Surgical Site Infections Are Associated With Higher Blood Loss and Open Access in General Thoracic Practice

Aeschbacher, Pauline; Nguyen, Thanh-Long; Dorn, Patrick; Kocher, Gregor J.; Lutz, Jon A.

doi:10.3389/fsurg.2021.656249

Cited by 8 publications

(9 citation statements)

References 27 publications

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“…It declined consistently throughout the observation period, which could probably be explained by improvements in surgical techniques and equipment. The observed association between blood loss and infection rates was observed previously by other authors [51].…”

Section: All Patientssupporting

confidence: 88%

The impact of age on rectal cancer treatment, complications and survival

Høydahl

Edna

Xanthoulis

et al. 2022

Preprint

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Background The number of older patients with rectal cancer is increasing. Treatment outcome discrepancies persist, despite similar treatment guidelines. To offer the oldest patients optimal individually adjusted care, further knowledge is needed regarding treatment strategy and outcome. The present study aimed to evaluate treatment, postoperative complications, and survival in older patients treated for rectal cancer. Methods This retrospective study included all 666 patients (n=255 females, n=411 males) treated for rectal cancer at Levanger Hospital during 1980-2016 (n=193 <65 years, n=329 65-79 years, n=144 ≥80 years). We performed logistic regression to analyse associations between complications, 90-day mortality, and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival.Results Despite a similar distribution of cancer stages across age-groups, patients aged ≥80 years were treated with a non-curative approach more frequently than younger age groups. Among patients aged ≥80 years, 42% underwent a non-curative treatment approach, compared to 25% of patients aged <65 years, and 25% of patients aged 65-79 years. The 90-day mortality was 15.3% among patients aged ≥80 years, compared to 5.7% among patients aged <65 years, and 9.4% among patients aged 65-79 years. Among 431 (65%) patients treated with a major resection with curative intent, the 90-day mortality was 5.9% among patients aged ≥80 years (n=68), compared to 0.8% among patients aged <65 years (n=126), and 3.8% among patients aged 65-79 years (n=237). The rate of postoperative complications was 47.6%. Pneumonia was the only complication that occurred more frequently in the older patient group. The severity of complications increased with three factors: age, American Society of Anaesthesiologists score, and >400 ml perioperative blood loss. Among patients that survived the first 90 days, the relative long-term survival rates, five-year local recurrence rates, and metastases rates were independent of age.Conclusion Patients aged ≥80 years were less likely to undergo a major resection with curative intent and experienced more severe complications after surgery than patients aged <80 years. When patients aged ≥80 years were treated with a major resection with curative intent, the long-term survival rate was comparable to that of younger patients.

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Section: All Patientssupporting

confidence: 88%

The impact of age on rectal cancer treatment, complications and survival

Høydahl

Edna

Xanthoulis

et al. 2022

Preprint

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“…Many studies have shown that compared with traditional open surgery, minimally invasive surgery (MIS) represented by laparoscopic or thoracoscopic, endoscopic, and robotic-assisted surgery has significantly reduced the risk of SSI. [2][3][4][5] However, there is little evidence for this in thoracic surgery. Over the last two decades, robotic-assisted thoracic surgery (RATS) is changing the concept and mode of MIS in general thoracic surgery practice, especially in pulmonary lobectomy for early-stage NSCLC.…”

Section: Introductionmentioning

confidence: 99%

“…With the increasingly complex types of surgery, combined with the long‐term use of hormone, neoadjuvant therapy, previous history of thoracic surgery or trauma, the risk of pulmonary complications can be increased. Many studies have shown that compared with traditional open surgery, minimally invasive surgery (MIS) represented by laparoscopic or thoracoscopic, endoscopic, and robotic‐assisted surgery has significantly reduced the risk of SSI 2–5 . However, there is little evidence for this in thoracic surgery.…”

Section: Introductionmentioning

confidence: 99%

Surgical site infection following minimally invasive lobectomy: Is robotic surgery superior?

Hou

Song

et al. 2022

Cancer Medicine

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Background: Surgical site infection (SSI) in thoracic surgery remains a significant cause of morbidity and prolonged hospitalization. Minimally invasive surgery (MIS) has significantly reduced the risk of SSI. We intended to compare whether there was difference between video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) in SSI and highlight possible factors influencing SSI in lobectomy.Methods: This retrospective study analyzed patients who underwent minimally invasive lobectomy from January 2018 to December 2019. All patients' clinical characteristics and surgery-related information which may be related to the likelihood of SSI were recorded.Results: A total of 1231 patients' records were reviewed with 806 VATS and 425 RATS. SSI was classified as deep or superficial SSI. Eighty-six (7.0%) patients were found to develop an SSI with 62 patients having deep infections and 24 had superficial infection. No statistical difference in the incidence rate and category of SSI was observed between patients undergoing VATS and RATS. Conclusions:There was no difference in the incidence of SSI between VATS and RATS lobectomy. Male gender, heavy smoking, uncontrolled diabetes mellitus, body mass index (BMI) > 27.9, more blood loss, and the higher National Healthcare Safety Network (NHSN) risk index score (1 or 2) were the independent risk factors of SSI following minimally invasive lobectomy, while male gender, uncontrolled diabetes mellitus, BMI > 27.9, more blood loss and the higher NHSN risk index score (1 or 2) were the main predictors of deep SSI.

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“…SSI prolongs the hospital length of stay (LOS) and increases the readmission rate and healthcare costs ( 5 ). Multiple approaches have been advocated to lower SSI, including adequate bowel preparation, appropriate skin preparation, prophylactic antibiotics, intraoperative maintenance of normothermia, oxygenation, tissue microcirculation perfusion, normoglycemia, use of incision protectors and incision irrigation technique ( 6 , 7 ). Among these methods, conclusions on incision irrigation remain controversial.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative incision irrigation with high-volume saline reduces surgical site infection for abdominal infections

Wang

et al. 2022

Front. Surg.

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PurposeSurgical site infection (SSI) remains one of the most common postoperative complications for patients with abdominal infections. This study aimed at investigating the effectiveness of high-volume normal saline (NS) irrigation in preventing postoperative SSI for patients with abdominal infections.MethodsIn this retrospective before-after clinical study, patients who underwent emergency laparotomy due to abdominal infections between Jan 2015 and Dec 2021 were included consecutively. A cohort of 207 patients with NS irrigation was compared to historical controls. A propensity score matching (PSM) with a 1:1 ratio was performed to reduce potential bias. The primary outcome was the 30-day SSI rate.ResultsIrrigation (n = 207) and control (n = 207) matched patients were statistically identical on baseline characteristics, perioperative, and intraoperative parameters. Irrigation patients had lower overall SSI rates (10.6% vs. 26.1%, p < 0.001), mainly due to reduction in superficial (4.3% vs. 17.9%) and deep (1.4% vs. 3.9%) SSIs, rather than space/organ SSIs (4.8% vs. 4.3%). Irrigation patients also had lower rates of incision seroma (4.8% vs. 11.6%, p = 0.012), shorter duration of antibiotics use (5.2 ± 1.7 d vs. 7.2 ± 2.0 d, p < 0.001), and unplanned readmission (1.0% vs. 8.7%, p < 0.001). Length of hospital stay showed a declining trend with irrigation intervention, while no significant difference was observed. Moreoever, logistic regression revealed that NS irrigationwas an independent protector against SSI (OR 0.309; 95% CI, 0.207–0.462; p < 0.001).ConclusionIntraoperative incision irrigation with high-volume NS is associated with a lower rate of SSI for patients with abdominal infections.

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Surgical Site Infections Are Associated With Higher Blood Loss and Open Access in General Thoracic Practice

Cited by 8 publications

References 27 publications

The impact of age on rectal cancer treatment, complications and survival

The impact of age on rectal cancer treatment, complications and survival

Surgical site infection following minimally invasive lobectomy: Is robotic surgery superior?

Intraoperative incision irrigation with high-volume saline reduces surgical site infection for abdominal infections

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