Is chemical antithrombotic prophylaxis effective in elective thoracolumbar spine surgery? Results of a systematic review What Are the Instability and Infection Rates After Reverse Shoulder Arthroplasty? Propionibacterium acnes infection in shoulder arthroscopy patients with postoperative pain. Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. Concurrent colorectal malignancy and abdominal aortic aneurysm: a multicentre experience and review of the literature. The Incidence of Propionibacterium acnes in Open Shoulder Surgery: A Controlled Diagnostic Study. Risk Factors for Infection After Spinal Surgery Identification of risk factors by systematic review and development of risk-adjusted models for surgical site infection. Efficacy of surgical preparation solutions in shoulder surgery. Efficacy of preoperative home use of 2% chlorhexidine gluconate cloth before shoulder surgery. Wound complications after hand assisted laparoscopic surgery. The Incidence of Propionibacterium acnes in Shoulder Arthroscopy. Closed wound drainage in shoulder surgery. An Increase in Compliance With the Surgical Care Improvement Project Measures Does Not Prevent Surgical Site Infection in Colorectal Surgery The effect of axillary hair on surgical antisepsis around the shoulder. The Prevalence of Glenohumeral Osteoarthrosis in Unstable Shoulders * The incidence and risk factors for surgical site infection after clean spinal operations: A prospective cohort study and review of the literature Mechanical Bowel Preparation for Children Undergoing Elective Colorectal Surgery Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Card Risk factors for surgical site infection in elective routine degenerative lumbar surgeries. Postoperative Surgical Site Infections in Patients Undergoing Spinal Tumor Surgery: Incidence and Risk Factors Preoperative prealbumin level as a risk factor for surgical site infection following elective spine surgery Antibiotic Prophylaxis in Hernia Repair and Breast Surgery: A Prospective Randomized Study Comparing Piperacillin/Tazobactam Versus Placebo
Study design : Systematic review Study rationale and context : There is controversy regarding the efficacy and safety of chemical prophylaxis to prevent deep venous thrombosis ( DVT ) and pulmonary embolism ( PE ) in elective spinal procedures .Commonly performed elective spine surgeries done through a posterior approach have a very low associated risk of DVT/PE . The lack of consensus is due in part to a limited amount of quality evidence based literature dealing with this issue . Objective : To compare chemical prophylaxis with no chemical prophylaxis in preventing venous thromboembolism in elective thoracolumbar spine surgery . Methods : We undertook a systematic review of the literature to assess the efficacy and safety of chemical prophylaxis in preventing venous thromboembolism in elective thoracolumbar spine surgery . Pubmed , EMBASE , Cochrane , National Guideline Clearinghouse Data bases as well as bibliographies of key articles were search ed . Articles were review ed by two independently working review ers . Inclusion and exclusion criteria were set and each article was subject to a predefined quality rating scheme . Results : We identified only two articles meeting our inclusion criteria . Neither study demonstrated a significant difference between chemical prophylaxis versus no prophylaxis in preventing thromboembolic events . There was an increased incidence of perioperative bleeding with low dose Coumadin in one of the studies . Conclusion : The incidence of DVT and PE in commonly performed elective posterior spinal procedures is very low . While there is a limited amount of r and omized literature looking at this issue , the current literature does not support the routine use of chemical prophylaxis for low risk patients undergoing these procedures 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 Recent studies have identified Propionibacterium acnes as the causal organism in an increasing number of postoperative shoulder infections . Most reports have found a high rate of P acnes infection after open surgery , particularly shoulder arthroplasty . However , there are limited data regarding P acnes infections after shoulder arthroscopy . MATERIAL S AND METHODS We prospect ively collected data on all shoulder arthroscopies performed by the senior author from January 1 , 2009 , until April 1 , 2013 . Cultures were taken in all revision shoulder arthroscopy  cases performed for pain , stiffness , or weakness . In addition , 2 cultures were taken from each of a cohort of 32 primary shoulder arthroscopy cases without concern for infection to determine the false-positive rate . RESULTS A total of 1,591 shoulder arthroscopies were performed during this period , 68 ( 4.3 % ) of which were revision procedures performed for pain , stiffness , or weakness . A total of 20 revision arthroscopies ( 29.4 % ) had positive culture findings , and 16 ( 23.5 % ) were positive for P acnes . In the control group , 1 patient ( 3.2 % ) had P acnes growth . CONCLUSIONS The rate of P acnes infection in patients undergoing revision shoulder arthroscopy  is higher than previously published and should be considered in cases characterized by refractory postoperative pain and stiffness BACKGROUND Anatomic total shoulder arthroplasty ( TSA ) and reverse total shoulder arthroplasty ( RTSA ) are increasingly common procedures employed to treat arthritic conditions . Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff , concerns about RTSA persist because of variable complication rates and outcomes . METHODS This is a prospect i ve , case-control study comparing outcomes and complications after TSA and RTSA . The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy . Average clinical follow-up was more than 2 years in both groups . Major complications included infection , periprosthetic fracture , instability , glenoid loosening , and need for revision surgery . Patient outcome measures included the American Shoulder and Elbow Surgeons score , pain visual analog scale score , and goniometer-measured range of motion . Plain radiographs were review ed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA . RESULTS At 2 years , there were no differences in rate of major complications  ( TSA , 15 % ; RTSA , 13 % ; P = .808 ) or revision surgeries  ( TSA , 11 % ; RTSA , 9 % ) . Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups . TSA patients had greater external rotation than RTSA patients did ( 53 ° vs 38 ° ; P = .001 ) . Otherwise , forward flexion , abduction , and internal rotation were comparable in range of motion . CONCLUSIONS TSA and RTSA  have similar complication rates , need for revision , patient-reported outcomes , and range of motion at 2 years of follow-up . The use of side-by-side cohorts in this study allows st and ardized comparison between these 2 shoulder arthroplasty procedures OBJECTIVES There is lack of consensus regarding concurrent vs. staged approaches , and the prioritisation of staged procedures in cases presenting with colorectal carcinoma ( CRC ) and abdominal aortic aneurysm ( AAA ) synchronously . We aim to present our experience , review the literature on this therapeutic dilemma and examine the role of  endovascular aortic repair ( EVAR ) . DESIGN , MATERIAL S AND METHODS An observational study of the experience of two centres and a systematic review of the published literature . RESULTS Twenty-four patients were identified from the prospect i ve data bases of two tertiary referral centres between 2001 and 2006 . Intervention for both malignancy and aneurysm was performed in 13 patients . In 10 patients , cancer resection was performed initially and was followed by open aneurysm repair ( n=3 ) or EVAR ( n=7 ) . Two patients ( AAA diameters : 7.0 and 8.0 cm ) underwent EVAR prior to colonic resection . One patient was selected for synchronous surgery . There were no interval AAA ruptures , graft infection or postoperative mortalities . Literature review identified 269 such cases ; of these 101 were treated by combined surgery . In staged surgery , there were nine interval aneurysmal ruptures and one aortic graft infection . CONCLUSIONS In our experience , staged management can be undertaken , without interval aneurysmal rupture .  EVAR has an evolving role in preventing delay in CRC management , in high-risk patients , and during combined intervention BACKGROUND Propionibacterium acnes has arisen as the most common microorganism identified at the time of revision shoulder arthroplasty . There is limited evidence to suggest how frequently false-positive cultures occur . The purpose of this prospect i ve controlled study was to evaluate culture growth from specimens obtained during open shoulder surgery . METHODS Patients undergoing an open deltopectoral approach to the shoulder were prospect ively enrolled . Patients with a history of shoulder surgery or any concern for active or previous shoulder infection were excluded . Three pericapsular soft-tissue sample s were taken from the shoulder for bacterial culture and were incubated for fourteen days . A sterile sponge was also analyzed in parallel with the tissue cultures . In addition , similar cultures were obtained from patients who had undergone previous shoulder surgery . RESULTS Overall , 20.5 % of surgeries ( twenty-four of 117 ) yielded at least one specimen removed for culture that was positive for bacterial growth , and 13.0 % of sterile control specimens ( seven of fifty-four ) had positive culture growth ( p = 0.234 ) . P. acnes represented 83.0 % of all positive cultures ( thirty-nine of forty-seven ) at a median incubation time of fourteen days . Among the subjects who had not undergone previous surgery , 17.1 % ( fourteen of eighty-two ) had at least one positive P. acnes culture . Male sex was univariably associated with a greater likelihood of bacterial growth ( p < 0.01 ) , and patients who had not undergone previous surgery and had received two or more preoperative corticosteroid injections had a higher likelihood of bacterial growth ( p = 0.047 ) . CONCLUSIONS The clinical importance of positive P. acnes cultures from specimens obtained from open shoulder surgery remains uncertain . Male sex and preoperative corticosteroid injections were associated with a higher likelihood of bacterial growth on culture and are risk factors that merit further investigation . Previously reported incidences of positive P. acnes culture results from specimens from primary and revision shoulder arthroplasty may be overestimated because of a substantial level of culture contamination . CLINICAL RELEVANCE P. acnes is isolated via culture at a substantial rate from shoulders undergoing a deltopectoral approach . The clinical importance of culture growth by this low-virulence organism still remains uncertain . Further study is necessary to more specifically characterize culture growth by P. acnes as an infection , commensal presence , or contaminant 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  Surgical site infections ( SSIs ) are complications of surgery that cause significant postoperative morbidity . SSI has been proposed as a potential indicator of the quality of care in the context of clinical governance and monitoring of the performance of NHS organisations against targets . OBJECTIVES We aim ed to address a number of objectives . Firstly , identify risk factors for SSI , criteria for stratifying surgical procedures and evidence about the importance of postdischarge surveillance ( PDS ) . Secondly , test the importance of risk factors for SSI in surveillance data bases and investigate interactions between risk factors . Thirdly , investigate and vali date different definitions of SSI . Lastly , develop models for making risk-adjusted comparisons between hospitals . DATA SOURCES A single hospital surveillance data base was used to address objectives 2 and 3 and the UK Surgical Site Infection Surveillance Service data base to address objective 4 . STUDY DESIGN There were four elements to the research : ( 1 ) systematic review s of risk factors for SSI ( two review ers assessed titles and abstract s of studies identified by the search strategy and the quality of studies was assessed using the Newcastle Ottawa Scale ) ; ( 2 ) assessment of agreement between four SSI definitions ; ( 3 ) validation of definitions of SSI , quantifying their ability to predict clinical outcomes ; and ( 4 ) development of operation-specific risk models for SSI , with hospitals fitted as r and om effects . RESULTS Review s of SSI risk factors other than established SSI risk indices identified other risk ; some were operation specific , but others applied to multiple operations . The factor most commonly identified was duration of preoperative hospital stay . The review of PDS for SSI confirmed the need for PDS if SSIs are to be compared meaningfully over time within an institution . There was wide variation in SSI rate ( SSI% ) using different definitions . Over twice as many wounds were classified as infected by one definition only as were classified as infected by both . Different SSI definitions also classified different wounds as being infected . The two most established SSI definitions had broadly similar ability to predict the chosen clinical outcomes . This finding is paradoxical given the poor agreement between definitions . Elements of each definition not common to both may be important in predicting clinical outcomes or outcomes may depend on only a subset of elements which are common to both . Risk factors fitted in multivariable models and their effects , including age and gender , varied by surgical procedure . Operative duration was an important risk factor for all operations , except for hip replacement . Wound class was included least often because some wound classes were not applicable to all operations or were combined because of small numbers . The American Association of Anesthesiologists class was a consistent risk factor for most operations . CONCLUSIONS The research literature does not allow surgery-specific or generic risk factors to be defined . SSI definitions varied between surveillance programmes and potentially between hospitals . Different definitions do not have good agreement , but the definitions have similar ability to predict outcomes influenced by SSI . Associations between components of the National Nosocomial Infections Surveillance risk index and odds of SSI varied for different surgical procedures . There was no evidence for effect modification by hospital . Estimates of SSI% should be disseminated within institutions to inform infection control . Estimates of SSI% across institutions or countries should be interpreted cautiously and should not be assumed to reflect quality of medical care . Future research should focus on developing an SSI definition that has satisfactory psychometric properties , that can be applied in everyday clinical setting s , includes PDS and is formulated to detect SSIs that are important to patients or health services . FUNDING The National Institute for Health Research Technology Assessment programme BACKGROUND Deep infection following shoulder surgery is a rare but devastating problem . The use of an effective skin-preparation solution may be an important step in preventing infection . The purpose s of the present study were to examine the native bacteria around the shoulder and to determine the efficacy of three different surgical skin-preparation solutions on the eradication of bacteria from the shoulder . METHODS A prospect i ve study was undertaken to evaluate 150 consecutive patients undergoing shoulder surgery at one institution . Each shoulder was prepared with one of three r and omly selected solutions : ChloraPrep ( 2 % chlorhexidine gluconate and 70 % isopropyl alcohol ) , DuraPrep ( 0.7 % iodophor and 74 % isopropyl alcohol ) , or povidone-iodine scrub and paint ( 0.75 % iodine scrub and 1.0 % iodine paint ) . Aerobic and anaerobic cultures were obtained prior to skin preparation for the first twenty patients , to determine the native bacteria around the shoulder , and following skin preparation for all patients . RESULTS Coagulase-negative Staphylococcus and Propionibacterium acnes were the most commonly isolated organisms prior to skin preparation . The overall rate of positive cultures was 31 % in the povidone-iodine group , 19 % in the DuraPrep group , and 7 % in the ChloraPrep group . The positive culture rate for the ChloraPrep group was lower than that for the povidone-iodine group ( p < 0.0001 ) and the DuraPrep group ( p = 0.01 ) . ChloraPrep and DuraPrep were more effective than povidone-iodine in eliminating coagulase-negative Staphylococcus from the shoulder region ( p < 0.001 for both ) . No significant difference was detected among the agents in their ability to eliminate Propionibacterium acnes from the shoulder region . No infections occurred in any of the patients treated in this study at a minimum of ten months of follow-up . CONCLUSIONS ChloraPrep is more effective than DuraPrep and povidone-iodine at eliminating overall bacteria from the shoulder region . Both ChloraPrep and DuraPrep are more effective than povidone-iodine at eliminating coagulase-negative Staphylococcus from the shoulder 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 PURPOSE  H and assisted laparoscopic surgery ( HALS )  provides benefits similar to st and ard laparoscopy but generally requires a larger incision . We assessed the nature of and risk factors for incisional complications after HALS . MATERIAL S AND METHODS All patients who underwent HALS at our institution from February 1997 through December 2003 were included in a prospect i ve and retrospective review to assess postoperative wound complications . Literature regarding wound complications associated with open surgery and st and ard laparoscopy was review ed . RESULTS A total of 424 consecutive procedures performed on 422 patients were evaluated . Postoperative HALS incision site complications included 29 infections ( 6.8 % ) , 15 hernias ( 3.5 % ) and 2 dehiscences ( 0.5 % ) . Multivariate logistic regression models revealed that HALS incision site hernias were associated with current or past tobacco smoking ( 6.0 % , p = 0.04 ) , with a trend toward significance for diabetes mellitus ( 14 % , p = 0.07 ) , male gender ( 5.3 % , p = 0.08 ) and renal failure ( 16 % , p = 0.08 ) . HALS incision site infections were associated with omission of perioperative antibiotics ( 13 % , p = 0.007 ) , obesity ( 12 % , p = 0.03 ) and increased operative time ( 252 vs 222 minutes in patients with and without infection , respectively , p = 0.001 ) . CONCLUSIONS Our findings suggest that wound infections and hernias occur less frequently with HALS than with open surgery , but more often than with st and ard laparoscopy . Certain patient comorbidities ( eg obesity ) , modifiable risk factors ( eg smoking status ) and procedural variables ( eg omission of perioperative antibiotics or length of procedure ) may adversely influence HALS wound complications . This information can be used to decide between HALS and st and ard laparoscopic approaches in particular patients PURPOSE To document the skin colonization and deep tissue inoculation rates associated with  arthroscopic shoulder surgery  and how these rates differ with procedural and demographic factors . METHODS We prospect ively recruited outpatient shoulder arthroscopy patients who agreed to participate and met the inclusion criteria from February 2013 to May 2014 . All patients received routine antibiotic prophylaxis intravenously . Initial cultures were obtained before the skin preparation by swabbing the skin at the 3 st and ard portal sites : posterior , anterosuperior , and anterolateral . The skin preparation used 4 % chlorhexidine scrub and 2 % chlorhexidine gluconate/70 % isopropyl alcohol paint applied to the entire shoulder . After completion of the arthroscopic procedure , a second culture was obtained through a cannula at the surgical site . All cultures were plated for 21 days using Brucella medium . RESULTS We enrolled 51 patients over a 15-month period . Cultures showed a 72.5 % Propionibacterium acnes superficial colonization rate : 46.1 % of female and 81.6 % of male patients ( P = .027 ) . We identified a deep culture-positive inoculation rate of 19.6 % , all with positive P acnes skin colonization . No correlation could be made concerning diagnosis , procedure , suture anchor use , age , or sex . CONCLUSIONS The rate of skin colonization with P acnes is high at arthroscopic portals , especially in men . Despite st and ard skin preparation and prophylactic antibiotics , the rate of deep tissue inoculation with P acnes in shoulder arthroscopy is much higher than the rate of infection reported in the literature . CLINICAL RELEVANCE Shoulder arthroscopy introduces a significant amount of P acnes into the deep tissues 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 PURPOSE : The primary goal of the Surgical Care Improvement Project is to improve quality of care by implementing evidence -based health care practice s that prevent surgical complications . This study was design ed to test the hypothesis that an increase in compliance with quality process measures decreases the rate of surgical site infections in patients undergoing colorectal surgeries . METHODS : A multidisciplinary task force implemented and monitored compliance with individual quality measures in patients undergoing elective colorectal resections at a tertiary institution . Individual compliance rates and infections were collected prospect ively and review ed monthly . For data analysis , patients were assigned to 2 consecutive 14-month periods : period A ( April 1 , 2006 to May 31 , 2007 ) and period B ( June 1 , 2007 to July 31 , 2008 ) . Comparisons between periods were performed to determine the association of compliance with process measures and outcomes in infections . RESULTS : A total of 491 consecutive patients were treated during the study periods ( period A : n = 238 ; period B : n = 253 ) . There were no statistically significant differences in patient characteristics , diagnoses , or surgical procedures between periods . Compliance with all process measures significantly increased within periods except for perioperative glucose control . Global compliance ( compliance with all measures per patient ) significantly improved from period A to B ( 40%–68 % , respectively ; P < .001 ) . In total , 99 patients ( 19 % ) developed surgical site infections ( period A , 18.9 % ; period B , 19.4 % ) . CONCLUSION : An increase in compliance with the Surgical Care Improvement Project aim ed to prevent surgical site infections does not translate into a significant reduction of surgical site infections in patients undergoing colorectal resections BACKGROUND Infection after shoulder surgery can have devastating consequences . Recent literature has implicated Propionibacterium acnes as a causative agent for postoperative shoulder infections . Axillary hair removal has been suggested as a method for infection prevention , although data quantifying its effect on the bacterial load around the shoulder are lacking . METHODS We clipped  one r and omly selected axilla in 85 healthy male volunteers with commercially available surgical clippers . Aerobic and anaerobic culture specimens were taken from the clipped and unclipped axillae . Each shoulder was then prepared with 2 % chlorhexidine gluconate and 70 % isopropyl alcohol . Repeated culture specimens were then taken from both axillae . Cultures were held for 14 days and recorded with a semiquantitative system ( 0 - 4 points ) . Results were compared by the Wilcoxon signed rank test . RESULTS There was no difference in the burden of P. acnes between the clipped and unclipped axillae before or after surgical preparation ( P = .109 , P = .344 , respectively ) . There was a significantly greater bacterial burden in the clipped shoulder compared with the unclipped shoulder before preparation ( P < .001 ) but not after preparation ( P = .285 ) . There was a significant reduction in total bacterial load and P. acnes load for both axillae after surgical preparation ( P < .001 for all ) . CONCLUSIONS Removal of axillary hair has no effect on the burden of P. acnes in the axilla . Clipped axillae had a higher total bacterial burden . A 2 % chlorhexidine gluconate surgical preparation is effective at removal of all bacteria and specifically P. acnes from the axilla Background Glenohumeral osteoarthritis has been a well-described complication of open procedures to correct shoulder instability . What remains unknown is whether chondral injuries sustained during instability episodes contribute to osteoarthritis or whether the cause is primarily the stabilization procedure itself . Purpose To determine the prevalence of osteoarthrosis in a large data base of patients with acute and chronic shoulder instability before primary stabilization surgery . Study Design Retrospective review of prospect ively collected data . Methods Surgical and demographic data were collected on 422 patients with a diagnosis of shoulder instability who underwent arthroscopic examination and shoulder stabilization .  Results There was a significant association between the grade of osteoarthrosis and the presence of osteoarthritis ( grade III or IV chondral damage ) with time from injury to surgery . Patients with osteoarthritis  were significantly older than those without ( 34.9 versus 29.6 years ) . Multivariate analysis identified older age and time from injury to surgery as independent predictors of osteoarthritis . We found no association between direction of instability and the presence of osteoarthritis . Conclusion The overall prevalence of glenohumeral osteoarthrosis was low . Predictors of osteoarthritis included time from injury to surgery and age Background : Postoperative infection is one of the most common complications after spine surgeries . In our study , surgical site infection ( SSI ) is described as ; superficial ( i.e. , skin and subcutaneous tissues ) and deep ( i.e. , fascia and muscles ) infections occurring in the short term ( i.e. , 1-month ) after spine surgeries ( Centers for Disease Control and Prevention definition 81.00–81.08 ) . To detect the risk factors for the occurrence of such a complication , studies require a large number of patients , a high quality of data and adequate analysis . In this study , we prospect ively enrolled 987 patients undergoing spinal surgery over a 3 years period . Methods : From November 2010 to November 2013 , 987 patients had a variety of spinal operations that included ; disc herniation , spinal stenosis , spondylolisthesis , fracture-dislocations , spine and spinal cord tumors , and syringomyelia . Patients under the age of 10 , those with a recent history of infection and antibiotherapy , and patients with immunodeficiency disorders were excluded . Results : Of the 987 spine procedures performed , 27 ( 2.73 % ) developed postoperative infections . Multi-variant data analysis indicated that multiple factors correlated with an increased risk of SSI in descending order ; trauma , a past history of diabetes , smoking , being confined to bed , in the perioperative period , mean blood sugar levels above 120 mg/dl , longer lengths of incisions , and longer hospital stay . Conclusion : Considering the preventable nature of most of the factors contributing to SSI , it should be possible to reduce these complications Objectives : Adult literature supports the elimination of mechanical bowel preparation ( MBP ) for elective colorectal surgical procedures . Prospect i ve data for the pediatric population regarding the utility of MBP are lacking . The primary aim of this study was to compare infectious complications , specifically anastomotic leak , intraabdominal abscess , and wound infection in patients who received MBP  with those who did not . Methods : A r and omized pilot study comparing MBP with polyethylene glycol with no MBP was performed . Patients , 0 to 21 years old , undergoing elective colorectal surgery were eligible and r and omized within 4 age strata . Statistical analyses were performed using & khgr;2 or Fisher exact test for categorical data and t test or Wilcoxon 2- sample test for continuous data . Results : Forty-four patients were enrolled in the study from December 2010 to February 2013 , of which 24 ( 55 % ) received  MBP and 20 ( 45 % ) did not . Two patients ( 5 % ) had anastomotic leak , 4 ( 9 % ) had intraabdominal infection , and 7 ( 16 % ) had wound infections . The rate of anastomotic leak , intraabdominal abscess , and wound infection did not differ between the 2 groups . Conclusions : MBP for elective colorectal surgery in children does not affect the incidence of infectious complications . A larger multiinstitutional study is necessary to vali date the results of this single-institution pilot study BACKGROUND The purpose of this statement is to up date the recommendations by the American Heart Association ( AHA ) for the prevention of infective endocarditis that were last published in 1997 . METHODS AND RESULTS A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis , with liaison members representing the American Dental Association , the Infectious Diseases Society of America , and the American Academy of Pediatrics . The writing group review ed input from national and international experts on infective endocarditis . The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis , in vitro susceptibility data of the most common microorganisms that cause infective endocarditis , results of prophylactic studies in animal models of experimental endocarditis , and retrospective and prospect i ve studies of prevention of infective endocarditis . MEDLINE data base search es from 1950 to 2006 were done for English- language papers using the following search terms : endocarditis , infective endocarditis , prophylaxis , prevention , antibiotic , antimicrobial , pathogens , organisms , dental , gastrointestinal , genitourinary , streptococcus , enterococcus , staphylococcus , respiratory , dental surgery , pathogenesis , vaccine , immunization , and bacteremia . The reference lists of the identified papers were also search ed . We also search ed the AHA online library . The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used . The paper was subsequently review ed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee . CONCLUSIONS The major changes in the up date d recommendations include the following : ( 1 ) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 % effective . ( 2 ) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis . ( 3 ) For patients with these underlying cardiac conditions , prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa . ( 4 ) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis . ( 5 ) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure . These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations BACKGROUND CONTEXT Surgical site infection ( SSI ) is one of the most serious complications of spine surgery . Its predisposing factors , especially in routine surgeries , are less reported . However , a number of patient- and procedure-related risk factors could be avoided or at least determined preoperatively . Moreover , the patient-specific risk for SSI could be estimated before the elective surgery . PURPOSE The aim of the present study was to analyze the preoperatively determinable risk factors for SSI in patients who require elective routine surgery related to lumbar disc degeneration and to build a multivariable model for the individual risk prediction . STUDY DESIGN Analysis of prospect ively collected st and ardized clinical data and the validation of the results on an independent prospect i ve cohort were performed . PATIENT SAMPLE One thous and thirty ( N=1,030 ) patients were included in the study . All subjects underwent primary lumbar single- or two-level decompression , microdiscectomy , or instrumented fusion .  OUTCOME MEASURES Occurrence of an SSI defined according to the current Centers for Disease Control and Prevention guidelines that required surgical or nonsurgical therapy . METHODS The effect of preoperative patient characteristics , comorbidities , disease history , and invasiveness of the elective surgery on the risk of SSI was determined in uni- and multivariate logistic regression models in the test cohort ( N=723 ) . The performance of the final multivariable regression model was assessed by measuring its discriminative ability ( c-index ) in receiver operating characteristic analysis . Performance of the multivariable risk estimation model was tested on the validation ( N=307 ) cohort . RESULTS The prevalence of SSI was 3.5 % and 3.9 % in the test and in the validation cohorts , respectively . The final multivariable regression model predictive ( p=.003 ) for SSI contained the patient 's age , body mass index ( BMI ) , and the presence of 5 comorbidities , such as diabetes , ischemic heart disease , arrhythmia , chronic liver disease , and autoimmune disease as risk factors . The c-index of the model was 0.71 , showing good discriminative ability , and it was confirmed by the data of the independent validation cohort ( c=0.72 ) . CONCLUSIONS Predisposing factors for SSI were older age , higher BMI , and the presence of certain comorbidities in the present study . The cumulative number of risk factors significantly associated with the increasing risk for an SSI ( p<.0001 ) . Our model needs further validation but it may be used for individual risk assessment and reduction in the future Study Design . We conducted a retrospective , case control study on patients undergoing surgery for spinal tumors . Objective . Our aim was to determine the incidence and to identify risk factors for surgical site infections ( SSIs ) in patients undergoing surgery for spinal tumors . Summary of Background Data . SSIs after spinal tumor surgery may be particularly devastating as they may add to substantial surgical morbidity and may further exacerbate already existing neurologic deficits . Incidence and risk factors predisposing to SSIs in patients undergoing surgery for spinal tumors are not well studied yet . Methods . Between January 1995 and February 2008 , 971 procedures for spinal tumors were performed on 739 patients . Excluding sacral tumors from the current study , 895 procedures on 678 patients were review ed to identify those cases with SSIs . Furthermore , 65 infected cases and a r and omly selected subset of 162 controls were analyzed by logistic regression modeling to identify the risk factors associated with SSIs . Results . There were 678 patients that were included in this study with 364 men ( 54 % ) and 314 women ( 46 % ) , with an average age of 47.2 year . Sixty-five patients who developed SSIs underwent a total of 162 procedures including 78 procedures for wound debridement and washout . The incidence of SSIs was 8.89 % for primary nonbony spinal tumors , 9.5 % for metastatic spinal tumors , and 13.7 % for primary bony spinal tumors . Staphylococcus aureus was the most commonly isolated organism ( n = 22 of 65 , 33 % ) . In the multivariate logistic regression model , previous spinal surgeries , complex plastic closures , increasing number of comorbidities , presence of a hospital acquired infection at the time of a previous surgery , and increasing duration of hospital stay during primary surgery were significantly associated with increased likelihood of developing postoperative SSIs . Conclusion . Surgery for spine tumors appears to be associated with a higher incidence of SSI than nontumor spine surgery . Identification of perioperative risk factors will help delineate this subset of patients with high risk for developing SSIs thus potentially allowing perioperative modification for such factors , which may lead to an overall better clinical outcome and patient satisfaction Background : Nutritional status is a critical factor in patient outcomes in a variety of medical context s. In the surgical fields , there is substantial evidence suggesting that clinical outcomes including infection risk and surgical efficacy may be affected by preoperative nutritional status . The purpose of this study is to evaluate preoperative serum prealbumin levels , the currently preferred serum biomarker of nutritional deficiency , in relation to the risk of developing a surgical site infection . Methods : A retrospective case – control series was conducted comparing prospect ively collected preadmission serum prealbumin levels  to the risk for surgical site infection following elective spine surgery .  The analysis was conducted under an approved institutional quality assurance protocol . Patients were identified by querying the department billing codes for deep wound washouts over a 3-year period . A cohort of 32 patients with preoperative prealbumin levels who underwent spine surgery complicated by postoperative deep tissue infection was identified . This was compared against a case – control cohort of 74 patients who underwent spine surgery and did not experience postoperative infection . Clinical variables included demographic information , body mass index , smoking , diabetes , steroid use , length of the procedure , and length of hospital stay . The data were analyzed using multivariate Cox regression . Results : Two variables : Preoperative prealbumin < 20 and diabetes were both statistically significant predictors for the risk of developing a postoperative infection with hazard ratios of 2.12 ( 95 % confidence interval [ CI ] : 1.03–4.37 ) and 2.22 ( 95 % CI : 1.04–4.75 ) , respectively . Conclusions : Our results reinforce the relationship between preoperative nutritional status and outcomes in elective spine surgery . The data indicate that preoperative prealbumin levels may be useful in risk stratification . Further study is needed to determine whether nutritional supplementation may reduce the risk of infection Abstract Although antibiotic prophylaxis is not explicitly indicated for hernia repair and breast surgery , its use for these clean procedures is widely adopted , albeit to a different extent in different countries , often on the personal decision of the individual surgeon . The present study was carried out to compare the efficacy of a single pre-operative dose of piperacillin-tazobactam with placebo in preventing surgical wound infections and to determine the main risk factors associated with infections following two main elective surgical clean procedures such as hernia repair and breast surgery . A total of 501 patients undergoing elective inguinal/femoral hernia repair or breast surgery were enrolled in this prospect i ve r and omized clinical study . Patients were r and omly assigned to receive preoperative antibiotic prophylaxis or placebo . One dose of piperacillin-tazobactam 2.250 g or placebo was administered i.v . 30 minutes prior to the surgical procedure . Using statistical univariate analysis , the following variables were correlated with a higher infection risk :  age > 40 years , concomitant disease , WBC < 3500 , surgical wound size > 9 cm , use of drainages , non-prophylaxis . Using multivariate analysis , no antibiotic pre-operative prophylaxis , concurrent chronic diseases , especially diabetes ( risk 15 times higher ) , and length of intervention > 45 min ( risk 6 times higher ) were independent predictors of infection . Finally , patients with postoperative infections  had a significantly longer hospitalisation . One pre-operative dose of piperacillin-tazobactam 2.250 g is more effective than placebo in preventing postoperative infections in breast surgery and hernia repair
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 .