Surgical infections
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Surgical infections · Mar 2020
Transfer Is Associated with a Higher Mortality Rate in Necrotizing Soft Tissue Infections.
Background: Necrotizing soft tissue infections (NSTI) are a surgical emergency with significant morbidity and mortality rates. It has been thought that NSTIs are best treated in large tertiary centers. However, the effect of transfer has been under-studied. ⋯ However, there was a trend toward a lower in-hospital mortality rate if patients were transferred early without prior debridement than in all other transfers (21.4% versus 40.0%; p = 0.21). The in-hospital mortality rate was significantly lower at the Level 1 trauma center than at the non-trauma tertiary center (15.5% versus 34.3%; p = 0.02). Conclusion: Transfer status is an independent predictor of in-hospital death in patients with NSTI. Larger, multi-institutional studies are needed to elucidate further what factors contribute to the higher mortality rate in these patients.
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Surgical infections · Mar 2020
Clinical TrialWound Irrigation with Chlorhexidine Gluconate Reduces Surgical Site Infection in Pilonidal Disease: Single-Blind Prospective Study.
Background: The aim of this study was to determine whether incision irrigation with chlorhexidine gluconate (CHG) reduces surgical site infections (SSIs) in pilonidal disease surgery. Methods: Between 2013 and 2018, patients who underwent wide excision with primary closure for pilonidal disease were enrolled in this prospective observational multi-institutional cohort. The incision was irrigated with either saline or 0.05% CHG before skin closure. ⋯ Time to healing was 20.5 ± 7.8 days in the control group and 16 ± 4.3 days in the CHG group (p < 0.001). Conclusion: Intra-operative incision irrigation with CHG decreased the SSI rate and time to healing in pilonidal disease surgery. Further randomized trials should focus on specific irrigation methods and procedures to build a consensus on the effect of incision irrigation on SSIs.
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Surgical infections · Feb 2020
Utilization of Augmented Renal Clearance in Trauma Intensive Care Scoring System to Improve Vancomycin Dosing in Trauma Patients at Risk for Augmented Renal Clearance.
Background: The Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) scoring system is a validated system to predict augmented renal clearance in trauma patients. This study examined the ability of the ARCTIC score to identify patients at risk for subtherapeutic vancomycin trough concentrations relative to estimated creatinine clearance (eCrCl) alone. Methods: Trauma patients admitted to the intensive care unit from September 2012 to December 2017 who received vancomycin and had a vancomycin trough concentration recorded were included. Patients were excluded if their serum creatinine concentration was >1.3 mg/dL, if they had received vancomycin doses <30 mg/kg per day, an improperly timed trough concentration measurement, or renal replacement therapy. ⋯ The final model included the addition of ARCTIC score ≥7, which improved the model significantly (p = 0.009). Predictors of subtherapeutic trough concentrations were (odds ratio [95% confidence interval]): eCrCl >105 mL/min (6.5 [1.66-25.07]), ARCTIC score ≥7 (3.26 [1.31-8.09]), and pelvic fracture (4.36 [1.27-14.93]). Conclusion: The ARCTIC score is useful when applied in conjunction with eCrCl. Patients with a eCrCl >105 mL/min and an ARCTIC score ≥7 may require a more aggressive dosing strategy.
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Surgical infections · Dec 2019
Clinical Outcome and Risk Factors for Emergency Department Adult Patients with Thoracic Empyema after Video-Assisted Thoracic Surgical Procedure.
Background: Empyema is a purulent infection of the pleural cavity that is most relevant to parapneumonia effusion. Video-assisted thoracoscopic surgery (VATS) is an option for stage 2 (fibrinopurulent) and stage 3 (organizational). Surgeons may see critically ill patients with pleural empyema who present to the emergency department (ED). ⋯ Two groups (survivors and non-survivors) significantly differed in age (p = 0.013), sex (p = 0.026), comorbidity (p = 0.017), cough (p = 0.024), chest pain (p = 0.016), serum hemoglobin (p = 0.001), and potassium (p = 0.004) levels. Further logistic regression analysis showed statistically significant differences in age, hemoglobin levels, and potassium levels. Conclusion: Among the ED patients with thoracic empyema, older age, lower hemoglobin levels, and higher potassium levels are associated with post-operative death after VATS. These findings underline the importance of careful peri-operative treatment in older patients with signs of empyema when they present to the ED.
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Background: Sepsis is an uncommon occurrence after appendectomy, but the morbidity and mortality of patients who develop sepsis after appendectomy remains exceedingly high. The purpose of this study is to identify risk factors and adverse post-operative outcomes associated with sepsis after appendectomy in adults. Patients and Methods: The American College of Surgery National Surgical Quality Improvement Program participant user database was queried from 2012 to 2015. Patients who underwent appendectomy were identified and demographic data, intra-operative variables, and post-operative outcomes were collected. ⋯ Patients who developed sepsis after appendectomy were more likely to return to the operating room (24.76 vs. 0.77%, p < 0.001), be re-admitted for any cause (53.38% vs. 2.70%, p < 0.0001), and die within 30 days of surgery (5.47% vs. 0.05%, p < 0.001). Conclusion: Patients who become septic after appendectomy are at risk for adverse post-operative morbidity and mortality. Age 60 years or more, African American race, morbid obesity, acute renal failure or dialysis, disseminated malignancy, and open appendectomy increase the risk for sepsis after appendectomy and sepsis-related morbidity and mortality. Given the remarkably large number of appendectomies that are performed each year, the findings of this study can assist in identifying at-risk patients, facilitate physician-patient discussion and shared decision-making, and guide appropriate care to further reduce the incidence of sepsis after appendectomy.