1101
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Calderwood MS, Kleinman K, Murphy MV, Platt R, Huang SS. Improving public reporting and data validation for complex surgical site infections after coronary artery bypass graft surgery and hip arthroplasty. Open Forum Infect Dis 2014; 1:ofu106. [PMID: 25734174 PMCID: PMC4324229 DOI: 10.1093/ofid/ofu106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/30/2014] [Indexed: 12/14/2022] Open
Abstract
Diagnosis codes in claims submitted for reimbursement following coronary artery bypass graft surgery and hip arthroplasty allow standardized and efficient identification of deep and organ/space surgical site infections. Background Deep and organ/space surgical site infections (D/OS SSI) cause significant morbidity, mortality, and costs. Rates are publicly reported and increasingly used as quality metrics affecting hospital payment. Lack of standardized surveillance methods threaten the accuracy of reported data and decrease confidence in comparisons based upon these data. Methods We analyzed data from national validation studies that used Medicare claims to trigger chart review for SSI confirmation after coronary artery bypass graft surgery (CABG) and hip arthroplasty. We evaluated code performance (sensitivity and positive predictive value) to select diagnosis codes that best identified D/OS SSI. Codes were analyzed individually and in combination. Results Analysis included 143 patients with D/OS SSI after CABG and 175 patients with D/OS SSI after hip arthroplasty. For CABG, 9 International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes identified 92% of D/OS SSI, with 1 D/OS SSI identified for every 4 cases with a diagnosis code. For hip arthroplasty, 6 ICD-9 diagnosis codes identified 99% of D/OS SSI, with 1 D/OS SSI identified for every 2 cases with a diagnosis code. Conclusions This standardized and efficient approach for identifying D/OS SSI can be used by hospitals to improve case detection and public reporting. This method can also be used to identify potential D/OS SSI cases for review during hospital audits for data validation.
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Affiliation(s)
- Michael S Calderwood
- Division of Infectious Diseases , Brigham and Women's Hospital , Boston, Massachusetts ; Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts
| | - Ken Kleinman
- Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts
| | - Michael V Murphy
- Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts
| | - Richard Platt
- Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts
| | - Susan S Huang
- Division of Infectious Diseases and Health Policy Research Institute , University of California Irvine School of Medicine
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1102
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Rushbrook JL, White G, Kidger L, Marsh P, Taggart TF. The antibacterial effect of 2-octyl cyanoacrylate (Dermabond®) skin adhesive. J Infect Prev 2014; 15:236-239. [PMID: 28989390 DOI: 10.1177/1757177414551562] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2014] [Indexed: 11/16/2022] Open
Abstract
Dermabond® is a tissue adhesive commonly used for wound or surgical incision closure. Its use has previously been associated with a reduction in wound infection, and it has been thought to act as a physical barrier to bacteria accessing the wound. This study aimed to establish whether the Dermabond® adhesive demonstrated any intrinsic antimicrobial properties. Solidified pellets of Dermabond® were placed on standardised Agar plates cultured with a variety of pathogens. Inhibition of growth was demonstrated against Gram-positive bacteria. Culture swabs taken from the inhibition rings demonstrated no growth, suggesting that Dermabond has a bactericidal mechanism of action. Based on the design of this study, the results suggest that Dermabond® demonstrates bactericidal properties against Gram-positive bacteria. Its use for wound closure following surgical intervention may reduce postoperative wound infection by Gram-positive organisms.
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Affiliation(s)
| | - Grace White
- Bradford Royal Infirmary, Duckworth Lane, Bradford, UK
| | - Lizi Kidger
- Bradford Royal Infirmary, Duckworth Lane, Bradford, UK
| | - Philip Marsh
- Bradford Royal Infirmary, Duckworth Lane, Bradford, UK
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1103
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Smith EJ, Stringer S. Current perioperative practice patterns for minimizing surgical site infection during rhinologic procedures. Int Forum Allergy Rhinol 2014; 4:1002-7. [PMID: 25400082 DOI: 10.1002/alr.21395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/18/2014] [Accepted: 06/26/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a paucity of information in the literature regarding the best practices to reduce surgical site infections associated with rhinologic surgery. METHODS We surveyed the American Rhinologic Society (ARS) membership to assess current perioperative infection control measures performed for rhinologic procedures, with the goal of establishing a baseline of current practice. RESULTS Results revealed that for most rhinologic procedures performed in the operating room (OR) setting, the majority of physicians gown and drape in a sterile fashion and perform a complete surgical scrub of their hands and forearms but do not prep the facial skin with an antimicrobial agent. For rhinologic procedures performed in the office setting, the majority of physicians do not perform any of the aforementioned perioperative measures for any of the office procedures. Interestingly, for physicians that perform inferior turbinate reductions in both settings, 45% gown and drape in a sterile fashion and 28% perform a complete surgical scrub of their hands in the OR setting but not in the office setting. The most stringent measures were performed for endoscopic skull-base procedures, with over 90% of responders administering perioperative antibiotics, gowning and draping in a sterile fashion, and performing a complete surgical scrub of their hands. Despite lack of demonstrated benefit, antibiotics were used variably for the other procedures. CONCLUSION This survey demonstrates that there is great variability in the perioperative measures rhinologists perform to reduce surgical site infection, which differs by the practice site. These data serve as a baseline for future studies.
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Affiliation(s)
- Erin J Smith
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS
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1104
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Wang H, Dou X, Hu X, Yu J, Wang S. Effectiveness and safety of endoscopy for treatment of surgical site infection: A randomized control trial. Exp Ther Med 2014; 8:1727-1730. [PMID: 25371723 PMCID: PMC4218710 DOI: 10.3892/etm.2014.2028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/21/2014] [Indexed: 11/17/2022] Open
Abstract
The aim of this randomized control study was to evaluate the effectiveness and safety of endoscopy for the treatment of surgical site infection (SSI), compared with conventional therapy. One hundred and six patients who were diagnosed with severe SSI were included in the study, performed from May 2005 to July 2012 at Tianjin Binhai New Area Dagang Hospital, China. Patients were randomly divided into two groups: 57 patients in group A treated by endoscopy and 49 patients in group B treated by conventional therapy for SSI. The primary outcome was the healing period of the wound; the secondary outcomes were the blood loss following surgery, visual analog scale (VAS) measurement, volume of irrigation saline during surgery, rate of skin transplantation, length of hospital stay and other complications. The mean wound healing time was significantly less in group A (10.0±2.5 days) than in group B (19.4±5.2 days). The mean VAS score 7 days after surgery in group A was significantly less compared with group B. The intra-operative blood loss, intra-operative volume of irrigation saline and length of the hospital stay were significantly reduced in group A compared with group B. No significant differences between the groups were revealed in terms of the duration of surgery and the clinical complications. This study demonstrated that the endoscopy procedure for the treatment of SSI reduces the wound healing time compared with that of traditional surgery, without increasing any risk of clinical events. The present study showed that endoscopy was not only effective but also safe in the therapy of serious SSI. However, a further randomized control trial is necessary to testify our conclusions.
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Affiliation(s)
- Hailong Wang
- Graduate School of Tianjin Medical University, Tianjin 300270, P.R. China ; Department of Oncology, Tianjin Binhai New Area Dagang Hospital, Tianjin 300270, P.R. China
| | - Xinli Dou
- Department of Oncology, Tianjin Binhai New Area Dagang Hospital, Tianjin 300270, P.R. China
| | - Xiangping Hu
- Department of Oncology, Tianjin Binhai New Area Dagang Hospital, Tianjin 300270, P.R. China
| | - Jinsheng Yu
- Department of Oncology, Tianjin Binhai New Area Dagang Hospital, Tianjin 300270, P.R. China
| | - Shaoshan Wang
- Department of Oncology, Tianjin Binhai New Area Dagang Hospital, Tianjin 300270, P.R. China
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1105
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Abstract
In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to 'germs' or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system.
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Affiliation(s)
- Brian Brown
- School of Applied Social Sciences, De Montfort University, Leicester, UK
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1106
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Abstract
PURPOSE Analyses of risk factors associated with surgical site infections (SSIs) after laparoscopic appendectomy (LA) have been limited. Especially, the association of an underweight body mass index (BMI) with SSIs has not been clearly defined. This study aimed to identify the impact of underweight BMI in predicting SSIs after LA. MATERIALS AND METHODS The records of a total of 101 consecutive patients aged ≥16 years who underwent LA by a single surgeon between March 2011 and December 2012 were retrieved from a prospectively collected database. The rate of SSIs was compared among the underweight, normal and overweight and obese groups. Also, univariate and multivariate analyses were performed to identify the factors associated with SSIs. RESULTS The overall rate of SSIs was 12.8%. The superficial incisional SSI rate was highest in the underweight group (44.4% in the underweight group, 11.0% in the normal group, and 0% in the overweight and obese group, p=0.006). In univariate analysis, open conversion and being underweight were determined to be risk factors for SSIs. Underweight BMI was also found to be a significant predictor for SSIs in multivariate analysis (odds ratio, 10.0; 95% confidence interval, 2.0-49.5; p=0.005). CONCLUSION This study demonstrated underweight BMI as being associated with SSIs after LA. Surgeons should be more cautious to prevent SSIs in patients that are underweight when performing LA.
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Affiliation(s)
- Mina Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jeonghyun Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
| | - Im-Kyung Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Young Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Kook Sohn
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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1107
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Basques BA, Golinvaux NS, Bohl DD, Yacob A, Toy JO, Varthi AG, Grauer JN. Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection. Spine (Phila Pa 1976) 2014; 39:1910-6. [PMID: 25188600 DOI: 10.1097/BRS.0000000000000558] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective database review. OBJECTIVE To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. SUMMARY OF BACKGROUND DATA Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. METHODS The American College of Surgeons National Surgical Quality Improvement Program database, which includes data from more than 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without the use of an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. RESULTS A total of 23,670 elective spine procedures were identified, of which 2226 (9.4%) used an operating microscope. The average patient age was 55.1±14.4 years. The average operative time (incision to closure) was 125.7±82.0 minutes.Microscope use was associated with minor increases in preoperative room time (+2.9 min, P=0.013), operative time (+13.2 min, P<0.001), and total room time (+18.6 min, P<0.001) on multivariate analysis.A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and nonmicroscope groups for occurrence of any infection, superficial surgical site infection, deep surgical site infection, organ space infection, or sepsis/septic shock, regardless of surgery type. CONCLUSION We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. LEVEL OF EVIDENCE 3.
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1108
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Dohmen PM, Markou T, Ingemansson R, Rotering H, Hartman JM, van Valen R, Brunott M, Kramer A, Segers P. Can post-sternotomy mediastinitis be prevented by a closed incision management system? GMS Hyg Infect Control 2014; 9:Doc19. [PMID: 25285263 PMCID: PMC4184039 DOI: 10.3205/dgkh000239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Post-sternotomy mediastinitis is a serious complication after cardiothoracic surgery and contribute significantly to post-operative morbidity, mortality, and healthcare costs. Negative pressure wound therapy is today's golden standard for post-sternotomy mediastinitis treatment. A systematic literature search was conducted at PubMed until October 2012 to analyse whether vacuum-assisted closure technique prevents mediastinitis after clean surgical incisions closure. Today's studies showed reduction of post-sternotomy mediastinitis including a beneficial socio-economic impact. Current studies, however included only high-risk patients, hence furthermore, larger randomised controlled trials are warranted to clarify the benefit for using surgical incision vacuum management systems in the general patient population undergoing sternotomy and clarify risk factor interaction.
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Affiliation(s)
- Pascal M Dohmen
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Germany
| | - Thanasie Markou
- Department of Cardiothoracic Surgery, Isala Klinieken Zwolle, The Netherlands
| | | | - Heinrich Rotering
- Department of Cardiothoracic Surgery, University Clinic Münster, Germany
| | - Jean M Hartman
- Department of Cardiothoracic Surgery, University Medical Center Groningen, The Netherlands
| | - René van Valen
- Department of Cardiothoracic Surgery, Erasmus University Rotterdam, The Netherlands
| | - Maaike Brunott
- Department of Cardiothoracic Surgery, Erasmus University Rotterdam, The Netherlands
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Patrique Segers
- Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, The Netherlands
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1109
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Toltzis P, O'Riordan M, Cunningham DJ, Ryckman FC, Bracke TM, Olivea J, Lyren A. A statewide collaborative to reduce pediatric surgical site infections. Pediatrics 2014; 134:e1174-80. [PMID: 25201794 DOI: 10.1542/peds.2014-0097] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Surgical site infections (SSIs) are preventable events associated with significant morbidity and cost. Few interventions have been tested to reduce SSIs in children. METHODS A quality improvement collaboration was established in Ohio composed of all referral children's hospitals. Collaborative leaders developed an SSI reduction bundle for selected cardiac, orthopedic, and neurologic operations. The bundle was composed of 3 elements: prohibition of razors for skin preparation, chlorhexidine-alcohol use for incisional site preparation, and correct timing of prophylactic antibiotic administration. The incidence of SSIs across the collaborative was compared before and after institution of the bundle. The association between 1 of the bundle elements, namely correct timing of antibiotic prophylaxis, and the proportion of centers achieving 0 SSIs per month was measured. RESULTS Eight pediatric hospitals participated. The proportion of months in which 0 SSIs per center was recorded was 56.9% before introduction of the bundle, versus 81.8% during the intervention (P < .001). Correct timing of preoperative prophylactic antibiotics also significantly improved; 39.4% of centers recorded correct timing in every eligible surgical procedure per month ("perfect timing") before the intervention versus 78.7% after (P < .001). The achievement of 0 SSIs per center in a given month was associated with the achievement of perfect antibiotic timing for that month (P < .003). CONCLUSIONS A statewide collaborative of children's hospitals was successful in reducing the occurrence of SSIs across Ohio.
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Affiliation(s)
- Philip Toltzis
- Rainbow Babies and Children's Hospital, Cleveland, Ohio;
| | | | | | | | - Tracey M Bracke
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jason Olivea
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anne Lyren
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
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1110
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Chaboyer W, Anderson V, Webster J, Sneddon A, Thalib L, Gillespie BM. Negative Pressure Wound Therapy on Surgical Site Infections in Women Undergoing Elective Caesarean Sections: A Pilot RCT. Healthcare (Basel) 2014; 2:417-28. [PMID: 27429285 PMCID: PMC4934567 DOI: 10.3390/healthcare2040417] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/28/2014] [Accepted: 09/22/2014] [Indexed: 01/15/2023] Open
Abstract
Obese women undergoing caesarean section (CS) are at increased risk of surgical site infection (SSI). Negative Pressure Wound Therapy (NPWT) is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its benefits. This pilot randomized controlled trial (RCT) assessed the effect of NPWT on SSI and other wound complications in obese women undergoing elective caesarean sections (CS) and also the feasibility of conducting a definitive trial. Ninety-two obese women undergoing elective CS were randomized in theatre via a central web based system using a parallel 1:1 process to two groups i.e., 46 women received the intervention (NPWT PICO™ dressing) and 46 women received standard care (Comfeel Plus(®) dressing). All women received the intended dressing following wound closure. The relative risk of SSI in the intervention group was 0.81 (95% CI 0.38-1.68); for the number of complications excluding SSI it was 0.98 (95% CI 0.34-2.79). A sample size of 784 (392 per group) would be required to find a statistically significant difference in SSI between the two groups with 90% power. These results demonstrate that a larger definitive trial is feasible and that careful planning and site selection is critical to the success of the overall study.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Gold Coast Campus, QLD 4222, Australia.
| | - Vinah Anderson
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Gold Coast Campus, QLD 4222, Australia.
| | - Joan Webster
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Gold Coast Campus, QLD 4222, Australia.
- Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia.
| | - Anne Sneddon
- Women's and Newborn Health, Gold Coast University Hospital, Southport, QLD 4215, Australia.
| | - Lukman Thalib
- Department of Community Medicine (Biostatistics), Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait.
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Gold Coast Campus, QLD 4222, Australia.
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1111
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Mundinger GS, Borsuk DE, Okhah Z, Christy MR, Bojovic B, Dorafshar AH, Rodriguez ED. Antibiotics and facial fractures: evidence-based recommendations compared with experience-based practice. Craniomaxillofac Trauma Reconstr 2014; 8:64-78. [PMID: 25709755 DOI: 10.1055/s-0034-1378187] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 10/26/2013] [Indexed: 10/24/2022] Open
Abstract
Efficacy of prophylactic antibiotics in craniofacial fracture management is controversial. The purpose of this study was to compare evidence-based literature recommendations regarding antibiotic prophylaxis in facial fracture management with expert-based practice. A systematic review of the literature was performed to identify published studies evaluating pre-, peri-, and postoperative efficacy of antibiotics in facial fracture management by facial third. Study level of evidence was assessed according to the American Society of Plastic Surgery criteria, and graded practice recommendations were made based on these assessments. Expert opinions were garnered during the Advanced Orbital Surgery Symposium in the form of surveys evaluating senior surgeon clinical antibiotic prescribing practices by time point and facial third. A total of 44 studies addressing antibiotic prophylaxis and facial fracture management were identified. Overall, studies were of poor quality, precluding formal quantitative analysis. Studies supported the use of perioperative antibiotics in all facial thirds, and preoperative antibiotics in comminuted mandible fractures. Postoperative antibiotics were not supported in any facial third. Survey respondents (n = 17) cumulatively reported their antibiotic prescribing practices over 286 practice years and 24,012 facial fracture cases. Percentages of prescribers administering pre-, intra-, and postoperative antibiotics, respectively, by facial third were as follows: upper face 47.1, 94.1, 70.6; midface 47.1, 100, 70.6%; and mandible 68.8, 94.1, 64.7%. Preoperative but not postoperative antibiotic use is recommended for comminuted mandible fractures. Frequent use of pre- and postoperative antibiotics in upper and midface fractures is not supported by literature recommendations, but with low-level evidence. Higher level studies may better guide clinical antibiotic prescribing practices.
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Affiliation(s)
- Gerhard S Mundinger
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Daniel E Borsuk
- Division of Plastic Surgery, University of Montreal, Montreal, Canada
| | - Zachary Okhah
- Division of Plastic and Reconstructive Surgery, Brown University, Providence, Rhode Island
| | - Michael R Christy
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Branko Bojovic
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Amir H Dorafshar
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Eduardo D Rodriguez
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
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1112
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Manoso MW, Cizik AM, Bransford RJ, Bellabarba C, Chapman J, Lee MJ. Medicaid status is associated with higher surgical site infection rates after spine surgery. Spine (Phila Pa 1976) 2014; 39:1707-13. [PMID: 24983931 DOI: 10.1097/BRS.0000000000000496] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The Spine End Results Registry (2003-2004) is a registry of prospectively collected data of all patients undergoing spinal surgery at the University of Washington Medical Center and Harborview Medical Center. Insurance data were prospectively collected and used in multivariate analysis to determine risk of perioperative complications. OBJECTIVE Given the negative financial impact of surgical site infections (SSIs) and the higher overall complication rates of patients with a Medicaid payer status, we hypothesized that a Medicaid payer status would have a significantly higher SSI rate. SUMMARY OF BACKGROUND DATA The medical literature demonstrates lesser outcomes and increased complication rates in patients who have public insurance than those who have private insurance. No one has shown that patients with a Medicaid payer status compared with Medicare and privately insured patients have a significantly increased SSI rate for spine surgery. METHODS The prospectively collected Spine End Results Registry provided data for analysis. SSI was defined as treatment requiring operative debridement. Demographic, social, medical, and the surgical severity index risk factors were assessed against the exposure of payer status for the surgical procedure. RESULTS The population included Medicare (N = 354), Medicaid (N = 334), the Veterans' Administration (N = 39), private insurers (N = 603), and self-pay (N = 42). Those patients whose insurer was Medicaid had a 2.06 odds (95% confidence interval: 1.19-3.58, P = 0.01) of having a SSI compared with the privately insured. CONCLUSION The study highlights the increased cost of spine surgical procedures for patients with a Medicaid payer status with the passage of the Patient Protection and Affordable Care Act of 2010. The Patient Protection and Affordable Care Act of 2010 provisions could cause a reduction in reimbursement to the hospital for taking care of patients with Medicaid insurance due to their higher complication rates and higher costs. This very issue could inadvertently lead to access limitations. LEVEL OF EVIDENCE 3.
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1113
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Marvil SC, Tiedeken NC, Hampton DM, Kwok SCM, Samuel SP, Sweitzer BA. Stockinette application over a non-prepped foot risks proximal contamination. J Arthroplasty 2014; 29:1819-22. [PMID: 24891004 DOI: 10.1016/j.arth.2014.04.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 04/08/2014] [Accepted: 04/22/2014] [Indexed: 02/01/2023] Open
Abstract
This study sought to determine if there was an increased risk for surgical site contamination during stockinette application for a lower extremity surgery draping technique. Utilizing a simulated, sterile surgical field, stockinettes were applied over 10 cadaver lower extremities that were contaminated with non-pathogenic Escherichia coli on the foot. Of those, five specimens were then disinfected with Chloroprep and another 5 did not undergo any disinfection. All the specimens in which the stockinette was applied over a non-prepped foot showed proximal contamination. No contamination occurred in any of the specimens where the foot was disinfected. Stockinette can be a source of surgical site contamination when placed over a non-prepared foot.
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Affiliation(s)
- Sean C Marvil
- Department of Orthopedic Surgery, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Nathan C Tiedeken
- Department of Orthopedic Surgery, Einstein Medical Center, Philadelphia, Pennsylvania
| | - David M Hampton
- Department of Orthopedic Surgery, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Simon C M Kwok
- Department of Orthopedic Surgery, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Solomon P Samuel
- Department of Orthopedic Surgery, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Brett A Sweitzer
- Department of Orthopedic Surgery, Einstein Medical Center, Philadelphia, Pennsylvania
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1114
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Abstract
Surgical site infection (SSI) is a common healthcare-associated infection that can cause patients extreme pain and discomfort, resulting in prolonged hospitalisation and additional costs to the NHS. Multidisciplinary team working, combined with audit and surveillance, early recognition of signs and symptoms of infection, and implementation of evidence-based guidance are essential for reducing the incidence of SSI. Nurses caring for patients in the pre, peri and post-operative period have an important role in advising individuals about the risks associated with SSI and how infection should be managed.
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1115
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Smith SC, Heal CF, Buttner PG. Prevention of surgical site infection in lower limb skin lesion excisions with single dose oral antibiotic prophylaxis: a prospective randomised placebo-controlled double-blind trial. BMJ Open 2014; 4:e005270. [PMID: 25079934 PMCID: PMC4120377 DOI: 10.1136/bmjopen-2014-005270] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the effectiveness of a single perioperative prophylactic 2 g dose of cephalexin in preventing surgical site infection (SSI) following excision of skin lesions from the lower limb. DESIGN Prospective double-blinded placebo-controlled trial testing for difference in infection rates. SETTING Primary care in regional North Queensland, Australia. PARTICIPANTS 52 patients undergoing lower limb skin lesion excision. INTERVENTIONS 2 g dose of cephalexin 30-60 min before excision. MAIN OUTCOME MEASURES Incidence of SSI. RESULTS Incidence of SSI was 12.5% (95% CI 2.7% to 32.4%) in the cephalexin group compared with 35.7% (95% CI 18.6% to 55.9%) in the placebo group (p=0.064). This represented an absolute reduction of 23.21% (95% CI -0.39% to 46.82%), relative reduction of 65.00% (95% CI -12.70% to 89.13%) and number-needed-to-treat of 4.3. CONCLUSIONS Administration of a single 2 g dose of cephalexin 30-60 min before skin lesion excision from the lower limb may produce a reduction in the incidence of infection; however, this study was underpowered to statistically determine this. TRIAL REGISTRATION NUMBER ACTRN12611000595910.
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Affiliation(s)
- Samuel C Smith
- The Townsville Hospital, Townsville, Queensland, Australia
| | - Clare F Heal
- School of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | - Petra G Buttner
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia
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1116
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Hutter G, von Felten S, Sailer MH, Schulz M, Mariani L. Risk factors for postoperative CSF leakage after elective craniotomy and the efficacy of fleece-bound tissue sealing against dural suturing alone: a randomized controlled trial. J Neurosurg 2014; 121:735-44. [PMID: 25036199 DOI: 10.3171/2014.6.jns131917] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cerebrospinal fluid leakage is an immanent risk of cranial surgery with dural opening. Recognizing the risk factors for this complication and improving the technique of dural closure may reduce the associated morbidity and its surgical burden. The aim of this paper was to investigate whether the addition of TachoSil on top of the dural suture reduces postoperative CSF leakage compared with dural suturing alone and to assess the frequency and risk factors for dural leakage and potentially related complications after elective craniotomy. METHODS The authors conducted a prospective, randomized, double-blinded single-center trial in patients undergoing elective craniotomy with dural opening. They compared their standard dural closure by running suture alone (with the use of a dural patch if needed) to the same closure with the addition of TachoSil on top of the suture. The primary end point was the incidence of CSF leakage, defined as CSF collection or any open CSF fistula within 30 days. Secondary end points were the incidence of infection, surgical revision, and length of stay in the intensive care unit (ICU) or intermediate care (IMC) unit. The site of craniotomy, a history of diabetes mellitus, a diagnosis of meningioma, the intraoperative need of a suturable dural substitute, and blood parameters were assessed as potential risk factors for CSF leakage. RESULTS The authors enrolled 241 patients, of whom 229 were included in the analysis. Cerebrospinal fluid leakage, mostly self-limiting subgaleal collections, occurred in 13.5% of patients. Invasive treatment was performed in 8 patients (3.5%) (subgaleal puncture in 6, lumbar drainage in 1, and surgical revision in 1 patient). Diabetes mellitus, a higher preoperative level of C-reactive protein (CRP), and the intraoperative need for a dural patch were positively associated with the occurrence of the primary end point (p = 0.014, 0.01, and 0.049, respectively). Cerebrospinal fluid leakage (9.7% vs 17.2%, OR 0.53 [95% CI 0.23-1.15], p = 0.108) and infection (OR 0.18 [95% CI 0.01-1.18], p = 0.077) occurred less frequently in the study group than in the control group. TachoSil significantly reduced the probability of staying in the IMC unit for 1 day or longer (OR 0.53 [95% CI 0.27-0.99], p = 0.048). Postoperative epidural hematoma and empyema occurred in the control group but not in the study group. CONCLUSIONS Dural leakage after elective craniotomy/durotomy occurs more frequently in association with diabetes mellitus, elevated preoperative CRP levels, and the intraoperative need of a dural patch. This randomized controlled trial showed no statistically significant reduction of postoperative CSF leakage and surgical site infections upon addition of TachoSil on the dural suture, but there was a significant reduction in the length of stay in the IMC unit. Dural augmentation with TachoSil was safe and not related to adverse events. Clinical trial registration no. NCT00999999 ( http://www.ClinicalTrials.gov ).
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1117
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Gharde P, Swarnkar M, Waghmare LS, Bhagat VM, Gode DS, Wagh DD, Muntode P, Rohariya H, Sharma A. Role of antibiotics on surgical site infection in cases of open and laparoscopic cholecystectomy: a comparative observational study. J Surg Tech Case Rep 2014; 6:1-4. [PMID: 25013542 PMCID: PMC4090972 DOI: 10.4103/2006-8808.135132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Surgical site infection (SSI) comes as third most common healthcare related infection which produces morbidity and deaths at large. Still many authors believe that it is better not to use prophylactic antibiotics in simple and uncomplicated cases. Laparoscope, now-a-days is a much used instrument for abdominal surgeries. Even after new aseptic techniques SSI remains to be a major problem. AIMS AND OBJECTIVES To study the effect of antibiotics on superficial SSI in the cases of open and laparoscopic cholecystectomy. OBSERVATION AND RESULTS One hundred patients were enrolled for cholecystectomy. The patients were divided into two groups, A and B. Group A consisted of patients in whom laparoscopic cholecystectomy was done and group B in whom open cholecystectomy was done. The male female ratio was 1: 2.23. The mean age of patients in Group A was 46 years and in Group B was 44; Standard deviation (SD) for age was 14.8% and 13.8% in groups A and B respectively; t-value was 0.654 and P value was 0.515 and they were not significant. The number of males and females was 16 and 26 respectively in Group A and 11 and 31 in Group B. The Chi square X(2) = 1.36 and P value was 0.248 and both were insignificant. The rate of superficial surgical site infection was 2.63% in both the groups. CONCLUSION Our study concludes that there is no difference in the outcome of patients in cases of open as well as laparoscopic cholecystectomy. There is no significant difference in the surgical site infection rate in cases of open as well as laparoscopic cholecystectomy.
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Affiliation(s)
- Pankaj Gharde
- Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
| | - Manish Swarnkar
- Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
| | - Lalitbhushan S Waghmare
- Department of Physiology and Dean Interdisciplinary Sciences, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
| | - Vijay Manohar Bhagat
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
| | - Dilip S Gode
- Honourable Vice Chancellor and laparoscopic surgeon, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
| | - Dhirendra D Wagh
- Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
| | - Pramita Muntode
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
| | - Hrituraj Rohariya
- Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
| | - Anoop Sharma
- Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
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Mishra PK, Ashoub A, Salhiyyah K, Aktuerk D, Ohri S, Raja SG, Luckraz H. Role of topical application of gentamicin containing collagen implants in cardiac surgery. J Cardiothorac Surg 2014; 9:122. [PMID: 25005533 PMCID: PMC4227288 DOI: 10.1186/1749-8090-9-122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 05/28/2014] [Indexed: 11/14/2022] Open
Abstract
Sternal wound infections (SWI) continue to be a major cause of concern after cardiac surgery. It leads to prolonged hospital stay and increased morbidity, mortality and increased hospital costs. Prophylactic systemic antibiotics have been used to prevent surgical site infection (SSI). However, prolonged postoperative use of systemic antibiotics can lead to emergence of resistant organisms. Gentamycin Containing Collagen Implants (GCCI) when used during sternotomy closure produces high local antibiotic concentrations in the wound with a low serum concentration. There is evidence that the concentration of gentamicin in the mediastinal fluid reaches levels high enough to be effective against bacteria that are considered resistant to gentamycin and other antibiotics.However, questions have been raised about the safety and efficacy of GCCI. There were concerns whether GCCI can lead to systemic absorption with renal impairment and whether use of topical antibiotics can lead to emergence of antimicrobial resistance.We, hereby, review the literature on GCCI (Collatamp) and take the opportunity to appraise the scientific community about their role in cardiac surgery. Several recent studies have supported their clinical effectiveness. They should be used in dry condition and should not be soaked in saline even for a short period prior to use. However, for GCCI to become part of routine practice in cardiac surgery further large randomised studies are required. As the incidence of sternal wound infection is low in the specialty of cardiac surgery, for any study to be sufficiently powered to address this issue, multicenter studies might be the way forward.Based on the evidence presented in this manuscript it is recommended GCCI (Collatamp) can be a cost effective adjunct for prevention of sternal wound infection. They can also be used for treatment of Deep Sternal Wound Infection.
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Affiliation(s)
- Pankaj Kumar Mishra
- Cardiothoracic Unit, Heart and Lung Centre, Wednesfield Road, Wolverhampton WV10 0QP, UK
| | - Ahmed Ashoub
- Wessex Cardiothoracic Centre, Tremona Road, Southampton SO16 6Y, UK
| | - Kareem Salhiyyah
- Wessex Cardiothoracic Centre, Tremona Road, Southampton SO16 6Y, UK
| | - Dincer Aktuerk
- Cardiothoracic Unit, Heart and Lung Centre, Wednesfield Road, Wolverhampton WV10 0QP, UK
| | - Sunil Ohri
- Wessex Cardiothoracic Centre, Tremona Road, Southampton SO16 6Y, UK
| | | | - Heyman Luckraz
- Cardiothoracic Unit, Heart and Lung Centre, Wednesfield Road, Wolverhampton WV10 0QP, UK
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Inacio MC, Paxton EW, Fisher D, Li RA, Barber TC, Singh JA. Bariatric surgery prior to total joint arthroplasty may not provide dramatic improvements in post-arthroplasty surgical outcomes. J Arthroplasty 2014; 29:1359-64. [PMID: 24674730 DOI: 10.1016/j.arth.2014.02.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/12/2014] [Accepted: 02/16/2014] [Indexed: 02/01/2023] Open
Abstract
This study compared the total joint arthroplasty (TJA) surgical outcomes of patients who had bariatric surgery prior to TJA to TJA patients who were candidates but did not have bariatric surgery. Patients were retrospectively grouped into: Group 1 (n = 69), those with bariatric surgery >2 years prior to TJA, Group 2 (n = 102), those with surgery within 2 years of TJA, and Group 3 (n = 11,032), those without bariatric surgery. In Group 1, 2.9% (95% CI 0.0-6.9%) had complications within 1 year compared to 5.9% (95% CI 1.3%-10.4%) in Group 2, and 4.1% (95% CI 3.8%-4.5%) in Group 3. Ninety-day readmission (7.2%, 95% CI 1.1%-13.4%) and revision density (3.4/100 years of observation) was highest in Group 1. Bariatric surgery prior to TJA may not provide dramatic improvements in post-operative TJA surgical outcomes.
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1120
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Pawl R. Commentary on four recently published papers on chronic pain and spinal surgery. Surg Neurol Int 2014; 5:S131-2. [PMID: 24843809 PMCID: PMC4023001 DOI: 10.4103/2152-7806.130671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 11/05/2022] Open
Abstract
This commentary evaluates four articles dealing with chronic pain from very different perspectives. The first paper by Tsantoulas and McMahon entitled “Opening paths to novel analgesics: the role of potassium channels in chronic pain” evaluates the membrane neurochemistry of the neural cells governing the transmission of pain impulses in the spinal cord and trigeminal systems. As potassium membrane potentials diminish excitability in the nociceptive pain pathways, damage to these pathways may result in excessive transmission of impulses that contribute to “chronic pain”. Haneder et al. analyzed degeneration in lumbar discs utilizing 23Na magnetic resonance (MR) imaging to determine whether this would help analyze low back pain versus standard 1H MR imaging. As degenerated discs lose glycosaminoglycan, which attracts 23Na, this imaging could potentially be useful in detecting degenerating intervertebral discs. Mroz et al. analyzed how 445 spinal surgeons handled recurrent lumbar discs (first and second recurrences) herniations in the United States. Surgeons in practice for more than 15 years were more likely to select simple disc revision, while those with fewer years experience and performing more than 200 cases per year were more likely to select revision surgery that included some form of inter-body fusion. Lee et al. performed a multivariate analysis of more than 1532 patients to validate a predictive model of the risk of surgical site infection after various spine surgeries. Outcomes analyzed the frequency of reoperations for irrigation/debridement, and evaluated how patients’ comorbidities helped predict the risk of infection (e.g. obesity, rheumatoid arthritis, and the number of levels/extent of surgery).
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Affiliation(s)
- Ronald Pawl
- Department of Neurosurgery, University of Illinois, Chicago (Ret), Center for Pain Treatment and Rehabilitation, Lake Forest Hospital, Lake Forest, Illinois (Ret)
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1121
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Kellam MD, Dieckmann LS, Austin PN. Forced-air warming devices and the risk of surgical site infections. AORN J 2014; 98:354-66; quiz 367-9. [PMID: 24075332 DOI: 10.1016/j.aorn.2013.08.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/05/2013] [Indexed: 11/25/2022]
Abstract
The potential that forced-air warming systems may increase the risk of surgical site infections (SSIs) by acting as a vector or causing unwanted airflow disturbances is a concern to health care providers. To investigate this potential, we examined the literature to determine whether forced-air warming devices increase the risk of SSIs in patients undergoing general, vascular, or orthopedic surgical procedures. We examined 192 evidence sources, 15 of which met our inclusion criteria. Most sources we found indirectly addressed the issue of forced-air warming and only three studies followed patients who were warmed intraoperatively with forced-air warming devices to determine whether there was an increased incidence of SSIs. All of the sources we examined contained methodological concerns, and the evidence did not conclusively suggest that the use of forced-air warming systems increases the risk of SSIs. Given the efficacy of these devices in preventing inadvertent perioperative hypothermia, practitioners should continue to use and clean forced-air warming systems according to the manufacturer's instructions until well-conducted, large-scale trials can further examine the issue.
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1122
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Kapadia BH, McElroy MJ, Issa K, Johnson AJ, Bozic KJ, Mont MA. The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty 2014; 29:929-32. [PMID: 24140271 DOI: 10.1016/j.arth.2013.09.017] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/17/2013] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to measure the impact of periprosthetic joint infections (PJIs) on the length of hospitalization, readmissions, and the associated costs. Between 2007 and 2011, our prospectively collected infection database was reviewed to identify PJIs that occurred following primary total knee arthroplasty (TKA), which required a two-stage revision. We identified 21 consecutive patients and matched them to 21 non-infected patients who underwent uncomplicated primary TKA. The patients who had PJIs had significantly longer hospitalizations (5.3 vs. 3.0 days), more readmissions (3.6 vs. 0.1), and more clinic visits (6.5 vs. 1.3) when compared to the matched group, respectively. The mean annual cost was significantly higher in the infected cohort ($116,383; range, $44,416 to $269,914) when compared to the matched group ($28,249; range, $20,454 to $47,957). Periprosthetic infections following TKA represent a tremendous economic burden for tertiary-care centers and to patients.
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1123
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Monn MF, Hui X, Lau BD, Streiff M, Haut ER, Wick EC, Efron JE, Gearhart SL. Infection and venous thromboembolism in patients undergoing colorectal surgery: what is the relationship? Dis Colon Rectum 2014; 57:497-505. [PMID: 24608307 DOI: 10.1097/DCR.0000000000000054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is evidence demonstrating an association between infection and venous thromboembolism. We recently identified this association in the postoperative setting; however, the temporal relationship between infection and venous thromboembolism is not well defined OBJECTIVE We sought to determine the temporal relationship between venous thromboembolism and postoperative infectious complications in patients undergoing colorectal surgery. DESIGN, SETTING, AND PATIENTS A retrospective cohort analysis was performed using data for patients undergoing colorectal surgery in the National Surgical Quality Improvement Project 2010 database. MAIN OUTCOME MEASURES The primary outcome measures were the rate and timing of venous thromboembolism and postoperative infection among patients undergoing colorectal surgery during 30 postoperative days. RESULTS Of 39,831 patients who underwent colorectal surgery, the overall rate of venous thromboembolism was 2.4% (n = 948); 729 (1.8%) patients were diagnosed with deep vein thrombosis, and 307 (0.77%) patients were diagnosed with pulmonary embolism. Eighty-eight (0.22%) patients were reported as developing both deep vein thrombosis and pulmonary embolism. Following colorectal surgery, the development of a urinary tract infection, pneumonia, organ space surgical site infection, or deep surgical site infection was associated with a significantly increased risk for venous thromboembolism. The majority (52%-85%) of venous thromboembolisms in this population occurred the same day or a median of 3.5 to 8 days following the diagnosis of infection. The approximate relative risk for developing any venous thromboembolism increased each day following the development of each type of infection (range, 0.40%-1.0%) in comparison with patients not developing an infection. LIMITATIONS We are unable to account for differences in data collection, prophylaxis, and venous thromboembolism surveillance between hospitals in the database. Additionally, there is limited patient follow-up. CONCLUSIONS These findings of a temporal association between infection and venous thromboembolism suggest a potential early indicator for using certain postoperative infectious complications as clinical warning signs that a patient is more likely to develop venous thromboembolism. Further studies into best practices for prevention are warranted.
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1124
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Lee JI, Kwon M, Roh JL, Choi JW, Choi SH, Nam SY, Kim SY. Postoperative hypoalbuminemia as a risk factor for surgical site infection after oral cancer surgery. Oral Dis 2014; 21:178-84. [PMID: 24605906 DOI: 10.1111/odi.12232] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/19/2014] [Accepted: 02/28/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Postoperative surgical site infection (SSI) is a frequent postoperative complication in patients with oral cancer and significantly affects patient recovery and medical expenses. The aim of this study was to examine the predictors of SSI in patients undergoing major surgery for oral or oropharyngeal squamous cell carcinoma (OSCC) and to determine the relationship between perioperative albumin and the development of SSI. SUBJECTS AND METHODS In 337 consecutive patients who underwent clean-contaminated surgery for OSCC, serum albumin, glucose, and hemoglobin levels were perioperatively measured. Differences between the groups were examined using Fisher's exact test, Mann-Whitney U-test, and multiple logistic regression analysis. RESULTS Surgical site infection was detected in 88 (26.1%) patients with median time to development of 10 (2-25) days. Multiple logistic regression analysis showed that only postoperative serum albumin < 2.5 g dl(-1) was an independent variable predictive of SSI (P = 0.003). The duration of hospital stay was negatively correlated with postoperative albumin (R(2) = -0.302, P < 0.001). CONCLUSION Early postoperative hypoalbuminemia <2.5 g dl(-1) is an independent risk factor for the development of SSI in patients undergoing oral cancer surgery. Clinicians should be aware of the implications of postoperative hypoalbuminemia and consider more intensive postoperative care in these patients.
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Affiliation(s)
- J-I Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Dorschner P, McElroy LM, Ison MG. Nosocomial infections within the first month of solid organ transplantation. Transpl Infect Dis 2014; 16:171-87. [PMID: 24661423 DOI: 10.1111/tid.12203] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/24/2013] [Accepted: 11/26/2013] [Indexed: 12/11/2022]
Abstract
Infections remain a common complication of solid organ transplantation. Early postoperative infections remain a significant cause of morbidity and mortality in solid organ transplant (SOT) recipients. Although significant effort has been made to understand the epidemiology and risk factors for early nosocomial infections in other surgical populations, data in SOT recipients are limited. A literature review was performed to summarize the current understanding of pneumonia, urinary tract infection, surgical-site infection, bloodstream infection, and Clostridium difficult colitis, occurring within the first 30 days after transplantation.
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Affiliation(s)
- P Dorschner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Boas R, Ensor K, Qian E, Hutzler L, Slover J, Bosco J. The relationship of hospital charges and volume to surgical site infection after total hip replacement. Am J Med Qual 2014; 30:283-8. [PMID: 24604908 DOI: 10.1177/1062860614525830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to analyze the effect of hospital volume and charges on the rate of surgical site infections for total hip replacements (THRs) in New York State (NYS). In NYS, higher volume hospitals have higher charges after THR. The study team analyzed 93,620 hip replacements performed in NYS between 2008 and 2011. Hospital charges increased significantly from $43,713 in 2008 to $50,652 in 2011 (P<.01). Compared with lower volume hospitals, patients who underwent THR at the highest volume hospitals had significantly lower surgical site infection rates (P=.003) and higher total hospital charges (P<.0001). The study team found that in the highest volume hospitals, preventing one surgical site infection was associated with $1.6 million dollars in increased charges.
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Affiliation(s)
| | | | - Edward Qian
- NYU Hospital for Joint Diseases, New York, NY
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Coleman JS, Green I, Scheib S, Sewell C, Lee JMH, Anderson J. Surgical site infections after hysterectomy among HIV-infected women in the HAART era: a single institution's experience from 1999-2012. Am J Obstet Gynecol 2014; 210:117.e1-7. [PMID: 23999425 DOI: 10.1016/j.ajog.2013.08.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/15/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We sought to determine risk factors associated with surgical site infection (SSI) among a cohort of human immunodeficiency virus (HIV)-infected women undergoing hysterectomy during the era of highly active antiretroviral therapy. STUDY DESIGN This is a retrospective study of HIV-infected women who underwent a hysterectomy for benign indications at a tertiary care center. Electronic medical records were reviewed from January 1999 through December 2012. SSI was defined using Centers for Disease Control and Prevention criteria. RESULTS There were 77 HIV-infected women who underwent a hysterectomy: 47 (61%) were abdominal; 16 (21%) were laparoscopic or robot-assisted; and 14 (18%) were vaginal. Acquired immune deficiency syndrome was diagnosed in 58% of patients, and 75% of patients self-reported use of highly active antiretroviral therapy at the time of surgery. There were 17 (22%) SSIs; 5 (29%) superficial incisional wound infections, 3 (18%) vaginal cuff cellulitis, and 9 (53%) pelvic abscesses were diagnosed. After multivariable logistic regression, preoperative albumin level (adjusted odds ratio [aOR], 0.14; 95% confidence interval [CI], 0.02-0.86) and minimally invasive hysterectomy (aOR, 0.16; 95% CI, 0.03-0.84) were associated with decreased SSI. Preoperative absolute CD4 count was not associated with SSI (aOR, 0.99; 95% CI, 0.99-1). CONCLUSION Low preoperative serum albumin levels and abdominal hysterectomy are associated with increased risk of SSIs in HIV-infected women.
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Goi T, Ueda Y, Nakazawa T, Sawai K, Morikawa M, Yamaguchi A. Measures for preventing wound infections during elective open surgery for colorectal cancer: scrubbing with gauze. Int Surg 2014; 99:35-9. [PMID: 24444266 PMCID: PMC3897338 DOI: 10.9738/intsurg-d-13-00144.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In addition to the general surgical-site infection prevention measures in colorectal cancer surgery, we performed a simple subcutaneous scrubbing procedure with gauze at the time of abdominal closure, which reduced the incidence of wound infections. There are 289 patients whose primary colon cancer lesions were removed by elective surgeries. They were divided into Group A (74 patients with no wound infection prevention measures who were treated from 2002 to 2003), Group B (76 patients with wound infection prevention measures who were treated from 2007 to 2008), and Group C (139 patients with subcutaneous scrubbing with gauze plus the measures in Group B who were treated from 2009 to 2012). The incidence in Group A was 23%, while the corresponding values in Group B and Group C were 14.5% and 2.9%, respectively. The incidence of wound infections was substantially reduced by additional subcutaneous scrubbing with a saline solution and gauze during closure of a surgical incision. This very simple procedure was considered useful for surgical site infection prevention.
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Affiliation(s)
- Takanori Goi
- First Department of Surgery, University of Fukui, Fukui, Japan
| | - Yuki Ueda
- First Department of Surgery, University of Fukui, Fukui, Japan
| | | | - Katsuji Sawai
- First Department of Surgery, University of Fukui, Fukui, Japan
| | | | - Akio Yamaguchi
- First Department of Surgery, University of Fukui, Fukui, Japan
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Labsaili H, Borik W, Demondion P, Leprince P. [Mediastinal omental flap in the treatment of post cardiac surgery mediastinitis: report of a case]. Pan Afr Med J 2014; 19:308. [PMID: 25883735 PMCID: PMC4393996 DOI: 10.11604/pamj.2014.19.308.5596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022] Open
Abstract
Nous rapportons le cas d'un patient diabétique et obèse, opéré d'une chirurgie de revascularisation myocardique avec l'utilisation des deux artères mammaires internes comme greffon. L'intervention s'est compliquée d'une médiastinite traitée premièrement à thorax fermé et secondairement par une épiplooplastie. Cette technique reste efficace dans les médiastinites graves et délabrantes. Tout chirurgien cardiaque et digestif doit la connaitre.
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Affiliation(s)
- Hicham Labsaili
- Service de Chirurgie Thoracique et Cardio-Vasculaire, Institut du Cœur, Hôpital de la pitié salpêtrière, Paris, France
| | - Waseem Borik
- Service de Chirurgie Thoracique et Cardio-Vasculaire, Institut du Cœur, Hôpital de la pitié salpêtrière, Paris, France
| | - Pierre Demondion
- Service de Chirurgie Thoracique et Cardio-Vasculaire, Institut du Cœur, Hôpital de la pitié salpêtrière, Paris, France
| | - Pascal Leprince
- Service de Chirurgie Thoracique et Cardio-Vasculaire, Institut du Cœur, Hôpital de la pitié salpêtrière, Paris, France
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1130
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Abstract
Silver hydrogel dressings are antimicrobial, nonadherent, and have an absorptive capacity many times their weight. Fifty-nine (49.44 ± 16.85 years) foot and ankle patients with incisions >1 cm were prospectively enrolled to compare infection, scarring, and complication rates between the postoperative use of a silver hydrogel sheet (SHS) dressing and a standard petroleum-based (P) dressing. Overall, there were 5 (8.47%) infections; 4 (6.78%) superficial and 1 (1.69%) deep. The SHS group had 1 (3.45%) superficial infection, whereas the P group had 3 (10.00%) superficial infections and 1 (3.33%) deep infection. Infection incidence was similar for both groups (P = .37). However, in the P group, 3 (10.00%) patients developed wound dehiscence and 1 (1.69%) patient developed a fibrinous scab. Compared with SHS patients, the P patients had a greater incidence of incisional complications (1 [3.45%] vs 8 [26.67%], respectively; P = .03). The percent change in scar length was greater in the SHS group (18.04 ± 41.10%) when compared with the P group (2.00 ± 9.93%; P < .001) while the percent change in scar width was similar in the 2 groups (P = .19). The lower incidence of incisional complications and the greater reduction in scar length suggest that the inherent properties of the silver hydrogel dressing aid in postsurgical healing.
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1131
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Glasgow RE, Hawn MT, Hosokawa PW, Henderson WG, Min SJ, Richman JS, Tomeh MG, Campbell D, Neumayer LA. Comparison of prospective risk estimates for postoperative complications: human vs computer model. J Am Coll Surg 2013; 218:237-45.e1-4. [PMID: 24440066 DOI: 10.1016/j.jamcollsurg.2013.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/23/2013] [Accepted: 10/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Surgical quality improvement tools such as NSQIP are limited in their ability to prospectively affect individual patient care by the retrospective audit and feedback nature of their design. We hypothesized that statistical models using patient preoperative characteristics could prospectively provide risk estimates of postoperative adverse events comparable to risk estimates provided by experienced surgeons, and could be useful for stratifying preoperative assessment of patient risk. STUDY DESIGN This was a prospective observational cohort. Using previously developed models for 30-day postoperative mortality, overall morbidity, cardiac, thromboembolic, pulmonary, renal, and surgical site infection (SSI) complications, model and surgeon estimates of risk were compared with each other and with actual 30-day outcomes. RESULTS The study cohort included 1,791 general surgery patients operated on between June 2010 and January 2012. Observed outcomes were mortality (0.2%), overall morbidity (8.2%), and pulmonary (1.3%), cardiac (0.3%), thromboembolism (0.2%), renal (0.4%), and SSI (3.8%) complications. Model and surgeon risk estimates showed significant correlation (p < 0.0001) for each outcome category. When surgeons perceived patient risk for overall morbidity to be low, the model-predicted risk and observed morbidity rates were 2.8% and 4.1%, respectively, compared with 10% and 18% in perceived high risk patients. Patients in the highest quartile of model-predicted risk accounted for 75% of observed mortality and 52% of morbidity. CONCLUSIONS Across a broad range of general surgical operations, we confirmed that the model risk estimates are in fairly good agreement with risk estimates of experienced surgeons. Using these models prospectively can identify patients at high risk for morbidity and mortality, who could then be targeted for intervention to reduce postoperative complications.
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Affiliation(s)
| | - Mary T Hawn
- Department of Surgery, University of Alabama, Birmingham, AL
| | | | | | - Sung-Joon Min
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Majed G Tomeh
- University of Colorado Health Outcomes Program, Aurora, CO
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1132
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Siribumrungwong B, Srikuea K, Thakkinstian A. Comparison of superficial surgical site infection between delayed primary and primary wound closures in ruptured appendicitis. Asian J Surg 2013; 37:120-4. [PMID: 24238751 DOI: 10.1016/j.asjsur.2013.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/09/2013] [Accepted: 09/23/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Delayed primary (DPC) and primary (PC) wound closures have been applied in ruptured appendicitis, but results were controversial. This study aims at comparing the rate of superficial surgical site infection (SSI) in ruptured appendicitis between DPC and PC. METHODS A retrospective cohort of ruptured appendicitis was conducted between October 2006 and November 2009. Demographic, operative findings and postoperative infection data were retrieved. The superficial SSI rates between groups were compared using an exact test. An odds ratio of SSI was then estimated. RESULTS One-hundred and twenty eight patients with ruptured appendicitis were eligible and their data were retrieved; 115 (90%) patients had received DPC and 13 (10%) patients had received PC. The SSI rate was much lower in PC patients than in DPC patients, i.e., 7.7% [95% confidence interval (CI): 0.02, 36.0] versus 27.8% (95% CI: 19.9, 37.0), respectively. There was an approximately 72% lower risk of SSI in the PC group than in the DPC group, but this did not reach statistical significance (p = 0.18). CONCLUSION Our study suggested that PC does not increase risk of SSI in low SSI risk patients with ruptured appendicitis. DPC should not be routinely done.
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Affiliation(s)
- Boonying Siribumrungwong
- Department of Surgery, Thammasat University Hospital, Thammasat University Rangsit Campus, Pathumthani, Thailand; Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Kanoklada Srikuea
- Department of Surgery, Thammasat University Hospital, Thammasat University Rangsit Campus, Pathumthani, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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1133
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van Boxel GI, Hart M, Kiszely A, Appleton S. Elective day-case laparoscopic cholecystectomy: a formal assessment of the need for outpatient follow-up. Ann R Coll Surg Engl 2013; 95:e142-6. [PMID: 24165332 PMCID: PMC4311530 DOI: 10.1308/003588413x13629960049559] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Elective laparoscopic cholecystectomy (LC) is performed routinely as day-case surgery. Most hospital trusts have a policy of no routine postoperative outpatient follow-up although there are no formal guidelines on this. The aim of this retrospective study was to identify the incidence of complications, the degree of symptom resolution and patient satisfaction with a view to formally appraising the need for outpatient follow-up. METHODS Patients who underwent LC in the period between February 2011 and June 2012 were contacted retrospectively by telephone. A standardised questionnaire was used to ascertain the incidence of surgical site infection (SSI), other complications, symptom resolution and patient satisfaction. RESULTS A total of 211 responses were collected. The rate of SSI was 7.6% (n=16), with the only specific risk factor being smoking (p=0.027). All other complications had a combined incidence of 7% (n=15). There was complete resolution of symptoms in 64% of patients. Of the 36% of patients with residual symptoms, 45% described abdominal discomfort or pain, 41% described reflux symptoms and 14% complained of diarrhoea. Patient satisfaction was very high (96%), yet 33% of patients visited their general practitioner postoperatively in relation to their surgery. CONCLUSIONS Patients are highly satisfied with elective day-case LC. However, SSI is not uncommon, occurring in 1 in 13 patients. Although the majority of patients experience complete symptom resolution, a significant proportion do not. In our experience, routine outpatient follow-up is not required. Nevertheless, the lack of formal follow-up may prove a missed learning opportunity, potentially resulting in inappropriate patient selection for surgery.
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Affiliation(s)
- G I van Boxel
- Wycombe Hospital, Queen Alexandra Road, High Wycombe, Buckinghamshire HP11 2TT, UK.
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1134
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Lake AG, McPencow AM, Dick-Biascoechea MA, Martin DK, Erekson EA. Surgical site infection after hysterectomy. Am J Obstet Gynecol 2013; 209:490.e1-9. [PMID: 23770467 DOI: 10.1016/j.ajog.2013.06.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 05/16/2013] [Accepted: 06/10/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective was to estimate the occurrence of surgical site infections (SSI) after hysterectomy and the associated risk factors. STUDY DESIGN We conducted a cross-sectional analysis of the 2005-2009 American College of Surgeons National Surgical Quality Improvement Program participant use data files to analyze hysterectomies. Different routes of hysterectomy were compared. The primary outcome was to identify the occurrence of 30-day superficial SSI (cellulitis) after hysterectomy. Secondary outcomes were the occurrence of deep and organ-space SSI after hysterectomy. Logistic regression models were conducted to further explore the associations of risks factors with SSI after hysterectomy. RESULTS A total of 13,822 women were included in our final analysis. The occurrence of postoperative cellulitis after hysterectomy was 1.6% (n = 221 women). Risk factors that were associated with cellulitis were route of hysterectomy with an adjusted odds ratio (AOR) of 3.74 (95% confidence interval [CI], 2.26-6.22) for laparotomy compared with the vaginal approach, operative time >75th percentile (AOR, 1.84; 95% CI, 1.40-2.44), American Society of Anesthesia class ≥ 3 (AOR, 1.79; 95% CI, 1.31-2.43), body mass index ≥40 kg/m(2) (AOR, 2.65; 95% CI, 1.85-3.80), and diabetes mellitus (AOR, 1.54; 95% CI, 1.06-2.24) The occurrence of deep and organ-space SSI was 1.1% (n = 154 women) after hysterectomy. CONCLUSION Our finding of the decreased occurrence of superficial SSI after the vaginal approach for hysterectomy reaffirms the role for vaginal hysterectomy as the route of choice for hysterectomy.
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1135
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Cohen B, Choi YJ, Hyman S, Furuya EY, Neidell M, Larson E. Gender differences in risk of bloodstream and surgical site infections. J Gen Intern Med 2013; 28:1318-25. [PMID: 23605308 DOI: 10.1007/s11606-013-2421-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 12/17/2012] [Accepted: 03/13/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Identifying patients most at risk for hospital- and community-associated infections is one essential strategy for preventing infections. OBJECTIVE To investigate whether rates of community- and healthcare-associated bloodstream and surgical site infections varied by patient gender in a large cohort after controlling for a wide variety of possible confounders. DESIGN Retrospective cohort study. PARTICIPANTS All patients discharged from January 1, 2006 through December 31, 2008 (133,756 adult discharges and 66,592 pediatric discharges) from a 650-bed tertiary care hospital, a 220-bed community hospital, and a 280-bed pediatric acute care hospital within a large, academic medical center in New York, NY. MAIN MEASURES Data were collected retrospectively from various electronic sources shared by the hospitals and linked using patients' unique medical record numbers. Infections were identified using previously validated computerized algorithms. KEY RESULTS Odds of community-associated bloodstream infections, healthcare-associated bloodstream infections, and surgical site infections were significantly lower for women than for men after controlling for present-on-admission patient characteristics and events during the hospital stay [odds ratios (95 % confidence intervals) were 0.85 (0.77-0.93), 0.82 (0.74-0.91), and 0.78 (0.68-0.91), respectively]. Gender differences were greatest for older adolescents (12-17 years) and adults 18-49 years and least for young children (<12 years) and older adults (≥ 70 years). CONCLUSIONS In this cohort, men were at higher risk for bloodstream and surgical site infections, possibly due to differences in propensity for skin colonization or other anatomical differences.
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1136
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Mazurek MJ, Rysz M, Jaworowski J, Nowakowski F, Krajewski R, Starościak S, Pietras M, Polowniak-Pracka H, Włodarczyk A. Contamination of the surgical field in head and neck oncologic surgery. Head Neck 2013; 36:1408-12. [PMID: 24038658 DOI: 10.1002/hed.23473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 06/04/2013] [Accepted: 08/14/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the timing and type of surgical field contamination in 50 consecutive resections for advanced head and neck cancer with same-stage tissue reconstruction and to analyze the relationship between contamination and the surgical site infection. METHODS Swabs from the surgical field and from surgical drapes close to the field were taken every 2 hours (at 0 hour, 2 hours, 4 hours, and 6 hours) and sent for a standard microbiological diagnostic procedure. Results were recorded in Microsoft Excel and analyzed with SPSS. RESULTS We collected 336 swabs of which 71% were contaminated. Polymicrobial contamination was observed in 153 samples (45%). Twenty-six species of pathogens were found, the most frequent was Streptococcus species. Surgical site infection with positive culture occurred in 3 patients. CONCLUSION In head and neck surgery for advanced cancer, standard aseptic procedures do not prevent contamination of the surgical field with physiological bacterial flora of the skin and oral cavity. Although contamination was common, surgical site infection was rare.
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Affiliation(s)
- Maciej J Mazurek
- Student Research Group, Head and Neck Cancer Department, Maria Sklodowska-Curie Cancer Center, Warsaw, Poland
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1137
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Berger RL, Li LT, Hicks SC, Davila JA, Kao LS, Liang MK. Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair. J Am Coll Surg 2013; 217:974-82. [PMID: 24051068 DOI: 10.1016/j.jamcollsurg.2013.08.003] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/13/2013] [Accepted: 08/05/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Current risk-assessment tools for surgical site occurrence (SSO) and surgical site infection (SSI) are based on expert opinion or are not specific to open ventral hernia repairs. We aimed to develop a risk-assessment tool for SSO and SSI and compare its performance against existing risk-assessment tools in patients with open ventral hernia repair. STUDY DESIGN A retrospective study of patients undergoing open ventral hernia repair (n = 888) was conducted at a single institution from 2000 through 2010. Rates of SSO and SSI were determined by chart review. Stepwise regression models were built to identify predictors of SSO and SSI and internally validated using bootstrapping. Odds ratios were converted to a point system and summed to create the Ventral Hernia Risk Score (VHRS) for SSO and SSI, respectively. Area under the receiver operating characteristic curve was used to compare the accuracy of the VHRS models against the National Nosocomial Infection Surveillance Risk Index, Ventral Hernia Working Group (VHWG) grade, and VHWG score. RESULTS The rates of SSO and SSI were 33% and 22%, respectively. Factors associated with SSO included mesh implant, concomitant hernia repair, dissection of skin flaps, and wound class 4. Predictors of SSI included concomitant repair, dissection of skin flaps, American Society of Anesthesiologists class ≥ 3, wound class 4, and body mass index ≥ 40. The accuracy of the VHRS in predicting SSO and SSI exceeded National Nosocomial Infection Surveillance and VHWG grade, but was not better than VHWG score. CONCLUSIONS The VHRS identified patients at increased risk for SSO/SSI more accurately than the National Nosocomial Infection Surveillance scores and VHWG grade, and can be used to guide clinical decisions and patient counseling.
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1138
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Abstract
We report 3 clinical cases of septic nonunions of lower limb long bones in which the pathogenicity of Propionibacterium acnes was retained after several weeks of poor outcome. The patients had fractures that were treated by internal fixation, without initially suspected infection. The diagnosis of delayed union coincided with the onset of treatment. Support was performed in 2 steps, allowing for the collection of several deep samples that were referred for microbiological analysis. Molecular techniques for microbiological investigation were performed on perioperative samples and were not contributive. The detection of P acnes, which was identified after several days of incubation, prompted us to consider the role of this bacterium. The presence of P acnes is regularly interpreted as contamination of samples during collection or handling in the laboratory. A multidisciplinary decision to make the diagnosis of surgical site infection with P acnes and specific antibiotic treatment for several months led to consolidation in all the patients. The ability of bacteria of the genus Propionibacterium to cause insidious surgical site infections should not be underestimated, and more extensive sample incubation is essential to diagnose such infections.
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1139
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Levy SM, Phatak UR, Tsao K, Wray CJ, Millas SG, Lally KP, Kao LS. What is the quality of reporting of studies of interventions to increase compliance with antibiotic prophylaxis? J Am Coll Surg 2013; 217:770-9. [PMID: 24041563 DOI: 10.1016/j.jamcollsurg.2013.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/13/2013] [Accepted: 06/13/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite studies reporting successful interventions to increase antibiotic prophylaxis compliance, surgical site infections remain a significant problem. The reasons for this lack of improvement are unknown. This review evaluates the internal and external validity of quality improvement studies of interventions to increase surgical antibiotic prophylaxis compliance. STUDY DESIGN Three investigators independently performed systematic literature searches and selected eligible studies that evaluated interventions to improve perioperative antibiotic prophylaxis timing, type, and/or discontinuation. Studies published before the Surgical Infection Prevention project inception in 2002 were excluded. Each study was assessed based on modified criteria for evaluating quality improvement studies (Standards for Quality Improvement Reporting Excellence) and for facilitating implementation of evidence into practice (Reach-Efficacy-Adoption-Implementation-Maintenance). RESULTS Forty-six articles met inclusion criteria; 93% reported improvement in antibiotic prophylaxis compliance. Surgical site infections were evaluated in 50% of studies and 65% reported an improvement. Less than 5% of studies used randomization, allocation concealment, or blinding. Nine percent of studies described efforts to minimize bias in the design results and analysis and 13% described a sample size calculation. Approximately one-third of studies described participant adoption of the intervention (26%), factors affecting generalizability (33%), or implementation barriers (37%). Most studies (80%) used multiple interventions; no single intervention was associated with change in compliance. Studies with the lowest baseline compliance showed the greatest improvement, regardless of the intervention(s). CONCLUSIONS The methodology and reporting of quality improvement studies on perioperative antibiotic prophylaxis is suboptimal, and factors that would improve generalizability of successful intervention implementation are infrequently reported. Clinicians should use caution in applying the results of these studies to their general practice.
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1140
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Poultsides LA, Memtsoudis SG, Vasilakakos T, Wanivenhaus F, Do HT, Finerty E, Alexiades M, Sculco TP. Infection following simultaneous bilateral total knee arthroplasty. J Arthroplasty 2013; 28:92-5. [PMID: 23937920 DOI: 10.1016/j.arth.2013.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 06/29/2013] [Accepted: 07/02/2013] [Indexed: 02/01/2023] Open
Abstract
Between 2000 and 2009, demographics, clinical characteristics, and infection details were compared among patients undergoing simultaneous BTKA (SBTKA), staged or UTKA. 2825 (16%) patients underwent SB, 1151 (6%) staged, and 13,983 (78%) UTKA. The overall infection rate following SBTKA (0.57%) was lower compared to staged (1.39%) or UTKA (1.1%) (P=0.01). The in-hospital infection rate was lower for the SB group (0.28% vs. 0.96% vs. 0.69%, respectively, P=0.01). The rate of late infections was comparable between the groups (0.32% vs. 0.43% vs. 0.43%, respectively, P=0.72). The rate of superficial infection was lower in the simultaneous cohort (0.28% vs. 1.04% vs. 0.87%; P=0.003). The overall rate of deep infection and reoperation for infection was similar among the groups. Among patients with late infection, age, gender, comorbidity score, time to infection, and most common organism isolated were not significantly different between the groups. Among infected patients after SB or staged TKA, 3 SB patients (18.75%), and 3 staged (20%) had bilateral involvement (P=1.0). Staged patients had more 2nd side infections, while simultaneous patients had more 1st side infections (P=0.02). Regression analysis showed that UTKA patients were 2.5 times more likely to develop in-hospital infection compared to SBTKA, while staged patients were almost 3.4 times more likely. Each additional hospital day increased the risk of late infection by 11.3%. SBTKA demonstrates an advantage over staged and maintains the safety profile of unilateral approaches with respect to infectious complications.
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Affiliation(s)
- Lazaros A Poultsides
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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1141
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Maletis GB, Inacio MCS, Reynolds S, Desmond JL, Maletis MM, Funahashi TT. Incidence of postoperative anterior cruciate ligament reconstruction infections: graft choice makes a difference. Am J Sports Med 2013; 41:1780-5. [PMID: 23749343 DOI: 10.1177/0363546513490665] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Infections after anterior cruciate ligament reconstruction (ACLR) can be devastating. Hamstring tendon autografts may be more susceptible to infections than other graft types. PURPOSE To determine the incidence of surgical site infections (SSIs) in a large sample of patients who underwent ACLR and to evaluate the risk of superficial and deep SSIs associated with grafts used for ACLR. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS All primary ACLRs performed between February 2005 and September 2010 registered in the Kaiser Permanente ACLR registry were included in the study. The graft types evaluated included the bone-patellar tendon-bone (BPTB) autograft, hamstring tendon autograft, and allograft (all types). The main end point of the study, SSIs (deep and superficial), was prospectively ascertained using an electronic screening algorithm and adjudicated by the principal investigator. Descriptive statistics were used to describe the cohort, and logistic regression models were used to evaluate the likelihood of an infection. RESULTS There were 10,626 cases that fit the study criteria. The overall cohort was 64% male, mean age was 29 ± 11 years, and mean body mass index (BMI) was 27 ± 5 kg/m2. The overall incidence of SSIs was 0.48% (n = 51), with 17 (0.16%) superficial infections and 34 (0.32%) deep infections. Hamstring tendon autografts (n = 20; 0.61%) had the highest incidence of deep SSIs of the graft types (BPTB autograft, n = 2 [0.07%]; allograft, n = 12 [0.27%]; P < .001). After adjusting for age, sex, and BMI, the likelihood of a patient with a hamstring autograft having a deep SSI was 8.24 times higher (95% CI, 1.91-35.55; P = .005) than someone receiving a BPTB autograft. The risk of infections in allografts was not statistically significantly higher than BPTB autografts. CONCLUSION The overall SSI rate after ACLR was 0.48%. Deep SSIs were identified in 0.32% of the ACLR cases and superficial SSIs in 0.16%. An 8.2-times higher risk of SSIs was observed in hamstring tendon autografts compared with BPTB autografts. No difference in SSI incidence was identified between allografts and BPTB autografts. Surgeons should bear in mind that although the overall infection rates after ACLR are low, there is an increased risk of deep infections with hamstring tendon autografts.
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Affiliation(s)
- Gregory B Maletis
- Surgical Outcomes and Analysis Department, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92123, USA
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1142
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Shields RK, Clancy CJ, Minces LR, Shigemura N, Kwak EJ, Silveira FP, Abdel-Massih RC, Bhama JK, Bermudez CA, Pilewski JM, Crespo M, Toyoda Y, Nguyen MH. Epidemiology and outcomes of deep surgical site infections following lung transplantation. Am J Transplant 2013; 13:2137-45. [PMID: 23710593 DOI: 10.1111/ajt.12292] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/18/2013] [Accepted: 04/04/2013] [Indexed: 01/25/2023]
Abstract
We conducted a retrospective study of deep surgical site infections (SSIs) among consecutive patients who underwent lung transplantation (LTx) at a single center from 2006 through 2010. Thirty-one patients (5%) developed SSIs at median 25 days after LTx. Empyema was most common (42%), followed by surgical wound infections (29%), mediastinitis (16%), sternal osteomyelitis (6%), and pericarditis (6%). Pathogens included Gram-positive bacteria (41%), Gram-negative bacteria (41%), fungi (10%) and Mycobacterium abscessus, Mycoplasma hominis and Lactobacillus sp. (one each). Twenty-three percent of SSIs were due to pathogens colonizing recipients' native lungs at time of LTx, suggesting surgical seeding as a source. Patient-related independent risk factors for SSIs were diabetes and prior cardiothoracic surgery; procedure-related independent risk factors were LTx from a female donor, prolonged ischemic time and number of perioperative red blood cell transfusions. Mediastinitis and sternal infections were not observed among patients undergoing minimally invasive LTx. SSIs were associated with 35% mortality at 1 year post-LTx. Lengths of stay and mortality in-hospital and at 6 months and 1 year were significantly greater for patients with SSIs other than empyema. In conclusion, deep SSIs were uncommon, but important complications in LTx recipients because of their diverse microbiology and association with increased mortality.
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Affiliation(s)
- R K Shields
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Kapadia BH, Johnson AJ, Issa K, Mont MA. Economic evaluation of chlorhexidine cloths on healthcare costs due to surgical site infections following total knee arthroplasty. J Arthroplasty 2013; 28:1061-5. [PMID: 23540539 DOI: 10.1016/j.arth.2013.02.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/08/2013] [Accepted: 02/20/2013] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to evaluate the overall annual healthcare cost savings of adding a pre-operative chlorhexidine cloth preparation protocol. We used reports from the National Healthcare Safety Network and previously published reports to determine a range of surgical site infection rates following total knee arthroplasty and the cost per revision procedure. The savings listed are potential, but may be less. The cost benefit of using chlorhexidine at our institution per 1,000 total knee arthroplasty patients was a net savings of approximately $2.1 million. The annual healthcare savings ranged from $0.78 to $3.18 billion. This epidemiologic evaluation of using chlorhexidine prior to undergoing total knee arthroplasty has demonstrated the potential to decrease healthcare costs primarily by decreasing the incidence of surgical site infections.
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Affiliation(s)
- Bhaveen H Kapadia
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
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1144
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Dusch N, Goranova D, Herrle F, Niedergethmann M, Kienle P. Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs direct suture. Colorectal Dis 2013; 15:1033-40. [PMID: 23634717 DOI: 10.1111/codi.12211] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/04/2012] [Indexed: 02/08/2023]
Abstract
AIM Surgical site infection (SSI) is a common complication following ileostomy closure with a frequency of up to 40%. This prospective randomized controlled trial was initiated to compare two surgical techniques - direct suture (DS) and purse-string suture (PSS) - used to close the wound following ileostomy closure. The primary end-point was the SSI rate. Secondary end-points were cosmetic outcome [using two validated scales: the Patient and Observer Scar Assessment Scale (POSAS) and the Body Image Questionnaire (BIQ)] and the influence of other factors on the SSI rate. METHOD Of a total of 99 patients screened, 84 were included in this study. Forty-three patients were randomized into the PSS group and 41 were randomized into the DS group. Follow up was performed within 3 days after surgery, at discharge, and 30 days and 6 months after the operation. RESULTS In the PSS group there were no cases of SSI compared with 10 (24%) cases in the DS group (P = 0.0004). There were no statistically significant differences in cosmetic outcome between the two groups. No other statistically significant factors influencing the incidence of SSI could be identified. CONCLUSION The rate of SSI is significantly lower following PSS than following DS, and both techniques have a similar cosmetic outcome. PSS closure should be considered as standard of care for wound closure after ileostomy reversal.
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Affiliation(s)
- N Dusch
- Department of Surgery, University of Heidelberg, Mannheim, Germany
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1145
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Woodward CS, Son M, Taylor R, Husain SA. Prevention of sternal wound infection in pediatric cardiac surgery: a protocolized approach. World J Pediatr Congenit Heart Surg 2013; 3:463-9. [PMID: 23804910 DOI: 10.1177/2150135112454145] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sternal wound infections (SWIs) are a costly complication for children after cardiac surgery, increasing morbidity, mortality, and financial cost. There are no pediatric guidelines to reduce the incidence of SWI in this vulnerable population. METHODS A quality improvement, multidisciplinary team was formed, and a protocol to prevent SWI was developed. A prospective review of patients who underwent pediatric cardiac surgery was conducted over a two-year period to follow adherence to the protocol and incidence of SWI. The Centers for Disease Control definitions for surgical site infections were used to determine the depth and presence of infection. RESULTS Three hundred and eight children <18 years of age had sternotomies during the study period. There was a reduction in all SWI between the first and second years of the study (odds ratio [OR] = 0.35; confidence interval [CI] 95% 0.12-1.01; P = .059). Delayed sternal closure (DSC) was associated with increased risk of SWI (OR = 5.4; CI 95% 2.13-14.9; P ≤ .001). Institution of a protocol in patients with DSC was associated with decreased infections during the second year (first year: n = 7 (14%), second year: n = 2 (4%), P = .14). CONCLUSIONS Institution of a protocol was associated with a decreased number of infections in children. A multicenter study of a bundled protocol approach to SWI prevention is needed. Children with DSC had a significantly higher risk of developing a wound infection. Initiating strategies to reduce SWI with a focus on children with DSC may result in improved overall infection rates.
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Affiliation(s)
- Cathy S Woodward
- Division of Critical Care, Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX, USA
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1146
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Kahramanca Ş, Kaya O, Azılı C, Celep B, Gökce E, Küçükpınar T. Does topical rifampicin reduce the risk of surgical field infection in hernia repair? Turk J Surg 2013; 29:54-8. [PMID: 25931846 DOI: 10.5152/ucd.2013.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/30/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Inguinal hernia operations are common procedures in general surgery. There have been many approaches in the historical development of hernia repair; tension free repair with mesh being the most commonly used technique today. Although it is a clean wound, antibiotic use is still controversial due to concerns about infection related to synthetic mesh. We aimed to determine the probable role of topical rifampicin in patients with tension-free hernia repair and mesh support. MATERIAL AND METHODS The charts of patients who underwent tension-free inguinal hernia repair were retrospectively analyzed. Information and operative notes on patients, in whom synthetic materials were used, were identified. The patients were divided into two groups, placebo group (G1) and patients with application of topical rifampicin on the mesh (G2). Infection rates between the groups in the early postoperative period were compared. RESULTS The mean age of the 278 patients who were included in the study was 49.6±15.39 and the female/male ratio was 10/268. There were recurrent hernias in four patients and superficial wound infections in 22 patients in the early period. One patient had testicle torsion and underwent an orchiectomy. There were no significant differences between the groups in terms of age and gender. The types of hernia and body mass index were homogenous between the two groups. In the early postoperative period the infection rates were 16/144 (11.1%) and 6/134 (4.48%) in the groups, respectively, with the difference being statistically significant (p=0.041). CONCLUSION We suggest that applying rifampicin locally can decrease surgical site infection in hernia operations where meshes are used.
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Affiliation(s)
- Şahin Kahramanca
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Teaching Hospital, Ankara, Turkey
| | - Oskay Kaya
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Teaching Hospital, Ankara, Turkey
| | - Cem Azılı
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Teaching Hospital, Ankara, Turkey
| | - Bahadır Celep
- Department of General Surgery, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Emre Gökce
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Teaching Hospital, Ankara, Turkey
| | - Tevfik Küçükpınar
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Teaching Hospital, Ankara, Turkey
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1147
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Abstract
Complex perineal wounds are at risk for nonhealing. High-risk procedures include proctectomy for Crohn disease, anal cancer and radiated distal rectal cancers. A basic understanding of both patient and procedural risk factors is helpful in planning and executing operative procedures for these conditions and to minimize associated wound complications. Diabetes, obesity, and malnutrition may contribute to wound breakdown and failure to heal. Delaying operative intervention, adding nutritional supplementation, and employing intestinal diversion as well as myocutaneous flaps may help optimize conditions for wound healing.
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Affiliation(s)
- Allen Kamrava
- LA Colon and Rectal Surgical Associates, Beverly Hills, California
| | - Najjia N. Mahmoud
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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1148
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Bateman BT, Rassen JA, Schneeweiss S, Bykov K, Franklin JM, Gagne JJ, Polinski JM, Liu J, Kulik A, Fischer MA, Choudhry NK. Adjuvant vancomycin for antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2013; 146:472-8. [PMID: 23541855 DOI: 10.1016/j.jtcvs.2013.02.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 02/12/2013] [Accepted: 02/28/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The incidence of hospital-acquired Clostridium difficile infection (CDI) has increased rapidly over the past decade; patients undergoing major surgery, including coronary artery bypass grafting (CABG), are at particular risk. Intravenous vancomycin exposure has been identified as an independent risk factor for CDI, but this is controversial. It is not known whether vancomycin administered for surgical site infection prophylaxis increases the risk of CDI. METHODS Using data from the Premier Perspective Comparative Database, we assembled a cohort of 69,807 patients undergoing CABG surgery between 2004 and 2010 who received either a cephalosporin alone (65.1%) or a cephalosporin plus vancomycin (34.9%) on the day of surgery. Patients were observed for CDI until discharge from the index hospitalization. In these groups, we evaluated the comparative rate of postoperative CDI with Cox models; confounding was addressed using propensity scores. RESULTS In all, 77 (0.32%) of the 24,393 patients receiving a cephalosporin plus vancomycin and 179 (0.39%) of the 45,414 patients receiving a cephalosporin alone had postoperative CDI (unadjusted hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.56-0.95). After adjusting for confounding variables with either propensity score matching or stratification, there was no meaningful association between adjuvant vancomycin exposure and postoperative CDI (HR, 0.85; 95% CI, 0.61-1.19; and HR, 0.85; 95% CI, 0.63-1.15, respectively). Results of multiple sensitivity analyses were similar to the main findings. CONCLUSIONS After adjustment for patient and surgical characteristics, a short course of prophylactic vancomycin was not associated with an increased risk of CDI among patients undergoing CABG surgery.
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Affiliation(s)
- Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass 02115, USA.
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1149
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Sajid MS, Craciunas L, Sains P, Singh KK, Baig MK. Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials. Gastroenterol Rep (Oxf) 2013; 1:42-50. [PMID: 24759666 PMCID: PMC3941439 DOI: 10.1093/gastro/got003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: The objective of this article is to systematically analyse the randomized, controlled trials that compare the use of antibacterial sutures (ABS) for skin closure in controlling surgical site infections. Methods: Randomized, controlled trials on surgical patients comparing the use of ABS for skin closure in controlling the surgical site infections were analysed systematically using RevMan® and combined outcomes were expressed as odds ratios (OR) and standardized mean differences (SMD). Results: Seven randomized, controlled trials evaluating 1631 patients were retrieved from electronic databases. There were 760 patients in the ABS group and 871 patients in the simple suture group. There was moderate heterogeneity among trials (Tau2 = 0.12; chi2 = 8.40, df = 6 [P < 0.01]; I2 = 29%). Therefore in the random-effects model, the use of ABS for skin closure in surgical patients was associated with a reduced risk of developing surgical site infections (OR, 0.16; 95% CI, 0.37, 0.99; z = 2.02; P < 0.04) and postoperative complications (OR, 0.56; 95% CI, 0.32, 0.98 z = 2.04; P = 0.04). The durations of operation and lengths of hospital stay were similar following the use of ABS and SS for skin closure in patients undergoing various surgical procedures. Conclusion: Use of ABS for skin closure in surgical patients is effective in reducing the risk of surgical site infection and postoperative complications. ABS is comparable with SS in terms of length of hospital stay and duration of operation.
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Affiliation(s)
- Muhammad S Sajid
- Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
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Xing D, Ma JX, Ma XL, Song DH, Wang J, Chen Y, Yang Y, Zhu SW, Ma BY, Feng R. A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J 2013; 22:605-15. [PMID: 23001381 PMCID: PMC3585628 DOI: 10.1007/s00586-012-2514-6] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/31/2012] [Accepted: 09/11/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify the independent risk factors, based on available evidence in the literature, for patients developing surgical site infections (SSI) after spinal surgery. METHODS Non-interventional studies evaluating the independent risk factors for patients developing SSI following spinal surgery were searched in Medline, Embase, Sciencedirect and OVID. The quality of the included studies was assessed by a modified quality assessment tool that had been previously designed for observational studies. The effects of studies were combined with the study quality score using a best-evidence synthesis model. RESULTS Thirty-six observational studies involving 2,439 patients with SSI after spinal surgery were identified. The included studies covered a wide range of indications and surgical procedures. These articles were published between 1998 and 2012. According to the quality assessment criteria for included studies, 15 studies were deemed to be high-quality studies, 5 were moderate-quality studies, and 16 were low-quality studies. A total of 46 independent factors were evaluated for risk of SSI. There was strong evidence for six factors, including obesity/BMI, longer operation times, diabetes, smoking, history of previous SSI and type of surgical procedure. We also identified 8 moderate-evidence, 31 limited-evidence and 1 conflicting-evidence factors. CONCLUSION Although there is no conclusive evidence for why postoperative SSI occurs, these data provide evidence to guide clinicians in admitting patients who will have spinal operations and to choose an optimal prophylactic strategy. Further research is still required to evaluate the effects of these above risk factors.
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Affiliation(s)
- Dan Xing
- />Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin, 300052 China
- />Department of Orthopaedics, Tianjin Gongan Hospital, 78 Nanjing Street, Heping District, Tianjin, 300042 China
| | - Jian-Xiong Ma
- />Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin, 300052 China
| | - Xin-Long Ma
- />Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin, 300052 China
- />Department of Orthopaedics Institute, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin, 300211 China
| | - Dong-Hui Song
- />Department of Orthopaedics, Tianjin Gongan Hospital, 78 Nanjing Street, Heping District, Tianjin, 300042 China
| | - Jie Wang
- />Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin, 300052 China
| | - Yang Chen
- />Department of Orthopaedics Institute, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin, 300211 China
| | - Yang Yang
- />Department of Orthopaedics Institute, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin, 300211 China
| | - Shao-Wen Zhu
- />Department of Orthopaedics Institute, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin, 300211 China
| | - Bao-Yi Ma
- />Department of Orthopaedics Institute, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin, 300211 China
| | - Rui Feng
- />Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin, 300052 China
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