American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

V39N4: Surgical Infection

Alexander JW, Solomkin JS, Edwards MJ. Updated recommendations for control of surgical site infections. Ann Surg. 2011;253(6):1082-1093.

This report provides clear, evidence-based advice on the use of interventions to reduce the risk of surgical site infection.

Cima R, Dankbar E, Lovely J, et al. Colorectal surgery surgical site infection reduction program: a national surgical quality improvement program-driven multidisciplinary single-institution experience. J Am Coll Surg. 2013;216(1):23-33.

Cima and coauthors describe a multidisciplinary effort to reduce surgical site infections. The effort emphasizes the principles of LEAN and Six Sigma approaches that have been successful in industry.

Croce MA, Brasel KJ, Coimbra R, et al. National Trauma Institute prospective evaluation of the ventilator bundle in trauma patients: does it really work? J Trauma Acute Care Surg. 2013;74(2):354-360; discussion 360-362.

This article reports data from a multi-institutional trial of the “ventilator bundle” approach to reducing the risk of ventilator-associated pneumonia. The bundle did not have significant impact in the patients studied. The patients were mainly trauma patients. The authors note that “horizontal” approaches to infections in critically ill patients, such as universal skin cleaning and staff hand hygiene, are likely to be effective.

de Mestral C, Rotstein OD, Laupacis A, et al. A population-based analysis of the clinical course of 10,304 patients with acute cholecystitis, discharged without cholecystectomy. J Trauma Acute Care Surg. 2013;74(1):26-30; discussion 30-31.

The authors note that young, good-risk patients were most likely to experience recurrent symptoms of cholecystitis and they suggest that this patient group would most likely benefit from early cholecystectomy.

Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368(24):2255-2265.

The data reported document the effectiveness of universal MRSA decolonization as a means of reducing bloodstream infections in critically ill patients.

Ingraham AM, Cohen ME, Bilimoria KY, et al. Association of surgical care improvement project infection-related process measure compliance with risk-adjusted outcomes: implications for quality measurement. J Am Coll Surg. 2010;211(6):705-714.

In this report, only administration of the appropriate prophylactic antimicrobial drug was associated with reduced risk of surgical site infection.

Lancerotto L, Tocco I, Salmaso R, et al. Necrotizing fasciitis: classification, diagnosis, and management. J Trauma Acute Care Surg. 2012;72(3):560-566.

This report is a useful review of necrotizing soft tissue infections.

Mohseni S, Talving P, Kobayashi L, et al. Closed-suction drain placement at laparotomy in isolated solid organ injury is not associated with decreased risk of deep surgical site infection. Am Surg. 2012;78(10):1187-1191.

The data in this article confirm the observations of experienced trauma surgeons that preemptive drain placement is not associated with a reduction in complications of solid organ injury treated operatively.

Neal MD, Alverdy JC, Hall DE, et al. Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease. Ann Surg. 2011;254(3):423-427; discussion 427-429.

This article describes a novel new approach to the operative management of fulminant C. Difficile colitis.

Oberkofler CE, Rickenbacher A, Raptis DA, et al. A multicenter randomized clinical trial of primary anastomosis or Hartmann's procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg. 2012;256(5):819-826; discussion 826-827.

The data reported suggest that primary anastomosis with diverting ileostomy is a safe and effective procedure. Unfortunately, problems of patient enrollment limit the strength of the evidence reported.

Rosen MJ, Krpata DM, Ermlich B, et al. A 5-year clinical experience with single-staged repairs of infected and contaminated abdominal wall defects utilizing biologic mesh. Ann Surg. 2013 Jun;257(6):991-996.

This article provides a single-center experience with the management of abdominal wall defects using biologic mesh. Closure of the midline with a components separation technique combined with extraperitoneal, retrorectus reinforcement with biologic mesh was useful in potentially contaminated wounds. Although hernia recurrence was common over the long term, reoperation for recurrence was not common.

Senekjian L, Nirula R. Tailoring the operative approach for appendicitis to the patient: a prediction model from national surgical quality improvement program data. J Am Coll Surg. 2013;216(1):34-40.

This report documents the effectiveness of laparoscopic appendectomy.