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Jonokuchi AJ, Knopman J, Radwanski RE, Martinez MA, Taylor BES, Rothbaum M, Sullivan S, Robison TR, Lo E, Christophe BR, Bruce EM, Khan S, Kellner CP, Sigounas D, Youngerman B, Bagiella E, Angevine PD, Lowy FD, Sander Connolly E. Topical vancomycin to reduce surgical-site infections in neurosurgery: Study protocol for a multi-center, randomized controlled trial. Contemp Clin Trials 2017; 64:195-200. [PMID: 29030268 DOI: 10.1016/j.cct.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/31/2017] [Revised: 09/23/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022]
Abstract
Surgical-site infections (SSIs) account for 20% of all healthcare-associated infections, are the most common nosocomial infection among surgical patients, and are a focus of quality improvement initiatives. Despite implementation of many quality care measures (e.g. prophylactic antibiotics), SSIs remain a significant cause of morbidity, mortality, and economic burden, particularly in the field of neurosurgery. Topical vancomycin is increasingly utilized in instrumented spinal and cardiothoracic procedures, where it has been shown to reduce the risk of SSIs. However, a randomized controlled trial assessing its efficacy in the general neurosurgical population has yet to be done. The principle aim of "Topical Vancomycin for Neurosurgery Wound Prophylaxis" (NCT02284126) is to determine whether prophylactic, topical vancomycin reduces the risk of SSIs in the adult neurosurgical population. This prospective, multicenter, patient-blinded, randomized controlled trial will enroll patients to receive the standard of care plus topical vancomycin, or the standard of care alone. The primary endpoint of this study is a SSI by postoperative day (POD) 30. Patients must be over 18years of age. Patients are excluded for renal insufficiency, vancomycin allergy, and some ineligible procedures. Univariate analysis and logistic regression will determine the effect of topical vancomycin on SSIs at 30days. A randomized controlled trial is needed to determine the efficacy of this treatment. Results of this trial are expected to directly influence the standard of care and prevention of SSIs in neurosurgical patients.
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Affiliation(s)
- Alexander J Jonokuchi
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Jared Knopman
- Department of Neurological Surgery, Weill Cornell Medical Center, 525 East 68th Street, Box 99, New York, NY 10065, United States.
| | - Ryan E Radwanski
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Moises A Martinez
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Blake Eaton Samuel Taylor
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States
| | - Michael Rothbaum
- Department of Neurological Surgery, Weill Cornell Medical Center, 525 East 68th Street, Box 99, New York, NY 10065, United States.
| | - Sean Sullivan
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, 630 W 168th Street, New York, NY 10032, United States.
| | - Trae R Robison
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Eric Lo
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Brandon R Christophe
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Eliza M Bruce
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States
| | - Sabrina Khan
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, 630 W 168th Street, New York, NY 10032, United States.
| | - Christopher P Kellner
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Dimitri Sigounas
- Department of Neurological Surgery, Weill Cornell Medical Center, 525 East 68th Street, Box 99, New York, NY 10065, United States
| | - Brett Youngerman
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Emilia Bagiella
- Center for Biostatistics, Department of Population Health Science & Policy, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, United States.
| | - Peter D Angevine
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Franklin D Lowy
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, 630 W 168th Street, New York, NY 10032, United States.
| | - E Sander Connolly
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
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Lieber BA, Appelboom G, Taylor BE, Lowy FD, Bruce EM, Sonabend AM, Kellner C, Connolly ES, Bruce JN. Preoperative chemotherapy and corticosteroids: independent predictors of cranial surgical-site infections. J Neurosurg 2015; 125:187-95. [PMID: 26544775 DOI: 10.3171/2015.4.jns142719] [Citation(s) in RCA: 26] [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] [Indexed: 01/27/2023]
Abstract
OBJECT Preoperative corticosteroids and chemotherapy are frequently prescribed for patients undergoing cranial neurosurgery but may pose a risk of postoperative infection. Postoperative surgical-site infections (SSIs) have significant morbidity and mortality, dramatically increase the length and cost of hospitalization, and are a major cause of 30-day readmission. In patients undergoing cranial neurosurgery, there is a lack of data on the role of patient-specific risk factors in the development of SSIs. The authors of this study sought to determine whether chemotherapy and prolonged steroid use before surgery increase the risk of an SSI at postoperative Day 30. METHODS Using the national prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for 2006-2012, the authors calculated the rates of superficial, deep-incisional, and organ-space SSIs at postoperative Day 30 for neurosurgery patients who had undergone chemotherapy or had significant steroid use within 30 days before undergoing cranial surgery. Trauma patients, patients younger than 18 years, and patients with a preoperative infection were excluded. Univariate analysis was performed for 25 variables considered risk factors for superficial and organ-space SSIs. To identify independent predictors of SSIs, the authors then conducted a multivariate analysis in which they controlled for duration of operation, wound class, white blood cell count, and other potential confounders that were significant on the univariate analysis. RESULTS A total of 8215 patients who had undergone cranial surgery were identified. There were 158 SSIs at 30 days (frequency 1.92%), of which 52 were superficial, 27 were deep-incisional, and 79 were organ-space infections. Preoperative chemotherapy was an independent predictor of organ-space SSIs in the multivariate model (OR 5.20, 95% CI 2.33-11.62, p < 0.0001), as was corticosteroid use (OR 1.86, 95% CI 1.03-3.37, p = 0.04), but neither was a predictor of superficial or deep-incisional SSIs. Other independent predictors of organ-space SSIs were longer duration of operation (OR 1.16), wound class of ≥ 2 (clean-contaminated and further contaminated) (OR 3.17), and morbid obesity (body mass index ≥ 40 kg/m(2)) (OR 3.05). Among superficial SSIs, wound class of 3 (contaminated) (OR 6.89), operative duration (OR 1.13), and infratentorial surgical approach (OR 2.20) were predictors. CONCLUSIONS Preoperative chemotherapy and corticosteroid use are independent predictors of organ-space SSIs, even when data are controlled for leukopenia. This indicates that the disease process in organ-space SSIs may differ from that in superficial SSIs. In effect, this study provides one of the largest analyses of risk factors for SSIs after cranial surgery. The results suggest that, in certain circumstances, modulation of preoperative chemotherapy or steroid regimens may reduce the risk of organ-space SSIs and should be considered in the preoperative care of this population. Future studies are needed to determine optimal timing and dosing of these medications.
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Affiliation(s)
- Bryan A Lieber
- Department of Neurosurgery, New York University;,Cerebrovascular Lab
| | | | | | - Franklin D Lowy
- Division of Infectious Diseases, Department of Medicine, Columbia University; and
| | | | - Adam M Sonabend
- Department of Neurosurgery.,Neuro-Intensive Care Unit, Columbia University Medical Center, New York, New York
| | | | - E Sander Connolly
- Cerebrovascular Lab.,Department of Neurosurgery.,Neuro-Intensive Care Unit, Columbia University Medical Center, New York, New York
| | - Jeffrey N Bruce
- Department of Neurosurgery.,The Gabriele Bartoli Brain Tumor Laboratory, and
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Mapa B, Taylor BES, Appelboom G, Bruce EM, Claassen J, Connolly ES. Impact of Hyponatremia on Morbidity, Mortality, and Complications After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review. World Neurosurg 2015; 85:305-14. [PMID: 26361321 DOI: 10.1016/j.wneu.2015.08.054] [Citation(s) in RCA: 50] [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: 03/24/2015] [Revised: 08/14/2015] [Accepted: 08/18/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hyponatremia is a common metabolic disturbance after aneurysmal subarachnoid hemorrhage (SAH), and it may worsen outcomes. This review aims to characterize the effect of hyponatremia on morbidity and mortality after SAH. OBJECTIVES We sought to determine the prevalence of hyponatremia after SAH, including in subgroups, as well as its effect on mortality and certain outcome measures, including degree of disability and duration of hospitalization. METHODS A search of terms "hyponatremia" and "subarachnoid hemorrhage" was performed on PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE. Studies were included if they reported prevalence of hyponatremia and if they discussed outcomes such as mortality, duration of stay, functional outcomes (e.g., Glasgow Outcomes Scale), or incidence of complications in patients with aneurysmal SAH. Two independent researchers assessed the titles and abstracts and reviewed articles for inclusion. RESULTS Thirteen studies met inclusion criteria. The prevalence of at least mild hyponatremia was 859 of 2387 (36%) of patients. Hyponatremia was associated with vasospasm and duration of hospitalization, but it did not influence mortality. CONCLUSION Hyponatremia is common after SAH, and there is evidence that it is associated with certain poorer outcomes. Larger, prospective studies are needed to assess these findings and provide further evidence.
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Affiliation(s)
- Ben Mapa
- Cerebrovascular Lab, Columbia University Medical Center, New York, New York, USA
| | - Blake E S Taylor
- Cerebrovascular Lab, Columbia University Medical Center, New York, New York, USA; Department of Neurosurgery, Columbia University, New York, New York, USA.
| | - Geoffrey Appelboom
- Cerebrovascular Lab, Columbia University Medical Center, New York, New York, USA; Department of Neurosurgery, Columbia University, New York, New York, USA
| | - Eliza M Bruce
- Cerebrovascular Lab, Columbia University Medical Center, New York, New York, USA; Department of Neurosurgery, Columbia University, New York, New York, USA
| | - Jan Claassen
- Department of Neurology, Columbia University, New York, New York, USA; Neuro-intensive Care Unit, Columbia University, New York, New York, USA
| | - E Sander Connolly
- Cerebrovascular Lab, Columbia University Medical Center, New York, New York, USA; Department of Neurosurgery, Columbia University, New York, New York, USA; Department of Neurology, Columbia University, New York, New York, USA
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Samuel Taylor BE, Robison T, Lo E, McCormick K, Bruce EM, Appelboom G, Connolly ES. 152 Remote, Continuous Monitoring of Patient Mobility After Discharge. Neurosurgery 2015. [DOI: 10.1227/01.neu.0000467114.39215.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Appelboom G, Yang AH, Christophe BR, Bruce EM, Slomian J, Bruyère O, Bruce SS, Zacharia BE, Reginster JY, Connolly ES. The promise of wearable activity sensors to define patient recovery. J Clin Neurosci 2013; 21:1089-93. [PMID: 24534628 DOI: 10.1016/j.jocn.2013.12.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [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] [Received: 11/14/2013] [Accepted: 12/02/2013] [Indexed: 12/30/2022]
Abstract
The recent emergence of mobile health--the use of mobile telecommunication and wireless devices to improve health outcomes, services, and research--has inspired a patient-centric approach to monitor health metrics. Sensors embedded in wearable devices are utilized to acquire greater self-knowledge by tracking basic parameters such as blood pressure, heart rate, and body temperature as well as data related to exercise, diet, and psychological state. To that end, recent studies on utilizing wireless fitness activity trackers to monitor and promote functional recovery in patients suggest that collecting up-to-date performance data could help patients regain functional independence and help hospitals determine the appropriate length of stay for a patient. This manuscript examines existing functional assessment scales, discusses the use of activity tracking sensors in evaluating functional independence, and explores the growing application of wireless technology in measuring and promoting functional recovery.
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Affiliation(s)
- Geoff Appelboom
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA.
| | - Annie H Yang
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA
| | - Brandon R Christophe
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA
| | - Eliza M Bruce
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA
| | - Justine Slomian
- Support Unit in Epidemiology and Biostatistics, Department of Public Health Sciences, University of Liège, Liège, Belgium
| | - Olivier Bruyère
- Support Unit in Epidemiology and Biostatistics, Department of Public Health Sciences, University of Liège, Liège, Belgium
| | - Samuel S Bruce
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA
| | - Brad E Zacharia
- Department of Neurosurgery, Columbia University Medical Center, New York, NY 10032, USA
| | - Jean-Yves Reginster
- Support Unit in Epidemiology and Biostatistics, Department of Public Health Sciences, University of Liège, Liège, Belgium
| | - E Sander Connolly
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA
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