Is Hand Surgery in the Procedure Room Setting Associated With Increased Surgical Site Infection? A Cohort Study of 2,717 Patients in the Veterans Affairs Population.

PURPOSE: Procedure rooms (PRs) are increasingly used for hand surgeries, but few studies have directly compared surgical site infection (SSI) rates between the PR and operating room. We tested the hypothesis that procedure setting is not associated with an increased SSI incidence in the VA population. METHODS: We identified carpal tunnel, trigger finger, and first dorsal compartment releases performed at our VA institution from 1999 to 2021 of which 717 were performed in the main operating room and 2,000 were performed in the PR. The incidence of SSI, defined as signs of wound infection within 60 days of the index procedure, which was treated with oral antibiotics, intravenous antibiotics, and/or operating room irrigation and debridement, was compared. We constructed a multivariable logistic regression analysis to assess the association between procedure setting and SSI incidence, adjusting for age, sex, procedure type, and comorbidities. RESULTS: Surgical site infection incidence was 55/2,000 (2.8%) in the PR cohort and 20/717 (2.8%) in the operating room cohort. In the PR cohort, five (0.3%) cases required hospitalization for intravenous antibiotics of which two (0.1%) cases required operating room irrigation and debridement. In the operating room cohort, two (0.3%) cases required hospitalization for intravenous antibiotics of which one (0.1%) case required operating room irrigation and debridement. All other SSIs were treated with oral antibiotics alone. The procedure setting was not independently associated with SSI (adjusted odds ratio, 0.84 [95% confidence interval, 0.49, 1.48]). The only risk factor for SSI was trigger finger release (odds ratio, 2.13 [95% confidence interval, 1.32, 3.48] compared with carpal tunnel release), which was independent of setting. CONCLUSIONS: Minor hand surgeries can be performed safely in the PR without an increased rate of SSI. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Long-term effects of sewage sludge-derived biochar on the accumulation and availability of trace elements in a tropical soil.

Thermal treatment by pyrolysis has been proposed as a sustainable alternative to enable the agricultural use of sewage sludge. The solid product obtained via pyrolysis of sewage sludge is called sewage sludge biochar and presents several advantages for its use as a fertilizer or soil conditioner. However, there are concerns about the accumulation and dynamics of trace elements in soil amended with sewage sludge biochar over the years. This study examined the effect of sewage sludge biochar, under field conditions for 5 yr, on the accumulation and availability of trace elements in a tropical soil. For this, 15 t ha-1 of sewage sludge biochar produced at 300 and 500 °C were applied in the first two growing seasons. Application was interrupted from the third to the fifth seasons to assess the residual effect of sewage sludge biochar in the soil. The total and available trace element concentrations were determined. The total contents of trace elements showed the following variation in the soil over the 5 yr (mg kg-1): Cd (16.8-20.0), Co (19.5-21.5), Cr (98.2-125.7), Cu (8.1-17.1), Mn (62.9-85.7), Ni (20.3-35.0), Pb (27.0-52.4), and Zn (20.3-35.8). There was no change in the availability of Cd, Cr, Ni, and Pb over the years. Additionally, a residual effect of the sewage sludge biochar was the increase in availability of trace elements that are considered essential (Cu, Mn, and Zn) and beneficial elements (Co) for plants. Therefore, in relation to contamination by trace elements, the pyrolysis of sewage sludge of domestic origin proved to be an adequate strategy to enable the safe use of this residue in tropical agriculture.