Surgical site infection in hand surgery

Menendez, Mariano E.; Lu, Na; Unizony, Sebastian; Choi, Hyon K.; Ring, David

doi:10.1007/s00264-015-2849-9

Cited by 40 publications

(42 citation statements)

References 36 publications

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“…The study's inferences regarding the impact of DM and overall rates of infection were similar to findings in a large administrative database study evaluating surgical site infections after ambulatory hand surgery, which determined a 0.33% rate of surgical site infection at 30 days. 9 The overall rates of surgical site complications were also similar to previously reported rates in outpatient ambulatory orthopedic surgery. 8 The absolute rate of superficial infections was higher in patients with DM and the lack of statistical significance may have been related to a low rate of superficial surgical site infections and sample size.…”

Section: Discussionsupporting

confidence: 84%

“…reported at a rate of 4.3% to 5.6% by 30 days after surgery in an administrative database study. 8 Surgical site infections after ambulatory hand surgery were reported to be 0.33% at 30 days in a large administrative database, 9 although that study evaluated only infections associated with acute care visits such as emergency department visitation, inpatient hospitalization, and additional surgery. However, to the authors' knowledge, no matched studies have specifically evaluated wound healing after CTR in patients with and without DM.…”

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confidence: 99%

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Matched Cohort Study of Wound-Healing Complications in Patients With and Without Diabetes Mellitus After Primary Open Carpal Tunnel Release

Cunningham

Baumgartner

Federer

et al. 2019

Journal of Hand Surgery Global Online

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Carpal tunnel release cohort diabetes surgical site infection wound healing Purpose: Diabetes mellitus (DM) is associated with increased rates of wound complications and reduced improvement in patient-reported outcomes across a wide range of surgical disciplines, although the impact of DM is less known after primary carpal tunnel release (CTR). This study's hypothesis was that DM would be an independent risk factor for wound complications after CTR. Methods: This retrospective, matched, cohort study evaluated all diabetic patients with a preoperative hemoglobin A1c value within 90 days of open primary CTR at a single academic institution from 2007 to 2017. Records were reviewed to determine rates of superficial or deep surgical site infection and delayed wound healing or wound dehiscence. Additional procedures, bilateral procedures, and administration of perioperative antibiotics were also noted. We calculated unadjusted and adjusted odds ratios and 95% confidence intervals to determine differences in all-cause and specific wound complication rates between patients with and without DM. Results: Diabetic patients (n ¼ 128) had an all-cause wound complication rate, surgical site infection rate, and delayed wound healing or wound dehiscence rate of 11 (8.6%), 5 (3.9%), and 6 (4.7%), respectively, compared with 8 (6.3%), 2 (1.6%), and 6 (4.7%), respectively, for nondiabetic patients (n ¼ 128). Diabetes was not significantly associated with an increased rate of all-cause wound complications at an unadjusted odds ratio of 1.41 (range, 0.55e3.63). Rates of specific wound complications also did not differ significantly, although superficial surgical site infections were more common among patients with DM at an unadjusted odds ratio of 5.16 (range, 0.59e44.82). Conclusions: Adjusted all-cause wound complication rates did not differ significantly in a matched cohort series. Superficial surgical site infections occurred at a higher rate in patients with DM, although this difference was not statistically significant. The presence of DM is not a contraindication to proceed with CTR in symptomatic patients. Type of study/level of evidence: Therapeutic III.

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Section: Discussionsupporting

confidence: 84%

mentioning

confidence: 99%

Matched Cohort Study of Wound-Healing Complications in Patients With and Without Diabetes Mellitus After Primary Open Carpal Tunnel Release

Cunningham

Baumgartner

Federer

et al. 2019

Journal of Hand Surgery Global Online

View full text Add to dashboard Cite

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“…Timing was significantly earlier in inpatients compared with outpatients for myocardial infarction (day 1 [IQR: [1][2][3] vs. day 3 [IQR: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15], p = 0.006) (►Table 3 and ►Fig. 3).…”

Section: Resultsmentioning

confidence: 99%

Timing of Complications following Hand Surgery

Goyal

Bohl

Wysocki

2022

Journal of Hand and Microsurgery

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Introduction Our purposes were to (1) characterize the timeline of eight postoperative complications following hand surgery, (2) assess complication timing for the procedures that account for the majority of adverse events, and (3) determine any differences in complication timing between outpatient and inpatient procedures. Materials and Methods Patients undergoing hand, wrist, and forearm procedures from 2005 to 2016 were identified in the National Surgical Quality Improvement Program database. Timing of eight adverse events was characterized. Cox proportional hazards modeling was used to compare adverse event timing between inpatient and outpatient procedures. Results A total of 59,040 patients were included. The median postoperative day of diagnosis for each adverse event was as follows: myocardial infarction 1, pulmonary embolism 2, acute kidney injury 3, pneumonia 8, deep vein thrombosis 9, sepsis 13, urinary tract infection 15, and surgical site infection 16. Amputations, fasciotomies, and distal radius open reduction internal fixation accounted for the majority of adverse events. Complication timing was significantly earlier in inpatients compared with outpatients for myocardial infarction. Conclusion This study characterizes postoperative adverse event timing following hand surgery. Surgeons should have the lowest threshold for testing for each complication during the time period of greatest risk. Level of Evidence This is a therapeutic, Level III study.

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“…As nearly two-thirds of surgeries in the United States are performed on an outpatient basis, assessment of the differences in MCA sterility between hospital main operating rooms (MOR) and ambulatory surgery center operating rooms (AOR) is warranted and deserves evaluation. 18 It is our hypothesis that there will be no difference in MCA contamination rates between MORs and AORs; however, we anticipate that under hand-table MCA technique will have increased contamination rates in both surgical settings.…”

Section: Introductionmentioning

confidence: 92%

Sterility of Miniature C-arm Fluoroscopy in Hand and Upper Extremity Surgery

Hovis

Moore‐Lotridge

Mansour

et al. 2022

Journal of Hand and Microsurgery

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Previous studies have demonstrated that sterile equipment is frequently contaminated intraoperatively, yet the incidence of miniature c-arm (MCA) contamination in hand and upper extremity surgery is unclear. To examine this incidence, a prospective study of MCA sterility in hand and upper extremity cases was performed in a hospital main operating room (MOR) (n = 13) or an ambulatory surgery center operating room (AOR) (n = 16) at a single tertiary care center. Case length, MCA usage parameters, and sterility of the MCA through the case were examined. We found that MOR surgical times trended toward significance (p = 0.055) and that MOR MCAs had significantly more contamination prior to draping than AOR MCAs (p < 0.001). In MORs and AORs, 46.2 and 37.5% of MCAs respectively were contaminated intraoperatively. In MORs and AORs, 85.7 and 80% of noncontaminated cases, respectively, used the above hand-table technique, while 50 and 83.3% of contaminated MOR and AOR cases, respectively, used a below hand-table technique. Similar CPT codes were noted in both settings. Thus, a high-rate of MCA intraoperative contamination occurs in both settings. MCA placement below the hand-table may impact intraoperative contamination, even to distant MCA areas. Regular sterilization of equipment and awareness of these possible risk factors could lower bacterial burden.

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Surgical site infection in hand surgery

Cited by 40 publications

References 36 publications

Matched Cohort Study of Wound-Healing Complications in Patients With and Without Diabetes Mellitus After Primary Open Carpal Tunnel Release

Matched Cohort Study of Wound-Healing Complications in Patients With and Without Diabetes Mellitus After Primary Open Carpal Tunnel Release

Timing of Complications following Hand Surgery

Sterility of Miniature C-arm Fluoroscopy in Hand and Upper Extremity Surgery

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