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Background: Robot-assisted thoracoscopic surgery has become prevalent as a feasible approach for anterior mediastinal tumor resections, while conventional open surgery, such as a median sternotomy, remains preferred for a combined resection of adjacent organs. However, an additional thoracotomy may be necessary when tumors extend into one hemithorax. This complex approach can cause significant damage to the osseous thoracic cage, increasing the risk of surgical morbidity especially in immunocompromised patients. Case presentation: A 77-year-old man presented with an anterior mediastinal thymoma measuring 71 mm, detected during an annual health check with suspected involvement of the left brachiocephalic vein and upper lobe of the left lung. The patient had a medical history of recurrent surgical site infections and fasciitis panniculitis syndrome requiring immunosuppressive therapy. To minimize any thoracic cage destruction, a multidisciplinary approach combining robotic surgery with open surgery according to vascular or pulmonary invasion was planned. The patient, initially placed in the supine position with the robot docked over the right side, underwent a thymic dissection, revealing a firm adhesion to the left brachiocephalic vein. The robot was then undocked, and a transmanubrial osteomuscular sparing approach was initiated, enabling a tumor dissection under the proximal and distal control of the left brachiocephalic vein. As invasion into the proximal upper pulmonary vein and extensive dorsal adhesions were observed, the patient was repositioned to the right lateral decubitus position, and a thoracoscopic left upper segmentectomy with adhesiolysis was performed, achieving an R0 resection. The patient was extubated on day 1 but required non-invasive ventilation until day 5. Mediastinitis, likely due to a sternal wire infection, developed on day 9, necessitating debridement, sternal wire removal, and negative pressure wound therapy. After 17 days of treatment, the infection subsided, allowing for a sequestrectomy and chest wall reconstruction with a pedicled pectoralis major myocutaneous flap. By avoiding a total sternotomy, the extent of the mediastinitis was localized, allowing for a limited sequestrectomy. Wound healing was satisfactory, with no recurrent infection at 12 months and minimal functional impairment. Conclusions: A multidisciplinary approach offers a feasible option for managing an invasive thymoma to minimize postoperative morbidity, particularly in immunocompromised patients. Preoperative surgical planning is essential for guiding intraoperative decision-making and ensuring optimal outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: While methicillin-resistant Staphylococcus aureus (MRSA) colonization is a known risk factor for surgical site infections, no definitive recommendations exist regarding preoperative S. aureus screening and decolonization protocols due to inconclusive evidence in Orthopedic Surgery. This study aimed to examine the correlation between preoperative MRSA colonization and postoperative infections in Total Knee Arthroplasty (TKA) patients. Methods: Data from 2005 to 2023 were collected from TriNetX, a global health research network, reviewing 237,360 unique patients. TKA patients were assigned under Current Procedural Terminology, while International Statistical Classification of Diseases Codes were used to identify preoperative comorbidities and postoperative complications. Demographic and analytical statistics were compared between MRSA-positive and control groups before and after propensity matching. Results: The MRSA-positive group had a significantly (p < 0.001) higher proportion of patients over 65 years (47.17% vs. 38.46%), obesity (41.76% vs. 34.67%), smoking disorders (33.36% vs. 19.73%), and diabetes (25.06% vs. 19.85%) compared to the control group. Postoperative complications were significantly (p < 0.001) more frequent in the MRSA-positive group, specifically periprosthetic joint infection (PJI) (4.11% vs. 0.79%, OR = 5.40), deep (0.12% vs. 0.01%, OR = 11.15) and superficial (0.37% vs. 0.09%, OR = 4.17) surgical site infections, and wound dehiscence (1.11% vs. 0.52%, OR = 2.13). The matched analysis confirmed significantly (p < 0.001) higher rates of PJI (4.39% vs. 1.18%, OR = 3.59). Conclusions: Our results illustrated preoperative colonization of MRSA as associated with an increased risk of wound-related complications. Surgeons and patients must consider preoperative MRSA colonization status when deciding if TKA is an optimal treatment option. [ABSTRACT FROM AUTHOR]

Background: There is a lack of consensus on the optimal antibiotic regimen for pediatric appendicitis, and conflicting data exist regarding the need for extended-spectrum use in this population. We implemented an antibiotic stewardship program with a standard, preferred antibiotic regimen for both uncomplicated and complicated appendicitis and hypothesized that clinical outcomes would be equivalent. Methods: This is a single-institution, retrospective study of pediatric patients (≤18 y) who underwent appendectomy for acute appendicitis between October 2015 and May 2022. We used institutional data from our stewardship program supplemented by manual chart review. Patients were assigned to pre- and post-pathway cohorts on the basis of appendectomy date. Patients were further stratified on the basis of whether they met criteria for complicated appendicitis on the basis of intra-operative findings. Results: There were 752 patients that were included: 346 (46.0%) in the pre-pathway cohort and 406 (54.0%) in the post-pathway cohort. The pre-pathway cohort had a higher rate of complicated appendicitis (40.2 vs. 25.6%). However, pre- and post-pathway cohorts had similar rates of post-operative infections, readmissions, and reoperations. When separated by complicated operative findings, patients with uncomplicated appendicitis had a shorter length of stay post-pathway implementation (p < 0.001). After controlling for complicated operative findings and pertinent covariates, the preferred antibiotic regimen was independently associated with decreased odds of post-operative organ space surgical site infections (SSI) (adjusted odds ratio 0.22, 95% CI: 0.05–0.99). Discussion: Antibiotic stewardship to increase the use of a standardized, preferred antibiotic regimen did not result in worse clinical outcomes. The preferred regimen was significantly associated with a decreased rate of organ space SSI, even when controlling for complicated operative findings. The mechanism of this finding requires additional study. [ABSTRACT FROM AUTHOR]

Context: Surgical site infection (SSI) is responsible for significant morbidity, prolonged hospital stays, and increased costs. Infectious endocarditis (IE) is a rare but serious complication of bacteremia, particularly that resulting from Staphylococcus aureus SSI. The VIRSTA score predicts the risk of IE and determines the priority of transthoracic echocardiography (TTE) in patients with S. aureus bacteremia. The aim of the study was to (1) assess the performance of the VIRSTA score and (2) determine the usefulness of TTE in S. aureus bacteremia related to spinal SSI. Materials and Methods: We carried out a retrospective study of consecutive patients with spinal SSI and S. aureus bacteremia at two university hospitals in France (Bordeaux and Tours) from January 2009 to January 2023. We collected the patients' clinical and surgical characteristics at baseline, VIRSTA score items, TTE results, and medicosurgical management. The associations of these parameters with IE were assessed using the chi-square test and logistic regression models. Results: Of 82 patients with spinal SSI and S. aureus bacteremia, only 1 (1.21%) developed IE. Thirteen patients did not benefit from TTE during hospitalization and were considered free of IE after clinical follow-up. Diabetes mellitus (p < 0.04) and the presence of severe sepsis or septic shock (p < 0.03) were significantly associated with the presence of IE in this population. Conclusions: Incidence of IE in patients with spinal SSI and S. aureus bacteremia is low. The VIRSTA score has high sensitivity but is not accurate for identifying patients at high risk for IE and systematic performance of TTE is complex and not useful in this setting. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Large, randomised trials are the bedrock of evidence-based medicine, but the resources required to complete such trials greatly limit the number of important clinical questions that can be addressed within a reasonable period of time. Adaptive platform trials can identify effective, ineffective, or harmful treatments faster. These trials have been shown to deliver rapid evidence through the COVID-19 pandemic and are now being adopted across surgery and anaesthesia, with many opportunities for surgeons, anaesthetists, and other perioperative physicians to conduct and collaborate in platform trials. [ABSTRACT FROM AUTHOR]

The Zero Surgical Infection Project (ZSIP) in Spain is a nationwide programme to prevent surgical site infections (SSIs), sponsored by the Ministry of Health. The programme includes the application of a bundle of five key preventive measures (5PM): peri-operative antibiotic prophylaxis (PAP), skin antisepsis (SA), hair removal (HR), normothermia and normoglycaemia. To assess the effectiveness of the 5PM, applied in a set of Spanish public hospitals between 2017 and 2021, under standard conditions of surgical health care in Spain. This prospective cohort study of 33,240 patients from the ZSIP Registry (National Database Network) included surveillance of SSI data of selected surgical interventions, compliance data and other risk factors. Compliance with the 5PM bundle was verified through a specific checklist. The intervention and comparison groups were patients who were compliant with the 5PM bundle and patients who were not compliant with the 5PM bundle, respectively. Adjusted odds ratios (OR) and preventive fractions (PF) were calculated using logistic regression. The overall SSI rates for patients in the compliant group and non-compliant group were 4.77% and 6.90%, respectively. Overall compliance with the 5PM bundle was 35.9%, and the compliance rates were highest for PAP (87.2%), SA (82.2%) and HR (78.7%). Compliance with the 5PM bundle had a PF of 32% and adjusted OR of 0.68 (95% confidence interval 0.60–0.76). The ZSIP, implemented between 2017 and 2021 in Spain, had a significant level of effectiveness against SSIs. [ABSTRACT FROM AUTHOR]