Welcome to ASCRS!

On behalf of the team at Prescient Surgical, I’d like to welcome those attending ASCRS to the dynamic City of Angels! 4 years after launching Prescient Surgical out of the Stanford Biodesign Program in 2012, I’m excited to announce the launch of this blog and share what we’ve learned about preventing surgical site infection. SSI remains one of the top issues in colorectal surgery, and I invite you to join in on the thought-provoking, science-based conversation we intend to promote on this blog.

I’ve personally enjoyed the privilege of attending ASCRS in the past, mostly in engineering and marketing roles at Ethicon and Covidien, where I learned how our technologies enable the ever-evolving clinical approaches developed by this community. And frankly, we wouldn’t be able to do any of it without your help. Prescient Surgical has benefited greatly from the generous support of the clinicians attending this meeting. In fact, some of you might recall in 2012 a certain “World’s Longest Paper-based Survey,” administered by myself and my co-founders, designed to get feedback on the next-generation wound retraction and protection products we were developing at the time.

We’ve come a long way since then. We’ve grown the company significantly, expect to finish enrollment in a large multi-center U.S. clinical trial this spring, and have worked to expand and update our product portfolio in view of responses from regulatory agencies. Founded around a core of engineers, scientists, and physicians, we remain committed to a science-forward approach. I’m proud of all that we’ve accomplished, and I look forward to reconnecting with the many colleagues and friends we’ve developed along the way this week in LA.

The Elephant in the Operating Room

Editor’s Comment: For this post I’d like to introduce guest blogger Michael Goldfarb, MD, who has generously agreed to contribute a few posts leveraging his surgical expertise and passion for the prevention of SSI. With a diverse career spanning the United States Army, hospital adminstration and leadership positions, and private and academic surgical practice, Dr. Goldfarb provides a unique perspective on the challenges of SSI. The post below is abstracted from an article Dr. Goldfarb wrote previously, entitled: “The Elephant in the OR,” General Surgery News, May 2014, volume 41, Issue 5.

Key Takeaway Points:

  • In patients with infectious complications after surgery for colorectal cancer, the survival rate was more than 50% lower than in patients without infections.
  • The presence of postoperative complications was an independent factor associated with a worse overall survival and a higher overall recurrence rate in colorectal cancer patients. Also, there is a significant association between colorectal anastomotic leak and reduced long-term cancer-specific survival.
  • What biological mechanisms might underlie this link? Consider the following:
    • Host–tumor interactions under surgical stress may act synergistically as potent tumor growth factors, and may thus influence long-term survival. Controlling surgical insults and/or regulating perioperative inflammatory responses may therefore lead to new therapeutic approaches for controlling disease recurrence.
    • Intravital microscopy showed that cancer cells adhered directly on top of arrested neutrophils, indicating that neutrophils may act as a bridge to facilitate interactions between cancer cells and the liver parenchyma.
  • If surgeons accept the notion that postoperative infection reduces survival, then certain algorithms in surgery should be modified.

Continue reading “The Elephant in the Operating Room”

In the News: Environmental Disinfection

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A recent article on SiliconHills, an Austin / San Antonio focused news outlet, touts the benefits of local San Antonio-based Xenex, a manufacturer and distributor of robotic UV disinfection systems. Morris Miller, a serial entrepreneur (he co-founded Rackspace in 1998) and the hard-charging CEO of the company, maintains that he “shouldn’t be going to sleep until we’re in every single healthcare facility in the U.S.”

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In the News: HAI Misreporting

Misreporting and/or under-reporting  of hospital acquired infections (HAIs), particularly surgical site infections (SSIs) is a well-known phenomenon (see Mahmoud, Surgical Infections 2009 and Smith, Annals of Surgery, 2004). Although it cannot be said that hospitals intentionally misreport these statistics, it is clear that with the arrival of reimbursement penalties and public reporting of complication rates on HospitalCompare.gov, there are significant pressures to minimize reported infection rates.

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Hello world! Let’s Talk About Wound Irrigation…

Editor’s Note: Welcome to Prescience, a blog focused on the science of surgical site infection (SSI). Since Prescient Surgical was founded to explore the potential benefits of surgical wound irrigation, I thought this would be an excellent first topic to explore. To that end, I invited Prescient Surgical’s Co-founders, Dr. Insoo Suh and Dr. Mark Welton, to provide some grounding context and present an overview of the literature on surgical wound irrigation.

Surgical Wound infection: A “perfect storm”
As is the case with many clinical problems, wound infection is a multifactorial disease with numerous identified risk factors. However, as Cheadle (2006) details in an informative review, these risk factors can be broken down into three broad categories (1):

  1. The patient. It is well-established that a patient’s underlying medical condition affects the risk of developing surgical complications including wound infection. Pre-existing medical conditions such as advanced age, poor nutritional status, diabetes, coronary artery disease, obesity, and previous abdominal surgery and/or irradiation have clearly been demonstrated to increase the likelihood of wound infection in surgical patients. A patient’s inherent immune status also directly affects the ability of a wound to fight off infection and properly heal. Although important, these risk factors as a whole are generally secondary to the fundamental mechanisms causing wound infection. In addition, these comorbidities are inherent to the makeup of the patient, and are therefore less amenable to significant improvement in a short time frame (other than making sure that they do not significantly worsen in the perioperative period).
  2. The microbe. By definition, a wound infection requires the presence of a responsible invasive organism, usually bacterial; therefore, the type of microbe that contaminates the wound edges is perhaps the most fundamental factor in the development of wound infection. Generally, wound infections from “clean” operations (those that do not violate the aerodigestive tract) are due to organisms that normally reside on the skin, such as Staphylococcus and Streptococcus species. On the other hand, operations that violate the GI tract (such as colorectal surgery) release millions of fecal organisms (E. coli, Klebsiella, Proteus, etc.), which are then responsible for the majority of wound infections in these procedures. As detailed below, antibiotics represent an active strategy to counteract and destroy bacteria.
  3. The operation. The setting in which the potential inciting events for wound infection occur is also profoundly important. Factors that either increase the patient’s physiologic stress response (e.g. tissue ischemia, increased blood loss, inadvertent hypothermia, etc.) or increase the exposure of the wound to the possibility of contamination (e.g. longer operative time, increased incision length, improper skin prep/sterilization, operations that expose the wound to contaminating intestinal contents, etc.) are known to increase the likelihood of wound infection. Some of these factors are highly dependent on the technical prowess of the individual surgeon or the inherent difficulty of the operative task, and are therefore difficult to control. However, some factors – namely, contact contamination – are critical factors that can be modified and improved through a standardized approach.

Continue reading “Hello world! Let’s Talk About Wound Irrigation…”