Search Results (666)

The aim of this retrospective clinical study was to assess surgical duration and surgical and post-operative complications associated with Video-Assisted Thoracoscopic Surgery (VATS) and lung biopsy in horses with severe Equine Pasture Asthma (EPA) and paired control horses. Twelve horses (6 EPA-affected, 6 control) were sex, age and breed matched. Twenty-four thoracic surgeries were performed. Surgery of each matched pair (EPA-affected and healthy) was performed during asthma exacerbation (summer) and remission (winter). Surgical times were shorter with uncomplicated thoracoscopy (85 min) and significantly longer (p < 0.001) when intra-operative complications necessitated conversion to thoracotomy (156 min). The overall surgical time of EPA-affected horses during asthma exacerbation was significantly longer than control horses at any time point, predicted mean difference of 78 min (p < 0.05). When comparing EPA-affected horses to themselves during asthma exacerbation and remission, surgical times were significantly longer (p < 0.01) with a predicted mean difference of 98 min; this effect of seasonality did not occur amongst control horses. Intra-operative surgical complications (6/24) were evenly divided between EPA and control horses, however, only severe EPA horses in exacerbation were noted to have lung hyperinflation. Post-operative complications: fever, colic, hemothorax, pneumothorax, subcutaneous emphysema, surgical site infection, and/or laminitis occurred in 13/24 surgical procedures (54%). No fatalities resulted from these procedures. Full article

Background: Cardiac surgery patients with pre- or post-operative atrial fibrillation are at an increased risk for thromboembolic stroke, often due left atrial appendage (LAA) thrombus. Surgical LAA exclusion (LAAE) can be performed and must be complete to avoid increased thrombus formation. Methods: This prospective, multi-center, post-market study (NCT05101993) evaluated the long-term safety and performance of the epicardial V-shape AtriClip device. Patients ≥18 years who had received V-shape AtriClip devices during non-emergent cardiac surgery consented to a prospective 12-month follow-up visit and LAA imaging. The primary performance was LAAE without residual left atrium-LAA communication, assessed by imaging at the last follow-up visit. The primary safety was device- or implant procedure-related serious adverse events (SAEs) (death, major bleeding, surgical site infection, pericardial effusion requiring intervention, myocardial infarction) within 30 days. Results: Of 155 patients from 11 U.S. centers, 151 patients had evaluable imaging. Complete LAAE was obtained in all patients. Primary performance in the intent-to-treat population was met, with 97% (95% CI 93.52%, 99.29%; p = 0.0001) complete LAAE. Primary safety was met, with 100% (95% CI 97.75%, 100%; p < 0.0001) of patients free from pre-defined SAEs within 30 days. One device-related SAE was reported, which resolved intraprocedurally. Conclusions: AtriClip V-Clip showed safe and successful LAAE through 12 months of follow-up. Full article

Background/Objectives: Antibiotic prophylaxis is a key component of infection prevention strategies. This study aimed to evaluate whether the duration of antibiotic prophylaxis influences the incidence of HAIs in patients undergoing elective colorectal surgery. Methods: This prospective cohort study included 278 adult patients who underwent elective colorectal surgery at a single tertiary care center. Patients were categorized into two groups based on the duration of antibiotic prophylaxis: one day or more than one day. Data on demographics, clinical characteristics, perioperative variables, and infection outcomes were collected. Results: The overall incidence of HAIs was 16.9%, with no significant difference between patients receiving one-day versus extended antibiotic prophylaxis. However, traditional multivariate analysis showed that prophylaxis lasting more than one day was independently associated with a significantly lower risk of HAI (RR = 0.30, 95% CI: 0.12–0.75, p = 0.010) and surgical site infections (RR = 0.24, 95% CI: 0.08–0.72, p = 0.011). After adjusting for confounders using propensity score matching, this association was no longer statistically significant. No significant association was found between prophylaxis duration and urinary tract infections. Regarding antibiotic selection, first-generation cephalosporins were the most commonly used agents, accounting for 78.8% of prophylactic prescriptions. This was followed by fluoroquinolones (14.4%) and third-generation cephalosporins (5.0%). All patients received metronidazole, a nitroimidazole-class antimicrobial, in combination with the above agents. Conclusions: One day of prophylactic antibiotics may be sufficient in SSI prevention in patients undergoing elective colorectal surgery. The use of extended antibiotic prophylaxis beyond one day should be considered for high-risk patients at high risk of infection, particularly those requiring ICU care. Full article

Nosocomial infections caused by ESKAPE pathogens represent a significant burden to global health. These pathogens may exhibit multidrug resistance (MDR) mechanisms, of which mechanisms such as efflux pumps and biofilm formation are gaining significant importance. Multidrug resistance mechanisms in ESKAPE pathogens have led to an increase in the effective costs in health care and a higher risk of mortality in hospitalized patients. These pathogens utilize antimicrobial efflux pump mechanisms and bacterial biofilm-forming capabilities to escape the bactericidal action of antimicrobials. ESKAPE bacteria forming colonies demonstrate increased expression of efflux pump-encoding genes. Efflux pumps not only expel antimicrobial agents but also contribute to biofilm formation by bacteria through (1) transport of molecules and transcription factors involved in biofilm quorum sensing, (2) bacterial fimbriae structure transport for biofilm adhesion to surfaces, and (3) regulation of a transmembrane gradient to survive the difficult conditions of biofilm microenvironments. The synergistic role of these mechanisms complicates treatment outcomes. Given the mechanistic link between biofilms and efflux pumps, therapeutic strategies should focus on targeting anti-biofilm mechanisms alongside efflux pump inactivation with efflux pump inhibitors. This review explores the molecular interplay between efflux pumps and biofilm formation, emphasizing potential therapeutic strategies such as efflux pump inhibitors (EPIs) and biofilm-targeting agents. Full article

Introduction: Biodegradable Temporizing Matrix (BTM) is a new synthetic dermal substitute suitable for wound closure and tissue regeneration. The data in paediatric population remain limited. The study purpose is to review the indications for BTM application in paediatric patients, evaluate the short-term and long-term results, including complications and functional outcomes, as well as to share some unique observations regarding the use of BTM in paediatric population. Patients and Methods: Patients undergoing reconstructive surgery and BTM application during the last three years were included. Data collected included patient demographics, primary diagnosis, previous surgical management, post-operative complications and final outcomes. BTM was used in 32 patients. The indications varied including epidermolysis bullosa (n = 6), burns (n = 4), trauma (n = 7), infection (n = 4), ischemia or necrosis (n = 11). Results: The results were satisfying with acceptable aesthetic and functional outcomes. Complications included haematoma underneath the BTM leading to BTM removal and re-application (n = 1), BTM infection (n = 1) and split-thickness skin graft failure on top of BTM requiring re-grafting (n = 2). Conclusions: BTM can be a good alternative to large skin grafts, locoregional flaps or even free flaps. The big advantages over other dermal substitutes or skin grafts are that BTM is less prone to infection and offers excellent scarring by preserving the normal skin architecture. Specifically in children, BTM might not require grafting, resulting in spontaneous healing with good scarring. In critically ill patients, BTM reduces the operation time and there is no donor site morbidity. BTM should be considered in the reconstructive ladder when discussing defect coverage options in children and young people. Full article

Background and Objectives: Surgical site infections (SSIs) are a frequent complication after lower extremity fracture surgery, yet tools for individualized risk prediction remain limited. This study aimed to develop and internally validate a nomogram for individualized SSI risk prediction based on perioperative clinical parameters. Materials and Methods: This retrospective cohort study included adults who underwent lower extremity fracture surgery between 2022 and 2025 at a tertiary care center. Thirty candidate predictors were evaluated. Feature selection was performed using six strategies, and the final model was developed with logistic regression based on bootstrap inclusion frequency. Model performance was assessed by area under the curve, calibration slope, Brier score, sensitivity, and specificity. Results: Among 638 patients undergoing lower extremity fracture surgery, 76 (11.9%) developed SSIs. Of six feature selection strategies compared, bootstrap inclusion frequency identified seven predictors: red blood cell count, preoperative C-reactive protein, chronic kidney disease, operative time, chronic obstructive pulmonary disease, body mass index, and blood transfusion. The final model demonstrated an AUROC of 0.924 (95% CI, 0.876–0.973), a calibration slope of 1.03, and a Brier score of 0.0602. Sensitivity was 86.2% (95% CI, 69.4–94.5) and specificity was 89.5% (95% CI, 83.8–93.3). Chronic kidney disease (OR, 88.75; 95% CI, 5.51–1428.80) and blood transfusion (OR, 85.07; 95% CI, 11.69–619.09) were the strongest predictors of infection. Conclusions: The developed nomogram demonstrates strong predictive performance and may support personalized SSI risk assessment in patients undergoing lower extremity fracture surgery. Full article

Gingival recession is a common problem, particularly affecting oral health and esthetics, and its treatment involves surgical root coverage procedures. The aim of this narrative review is to evaluate the role of systemic antibiotic therapy in mucogingival surgery for recession treatment. The available literature does not support routine antibiotic use in systemically healthy patients undergoing recession coverage surgery. Indications for prophylactic antibiotics are restricted to individuals at high risk of infective endocarditis and immunocompromised patients with elevated susceptibility to surgical site infections. Although mucogingival surgeries are performed in a non-sterile environment, the risk of infection remains low when proper aseptic techniques and good preoperative tissue preparation are applied. The review emphasizes the importance of making clinical decisions that consider the patient’s health status and are aligned with current recommendations. It also emphasizes the necessity for prospective studies to evaluate antibiotics’ effect on recession coverage procedures outcome. To bridge the gap between contemporary evidence and clinical practice and to foster responsible use of antibiotics in periodontal plastic surgery, the authors of this review integrate current evidence and clinical guidelines into a practical tool designed to assist clinicians in making reasoned, evidence-based decisions. Full article

Hernia is a physiological condition that significantly impacts patients’ quality of life. Surgical treatment for hernias often involves the use of specialized meshes to support the abdominal wall. While this method is highly effective, it frequently leads to complications such as pain, infections, inflammation, adhesions, and even the need for revision surgeries. According to the Food and Drug Administration (FDA), hernia recurrence rates can reach up to 11%, surgical site infections occur in up to 21% of cases, and chronic pain incidence ranges from 0.3% to 68%. These statistics highlight the urgent need to improve mesh technologies to minimize such complications. The design and material composition of meshes are critical in reducing postoperative complications. Moreover, integrating drug-eluting properties into the meshes could address issues like infections and inflammation by enabling localized delivery of antibiotics and anti-inflammatory agents. Mesh design is equally important, with innovative structures like auxetic designs offering enhanced mechanical properties, flexibility, and tissue integration. These advanced designs can distribute stress more evenly, reduce fatigue, and improve performance in areas subjected to high pressures, such as during intense coughing, sneezing, or heavy lifting. Technological advancements, such as 3D printing, enable the precise fabrication of meshes with tailored designs and properties, providing new opportunities for innovation. By addressing these challenges, the development of next-generation mesh implants has the potential to reduce complications, improve patient outcomes, and significantly enhance quality of life for individuals undergoing hernia repair. Full article

Background and Objectives: Diabetes mellitus (DM) significantly impacts post-surgical recovery and fracture healing; however, few studies have specifically investigated the impact of DM on outcomes in patients undergoing surgical stabilization of rib fractures (SSRF). This study investigated the potential influence of DM on perioperative outcomes following SSRF, using data from Taiwan’s National Health Insurance Research Database (NHIRD). Materials and Methods: Data of 1603 patients with multiple rib fractures who underwent SSRF between 2001 and 2019 were retrospectively analyzed. Patients were categorized into three groups: no DM, DM without chronic complications, and DM with chronic complications. The associations between DM status and perioperative outcomes, including hospital length of stay (LOS), in-hospital mortality, readmission rates, and complications such as pneumonia, surgical site infection (SSI), acute myocardial infarction (AMI), and total hospital costs were determined using univariate and multivariable regression analyses. Results: The mean age of the 1603 patients was 52.0 years, and 71% were male. Patients with DM and chronic complications had higher risks of 14-day readmission (adjusted odds ratio [aOR] = 2.99; 95% confidence interval [CI]: 1.18–7.62), 15–30 day readmission (aOR = 3.28; 95% CI: 1.25–8.60), SSI (aOR = 2.90; 95% CI: 1.37–6.14), AMI (aOR = 3.44; 95% CI: 1.28–9.24), and acute respiratory distress syndrome (ARDS) (aOR = 1.96; 95% CI: 1.03–3.74). In conclusion, DM, particularly DM with chronic complications, significantly increases the risk of adverse short-term outcomes following SSRF. Conclusions: These findings emphasize the need for enhanced care for patients with DM to optimize the outcomes of SSRF. Full article

Background/Objectives: Single-dose pre-operative antibiotic prophylaxis for cardiac-device implantation is recommended but extending antibiotic prophylaxis is common. Locally, 50–60% of patients had extended prophylaxis after pacemaker insertion or generator change. Our antimicrobial stewardship programme (ASP) incorporated behavioural change strategies in implementing a multi-pronged intervention bundle to address this and evaluated its effectiveness and safety. Methods: This single-centre, retrospective cohort study included patients aged 21 years old or older, undergoing uncomplicated pacemaker insertion or generator change at Singapore General Hospital (SGH) from October 2022 to March 2025. To improve antibiotic use, ASP interventions incorporating behaviour change strategies were implemented, namely (1) data-driven feedback, (2) targeted education, (3) identification and engagement of ASP champion, and (4) clinical pathway revision. Results: There were 779 patients evaluated; 380 (48.8%) received standard prophylaxis while 399 (51.2%) received extended prophylaxis with oral antibiotics (mean duration, 3.3 ± 0.8 days). Following ASP interventions, the practice of extended prophylaxis declined significantly from 43.8% to 24.0% (p < 0.01). The incidence of surgical site infections was low and similar in both groups (0.8%, p = 1.000); all infections were superficial. There was also significant reduction in the proportion of patients on all antibiotics from 20.7% to 16.3% (p < 0.01). Identification and engagement of ASP champion proved pivotal in changing prescribing behaviour through peer influence and credibility. Conclusions: The bundled ASP interventions, incorporating behavioural change strategies, have effectively and safely reduced the use of extended prophylaxis post-cardiac device implantation. Behavioural change interventions are essential to achieve sustained stewardship success. Full article

Infections with multidrug-resistant (MDR) organisms remain a significant cause of morbidity and mortality among liver transplant recipients, despite advances in surgical techniques and immunosuppressive therapy. This prospective observational study aimed to evaluate the impact of targeted perioperative antibiotic prophylaxis against MDR Gram-negative bacteria on postoperative infections and mortality in liver transplant recipients. Seventy-nine adult patients who underwent liver transplantation and were admitted to the ICU for more than 24 h postoperatively were included. Demographics, disease severity scores, comorbidities, and lengths of ICU and hospital stay were recorded. Colonization with carbapenem-resistant Gram-negative bacteria was assessed via preoperative and postoperative cultures from the blood, urine, rectum, and tracheal secretions. Patients were divided into two groups: those with MDR colonization or infection who received targeted prophylaxis and controls who received standard prophylaxis. Infectious complications (30.4%) occurred significantly less frequently than non-infectious ones (62.0%, p = 0.005). The most common infections were bacteremia (22.7%), pneumonia (17.7%), and surgical site infections (2.5%), with most events occurring within 15 days post-transplant. MDR pathogens isolated included Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Although overall complication and mortality rates at 30 days and 3 months did not differ significantly between groups, the targeted prophylaxis group had fewer infectious complications (22.8% vs. 68.5%, p = 0.008), particularly bacteremia (p = 0.007). Infection-related mortality was also significantly reduced in this group (p = 0.039). These findings suggest that identification of MDR colonization and administration of targeted perioperative antibiotics may reduce septic complications in liver transplant patients. Further prospective studies are warranted to confirm benefits on outcomes and resource utilization. Full article

Background: Deep surgical site infections (SSIs) represent a serious complication following abdominal trauma surgery; however, comprehensive risk factor analysis in large trauma populations remains limited. Although surgical site infections are recognized as preventable complications, little is known about the specific risk factors and clinical outcomes associated with deep SSIs in trauma patients at the national level. Methods: A retrospective cohort study analyzed data from the National Trauma Data Bank from 2020–2022, including 1,198,262 trauma patients with complete demographic, injury severity, and surgical procedure data. Deep SSI development, length of hospital stay, intensive care unit utilization, duration of mechanical ventilation, discharge disposition, and in-hospital mortality were assessed. Multivariate logistic regression was used to identify independent risk factors and quantify associations between patient characteristics and deep SSI occurrence. Results: Deep SSIs occurred in 601 patients (0.05%). Affected patients were younger (median 41 vs. 54 years, p < 0.001), predominantly male (73.7% vs. 61.8%, p < 0.001), and exhibited higher injury severity scores (median 17.0 vs. 5.0, p < 0.001). Major abdominal surgery was the strongest independent predictor (OR 3.08, 95% CI: 2.21–4.23, p < 0.001), followed by injury severity score (OR 1.05, 95% CI: 1.04–1.06, p < 0.001) and ICU length of stay (OR 1.04 per day, 95% CI: 1.03–1.05, p < 0.001). Patients with deep SSIs demonstrated dramatically increased hospital stays (89.5% vs. 4.5% exceeding 21 days, p < 0.001), reduced home discharge rates (28.5% vs. 48.9%, p < 0.001), and higher mortality (4.2% vs. 1.2%, p < 0.001). Conclusions: Major abdominal surgery and injury severity are primary risk factors for deep SSIs in trauma patients, with profound impacts on clinical outcomes and healthcare resource utilization. These findings highlight the importance of targeted prevention strategies for high-risk trauma patients undergoing major abdominal procedures and emphasize the significant burden that deep SSIs place on healthcare systems. Full article

Background/Objectives: Clostridioides difficile infection (CDI) is a major cause of infectious diarrhea in the inpatient and community setting. Real-world data outside the strict environment of randomized controlled trials (RCTs) are needed to improve the quality of evidence. The aim of this study was to compare different clinical outcomes of CDI patients treated with fidaxomicin with those treated with vancomycin using a representative patient population in the United States of America (USA). Methods: Comprehensive real-world data were analyzed for this retrospective observational study, provided by the TriNetX database, an international research network with electronic health records from multiple USA healthcare providers. This includes in- and outpatients treated with fidaxomicin (FDX) or vancomycin (VAN) for CDI between 01/2013 and 12/2023. The following cohorts were compared: (i) patients treated with fidaxomicin within 10 days following CDI diagnosis (FDX group) vs. (ii) patients treated with vancomycin within 10 days following CDI diagnosis (VAN group). Outcomes analysis between the two cohorts was performed after propensity score matching and included event risk and Kaplan–Meier survival analyses for the following concomitant diseases/events occurring during an observational period of 12 months following CDI diagnosis: death, sepsis, candidiasis, infections caused by vancomycin-resistant enterococci, inflammatory bowel disease, cardiovascular disease, psychological disease, central line-associated blood stream infection, surgical site infection, and ventilator-associated pneumonia. Results: Following propensity score matching, 2170 patients were included in the FDX group and VAN groups, respectively. The event risk analysis demonstrated improved outcomes of patients treated with FDX compared to VAN in 6 out of the 10 events that were analyzed. The highest risk ratio (RR) and odds ratio (OR) were found for sepsis (RR: 3.409; OR: 3.635), candidiasis (RR: 2.347; OR: 2.431), and death (RR: 1.710; OR: 1.811). The Kaplan–Meier survival analysis showed an overall survival rate until the end of the 12-month observational period of 87.06% in the FDX group and 78.49% in the VAN group (log-rank p < 0.001). Conclusions: Our comparative event risk analysis demonstrated improved outcomes for patients treated with FDX compared to VAN in most of the observed events and underlines the results of previously conducted RCTs, highlighting the beneficial role of FDX compared to VAN. Further big data analyses from other industrialized countries are needed for comparison with our observations. Full article

Background and Objectives: Postoperative pancreatic fistula and post-hepatectomy liver failure remain significant complications after HPB surgery; however, superficial surgical site infection (SSI) is the most frequent wound-related complication. Closed-incision negative-pressure wound therapy (ciNPWT) has been proposed to reduce superficial contamination, yet no liver-focused quantitative synthesis exists. We aimed to evaluate the effectiveness and safety of prophylactic ciNPWT after hepatopancreatobiliary (HPB) surgery. Methods: MEDLINE, Embase, and PubMed were searched from inception to 30 April 2025. Randomized and comparative observational studies that compared ciNPWT with conventional dressings after elective liver transplantation, hepatectomy, pancreatoduodenectomy, and liver resections were eligible. Two reviewers independently screened, extracted data, and assessed risk of bias (RoB-2/ROBINS-I). A random-effects Mantel–Haenszel model generated pooled risk ratios (RRs) for superficial SSI; secondary outcomes were reported descriptively. Results: Twelve studies (seven RCTs, five cohorts) encompassing 15,212 patients (3561 ciNPWT; 11,651 control) met the inclusion criteria. Device application lasted three to seven days in all trials. The pooled analysis demonstrated a 29% relative reduction in superficial SSI with ciNPWT (RR 0.71, 95% CI 0.63–0.79; p < 0.001) with negligible heterogeneity (I² 0%). Absolute risk reduction ranged from 0% to 13%, correlating positively with the baseline control-group SSI rate. Deep/organ-space SSI (RR 0.93, 95% CI 0.79–1.09) and 90-day mortality (RR 0.94, 95% CI 0.69–1.28) were unaffected. Seven studies documented a 1- to 3-day shorter median length of stay; only two reached statistical significance. Device-related adverse events were rare (one seroma, no skin necrosis). Conclusions: Prophylactic ciNPWT safely reduces superficial SSI after high-risk HPB surgery, with the greatest absolute benefit when baseline SSI risk exceeds ≈10%. Its influence on deep infection and mortality is negligible. Full article

Background: Surgical site infections (SSIs) are among the most common postoperative complications. Environmental factors, including intraoperative traffic and door openings in the operating room (OR), have been identified as critical contributors to microbial air contamination. Nurses play a pivotal role in managing these factors, directly influencing infection control practices. Methods: An integrative review was conducted to synthesize current evidence on the association between intraoperative traffic, door openings, and SSIs. A structured methodology was employed to identify, assess, and analyze the existing literature, with a specific focus on the nursing role in infection prevention. Results: Findings from a single-center prospective cohort study indicate that ORs with more than 10 personnel present exhibit a threefold increase in SSI risk [Relative Risk (RR) = 3.12; 95% Confidence Interval (CI): 0.71–13.66] compared to ORs with fewer personnel. Additionally, every five door openings per procedure were associated with a significant increase in SSI incidence [Hazard Ratio (HR) = 2.00; 95% CI: 1.24–3.20, p = 0.005]. Conclusions: These findings underscore the importance of strict protocols to limit intraoperative traffic and unnecessary OR access. A multidisciplinary approach plays a crucial role in ensuring surgical safety and preventing SSIs by regulating OR access and adhering to infection control best practices. Full article