The occurrence of pyoderma gangrenosum at a surgical site is rare (especially if there is no predisposing illness), but is well recognised. We present a case of a 63-year-old man who developed erythematous ulcerative lesions due to pyoderma gangrenosum in and around a lower limb fasciocutaneous flap used to cover an exposed total knee prosthesis. The lesions were initially confused with postoperative wound infection. No predisposing disorder, other than the rarely reported association with osteoarthritis, was found. The diagnosis is important because its rapid detection not only avoids unnecessary treatment but also allows for prompt intervention with oral steroids. This case is presented to alert surgeons to the presence of pyoderma gangrenosum and its diagnostic confusion with postoperative wound infection.

Anti-Inflammatory Agents↗

PubMed1981

Effect of implant location on compressibility and capsule formation around miniprostheses in rats, and experimental capsule contracture.

Our study of experimental contracture in rats confirms the existence in laboratory animals of a phenomenon very much like human capsule contracture. The ultrastructural features of capsules in rats are essentially identical to those for humans and rabbits. Macrophages with silicon-containing material were present. Star-shaped myofibroblasts with extended processes appeared in contracted and noncontracted capsules. The myofibroblasts contained bundles of 60 to 80 A microfilaments with included dense bodies, convoluted nuclei, and extensive peripheral vesiculation. The myofibroblasts tended to be associated with more extensive ground substance and smaller diameter extracellular fibrils than were normal synthetic fibroblasts. The incidence of contracture was similar for implants beneath different amounts of overlying soft tissue dorsally and sternally, while compressibility and subjective softness were greater for implants beneath lesser amounts of overlying tissue. A greater mass of capsule formed beneath the heavier covering, however, suggesting that in clinical experience, cosmetically more acceptable results from submuscular prosthesis placement are probably due to a padding effect. Capsule glycosaminoglycans were primarily hyaluronic acid and dermatan sulfate. The occurrence of myofibroblasts in these capsules at a relatively late period (26 weeks) implicates myofibroblasts in the contracture mechanism, but details are still unknown. Contracture is a property of the capsule tissue; preliminary observations suggest that its occurrence is independent of species, anatomical site, surgical procedure, presence of extruded gel, presence of myofibroblasts, capsule thickness, or protein, collagen, or glycosaminoglycan composition. Cells within the capsule were geometrically asymmetrical, being extremely flattened in the plane parallel to the prosthesis surface.

Animals↗

PubMed1990

Recurrent osteoid osteoma. Case report with a ten-year asymptomatic interval.

Osteoid osteoma has been accepted as a distinct clinical and pathologic entity for more than 50 years. Surgical curettage will often cure the lesion, although en bloc excision is now the preferred treatment. The development of local recurrence after surgery, although rare, has been well documented after both curettage and en bloc excision. Symptomatic recurrence of an osteoid osteoma was seen ten years after surgical curettage. Its occurrence at the same site as the original lesion is consistent with the concept that it had originated from residual tissue and is in keeping with the concept of osteoid osteoma as a benign tumor.

Bone Neoplasms↗

PubMed1995

[A case of vascular leiomyoma in the larynx].

We report a recently encountered case of vascular leiomyoma in the larynx. The patient was a 76-year-old man with a chief complaint of hoarseness. Laryngoscopy revealed a bean-sized, reddish tumor with a smooth surface, suspended from the right vocal cord toward the subglottis. Its border was clear on MR imaging. Tracheotomy was performed under local anesthesia, and laryngomicrosurgery was then carried out under general anesthesia. The tumor was encapsulated and could be completely resected. Histological study indicated smooth muscule cell proliferation, especially around capillaries, and the tumor was diagnosed as a vascular leiomyoma. Our extensive survey of the literature revealed 20 reports of benign myogenic tumor of the larynx (9 cases of simple leiomyoma, 10 of vascular leiomyoma, and 1 of leiomyoblastoma), many of which occurred in the middle and advanced years. The patients consisted of 15 men and 5 women, including 9 male vascular leiomyoma patients of middle or advanced age. The site of occurrence was supraglottic in 12, glottic in 4 and subglottic in 4; no relation was observed with the histological picture, however. Treatment was surgical, and some cases also required tracheotomy depending on the site of occurrence and morphology.

Aged↗

PubMed1999

Unusual multiple pilomatrixomata: case report and review of the literature.

Pilomatrixomata are rare, benign, calcifying cutaneous tumours of the hair matrix cells. They usually present in childhood with a pre-surgical diagnosis of sebaceous cyst, because of their size and appearance. The usual sites of occurrence are the scalp, head and neck. Treatment is usually surgical excision. We report a case of unusual, multiple, benign pilomatrixomata in an Indian adult. The plastic surgeon should be aware of the various guises of pilomatrixoma and be alert to the important, although rare, occurrence of malignancy.

Adolescent↗

PubMed1999

Shingles developing within recent surgical scars.

Occurrence of varicella and recurrence of herpes simplex on traumatized sites of the skin are well-described events. By contrast, herpes zoster occurring specifically at the site of previously injured skin has not yet been reported. Two patients are presented who developed shingles limited to skin on and around recent surgical scars. Varicella zoster virus was identified using immunohistochemistry on skin biopsy specimens and Tzanck smears. We suspect that the occurrence of herpes zoster involving surgical scars is usually misdiagnosed and therefore unrecognized. Whether shingles adjacent to scars represents a coincidental event or is specifically triggered by local injury is unknown.

Adult↗

PubMed1995

Infusion phlebitis in medical and surgical patients in Siriraj Hospital.

A study on infusion phlebitis was done in medical and surgical departments in Siriraj Hospitals from February to April 1992. Two hundred and eighty-one patients and 406 infusion sites were included. The infusion time was 40.6 +/- 31.9 hours. The incidence rate of phlebitis was 25.9%. There was no difference in its occurrence in medical and surgical patients. Dorsum of the hand was the site associated with low incidence and less severe phlebitis. The contrary applied to the forearm and arm. Plastic cannulae were associated with higher incidence, more severe phlebitis than steel needles, but this was not statistically significant. Intravenous antimicrobials were followed by higher incidence and more severe phlebitis. The value of early diagnosis of infusion phlebitis so as to halt its progress was also demonstrated in the study. In no case was the phlebitis, in the most severe form i.e. grade 5, encountered.

Adolescent↗

PubMed2003

Infections in 346 consecutive video-assisted thoracoscopic procedures.

BACKGROUND: Postoperative infections, as related to risk factors, in patients undergoing video-assisted thoracoscopic surgery (VATS) procedures have been studied infrequently. MATERIALS AND METHODS: We evaluated 346 consecutive patients who underwent VATS procedures between October 1996 and June 2002 at our center. Patients preoperatively were free of chest infections and were divided into two groups: Group A (n = 139) who underwent lung wedge resection; group B (n = 207), who underwent pleural biopsy (n = 183) or biopsy of a mediastinal mass (n = 24). We recorded prospectively the following preoperative infection risk parameters: Hemoglobin concentration, hematocrit, serum albumin concentration, lymphocyte count, length of preoperative stay, duration of surgery, blood transfusion, age, comorbidity, and chronic obstructive pulmonary disease specifically (COPD, measured as FEV(1) <70% of expected). Short-term antibiotic prophylaxis was given to 94% of patients in group A and to 90% of patients in group B. As outcome measures we recorded the occurrence of postoperative infections within 30 days (surgical site infection, pneumonia, empyema) and the final patient outcome. RESULTS: Patients who developed postoperative infections (all the above types included) were 17/346 (4.9%), the difference between group A (5.0%) and group B (4.8%) being not significant. The overall surgical site infection rate was 1.7%. Groups A and B showed a similar incidence of surgical site infection (2.8% vs. 1.0%; p = NS), of pneumonia (2.8% vs. 3.4%; p = NS), and of empyema (0.7% vs. 2.0%; p = NS). Among assessed infection risk parameters, a FEV(1) <70% of expected was the only parameter associated with a significantly increased incidence of surgical site infection (p < 0.05). CONCLUSIONS: This prospective study confirms that the wound infection rate is low (1.7%) after minimally invasive VATS procedures. The cumulative incidence of postoperative infections (including wound infection, pneumonia, empyema) was similar after lung wedge resection and after pleural or mediastinal mass biopsy procedures. Among the infection risk parameters, COPD was the only parameter associated with a significantly increased incidence of postoperative infection. Our results suggest that patients with COPD who undergo VATS for lung wedge resections and for pleural/mediastinal biopsy should receive antibiotic prophylaxis to prevent surgical site infection.

Adult↗

PubMed2000

Surgical therapy for distant metastases of malignant melanoma.

BACKGROUND: Manifestation of distant metastases in melanoma patients commonly indicates a poor prognosis. The aim of the current study was to examine the role of surgical treatment in these patients. METHODS: Data from 444 patients with distant melanoma metastases were gathered prospectively from January 1978 through December 1997. Characteristics of the primary tumor, time until the first occurrence of distant metastases, frequency and site of distant metastases, surgical therapy, and survival were evaluated by univariate and multivariate analyses. RESULTS: Histology, Breslow thickness, Clark level, and pT and pN categories (UICC 1997) significantly influenced the median interval from initial diagnosis to manifestation of distant metastases. The most common single localization was the lung (n = 83), followed by distant lymph node (n = 79), and skin metastases (n = 51). One hundred seventy-four patients received surgical treatment (39%) and 111 (25%) patients received surgical treatment with curative resection (R0, UICC 1997), most frequently in distant lymph node or skin metastases (57% and 59%, respectively). Median survival time and 2-year survival rate for all patients were 7 months and 15.8%, respectively, 17 months and 36.1% following curative resection, 6 months and 12.7% after incomplete resection (n = 63) (P < 0.0001). Conservatively treated patients survived for a median of only 4 months with a 2-year survival of 8.1%. Multivariate survival analysis showed localization of the primary tumor (head/neck/trunk vs. extremities), the number of involved sites, and surgical therapy to be independent prognostic factors. CONCLUSIONS: Surgical therapy of distant metastases was most beneficial when complete removal of metastatic tissue was achieved. Selection of patients for surgical excision should be determined by individual patient indications.

Adult↗