Timing of surgical site infection and pulmonary complications after laparotomy

Gundel, Ossian; Gundersen, Sofie Kirchhoff; Jørgensen, Lars Nannestad; Rasmussen, Lars S.; Wetterslev, Jørn; Sæbye, Ditte; Meyhoff, Christian S.

doi:10.1016/j.ijsu.2018.02.022

Cited by 22 publications

(14 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent studies have observed a higher risk of mortality and in-hospital complications among severely obese and morbidly obese trauma patients [25,26], suggesting outcomes in trauma may vary depending on the degree of obesity. While there have been multiple studies on general surgical populations purporting the increased risk for postoperative pulmonary complications (PPCs) and mortality with a laparotomy as well as with obesity independently [16,[27][28][29], fewer studies have specifically examined the association of obese trauma patients requiring trauma laparotomy. Furthermore, obesity is not currently considered among the patient-related risk factors for the development of PPCs [30].…”

Section: Introductionmentioning

confidence: 99%

Obesity associated with increased postoperative pulmonary complications and mortality after trauma laparotomy

Covarrubias

Grigorian

Schubl

et al. 2020

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Background Patient-related risk factors for the development of postoperative pulmonary complications (PPCs) include age ≥ 60-years, congestive heart failure, hypoalbuminemia and smoking. The effect of obesity is unclear and has not been shown to independently increase the likelihood of PPCs in trauma patients undergoing trauma laparotomy. We hypothesized the likelihood of mortality and PPCs would increase as body mass index (BMI) increases in trauma patients undergoing trauma laparotomy. Methods The Trauma Quality Improvement Program (2010-2016) was queried to identify trauma patients ≥ 18-years-old undergoing trauma laparotomy within 6-h of presentation. A multivariable logistic regression analysis was used to determine the likelihood of PPCs and mortality when stratified by BMI. Results From 8,330 patients, 2,810 (33.7%) were overweight (25-29.9 kg/m 2 ), 1444 (17.3%) obese (30-34.9 kg/m 2 ), 580 (7.0%) severely obese (35-39.9 kg/m 2 ), and 401 (4.8%) morbidly obese (≥ 40 kg/m 2 ). After adjusting for covariates including age, injury severity score, chronic obstructive pulmonary disease, smoking, and rib/lung injury, the likelihood of PPCs increased with increasing BMI: overweight (OR = 1.37, CI 1.07-1.74, p = 0.012), obese (OR = 1.44, CI 1.08-1.92, p = 0.014), severely obese (OR = 2.20, CI 1.55-3.14, p < 0.001), morbidly obese (OR = 2.42, CI 1.67-3.51, p < 0.001), compared to those with normal BMI. In addition, the adjusted likelihood of mortality increased for the morbidly obese (OR = 2.60, CI 1.78-3.80, p < 0.001) compared to those with normal BMI. Conclusion Obese trauma patients undergoing emergent trauma laparotomy have a high likelihood for both PPCs and mortality, with morbidly obese trauma patients having the highest likelihood for both. This suggests obesity should be accounted for in risk prediction models of trauma patients undergoing laparotomy.

show abstract

Section: Introductionmentioning

confidence: 99%

Obesity associated with increased postoperative pulmonary complications and mortality after trauma laparotomy

Covarrubias

Grigorian

Schubl

et al. 2020

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

show abstract

“…The overall rate of IC in our population (33.8%) aligns with a recent study by Gundel et al , who identified at least one infectious or respiratory complication in 24% of laparotomy patients. 5 It is understandable that our rate would be somewhat higher because our study population included DCL patients and excluded patients who had primary closure; that is, our study population included more severe, ‘sicker’ patients. The differences in rates of infections and re-explorations were consistent with recent literature as well.…”

Section: Discussionmentioning

confidence: 97%

“…The following patient characteristics were analyzed for association with the exposure and primary variables: age, sex, race, ethnicity, insurance used, injury type (blunt vs. all others), interhospital transfer status, multiple comorbidities and pre-existing conditions, Injury Severity Score (ISS, <16 vs. ≥16), Glasgow Coma Scale score (GCS, 13-15 vs. [3][4][5][6][7][8][9][10][11][12], abnormal emergency department (ED) vital sign measures (oxygen saturation <95%, body temperature <36.4°C or >37.6°C, heart rate <60 or >100 beats per minute, systolic blood pressure (SBP) <90 mm Hg, respiratory rate <12 or >16 breaths per minute).…”

Section: Study Variablesmentioning

confidence: 99%

Six-year national study of damage control laparotomy and the effect of repeat re-exploration on rate of infectious complications

Foster

Yon

Pelzl

et al. 2021

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

BackgroundDamage control laparotomy (DCL) is a life-saving procedure in patients with abdominal hemorrhage. After DCL, patients are sometimes left with an open abdomen (OA) so they may undergo multiple exploratory laparotomies (EXLAP), or re-explorations. Patients with OA are at increased risk of infectious complications (ICs). The association between number of re-explorations after DCL and the number of ICs is not clear. We hypothesized that each additional re-exploration increases the risk of developing IC.MethodsThis 6-year retrospective cohort study included patients aged ≥16 years from the NTDB who had DCL defined as EXLAP within 2 hours of arrival (ICD-9: 54.11, 54.12, 54.19) with at least one re-exploration. The primary outcome was IC (ie, superficial surgical site infection (SSI), organ space SSI, deep SSI, sepsis, pneumonia, or catheter-related bloodstream infection), examined dichotomously (present/absent) and ordinally as the number of ICs. Multivariate Poisson regression was used to assess the association between number of re-explorations and number of ICs. Significance was assigned at p<0.01.ResultsThere were 7431 patients who underwent DCL; 2509 (34%) patients developed at least one IC. The rate of IC was lowest in patients who were closed during the first re-exploration (27%) and significantly increased with each re-exploration to 59% in patients who had five or more re-explorations (Cochran-Armitage trend p<0.001). After adjustment, there was 14% increased risk of an additional IC with each re-exploration (p<0.001).DiscussionFor patients requiring DCL, each re-exploration of the abdomen is associated with increased rate of ICs.Level of evidenceIII, retrospective epidemiological study.

show abstract

“…Surgical site infections (SSI), the most common complications after abdominal surgery, are often observed in clinical practice, varying from 4% to 40% ( 1 , 2 ). In the emergency setting, SSI contributes to a more significant proportion of postoperative morbidity, with reported rates of 25% to 40% ( 3 , 4 ). SSI prolongs the hospital length of stay (LOS) and increases the readmission rate and healthcare costs ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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

Wang

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

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.

show abstract

Timing of surgical site infection and pulmonary complications after laparotomy

Cited by 22 publications

References 23 publications

Obesity associated with increased postoperative pulmonary complications and mortality after trauma laparotomy

Obesity associated with increased postoperative pulmonary complications and mortality after trauma laparotomy

Six-year national study of damage control laparotomy and the effect of repeat re-exploration on rate of infectious complications

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

Contact Info

Product

Resources

About