Incidence surveillance of wound infection in hernia surgery during hospitalization and after discharge in a university hospital. Risk Factors for Infection After Spinal Surgery Risk factors for periprosthetic infection after reverse shoulder arthroplasty. Prospective multicenter surveillance and risk factor analysis of deep surgical site infection after posterior thoracic and/or lumbar spinal surgery in adults The role of pre-operative assessment and ringfencing of services in the control of methicillin resistant Staphlococcus aureus infection in orthopaedic patients. Surveillance and epidemiology of surgical site infections after cardiothoracic surgery in The Netherlands, 2002-2007. Patient expectations before arthroscopic shoulder surgery: correlation with patients' reasons for seeking treatment. What Are the Instability and Infection Rates After Reverse Shoulder Arthroplasty? A randomized controlled trial on the prevention of seroma after partial or total mastectomy and axillary lymph node dissection Efficacy of preoperative home use of 2% chlorhexidine gluconate cloth before shoulder surgery. Diabetes as a risk factor for poorer early postoperative outcomes after shoulder arthroplasty. The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study A survey on prevention of surgical infections in operating theaters. Closed wound drainage in shoulder surgery. Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery? Antibiotics in trauma and orthopedic surgery -- a primer of evidence-based recommendations. A study of wound infections following inguinal hernia repair.
A six-month prospect i ve incidence surveillance of  wound infection  was conducted in the department of general surgery of the Rio de Janeiro University Hospital . Postoperative infections were classified according to Centers for Disease Control criteria . This study reports a rate of 14.04 % in surgical infections limited to herniorrhaphy and detected by surveillance . The majority ( 87.50 % ) of them were only apparent after hospital discharge . Fourteen out of 16 patients ( 88.60 % ) were not deemed to be at risk for surgical infections . Staphylococcus aureus was the most important pathogen associated with infection . This report shows that community surveillance is necessary to determine accurate rates of hospital-acquired infection and will help establish prevention and control policies in Brazil Study Design . A retrospective case control analysis of 48 cases of postoperative infection following spinal procedures .  Objectives . Spinal procedures that became infected after surgery were analyzed to identify the significance of preoperative and intraoperative risk factors . Characterization of the nature and timing of the infections was also performed . Summary of Background Data . The rate of postoperative infection following  spinal surgery  varies widely depending on the nature of the procedure and the patient ’s diagnosis . Preoperative comorbidities and risk factors also influence the likelihood of infection . Methods . A review of 1629 procedures performed on 1095 patients revealed that a postoperative infection  developed in 48 patients ( 4.4 % ) . Data regarding preoperative and intraoperative risk factors were gathered from patient charts for these and a r and omly selected control group of 95 uninfected patients . For analysis , these patient groups were further divided into adult and pediatric subgroups , with an age cutoff of 18 years . Preoperative risk factors review ed included smoking , diabetes , previous surgery , previous infection , steroid use , body mass index , and alcohol abuse . Intraoperative factors review ed included staging of procedures , estimated blood loss , operating time , and use of allograft or instrumentation . Results . The majority of infections occurred during the early postoperative period ( less than 3 months ) . Age > 60 years , smoking , diabetes , previous surgical infection , increased body mass index , and alcohol abuse were statistically significant preoperative risk factors . The most likely procedure to be complicated by an infection was a combined anterior/posterior spinal fusion performed in a staged manner under separate anesthesia . Infections were primarily monomicrobial , although 5 patients had more than 4 organisms identified . The most common organism cultured from the wounds was Staphylococcus aureus . All patients were treated with surgical irrigation and débridement , and appropriate antibiotics to treat the cultured organism . Conclusions . Aggressive treatment of patients undergoing complex or prolonged spinal procedures is essential to prevent and treat infections . Underst and ing a patient ’s preoperative risk factors may help the physician to optimize a patient ’s preoperative condition . Additionally , awareness of critical intraoperative parameters will helpto optimize surgical treatment . It may be appropriate to increase the duration of prophylactic antibiotics or implement other measures to decrease the incidence of infection for high risk patients BACKGROUND Management of periprosthetic infection after  reverse shoulder arthroplasty ( RSA )  remains a challenge . Whereas the infection rate after RSA has improved , more information would be helpful to identify patient risk factors for infection after RSA . The purpose of this study was to evaluate risk factors for infection after RSA . METHODS We identified 301 primary RSAs with a minimum of 1-year follow-up in a prospect ively collected shoulder arthroplasty registry . We performed bivariate and multivariable logistic regression analyses to assess the association between patient demographic and clinical characteristics ( age , sex , smoking , diabetes , rheumatoid arthritis , body mass index , and history of prior failed hemiarthroplasty or total shoulder arthroplasty ) and periprosthetic infection after RSA . RESULTS There were 15 periprosthetic infections after RSA ( 5.0 % ) . Patients with a history of RSA for failed arthroplasty ( odds ratio , 5.75 ; 95 % confidence interval , 2.01 - 16.43 ; P = .001 ) and patients younger than 65 years had an increased risk for development of an infection ( odds ratio , 4.0 ; 95 % confidence interval , 1.21 - 15.35 ; P = .021 ) . History of smoking , diabetes , rheumatoid arthritis , or obesity did not contribute to an increased risk of infection after RSA . CONCLUSIONS This is the first study evaluating risk factors for infection after RSA while controlling for confounding variables with multivariable analysis . The greatest risk factors for infection after RSA were history of a prior failed arthroplasty and age younger than 65 years . Patients with these clinical characteristics should be counseled preoperatively about the increased risk for development of infection after RSA Background Surgical site infection is a serious and significant complication after spinal surgery and is associated with high morbidity rates , high healthcare costs and poor patient outcomes . Accurate identification of risk factors is essential for developing strategies to prevent devastating infections . The purpose of this study was to identify independent risk factors for surgical site infection among posterior thoracic and /or lumbar spinal surgery in adult patients using a prospect i ve multicenter surveillance research method . Methods From July 2010 to June 2012 , we performed a prospect i ve surveillance study in adult patients who had developed surgical site infection after undergoing thoracic and /or lumbar posterior spinal surgery at 11 participating hospitals . Detailed preoperative and operative patient characteristics were prospect ively recorded using a st and ardized data collection format . Surgical site infection was based on the definition established by the Centers for Disease Control and Prevention . Results A total of 2,736 consecutive adult patients were enrolled , of which 24 ( 0.9 % ) developed postoperative deep surgical site infection . Multivariate regression analysis indicated four independent risk factors . Preoperative steroid therapy ( P = 0.001 ) , spinal trauma ( P = 0.048 ) and gender ( male ) ( P = 0.02 ) were statistically significant independent patient-related risk factors , whereas an operating time ≥3 h ( P < 0.001 ) was a surgery-related independent risk factor . Conclusion Preoperative steroid therapy , spinal trauma , male gender and an operating time ≥3 h were independent risk factors for deep surgical site infection after thoracic and /or lumbar spinal surgery in adult patients . Identification of these risk factors can be used to develop protocol s aim ed at decreasing the risk of surgical site infection BACKGROUND MRSA is a major economic and health issue internationally and as such is of particular importance in the appropriate management of orthopaedic patients . Bone , joint and implant infection can lead to unfavourable outcomes with a long protracted in hospital stay inevitable . The cost for the patient , the hospital and society are substantial . MATERIAL S AND METHODS This study was a review of a prospect ively maintained data base from our unit over three time points from 2005 to 2007 . At each time point a new infection control measure was implemented in an effort to reduce MRSA infections . Total rates of MRSA infection and colonisation in all orthopaedic patients were recorded , before and after separation of trauma and elective services , and after the introduction of a screening pre assessment clinic . RESULTS 12259 orthopaedic patients were review ed over the three years . The mean age of MRSA infected patients was 71 . A higher proportion of female patients were infected than male patients . The mean length of stay for infected patients was 23.4 days . The rate of infection dropped from 0.49 % in 2005 to 0.24%in 2007 . After the introduction of these measures there was a substantial reduction in organ space and deep tissue infections . CONCLUSION The separation of emergency and elective orthopaedic services coupled with effective pre-operative screening has result ed in a significant reduction in MRSA infection despite an ever increasing prevalance OBJECTIVE Surgical site infections  after cardiothoracic surgery substantially increase the risk for illness , mortality , and costs . Surveillance of surgical site infections might assist in the prevention of these infections . This study describes the Dutch surveillance methods and results of data collected between 2002 and 2007 . METHODS Three cardiothoracic procedures were included : coronary artery bypass graft procedures , valve surgery , and a combination of coronary artery bypass graft procedures with concomitant valve surgery .  The surgical site infections were divided into sternal and harvest-site infections . Postdischarge surveillance of surgical site infections was m and atory for sternal wounds and elective for harvest-site wounds , with a follow-up period of 42 postoperative days . Multivariate logistic regression was used for risk factor analysis of coronary artery bypass grafts , with adjustment for r and om variation among hospitals . RESULTS Eight of the 16 Dutch cardiothoracic centers participated and collected data on 4066 procedures and 183 surgical site infections , revealing a surgical site infection rate of 2.4 % for sternal wounds and 3.2 % for harvest sites . Sixty-one percent of all surgical site infections were recorded after discharge . For sternal surgical site infections after coronary artery bypass graft procedures , the significant risk factors were rethoracotomy , diabetes , preoperative length of stay , and obesity ; for harvest-site infections , the most relevant risk factor was a long time on extracorporeal circulation . Adjusted surgical site infection rates regarding coronary artery bypass graft procedures varied between hospitals from 0.0 % to 9.7 % . CONCLUSIONS Large differences were found in surgical site infection rates between Dutch hospitals , which indicate room for improvement . The follow-up of patients after hospital discharge reduces underestimation of surgical site infection rates BACKGROUND Elevated expectations before orthopaedic procedures appear to correlate with inferior preoperative subjective measures . The purpose of this study was to evaluate preoperative patient expectations before  arthroscopic shoulder surgery  and to correlate them with preoperative subjective measures and patients ' reasons for seeking treatment . METHODS We prospect ively collected and retrospectively analyzed data from patients before elective arthroscopic shoulder surgery for a wide range of pathologic processes . Preoperative subjective data included QuickDASH scores , pain and functional components of the American Shoulder and Elbow Surgeons ( ASES ) score , and mental and physical components of the SF-12 score . Expectations data were collected and grouped on the basis of the reasons for seeking of medical treatment and ranked according to their relative importance . RESULTS The study included 313 shoulders . There were 205 men and 108 women with a mean age at surgery of 48.7 years ( range , 18 - 78 years ) . Overall , the most important expectations were for the " shoulder to be back to the way it was before the problem started " and to continue participation in sporting activities . Patients who presented with the " shoulder coming out " had fewer important expectations than did those who presented for other reasons . Those patients who indicated a desire to continue participation in sports had significantly less pain ( improved ASES pain scores ) compared with the rest of the population . CONCLUSIONS Although return to sport was the most important expectation overall , the importance of other expectations varied by patients ' reasons for seeking treatment . The current question naire may have limited use in patients with shoulder instability . LEVEL OF EVIDENCE Level III , cross-sectional design , epidemiology Background A concern regarding  reverse shoulder arthroplasty ( RSA )  is the possibly higher complication rate compared with conventional unconstrained shoulder arthroplasty . Questions / purpose sWe determined ( 1 ) the rate of instability and infection ; ( 2 ) whether diagnosis influenced instability and infection rates ; and ( 3 ) whether these complications affect ASES , Constant , and WOOS scores after RSA . Methods A prospect i ve data base , clinical charts , and radiographs of 284 patients who had undergone primary ( n = 212 patients ) or revision ( n = 72 patients ) RSA  were review ed to identify patients whose postoperative course was complicated by instability or infection . Results The rate of instability was similar in patients with primary ( eleven of 212 [ 5 % ) ] and revision ( six of 72 [ 8 % ] ) reverse arthroplasty . The rate of infection was higher in the revision ( five of 72 [ 7 % ] ) than in the primary ( three of 212 [ 1 % ] ) group . Patients with an irreparable subscapularis tendon had a higher rate of instability ( 14 of 123 [ 12 % ] ) compared with patients with a repairable subscapularis tendon ( one of 161 [ less than 1 % ] ) . The fracture sequelae group had the highest rate of instability ( seven of 25 [ 28 % ] ) among diagnoses within the primary group . The rates of infection were similar between the diagnoses within the primary group . The improvements in the ASES score , the Constant score , and the WOOS score from preoperatively to postoperatively were better in the no instability/infection group as compared with the instability/infection group . Conclusions This information confirms the available literature allowing surgeons to give patients realistic expectations regarding the infection and instability rates after RSA.Level of Evidence Level III , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Background Wound seroma is one of the most frequent complications of mastectomy , but an effective strategy Tor its prevention has not yet been established . The purpose of this study was to determine the effectiveness of delayed shoulder exercise on the prevention of wound seroma after partial or total mastectomy with axillary dissection for the treatment of cancer . Methods This study prospect ively r and omized two exercise schemes after mastectomy with axillary lymph node dissection . The  immediate exercise group ( n=58 ) started shoulder exercise on the first postoperative day . In the  delayed exercise group ( n=58 ) the movement of the upper limb was limited to usual daily activities during the first postoperative week . Results Preoperative levels of shoulder function were regained within one month when shoulder exercise was delayed for one week after operation . Significant decrease of drainage volume and lower incidence of seroma formation were seen in the delayed exercise group . Conclusion These observations suggest that seven days of unrestricted movement and avoiding active exercise of the shoulder joint , is the optimal routine reduce seroma formation after mastectomy HYPOTHESIS Deep infection after shoulder surgery is a rare but devastating problem . This study tested the hypothesis that the home application of a 2 % chlorhexidine gluconate cloth before shoulder surgery would be more efficacious than a st and ard shower of soap and water at decreasing the preoperative cutaneous levels of pathogenic bacteria on the shoulder . MATERIAL S AND METHODS This r and omized , prospect i ve study evaluated 100 consecutive patients undergoing shoulder surgery . Patients were r and omly assigned to use 2 % chlorhexidine gluconate-impregnated cloths ( treatment group ) or to shower with soap and water before surgery ( control group ) . Cutaneous cultures were taken from the patients ' shoulders in the preoperative holding area . Patients were monitored for 2 months postoperatively for clinical signs of infection . RESULTS In the treatment group vs the control group , the overall positive culture rate was 66 % vs 94 % ( P = .0008 ) , and the positive culture rate for coagulase-negative Staphylococcus was 30 % vs 70 % ( P = .0001 ) . The positive culture rate for Propionibacterium acnes was 46 % in the treatment group vs 58 % in the control group ( P = .32 ) . No infections occurred in any patients at a minimum of 2-months after surgery . DISCUSSION The use of the 2 % chlorhexidine cloth was effective at decreasing overall bacterial culture rates before shoulder surgery and was particularly effective at decreasing the quantity of coagulase-negative Staphylococcus , a known causative agent of postoperative shoulder infections . CONCLUSION Use of chlorhexidine impregnated cloths prior to shoulder surgery may be a useful adjunct to presently used infection prevention strategies BACKGROUND Although diabetes has been associated with increased perioperative morbidity and mortality after hip and knee arthroplasty , its impact on early postoperative outcomes after shoulder replacement remains relatively unexplored . The purpose of the study was to determine the association of diabetes with in-hospital death , complications , length of stay , non-homebound disposition , and cost in patients undergoing shoulder arthroplasty . METHODS By use of the Nationwide Inpatient Sample data base for the year 2011 , an estimated 66,485 patients having undergone shoulder arthroplasty were identified and separated into groups with ( 21 % ) and without ( 79 % ) diabetes mellitus . Comparisons of specific outcome measures between diabetic and nondiabetic cohorts were performed by bivariate and multivariable analyses with logistic regression modeling . RESULTS Diabetes mellitus was independently associated with in-hospital death , a number of perioperative complications , prolonged hospital stay , and increased non-homebound disposition after shoulder arthroplasty . The presence of diabetes was not associated with increased hospital cost . CONCLUSION Patients with preexisting diabetes are at higher risk for perioperative morbidity and mortality after shoulder arthroplasty . Future prospect i ve research should explore in more detail the relationship between diabetes and shoulder arthroplasty outcomes Background Psychological symptoms are highly prevalent in patients with shoulder complaints . Psychological symptoms in patients with shoulder complaints might play a role in the aetiology , perceived disability and pain and clinical outcome of treatment . The aim of this study was to assess whether preoperative symptoms of distress , depression , anxiety and somatisation were associated with a change in function after shoulder surgery and postoperative patient perceived improvement of pain and function . In addition , the change of psychological symptoms after shoulder surgery was analyzed and the influence of postoperative symptoms of psychological disorders after surgery on the change in function after shoulder surgery and perceived postoperative improvement of pain and function . Methods and Findings A prospect i ve longitudinal cohort study was performed in a general teaching hospital . 315 consecutive patients planned for elective shoulder surgery were included . Outcome measures included change of Disabilities of the Arm , Shoulder and H and ( DASH ) score and anchor questions about improvement in pain and function after surgery . Psychological symptoms were identified before and 12 months after surgery with the vali date d Four-Dimensional Symptom Question naire ( 4DSQ ) . Psychological symptoms were encountered in all the various shoulder diagnoses . Preoperative symptoms of psychological disorders persisted after surgery in 56 % of patients , 10 % of patients with no symptoms of psychological disorders before surgery developed new psychological symptoms . Preoperative symptoms of psychological disorders were not associated with the change of DASH score and perceived improvement of pain and function after shoulder surgery . Patients with symptoms of psychological disorders after surgery were less likely to improve on the DASH score . Postoperative symptoms of distress and depression were associated with worse perceived improvement of pain . Postoperative symptoms of distress , depression and somatisation were associated with worse perceived improvement of function . Conclusions Preoperative symptoms of distress , depression , anxiety and somatisation were not associated with worse clinical outcome 12 months after shoulder surgery . Symptoms of psychological disorders before shoulder surgery persisted in 56 % of patients after surgery . Postoperative symptoms of psychological disorders 12 months after shoulder surgery were strongly associated with worse clinical outcome BACKGROUND It is well known that surgical site infections ( SSIs ) contribute significantly to the cost of nosocomial infections . Although many guidelines and recommendations exist , research has demonstrated that practice s for preventing SSIs in operating theaters ( OT ) vary . AIM The purpose of this study was to describe the current infection control practice s for SSIs , formerly called surgical wound infections , in OTs , and compare these findings with evidence -based practice guidelines . METHODS In order to accomplish the purpose , a prospect i ve , cross-sectional descriptive survey was conducted . Data were collected by interviewing the charge nurses in 24 OTs of 11 hospitals in the city of Izmir , Turkey . The results were tabulated and compared with an evidence -based guideline . RESULTS Data showed that there is a lack of adherence to the guideline . The most compliant areas to the guideline were h and /forearm antisepsis and the use of surgical gowns and drapes . IMPLICATION S It is suggested that increased compliance to infection control guidelines for surgical infections in OTs would facilitate providing best practice and evidence -based care . There is a need for further research to determine why there is a difference between what is practice d and what guidelines indicate should be practice To evaluate the effectiveness of  closed wound drainage  in shoulder surgery , 300 patients were enrolled in a prospect i ve r and omized study . Three operations were studied : rotator cuff repair , anterior reconstruction for instability , and arthroplasty . One hundred patients were included in each group . All patients were evaluated for wound hematoma , infection , variation in postoperative rehabilitation caused by wound problems , and length of hospital stay . No statistical difference was found between the patients whose wounds were drained and those whose wounds were not drained . This finding existed within each category . Our data do not support the routine use of  closed wound drainage  in elective shoulder surgery AIM An association has been proposed between perioperative administration of 80 % oxygen and a lower incidence of wound infection after colorectal surgery . The present study was conducted to assess this hypothesis . METHODS Thirty-eight patients ( ASA classification 1 and 2 ) undergoing elective colorectal cancer surgery were allocated at r and om to 2 groups . Group 1 consisted of 19 patients who received an admixture of 80 % oxygen and 20 % nitrogen during anesthesia through an orotracheal tube and during the 2 first hours in the recovery room through a tight facemask with reservoir . Group 2 consisted of 19 patients who received an admixture of 70 % nitrous oxide and 30 % oxygen during anesthesia , followed by administration of 30 % oxygen delivered by a blender through a tight facemask with reservoir in the same manner than group 1 , during the first 2 hours in the recovery room . Wound infection was evaluated daily during hospital stay and after 7 days , 2 weeks , and 1 month . RESULTS The incidence of wound infection was 12.5 % in group 1 and 17.6 % in group 2 ( p=0.53 ) . CONCLUSIONS The results of this study showed no reduction in the incidence of wound infection following elective colorectal surgery in patients receiving 80 % oxygen during the perioperative period Systematic review s and meta-analyses published in recent years have allowed drafting of evidence -based guidelines for antibiotic prophylaxis in orthopedic and trauma surgery . It is important to recognize the limitations of the recommendations derived from the available body of evidence . Since some of the most relevant r and omized controlled clinical trials were performed more than 20 years ago , it is sometimes difficult to apply the data to today 's clinical practice . In establishing consensus guidelines , it could prove difficult to identify areas for improvement through further research and better compliance . Although recommendations for optimized treatment of orthopedic implant infections are not currently based on first-class evidence , there are very promising new concepts emerging in this field , and we are awaiting more data and decisive conclusions from larger clinical trials A prospect i ve study was carried out to determine the incidence of  wound infection following surgery for inguinal hernia repair in a day surgery unit . The study incorporated surveillance for 1 month postoperatively . All patients were contacted by telephone , and reports of possible wound infection investigated via their General Practitioners . Ninety-seven patients were included in the study and the infection rate was 4 %
Conclusion There are many risk factors associated with developing an infection after elective shoulder surgery .
The findings of this systematic review are clinical ly relevant as it has been shown that infection after shoulder surgery results in poor patient-reported outcomes and pose a significant financial burden .
Purpose Infection is a concern after all orthopedic procedures , including shoulder surgery .
This systematic review of literature aim ed to determine risk factors for infection as well as the availability and effectiveness of measures utilized to prevent infection after elective shoulder surgery .