Effects of modifiable, non-modifiable and clinical process factors in ventral hernia repair surgical site infections: A retrospective study

Chipko, John; DeSantis, Anthony J.; Quinn, Eric; Velanovich, Vic

doi:10.1016/j.amjsurg.2017.07.017

Cited by 10 publications

(8 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to high ASA score, longer operation time was another independent predictor of short-term morbidity in the analyzed cohort. This was also in agreement with similar findings in the head and neck literature 38,41,42 or in other surgical fields such as spine, 43 hernia, 44 and urolithiasis surgery. 45 As such, this large cohort's averaged operation time for cases with complication (131.5 ± 112.7 minutes) versus no complication (95.8 ± 59.8 minutes) may serve as a valuable reference for clinicians treating HD.…”

Section: Discussionsupporting

confidence: 93%

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Goshtasbi

Verma

2020

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objective: To describe rates of short-term morbidity following transcervical surgical treatment of hypopharyngeal diverticulum (HD) and analyze predictors of adverse events. Methods: The 2005 to 2017 National Surgical Quality Improvement Program database was queried to identify patients diagnosed with HD undergoing open transcervical diverticulectomy. Results: A total of 597 patients with a mean age of 71.4 ± 12.3 years were included. Thirty-day adverse events were experienced by 63 (10.6%) subjects, including 6.5% unplanned reoperations, 4.2% surgical complications, 4.4% medical complications, 2.7% readmissions, and 0.7% deaths. Medical complications notably included pneumonia (2.0%), reintubation (1.2%), sepsis (1.2%), intubation >48 hours (0.5%), urinary tract infection (0.5%), or deep vein thrombosis (0.5%), while surgical complications included organ/space infection (2.0%) and superficial (1.3%) or deep (1.0%) surgical site infection. Gender, race, functional status, diabetes, dyspnea, hypertension, steroid use, and recent weight loss were not associated with adverse events. Length of operation and hospitalization were both higher among those with adverse events (127.4 ± 107.9 vs 95.7 ± 59.8 minutes, P = 0.027, and 7.4 ± 7.4 vs 2.8 ± 3.6 days, P < 0.001). On multivariable logistic regression, high American Society of Anesthesiologists (ASA) class (OR = 2.02, P = 0.017), smoking (OR = 2.10, P = 0.044), and operation time (OR = 1.01; P = 0.005) were independent predictors of adverse events. Obesity was not associated with length of stay, readmission/reoperation, or complications. However, increased age was associated with shorter operations ( P = 0.020), higher length of hospitalization ( P < 0.001), and higher mortality ( P = 0.027) and readmission rates ( P = 0.023). Conclusion: Understanding clinical factors associated with complications following open surgery for HD such as ASA score, smoking status, length of operation, and age can help optimize surgical outcomes for at-risk patients. Level of Evidence: NA

show abstract

Section: Discussionsupporting

confidence: 93%

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Goshtasbi

Verma

2020

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

show abstract

“…Two studies suggested no association between CSD and SSI and an overall low rate of SSI in VHR despite the use of drains. 10,19 Two studies suggested a potential for an association between CSD use and SSI, 4,18 but in both, drain placement was uncontrolled, placed at the discretion of the operating surgeon in selective circumstances, assessed retrospectively, and analyzed in univariate analysis. With regard to CSD and SSI, both studies therefore likely carried substantial procedural and patient selection biases.…”

Section: Discussionmentioning

confidence: 99%

“…1 and Table 1). 4,10,11,18,19 Among the selected studies, 772 patients were included, of whom 525 were confirmed to have CSD and 434 were treated with PPA.…”

Section: Literature Search and Summarymentioning

confidence: 99%

“…Four studies specifically focused on VHR, 4,11,18,19 three of which primarily examined ventral incisional hernia repair. Another focused on soft tissue procedures that required CSD placement, which incorporated a subgroup who underwent VHR.…”

Section: Literature Search and Summarymentioning

confidence: 99%

“…Chipko et al 19 conducted a retrospective review of the National Surgical Quality Improvement Program data and evaluated the risk factors for SSI in patients undergoing VHR over a one-year period at a single institution. Among 164 patients in the study who underwent VHR with placement of CSD, postoperative SSI rates were 9 per cent and 4 per cent for patients with and without CSD, respectively.…”

Section: Association Between Csd and Ssi In Incisional Hernia Repairmentioning

confidence: 99%

See 2 more Smart Citations

Use of Prolonged Prophylactic Antibiotics with Closed Suction Drains in Ventral Abdominal Hernia Repair

Weiss

McClelland

Krupp

et al. 2019

The American Surgeon™

View full text Add to dashboard Cite

Closed suction drains (CSD) are commonly used in ventral hernia repair (VHR), with or without prolonged postoperative prophylactic antibiotics (PPA) for the duration of their use. We examine the evidence that PPA with CSD reduce surgical site infection (SSI) in patients undergoing VHR. We also examine the evidence assessing the association between SSI and CSD in VHR. A systematic review of PubMed, CIHNL, and Cochrane databases was performed to identify studies analyzing rates of SSI with CSD in patients undergoing abdominal VHR and related procedures with or without the concomitant use of PPA. The primary outcome was the rate of SSI. Five studies totaling 772 patients were identified, 525 patients were confirmed to have CSD, and 434 patients received prolonged antibiotics while drains were in place. PPA had no significant effect on SSI in two studies and were associated with decreased SSI in one study (Odds ratio 0.235, 95% confidence interval 0.090–0.617, P = 0.003). Two studies documented a higher rate of SSI in patients with CSD (79% vs 49% and 19% vs 10%) on univariate analysis. One study demonstrated a very low risk of SSI despite CSD (4.2%) and another demonstrated no increased risk with or without CSD. The use of drains is not clearly associated with an increased risk of SSI in VHR, and there is limited evidence to support antibiotic use while the drains are in place to decrease the potential risk. Prospective randomized studies are needed to more clearly assess these associations.

show abstract

Clinical characteristics and temporal trends of lumbar drain use in minimally invasive resection of pituitary neoplasms

Bitner,

Torabi,

Hong

et al. 2024

World j. otorhinolaryngol.-head neck surg.

View full text Add to dashboard Cite

ObjectivesAppropriate scenarios of lumbar drain (LD) use in endonasal skull base surgery is an active area of investigation. However, existing data is limited. The purpose of this study is to evaluate the robustness of the NSQIP database to characterize morbidity and complications associated with LD usage concurrent to minimally invasive resection of pituitary tumors.MethodsA cross‐sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program database was used to query patients undergoing transnasal resection of pituitary tumor. Patients were stratified by concurrent perioperative use of LD and outcomes were compared.ResultsA total of 1714 patients underwent minimally invasive endonasal (microscopic or endoscopic) pituitary tumor resection, of which LD was concurrently placed in 98 (5.7%) cases. Operative time was significantly longer for patients who had LD placed compared to those without (176.5 min (IQR 114.8–229.5) vs. 137 min [IQR 100–185]), (p < 0.001) with a significantly longer length of stay (5 days [IQR 4–6] vs. 3 days [IQR 2–5]), (p < 0.001). Multivariate regression demonstrated LD placement was an independent predictor of postoperative medical complication (OR 2.41, 95% CI 1.15–5.03, p = 0.020) and unplanned readmission (OR 2.06, 95% CI 1.02–4.16, p = 0.044), but not CSF leak (OR 2.30, 95% CI 0.51–10.26; p = 0.276). Temporal analysis during the study period demonstrated a decrease in LD use from 8% to 5% (R2 = 0.60; p = 0.025).ConclusionsThe NSQIP database provides a large patient population for examining LD use in endoscopic pituitary adenoma resection. LD use for minimally invasive pituitary surgery is associated with postoperative medical complications and unplanned readmissions, with no apparent impact on reconstructive outcomes, and there is overall decreasing usage. Clinical judgment should be exercised in selecting appropriate scenarios for use.

show abstract

Effects of modifiable, non-modifiable and clinical process factors in ventral hernia repair surgical site infections: A retrospective study

Cited by 10 publications

References 24 publications

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Use of Prolonged Prophylactic Antibiotics with Closed Suction Drains in Ventral Abdominal Hernia Repair

Clinical characteristics and temporal trends of lumbar drain use in minimally invasive resection of pituitary neoplasms

Contact Info

Product

Resources

About