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O’Brien WJ, Schweizer ML, Strymish J, Beck BF, Au V, Chan JA, Brown M, Itani KMF, Dukes KC, Walhof JF, Gupta K. Propensity Score-Weighted Analysis of Postoperative Infection in Patients With and Without Preoperative Urine Culture. JAMA Netw Open 2024; 7:e240900. [PMID: 38436958 PMCID: PMC10912952 DOI: 10.1001/jamanetworkopen.2024.0900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/11/2024] [Indexed: 03/05/2024] Open
Abstract
Importance Although recent guidelines recommend against performance of preoperative urine culture before nongenitourinary surgery, many clinicians still order preoperative urine cultures and prescribe antibiotics for treatment of asymptomatic bacteriuria in an effort to reduce infection risk. Objective To assess the association between preoperative urine culture testing and postoperative urinary tract infection (UTI) or surgical site infection (SSI), independent of baseline patient characteristics or type of surgery. Design, Setting, and Participants This cohort study analyzed surgical procedures performed from January 1, 2017, to December 31, 2019, at any of 112 US Department of Veterans Affairs (VA) medical centers. The cohort comprised VA enrollees who underwent major elective noncardiac, nonurological operations. Machine learning and inverse probability of treatment weighting (IPTW) were used to balance the characteristics between those who did and did not undergo a urine culture. Data analyses were performed between January 2023 and January 2024. Exposures Performance of urine culture within 30 days prior to surgery. Main Outcomes and Measures The 2 main outcomes were UTI and SSI occurring within 30 days after surgery. Weighted logistic regression was used to estimate odds ratios (ORs) for postoperative infection based on treatment status. Results A total of 250 389 VA enrollees who underwent 288 858 surgical procedures were included, with 88.9% (256 753) of surgical procedures received by males and 48.9% (141 340) received by patients 65 years or older. Baseline characteristics were well balanced among treatment groups after applying IPTW weights. Preoperative urine culture was performed for 10.5% of surgical procedures (30 384 of 288 858). The IPTW analysis found that preoperative urine culture was not associated with SSI (adjusted OR [AOR], 0.99; 95% CI, 0.90-1.10) or postoperative UTI (AOR, 1.18; 95% CI, 0.98-1.40). In analyses limited to orthopedic surgery and neurosurgery as a proxy for prosthetic implants, the adjusted risks for UTI and SSI were also not associated with preoperative urine culture performance. Conclusions and Relevance This cohort study found no association between performance of a preoperative urine culture and lower risk of postoperative UTI or SSI. The results support the deimplementation of urine cultures and associated antibiotic treatment prior to surgery, even when using prosthetic implants.
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Affiliation(s)
- William J. O’Brien
- Veterans Affairs (VA) Boston Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Marin L. Schweizer
- William S. Middleton VA Hospital, Madison, Wisconsin
- Department of Medicine, University of Wisconsin-Madison, Madison
| | | | - Brice F. Beck
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
| | - Vanessa Au
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
| | - Jeffrey A. Chan
- Veterans Affairs (VA) Boston Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Madisen Brown
- Veterans Affairs (VA) Boston Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Kamal M. F. Itani
- VA Boston Health Care System Department of Surgery, Boston University and Harvard Medical School, Boston, Massachusetts
| | - Kimberly C. Dukes
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, The University of Iowa, Iowa City
| | - Julia Friberg Walhof
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
| | - Kalpana Gupta
- Veterans Affairs (VA) Boston Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
- VA Boston Department of Medicine, Boston, Massachusetts
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de Moya M, Haukoos JS, Itani KMF. Practical Guide to Education Program Evaluation Research. JAMA Surg 2024:2813489. [PMID: 38170498 DOI: 10.1001/jamasurg.2023.6702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
This Guide to Statistics and Methods describes common methods for building evidence of validity for a program within health professional education and provides a framework for program evaluation.
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Affiliation(s)
- Marc de Moya
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Jason S Haukoos
- Department of Emergency Medicine, University of Colorado, Aurora
- Statistical Editor, JAMA Surgery
| | - Kamal M F Itani
- Department of Surgery, VA Boston Healthcare System, Boston University, Harvard Medical School, Boston, Massachusetts
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3
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Sartelli M, Barie PS, Coccolini F, Abbas M, Abbo LM, Abdukhalilova GK, Abraham Y, Abubakar S, Abu-Zidan FM, Adebisi YA, Adamou H, Afandiyeva G, Agastra E, Alfouzan WA, Al-Hasan MN, Ali S, Ali SM, Allaw F, Allwell-Brown G, Amir A, Amponsah OKO, Al Omari A, Ansaloni L, Ansari S, Arauz AB, Augustin G, Awazi B, Azfar M, Bah MSB, Bala M, Banagala ASK, Baral S, Bassetti M, Bavestrello L, Beilman G, Bekele K, Benboubker M, Beović B, Bergamasco MD, Bertagnolio S, Biffl WL, Blot S, Boermeester MA, Bonomo RA, Brink A, Brusaferro S, Butemba J, Caínzos MA, Camacho-Ortiz A, Canton R, Cascio A, Cassini A, Cástro-Sanchez E, Catarci M, Catena R, Chamani-Tabriz L, Chandy SJ, Charani E, Cheadle WG, Chebet D, Chikowe I, Chiara F, Cheng VCC, Chioti A, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Dasic M, de Francisco Serpa N, de Jonge SW, Delibegovic S, Dellinger EP, Demetrashvili Z, De Palma A, De Silva D, De Simone B, De Waele J, Dhingra S, Diaz JJ, Dima C, Dirani N, Dodoo CC, Dorj G, Duane TM, Eckmann C, Egyir B, Elmangory MM, Enani MA, Ergonul O, Escalera-Antezana JP, Escandon K, Ettu AWOO, Fadare JO, Fantoni M, Farahbakhsh M, Faro MP, Ferreres A, Flocco G, Foianini E, Fry DE, Garcia AF, Gerardi C, Ghannam W, Giamarellou H, Glushkova N, Gkiokas G, Goff DA, Gomi H, Gottfredsson M, Griffiths EA, Guerra Gronerth RI, Guirao X, Gupta YK, Halle-Ekane G, Hansen S, Haque M, Hardcastle TC, Hayman DTS, Hecker A, Hell M, Ho VP, Hodonou AM, Isik A, Islam S, Itani KMF, Jaidane N, Jammer I, Jenkins DR, Kamara IF, Kanj SS, Jumbam D, Keikha M, Khanna AK, Khanna S, Kapoor G, Kapoor G, Kariuki S, Khamis F, Khokha V, Kiggundu R, Kiguba R, Kim HB, Kim PK, Kirkpatrick AW, Kluger Y, Ko WC, Kok KYY, Kotecha V, Kouma I, Kovacevic B, Krasniqi J, Krutova M, Kryvoruchko I, Kullar R, Labi KA, Labricciosa FM, Lakoh S, Lakatos B, Lansang MAD, Laxminarayan R, Lee YR, Leone M, Leppaniemi A, Hara GL, Litvin A, Lohsiriwat V, Machain GM, Mahomoodally F, Maier RV, Majumder MAA, Malama S, Manasa J, Manchanda V, Manzano-Nunez R, Martínez-Martínez L, Martin-Loeches I, Marwah S, Maseda E, Mathewos M, Maves RC, McNamara D, Memish Z, Mertz D, Mishra SK, Montravers P, Moro ML, Mossialos E, Motta F, Mudenda S, Mugabi P, Mugisha MJM, Mylonakis E, Napolitano LM, Nathwani D, Nkamba L, Nsutebu EF, O’Connor DB, Ogunsola S, Jensen PØ, Ordoñez JM, Ordoñez CA, Ottolino P, Ouedraogo AS, Paiva JA, Palmieri M, Pan A, Pant N, Panyko A, Paolillo C, Patel J, Pea F, Petrone P, Petrosillo N, Pintar T, Plaudis H, Podda M, Ponce-de-Leon A, Powell SL, Puello-Guerrero A, Pulcini C, Rasa K, Regimbeau JM, Rello J, Retamozo-Palacios MR, Reynolds-Campbell G, Ribeiro J, Rickard J, Rocha-Pereira N, Rosenthal VD, Rossolini GM, Rwegerera GM, Rwigamba M, Sabbatucci M, Saladžinskas Ž, Salama RE, Sali T, Salile SS, Sall I, Kafil HS, Sakakushev BE, Sawyer RG, Scatizzi M, Seni J, Septimus EJ, Sganga G, Shabanzadeh DM, Shelat VG, Shibabaw A, Somville F, Souf S, Stefani S, Tacconelli E, Tan BK, Tattevin P, Rodriguez-Taveras C, Telles JP, Téllez-Almenares O, Tessier J, Thang NT, Timmermann C, Timsit JF, Tochie JN, Tolonen M, Trueba G, Tsioutis C, Tumietto F, Tuon FF, Ulrych J, Uranues S, van Dongen M, van Goor H, Velmahos GC, Vereczkei A, Viaggi B, Viale P, Vila J, Voss A, Vraneš J, Watkins RR, Wanjiru-Korir N, Waworuntu O, Wechsler-Fördös A, Yadgarova K, Yahaya M, Yahya AI, Xiao Y, Zakaria AD, Zakrison TL, Zamora Mesia V, Siquini W, Darzi A, Pagani L, Catena F. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World J Emerg Surg 2023; 18:50. [PMID: 37845673 PMCID: PMC10580644 DOI: 10.1186/s13017-023-00518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
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Sartelli M, Boermeester MA, Cainzos M, Coccolini F, de Jonge SW, Rasa K, Dellinger EP, McNamara DA, Fry DE, Cui Y, Delibegovic S, Demetrashvili Z, De Simone B, Gkiokas G, Hardcastle TC, Itani KMF, Isik A, Labricciosa FM, Lohsiriwat V, Marwah S, Pintar T, Rickard J, Shelat VG, Catena F, Barie PS. Six Long-Standing Questions about Antibiotic Prophylaxis in Surgery. Antibiotics (Basel) 2023; 12:antibiotics12050908. [PMID: 37237811 DOI: 10.3390/antibiotics12050908] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Surgical site infections (SSIs) are the most common adverse event occurring in surgical patients. Optimal prevention of SSIs requires the bundled integration of a variety of measures before, during, and after surgery. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs. It aims to counteract the inevitable introduction of bacteria that colonize skin or mucosa into the surgical site during the intervention. This document aims to guide surgeons in appropriate administration of SAP by addressing six key questions. The expert panel identifies a list of principles in response to these questions that every surgeon around the world should always respect in administering SAP.
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Affiliation(s)
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Miguel Cainzos
- Department of Surgery, Hospital Clínico Universitario, 15706 Santiago de Compostela, Spain
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, University of Pisa, 55126 Pisa, Italy
| | - Stijn W de Jonge
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, 41200 Kocaeli, Turkey
| | | | - Deborah A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, D09V2N0 Dublin, Ireland
| | - Donald E Fry
- Department of Surgery, Northwestern University, Chicago, IL 60208, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300100, China
| | - Samir Delibegovic
- Department of Surgery, University Clinical Center of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department General Surgery, Kipshidze Central University Hospital, Tbilisi 0162, Georgia
| | - Belinda De Simone
- Department of Emergency and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal de Poissy/Saint Germain en Laye, 78300 Poissy CEDEX, France
| | - George Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Timothy C Hardcastle
- Department of Surgery, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Mayville 4058, South Africa
| | - Kamal M F Itani
- Department of Surgery, VA Boston Health Care System, Boston University and Harvard Medical School, Boston, MA 02118, USA
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, 34700 Istanbul, Turkey
| | | | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Sanjay Marwah
- Department of Surgery, BDS Post-Graduate Institute of Medical Sciences, Rohtak 124001, India
| | - Tadeja Pintar
- Department of Abdominal Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Vishal G Shelat
- Department of Hepato-Pancreatic-Biliary Surgery, Tan Tok Seng Hospital, Singapore 308433, Singapore
| | - Fausto Catena
- Department of Surgery, "Bufalini" Hospital, 47023 Cesena, Italy
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medicine, E. Northport, New York, NY 11731, USA
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5
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O'Brien WJ, Gupta K, Itani KMF. Estimated Risk of Adverse Surgical Outcomes Among Patients With Recent COVID-19 Infection Using Target Trial Emulation Methods. JAMA Netw Open 2023; 6:e234876. [PMID: 36976565 PMCID: PMC10051067 DOI: 10.1001/jamanetworkopen.2023.4876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Affiliation(s)
- William J O'Brien
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston, Boston, Massachusetts
| | - Kalpana Gupta
- Department of Medicine, Veterans Affairs Boston, Boston, Massachusetts
| | - Kamal M F Itani
- Department of Surgery, Veterans Affairs Boston, Boston, Massachusetts
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6
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Pawlik TM, Schwartz TA, Itani KMF. Practical Guide to Ethical Considerations in Clinical Trials in Surgery. JAMA Surg 2023; 158:204-205. [PMID: 36287536 DOI: 10.1001/jamasurg.2022.4895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This Guide to Statistics and Methods provides an overview of current ethical considerations and standards for clinical research.
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Affiliation(s)
- Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus.,Deputy Editor, JAMA Surgery
| | - Todd A Schwartz
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.,Statistical Editor, JAMA Surgery
| | - Kamal M F Itani
- Department of Surgery Veterans Affairs Boston Healthcare System, Boston University, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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7
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de Jonge SW, Kaji AH, Itani KMF. Practical Guide to Statistical Considerations in Clinical Trials in Surgery. JAMA Surg 2023; 158:89-90. [PMID: 36287537 DOI: 10.1001/jamasurg.2022.4892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This Guide to Statistics and Methods discusses key statistical considerations in the conduct of randomized clinical trials in surgery.
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Affiliation(s)
- Stijn W de Jonge
- Department of Surgery, Amsterdam UMC, location AMC, Amsterdam Gastroenterology Endocrinology and Metabolism, University of Amsterdam, Amsterdam, the Netherlands
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California.,Statistical Editor, JAMA Surgery
| | - Kamal M F Itani
- Veterans Affairs Boston Health Care System, Boston University, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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8
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Dijkgraaf MGW, Haukoos J, Itani KMF. Practical Guide to Design Choice of Randomized Clinical Trials in Surgery. JAMA Surg 2022; 157:1154-1155. [PMID: 36287547 DOI: 10.1001/jamasurg.2022.4889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This Guide to Statistics and Methods provides an overview of the strengths and weaknesses of several randomized clinical trial design options.
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Affiliation(s)
- Marcel G W Dijkgraaf
- Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Methodology, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Jason Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, University of Colorado School of Medicine, Denver.,Department of Epidemiology, Colorado School of Public Health, Aurora.,Statistical Editor, JAMA Surgery
| | - Kamal M F Itani
- Department of Surgery, Veterans Affairs Boston Health Care System, Boston, Massachusetts.,Department of Surgery, Boston Medical Center, Boston University, Boston, Massachusetts.,Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Kamal M F Itani
- Department of Surgery, VA Boston Health Care System, Boston, Massachusetts.,Boston University, Harvard Medical School, Boston, Massachusetts
| | - Melina R Kibbe
- Departments of Surgery and Biomedical Engineering, University of Virginia School of Medicine, Charlottesville.,Editor, JAMA Surgery
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10
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Itani KMF, Rosen AK. Association of Expanded Health Care Options for Community Care With Veterans' Surgical Outcomes. JAMA Surg 2022; 157:1123-1124. [PMID: 36223140 DOI: 10.1001/jamasurg.2022.4986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Kamal M F Itani
- Department of Surgery, VA Boston Health Care System, Boston, Massachusetts.,Department of Surgery, Boston University, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Amy K Rosen
- Department of Surgery, Boston University, Boston, Massachusetts.,Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Health Care System, Boston, Massachusetts
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11
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Stolarski AE, Itani KMF. Nailing the Coffin on Biological Mesh in Contaminated Ventral Hernias. JAMA Surg 2022; 157:302. [PMID: 35044420 DOI: 10.1001/jamasurg.2021.6903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Allan E Stolarski
- Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts.,Department of Surgery, Boston Medical Center, Boston University, Boston, Massachusetts
| | - Kamal M F Itani
- Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts.,Department of Surgery, Boston Medical Center, Boston University, Boston, Massachusetts.,Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Dipp Ramos R, O'Brien WJ, Gupta K, Itani KMF. Events, care, and outcomes after hernia mesh explantation for infection. Am J Surg 2021; 224:174-176. [PMID: 34876254 DOI: 10.1016/j.amjsurg.2021.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/26/2021] [Revised: 11/03/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Mesh explantation for infection after hernia surgery sets a cascade of events that has not been previously described. The purpose of this study is to review the care of these patients and outcomes. METHODS We obtained data on all Veterans Health Administration enrollees undergoing hernia repair during 2008-2015. All mesh explantation cases were identified and manually reviewed through December 2020 to identify surgical site occurrences, re-repairs, and subsequent explantations. RESULTS We identified 332 index explantations due to infection. A first subsequent repair was performed in 82.5% (274/332); a second repair in 18.2% (50/274); a third repair in 16.0% (8/50); and a fourth repair in 25% (2/8). Overall recurrence rate over a 12 year-period was 160/332 (48.1%). CONCLUSIONS Mesh explantation due to infection sets a cascade of complications and hernia recurrences necessitating re-operation. Complications resulting from mesh explantation suggest that resolution of the initial abdominal wall infection is crucial to prevent future mesh infections.
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Affiliation(s)
- Radwan Dipp Ramos
- VA Boston Dept. of Surgery, 1400 VFW Parkway, Boston, MA, 02132, USA
| | | | - Kalpana Gupta
- VA Boston Dept. of Medicine, 1400 VFW Parkway, Boston, MA, 02132, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
| | - Kamal M F Itani
- VA Boston Dept. of Surgery, 1400 VFW Parkway, Boston, MA, 02132, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
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13
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O’Brien WJ, Dipp Ramos R, Gupta K, Itani KMF. Risk of Hernia Mesh Explantation following Early Versus Late Onset Skin and Soft Tissue Infection. Ann Surg Open 2021; 2:e098. [PMID: 34957470 PMCID: PMC8694247 DOI: 10.1097/as9.0000000000000098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/09/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022] Open
Abstract
To estimate the relative risk of explantation in patients with skin and soft tissue infection onset within 90 days of hernia surgery, compared with days 91-365 and after 1 year. BACKGROUND Infectious complications occurring after hernia repair with synthetic mesh require prolonged treatment, and eventual mesh explantation. Little is known whether early versus late onset infection is associated with differential risk of mesh removal, and whether treatment with long-term antibiotics or debridement are associated with mesh salvage. METHODS This was a retrospective observational cohort study. We obtained data on all inguinal, umbilical, and ventral hernia repairs with implanted synthetic mesh performed in Veterans Affairs hospitals during 2008-2015. Participants without a 5-year infection after hernia surgery were excluded. Logistic regression estimated the association of mesh explantation with exposure to mesh-related infection during postoperative days 0-90, versus days 91-365 versus after 1 year. Additional covariates included any subsequent abdominal operation, antibiotic administration, and incision and drainage (I&D) or debridement procedures. RESULTS One thousand eight hundred eighty-five patients underwent index hernia repair and developed a skin and soft tissue infection within 5 years. Infection onset during days 91-365 was associated with increased explantation risk (OR, 1.62; 95% CI, 1.04-2.48), as was increased antibiotic use (OR, 1.04; 95% CI, 1.03-1.05) and surgical treatments (OR, 3.74; 95% CI, 3.02-4.67). Subsequent abdominal operation was associated with lower explantation risk (OR, 0.46; 95% CI, 0.33-0.61). CONCLUSIONS Early infections may be more suitable for conservative management. Later-onset infections have lower probability of mesh salvage and should be considered for earlier explantation to save the patients prolonged courses of antibiotics and surgical interventions.
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Affiliation(s)
- William J. O’Brien
- From the VA Boston Center for Healthcare Organization and Implementation Research, Boston, MA
- VA Boston Department of Surgery, Boston, MA
| | | | - Kalpana Gupta
- VA Boston Department of Surgery, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Kamal M. F. Itani
- VA Boston Department of Surgery, Boston, MA
- Boston University School of Medicine, Boston, MA
- Harvard Medical School, Boston, MA
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14
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Affiliation(s)
- Ryan P Merkow
- Feinberg School of Medicine, Department of Surgery, Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor University of California, Los Angeles Medical Center, Torrance.,David Geffen School of Medicine at University of California, Los Angeles.,Statistical Editor, JAMA Surgery
| | - Kamal M F Itani
- Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts.,Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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15
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Dipp Ramos R, O'Brien WJ, Gupta K, Itani KMF. Re-Infection after Explantation of Infected Hernia Mesh: Are the Same Micro-Organisms Involved? Surg Infect (Larchmt) 2021; 22:1077-1080. [PMID: 34388028 DOI: 10.1089/sur.2021.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/14/2023] Open
Abstract
Background: It is unclear if a history of mesh explantation for infection is predictive of future microbiology after subsequent hernia operations. We investigated how often the same causative organism is cultured in the initial explantation and subsequent repairs. Patients and Methods: We obtained data on patients undergoing ventral/incisional, umbilical, and inguinal hernia repairs from the Veterans Affairs Surgical Quality Improvement Program during 2008-2015. Manual review was performed for all patients with an administrative code indicative of mesh explantation and those with explantation for infection were retained. We then obtained data on cultured organisms from the mesh site at the time of index explantation and at any re-repair or subsequent explantation during a follow-up period ending in December 2020. Results: We identified 332 patients undergoing mesh explantation because of infection (64.8% ventral, 18.7% umbilical, 16.6% inguinal). Mean age was 60.3 years (standard deviation [SD], 9.7) and 93.9% were male. The same organism was cultured at re-infection in 23 of 59 (39%) cases. Gram-positive micro-organisms were the most prevalent in 20 of 23 (87%). Among the gram-positive, Staphylococcus aureus was the most common pathogen and was cultured in 18 of 20 (90%) cases, of which 14 of 18 (77.8%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 4 of 18 (22.2%) were methicillin-resistant Staphylococcus aureus (MRSA). Three of 23 (13%) gram-negative organisms were the same at both re-infection and index explantation consisting of Escherichia coli in 2 of 3 (66.7%), and Pseudomonas aeruginosa in one of three (33.3%). Conclusions: Identification of organisms at time of prosthetic infection is helpful not only in treating the initial infection, but also in prevention of infection with the same organisms after subsequent repairs. Same organism re-infection should not be underestimated, particularly when Staphylococcus aureus is isolated.
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Affiliation(s)
| | - William J O'Brien
- VA Boston Department of Surgery, West Roxbury, Massachusetts, USA.,VA Boston Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA
| | - Kalpana Gupta
- VA Boston Department of Medicine, West Roxbury, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kamal M F Itani
- VA Boston Department of Surgery, West Roxbury, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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16
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Abstract
Importance Surgical site infection has been shown to decrease survival in veterans by up to 42%. The association of 30-day postoperative infections with long-term infections in the overall surgical population remains unknown. Objective To determine whether exposure to 30-day postoperative infection is associated with increased incidence of infection and mortality during postoperative days 31 to 365. Design, Setting, and Participants In this retrospective observational cohort study, veterans undergoing major surgery through the Veterans Health Administration from January 2008 to December 2015 were included. Stabilized inverse probability of treatment weighting was used to balance baseline characteristics of the control and exposure groups. Cox proportional hazards regression was used to estimate hazard ratios of long-term infection and mortality. Data were analyzed from September 2018 to May 2019. Exposures Any 30-day postoperative infection (exposure group) vs no 30-day infection (control group). Main Outcomes and Measures Number of days between index surgery and the occurrence of death or the patient's first infection during postoperative days 31 to 365. Patients who died before having a long-term infection were censored for the infection outcome. Results Of the 659 486 included patients, 604 534 (91.7%) were male, and the mean (SD) age was 59.7 (13.6) years. Among these patients, 23 815 (3.6%) had a 30-day infection, 43 796 (6.6%) had a long-term infection, and 24 810 (3.8%) died during follow-up. The most frequent 30-day infections were surgical site infection (9574 [40.2%]), urinary tract infection (6545 [27.5%]), pneumonia (3515 [14.8%]), and bloodstream infection (1906 [8.0%]). Long-term infection types included urinary tract infection (21 420 [48.7%]), skin and soft tissue infection (14 348 [32.6%]), bloodstream infection (3862 [8.8%]), and pneumonia (2543 [5.8%]). Patients in the exposure group had a higher observed incidence of long-term infection (5187 of 23 815 [21.8%]) and mortality (3067 of 23 815 [12.9%]) compared with those without 30-day infection (38 789 of 635 671 [6.1%] and 21 743 of 635 671 [3.4%], respectively). The estimated hazard ratio for long-term infection was 3.17 (95% CI, 3.05-3.28) and for mortality was 1.89 (95% CI, 1.79-1.99). Conclusions and Relevance At any given point during the follow-up period, patients with 30-day postoperative infection had a 3.2-fold higher risk of 1-year infection and a 1.9-fold higher risk of mortality compared with those who had no 30-day infection. Cost-benefit calculations for surgical infection prevention programs should include the increased risk and costs of long-term infection and death. Preventive efforts in the first 30 days postoperatively may improve long-term patient outcomes.
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Affiliation(s)
- William J O'Brien
- Center for Healthcare Organization and Implementation Research, VA Boston, Boston, Massachusetts.,VA Boston Health Care System, Boston, Massachusetts
| | - Kalpana Gupta
- VA Boston Health Care System, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Kamal M F Itani
- VA Boston Health Care System, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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17
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Dipp Ramos R, O'Brien WJ, Gupta K, Itani KMF. Incidence and Risk Factors for Long-Term Mesh Explantation Due to Infection in More than 100,000 Hernia Operation Patients. J Am Coll Surg 2021; 232:872-880.e2. [PMID: 33601005 DOI: 10.1016/j.jamcollsurg.2020.12.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Infectious complications after hernia operation are potentially disastrous, often requiring long-term antibiotic administration, debridement, and mesh explantation. Our objective was to describe the long-term incidence and risk factors for synthetic mesh explantation due to infection after hernia operation in a large cohort. STUDY DESIGN Retrospective database study using Veterans Affairs Surgical Quality Improvement Program and chart review of veterans undergoing abdominal or groin hernia repair with synthetic mesh implantation during 2008-2015. The main outcome was mesh explantation due to infection within 5 years. RESULTS The study population consisted of 103,869 hernia operations, of which 74.3% were inguinal, 10.7% umbilical, and 15.0% ventral. Explantation incidence was highest among ventral (1.5%). Median explantation interval overall was 208 days. In multivariable logistic regression, all obesity levels from pre-obesity to obesity class III were associated with higher explantation risk. American Society of Anesthesiology physical status classification of 3 to 5 was associated with odds ratio (OR) of 1.7 (95% CI, 1.28 to 2.26), as was longer operative duration (OR 1.83; 95% CI, 1.51 to 2.21), and contaminated or dirty surgical wound classification (OR 2.27; 95% CI, 1.11 to 4.64). Umbilical repair (OR 6.11; 95% CI, 4.14 to 9.02) and ventral repair (OR 14.35; 95% CI, 10.39 to 19.82) were associated with higher risk compared with inguinal. Open repair was associated with a higher risk compared with laparoscopic (OR 3.57; 95% CI, 2.52 to 5.05). Deep incisional surgical site infection within 30 days of operation was more likely to result in long-term mesh explantation (29.2%) than either superficial (6.4%) or organ space infection (22.4%). CONCLUSIONS Mesh explantation for infection is most common after ventral hernia repair. Risk factor optimization is crucial to minimize such an end point.
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Affiliation(s)
| | - William J O'Brien
- Department of Surgery, Boston, MA; Center for Organization and Implementation Research, Boston, MA
| | | | - Kamal M F Itani
- Department of Surgery, Boston, MA; Veterans Affairs Boston, Department of Surgery, Boston University, Boston, MA; Harvard Medical School, Boston, MA.
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18
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Sambare TD, Graham LA, Itani KMF, Morris MS, Moshrefi S, Hawn MT. Impact of Gastrointestinal Surgical Site Wound Complications on Long-term Healthcare Utilization. J Gastrointest Surg 2021; 25:503-511. [PMID: 31993964 DOI: 10.1007/s11605-019-04489-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/30/2019] [Accepted: 11/23/2019] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Wound complication following gastrointestinal surgery substantially impacts the quality and costs of surgical care. The impact of wound complication on subsequent long-term healthcare utilization has not been fully studied. OBJECTIVE We assessed the impact of surgical wound complication on inpatient and outpatient healthcare utilization in the 2 years after gastrointestinal (GI) surgery. DESIGN An observational retrospective cohort study was conducted on Veterans Affairs health system patients who underwent an inpatient GI surgical procedure, were assessed by the Veterans Affairs Surgical Quality Improvement Program (VASQIP), and were discharged alive from Veterans Affairs (VA) hospitals between October 1, 2007 and September 30, 2014. SETTING Population-based PARTICIPANTS: A total of 64,351 patients underwent a GI surgical procedure in the VA system between 2007 and 2014. The cohort was 93.5% male, with a median age of 63.0 years (interquartile range (IQR) 57.0-70.0). A total of 7880 patients (12.2%) had at least one reported wound complication, 5460 of which had their postoperative wound complication classified by a VASQIP nurse. EXPOSURE VASQIP-assessed or ICD-9-coded wound complication in the 30 days after surgery MAIN OUTCOME MEASUREMENTS: Inpatient visits, total inpatient days, outpatient visits, and emergency department visits, and operative interventions up to 2 years after discharge from index admission RESULTS: Patients with a postoperative wound complication had greater inpatient healthcare utilization compared with no-wound complication for up to 2 years after surgery: inpatient admissions (mean number 3.5 vs. 2.8; P < .001), inpatient bed days (mean 41.0 vs. 25.0; P < .001). Patients with a postoperative wound complication also had greater 2-year outpatient utilization than the no-wound complication cohort: outpatient visits (mean number 92.7 vs. 75.9; P < .001) and emergency department visits (mean 3.5 vs. 2.7; P < .001). The same relationship held for wound-related parameters; inpatient admissions (2.2 vs. 0.4; P < .001); inpatient bed days (21.4 vs. 3.7; P < .001); and outpatient visits (56.2 vs. 9.7; P < .001). A greater proportion of patients in the wound complication cohort had an operative intervention for all time intervals examined (P < .001). CONCLUSIONS Surgical wound complications impact healthcare utilization patterns for up to 2 years after the index procedure including hospital readmissions and operative interventions; efforts to reduce postoperative wound complications will have substantial effects on patient outcomes and healthcare expenditures well beyond the 30-day postoperative period.
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Affiliation(s)
- Tanmaya D Sambare
- Stanford University School of Medicine, Alway Building, Room M121, 300 Pasteur Drive, MC 5115, Stanford, CA, 94305, USA
| | - Laura A Graham
- Stanford University School of Medicine, Alway Building, Room M121, 300 Pasteur Drive, MC 5115, Stanford, CA, 94305, USA
| | | | | | - Shawn Moshrefi
- Stanford University School of Medicine, Alway Building, Room M121, 300 Pasteur Drive, MC 5115, Stanford, CA, 94305, USA
| | - Mary T Hawn
- Stanford University School of Medicine, Alway Building, Room M121, 300 Pasteur Drive, MC 5115, Stanford, CA, 94305, USA.
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19
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Parker SG, Halligan S, Liang MK, Muysoms FE, Adrales GL, Boutall A, de Beaux AC, Dietz UA, Divino CM, Hawn MT, Heniford TB, Hong JP, Ibrahim N, Itani KMF, Jorgensen LN, Montgomery A, Morales-Conde S, Renard Y, Sanders DL, Smart NJ, Torkington JJ, Windsor ACJ. Definitions for Loss of Domain: An International Delphi Consensus of Expert Surgeons. World J Surg 2021; 44:1070-1078. [PMID: 31848677 DOI: 10.1007/s00268-019-05317-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND No standardized written or volumetric definition exists for 'loss of domain' (LOD). This limits the utility of LOD as a morphological descriptor and as a predictor of peri- and postoperative outcomes. Consequently, our aim was to establish definitions for LOD via consensus of expert abdominal wall surgeons. METHODS A Delphi study involving 20 internationally recognized abdominal wall reconstruction (AWR) surgeons was performed. Four written and two volumetric definitions of LOD were identified via systematic review. Panelists completed a questionnaire that suggested these definitions as standardized definitions of LOD. Consensus on a preferred term was pre-defined as achieved when selected by ≥80% of panelists. Terms scoring <20% were removed. RESULTS Voting commenced August 2018 and was completed in January 2019. Written definition: During Round 1, two definitions were removed and seven new definitions were suggested, leaving nine definitions for consideration. For Round 2, panelists were asked to select all appealing definitions. Thereafter, common concepts were identified during analysis, from which the facilitators advanced a new written definition. This received 100% agreement in Round 3. Volumetric definition: Initially, panelists were evenly split, but consensus for the Sabbagh method was achieved. Panelists could not reach consensus regarding a threshold LOD value that would preclude surgery. CONCLUSIONS Consensus for written and volumetric definitions of LOD was achieved from 20 internationally recognized AWR surgeons. Adoption of these definitions will help standardize the use of LOD for both clinical and academic activities.
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Affiliation(s)
- Samuel G Parker
- The Abdominal Wall Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - Steve Halligan
- UCL Centre for Medical Imaging, 2nd floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Mike K Liang
- Department of Surgery, McGovern Medical Center, University of Texas Health Science Center, 5656 Kelley Street, Houston, TX, 77026, USA
| | - Filip E Muysoms
- Department of Surgery, Maria Middelares Hospital, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium
| | - Gina L Adrales
- Division of Minimally Invasive Surgery, The John Hopkins Hospital, 600 North Wolfe Street Blalock 618, Baltimore, MD, 21287, USA
| | - Adam Boutall
- The Colorectal Unit, Groote Schuur Hospital, Main Road, Observatory, Cape Town, 7925, South Africa
| | - Andrew C de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Kantonal Hospital of Olten, Baselstrasse 150, Olten, 4600, Switzerland
| | - Celia M Divino
- Department of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, 10029, USA
| | - Mary T Hawn
- Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA, 94304, USA
| | - Todd B Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - Joon P Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, 88 Oympicro, 43gil Songpagu, Seoul, 05505, South Korea
| | - Nabeel Ibrahim
- Department of General Surgery, Macquarie University Hospital, 3 Technology Pl, Macquarie University, Sydney, NSW, 2109, Australia
| | - Kamal M F Itani
- Department of General Surgery, Veterans Affairs Boston Health Care System, Boston and Harvard Universities, 1400 VFW Parkway, West Roxbury, MA, 02132, USA
| | - Lars N Jorgensen
- Digestive Disease Center, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Agneta Montgomery
- Department of Surgery, Skane University Hospital Malmo, 202 05, Malmo, Sweden
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital ''Virgen del Rocio'', Betis-65, 1, 41010, Seville, Spain
| | - Yohann Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debre´ University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France
| | - David L Sanders
- Department of General and Upper GI Surgery, North Devon, District Hospital, Raleigh Park, Barnstaple, Devon, EX31 4JB, UK
| | - Neil J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, England, UK
| | - Jared J Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Alastair C J Windsor
- The Abdominal Wall Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
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20
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Affiliation(s)
- Benjamin S Brooke
- Department of Surgery, University of Utah School of Medicine, Salt Lake City.,Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance.,David Geffen School of Medicine at UCLA, Los Angeles
| | - Kamal M F Itani
- Department of Surgery, Veterans Affairs Boston Health Care System, Boston, Massachusetts.,Department of Surgery, Boston University, Boston, Massachusetts.,Department of Surgery, Harvard Medical School, Boston, Massachusetts
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21
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Massarweh NN, Itani KMF, Tsai TC. Maximizing the US Department of Veterans Affairs' Reserve Role in National Health Care Emergency Preparedness-The Fourth Mission. JAMA Surg 2020; 155:913-914. [PMID: 32808966 DOI: 10.1001/jamasurg.2020.4153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nader N Massarweh
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Kamal M F Itani
- VA Boston Health Care System, Boston, Massachusetts.,Boston University Medical School, Boston, Massachusetts
| | - Thomas C Tsai
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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22
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Affiliation(s)
- Nader N Massarweh
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Kamal M F Itani
- Boston University Medical School, Boston, Massachusetts
- VA Boston Health Care System, Boston, Massachusetts
| | - Melanie S Morris
- Department of Surgery, University of Alabama at Birmingham
- Birmingham VA Medical Center, Birmingham, Alabama
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23
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O'Brien WJ, Gupta K, Itani KMF. Implications of Postoperative Infections on Long-term Outcomes-Reply. JAMA Surg 2020; 155:668. [PMID: 32267473 DOI: 10.1001/jamasurg.2020.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- William J O'Brien
- VA Boston Center for Healthcare Organization and Implementation Research, Boston, Massachusetts
| | - Kalpana Gupta
- VA Boston Department of Medicine, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Kamal M F Itani
- VA Boston Department of Surgery, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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24
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Abstract
Management of antiplatelet therapy in patients with cardiac stents who need subsequent surgery is complex. Current guidelines recommend delaying elective surgery or, if surgery is emergent, proceeding without aspirin cessation. This study assessed provider knowledge, attitudes, and practices for patients with cardiac stents needing subsequent surgery. A national survey was administered to Veterans Administration surgeons, anesthesiologists, and cardiologists. Questions examined guideline awareness and agreement, perceptions of bleeding risk and stent thrombosis, practice patterns for antiplatelet therapy management, and experience with perioperative stent thrombosis. Chi-square tests and generalized estimating equations were used to examine differences in reported practices. Among 295 respondents, guideline awareness (92%) and agreement (93%) were high but higher among cardiologists and anesthesiologists than surgeons. Guideline agreement and personal experience with stent thrombosis were also associated with reported practice patterns. In adjusted models for early surgeries, cardiologists and anesthesiologists were more likely to report continuation of dual therapy as compared with surgeons regardless of stent type (drug-eluting P = 0.03; bare metal P < 0.01). Despite successful guideline adoption, significant variations in practice patterns by provider type were found. Understanding reasons behind the variation and outcomes of various antiplatelet management strategies are important steps in optimizing care of patients with coronary stents undergoing noncardiac surgery.
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Affiliation(s)
- Laura A. Graham
- Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, Alabama; the
| | - Thomas M. Maddox
- VA Eastern Colorado Health Care System, University of Colorado Denver, Denver, Colorado
| | - Kamal M. F. Itani
- VA Eastern Colorado Health Care System, University of Colorado Denver, Denver, Colorado
| | - Mary T. Hawn
- Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, Alabama; the
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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25
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Affiliation(s)
- Adam C Fields
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kamal M F Itani
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
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26
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Sartelli M, Coccolini F, Abu-Zidan FM, Ansaloni L, Bartoli S, Biffl W, Borghi F, Chouillard E, Cui Y, Nascimento RDO, De Simone B, Di Saverio S, Duane T, Eckmann C, Eid HO, Gomes CA, Gomes FC, Hecker A, Hecker B, Isik A, Itani KMF, Leppaniemi A, Litvin A, Luppi D, Maier R, Manzano-Nunez R, Marwah S, Mazuski J, Moore E, Perrone G, Rasa K, Rubio I, Sawyer R, Labricciosa FM, Catena F. Hey surgeons! It is time to lead and be a champion in preventing and managing surgical infections! World J Emerg Surg 2020; 15:28. [PMID: 32306979 PMCID: PMC7168830 DOI: 10.1186/s13017-020-00308-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/13/2020] [Accepted: 04/02/2020] [Indexed: 12/14/2022] Open
Abstract
Appropriate measures of infection prevention and management are integral to optimal clinical practice and standards of care. Among surgeons, these measures are often over-looked. However, surgeons are at the forefront in preventing and managing infections. Surgeons are responsible for many of the processes of healthcare that impact the risk for surgical site infections and play a key role in their prevention. Surgeons are also at the forefront in managing patients with infections, who often need prompt source control and appropriate antibiotic therapy, and are directly responsible for their outcome. In this context, the direct leadership of surgeons in infection prevention and management is of utmost importance. In order to disseminate worldwide this message, the editorial has been translated into 9 different languages (Arabic, Chinese, French, German, Italian, Portuguese, Spanish, Russian, and Turkish).
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Affiliation(s)
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Luca Ansaloni
- General Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Stefano Bartoli
- Department of Vascular Surgery, Sant'Eugenio Hospital, Rome, Italy
| | - Walter Biffl
- Trauma Surgery Department, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Felice Borghi
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Elie Chouillard
- Department of Surgery, Poissy Saint Germain Medical Center, Poissy, France
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | | | - Belinda De Simone
- Department of Surgery, Poissy Saint Germain Medical Center, Poissy, France
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, UK.,Department of General Surgery, University Hospital of Varese, ASST SetteLaghi, RegioneLombardia, Varese, Italy
| | | | - Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Münden Academic Hospital of Goettingen University, Goettingen, Germany
| | - Hani O Eid
- Department of Emergency Medicine, Mediclinic Middle East, Airport Road Hospital, Abu Dhabi, United Arab Emirates
| | - Carlos Augusto Gomes
- Department of Surgery, Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, Brazil
| | - Felipe Couto Gomes
- Cirurgia Geral Hospital Lifecenter Belo Horizonte, Belo Horizonte, Brazil
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
| | - Birgit Hecker
- Department of Anaesthesiology and Intensive Care, Saint Josef Hospital, Giessen, Germany
| | - Arda Isik
- Department of General Surgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Kamal M F Itani
- Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Andrey Litvin
- Surgical Disciplines, Immanuel Kant Baltic Federal University/Regional Clinical Hospital, Kaliningrad, Russian Federation
| | - Davide Luppi
- Department of General and Emergency Surgery, ASMN Reggio Emilia, Reggio Emilia, Italy
| | - Ronald Maier
- Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Sanjay Marwah
- Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - John Mazuski
- Department of Surgery, School of Medicine, Washington University, Saint Louis, USA
| | - Ernest Moore
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO, USA
| | - Gennaro Perrone
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, Kocaali, Turkey
| | - Ines Rubio
- General Surgery Department, Colorectal Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Robert Sawyer
- Department of Surgery, Western Michigan University School of Medicine, Kalamazoo, MI, USA
| | | | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
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27
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Dipp Ramos R, Itani KMF. Emotions, Common Sense, and Evidence in Operating Room Attire. JAMA Surg 2020; 155:329. [PMID: 32049273 DOI: 10.1001/jamasurg.2019.6023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Radwan Dipp Ramos
- Department of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
| | - Kamal M F Itani
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston University and Harvard Medical School, West Roxbury, Massachusetts
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28
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Affiliation(s)
- Adam C Fields
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason C Pradarelli
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kamal M F Itani
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
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29
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Affiliation(s)
- Kamal M F Itani
- Veterans Affairs Boston Health Care System, Boston University and Harvard Medical School, Boston, Massachusetts
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30
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Parker SG, Halligan S, Liang MK, Muysoms FE, Adrales GL, Boutall A, de Beaux AC, Dietz UA, Divino CM, Hawn MT, Heniford TB, Hong JP, Ibrahim N, Itani KMF, Jorgensen LN, Montgomery A, Morales-Conde S, Renard Y, Sanders DL, Smart NJ, Torkington JJ, Windsor ACJ. International classification of abdominal wall planes (ICAP) to describe mesh insertion for ventral hernia repair. Br J Surg 2019; 107:209-217. [PMID: 31875954 DOI: 10.1002/bjs.11400] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/25/2019] [Accepted: 09/18/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Nomenclature for mesh insertion during ventral hernia repair is inconsistent and confusing. Several terms, including 'inlay', 'sublay' and 'underlay', can refer to the same anatomical planes in the indexed literature. This frustrates comparisons of surgical practice and may invalidate meta-analyses comparing surgical outcomes. The aim of this study was to establish an international classification of abdominal wall planes. METHODS A Delphi study was conducted involving 20 internationally recognized abdominal wall surgeons. Different terms describing anterior abdominal wall planes were identified via literature review and expert consensus. The initial list comprised 59 possible terms. Panellists completed a questionnaire that suggested a list of options for individual abdominal wall planes. Consensus on a term was predefined as occurring if selected by at least 80 per cent of panellists. Terms scoring less than 20 per cent were removed. RESULTS Voting started August 2018 and was completed by January 2019. In round 1, 43 terms (73 per cent) were selected by less than 20 per cent of panellists and 37 new terms were suggested, leaving 53 terms for round 2. Four planes reached consensus in round 2, with the terms 'onlay', 'inlay', 'preperitoneal' and 'intraperitoneal'. Thirty-five terms (66 per cent) were selected by less than 20 per cent of panellists and were removed. After round 3, consensus was achieved for 'anterectus', 'interoblique', 'retro-oblique' and 'retromuscular'. Default consensus was achieved for the 'retrorectus' and 'transversalis fascial' planes. CONCLUSION Consensus concerning abdominal wall planes was agreed by 20 internationally recognized surgeons. Adoption should improve communication and comparison among surgeons and research studies.
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Affiliation(s)
- S G Parker
- Abdominal Wall Unit, University College London Hospital, London, UK
| | - S Halligan
- UCL Centre for Medical Imaging, London, UK
| | - M K Liang
- Department of Surgery, McGovern Medical Center, University of Texas Health Science Center, Houston, Texas, USA
| | - F E Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
| | - G L Adrales
- Division of Minimally Invasive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - A Boutall
- Colorectal Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - A C de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - U A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Kantonal Hospital of Olten, Olten, Switzerland
| | - C M Divino
- Department of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, USA
| | - M T Hawn
- Department of Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - T B Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - J P Hong
- Department of Plastic Surgery, Asan Medical Centre, University of Ulsan, Seoul, South Korea
| | - N Ibrahim
- Department of General Surgery, Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia
| | - K M F Itani
- Department of General Surgery, Veterans Affairs Boston Health Care System, Boston and Harvard Universities, West Roxbury, Massachusetts, USA
| | - L N Jorgensen
- Digestive Disease Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - A Montgomery
- Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital 'Virgen del Rocio', Seville, Spain
| | - Y Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims Cedex, France
| | - D L Sanders
- Department of General and Upper Gastrointestinal Surgery, North Devon District Hospital, Barnstaple, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - J J Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - A C J Windsor
- Abdominal Wall Unit, University College London Hospital, London, UK
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31
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Mull HJ, Graham LA, Morris MS, Rosen AK, Richman JS, Whittle J, Burns E, Wagner TH, Copeland LA, Wahl T, Jones C, Hollis RH, Itani KMF, Hawn MT. Association of Postoperative Readmissions With Surgical Quality Using a Delphi Consensus Process to Identify Relevant Diagnosis Codes. JAMA Surg 2019; 153:728-737. [PMID: 29710234 DOI: 10.1001/jamasurg.2018.0592] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Postoperative readmission data are used to measure hospital performance, yet the extent to which these readmissions reflect surgical quality is unknown. Objective To establish expert consensus on whether reasons for postoperative readmission are associated with the quality of surgery in the index admission. Design, Setting, and Participants In a modified Delphi process, a panel of 14 experts in medical and surgical readmissions comprising physicians and nonphysicians from Veterans Affairs (VA) and private-sector institutions reviewed 30-day postoperative readmissions from fiscal years 2008 through 2014 associated with inpatient surgical procedures performed at a VA medical center between October 1, 2007, and September 30, 2014. The consensus process was conducted from January through May 2017. Reasons for readmission were grouped into categories based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes. Panelists were given the proportion of readmissions coded by each reason and median (interquartile range) days to readmission. They answered the question, "Does the readmission reason reflect possible surgical quality of care problems in the index admission?" on a scale of 1 (never related) to 5 (directly related) in 3 rounds of consensus building. The consensus process was completed in May 2017 and data were analyzed in June 2017. Main Outcomes and Measures Consensus on proportion of ICD-9-coded readmission reasons that reflected quality of surgical procedure. Results In 3 Delphi rounds, the 14 panelists achieved consensus on 50 reasons for readmission; 12 panelists also completed group telephone calls between rounds 1 and 2. Readmissions with diagnoses of infection, sepsis, pneumonia, hemorrhage/hematoma, anemia, ostomy complications, acute renal failure, fluid/electrolyte disorders, or venous thromboembolism were considered associated with surgical quality and accounted for 25 521 of 39 664 readmissions (64% of readmissions; 7.5% of 340 858 index surgical procedures). The proportion of readmissions considered to be not associated with surgical quality varied by procedure, ranging from to 21% (613 of 2331) of readmissions after lower-extremity amputations to 47% (745 of 1598) of readmissions after cholecystectomy. Conclusions and Relevance One-third of postoperative readmissions are unlikely to reflect problems with surgical quality. Future studies should test whether restricting readmissions to those with specific ICD-9 codes might yield a more useful quality measure.
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Affiliation(s)
- Hillary J Mull
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts.,Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Laura A Graham
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Melanie S Morris
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Amy K Rosen
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts.,Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Joshua S Richman
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Jeffery Whittle
- Medicine Division, Milwaukee VA Medical Center, Milwaukee, Wisconsin.,Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Edith Burns
- Medicine Division, Milwaukee VA Medical Center, Milwaukee, Wisconsin.,Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Todd H Wagner
- VA Palo Alto Medical Center, Palo Alto, California.,Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Leeds.,University of Massachusetts Medical School, Worcester.,Baylor Scott & White Health, Center for Applied Health Research, Temple, Texas
| | - Tyler Wahl
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Caroline Jones
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Robert H Hollis
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Kamal M F Itani
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts.,Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,Harvard University School of Medicine, Boston, Massachusetts
| | - Mary T Hawn
- VA Palo Alto Medical Center, Palo Alto, California.,Department of Surgery, Stanford University School of Medicine, Palo Alto, California
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32
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Affiliation(s)
- Nader N Massarweh
- Veterans Affairs Health Services Research & Development, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.,Division of Surgical Oncology, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor, University of California in Los Angeles Medical Center, Los Angeles.,Statistical Editor
| | - Kamal M F Itani
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Boston University, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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O’brien WJ, Gupta K, Itani KMF. A Longitudinal Study of S. aureus Infection in a National Cohort of Surgical Patients. Open Forum Infect Dis 2019; 6:ofz350. [PMID: 31407780 PMCID: PMC6786508 DOI: 10.1093/ofid/ofz350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Postoperative infections are a common and often preventable complication of surgery. S. aureus is a prevalent organism cultured in these infections and is associated with morbidity, mortality, and increased healthcare utilization. However, the long-term burden of S. aureus infection in surgical patients is not well studied. The purpose of this retrospective observational study is to assess the incidence, time trend, and burden of S. aureus infection up to 1 year after surgery. METHODS We obtained manually-reviewed data from the VA Surgical Quality Improvement Program (VASQIP) to identify surgeries in all major specialties. These were combined with laboratory microbiology and pharmacy data to identify pneumonia and infections of the urinary tract, surgical site, and blood. RESULTS In the study population of 559,550 patients, S. aureus incidence decreased each year, from 2.1% in 2008 to 1.1% in 2015. Among these, incidence of methicillin-resistant S. aureus (MRSA) infection decreased from 0.7% to 0.4%, and methicillin-susceptible S. aureus (MSSA) decreased from 1.4% to 0.7%. S. aureus infection was associated with increased length of stay, ED utilization, inpatient admissions, as well as a 4-fold increase in mortality. CONCLUSIONS This is one of the largest studies describing the long-term incidence of S. aureus in the surgical population of a national integrated healthcare system. We conclude that the burden of S. aureus infection extends well beyond the conventional 30-day postoperative window, and late infection should be included in assessing the effects of interventions.
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Affiliation(s)
- William J O’brien
- VA Boston Center for Healthcare Organization and Implementation Research, Boston, Massachusetts
| | - Kalpana Gupta
- VA Boston Department of Medicine, Boston, Massachusetts
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34
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Kristo G, Itani KMF. Complicated and Uncomplicated Acute Appendicitis Are Different Diseases-Do Not Compare Apples With Oranges-Reply. JAMA Surg 2019; 154:783. [PMID: 31042276 DOI: 10.1001/jamasurg.2019.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gentian Kristo
- Department of Surgery, Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, Massachusetts
| | - Kamal M F Itani
- Department of Surgery, Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Boston University, Boston, Massachusetts
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35
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Graham LA, Mull HJ, Wagner TH, Morris MS, Rosen AK, Richman JS, Whittle J, Burns E, Copeland LA, Itani KMF, Hawn MT. Comparison of a Potential Hospital Quality Metric With Existing Metrics for Surgical Quality-Associated Readmission. JAMA Netw Open 2019; 2:e191313. [PMID: 31002316 PMCID: PMC6481441 DOI: 10.1001/jamanetworkopen.2019.1313] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/29/2019] [Indexed: 11/16/2022] Open
Abstract
Importance The existing readmission quality metric does not meaningfully distinguish readmissions associated with surgical quality from those that are not associated with surgical quality and thus may not reflect the quality of surgical care. Objective To compare a quality metric that classifies readmissions associated with surgical quality with the existing metric of any unplanned readmission in a surgical population. Design, Setting, and Participants Cohort study using US nationwide administrative data collected on 4 high-volume surgical procedures performed at 103 Veterans Affairs hospitals from October 1, 2007, through September 30, 2014. Data analysis was conducted from October 1, 2017, to January 24, 2019. Main Outcomes and Measures Hospital-level rates of unplanned readmission (existing metric) and surgical readmissions associated with surgical quality (new metric) in the 30 days following hospital discharge for an inpatient surgical procedure. Results The study population included 109 258 patients who underwent surgery at 103 hospitals. Patients were majority male (94.1%) and white (78.2%) with a mean (SD) age of 64.0 (10.0) years at the time of surgery. After case-mix adjustment, 30-day surgical readmissions ranged from 4.6% (95% CI, 4.5%-4.8%) among knee arthroplasties to 11.1% (95% CI, 10.9%-11.3%) among colorectal resections. The new surgical readmission metric was significantly correlated with facility-level postdischarge complications for all procedures, with ρ coefficients ranging from 0.33 (95% CI, 0.13-0.51) for cholecystectomy to 0.52 (95% CI, 0.38-0.68) for colorectal resection. Correlations between postdischarge complications and the new surgical readmission metric were higher than correlations between complications and the existing readmission metric for all procedures examined (knee arthroplasty: 0.50 vs 0.48; hip replacement: 0.44 vs 0.18; colorectal resection: 0.52 vs 0.42; and cholecystectomy: 0.33 vs 0.10). When compared with using the existing readmission metric, using the new surgical readmission metric could change hip replacement-associated payment penalty determinations in 28.4% of hospitals and knee arthroplasty-associated penalties in 26.0% of hospitals. Conclusions and Relevance In this study, surgical quality-associated readmissions were more correlated with postdischarge complications at a higher rate than were unplanned readmissions. Thus, a metric based on such readmissions may be a better measure of surgical care quality. This work provides an important step in the development of future value-based payments and promotes evidence-based quality metrics targeting the quality of surgical care.
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Affiliation(s)
- Laura A. Graham
- Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, Alabama
- Department of Surgery, University of Alabama at Birmingham, Birmingham
| | - Hillary J. Mull
- Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Boston, Massachusetts
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Todd H. Wagner
- Veterans Affairs, Palo Alto, Veterans Affairs Medical Center, Palo Alto, California
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Melanie S. Morris
- Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, Alabama
- Department of Surgery, University of Alabama at Birmingham, Birmingham
| | - Amy K. Rosen
- Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Boston, Massachusetts
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Joshua S. Richman
- Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, Alabama
- Department of Surgery, University of Alabama at Birmingham, Birmingham
| | - Jeffery Whittle
- Milwaukee Veterans Affairs Medical Center, Milwaukee, Wisconsin
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Edith Burns
- Milwaukee Veterans Affairs Medical Center, Milwaukee, Wisconsin
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Laurel A. Copeland
- Veterans Affairs Central Western Massachusetts Healthcare System, Leeds
- University of Massachusetts Medical School, Worcester
| | - Kamal M. F. Itani
- Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Boston, Massachusetts
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
- Harvard University School of Medicine, Boston, Massachusetts
| | - Mary T. Hawn
- Veterans Affairs, Palo Alto, Veterans Affairs Medical Center, Palo Alto, California
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
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36
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Branch-Elliman W, Pizer SD, Dasinger EA, Gold HS, Abdulkerim H, Rosen AK, Charns MP, Hawn MT, Itani KMF, Mull HJ. Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study. Antimicrob Resist Infect Control 2019; 8:49. [PMID: 30886702 PMCID: PMC6404270 DOI: 10.1186/s13756-019-0503-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/18/2018] [Accepted: 02/27/2019] [Indexed: 12/13/2022] Open
Abstract
Background Guidelines recommend discontinuation of antimicrobial prophylaxis within 24 h after incision closure in uninfected patients. However, how facility and surgical specialty factors affect the implementation of these evidence-based surgical prophylaxis guidelines in outpatient surgery is unknown. Thus, we sought to measure how facility complexity, including ambulatory surgical center (ASC) status and availability of ancillary services, impact adherence to guidelines for timely discontinuation of antimicrobial prophylaxis after outpatient surgery. A secondary aim was to measure the association between surgical specialty and guideline compliance. Methods A multi-center, national Veterans Health Administration retrospective cohort from 10/1/2015-9/30/2017 including any Veteran undergoing an outpatient surgical procedure in any of five specialties (general surgery, urology, ophthalmology, ENT, orthopedics) was created. The primary outcome was the association between facility complexity and proportion of surgeries not compliant with discontinuation of antimicrobials within 24 h of incision closure. Data were analyzed using logistic regression with adjustments for patient and procedural factors. Results Among 153,097 outpatient surgeries, 7712 (5.0%) received antimicrobial prophylaxis lasting > 24 h after surgery; rates ranged from 0.4% (eye surgeries) to 13.7% (genitourinary surgeries). Cystoscopies and cystoureteroscopy with lithotripsy procedures had the highest rates (16 and 20%), while hernia repair, cataract surgeries, and laparoscopic cholecystectomies had the lowest (0.2-0.3%). In an adjusted logistic regression model, lower complexity ASC and hospital outpatient departments had higher odds of prolonged antimicrobial prophylaxis compared to complex hospitals (OR ASC, 1.3, 95% CI: 1.2-1.5). Patient factors associated with higher odds of noncompliance with antimicrobial discontinuation included younger age, female sex, and white race. Genitourinary and ear/nose/throat surgeries were associated with the highest odds of prolonged antimicrobial prophylaxis. Conclusions Facility complexity appears to play a role in adherence to surgical infection prevention guidelines. Lower complexity facilities with limited infection prevention and antimicrobial stewardship resources may be important targets for quality improvement. Such interventions may be especially useful for genitourinary and ear/nose/throat surgical subspecialties. Increasing pharmacy, antimicrobial stewardship and/or infection prevention resources to promote more evidence-based care may support surgical providers in lower complexity ambulatory surgery centers and hospital outpatient departments in their efforts to improve this facet of patient safety.
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Affiliation(s)
- Westyn Branch-Elliman
- 1Department of Medicine, Section of Infectious Diseases, VA Boston Healthcare System, MA 1400 VFW Parkway West Roxbury, Boston, MA 02132 USA.,2Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston, Healthcare System, 150 South Huntington Avenue, Boston, MA 02130 USA.,3Harvard Medical School, 25 Shattuck Street Boston, Boston, MA 02115 USA
| | - Steven D Pizer
- 4Partnered Evidence-based Policy Resource Center (PEPReC), Department of Veterans Affairs, 150 South Huntington Avenue Boston, Boston, MA 02130 USA.,5Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Elise A Dasinger
- VA Quality Scholars Program, Birmingham VA Medical Center, Birmingham, 700 19th Street S, AL 35233 England
| | - Howard S Gold
- 3Harvard Medical School, 25 Shattuck Street Boston, Boston, MA 02115 USA.,7Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 110 Francis Street, Boston, MA 02115 USA
| | - Hassen Abdulkerim
- 2Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston, Healthcare System, 150 South Huntington Avenue, Boston, MA 02130 USA
| | - Amy K Rosen
- 2Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston, Healthcare System, 150 South Huntington Avenue, Boston, MA 02130 USA.,8Department of Surgery, Boston University School of Medicine, 88 East Newton Street, C515, Boston, MA 02118 USA
| | - Martin P Charns
- 2Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston, Healthcare System, 150 South Huntington Avenue, Boston, MA 02130 USA
| | - Mary T Hawn
- 9Palo Alto VA Medical Center, 3801 Miranda Ave, Palo Alto, CA 95010 USA.,10Stanford University School of Medicine, 291 Campus Drive Stanford, Stanford, CA 94305 USA
| | - Kamal M F Itani
- 11Department of Surgery, VA Boston Healthcare System, 1400 VFW Parkway West Roxbury, Boston, MA 02132 USA.,3Harvard Medical School, 25 Shattuck Street Boston, Boston, MA 02115 USA.,8Department of Surgery, Boston University School of Medicine, 88 East Newton Street, C515, Boston, MA 02118 USA
| | - Hillary J Mull
- 2Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston, Healthcare System, 150 South Huntington Avenue, Boston, MA 02130 USA.,8Department of Surgery, Boston University School of Medicine, 88 East Newton Street, C515, Boston, MA 02118 USA
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37
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Affiliation(s)
- Gentian Kristo
- Department of Surgery, VA Boston Healthcare System, West Roxbury, Massachusetts.,Department of Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Boston University, Boston, Massachusetts
| | - Kamal M F Itani
- Department of Surgery, VA Boston Healthcare System, West Roxbury, Massachusetts.,Department of Surgery, Boston University, Boston, Massachusetts
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Sartelli M, Di Bella S, McFarland LV, Khanna S, Furuya-Kanamori L, Abuzeid N, Abu-Zidan FM, Ansaloni L, Augustin G, Bala M, Ben-Ishay O, Biffl WL, Brecher SM, Camacho-Ortiz A, Caínzos MA, Chan S, Cherry-Bukowiec JR, Clanton J, Coccolini F, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Demetrashvili Z, Di Carlo I, Di Saverio S, Dumitru IM, Eckmann C, Eiland EH, Forrester JD, Fraga GP, Frossard JL, Fry DE, Galeiras R, Ghnnam W, Gomes CA, Griffiths EA, Guirao X, Ahmed MH, Herzog T, Kim JI, Iqbal T, Isik A, Itani KMF, Labricciosa FM, Lee YY, Juang P, Karamarkovic A, Kim PK, Kluger Y, Leppaniemi A, Lohsiriwat V, Machain GM, Marwah S, Mazuski JE, Metan G, Moore EE, Moore FA, Ordoñez CA, Pagani L, Petrosillo N, Portela F, Rasa K, Rems M, Sakakushev BE, Segovia-Lohse H, Sganga G, Shelat VG, Spigaglia P, Tattevin P, Tranà C, Urbánek L, Ulrych J, Viale P, Baiocchi GL, Catena F. 2019 update of the WSES guidelines for management of Clostridioides ( Clostridium) difficile infection in surgical patients. World J Emerg Surg 2019. [PMID: 30858872 DOI: 10.1186/s13017-19-0228-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Stefano Di Bella
- 2Infectious Diseases Department, Trieste University Hospital, Trieste, Italy
| | - Lynne V McFarland
- 3Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle, WA USA
| | - Sahil Khanna
- 4Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN USA
| | - Luis Furuya-Kanamori
- 5Research School of Population Health, Australian National University, Acton, ACT Australia
| | - Nadir Abuzeid
- 6Department of Microbiology, Faculty of Medical Laboratory Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Fikri M Abu-Zidan
- 7Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Luca Ansaloni
- 8Department of General Surgery, Bufalini Hospital, Cesena, Italy
| | - Goran Augustin
- 9Department of Surgery, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Miklosh Bala
- 10Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Offir Ben-Ishay
- 11Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Walter L Biffl
- 12Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA USA
| | - Stephen M Brecher
- 13Pathology and Laboratory Medicine, VA Boston Healthcare System, West Roxbury MA and BU School of Medicine, Boston, MA USA
| | - Adrián Camacho-Ortiz
- Department of Internal Medicine, University Hospital, Dr. José E. González, Monterrey, Mexico
| | - Miguel A Caínzos
- 15Department of Surgery, University of Santiago de Compostela, A Coruña, Spain
| | - Shirley Chan
- 16Department of General Surgery, Medway Maritime Hospital, Gillingham, Kent UK
| | - Jill R Cherry-Bukowiec
- 17Department of Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor, MI USA
| | - Jesse Clanton
- 18Department of Surgery, West Virginia University Charleston Division, Charleston, WV USA
| | | | - Maria E Cocuz
- 19Faculty of Medicine, Transilvania University, Infectious Diseases Hospital, Brasov, Romania
| | - Raul Coimbra
- 20Riverside University Health System Medical Center and Loma Linda University School of Medicine, Moreno Valley, CA USA
| | | | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jacek Czepiel
- 23Department of Infectious Diseases, Jagiellonian University, Medical College, Kraków, Poland
| | - Zaza Demetrashvili
- 24Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Isidoro Di Carlo
- 25Department of Surgical Sciences, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- 26Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Irina M Dumitru
- 27Clinical Infectious Diseases Hospital, Ovidius University, Constanta, Romania
| | - Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Hospital of Medical University Hannover, Peine, Germany
| | | | | | - Gustavo P Fraga
- 31Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jean L Frossard
- 32Service of Gastroenterology and Hepatology, Geneva University Hospital, Genève, Switzerland
| | - Donald E Fry
- 33Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL USA.,34University of New Mexico School of Medicine, Albuquerque, NM USA
| | - Rita Galeiras
- 35Critical Care Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
| | - Wagih Ghnnam
- 36Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Carlos A Gomes
- 37Surgery Department, Hospital Universitario (HU) Terezinha de Jesus da Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Hospital Universitario (HU) Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Ewen A Griffiths
- 38Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Xavier Guirao
- Unit of Endocrine, Head, and Neck Surgery and Unit of Surgical Infections Support, Department of General Surgery, Parc Taulí, Hospital Universitari, Sabadell, Spain
| | - Mohamed H Ahmed
- 40Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire UK
| | - Torsten Herzog
- 41Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jae Il Kim
- 42Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Tariq Iqbal
- 43Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham, UK
| | - Arda Isik
- 44General Surgery Department, Magee Womens Hospital, UPMC, Pittsburgh, USA
| | - Kamal M F Itani
- 45Department of Surgery, VA Boston Health Care System, Boston University and Harvard Medical School, Boston, MA USA
| | | | - Yeong Y Lee
- 47School of Medical Sciences, University Sains Malaysia, Kota Bharu, Kelantan Malaysia
| | - Paul Juang
- 48Department of Pharmacy Practice, St Louis College of Pharmacy, St Louis, MO USA
| | - Aleksandar Karamarkovic
- Faculty of Mediine University of Belgrade Clinic for Surgery "Nikola Spasic", University Clinical Center "Zvezdara" Belgrade, Belgrade, Serbia
| | - Peter K Kim
- 50Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Yoram Kluger
- 11Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ari Leppaniemi
- 51Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland
| | - Varut Lohsiriwat
- 52Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Gustavo M Machain
- 53Department of Surgery, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | - Sanjay Marwah
- 54Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - John E Mazuski
- 55Department of Surgery, Washington University School of Medicine, Saint Louis, USA
| | - Gokhan Metan
- 56Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ernest E Moore
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA
| | | | - Carlos A Ordoñez
- 59Department of Surgery, Fundación Valle del Lili, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Nicola Petrosillo
- National Institute for Infectious Diseases - INMI - Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francisco Portela
- 62Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, Kocaali, Turkey
| | - Miran Rems
- Department of Abdominal and General Surgery, General Hospital Jesenice, Jesenice, Slovenia
| | - Boris E Sakakushev
- 65Department of Surgery, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Gabriele Sganga
- 66Division of Emergency Surgery, Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vishal G Shelat
- 67Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Patrizia Spigaglia
- 68Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Pierre Tattevin
- 69Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Libor Urbánek
- 70First Department of Surgery, Faculty of Medicine, Masaryk University Brno and University Hospital of St. Ann Brno, Brno, Czech Republic
| | - Jan Ulrych
- 71First Department of Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Pierluigi Viale
- 72Clinic of Infectious Diseases, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Gian L Baiocchi
- 73Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fausto Catena
- 74Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy
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39
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Dasinger EA, Branch-Elliman W, Pizer SD, Abdulkerim H, Rosen AK, Charns MP, Hawn MT, Itani KMF, Mull HJ. Association between postoperative opioid use and outpatient surgical adverse events. Am J Surg 2019; 217:605-612. [PMID: 30639132 DOI: 10.1016/j.amjsurg.2018.12.068] [Citation(s) in RCA: 2] [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: 10/23/2018] [Revised: 12/26/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Opioid-related adverse drug events are common following inpatient surgical procedures. Little is known about opioid prescribing after outpatient surgical procedures and if opioid use is associated with short term risks of outpatient surgical adverse events (AEs). METHODS VA Corporate Data Warehouse was used to identify opioid use within 48 h for FY2012-14 chart-reviewed cases from a larger VA study of AEs in outpatient surgeries. We estimated a multilevel logistic regression model to determine the effect of opioid exposure on risk of AEs between 2 and 30 days postoperatively. RESULTS Of the 1730 outpatient surgical cases, 628 (36%) had postoperative opioid use and 12% had an AE. Opioid use following outpatient surgery was not significantly associated with higher surgical AE rates after controlling for relevant covariates (OR = 1.1 95% CI 0.79-1.54). Only procedure RVUs were associated with higher odds of postoperative AEs. CONCLUSIONS Postoperative opioid use following outpatient surgery is not a significant driver of postoperative AEs.
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Affiliation(s)
- Elise A Dasinger
- VA Quality Scholars Program, Birmingham VA Medical Center, Birmingham, AL, United States.
| | - Westyn Branch-Elliman
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, United States; Department of Medicine, VA Boston Healthcare System, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Steven D Pizer
- Partnered Evidence-based Policy Resource Center (PEPReC), Department of Veterans Affairs, Boston, MA, United States; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Hassen Abdulkerim
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, United States
| | - Amy K Rosen
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, United States; Department of Surgery, Boston University School of Medicine, Boston, MA, United States
| | - Martin P Charns
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, United States; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Mary T Hawn
- Palo Alto VA Medical Center, Palo Alto, CA, United States; Stanford University School of Medicine, Stanford, CA, United States
| | - Kamal M F Itani
- Harvard Medical School, Boston, MA, United States; Department of Surgery, Boston University School of Medicine, Boston, MA, United States; Department of Surgery, VA Boston Healthcare System, Boston, MA, United States
| | - Hillary J Mull
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, United States; Department of Surgery, Boston University School of Medicine, Boston, MA, United States
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40
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Sartelli M, Di Bella S, McFarland LV, Khanna S, Furuya-Kanamori L, Abuzeid N, Abu-Zidan FM, Ansaloni L, Augustin G, Bala M, Ben-Ishay O, Biffl WL, Brecher SM, Camacho-Ortiz A, Caínzos MA, Chan S, Cherry-Bukowiec JR, Clanton J, Coccolini F, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Demetrashvili Z, Di Carlo I, Di Saverio S, Dumitru IM, Eckmann C, Eiland EH, Forrester JD, Fraga GP, Frossard JL, Fry DE, Galeiras R, Ghnnam W, Gomes CA, Griffiths EA, Guirao X, Ahmed MH, Herzog T, Kim JI, Iqbal T, Isik A, Itani KMF, Labricciosa FM, Lee YY, Juang P, Karamarkovic A, Kim PK, Kluger Y, Leppaniemi A, Lohsiriwat V, Machain GM, Marwah S, Mazuski JE, Metan G, Moore EE, Moore FA, Ordoñez CA, Pagani L, Petrosillo N, Portela F, Rasa K, Rems M, Sakakushev BE, Segovia-Lohse H, Sganga G, Shelat VG, Spigaglia P, Tattevin P, Tranà C, Urbánek L, Ulrych J, Viale P, Baiocchi GL, Catena F. 2019 update of the WSES guidelines for management of Clostridioides ( Clostridium) difficile infection in surgical patients. World J Emerg Surg 2019; 14:8. [PMID: 30858872 PMCID: PMC6394026 DOI: 10.1186/s13017-019-0228-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [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: 01/28/2019] [Accepted: 02/17/2019] [Indexed: 02/08/2023] Open
Abstract
In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Stefano Di Bella
- 0000000459364044grid.460062.6Infectious Diseases Department, Trieste University Hospital, Trieste, Italy
| | - Lynne V. McFarland
- 0000000122986657grid.34477.33Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle, WA USA
| | - Sahil Khanna
- 0000 0004 0459 167Xgrid.66875.3aDivision of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN USA
| | - Luis Furuya-Kanamori
- 0000 0001 2180 7477grid.1001.0Research School of Population Health, Australian National University, Acton, ACT Australia
| | - Nadir Abuzeid
- grid.442422.6Department of Microbiology, Faculty of Medical Laboratory Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Fikri M. Abu-Zidan
- 0000 0001 2193 6666grid.43519.3aDepartment of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Luca Ansaloni
- 0000 0004 1758 8744grid.414682.dDepartment of General Surgery, Bufalini Hospital, Cesena, Italy
| | - Goran Augustin
- 0000 0001 0657 4636grid.4808.4Department of Surgery, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Miklosh Bala
- 0000 0001 2221 2926grid.17788.31Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Offir Ben-Ishay
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Walter L. Biffl
- 0000 0004 0449 3295grid.415402.6Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA USA
| | - Stephen M. Brecher
- 0000 0004 0367 5222grid.475010.7Pathology and Laboratory Medicine, VA Boston Healthcare System, West Roxbury MA and BU School of Medicine, Boston, MA USA
| | - Adrián Camacho-Ortiz
- Department of Internal Medicine, University Hospital, Dr. José E. González, Monterrey, Mexico
| | - Miguel A. Caínzos
- 0000000109410645grid.11794.3aDepartment of Surgery, University of Santiago de Compostela, A Coruña, Spain
| | - Shirley Chan
- grid.439210.dDepartment of General Surgery, Medway Maritime Hospital, Gillingham, Kent UK
| | - Jill R. Cherry-Bukowiec
- 0000000086837370grid.214458.eDepartment of Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor, MI USA
| | - Jesse Clanton
- 0000 0001 2156 6140grid.268154.cDepartment of Surgery, West Virginia University Charleston Division, Charleston, WV USA
| | - Federico Coccolini
- 0000 0004 1758 8744grid.414682.dDepartment of General Surgery, Bufalini Hospital, Cesena, Italy
| | - Maria E. Cocuz
- 0000 0001 2159 8361grid.5120.6Faculty of Medicine, Transilvania University, Infectious Diseases Hospital, Brasov, Romania
| | - Raul Coimbra
- 0000 0000 9852 649Xgrid.43582.38Riverside University Health System Medical Center and Loma Linda University School of Medicine, Moreno Valley, CA USA
| | | | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jacek Czepiel
- 0000 0001 2162 9631grid.5522.0Department of Infectious Diseases, Jagiellonian University, Medical College, Kraków, Poland
| | - Zaza Demetrashvili
- 0000 0004 0428 8304grid.412274.6Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Isidoro Di Carlo
- 0000 0004 1757 1969grid.8158.4Department of Surgical Sciences, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- 0000 0004 0622 5016grid.120073.7Department of Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Irina M. Dumitru
- 0000 0001 1089 1079grid.412430.0Clinical Infectious Diseases Hospital, Ovidius University, Constanta, Romania
| | - Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Hospital of Medical University Hannover, Peine, Germany
| | | | - Joseph D. Forrester
- 0000000419368956grid.168010.eDepartment of Surgery, Stanford University, Stanford, CA USA
| | - Gustavo P. Fraga
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jean L. Frossard
- 0000 0001 0721 9812grid.150338.cService of Gastroenterology and Hepatology, Geneva University Hospital, Genève, Switzerland
| | - Donald E. Fry
- 0000 0001 2299 3507grid.16753.36Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- 0000 0001 2188 8502grid.266832.bUniversity of New Mexico School of Medicine, Albuquerque, NM USA
| | - Rita Galeiras
- 0000 0001 2176 8535grid.8073.cCritical Care Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
| | - Wagih Ghnnam
- 0000000103426662grid.10251.37Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Carlos A. Gomes
- 0000 0001 2170 9332grid.411198.4Surgery Department, Hospital Universitario (HU) Terezinha de Jesus da Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Hospital Universitario (HU) Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Ewen A. Griffiths
- 0000 0001 2177 007Xgrid.415490.dDepartment of Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Xavier Guirao
- Unit of Endocrine, Head, and Neck Surgery and Unit of Surgical Infections Support, Department of General Surgery, Parc Taulí, Hospital Universitari, Sabadell, Spain
| | - Mohamed H. Ahmed
- grid.415667.7Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire UK
| | - Torsten Herzog
- grid.416438.cDepartment of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jae Il Kim
- 0000 0004 0371 8173grid.411633.2Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Tariq Iqbal
- 0000 0001 2177 007Xgrid.415490.dDepartment of Gastroenterology, Queen Elizabeth Hospital, Birmingham, UK
| | - Arda Isik
- 0000 0004 0455 1723grid.411487.fGeneral Surgery Department, Magee Womens Hospital, UPMC, Pittsburgh, USA
| | - Kamal M. F. Itani
- 000000041936754Xgrid.38142.3cDepartment of Surgery, VA Boston Health Care System, Boston University and Harvard Medical School, Boston, MA USA
| | | | - Yeong Y. Lee
- 0000 0001 2294 3534grid.11875.3aSchool of Medical Sciences, University Sains Malaysia, Kota Bharu, Kelantan Malaysia
| | - Paul Juang
- 0000 0000 8660 3507grid.419579.7Department of Pharmacy Practice, St Louis College of Pharmacy, St Louis, MO USA
| | - Aleksandar Karamarkovic
- Faculty of Mediine University of Belgrade Clinic for Surgery “Nikola Spasic”, University Clinical Center “Zvezdara” Belgrade, Belgrade, Serbia
| | - Peter K. Kim
- 0000000121791997grid.251993.5Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Yoram Kluger
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ari Leppaniemi
- 0000 0000 9950 5666grid.15485.3dAbdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland
| | - Varut Lohsiriwat
- 0000 0004 1937 0490grid.10223.32Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Gustavo M. Machain
- 0000 0001 2289 5077grid.412213.7Department of Surgery, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | - Sanjay Marwah
- 0000 0004 1771 1642grid.412572.7Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - John E. Mazuski
- 0000 0001 2355 7002grid.4367.6Department of Surgery, Washington University School of Medicine, Saint Louis, USA
| | - Gokhan Metan
- 0000 0001 2342 7339grid.14442.37Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ernest E. Moore
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA
| | - Frederick A. Moore
- 0000 0004 1936 8091grid.15276.37Department of Surgery, University of Florida, Gainesville, FL USA
| | - Carlos A. Ordoñez
- 0000 0001 2295 7397grid.8271.cDepartment of Surgery, Fundación Valle del Lili, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Nicola Petrosillo
- National Institute for Infectious Diseases - INMI - Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francisco Portela
- 0000000106861985grid.28911.33Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, Kocaali, Turkey
| | - Miran Rems
- Department of Abdominal and General Surgery, General Hospital Jesenice, Jesenice, Slovenia
| | - Boris E. Sakakushev
- 0000 0001 0726 0380grid.35371.33Department of Surgery, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Helmut Segovia-Lohse
- 0000 0001 2289 5077grid.412213.7Department of Surgery, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | - Gabriele Sganga
- grid.414603.4Division of Emergency Surgery, Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vishal G. Shelat
- grid.240988.fDepartment of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Patrizia Spigaglia
- 0000 0000 9120 6856grid.416651.1Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Pierre Tattevin
- grid.414271.5Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Libor Urbánek
- 0000 0001 2194 0956grid.10267.32First Department of Surgery, Faculty of Medicine, Masaryk University Brno and University Hospital of St. Ann Brno, Brno, Czech Republic
| | - Jan Ulrych
- 0000 0000 9100 9940grid.411798.2First Department of Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Pierluigi Viale
- grid.412311.4Clinic of Infectious Diseases, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Gian L. Baiocchi
- 0000000417571846grid.7637.5Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fausto Catena
- grid.411482.aEmergency Surgery Department, Maggiore Parma Hospital, Parma, Italy
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41
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Itani KMF, May AK. Surgical Infection Society: We Endorse Antimicrobial Stewardship We Stand by Our International Colleagues and Societies in the Fight for Proper Antimicrobial Therapy. Surg Infect (Larchmt) 2018; 18:843-845. [PMID: 29120282 DOI: 10.1089/sur.2017.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kamal M F Itani
- 1 VA Boston Health Care System, Boston University and Harvard Medical School , Boston, Massachusetts
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42
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Mull HJ, Itani KMF, Pizer SD, Charns MP, Rivard PE, McIntosh N, Hawn MT, Rosen AK. Development of an Adverse Event Surveillance Model for Outpatient Surgery in the Veterans Health Administration. Health Serv Res 2018; 53:4507-4528. [PMID: 30151826 DOI: 10.1111/1475-6773.13037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/29/2022] Open
Abstract
OBJECTIVE Develop and validate a surveillance model to identify outpatient surgical adverse events (AEs) based on previously developed electronic triggers. DATA SOURCES Veterans Health Administration's Corporate Data Warehouse. STUDY DESIGN Six surgical AE triggers, including postoperative emergency room visits and hospitalizations, were applied to FY2012-2014 outpatient surgeries (n = 744,355). We randomly sampled trigger-flagged and unflagged cases for nurse chart review to document AEs and measured positive predictive value (PPV) for triggers. Next, we used chart review data to iteratively estimate multilevel logistic regression models to predict the probability of an AE, starting with the six triggers and adding in patient, procedure, and facility characteristics to improve model fit. We validated the final model by applying the coefficients to FY2015 outpatient surgery data (n = 256,690) and reviewing charts for cases at high and moderate probability of an AE. PRINCIPAL FINDINGS Of 1,730 FY2012-2014 reviewed surgeries, 350 had an AE (20 percent). The final surveillance model c-statistic was 0.81. In FY2015 surgeries with >0.8 predicted probability of an AE (n = 405, 0.15 percent), PPV was 85 percent; in surgeries with a 0.4-0.5 predicted probability of an AE, PPV was 38 percent. CONCLUSIONS The surveillance model performed well, accurately identifying outpatient surgeries with a high probability of an AE.
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Affiliation(s)
- Hillary J Mull
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.,Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Kamal M F Itani
- Department of Surgery, Boston University School of Medicine, Boston, MA.,Department of Surgery, VA Boston Healthcare System, Boston, MA.,Harvard Medical School, Boston, MA
| | - Steven D Pizer
- Department of Veterans Affairs, Partnered Evidence-based Policy Resource Center (PEPReC), Boston, MA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Martin P Charns
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Peter E Rivard
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.,Healthcare Administration, Sawyer Business School Suffolk University, Boston, MA
| | | | - Mary T Hawn
- Palo Alto VA Medical Center, Palo Alto, CA.,Stanford University School of Medicine, Stanford, CA
| | - Amy K Rosen
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.,Department of Surgery, Boston University School of Medicine, Boston, MA
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43
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Sidhwa F, Itani KMF. Discussion: Fight or Flight: The Role of Staged Approaches to Complex Abdominal Wall Reconstruction. Plast Reconstr Surg 2018; 142:45S-46S. [PMID: 30138265 DOI: 10.1097/prs.0000000000004848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Feroze Sidhwa
- From the Department of Surgery, VA Boston Health Care System; and Harvard Medical School
| | - Kamal M F Itani
- From the Department of Surgery, VA Boston Health Care System; and Harvard Medical School
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Sartelli M, Kluger Y, Ansaloni L, Coccolini F, Baiocchi GL, Hardcastle TC, Moore EE, May AK, Itani KMF, Fry DE, Boermeester MA, Guirao X, Napolitano L, Sawyer RG, Rasa K, Abu-Zidan FM, Adesunkanmi AK, Atanasov B, Augustin G, Bala M, Cainzos MA, Chichom-Mefire A, Cortese F, Damaskos D, Delibegovic S, Demetrashvili Z, De Simone B, Duane TM, Ghnnam W, Gkiokas G, Gomes CA, Hecker A, Karamarkovic A, Kenig J, Khokha V, Kong V, Isik A, Leppäniemi A, Litvin A, Lostoridis E, Machain GM, Marwah S, McFarlane M, Mesina C, Negoi I, Olaoye I, Pintar T, Pupelis G, Rems M, Rubio-Perez I, Sakakushev B, Segovia-Lohse H, Siribumrungwong B, Talving P, Ulrych J, Vereczkei AG, Labricciosa FM, Catena F. Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion. World J Emerg Surg 2018; 13:37. [PMID: 30140304 PMCID: PMC6098571 DOI: 10.1186/s13017-018-0198-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/29/2018] [Accepted: 08/08/2018] [Indexed: 02/08/2023] Open
Abstract
Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The “surgeon champion” can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia, 62100 Macerata, Italy
| | - Yoram Kluger
- 2Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Luca Ansaloni
- General Surgery Department, "M. Bufalini" Cesena Hospital, Cesena, Italy
| | - Federico Coccolini
- General Surgery Department, "M. Bufalini" Cesena Hospital, Cesena, Italy
| | - Gian Luca Baiocchi
- 4Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Timothy C Hardcastle
- Department of Surgery, Trauma Service, Inkosi Albert Luthuli Central Hospital, Nelson R Mandela School of Clinical Medicine, Durban, South Africa
| | - Ernest E Moore
- 6Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, CO USA
| | - Addison K May
- 7Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN USA
| | - Kamal M F Itani
- Department of Surgery, VA Boston Health Care System, Boston University, Harvard Medical School, Boston, MA USA
| | - Donald E Fry
- 9Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL USA.,10University of New Mexico School of Medicine, Albuquerque, NM USA
| | | | - Xavier Guirao
- Unit of Endocrine, Head, and Neck Surgery and Unit of Surgical Infections Support, Department of General Surgery, ParcTaulí, Hospital University, Sabadell, Spain
| | - Lena Napolitano
- 13Department of Surgery, University of Michigan, Ann Arbor, MI USA
| | - Robert G Sawyer
- 14Department of Surgery, Western Michigan University School of Medicine, Kalamazoo, MI USA
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, Kocaali, Turkey
| | - Fikri M Abu-Zidan
- 16Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Boyko Atanasov
- 18Department of General Surgery, Medical University of Plovdiv, UMHAT Eurohospital, Plovdiv, Bulgaria
| | - Goran Augustin
- 19Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miklosh Bala
- 20Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Miguel A Cainzos
- 21Department of Surgery, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Alain Chichom-Mefire
- Department of Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon
| | | | - Dimitris Damaskos
- 24Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Samir Delibegovic
- 25Department of Surgery, University Clinical Center of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department General Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia
| | | | - Therese M Duane
- Department of Surgery, John Peter Smith Health Network, Fort Worth, TX USA
| | - Wagih Ghnnam
- 29Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - George Gkiokas
- 30Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Carlos A Gomes
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Department of Surgery, Hospital Universitário Terezinha de Jesus, Juiz de Fora, Brazil
| | - Andreas Hecker
- 32Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
| | | | - Jakub Kenig
- 34Third Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Victor Kong
- 36Department of Surgery, Edendale Hospital, Pietermaritzburg, South Africa
| | - Arda Isik
- 37General Surgery Department, Magee Womens Hospital, UPMC, Pittsburgh, USA
| | - Ari Leppäniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Andrey Litvin
- 39Surgical Disciplines, Immanuel Kant Baltic Federal University/Regional Clinical Hospital, Kaliningrad, Russian Federation
| | | | - Gustavo M Machain
- 41Department of Surgery, II Cátedra de Clínica Quirúrgica, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Sanjay Marwah
- 42Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Michael McFarlane
- 43Department of Surgery, Radiology, University Hospital of the West Indies, Kingston, Jamaica
| | - Cristian Mesina
- Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Romania
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Iyiade Olaoye
- 46Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Tadeja Pintar
- 47Department of Surgery, UMC Ljubljana, Ljubljana, Slovenia
| | - Guntars Pupelis
- 48Department of General and Emergency Surgery, Riga East University Hospital "Gailezers", Riga, Latvia
| | - Miran Rems
- Department of General Surgery, Jesenice General Hospital, Jesenice, Slovenia
| | - Ines Rubio-Perez
- 50Colorectal Surgery Unit, General Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Helmut Segovia-Lohse
- 41Department of Surgery, II Cátedra de Clínica Quirúrgica, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Boonying Siribumrungwong
- 52Faculty of Medicine, Department of Surgery, Thammasat University Hospital, Thammasat University, Amphoe Khlong Luang, Pathum Thani Thailand
| | - Peep Talving
- Department of Surgery, North Estonia Medical Center, Tallinn, Estonia
| | - Jan Ulrych
- 54First Department of Surgery-Department of Abdominal, Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic
| | - András G Vereczkei
- 55Department of Surgery, Medical School University of Pécs, Pécs, Hungary
| | | | - Fausto Catena
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
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Borzecki AM, Chen Q, O'Brien W, Shwartz M, Najjar PA, Itani KMF, Rosen AK. The Patient Safety Indicator Perioperative Pulmonary Embolism or Deep Vein Thrombosis: Is there associated surveillance bias in the Veterans Health Administration? Am J Surg 2018; 216:974-979. [PMID: 30005806 DOI: 10.1016/j.amjsurg.2018.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/11/2017] [Revised: 06/15/2018] [Accepted: 06/21/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Studies disagree whether surveillance bias is associated with perioperative venous thromboembolism (VTE) performance measures. A prior VA study used a chart-based outcome; no studies have used the fully specified administrative data-based AHRQ Patient Safety Indicator, PSI-12, as their primary outcome. If surveillance bias were present, we hypothesized that inpatient surveillance rates would be associated with higher PSI-12 rates, but with lower post-discharge VTE rates. METHODS Using VA data, we examined Pearson correlations between hospital-level VTE imaging rates and risk-adjusted PSI-12 rates and post-discharge VTE rates. To determine the robustness of findings, we conducted several sensitivity analyses. RESULTS Hospital imaging rates were positively correlated with both PSI-12 (r = 0.24, p = 0.01) and post-discharge VTE rates (r = 0.16, p = 0.09). Sensitivity analyses yielded similar findings. CONCLUSIONS Like the prior VA study, we found no evidence of PSI-12-related surveillance bias. Given the use of PSI-12 in nationwide measurement, these findings warrant replication using similar methods in the non-VA setting.
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Affiliation(s)
- Ann M Borzecki
- Center for Healthcare Organization and Implementation Research, Bedford VAMC, Bedford, MA, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
| | - Qi Chen
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - William O'Brien
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Michael Shwartz
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA; Boston University, Questrom School of Business, Boston, MA, USA
| | - Peter A Najjar
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Kamal M F Itani
- VA Boston Healthcare System, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Amy K Rosen
- Boston University School of Medicine, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
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Bigelow TA, Thomas CL, Wu H, Itani KMF. Histotripsy Treatment of S. Aureus Biofilms on Surgical Mesh Samples Under Varying Scan Parameters. IEEE Trans Ultrason Ferroelectr Freq Control 2018; 65:1017-1024. [PMID: 29856719 PMCID: PMC6602080 DOI: 10.1109/tuffc.2018.2819363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Cavitation-based ultrasound histotripsy has shown potential for treating infections on surgical mesh. The goal of this paper was to explore a new scan strategy while assessing the impact of scan speed, scan step size, and the number of cycles in the tone burst on the destruction of S. aureus biofilms grown on surgical mesh samples using ultrasound histotripsy pulses (150 MPa/-17 MPa). For each exposure, the number of colony forming units (CFUs) on the mesh and released onto the surrounding gel was quantified. Most of the exposed mesh samples had no CFUs, and there was a statistically significant reduction in CFUs on the mesh for each of the exposures, with an average reduction of 3.8 log10 relative to the sham. Compared with the sham, there was also a statistically significant reduction in CFUs on the gel with the highest exposures.
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Mull HJ, Rosen AK, Pizer SD, Itani KMF. Association Between Postoperative Admission and Location of Hernia Surgery: A Matched Case-Control Study in the Veterans Administration. JAMA Surg 2018; 151:1187-1190. [PMID: 27682221 DOI: 10.1001/jamasurg.2016.3113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hillary J Mull
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts2Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Amy K Rosen
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts2Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Steven D Pizer
- Health Care Financing & Economics, Department of Veterans Affairs, Boston, Massachusetts4Northeastern University, Boston, Massachusetts
| | - Kamal M F Itani
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts5Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts6Harvard Medical School, Boston, Massachusetts
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Chen Q, Rosen AK, Amirfarzan H, Rochman A, Itani KMF. Improving detection of intraoperative medical errors (iMEs) and intraoperative adverse events (iAEs) and their contribution to postoperative outcomes. Am J Surg 2018; 216:846-850. [PMID: 29563021 DOI: 10.1016/j.amjsurg.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 02/25/2018] [Accepted: 03/02/2018] [Indexed: 12/18/2022]
Abstract
Our knowledge of the types of intraoperative patient safety events, their harm to patients, and relationship to postoperative complications is sparse. This study examined intraoperative medical errors (iMEs) and intraoperative adverse events (iAEs) voluntarily reported by providers using two programs at our hospital: surgical debriefing and incident reporting. Among the 3020 surgical procedures assessed, 142 iMEs and 103 iAEs were reported, yielding an overall rate of 8%. Of these events, 135 (55%) were obtained from incident reporting and 110 (45%) from surgical debriefing. The overall association between intraoperative events (iMEs and iAEs) and 30-day postoperative morbidity was significant (adjusted odds ratio = 1.08 with 95% confidence interval (CI) of (1.03, 1.13). This association was stronger when we included only the iAEs (1.47, 95% CI (1.35, 1.58)). Our findings suggest that hospitals should consider using both programs to obtain a more complete picture of intraoperative patient safety and to reduce postoperative morbidity.
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Affiliation(s)
- Qi Chen
- Patient Safety Center of Inquiry on Measurement to Advance Patient Safety, Boston, MA, USA; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
| | - Amy K Rosen
- Patient Safety Center of Inquiry on Measurement to Advance Patient Safety, Boston, MA, USA; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Houman Amirfarzan
- Patient Safety Center of Inquiry on Measurement to Advance Patient Safety, Boston, MA, USA; Department of Anesthesiology, Critical Care and Pain Medicine, VA Boston Healthcare System, Boston, MA, USA
| | - Alexandra Rochman
- Patient Safety Center of Inquiry on Measurement to Advance Patient Safety, Boston, MA, USA; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Kamal M F Itani
- Patient Safety Center of Inquiry on Measurement to Advance Patient Safety, Boston, MA, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA; Department of Surgery, VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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49
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Pilieci SN, Salim SY, Heffernan DS, Itani KMF, Khadaroo RG. A Randomized Controlled Trial of Video Education versus Skill Demonstration: Which Is More Effective in Teaching Sterile Surgical Technique? Surg Infect (Larchmt) 2018; 19:303-312. [PMID: 29406814 DOI: 10.1089/sur.2017.231] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 11/13/2022] Open
Abstract
BACKGROUND Video education has many advantages over traditional education including efficiency, convenience, and individualized learning. Learning sterile surgical technique (SST) is imperative for medical students, because proper technique helps prevent surgical site infections (SSIs). We hypothesize that video education is at least as effective as traditional skill demonstration in teaching first-year medical students SST. METHODS A video series was created to demonstrate SST ( https://www.youtube.com/playlist?list=PLcRU-gvOmxE2mwMWkowouBkxGXkLZ8Uis ). A randomized controlled trial was designed to assess which education method best teaches SST: video education or skill demonstration. First-year medical students (n = 129) were consented and randomly assigned into two groups: those who attended a skill demonstration (control group; n = 70) and those who watched the video series (experimental group; n = 59). The control group attended a pre-existing 90-minute nurse educator-led skill demonstration. Participants then completed a 30-item multiple choice quiz to test their knowledge. Each group then received the alternate education method and completed a 23-item follow-up survey to determine their preferred method. RESULTS Seven 2- to 6-minute videos (30 minutes total) were created on surgical attire, scrubbing, gowning and gloving, and maintaining sterility. The experimental group (n = 51) scored higher on the quiz compared with the control group (n = 63) (88% ± 1% versus 72% ± 1%; p < 0.0001). Students preferred the videos when it came to convenience, accessibility, efficiency, and review, and preferred the skill demonstration when it came to knowledge retention, preparedness, and ease of completion. CONCLUSIONS Video education is superior to traditional skill demonstration in providing medical students with knowledge of SST. Students identified strengths to each method of teaching. Video education can augment medical students' knowledge prior to their operating room experience to ensure that a sterile environment is maintained for patients. The ultimate goal is to reduce SSIs.
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Affiliation(s)
- Stephanie N Pilieci
- 1 Faculty of Medicine and Dentistry, University of Alberta , Edmonton, Alberta, Canada
| | - Saad Y Salim
- 2 Department of Surgery, University of Alberta , Edmonton, Alberta, Canada
| | | | - Kamal M F Itani
- 4 Veterans Health Administration , Surgical Service, Boston, Massachusetts
| | - Rachel G Khadaroo
- 5 Department of Surgery and Critical Care Medicine, University of Alberta , Edmonton, Alberta, Canada
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Mull HJ, Rosen AK, O'Brien WJ, McIntosh N, Legler A, Hawn MT, Itani KMF, Pizer SD. Factors Associated with Hospital Admission after Outpatient Surgery in the Veterans Health Administration. Health Serv Res 2018; 53:3855-3880. [PMID: 29363106 DOI: 10.1111/1475-6773.12826] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine factors associated with 0- to 7-day admission after outpatient surgery in high-volume specialties: general surgery, orthopedics, urology, ear/nose/throat, and podiatry. STUDY DESIGN We calculated rates and assessed diagnosis codes for 0- to 7-day admission after outpatient surgery for Centers for Medicare and Medicaid Services (CMS) and Veterans Health Administration (VA) dually enrolled patients age 65 and older. We also estimated separate multilevel logistic regression models to compare patient, procedure, and facility characteristics associated with postoperative admission. DATA COLLECTION 2011-2013 surgical encounter data from the VA Corporate Data Warehouse; geographic data from the Area Health Resources File; CMS enrollment and hospital admission data. PRINCIPAL FINDINGS Among 63,585 outpatient surgeries in 124 facilities, 0- to 7-day admission rates ranged from 5 percent (podiatry) to 28 percent (urology); nearly 66 percent of the admissions occurred on the day of surgery. Only 97 admissions were detected in the CMS data (1 percent). Surgical complications were diagnosed in 4 percent of admissions. Procedure complexity, measured by relative value units or anesthesia risk score, was associated with admission across all specialties. CONCLUSION As many as 20 percent of VA outpatient surgeries result in an admission. Complex procedures are more likely to be followed by admission, but more evidence is required to determine how many of these reflect potential safety or quality problems.
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Affiliation(s)
- Hillary J Mull
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.,Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Amy K Rosen
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.,Department of Surgery, Boston University School of Medicine, Boston, MA
| | - William J O'Brien
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA
| | | | - Aaron Legler
- Department of Veterans Affairs, Partnered Evidence-based Policy Resource Center (PEPReC), Boston, MA
| | - Mary T Hawn
- Palo Alto VA Medical Center, Palo Alto, CA.,Stanford University School of Medicine, Stanford, CA
| | - Kamal M F Itani
- Department of Surgery, Boston University School of Medicine, Boston, MA.,Department of Surgery, VA Boston Healthcare System, Boston, MA.,Harvard Medical School, Boston, MA
| | - Steven D Pizer
- Department of Veterans Affairs, Partnered Evidence-based Policy Resource Center (PEPReC), Boston, MA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
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