Presentation Number:

Author(s): Hanna Labiner, The Ohio State University Wexner Medical Center; Kelli Sas, The Ohio State University Wexner Medical Center; Joseph Baur, University of Pennsylvania; Carrie Sims, The Ohio State University Wexner Medical Center

Eligible for the Resident Award

Presentation Number:

Author(s): Sara Myers, Boston University School of Medicine; Crisanto Torres, Boston University School of Medicine; Lisa Allee, Boston Medical Center; Tracey Dechert, Boston University School of Medicine; Tejal Brahmbhatt, Boston University School of Medicine; Sabrina Sanchez, Boston University School of Medicine

Eligible for the Resident Award and New Member Award

Author(s):

Abagail Raiter; Krista Wilhelmson; Melissa Harry; Kristin Colling

Background:
In the era of acute care surgery (ACS) urgent cholecystectomies (UC) performed by ACS specialists has led to higher rates of successful laparoscopic operations and improved outcomes, even with increased case complexity. However data on surgical infection risk following UC is lacking.

Hypothesis:
We hypothesize that patient and case complexity will be associated with higher rates of SSI.

Methods:
A prospective observational study was performed including all UC by the ACS team at a rural level 1 trauma center between April 2021 and March 2022. Patient demographics, comorbidities, hospital data, operative data and pathology were collected. The severity of cholecystitis was graded using the Parkland grading scale (PGS) for cholecystitis.

Results:
213 patients underwent UC. Patients ages ranged between 18-95, and approximately half were female (table below). Most patients had pre-existing comorbidities. Laparoscopic cholecystectomy was successful in 93% of cases, 4% converted to open, 2% underwent laparoscopic subtotal cholecystectomy and 0.5% underwent planned open procedure. SSI occurred in 17 patients (6 patients had superficial SSI, 10 organ space SSI and one patient both superficial and organ space SSI). Many pre-operative patient factors were associated with increased risk of infection; however none were modifiable. Antibiotic dosing and duration varied; similar number of patients received perioperative, both peri- and postoperative, and pre-, peri- and postoperative antibiotics. However, antibiotics pre- or postoperatively did not decrease infections. The SSI rate was similar or lower for patients receiving only peri-operative antibiotics compared to longer duration. Intra-operative factors associated with increased risk of SSI were severe cholecystitis (higher PCG scores), longer case duration, bile spillage, and surgical drains. Patients with SSI had significantly longer hospital stays and readmissions.

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Conclusions:
SSIs occurred in 8% of UCs. Pre and intraoperative factors were associated with increased risk of SSI and those with SSI had worse postoperative outcomes. Most factors were not modifiable prior to surgery but avoidance of bile spillage may decrease SSI. Appropriate antibiotic timing is still unclear, however more antibiotics did not decrease SSIs.

Presentation Number:

Author(s): Jennifer Hubbard, Brown University, Department of Surgery; Chibueze Nwaiwu, Brown University, Department of Surgery; Daithi Heffernan, Brown University, Department of Surgery; Andrew Stephen, Brown University, Department of Surgery

Eligible for the Resident Award

Presentation Number:

Author(s): Emanuele Lagazzi, Massachusetts General Hospital; Jefferson Proaño-Zamudio, Massachusetts General Hospital; Dias Argandykov, Massachusetts General Hospital; Wardah Rafaqat, Massachusetts General Hospital; May Abiad, Massachusetts General Hospital; Anne-Sophie Romijn , Massachusetts General Hospital; Elaine van Ee, Massachusetts General Hospital; Angela Renne, Massachusetts General Hospital; George Velmahos, Massachusetts General Hospital; Haytham Kaafarani, Massachusetts General Hospital; John Hwabejire, Massachusetts General Hospital