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[Systematic investigation of surgical site infections (SSI) in plastic reconstructive and aesthetic surgery (ERCS):
A Ramon1, T Guillard2, M Rosenstiel1
1Chirurgie plastique reconstructrice et esthétique, hôpital Maison-Blanche, Reims, France.
Abstract:
Surgical site infection (SSI) in plastic, reconstructive and aesthetic surgery (ERCP) is quite uncommon compared to other surgical specialities but remains one of the main complications. The aim of our study was to provide feedback on the systematic investigation of SSI in ERCP. This is a monocentric retrospective study, including all paediatric and adult patients who have undergone ERCP surgery between 01/01/2014 and 31/12/2021. During this period, the department systematically investigated all SSI cases. Eight thousand eight hundred and seventy-eight surgical procedures were performed. The SSI rate was 0.34%. Thirty SSIs (19W,11M), with a mean age of 56 years (none paediatric), were investigated. Twenty-seven patients suffered from comorbidities. The surgical indications included 17 cases of skin cancer, 7 cases of weight loss, 4 cases of breast reconstruction, 1 lipoma, 1 pectus excavatum. Eleven surgeries consisted in lymphnode procedures (8 sentinel lymphnodes, 3 curage). The average operating time was 116minutes. Nineteen patients received antibiotic prophylaxis. The average time to onset of SSI after surgery was 10 days. The most prevalent bacteria were commensals of the skin flora and the digestive tract. Apart from surgical management, 100% of patients were treated with antibiotics. High age, multiple comorbidities, long, combined procedures, placement of equipment, lymph node surgery, post-operative punctures on implanted equipment, are all risks factors for SSI. The implementation of a systematic monitoring of SSI within our department has provided us with the opportunity to analyse our data in real time and allow us to adjust our practices if necessary. This process can be used in other plastic reconstructive and aesthetic surgery departments. The collection and analysis of SSIs is both easily done and the procedure is well standardized. The assistance of the operational hygiene team is a key asset for the success of this project. The development of this type of procedure on a national level could be an asset to improve the management of SSI by taking advantage of the experience of a larger number of centres.
Insights
Surgical site infections (SSIs) are rare but significant complications in plastic, reconstructive, and aesthetic surgery (ERAS). Systematic SSI monitoring helps analyze data in real-time, allowing practice adjustments to improve patient outcomes.
Area of Science:
- Plastic Surgery
- Infectious Disease Epidemiology
- Surgical Outcomes
Context:
- Surgical site infections (SSIs) are uncommon but critical complications in plastic, reconstructive, and aesthetic surgery (ERAS).
- Understanding SSI risk factors and incidence is crucial for enhancing patient safety in ERAS.
- Previous research has highlighted the need for systematic surveillance of SSIs in specialized surgical fields.
Purpose:
- To report on the systematic investigation of surgical site infections (SSIs) within a plastic, reconstructive, and aesthetic surgery (ERAS) department.
- To analyze the incidence, characteristics, and risk factors of SSIs in a large cohort of ERAS patients.
- To evaluate the utility of a standardized SSI monitoring protocol for real-time data analysis and practice improvement.
Summary:
- A retrospective study of 8,878 ERAS procedures (2014-2021) identified an SSI rate of 0.34% (30 cases).
- Common SSIs involved skin flora and digestive tract commensals, with risk factors including advanced age, comorbidities, prolonged procedures, and lymph node surgery.
- Systematic SSI monitoring enabled real-time data analysis, facilitating practice adjustments and demonstrating a standardized, easily implementable surveillance model.
Impact:
- The findings underscore the importance of systematic SSI surveillance in ERAS to identify and mitigate patient risks.
- Implementation of this standardized monitoring process can be adopted by other ERAS departments to improve surgical site infection management.
- National-level adoption of such procedures could leverage broader experience, significantly enhancing SSI control strategies across multiple centers.
