Surgical wound infection rates by wound class, operative procedure, and patient risk index

Culver, David H.; Horan, Teresa C.; Gaynes, Robert P.; Martone, William J.; Jarvis, William R.; Emori, T. Grace; Banerjee, Shailen N.; Edwards, Jonathan R.; Tolson, James S.; Henderson, Tonya S.; Hughes, James M.

doi:10.1016/0002-9343(91)90361-z

Cited by 1,353 publications

(494 citation statements)

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“…Moreover, our data acquisition is a combination of prospective data entry, retrospective chart review, and peer review by the hospital epidemiology staff. The combination of active surveillance by two independent The number of surgical procedures as well as the number and percentage of surgical site infections (SSI) per variable are given in Table 3 a T-time 75th percentile time as defined in the NNIS system [7] odds ratios ssi departments, complemented by vigorous postdischarge surveillance, explains the higher infection rates. In addition, a tertiary care center in general has higher infection rates due to the case-mix that is very difficult to control for by statistical methods.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Surgical Training on Incidence of Surgical Site Infection

et al. 2009

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Background Despite availability of other training forms, tutorial assistance cannot be entirely replaced in surgical education. Concerns exist that tutorial assistance may lead to an increased rate of surgical site infection (SSI). The purpose of the present study was to investigate whether the risk of SSI is higher after surgery with tutorial assistance than after surgery performed autonomously by a fully trained surgeon. Methods All consecutive visceral, vascular, and traumatological inpatient procedures at a Swiss University Hospital were prospectively recorded during a 24-month period, and the patients were followed for 12 months to ascertain the occurrence of SSI. Using univariable and multivariable logistic regressions, we assessed the association of tutorial assistance surgery with SSI in 6,103 interventions. Results Autonomously performed surgery was associated with SSI in univariable analysis (5.36% SSI vs. 3.81% for tutorial assistance, p = 0.006). In multivariable analysis, the odds of SSI for tutorial assistance was no longer Conclusions Surgical training does not lead to higher SSI rate if trainees are adequately supervised and interventions are carefully selected. Although other forms of training are useful, tutorial assistance in the operating room continues to be the mainstay of surgical education.

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Section: Discussionmentioning

confidence: 99%

“…ASA American Society of Anesthesiologists, BMI body mass index a T-time 75th percentile time as defined in the NNIS system [7] World J Surg (2009) 33:1165-1173 1167…”

Section: Data Acquisitionmentioning

confidence: 99%

Impact of Surgical Training on Incidence of Surgical Site Infection

et al. 2009

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“…D Di is sc cu us ss si io on n Perioperative infections may increase morbidity and mortality, the number of days in hospital and consequently the cost to the public health system. [21][22][23][24] In this context, propofol handling can be a pivotal factor as the drug is considered a highly potent vector of infection. The results of our study suggest that, in the daily routine of the operating theatre, a modified propofol handling technique based on routine aseptic precautions prevents the contamination of propofol syringes as effectively as does strict adherence to the manufacturer's specific handling recommendations.…”

Section: Discussionmentioning

confidence: 99%

Le maniement d’usage du propofol prévient la contamination aussi effectivement que la stricte adhésion aux recommandations du fabricant

Lorenz

Kolbitsch

Lass‐Flörl

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Propofol is a potential vector of infection, because it contains no preservative. Thus, the manufacturer's specific recommendations for preparing injections or infusions go beyond the guidelines commonly used in our operating rooms for preparing other iv drugs. The purpose of the present study was to determine whether in the daily routine of an operating theatre a modified propofol handling technique can prevent contamination as effectively as do the manufacturer's handling recommendations. M Me et th ho od ds s: : A total of 160 consecutive neurosurgical patients were allocated to either Group I (manufacturer's handling recommendations: i.e., 1) disinfecting propofol vials and ampoules before filling syringes; 2) replacing empty syringes; 3) discarding all material at the end of surgery); or Group II (modified propofol handling protocol: i.e., 1) refilling empty syringes; 2) renewing only the infusion line to the patient). R Re es su ul lt ts s: : Total contamination rates were comparable in both groups (Group I: 14/160 (8.75%), Group II: 13/160 (8.13%) (P 2 =0.074; P=0.96). Frequency of contamination was not different between groups; either in sample 1 taken at the beginning of the procedure, (Group I: 5/80 (6.25%) vs Group II: 6/80 (7.5%); P 2 =0.098; P=0.76) or in sample 2, taken at the end, (Group I: 9/80 (11.25%) vs Group II: 7/80 (8.75%); P 2 =0.278; P=0.598). C Co on nc cl lu us si io on n: : We conclude that in the daily routine of the operating theatre following a modified propofol handling protocol prevents contamination of propofol syringes as effectively as does adhering to the manufacturer's specific handling recommendations. However, neither of the tested guidelines completely prevented contamination. Groupe I et 13/160 (8,13 %) dans le Groupe II (P 2 = 0,074; P = 0,96). La fréquence de contamination ne diffère pas d'un groupe à l'autre, pour l'échantillon 1 prélevé au début de l'opération (Groupe I : 5/80 (6,25 %) vs Groupe II : 6/80 (7,5 %); P 2 = 0,098; P = 0,76) ou l'échantillon 2 à la fin (Groupe I : 9/80 (11,25 %)vs Groupe II : 7/80 (8,75 %); P 2 = 0,278; P = 0,598 Objectif : Le propofol, ne contenant aucun agent de conservation, est un vecteur potentiel d'infection. C'est pourquoi les recommandations spécifiques du fabricant au sujet de la préparation d'injections ou de perfusions vont au delà des directives habituellement suivies dans nos salles d'opération pour la préparation d'autres médicaments intraveineux. Nous avons voulu déterminer si, en modifiant le maniement du propofol en salle d'opération, nous pouvions prévenir la contamination aussi efficacement qu'en suivant à la lettre les recom

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“…Postoperative wound complications, such as infection, dehiscence, and formation of haematoma or seroma, are common complications of surgical procedures1, 2, particularly among patients with risk factors such as obesity and diabetes3, 4, 5. Postoperative wound complications may lead to increased healthcare costs due to prolonged inpatient stay, repeat surgery and the need for increased follow‐up6, 7.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Hyldig

Birke-Sørensen

Kruse

et al. 2016

British Journal of Surgery

194

166

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BackgroundPostoperative wound complications are common following surgical procedures. Negative‐pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions.MethodsThis was a systematic review and meta‐analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions.ResultsTen studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care. The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence.ConclusionCompared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet.

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Surgical wound infection rates by wound class, operative procedure, and patient risk index

Cited by 1,353 publications

References 13 publications

Impact of Surgical Training on Incidence of Surgical Site Infection

Impact of Surgical Training on Incidence of Surgical Site Infection

Le maniement d’usage du propofol prévient la contamination aussi effectivement que la stricte adhésion aux recommandations du fabricant

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

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