Surgery in practice and science最新文献

{"title":"Respiratory dysfunction in whiplash associated disorders (WAD) with cervical plexus syndrome – A case report","authors":"NA Nystrom ,&nbsp;SR Daulat ,&nbsp;A Zakaria ,&nbsp;M Petersen ,&nbsp;VM Moodley ,&nbsp;LP. Champagne","doi":"10.1016/j.sipas.2025.100271","DOIUrl":"10.1016/j.sipas.2025.100271","url":null,"abstract":"<div><div>Whiplash Associated Disorders (WAD) represents a chronic post-traumatic pain syndrome from indirect flexion-extension trauma to the neck. The condition exhibits significant variability among affected individuals and can involve numerous secondary symptoms, including but not limited to myalgia, central sensitization, migraines, photophobia, jaw pain, dysphagia, joint stiffness, and tinnitus, while significant breathing problems are not commonly associated with or prominently considered in WAD.</div><div>Herein, we present the diagnosis and successful surgical treatment of severe respiratory dysfunction and staccato speech in a patient with WAD, who over a period of more than ten years underwent multiple spirometry evaluations for breathing difficulties that correlated with the severity of neck pain. In 2019, his condition deteriorated, with significantly increased pain and dyspnea leading to further evaluations that included laboratory studies and consultations with specialists in neurosurgery, neurology, pulmonology, neurophysiology, ENT, general internal medicine, cardiology, radiology, speech pathology, physical medicine, orthopedic surgery, and hand surgery at three separate academic centers in Norway.</div><div>Eventually, the patient was diagnosed with a condition that is regularly observed among patients referred to our office for evaluation and surgical treatment of chronic, whiplash related pain, and that we propose to label Cervical Plexus Syndrome.</div><div>One year following exploration and neurolysis of sensory nerves to the right and left superficial cervical plexus, the patient remains pain free, with unimpeded speech and breathing as demonstrated by postoperative spirometry and video recordings.</div><div>Although the underlying pathophysiology remains unclear, we report what we believe to be the first successful surgical treatment of serious respiratory dysfunction from pain generators in tissue that historically is considered anatomically and functionally separate from the mechanics of breathing. Further investigation will be needed to determine prevalence of respiratory dysfunction in chronic neck pain.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100271"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operating room times differ for surgical fixation of metacarpal fractures: An analysis of two principally different techniques","authors":"Sohail R. Daulat ,&nbsp;Viashen Moodley ,&nbsp;Carina Ho ,&nbsp;Michael Mazarei ,&nbsp;Cina Karodeh ,&nbsp;Nils A. Nystrom ,&nbsp;Lloyd P. Champagne","doi":"10.1016/j.sipas.2024.100266","DOIUrl":"10.1016/j.sipas.2024.100266","url":null,"abstract":"<div><h3>Introduction</h3><div>Time spent in the operating room (OR) has ramifications that impact patient outcomes and the economics of patients, physicians, surgery centers, and insurance industry. For that reason, there is an incentive to seek approaches that allow shorter times to be spent in the OR. To what extent varying routine techniques impact on operating times has not been extensively studied in metacarpal fixation literature, specifically investigating retrograde threaded intramedullary nail fixations (RTNF) and comparing it to open plating fixations (OPF). The present study was designed for the purpose of comparing OR times for different but broadly adopted techniques for internal stabilization of metacarpal shaft fractures.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted for patients aged 18 and above, who over a 41-month period underwent internal fixation with RTNF or OPF for single, extra articular, closed fractures of the index through little finger metacarpals. We examined anesthesia records, which indicated total operating (“skin-to-skin”) times.</div></div><div><h3>Results</h3><div>A total of 81 charts remained for review after exclusions. Statistical analysis of the recorded data showed significantly shorter median OR time values for RTNF (17 minutes, IQR = 14 – 20.75) vs. OPF (36 minutes, IQR = 31.55 – 44; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Statistical analysis of data shows significantly shorter operating times to achieve satisfactory fracture stabilization using RTNF compared to OPF. Since the differences in OR time significantly differ between the two principally different surgical techniques, it should be considered when choosing which surgical technique to use. However, further review of indications and clinical outcomes is necessary to develop definitive recommendations or guidelines on which technique should be preferred, especially when considering specific patient presentations.</div></div><div><h3>Level of Evidence</h3><div>Retrospective Comparative Study III</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100266"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs of surgical futility in emergency laparotomy","authors":"C.L. Downey,&nbsp;D.G. Jayne","doi":"10.1016/j.sipas.2025.100273","DOIUrl":"10.1016/j.sipas.2025.100273","url":null,"abstract":"<div><h3>Background</h3><div>Surgical futility has been defined as death within 72 h of emergency laparotomy. It is associated with patient distress, moral injury and opportunity costs. This study aimed to determine the rates of surgical futility after emergency laparotomy at a single high-volume centre, and to attribute costs to cases of surgical futility.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted between 1st August 2021 and 1st August 2023 at a single high-volume acute hospital trust in the United Kingdom. A national patient-level costings system was used to determine the costs of hospital care from the day of surgery to the time of death.</div></div><div><h3>Results</h3><div>In a cohort of 741 patients, there was a 3.6 % surgical futility rate. Most of these patients died within 24 h of surgery. The median total cost of admission for each patient was £14,118 (range £6,618 to £29,583). The median cost per day of admission was £6,004 (range £1,324 to £15,255).</div></div><div><h3>Conclusion</h3><div>This is the first study to report the costs of surgical futility in the emergency laparotomy setting. Futile surgery appears to cost more and require more resource than non-futile laparotomies. Further research should focus on how to better predict surgical futility, reduce inappropriate interventions and improve patient care.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100273"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143262682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical sharp debridement alongside maggot debridement therapy (MDT) for the treatment of diabetic foot ulcers (DFUs): A systematic review of case reports","authors":"Babak Choobi Anzali ,&nbsp;Anna Javanbakht ,&nbsp;Maryam Rasouli ,&nbsp;Nasim Talebiazar ,&nbsp;Milad Hashemzadeh ,&nbsp;Mir Amir Hossein Seyed Nazari","doi":"10.1016/j.sipas.2024.100270","DOIUrl":"10.1016/j.sipas.2024.100270","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this systematic review of case reports is to evaluate the efficacy and safety of combining surgical sharp debridement with maggot debridement therapy (MDT) for the treatment of diabetic foot ulcers (DFUs).</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science. Inclusion criteria were studies that reported on the use of surgical sharp debridement alongside MDT for DFUs, while exclusion criteria included insufficient detail on treatment methods or patient outcomes, non-human studies, and non-English publications. Data were extracted using a standardized form, and the quality of case reports was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. A narrative synthesis was conducted due to the anticipated heterogeneity of the case reports, and a sensitivity analysis was performed to assess the robustness of the findings.</div></div><div><h3>Results</h3><div>The review process began with 1003 records, which were narrowed down to 721 unique records after removing duplicates. Following title and abstract screening, and full-text assessment, 8 studies were selected for inclusion in the final analysis. The narrative synthesis identified several key findings, including significant wound size reduction, improved glycemic control, disappearance of foul odor, improved healing rates, infection control, granulation tissue formation, epithelialization, complete wound closure, avoidance of amputation, and pain alleviation. The combination therapy showed promise in managing DFUs effectively.</div></div><div><h3>Conclusion</h3><div>The systematic review of case reports presents evidence supporting the combined use of surgical sharp debridement and maggot debridement therapy in the management of diabetic foot ulcers. The findings suggest that this approach can lead to successful wound healing and limb preservation, offering a valuable addition to the clinician's toolkit for treating DFUs.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100270"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency laparotomy preoperative risk assessment tool performance: A systematic review","authors":"Joseph N. Hewitt ,&nbsp;Thomas J. Milton ,&nbsp;Jack Jeanes ,&nbsp;Ishraq Murshed ,&nbsp;Silas Nann ,&nbsp;Susanne Wells ,&nbsp;Aashray K. Gupta ,&nbsp;Christopher D. Ovenden ,&nbsp;Joshua G. Kovoor ,&nbsp;Stephen Bacchi ,&nbsp;Christopher Dobbins ,&nbsp;Markus I. Trochsler","doi":"10.1016/j.sipas.2024.100264","DOIUrl":"10.1016/j.sipas.2024.100264","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative assessment of risk for emergency laparotomy may enhance decision making with regards to urgency or perioperative critical care admission and promote a more informed consent process for patients. Accordingly, we aimed to assess the performance of risk assessment tools in predicting mortality after emergency laparotomy.</div></div><div><h3>Methods</h3><div>PubMed, Embase, the Cochrane Library and CINAHL were searched to 12 February 2022 for observational studies reporting expected mortality based on a preoperative risk assessment and actual mortality after emergency laparotomy. Study screening, data extraction, and risk of bias using the Downs and Black checklist were performed in duplicate. Data on setting, operation undertaken, expected and actual mortality rates were extracted. Meta-analysis was planned but not possible due to heterogeneity. This study is registered with PROSPERO, CRD42022299227.</div></div><div><h3>Results</h3><div>From 10,168 records, 82 observational studies were included. 17 risk assessment tools were described, the most common of which were P-POSSUM (42 studies), POSSUM (13 studies), NELA (12 studies) and MPI (11 studies). Articles were published between 1990 and 2022 with the most common country of origin being the UK (33 studies) followed by India (11 studies). Meta-analysis was not possible. Observed mortality and expected mortality based on risk assessment is reported for each study and generally shows most studies show accurate risk prediction.</div></div><div><h3>Conclusions</h3><div>This review synthesises available literature to characterise the performance of various risk assessment tools in predicting mortality after emergency laparotomy. Findings from this study may benefit those undertaking emergency laparotomy and future research in risk prediction.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"19 ","pages":"Article 100264"},"PeriodicalIF":0.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The CRP/PAB ratio outperforms the LRINEC score in early diagnosis of Fournier's gangrene","authors":"Jin-Liang Zhu,&nbsp;Hong-Jian Gao,&nbsp;Zhi-Tao Yin","doi":"10.1016/j.sipas.2024.100267","DOIUrl":"10.1016/j.sipas.2024.100267","url":null,"abstract":"<div><h3>Background</h3><div>Fournier's gangrene (FG) is scarce and potentially fatal disease. Although the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was established in 2004, its reliability as a diagnostic tool to differentiate between FG and perianal abscess is still debated. The objective of this study was to assess the reliability of the LRINEC score and other relevant inflammatory markers. The diagnostic effectiveness of these inflammatory factors was evaluated and compared.</div></div><div><h3>Methods</h3><div>Retrospective observational study of patients with FG or with perianal abscess. Fifty-two patients with FG and 39 patients with perianal abscess treated in Shenyang Coloproctology Hospital between January 2019 and December 2023 were enrolled in the study.</div></div><div><h3>Results</h3><div>The area under the ROC curve (C-statistic) of a LRINEC score ≥6 for diagnosing FG was 0.736. Inflammatory markers, including C-reactive protein (CRP), procalcitonin (PCT), prealbumin (PAB), neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammation index (SII), demonstrated better diagnostic ability compared to the LRINEC score. Particularly, the compound inflammatory factor of CRP-to-PAB (CRP/PAB) ratio exhibited superior diagnostic ability compared to other markers (C-statistic: 0.908; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The LRINEC score demonstrated only modest discriminative performance in this study. Patients with PAB&lt; 91mg/L and a CRP/PAB≥ 1.52 should undergo careful evaluation for the presence of FG. The elevated CRP/PAB ratio is considered an early indicator for FG, particularly in distinguishing it from deep perianal abscesses. Further investigation is warranted in future studies to support these findings.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"19 ","pages":"Article 100267"},"PeriodicalIF":0.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances and results in omental patch repair of gastrointestinal perforations: A narrative review","authors":"Francesca Velasco-Velasco ,&nbsp;Jordan Llerena-Velastegui","doi":"10.1016/j.sipas.2024.100261","DOIUrl":"10.1016/j.sipas.2024.100261","url":null,"abstract":"<div><div>Omental patch repair is a crucial surgical procedure for managing gastrointestinal perforations, particularly those associated with peptic ulcers, necessitating a detailed review of its effectiveness and outcomes. This literature review aims to assess current knowledge on omental patch repair, focusing on advancements in surgical techniques and patient outcomes. Major medical databases, including PubMed, Scopus, and Web of Science, were searched for relevant studies published between 2020 and 2024, prioritizing those that explored omental patch repair, surgical methods, and associated clinical outcomes. The results provide insights into the pathophysiology of gastrointestinal perforations, the effectiveness of omental patch repair in promoting healing, and its role in reducing postoperative complications. Both open and laparoscopic techniques have demonstrated improved patient outcomes, including reduced mortality, morbidity, and faster recovery times. Additionally, alternative methods, such as the use of the falciform ligament, offer comparable efficacy in cases where the omentum is unavailable. This review underscores the importance of omental patch repair as a reliable surgical intervention adaptable to various clinical environments. However, further research is necessary to address gaps in long-term outcomes, particularly regarding recurrence rates and complications, highlighting the need for continued innovation and refinement of techniques to enhance patient care.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"19 ","pages":"Article 100261"},"PeriodicalIF":0.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary medullary adenocarcinoma of the colon: Literature review and case series","authors":"Hein Maung ,&nbsp;Oliver Gregory ,&nbsp;Thomas De Hoog ,&nbsp;Matthew Hutchinson ,&nbsp;Dr. Pith Beh Soh ,&nbsp;Matthew Marino ,&nbsp;Tobias Evans ,&nbsp;Adrian Yeoh ,&nbsp;Richard C. Turner","doi":"10.1016/j.sipas.2024.100254","DOIUrl":"10.1016/j.sipas.2024.100254","url":null,"abstract":"<div><h3>Aims</h3><div>Medullary carcinoma of the colon is a rare subtype of adenocarcinoma, first described in 1999. Clinically known to have a favourable prognosis in comparison to poorly differentiated cancers, it is associated with deficient mismatch repair. This is an observational single center study of patients with medullary cancer, and comparison with the current literature.</div></div><div><h3>Methods</h3><div>We performed a search of the pathological database at our institution for medullary adenocarcinomas between the years of 2016–2023 and reviewed their clinical information to collect all relevant data including patient history, hospital admissions. surgery and clinic visits. We then performed a literature search using Pubmed for search terms medullary cancer/carcinoma of the colon/colorectum.</div></div><div><h3>Results</h3><div>11 patients were found in our database, 34 studies in the literature, 19 retrospective cohort studies (3144 patients) and 13 case reports. 81.8% (vs. 73.22% in cohort studies) were female patients. 8/11 patients' tumours had lympho-vascular invasion with 2/11 perineural involvement. Immunohistochemistry demonstrated 11/11 patients’ tumours with MLH1 and PMS2 loss, and presence of MSH2 and MSH6. Cohort studies demonstrated 302/1897 (15.92%) tumours had perineural invasion with 1133/2151 (52.67%) demonstrating lympho-vascular invasion. MLH1 testing was available for 192 patients, with 93.75% having loss of MLH1.</div></div><div><h3>Conclusion</h3><div>Our cohort of medullary cancer patients were similar to that in the literature, with regards to demographics, staging and tumour characteristics. A longer follow-up time is required for our cohort to analyze long term survival outcomes.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"19 ","pages":"Article 100254"},"PeriodicalIF":0.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and associated factors of acute postoperative pain in adult surgical patients: A prospective study","authors":"Eyob Asefa Bekele ,&nbsp;Tseganesh Berhanu Tulu ,&nbsp;Yonathan Abebe Bulto ,&nbsp;Gebeyehu Tessema Azibte ,&nbsp;Waltengus Birhanu","doi":"10.1016/j.sipas.2024.100262","DOIUrl":"10.1016/j.sipas.2024.100262","url":null,"abstract":"<div><h3>Background</h3><div>Pain, as defined by the International Association for the Study of Pain, is an unpleasant sensory and emotional experience associated with, or resembling, that is associated with actual or potential tissue damage. In Ethiopia, where healthcare facilities and offerings are expanding to handle countless patients requiring surgical intervention, managing acute postoperative pain is a serious concern.</div></div><div><h3>Objectives</h3><div>To assess the prevalence of acute postoperative pain and associated factors after elective surgery among adult patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2023</div></div><div><h3>Methodology</h3><div>This is an institution-based cross-sectional study. A structured data collection format was used to collect data from 219 participants. Bivariable and multivariable logistic regression analyses described the association between independent and dependent variables.</div></div><div><h3>Results</h3><div>Of 219 patients, 180 (82.2 %) had acute postoperative pain. The prevalence of moderate to severe pain was 34.24 %. Preoperative anxiety, the use of intraoperative analgesics, and duration of surgery were the main factors associated with the prevalence of acute postoperative pain.</div></div><div><h3>Conclusion</h3><div>Our study revealed that the overall prevalence of postoperative pain was relatively low in the study area. This suggests that the attention given to postoperative pain recognition and management is better than that in other areas. However, the finding of a significant gap in managing postoperative pain underscores the need for further improvements in pain management practices. This should motivate us to commit to change, particularly in the identified areas of concern, such as preoperative anxiety, use of intraoperative analgesics, and duration of surgery.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"19 ","pages":"Article 100262"},"PeriodicalIF":0.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elective hand surgery and concomitant corticosteroid injection: Confirming increased infection risk using A national dataset","authors":"Benjamin J. Kirby ,&nbsp;Jashvant Poeran ,&nbsp;Nicole Zubizarreta ,&nbsp;Daniel A. London","doi":"10.1016/j.sipas.2024.100259","DOIUrl":"10.1016/j.sipas.2024.100259","url":null,"abstract":"<div><h3>Background</h3><p>Recent studies demonstrate a link between corticosteroid injection and surgical complications when procedures occur shortly after steroid administration. These publications focus on single procedures like carpal tunnel release. This study seeks to demonstrate how surgical site infection risk changes across thirteen common elective hand procedures when steroid injection is performed contemporaneously.</p></div><div><h3>Methods</h3><p>The Truven MarketScan® database identified patients who had undergone elective hand surgery between 2015 and 2016. Two cohorts were created based on the administration, or absence thereof, of contemporaneous corticosteroid injection. The primary outcome measure was infection within 30 days of surgery as measured by antibiotic prescription or repeat surgical intervention. Multivariate logistic regression was performed to assess the association between concomitant corticosteroid injections and post-operative infections while controlling for demographics and comorbidities.</p></div><div><h3>Results</h3><p>149,689 patients underwent elective hand surgery. 6104 (4.1 %) received concomitant corticosteroid injection and 14,070 (9.4 %) received post-operative antibiotics or underwent secondary surgical intervention for infection. Treatment for post-operative infection was significantly higher in the corticosteroid group (10.2 % versus 9.3 %; <em>p</em> = 0.02) driven by difference in severe infection requiring surgical intervention (3.7 % versus 3.1 %; <em>p</em> = 0.03). This finding persisted when controlling for demographics and comorbidities with adjusted OR of 1.10 (CI 1.01–1.20) for all infections and 1.16 (CI 1.01–1.33) for severe infections.</p></div><div><h3>Discussion</h3><p>These results support prior findings that patients undergoing concurrent steroid injections and surgery have increased rates of infectious complications though the absolute risk remains small. Limitations of the database preclude further investigation into the details of each procedure (e.g. ipsilateral vs contralateral injection, peri-operative antibiotics) which may impact infection rates.</p></div><div><h3>Conclusions</h3><p>Concomitant steroid injection with elective hand surgery may increase the risk of postoperative infection, particularly severe infection. However, that relative increase lies between 1 and 33 percent and should be weighed against the benefit from intraoperative corticosteroid administration.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"19 ","pages":"Article 100259"},"PeriodicalIF":0.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000263/pdfft?md5=0debdc49054f364b7afd4a6897e1b558&pid=1-s2.0-S2666262024000263-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142169507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}