Browsing by Subject "Surgical Wound Infection"
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Item The Effect of Antibiotic Prophylaxis on Infection Rates in Mohs Micrographic Surgery: A Single-institution Retrospective Study(2021-05-01T05:00:00.000Z) Li, Jeffrey Niu; Srivastava, Divya; Nijhawan, Rajiv I.; Nguyen, KhangBACKGROUND: Data and recommendations regarding antibiotic prophylaxis in dermatologic surgery vary in terms of effectiveness in preventing surgical site infection, prosthetic joint infection, infective endocarditis, and specifics regarding administration. OBJECTIVE: The objective of this study is to describe the effect of antibiotic prophylaxis (AP) in Mohs micrographic surgery (MMS) on infective endocarditis, prosthetic joint infection, and surgical site infection. METHODS: A single-institution retrospective cohort study of antibiotic use (pre-/intra-operative, post-operative or none) among 2,364 patient encounters treated with MMS was performed. Information regarding patient demographics, surgical site infection, prophylactic antibiotic administration (e.g. none, pre-/intraoperative loading dose, postoperative), type of repair, tumor type, surgery site, duration of patient stay, and other relevant covariates were collected. Inclusion criteria also included those who had at last one follow-up appointment or phone call with any provider after surgery. Bivariate logistic regression evaluated for associations between patient and operative characteristics, antibiotic use, and infectious complications. RESULTS: 85.8% of patients received no AP, 10.0% received post-operative AP, and 4.1% received pre-/intra-operative AP. The overall surgical site infection (SSI) rate was 1.3%. SSI did not differ between patients who received pre-/intra-operative prophylaxis, post-operative prophylaxis or no antibiotics. One patient receiving pre-/intra-operative prophylaxis developed SSI. Repairs involving porcine xenografts and interpolation/pedicle flaps were associated with increased SSI. In addition, there were no patients who post-operatively experienced an infected joint or infective endocarditis. CONCLUSION: There was no difference in rates of SSI when comparing MMS patients who received pre-/intra-operative, post-operative or no AP. There were no cases of infective endocarditis or infected prosthetic joints.Item Risk Factors for Surgical Site Infection in Distal Radius Fracture Surgery(2020-05-01T05:00:00.000Z) Davis, Justin Joe; Zhang, Andrew; Sammer, Douglas; Koehler, DanielPURPOSE: Surgical site infections (SSI) after distal radius surgery can introduce substantial morbidity and additional direct and indirect costs. The clearest risk factors for SSI are the use of externalized Kirschner wires (K-wires) or external fixation (ex-fix). The roles of other potential risk factors such as open injuries, diabetes mellitus, and tobacco use are less clear. The purpose of this study was to identify independent risk factors for SSI in distal radius surgery. METHODS: A retrospective study of 541 operative distal radius fractures over a 5-year period was performed. Potential risk factors for infection included surgery duration, externalized K-wires or ex-fix, diabetes mellitus, uncontrolled diabetes defined as a HgBA1c >7 documented within a 90-day perioperative period, open fracture, tobacco use, osteoporosis, gender, and age. A screening bivariate logistic regression was performed, followed by a multiple logistic regression of the selected independent variables, with SSI as the dependent variable. A p-value of <0.05 was considered statistically significant. RESULTS: Twenty fractures (3.7%) were complicated by post-operative SSI, and 521 (96.3%) were not. Uncontrolled diabetes with HgA1c >7 (OR = 7.83, p=0.002), the presence of an ex-fix or k-wires (OR =3.73, p=0.007), and tobacco use (OR=3.79, p=0.007) were significant independent predictors of SSI. Of note, while uncontrolled diabetes was an independent risk factor, the diagnosis of diabetes alone was not. CONCLUSIONS: Previously identified risk factors for SSI after distal radius surgery including the presence of externalized K-wires or ex-fix were confirmed in this study. Additionally, this study demonstrates that tobacco use and uncontrolled diabetes (HgA1c >7) are both independent risks factors for SSI. Notably, the presence of diabetes alone was not an independent risk factor, highlighting the importance of glycemic control. LEVEL OF EVIDENCE: Level III