The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to evaluate the incidence of postoperative surgical site infections (SSIs) between laparoscopic (LAP) and open colorectal surgery. The 2008 ACS-NSQIP Participant Use File was queried by Current Procedural Terminology codes for colorectal surgery cases. SSI rates were compared between groups using Pearson chi-square and Fisher exact tests. Univariate and multivariate analyses were performed to identify factors associated with the LAP approach and/or SSIs. A total of 7,755 LAP and 16,184 open cases were identified. The laparoscopic group had an SSI rate of 9.4 versus 15.7 per cent for the open group ( P < 0.0001). There was no statistical difference in the type of SSI (superficial, deep, and/or organ space) between the two groups. Although multivariate analysis identified several factors associated with SSIs of different types, LAP was the only factor found to decrease risk, whereas wound class and operative time were found to increase risk among all categories of SSIs. Despite a significantly lower incidence of postoperative SSI, only 32 per cent of colorectal surgery was performed laparoscopically in NSQIP hospitals in 2008. Wider adoption of LAP approaches for colorectal surgery should continue to reduce SSIs.

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The DRIL procedure is a very effective treatment for symptomatic steal syndrome and is associated with low morbidity and mortality. It is extremely effective in the treatment of ischemic hand pain and tissue loss, but less so for neurological sequelae. It can allow for prolonged fistula utilization.

Objective: Arterial steal syndrome after angioaccess surgery can lead to potentially devastating complications. Past treatments ensured loss of the newly created access by performing ligation or attempted salvage by increasing resistance within the fistula. None of these proved to be entirely satisfactory. In 1994, we began to use distal revascularization with interval ligation (DRIL) as our primary method of relieving hand ischemia after dialysis access creation. We describe our experience with this procedure.Methods: After Investigational Review Board approval, the records of all patients undergoing the DRIL procedure for relief of hand ischemia after dialysis access surgery were reviewed. Patient demographics, risk factors, type of fistula, and indications for operation were recorded. The clinical results of DRIL surgery, duration of fistula use for dialysis, and bypass graft patency were noted. Kaplan-Meier survival curves were created, and differences between groups were tested by the log-rank method. Fistula survival was defined as the duration of use before abandonment as the primary method of achieving dialysis access, and bypass graft survival was determined by clinical examination or duplex scan.Results: Between May 1994 and August 2011, 81 DRIL procedures were performed on 77 patients (32 men, 45 women) with a mean age of 64 years (range, 37-91 years). Diabetes was present in 77.6%. DRIL procedures were performed for ischemic symptoms after 51 autogenous fistulas (37 brachiocephalic and 14 brachiobasilic), and 30 were created after prosthetic bridge fistulas. Thirty-eight DRILS were performed for patients with ischemic rest pain, 20 after the development of digital ulcers, 16 to help resolve neurologic symptoms, and seven to heal digital gangrene. After performance of the DRIL procedure, complete resolution of symptoms was noted in 90% of patients treated for digital ulceration, 81.6% of patients treated for ischemic rest pain, 56.3% of patients treated for neurologic deficits, and 42.9% of patients treated for digital gangrene. Overall fistula survival after the DRIL procedure was 70.1%, 57.8%, and 44.5% at 12, 24, and 36 months, respectively. Autogenous fistulas had a significantly longer survival after DRIL than prosthetic bridge fistulas (P ϭ .009). The 5-year patency of the brachial-brachial bypass graft was 93.7%. No patients died Յ30 days of operation.Conclusions: The DRIL procedure is a very effective treatment of hand ischemia after dialysis access creation and can be performed with a low mortality. It is extremely successful in treating ischemic rest pain and digital ulceration, but less so when used to treat patients with digital gangrene and neurologic deficits. Autogenous fistula survival after the creation of the DRIL is excellent and considerably longer than that of prosthetic bridge fistulas.