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Surgical wound class

Ravi K Garg, Aaron M Wieland, Gregory K Hartig, Samuel O Poore
INTRODUCTION: Unplanned readmissions are associated with decreased healthcare quality and increased costs. This nationwide study examines causes for unplanned readmission among head and neck cancer patients undergoing immediate microsurgical reconstruction. METHODS: Patients undergoing head and neck tumor resection with microsurgical reconstruction were identified in the 2011-2014 National Surgical Quality Improvement Program database. Clinical characteristics and complications were compared among patients who did and did not undergo unplanned readmission...
September 23, 2016: Microsurgery
Chih-Chun Chang, Chin-Chuan Yeh, Fang-Yeh Chu
The Formosa Fun Coast explosion, occurring in a recreational water park located in the Northern Taiwan on 27 June 2015, made 499 people burn-injured. For those who had severe burn trauma, surgical intervention and fluid resuscitation were necessary, and potential blood transfusion therapy could be initiated, especially during and after broad escharotomy. Here, we reviewed the literature regarding transfusion medicine and skin grafting as well as described the practicing experience of combined tissue and blood bank in the burn disaster in Taiwan...
October 2016: Transfusion and Apheresis Science
Adam I Edelstein, Francis Lovecchio, Dimitri E Delagrammaticas, David W Fitz, Kevin D Hardt, David W Manning
BACKGROUND: The arthroplasty population increasingly presents with comorbid conditions linked to elevated risk of postsurgical complications. Current quality improvement initiatives require providers to more accurately assess and manage risk presurgically. In this investigation, we assess the effect of metabolic syndrome (MetS), as well as the effect of body mass index (BMI) within MetS, on the risk of complication following hip and knee arthroplasty. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program database for total hip or knee arthroplasty cases...
August 20, 2016: Journal of Arthroplasty
Erica Pettke, Nicole Ilonzo, Martha Ayewah, Sara Tsantes, Alison Estabrook, Aye Moe Thu Ma
BACKGROUND: This study compares early postoperative breast cancer outcomes between patients 80 years and older (older patients) and those younger than 80 years (<80 years). METHODS: The National Surgical Quality Improvement Program database was used to identify patients who had breast surgery between 2005 and 2013 for malignancy. RESULTS: Older patients had a significantly higher percentage of comorbidities and partial mastectomies. Postoperatively, they had higher rates of pneumonia, urinary tract infection, cardiac arrest, and mortality but had lower rates of wound dehiscence, deep wound, and organ space infections...
October 2016: American Journal of Surgery
Caitlin W Hicks, Katherine E Poruk, Pablo A Baltodano, Kevin C Soares, Said C Azoury, Carisa M Cooney, Peter Cornell, Frederic E Eckhauser
BACKGROUND: Sandwich ventral hernia repair (SVHR) may reduce ventral hernia recurrence rates, although with an increased risk of surgical site occurrences (SSOs) and surgical site infections (SSIs). Previously, we found that a modified negative pressure wound therapy (hybrid vacuum-assisted closure [HVAC]) system reduced SSOs and SSIs after ventral hernia repair. We aimed to describe our outcomes after SVHR paired with HVAC closure. METHODS: We conducted a 4-y retrospective review of all complex SVHRs (biologic mesh underlay and synthetic mesh overlay) with HVAC closure performed at our institution by a single surgeon...
August 2016: Journal of Surgical Research
Yoshua Esquenazi, Giridhar P Kalamangalam, Omotola A Hope, Sonia N Krish, Jeremy Slater, Nitin Tandon
OBJECTIVE: The surgical management of epilepsy following penetrating gunshot wounds (GSWs) to the head has not been described in the modern; era. Given the extensive damage to the cranium and cortex from such; injuries, the safety and efficacy of surgical intervention is unclear. We; report the surgical strategy and outcomes following resections for; medically refractory epilepsy following GSWs in four patients. METHODS: A prospectively compiled database of 325 epilepsy patients was used to identify patients undergoing epilepsy surgery for medically; refractory epilepsy following a GSW to the brain...
August 18, 2016: World Neurosurgery
Christopher T Martin, Yubo Gao, Andrew J Pugely
BACKGROUND: Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery. METHODS: Patients over the age of 18 years who underwent hip fracture surgery, including open reduction internal fixation (ORIF), intramedullary nailing, hemi-arthroplasty, or total hip arthroplasty, between the years 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality improvement Program (NSQIP) database...
2016: Iowa Orthopaedic Journal
Avita Rath, Smrithi Varma, Renny Paul
Introduction. Gingival recession is an apical shift of the gingival margin with exposure of the root surface. This migration of the marginal tissue leads to esthetic concerns, dentin hypersensitivity, root caries, and cervical wear. It is, paradoxically, a common finding in patients with a high standard of oral hygiene, as well as in periodontally untreated populations with poor oral hygiene. Changing the topography of the marginal soft tissue in order to facilitate plaque control is a common indication for root coverage procedures and forms a major aspect of periodontal plastic surgeries...
2016: Case Reports in Dentistry
R B Baucom, J Ousley, O O Oyefule, M K Stewart, S E Phillips, K K Browman, K W Sharp, M D Holzman, B K Poulose
PURPOSE: Previous work demonstrated that prior MRSA infection [MRSA(+)] is associated with 30-day surgical site infection (SSI) following ventral hernia repair (VHR). We aimed to determine the impact of MRSA(+) on long-term wound outcomes after VHR. PARTICIPANTS: A retrospective cohort study was performed at a tertiary center between July 11, 2005, and May 18, 2012, of patients undergoing elective VHR with class I wounds. Patients with documented preoperative MRSA infection at any site (urinary, bloodstream, SSI, etc...
October 2016: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Meghan E Murphy, Brandon A McCutcheon, Panagiotis Kerezoudis, Amanda Porter, Lorenzo Rinaldo, Daniel Shepherd, Tarek Rayan, Patrick R Maloney, Bob S Carter, Mohamad Bydon, Jamie J Van Gompel, Michael J Link
OBJECTIVE: Obesity has been associated with increased risk for postoperative CSF leak in patients with benign cranial nerve tumors. Other measures of postoperative morbidity associated with obesity have not been well characterized. METHODS: Patients enrolled in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) from 2007 to 2013 with a diagnosis code of a benign neoplasm of a cranial nerve were included. The primary outcome of postoperative morbidity was analyzed as well as secondary outcomes of readmission and reoperation...
September 2016: Clinical Neurology and Neurosurgery
Nathan W Kugler, Thomas W Carver, Jasmeet S Paul
BACKGROUND: CDC wound classification demonstrates surgical site infection (SSI) occurs in 15%-30% of contaminated (class III) and >30% of dirty-infected (class IV) wounds. Several techniques have been used to decrease SSI rates in midline laparotomy incisions; however, no technique has shown superiority. Evidence suggests incisional negative pressure wound therapy (INPWT) can decrease wound complications, but no literature exists regarding INPWT for high-risk laparotomy incisions. We sought to analyze the efficacy of INPWT in the management of high-risk midline laparotomy incisions...
June 15, 2016: Journal of Surgical Research
Crystal F Totten, Daniel L Davenport, Nicholas D Ward, J Scott Roth
BACKGROUND: Patients undergoing ventral hernia repair (VHR) with biologic mesh (BioM) have higher hospital costs compared with synthetic mesh (SynM). This study compares 90-d pre- and post-VHR hospital costs (180-d) among BioM and SynM based on infection risk. METHODS: This retrospective National Surgical Quality Improvement Program study matched patient perioperative risk with resource utilization cost for a consecutive series of VHR repairs. Patient infection risks, clinical and financial outcomes were compared in unmatched SynM (n = 303) and BioM (n = 72) groups...
June 15, 2016: Journal of Surgical Research
Grant W Reed, Negar Salehi, Pejman R Giglou, Rami Kafa, Umair Malik, Michael Maier, Mehdi H Shishehbor
PURPOSE: There are few studies that quantify the impact of time to wound healing on outcomes after endovascular revascularization of critical limb ischemia (CLI). MATERIAL AND METHODS: In this retrospective study, 179 patients with CLI and tissue loss were assessed for adverse events after endovascular therapy. Associations between time to wound healing and outcomes were determined via Cox proportional hazards analysis. The long-term probability of events was assessed with Kaplan-Meier analysis...
June 25, 2016: Annals of Vascular Surgery
Michael J Rosen, Joel J Bauer, Marco Harmaty, Alfredo M Carbonell, William S Cobb, Brent Matthews, Matthew I Goldblatt, Don J Selzer, Benjamin K Poulose, Bibi M E Hansson, Camiel Rosman, James J Chao, Garth R Jacobsen
OBJECTIVE: The aim of the study was to evaluate biosynthetic absorbable mesh in single-staged contaminated (Centers for Disease Control class II and III) ventral hernia (CVH) repair over 24 months. BACKGROUND: CVH has an increased risk of postoperative infection. CVH repair with synthetic or biologic meshes has reported chronic biomaterial infections and high hernia recurrence rates. METHODS: Patients with a contaminated or clean-contaminated operative field and a hernia defect at least 9 cm had a biosynthetic mesh (open, sublay, retrorectus, or intraperitoneal) repair with fascial closure (n = 104)...
December 17, 2015: Annals of Surgery
Thomas O Mitchell, Julie L Holihan, Erik P Askenasy, Jacob A Greenberg, Jerrod N Keith, Robert G Martindale, John Scott Roth, Mike K Liang
INTRODUCTION: Current risk assessment models for surgical site occurrence (SSO) and surgical site infection (SSI) after open ventral hernia repair (VHR) have limited external validation. Our aim was to determine (1) whether existing models stratify patients into groups by risk and (2) which model best predicts the rate of SSO and SSI. METHODS: Patients who underwent open VHR and were followed for at least 1 mo were included. Using two data sets-a retrospective multicenter database (Ventral Hernia Outcomes Collaborative) and a single-center prospective database (Prospective)-each patient was assigned a predicted risk with each of the following models: Ventral Hernia Risk Score (VHRS), Ventral Hernia Working Group (VHWG), Centers for Disease Control and Prevention Wound Class, and Hernia Wound Risk Assessment Tool (HW-RAT)...
June 1, 2016: Journal of Surgical Research
Seokchun Lim, Kartik Kesavabhotla, George R Cybulski, Nader S Dahdaleh, Zachary A Smith
STUDY DESIGN: Retrospective, multivariate analyses of a prospectively collected multi-center database OBJECTIVE.: To evaluate the risk factors for postoperative airway complications following single- and multi-level anterior cervical discectomy and fusion (ACDF) SUMMARY OF BACKGROUND DATA.: Airway compromise following ACDF may result in catastrophic outcome. However, its predictors have not been identified by a multi-institutional study. METHODS: Patients who underwent ACDF between 2011-2013 were selected from the American College of Surgeons National Surgical Quality Improvement Program database...
June 16, 2016: Spine
John I Shin, Aakash Keswani, Andrew J Lovy, Calin S Moucha
BACKGROUND: The modified frailty index (mFI) has been shown to predict adverse outcomes in multiple nonorthopedic surgical specialties. This study aimed to assess whether mFI is a predictor of adverse events in patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: Patients who underwent THA and TKA from 2005-2012 were identified in the National Surgical Quality Improvement Program database. mFI was calculated for each patient using 15 variables found in National Surgical Quality Improvement Program...
April 27, 2016: Journal of Arthroplasty
P L Bastier, C Leroyer, A Lashéras, A-M Rogues, V Darrouzet, V Franco-Vidal
A retroauricular approach is routinely used for treating chronic otitis media. The incidence of surgical site infections after ear surgery is around 10% in contaminated or dirty procedures. This observational prospective study describes surgical site infections after chronic otitis media surgery with the retroauricular approach and investigated their potential predictive factors. This observational prospective study included patients suffering from chronic otitis media and eligible for therapeutic surgery with a retroauricular approach...
April 2016: Acta Otorhinolaryngologica Italica
Patrick C Sanger, Gabrielle H van Ramshorst, Ezgi Mercan, Shuai Huang, Andrea L Hartzler, Cheryl A L Armstrong, Ross J Lordon, William B Lober, Heather L Evans
BACKGROUND: Surgical site infection (SSI) remains a common, costly, and morbid health care-associated infection. Early detection can improve outcomes, yet previous risk models consider only baseline risk factors (BF) not incorporating a proximate and timely data source-the wound itself. We hypothesize that incorporation of daily wound assessment improves the accuracy of SSI identification compared with traditional BF alone. STUDY DESIGN: A prospective cohort of 1,000 post open abdominal surgery patients at an academic teaching hospital were examined daily for serial features (SF), for example, wound characteristics and vital signs, in addition to standard BF, for example, wound class...
August 2016: Journal of the American College of Surgeons
Tejaswini Vallabha, Uday Karjol, Vijayakumar Kalyanappagol, Vikram Sindgikar, Ravindra Nidoni, Harshavardhan Biradar, Aniketan K V, K K Das
Oxygen supplemented at a concentration higher than 40-50 % for at least 2 h perioperatively is expected to reduce surgical site infections (SSI). Although supplementation of 80 % of oxygen perioperatively has shown to reduce SSI in various studies, this concentration is known to be associated with airway complications. This study was taken up to assess the efficacy of 60 %, i.e. <80 and >50 %, inspired oxygen supplemented perioperatively in reducing SSI. One hundred and eighty-eight patients who underwent elective class I and II surgeries were studied...
February 2016: Indian Journal of Surgery
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