1
|
van Rossum C, de Bree K, de Jong G, Bartels R, Heeren G, Nabuurs M, Meijer C, Tostmann A, Aquarius R. Usability and outcomes of self-monitored surgical wound healing using a smartphone-based application by patients following neurosurgery. J Hosp Infect 2024; 148:138-144. [PMID: 38554806 DOI: 10.1016/j.jhin.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The Radboudumc developed a smartphone application (WondGezond) to collect surgical wound-healing information provided by the patient. AIM To evaluate usability and outcomes to assess its potential for early surgical site infection (SSI) detection. METHODS Patients surgically treated for degenerative spinal disorders or carpal tunnel syndrome between August 2020 and February 2023 were enrolled one day post surgery and asked to download the app via a quick-response (QR) code. Participants uploaded a photo and answered four questions about their wound daily, for 14 days. Afterwards, participants indicated whether they received treatment for a suspected SSI (participant-reported outcome). Two neurosurgeons independently assessed photos and questionnaire answers for suspected SSIs (physician-assessed outcome). The association between both outcomes was determined by calculating sensitivity, specificity, and positive and negative predictive value (PPV/NPV). FINDINGS After 2009 surgeries, 1695 QR-codes were distributed and 412 (21%) were activated. In all, 232 (56%) participants completed the 14-day period of whom 22 (10%) reported SSI treatment. Physician assessment identified 15 (7%) SSIs. Concordance was reached in 88% of cases. Among 27 discordant cases were 17 false-positives and 10 false-negatives, resulting in low sensitivity (33%) and PPV (23%), but high NPV (95%). CONCLUSION WondGezond provides clinicians with information regarding wound healing and SSIs to follow-up on patients at risk, while possibly also reducing antibiotic (over)treatment and unnecessary visits for patients without issues in wound healing. However, the low participation and false-positive results render the app in its current form unsuitable for surveillance purposes. Further validation of WondGezond is required.
Collapse
Affiliation(s)
- C van Rossum
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - K de Bree
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Neurosurgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - G de Jong
- Department of Oral & Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Bartels
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Neurosurgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - G Heeren
- Department of Medical Microbiology and Immunology, Dicoon/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M Nabuurs
- Department of Medical Microbiology and Immunology, Dicoon/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - C Meijer
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A Tostmann
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands; Regional Antimicrobial Resistance and Infection Prevention Network Gelderland, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Aquarius
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Khalife T, Dewitt JJ, Brien AL. Pre-post pilot study: investigating the role of rectovaginal contamination in laparoscopic hysterectomy-related infectious morbidity. AJOG GLOBAL REPORTS 2023; 3:100258. [PMID: 37645644 PMCID: PMC10461244 DOI: 10.1016/j.xagr.2023.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
- Tarek Khalife
- Mayo Clinic Health System, 1025 Marsh St., Mankato, MN 56001
| | - Jason J. Dewitt
- Mayo Clinic Health System, 1025 Marsh St., Mankato, MN 56001
| | - Amy L. Brien
- Mayo Clinic Health System, 1025 Marsh St., Mankato, MN 56001
| |
Collapse
|
3
|
Smith HA, Garcia-Ochoa C, Fontaine Calder J, Miller T, Babak R, McIsaac C, Musselman R. A mobile application for wound and symptom surveillance after colorectal surgery: a feasibility randomized controlled trial protocol. JMIR Res Protoc 2021; 11:e26717. [PMID: 34854816 PMCID: PMC8763310 DOI: 10.2196/26717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/24/2021] [Accepted: 10/19/2021] [Indexed: 11/22/2022] Open
Abstract
Background Surgical site infections (SSIs) are the most common nosocomial infection and occur in 16.3% of patients undergoing colorectal surgery at our institution (The Ottawa Hospital), the majority of which are identified after discharge from hospital. Patients who suspect having an SSI generally present to the emergency department or surgery clinic. Both options for in-person interaction are costly to the health care system and patients. A mobile app, how2trak, has proven to be beneficial for patients with complex wounds at our institution by facilitating at-home monitoring and virtual consultations. Objective This study aims to assess the feasibility of a randomized controlled trial to assess if how2trak can improve patients’ experience and increase detection of SSIs after colorectal surgery while reducing patients’ risk of COVID-19 exposure. Methods In this single-center prospective feasibility trial, eligible patients undergoing colorectal surgery will be randomized to either standard care or how2trak postoperative monitoring of their incision, symptoms, and ostomy function. Patient self-assessments will be monitored by a nurse specialized in wound and ostomy care who will follow-up with patients with a suspected SSI. The primary outcome is feasibility as measured by enrollment, randomization, app usability, data extraction, and resource capacity. Results This study was approved by our institution’s ethics board on February 26, 2021, and received support from The Ottawa Hospital Innovation and Care Funding on November 12, 2021. Recruitment started June 3, 2021, and 29 were patients enrolled as of September 2021. We expect to publish results in spring 2022. Conclusions This study will determine the feasibility of using a mobile app to monitor patients’ wounds and detect SSIs after colorectal surgery. If feasible, we plan to assess if this mobile app facilitates SSI detection, enhances patient experience, and optimizes their care. Trial Registration ClinicalTrials.gov NCT04869774; https://clinicaltrials.gov/ct2/show/NCT04869774 International Registered Report Identifier (IRRID) DERR1-10.2196/26717
Collapse
Affiliation(s)
- Heather Anne Smith
- Division of General Surgery, Faculty of Medicine, University of Ottawa, 725 Parkdale Ave, Ottawa, CA
| | - Carlos Garcia-Ochoa
- Division of General Surgery, Faculty of Medicine, University of Ottawa, 725 Parkdale Ave, Ottawa, CA
| | | | - Toba Miller
- Wound, Ostomy, and Rehabilitation, The Ottawa Hospital, Ottawa, CA
| | - Rashidi Babak
- Department of Internal Medicine, Faculty of Medicine, University of Ottawa, Ottawa, CA
| | | | - Reilly Musselman
- Division of General Surgery, Faculty of Medicine, University of Ottawa, 725 Parkdale Ave, Ottawa, CA
| |
Collapse
|
4
|
Using administrative data to determine rates of surgical site infections following spinal fusion and laminectomy procedures. Am J Infect Control 2021; 49:759-763. [PMID: 33091510 DOI: 10.1016/j.ajic.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Surgical site infections (SSIs) are a serious and costly post-op complication. Generating SSI rates often requires labor-intensive methods, but increasing numbers of publications reported SSI rates using administrative data. METHODS Index laminectomy and spinal fusion procedures were identified using Canadian Classification of Health Interventions (CCI) procedure codes for inpatients and outpatients in the province of Alberta, Canada between 2008 and 2015. SSIs occurring in the year postsurgery were identified using the International Classification of Diseases, 10th Revision, Canada (ICD-10-CA) diagnosis and CCI procedure codes indicative of post-op infection. Rates of SSIs and case characteristics were reported. RESULTS Over the 8-year study period, 21,222 index spinal procedures were identified of which 12,027 (56.7%) were laminectomy procedures, with 322 SSIs identified, an SSI rate of 2.7 per 100 procedures. Of the 9,195 (43.3%) fusion procedures, 298 were identified as an SSI, an SSI rate of 3.2 per 100 procedures. This study found SSI rates increased from 2008 and 2015, and rates were the highest in the 0-18 year age group. CONCLUSIONS The rates reported in this study were similar to published SSI rates using traditional surveillance methods, suggesting administrative data may be a viable method for reporting SSI rates following spinal procedures. Further work is needed to validate SSIs identified using administrative data by comparing to traditional surveillance.
Collapse
|
5
|
Bompas V, Andréo A, Bouchand C, Rahal A, Ferriot C, Le Gallou F, Guille des Buttes AC, Quimbre M, Bodet N, Bourigault C, Lepelletier D. Day surgery: should we be worried about the occurrence of surgical site infection in outpatients? J Hosp Infect 2021; 114:185-186. [PMID: 33901581 DOI: 10.1016/j.jhin.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- V Bompas
- Infection Control Department, Nantes University Hospital, Nantes, France
| | - A Andréo
- Infection Control Department, Nantes University Hospital, Nantes, France
| | - C Bouchand
- MiHAR Laboratory, University of Nantes, Nantes, France
| | - A Rahal
- Infection Control Department, Nantes University Hospital, Nantes, France
| | - C Ferriot
- Infection Control Department, Nantes University Hospital, Nantes, France
| | - F Le Gallou
- Infection Control Department, Nantes University Hospital, Nantes, France
| | | | - M Quimbre
- Day Surgery Department, Nantes University Hospital, Nantes, France
| | - N Bodet
- Infection Control Department, Nantes University Hospital, Nantes, France
| | - C Bourigault
- Infection Control Department, Nantes University Hospital, Nantes, France
| | - D Lepelletier
- Infection Control Department, Nantes University Hospital, Nantes, France; MiHAR Laboratory, University of Nantes, Nantes, France.
| |
Collapse
|
6
|
Sengupta D, Banerjee T, Roy S. Estimation of Poisson mean with under‐reported counts: a double sampling approach. AUST NZ J STAT 2021. [DOI: 10.1111/anzs.12308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Debjit Sengupta
- Department of Statistics St. Xavier's College 30, Mother Teresa Sarani Kolkata West Bengal700016India
| | - Tathagata Banerjee
- Indian Institute of Management Ahmedabad Vastrapur Ahmedabad Gujarat380015India
| | - Surupa Roy
- Department of Statistics St. Xavier's College 30, Mother Teresa Sarani Kolkata West Bengal700016India
| |
Collapse
|
7
|
The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018. Surg Today 2020; 51:1-31. [PMID: 33320283 PMCID: PMC7788056 DOI: 10.1007/s00595-020-02181-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/27/2022]
Abstract
Background The guidelines for the prevention, detection, and management of gastroenterological surgical site infections (SSIs) were published in Japanese by the Japan Society for Surgical Infection in 2018. This is a summary of these guidelines for medical professionals worldwide. Methods We conducted a systematic review and comprehensive evaluation of the evidence for diagnosis and treatment of gastroenterological SSIs, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Modifications were made to the guidelines in response to feedback from the general public and relevant medical societies. Results There were 44 questions prepared in seven subject areas, for which 51 recommendations were made. The seven subject areas were: definition and etiology, diagnosis, preoperative management, prophylactic antibiotics, intraoperative management, perioperative management, and wound management. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the results of the meta-analysis, recommendations were graded using the Delphi method to generate useful information. The final version of the recommendations was published in 2018, in Japanese. Conclusions The Japanese Guidelines for the prevention, detection, and management of gastroenterological SSI were published in 2018 to provide useful information for clinicians and improve the clinical outcome of patients. Electronic supplementary material The online version of this article (10.1007/s00595-020-02181-6) contains supplementary material, which is available to authorized users.
Collapse
|
8
|
Moges G, Belete L, Mengesha Y, Ahmed S. Evaluation of Surgical Antimicrobial Prophylaxis and Incidence of Surgical Site Infection at Borumeda Hospital, Northeast Ethiopia: Retrospective Cross-Sectional Study. DRUG HEALTHCARE AND PATIENT SAFETY 2020; 12:257-268. [PMID: 33304108 PMCID: PMC7723029 DOI: 10.2147/dhps.s280442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/22/2020] [Indexed: 12/21/2022]
Abstract
Background Surgical site infections are global healthcare problems. Although surgical site infections are preventable, they still cause significant morbidity, high death rates, and financial stress on national budgets and individual patients. Inappropriate uses of surgical antimicrobial prophylaxis are increasing and worsening patients’ quality of life. This study determined the incidence and risk factors of surgical site infections. Methods Institution-based retrospective cross-sectional study was conducted using a structured data abstraction format on patients who were attending at the surgical ward of Borumeda hospital from April 1, 2017, to March 31, 2019. The data were collected during July 15–30, 2019. A systematic random sampling technique was employed to select 227 surgical cases. Multivariate logistic regression was computed using the statistical package for social sciences version 23. Results The incidence of surgical site infections was 46.7%. Prophylaxis was administered to 188 (82.8%) surgical cases. Prophylaxis was recommended for 151 (66.5%). Out of these, only 143 (94.7%) received prophylaxis. One hundred seventy-four (78.4%) of the procedures had appropriate indication. The compliance of surgical antimicrobial prophylaxis use was 13.7%. The predictors of surgical site infections were receiving prophylaxis more than 24 h after surgery (AOR=3.53, 95% CI: 1.22–10.17), clean-contaminated wounds (AOR=4.54, 95% CI: 1.33–15.53), surgical procedure of thyroidectomy (AOR=5.2, 95% CI: 0.9–21.4), appendectomy (AOR = 29, 95% CI: 6.2–141.7), cholecystectomy (AOR = 21, 95% CI: 3.5 −126.7), hernia (AOR= 8.8, 95% CI: 1.2–62.2), skin and deep tissue (AOR = 125, 95% CI: 7.8–196.7), and orthopedic (AOR=57, 95% CI: 1.6–209.5). Conclusion There was high inconsistency between surgical antimicrobial prophylaxis practice and international surgical site infections prevention guideline. Wrong selection of antimicrobial agents was the most noncompliant to the guidelines. The incidence of surgical antimicrobial prophylaxis was high and requires due attention. The duration of postoperative prophylaxis should be kept to less than 24 h.
Collapse
Affiliation(s)
- Getachew Moges
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Lielet Belete
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yohannes Mengesha
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Solomon Ahmed
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
9
|
De la Plaza Llamas R, Ramia JM. Cost of postoperative complications: How to avoid calculation errors. World J Gastroenterol 2020; 26:2682-2690. [PMID: 32550746 PMCID: PMC7284181 DOI: 10.3748/wjg.v26.i21.2682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/27/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
Postoperative complications (PC) are a basic health outcome, but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs. Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency. The payment system in place often rewards the volume of services provided rather than the quality of patients’ clinical outcomes. Without a thorough registration of PC, the economic costs involved cannot be determined. An accurate, reliable appraisal would help identify areas for investment in order to reduce the incidence of PC, improve surgical results, and bring down the economic costs. This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index, discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established, and makes various recommendations. The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs. Patients, the health authorities, and society as a whole are sure to benefit.
Collapse
Affiliation(s)
- Roberto De la Plaza Llamas
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
| | - José M Ramia
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
| |
Collapse
|
10
|
Stryja J, Sandy-Hodgetts K, Collier M, Moser C, Ousey K, Probst S, Wilson J, Xuereb D. PREVENTION AND MANAGEMENT ACROSS HEALTH-CARE SECTORS. J Wound Care 2020; 29:S1-S72. [DOI: 10.12968/jowc.2020.29.sup2b.s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jan Stryja
- Vascular Surgeon, Centre of vascular and miniinvasive surgery, Hospital Podlesi, Trinec, The Czech Republic. Salvatella Ltd., Centre of non-healing wounds treatment, Podiatric outpatients’ department, Trinec, The Czech Republic
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow – Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia, Director, Skin Integrity Clinical Trials Unit, University of Western Australia
| | - Mark Collier
- Nurse Consultant and Associate Lecturer – Tissue Viability, Independent – formerly at the United Lincolnshire Hospitals NHS Trust, c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9Q
| | - Claus Moser
- Clinical microbiologist, Rigshospitalet, Department of Clinical Microbiology, Copenhagen, Denmark
| | - Karen Ousey
- Professor of Skin Integrity, University of Huddersfield. Institute of Skin Integrity and Infection Prevention, Huddersfield, UK
| | - Sebastian Probst
- Professor of wound care, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Jennie Wilson
- Professor of Healthcare Epidemiology, University of West London, College of Nursing, Midwifery and Healthcare, London, UK
| | - Deborah Xuereb
- Senior Infection Prevention & infection Control Nurse, Mater Dei Hospital, Msida, Malta
| |
Collapse
|
11
|
Gibula DR, Singh AB, Bronsert MR, Henderson WG, Battaglia C, Hammermeister KE, Glebova NO, Meguid RA. Accurate preoperative prediction of unplanned 30-day postoperative readmission using 8 predictor variables. Surgery 2019; 166:812-819. [DOI: 10.1016/j.surg.2019.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/21/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
|
12
|
Daneman N, Homenauth E, Saskin R, Ng R, Ha A, Wijeysundera HC. The predictors and economic burden of early-, mid- and late-onset cardiac implantable electronic device infections: a retrospective cohort study in Ontario, Canada. Clin Microbiol Infect 2019; 26:255.e1-255.e6. [PMID: 30797886 DOI: 10.1016/j.cmi.2019.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 12/23/2022]
Abstract
The rate of cardiac implantable electronic device (CIED) infection is increasing with time. We sought to determine the predictors, relative mortality, and cost burden of early-, mid- and late-onset CIED infections. We conducted a retrospective cohort study of all CIED implantations in Ontario, Canada between April 2013 and March 2016. The procedures and infections were identified in validated, population-wide health-care databases. Infection onset was categorized as early (0-30 days), mid (31-182 days) and late (183-365 days). Cox proportional hazards regression was used to assess the mortality impact of CIED infections, with infection modelled as a time-varying covariate. A generalized linear model with a log-link and γ distribution was used to compare health-care system costs by infection status. Among 17 584 patients undergoing CIED implantation, 215 (1.2%) developed an infection, including 88 early, 85 mid, and 42 late infections. The adjusted hazard ratio (aHR) of death was higher for patients with early (aHR 2.9, 95% CI 1.7-4.9), mid (aHR 3.3, 95% CI 1.9-5.7) and late (aHR 19.9, 95% CI 9.9-40.2) infections. Total mean 1-year health costs were highest for late-onset (mean Can$113 778), followed by mid-onset (mean Can$85 302), and then early-onset (Can$75 415) infections; costs for uninfected patients were Can$25 631. After accounting for patient and procedure characteristics, there was a significant increase in costs associated with early- (rate ratio (RR) 3.1, 95% CI 2.3-4.1), mid- (RR 2.8, 95% CI 2.4-3.3) and late- (RR 4.7, 95% CI 3.6-6.2) onset infections. In summary, CIED infections carry a tremendous clinical and economic burden, and this burden is disproportionately high for late-onset infections.
Collapse
Affiliation(s)
- N Daneman
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - E Homenauth
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - R Saskin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - R Ng
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - A Ha
- Division of Cardiology, University Health Network, Toronto, ON, Canada
| | - H C Wijeysundera
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
13
|
Fisher AV, Campbell-Flohr SA, Sell L, Osterhaus E, Acher AW, Leahy-Gross K, Brenny-Fitzpatrick M, Kind AJH, Carayon P, Abbott DE, Winslow ER, Greenberg CC, Fernandes-Taylor S, Weber SM. Adaptation and Implementation of a Transitional Care Protocol for Patients Undergoing Complex Abdominal Surgery. Jt Comm J Qual Patient Saf 2018; 44:741-750. [PMID: 30097384 DOI: 10.1016/j.jcjq.2018.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Transitional care protocols are effective at reducing readmission for medical patients, yet no evidence-based protocols exist for surgical patients. A transitional care protocol was adapted to meet the needs of patients discharged to home after major abdominal surgery. APPROACH The Coordinated-Transitional Care (C-TraC) protocol, initially designed for medical patients, was used as the initial framework for the development of a surgery-specific protocol (sC-TraC). Adaptation was accomplished using a modification of the Replicating Effective Programs (REP) model, which has four phases: (1) preconditions, (2) preimplementation, (3) implementation, and (4) maintenance and evolution. A random sample of five patients each month was selected to complete a phone survey regarding patient satisfaction. Preimplementation planning allowed for integration with current systems, avoided duplication of processes, and defined goals for the protocol. The adapted protocol specifically addressed surgical issues such as nutrition, fever, ostomy output, dehydration, drain character/output, and wound appearance. After protocol launch, the rapid iterative adaptation process led to changes in phone call timing, inclusion and exclusion criteria, and discharge instructions. OUTCOMES Survey responders reported 100% overall satisfaction with the transitional care program. KEY INSIGHTS The adaptable nature of sC-TraC may allow for low-resource hospitals, such as rural or inner-city medical centers, to use the methodology provided in this study for implementation of local phone-based transitional care protocols. In addition, as the C-TraC program has begun to disseminate nationally across US Department of Veterans Affairs (VA) hospitals and rural health settings, sC-TraC may be implemented using the existing transitional care infrastructure in place at these hospitals.
Collapse
|
14
|
Gunter RL, Fernandes-Taylor S, Rahman S, Awoyinka L, Bennett KM, Weber SM, Greenberg CC, Kent KC. Feasibility of an Image-Based Mobile Health Protocol for Postoperative Wound Monitoring. J Am Coll Surg 2018; 226:277-286. [PMID: 29366555 DOI: 10.1016/j.jamcollsurg.2017.12.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is the most common nosocomial infection and the leading cause of readmission among surgical patients. Many SSIs develop in the postdischarge period and are inadequately recognized by patients. To address this, we developed a mobile health protocol of remote wound monitoring using smartphone technology. The current study aims to establish its feasibility among patients and providers. STUDY DESIGN We enrolled vascular surgery patients during their inpatient stay. They were trained to use our mobile health application, which allowed them to transmit digital images of their surgical wound and answer a survey about their recovery. After hospital discharge, participants completed the application daily for 2 weeks. Providers on the inpatient team reviewed submissions daily and contacted patients for concerning findings. RESULTS Forty participants were enrolled. Forty-five percent of participants submitted data every day for 2 weeks, with an overall submission rate of 90.2%. Submissions were reviewed within an average of 9.7 hours of submission, with 91.9% of submissions reviewed within 24 hours. We detected 7 wound complications with 1 false negative. Participant and provider satisfaction was universally high. CONCLUSIONS Patients and their caregivers are willing to participate in a mobile health program aimed at remote monitoring of postoperative recovery, and they are able to complete it with a high level of fidelity and satisfaction. Preliminary results indicate the ability to detect and intervene on wound complications.
Collapse
Affiliation(s)
- Rebecca L Gunter
- Wisconsin Institute of Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, WI.
| | - Sara Fernandes-Taylor
- Wisconsin Institute of Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, WI
| | - Shahrose Rahman
- Wisconsin Institute of Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, WI
| | - Lola Awoyinka
- Wisconsin Institute of Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, WI
| | - Kyla M Bennett
- Wisconsin Institute of Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, WI
| | - Sharon M Weber
- Wisconsin Institute of Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, WI
| | - Caprice C Greenberg
- Wisconsin Institute of Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, WI
| | - K Craig Kent
- Wisconsin Institute of Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, WI
| |
Collapse
|
15
|
Bhagat R, Bronsert MR, Ward AN, Martin J, Juarez-Colunga E, Glebova NO, Henderson WG, Fullerton D, Weyant MJ, Mitchell JD, Meguid RA. National Analysis of Unplanned Readmissions After Thoracoscopic Versus Open Lung Cancer Resection. Ann Thorac Surg 2017; 104:1782-1790. [PMID: 29102302 DOI: 10.1016/j.athoracsur.2017.08.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hospital readmissions are viewed as a mark of inferior health care quality and are penalized. Unplanned postoperative readmission reason and timing after lung resection are not well understood. We examine related, unplanned readmissions after thoracoscopic versus open anatomic lung resections to identify opportunities to improve patient care. METHODS We analyzed the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data set, 2012 to 2015, characterizing 30-day related, unplanned postoperative readmissions after anatomic lung resections for primary lung cancer. Risk-adjusted comparison of readmission after thoracoscopic and open resection was performed using propensity matching. RESULTS Patients (n = 9,510) underwent anatomic lung resections; 4,935 (51.9%) were thoracoscopic resections and 4,575 (48.1%) were open resections. Of the thoracoscopic patients, 10.9% experienced one or more complications, versus 19.4% of patients with open resection (p < 0.0001). Of the thoracoscopic patients 5.5% experienced related, unplanned readmissions versus 7.2% of the patients with open resection (p < 0.001). 24.8% of complications after thoracoscopic approach occurred after discharge, versus 15.5% after open approach (p < 0.0001). Timing of unplanned readmission was similar for both groups. The propensity-matched odds ratio of risk of readmission after thoracoscopic versus open resection was 1.16 (95% confidence interval, 0.949 to 1.411, p = 0.15). CONCLUSIONS Open anatomic lung resections for primary lung cancer had nearly twice the complication rate but only a slightly higher readmission rate than thoracoscopic resection. More complications occurred after discharge after thoracoscopic than open resections. Most readmissions occurred within 2 weeks after both thoracoscopic and open resections. Risk-adjusted comparison identified no statistically significant difference in risk of related, unplanned readmission after thoracoscopic versus open resections. Future studies should focus on identification of processes of care to decrease complications and unplanned readmissions after lung cancer resection.
Collapse
Affiliation(s)
- Rohun Bhagat
- Surgical Outcomes and Applied Research Program (SOAR), University of Colorado School of Medicine, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program (SOAR), University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado
| | - Austin N Ward
- Department of Surgery, University of Kentucky School of Medicine, Lexington, Kentucky
| | - Jeremiah Martin
- Department of Cardiothoracic Surgery, Southern Ohio Medical Center, Portsmouth, Ohio
| | - Elizabeth Juarez-Colunga
- Surgical Outcomes and Applied Research Program (SOAR), University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Natalia O Glebova
- Surgical Outcomes and Applied Research Program (SOAR), University of Colorado School of Medicine, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - William G Henderson
- Surgical Outcomes and Applied Research Program (SOAR), University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - David Fullerton
- Surgical Outcomes and Applied Research Program (SOAR), University of Colorado School of Medicine, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Michael J Weyant
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - John D Mitchell
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert A Meguid
- Surgical Outcomes and Applied Research Program (SOAR), University of Colorado School of Medicine, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
| |
Collapse
|
16
|
Aziz F, Bohr T, Lehman EB. Wound Disruption after Lower Extremity Bypass Surgery is a Predictor of Subsequent Development of Wound Infection. Ann Vasc Surg 2017; 43:176-187. [DOI: 10.1016/j.avsg.2016.10.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 11/25/2022]
|
17
|
Affiliation(s)
- Tyler S Wahl
- Department of Surgery, University of Alabama at Birmingham, 1922 7th Avenue South, Kracke Building 417, Birmingham, AL 35249, USA
| | - Mary T Hawn
- Department of Surgery, Stanford University, Alway Building M121, 300 Pasteur Drive, MC 5115, Stanford, CA 94305-2200, USA.
| |
Collapse
|
18
|
Sullivan E, Gupta A, Cook CH. Cost and Consequences of Surgical Site Infections: A Call to Arms. Surg Infect (Larchmt) 2017; 18:451-454. [PMID: 28402728 DOI: 10.1089/sur.2017.072] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite decades of attention and advances in medical treatments, surgical site infections (SSI) remain a significant problem to our patients. Surprisingly, the reported incidence of SSI has not changed appreciably in the past five decades, although not surprisingly the timing to diagnosis (inpatient vs. outpatient) has changed. Although the patient consequences have not escaped our notice, until recently the costs associated with SSI have been difficult to ascertain. In this review, we discuss the relevant history of SSI monitoring, the incidence as well as the costs and consequences associated with this complication.
Collapse
Affiliation(s)
- Elizabeth Sullivan
- Department of Surgery, Beth Israel Deaconess Medical Center , Boston, Massachusetts
| | - Alok Gupta
- Department of Surgery, Beth Israel Deaconess Medical Center , Boston, Massachusetts
| | - Charles H Cook
- Department of Surgery, Beth Israel Deaconess Medical Center , Boston, Massachusetts
| |
Collapse
|
19
|
Sanger PC, Simianu VV, Gaskill CE, Armstrong CAL, Hartzler AL, Lordon RJ, Lober WB, Evans HL. Diagnosing Surgical Site Infection Using Wound Photography: A Scenario-Based Study. J Am Coll Surg 2017; 224:8-15.e1. [PMID: 27746223 PMCID: PMC5183503 DOI: 10.1016/j.jamcollsurg.2016.10.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/03/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative surgical site infections (SSI) are common and costly. Most occur post discharge, and can result in potentially preventable readmission or unnecessary urgent evaluation. Mobile health approaches incorporating patient-generated wound photos are being implemented in an attempt to optimize triage and management. We assessed how adding wound photos to existing data sources modifies provider decision making. STUDY DESIGN We used a web-based simulation survey using a convenience sample of providers with expertise in surgical infections. Participants viewed a range of scenarios, including surgical history, physical exam, and description of wound appearance. All participants reported SSI diagnosis, diagnostic confidence, and management recommendations (main outcomes) first without, and then with, accompanying wound photos. At each step, participants ranked the most important features contributing to their decision. RESULTS Eighty-three participants completed a median of 5 scenarios (interquartile range 4 to 7). Most participants were physicians in academic surgical specialties (n = 70 [84%]). The addition of photos improved overall diagnostic accuracy from 67% to 76% (p < 0.001), and increased specificity from 77% to 92% (p < 0.001), but did not significantly increase sensitivity (55% to 65%; p = 0.16). Photos increased mean confidence in diagnosis from 5.9 of 10 to 7.4 of 10 (p < 0.001). Overtreatment recommendations decreased from 48% to 16% (p < 0.001), and undertreatment did not change (28% to 23%; p = 0.20) with the addition of photos. CONCLUSIONS The addition of wound photos to existing data as available via chart review and telephone consultation with patients significantly improved diagnostic accuracy and confidence, and prevented proposed overtreatment in scenarios without SSI. Post-discharge mobile health technologies have the potential to facilitate patient-centered care, decrease costs, and improve clinical outcomes.
Collapse
Affiliation(s)
- Patrick C Sanger
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA.
| | - Vlad V Simianu
- Department of Surgery, University of Washington, Seattle, WA
| | | | | | - Andrea L Hartzler
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Ross J Lordon
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA
| | - William B Lober
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA; Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA
| | - Heather L Evans
- Department of Surgery, University of Washington, Seattle, WA
| |
Collapse
|
20
|
Woelber E, Schrick EJ, Gessner BD, Evans HL. Proportion of Surgical Site Infections Occurring after Hospital Discharge: A Systematic Review. Surg Infect (Larchmt) 2016; 17:510-9. [DOI: 10.1089/sur.2015.241] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Erik Woelber
- University of Washington School of Medicine, Seattle, Washington
| | - Emily J. Schrick
- University of Washington College of Arts and Sciences, Seattle, Washington
| | | | | |
Collapse
|
21
|
Sanger PC, van Ramshorst GH, Mercan E, Huang S, Hartzler AL, Armstrong CAL, Lordon RJ, Lober WB, Evans HL. A Prognostic Model of Surgical Site Infection Using Daily Clinical Wound Assessment. J Am Coll Surg 2016; 223:259-270.e2. [PMID: 27188832 DOI: 10.1016/j.jamcollsurg.2016.04.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/12/2016] [Accepted: 04/29/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Surgical site infection (SSI) remains a common, costly, and morbid health care-associated infection. Early detection can improve outcomes, yet previous risk models consider only baseline risk factors (BF) not incorporating a proximate and timely data source-the wound itself. We hypothesize that incorporation of daily wound assessment improves the accuracy of SSI identification compared with traditional BF alone. STUDY DESIGN A prospective cohort of 1,000 post open abdominal surgery patients at an academic teaching hospital were examined daily for serial features (SF), for example, wound characteristics and vital signs, in addition to standard BF, for example, wound class. Using supervised machine learning, we trained 3 Naïve Bayes classifiers (BF, SF, and BF+SF) using patient data from 1 to 5 days before diagnosis to classify SSI on the following day. For comparison, we also created a simplified SF model that used logistic regression. Control patients without SSI were matched on 5 similar consecutive postoperative days to avoid confounding by length of stay. Accuracy, sensitivity/specificity, and area under the receiver operating characteristic curve were calculated on a training and hold-out testing set. RESULTS Of 851 patients, 19.4% had inpatient SSIs. Univariate analysis showed differences in C-reactive protein, surgery duration, and contamination, but no differences in American Society of Anesthesiologists scores, diabetes, or emergency surgery. The BF, SF, and BF+SF classifiers had area under the receiver operating characteristic curves of 0.67, 0.76, and 0.76, respectively. The best-performing classifier (SF) had optimal sensitivity of 0.80, specificity of 0.64, positive predictive value of 0.35, and negative predictive value of 0.93. Features most associated with subsequent SSI diagnosis were granulation degree, exudate amount, nasogastric tube presence, and heart rate. CONCLUSIONS Serial features provided moderate positive predictive value and high negative predictive value for early identification of SSI. Addition of baseline risk factors did not improve identification. Features of evolving wound infection are discernable before the day of diagnosis, based primarily on visual inspection.
Collapse
Affiliation(s)
- Patrick C Sanger
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA.
| | | | - Ezgi Mercan
- Department of Computer Science, University of Washington, Seattle, WA
| | - Shuai Huang
- Department of Industrial and Systems Engineering, University of Washington, Seattle, WA
| | - Andrea L Hartzler
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | | | - Ross J Lordon
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA
| | - William B Lober
- Department of Biobehavioral Nursing and Health Systems, and Biomedical Informatics and Medical Education, University of Washington, Seattle, WA
| | - Heather L Evans
- Department of Surgery, University of Washington, Seattle, WA
| |
Collapse
|
22
|
Dhurandhar NV, Bailey D, Thomas D. Interaction of obesity and infections. Obes Rev 2015; 16:1017-29. [PMID: 26354800 DOI: 10.1111/obr.12320] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/20/2015] [Accepted: 08/03/2015] [Indexed: 12/11/2022]
Abstract
There is evidence that certain infections may induce obesity. Obese persons may also have more severe infections and have compromised response to therapies. The objective of this study is to review the available literature identifying infections that potentially contribute to greater body mass index (BMI) and differential responses of overweight and obese persons to infections. A systematic literature review of human studies examining associations between infections and weight gain, differential susceptibility, severity, and response to prevention and treatment of infection according to BMI status (January 1980-July 2014) was conducted. Three hundred and forty-three studies were eligible for inclusion. Evidence indicated that viral infection by human adenovirus Ad36 and antibiotic eradication of Helicobacter pylori were followed by weight gain. People who were overweight or obese had higher susceptibility to developing post-surgical infections, H1N1 influenza and periodontal disease. More severe infections tended to be present in people with a larger BMI. People with a higher BMI had a reduced response to vaccinations and antimicrobial drugs. Higher doses of antibiotics were more effective in obese patients. Infections may influence BMI, and BMI status may influence response to certain infections, as well as to preventive and treatment measures. These observations have potential clinical implications.
Collapse
Affiliation(s)
- N V Dhurandhar
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - D Bailey
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - D Thomas
- Center for Quantitative Obesity Research, Department of Mathematical Sciences, Montclair State University, Montclair, NJ, USA
| |
Collapse
|
23
|
Wiseman JT, Fernandes-Taylor S, Barnes ML, Saunders RS, Saha S, Havlena J, Rathouz PJ, Kent KC. Predictors of surgical site infection after hospital discharge in patients undergoing major vascular surgery. J Vasc Surg 2015; 62:1023-1031.e5. [PMID: 26143662 PMCID: PMC4586313 DOI: 10.1016/j.jvs.2015.04.453] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/30/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Surgical site infection (SSI) is one of the most common postoperative complications after vascular reconstruction, producing significant morbidity and hospital readmission. In contrast to SSI that develops while patients are still hospitalized, little is known about the cohort of patients who develop SSI after discharge. In this study, we explore the factors that lead to postdischarge SSI, investigate the differences between risk factors for in-hospital vs postdischarge SSI, and develop a scoring system to identify patients who might benefit from postdischarge monitoring of their wounds. METHODS Patients who underwent major vascular surgery from 2005 to 2012 for aneurysm and lower extremity occlusive disease were identified from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Files. Patients were categorized as having no SSI, in-hospital SSI, or SSI after hospital discharge. Predictors of postdischarge SSI were determined by multivariable logistic regression and internally validated by bootstrap resampling. Risk scores were assigned to all significant variables in the model. Summative risk scores were collapsed into quartile-based ordinal categories and defined as low, low/moderate, moderate/high, and high risk. Multivariable logistic regression was used to determine predictors of in-hospital SSI. RESULTS Of the 49,817 patients who underwent major vascular surgery, 4449 (8.9%) were diagnosed with SSI (2.1% in-hospital SSI; 6.9% postdischarge SSI). By multivariable analysis, factors significantly associated with increased odds of postdischarge SSI include female gender, obesity, diabetes, smoking, hypertension, coronary artery disease, critical limb ischemia, chronic obstructive pulmonary disease, dyspnea, neurologic disease, prolonged operative time >4 hours, American Society of Anesthesiology class 4 or 5, lower extremity revascularization or aortoiliac procedure, and groin anastomosis. The model exhibited moderate discrimination (bias-corrected C statistic, 0.691) and excellent internal calibration. The postdischarge SSI rate was 2.1% for low-risk patients, 5.1% for low/moderate-risk patients, 7.8% for moderate/high-risk patients, and 14% for high-risk patients. In a comparative analysis, comorbidities were the primary driver of postdischarge SSI, whereas in-hospital factors (operative time, emergency case status) and complications predicted in-hospital SSI. CONCLUSIONS The majority of SSIs after major vascular surgery develop following hospital discharge. We have created a scoring system that can select a cohort of patients at high risk for SSI after discharge. These patients can be targeted for transitional care efforts focused on early detection and treatment with the goal of reducing morbidity and preventing readmission secondary to SSI.
Collapse
Affiliation(s)
- Jason T Wiseman
- Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Sara Fernandes-Taylor
- Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Maggie L Barnes
- Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - R Scott Saunders
- Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Sandeep Saha
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Jeffrey Havlena
- Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Paul J Rathouz
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - K Craig Kent
- Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
| |
Collapse
|
24
|
Sanger PC, Hartzler A, Han SM, Armstrong CAL, Stewart MR, Lordon RJ, Lober WB, Evans HL. Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution. PLoS One 2014; 9:e114016. [PMID: 25436912 PMCID: PMC4250175 DOI: 10.1371/journal.pone.0114016] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/01/2014] [Indexed: 12/05/2022] Open
Abstract
Background Post-discharge surgical site infections (SSI) are a major source of morbidity, expense and anxiety for patients. However, patient perceptions about barriers experienced while seeking care for post-discharge SSI have not been assessed in depth. We explored patient experience of SSI and openness to a mobile health (mHealth) wound monitoring “app” as a novel solution to address this problem. Methods Mixed method design with semi-structured interviews and surveys. Participants were patients who had post-discharge surgical wound complications after undergoing operations with high risk of SSI, including open colorectal or ventral hernia repair surgery. The study was conducted at two affiliated teaching hospitals, including an academic medical center and a level 1 trauma center. Results From interviews with 13 patients, we identified 3 major challenges that impact patients' ability to manage post-discharge surgical wound complications, including required knowledge for wound monitoring from discharge teaching, self-efficacy for wound monitoring at home, and accessible communication with their providers about wound concerns. Patients found an mHealth wound monitoring application highly acceptable and articulated its potential to provide more frequent, thorough, and convenient follow-up that could reduce post-discharge anxiety compared to the current practice. Major concerns with mHealth wound monitoring were lack of timely response from providers and inaccessibility due to either lack of an appropriate device or usability challenges. Conclusions Our findings reveal gaps and frustrations with post-discharge care after surgery which could negatively impact clinical outcomes and quality of life. To address these issues, we are developing mPOWEr, a patient-centered mHealth wound monitoring application for patients and providers to collaboratively bridge the care transition between hospital and home.
Collapse
Affiliation(s)
- Patrick C Sanger
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, Washington, United States of America
| | - Andrea Hartzler
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington, United States of America
| | - Sarah M Han
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | - Cheryl A L Armstrong
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | - Mark R Stewart
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington, United States of America
| | - Ross J Lordon
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, Washington, United States of America
| | - William B Lober
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington, United States of America
| | - Heather L Evans
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
25
|
Lewis SS, Moehring RW, Chen LF, Sexton DJ, Anderson DJ. Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infect Control Hosp Epidemiol 2014; 34:1229-30. [PMID: 24113613 DOI: 10.1086/673443] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Hospital-acquired infections (HAIs) occur commonly, cause significant harm to patients, and result in excess healthcare expenditures. The urinary tract is frequently cited as the most common site of HAI, but these estimates were extrapolated from National Nosocomial Infection Surveillance (NNIS) data from the 1990s. Updated information regarding the relative burden of specific types of HAIs would help governmental agencies and other stakeholders within the field of infection prevention to prioritize areas for research and innovation. The objective of our study was to assess the relative proportion of HAIs attributed to each of the following 5 types of infection in a network of community hospitals: catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI), ventilator-associated pneumonia (VAP), central line–associated bloodstream infection (CLABSI), and Clostridium difficile infection (CDI).We performed a retrospective cohort study using prospectively collected HAI surveillance data from hospitals participating in the Duke Infection Control Outreach Network (DICON). DICON hospital epidemiologists and liaison infection preventionists work directly with local hospital infection preventionists to provide surveillance data validation, benchmarking, and infection prevention consultation services to participating hospitals.
Collapse
Affiliation(s)
- Sarah S Lewis
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | | | | | | | | |
Collapse
|
26
|
Gibson A, Tevis S, Kennedy G. Readmission after delayed diagnosis of surgical site infection: a focus on prevention using the American College of Surgeons National Surgical Quality Improvement Program. Am J Surg 2014; 207:832-9. [PMID: 24119885 PMCID: PMC4811594 DOI: 10.1016/j.amjsurg.2013.05.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/24/2013] [Accepted: 05/30/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is a costly complication leading to increased resource use and patient morbidity. We hypothesized that postdischarge SSI results in a high rate of preventable readmissions. METHODS We used our institutional American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing general surgery procedures from 2006 to 2011. RESULTS SSIs developed in 10% of the 3,663 patients who underwent an inpatient general surgical procedure. SSI was diagnosed after discharge in 48% of patients. Patients with a diagnosis of SSI after discharge were less likely to have a history of smoking (15% vs 28%, P = .001), chronic obstructive pulmonary disease (3% vs 9%, P = .015), congestive heart failure (0% vs 3%, P = .03), or sepsis within 48 hours preoperatively (17% vs 32%, P = .001) compared with patients diagnosed before discharge. Over 50% of the patients diagnosed with SSI after discharge required readmission. CONCLUSIONS A diagnosis of SSI after discharge is associated with a high readmission rate despite occurring in healthier patients. We propose discharge teaching improvements and a wound surveillance clinic within the first week may result in a decreased readmission rate.
Collapse
Affiliation(s)
- Angela Gibson
- Department of Surgery, University of Wisconsin, H4/3 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Sarah Tevis
- Department of Surgery, University of Wisconsin, H4/3 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Gregory Kennedy
- Department of Surgery, University of Wisconsin, H4/3 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA.
| |
Collapse
|
27
|
Scientific and Clinical Abstracts From the WOCN® Society's 46th Annual Conference. J Wound Ostomy Continence Nurs 2014. [DOI: 10.1097/won.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Gili-Miner M, Béjar-Prado L, Gili-Ortiz E, Ramírez-Ramírez G, López-Méndez J, López-Millán JM, Sharp B. Alcohol use disorders among surgical patients: unplanned 30-days readmissions, length of hospital stay, excessive costs and mortality. Drug Alcohol Depend 2014; 137:55-61. [PMID: 24529967 DOI: 10.1016/j.drugalcdep.2014.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
Abstract
AIMS Alcohol use disorders (AUD) have been associated with an increased risk of unplanned hospital readmissions (URA). We analyzed in a sample of 87 Spanish Hospitals if surgical patients with AUD had a higher risk of URA and if among patients with URA, those with AUD had an excess length of hospital stay, higher hospital expenses and increased risk of mortality. METHOD We analyzed data of patients who underwent surgical operations during the period between 2008 and 2010. URA was defined as unplanned readmissions during the first 30 days after hospital departure. The primary outcome was risk of URA in patients with AUD. Secondary outcomes were mortality, excess length of stay and over expenditure. RESULTS A total of 2,076,958 patients who underwent surgical operations were identified: 68,135 (3.3%) had AUD, and 62,045 (3.0%) had at least one URA. Among patients with AUD 4212 (6.2%) had at least one URA and among patients without AUD 57,833 (2.9%) had at least one URA. Multivariable analysis demonstrated that AUD was an independent predictor of developing URA (Odds ratio: 1.56; 95% CI: 1.50-1.62). Among surgical patients with URA, those with AUD had longer lengths of hospital stay (2.9 days longer), higher hospital costs (2885.8 Euros or 3858.3 US Dollars), higher risk of death (OR: 2.16, 95% CI: 1.92-2.44) and higher attributable mortality (11.2%). CONCLUSIONS Among surgical patients, AUD increase the risk of URA, and among patients with URA, AUD heighten the risk of in-hospital death, and cause longer hospital stays and over expenditures.
Collapse
Affiliation(s)
- Miguel Gili-Miner
- Unidad de Gestión Clínica de Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani s/n, 41070 Seville, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Av. Sánchez Pizjuán s/n, 41007 Seville, Spain.
| | - Luis Béjar-Prado
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Av. Sánchez Pizjuán s/n, 41007 Seville, Spain
| | - Enrique Gili-Ortiz
- Unidad de Gestión Clínica de Anestesiología y Bloque Quirúrgico, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani s/n, 41070 Seville, Spain
| | - Gloria Ramírez-Ramírez
- Unidad de Gestión Clínica de Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani s/n, 41070 Seville, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Av. Sánchez Pizjuán s/n, 41007 Seville, Spain
| | - Julio López-Méndez
- Unidad de Gestión Clínica de Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani s/n, 41070 Seville, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Av. Sánchez Pizjuán s/n, 41007 Seville, Spain
| | - José-Manuel López-Millán
- Unidad de Gestión Clínica de Anestesiología y Bloque Quirúrgico, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani s/n, 41070 Seville, Spain
| | - Brett Sharp
- Unidad de Gestión Clínica de Diagnóstico por la Imagen, Hospital Universitario Virgen de Rocío, Av. Manuel Siurot s/n, 41013 Seville, Spain
| |
Collapse
|
29
|
Li GQ, Guo FF, Ou Y, Dong GW, Zhou W. Epidemiology and outcomes of surgical site infections following orthopedic surgery. Am J Infect Control 2013; 41:1268-71. [PMID: 23890741 DOI: 10.1016/j.ajic.2013.03.305] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 03/24/2013] [Accepted: 03/25/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) are common complications after surgeries, usually leading to increased health care costs. Therefore, we evaluated the efficiency of current preoperative antibiotic prophylaxis and risk factors of SSIs in the orthopedic wards in a major teaching hospital in China. METHODS We retrospectively reviewed a population of 2,061 patients who underwent orthopedic surgeries between January 2010 and January 2012 and examined the bacterial isolates and their resistance patterns associated with orthopedic infections. Moreover, a multivariate logistic regression was used to identify independent risk factors for SSIs. RESULTS Thirty-three out of the 45 clinical SSIs were culture positive, and a total of 35 bacterial strains was isolated, among which, 65.72% (n= 23) were gram-positive isolates, and 34.28% (n = 12) were gram-negative bacteria. Significantly, 68.6% of all bacterial isolates were resistant to cefuroxime. Additionally, this study found that diabetes mellitus (odds ratio [OR], 7.539), smoking (OR, 2.378), duration of surgeries longer than 3 hours (OR, 3.633), absence of antibiotic prophylaxis (OR, 6.562), and previous operations (OR, 2.190) were crucial independent risk factors associated with a significant increase in the development rate of SSIs following orthopedic incisional operations. CONCLUSION Our data suggested that appropriate modifications to antibiotic prophylaxis regimens should be considered. Furthermore, tightening glucose control, stopping smoking, providing proper antibiotic prophylaxis, and shortening surgery time are promising approaches to reduce the SSIs rate.
Collapse
Affiliation(s)
- Guo-qing Li
- School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | | | | | | | | |
Collapse
|
30
|
|
31
|
Gender differences in risk of bloodstream and surgical site infections. J Gen Intern Med 2013; 28:1318-25. [PMID: 23605308 PMCID: PMC3785652 DOI: 10.1007/s11606-013-2421-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 12/17/2012] [Accepted: 03/13/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Identifying patients most at risk for hospital- and community-associated infections is one essential strategy for preventing infections. OBJECTIVE To investigate whether rates of community- and healthcare-associated bloodstream and surgical site infections varied by patient gender in a large cohort after controlling for a wide variety of possible confounders. DESIGN Retrospective cohort study. PARTICIPANTS All patients discharged from January 1, 2006 through December 31, 2008 (133,756 adult discharges and 66,592 pediatric discharges) from a 650-bed tertiary care hospital, a 220-bed community hospital, and a 280-bed pediatric acute care hospital within a large, academic medical center in New York, NY. MAIN MEASURES Data were collected retrospectively from various electronic sources shared by the hospitals and linked using patients' unique medical record numbers. Infections were identified using previously validated computerized algorithms. KEY RESULTS Odds of community-associated bloodstream infections, healthcare-associated bloodstream infections, and surgical site infections were significantly lower for women than for men after controlling for present-on-admission patient characteristics and events during the hospital stay [odds ratios (95 % confidence intervals) were 0.85 (0.77-0.93), 0.82 (0.74-0.91), and 0.78 (0.68-0.91), respectively]. Gender differences were greatest for older adolescents (12-17 years) and adults 18-49 years and least for young children (<12 years) and older adults (≥ 70 years). CONCLUSIONS In this cohort, men were at higher risk for bloodstream and surgical site infections, possibly due to differences in propensity for skin colonization or other anatomical differences.
Collapse
|
32
|
Chen MM, Roman SA, Sosa JA, Judson BL. Postdischarge Complications Predict Reoperation and Mortality after Otolaryngologic Surgery. Otolaryngol Head Neck Surg 2013; 149:865-72. [DOI: 10.1177/0194599813505078] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives (1) Determine procedure-specific rates of postdischarge complications (PDCs) and their risk factors in the first 30 days following inpatient otolaryngologic surgery. (2) Evaluate association between PDCs and risk of reoperation and mortality. Study Design Retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program (2005-2011). Subjects and Methods We identified 48,028 adult patients who underwent inpatient otolaryngologic surgery. Outcomes of interest included complications, reoperation, and mortality in the first 30 days following surgery. Statistical analysis included chi-square, t tests, and multivariate regression. Results Laryngectomy, lip, and tongue/floor of mouth surgery had the highest PDC rates (8.0%, 7.4%, and 4.1%, respectively). Within the first 48 hours, week, and 2 weeks post discharge, 10%, 44%, and 73% of PDCs occurred, respectively. Common PDCs included surgical site infections (53.6%), other infections (37.4%), and venous thromboembolic events (7.4%). Multivariate analysis demonstrated that increasing age (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.01-1.02), prolonged operative time (OR = 1.68; 95% CI, 1.39-2.03), hospital stay >1 day (OR = 1.49; 95% CI, 1.18-1.86), and American Society of Anesthesiologists (ASA) class ≥3 (OR = 1.45; 95% CI, 1.18-1.78) were independently associated with PDCs. Patients with PDCs were more likely to die (0.9% vs 0.1%, P < .001) or have a reoperation (10.4% vs 1.2%, P < .001). Conclusion This is the first study of overall postdischarge events after otolaryngologic surgery. PDC rates in otolaryngology occur soon after discharge, are procedure specific, and are associated with reoperation and mortality. Targeted procedure-specific triage and follow-up plans for high-risk patients may improve outcomes.
Collapse
Affiliation(s)
- Michelle M. Chen
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sanziana A. Roman
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Julie A. Sosa
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Benjamin L. Judson
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
33
|
The Epidemiology and Clinical Impact of Surgical Site Infections in the Older Adult. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13670-013-0048-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
34
|
Scientific and Clinical Abstracts From the WOCN® Society's 45th Annual Conference. J Wound Ostomy Continence Nurs 2013. [DOI: 10.1097/won.0b013e31828f9649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Forbes SS, McLean RF. Review article: the anesthesiologist's role in the prevention of surgical site infections. Can J Anaesth 2012; 60:176-83. [PMID: 23263980 DOI: 10.1007/s12630-012-9858-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 11/27/2012] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To highlight the role of anesthesiologists in the prophylaxis of surgical site infections (SSIs) and to recognize the central role they play in quality improvement initiatives for the prevention of SSIs. SOURCE The medical literature was searched with a focus on three interventions affecting the risk of SSIs: preoperative antibiotic administration, perioperative normothermia, and perioperative hyperoxia. The literature was also searched for examples of initiatives in patient safety and quality improvement that highlight the role of anesthesiologists in preventing SSIs. PRINCIPAL FINDINGS The timely administration of preoperative antibiotics and the maintenance of perioperative normothermia have been shown to reduce the risk of SSI significantly. Perioperative hyperoxia in the prevention of SSIs remains controversial but may improve outcomes in specific subsets of the surgical population. Initiatives in quality improvement show the challenges faced by many centres to improve upon these processes of care, but they also highlight the role of anesthesiologists as champions in the multidisciplinary efforts for the prevention of SSIs. CONCLUSIONS Anesthesiologists are responsible for many of the processes of care shown to impact the risk for SSIs, and they play an important role in the prevention of SSIs. Their leadership in the multidisciplinary efforts to improve the quality of the surgical patient is of critical importance.
Collapse
Affiliation(s)
- Shawn S Forbes
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | |
Collapse
|
36
|
Young H, Bliss R, Carey JC, Price CS. Beyond Core Measures: Identifying Modifiable Risk Factors for Prevention of Surgical Site Infection after Elective Total Abdominal Hysterectomy. Surg Infect (Larchmt) 2011; 12:491-6. [DOI: 10.1089/sur.2010.103] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Heather Young
- Department of Internal Medicine, Division of Infectious Diseases, Denver Health Hospital & University of Colorado Health Sciences Center, Denver, Colorado
| | - Robin Bliss
- Department of Orthopedic Surgery and Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - J. Chris Carey
- Obstetrics and Gynecology, Denver Health Hospital & University of Colorado Health Sciences Center, Denver, Colorado
| | - Connie S. Price
- Department of Internal Medicine, Division of Infectious Diseases, Denver Health Hospital & University of Colorado Health Sciences Center, Denver, Colorado
| |
Collapse
|
37
|
Corrigan MA, McHugh SM, Murphy RKJ, Dhillon P, Shah A, Hennessy I, Sheikh A, Lehane E, Hill ASK. Improving Surgical Outpatient Efficiency Through Mobile Phone Text Messaging. Surg Innov 2011; 18:354-7. [DOI: 10.1177/1553350611403771] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction. Currently, 175 000 people are on outpatient waiting lists in Irish hospitals. Many clinic slots are taken by patients returning for routine review postoperatively. Methods. A Nokia mobile phone was used to send an outpatient text (OPT) to patients 2 weeks postdischarge. Patients replying that they were well were discharged. If no reply after 2 attempts was received, they were scheduled for the next outpatient clinic. Results. Overall, 55 patients were offered the service over a 4-month period. Of these, 74.5% of patients were discharged from follow-up using text message surveillance. Patients were surveyed regarding their perception of the surveillance model, with all respondents ranking OPT surveillance as their preferred method of follow-up. There was a 13.6% decrease in outpatient visits over the study period. In addition, 6 emergency department visits were also avoided. Conclusion. Text message surveillance decreases outpatient waiting times and increases quality of care.
Collapse
Affiliation(s)
- Mark A. Corrigan
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Seamus M. McHugh
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
The world is now experiencing an epidemic of obesity. Although the effects of obesity on the development of metabolic and cardiovascular problems are well studied, much less is known about the impact of obesity on immune function and infectious disease. Studies in obese humans and with obese animal models have repeatedly demonstrated impaired immune function, including decreased cytokine production, decreased response to antigen/mitogen stimulation, reduced macrophage and dendritic cell function, and natural killer cell impairment. Recent studies have demonstrated that the impaired immune response in the obese host leads to increased susceptibility to infection with a number of different pathogens such as community-acquired tuberculosis, influenza, Mycobacterium tuberculosis, coxsackievirus, Helicobacter pylori and encephalomyocarditis virus. While no specific mechanism has been defined for the decreased immune response to infectious disease in the obese host, several obesity-associated changes such as excessive inflammation, altered adipokine signaling, metabolic changes and even epigenetic regulation could affect the immune response. This review will discuss what is currently known about the relationship between obesity and infectious disease.
Collapse
Affiliation(s)
- Erik A Karlsson
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN 38105-3678
| | - Melinda A Beck
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7461, USA
| |
Collapse
|
39
|
Surgical site infection in patients with prosthetic implants. J Hosp Infect 2010; 76:185. [DOI: 10.1016/j.jhin.2010.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 05/27/2010] [Indexed: 11/19/2022]
|