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Prey BJ, Colburn ZT, Williams JM, Francis AD, Vu M, Lammers D, McClellan J, Bingham JR. The use of mobile thermal imaging and machine learning technology for the detection of early surgical site infections. Am J Surg 2024; 231:60-64. [PMID: 37173166 DOI: 10.1016/j.amjsurg.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/17/2023] [Accepted: 04/16/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Surgical Site Infections (SSI) yield subtle, early signs that are not readily identifiable. This study sought to develop a machine learning algorithm that could identify early SSIs based on thermal images. METHODS Images were taken of surgical incisions on 193 patients who underwent a variety of surgical procedures. Two neural network models were generated to detect SSIs, one using RGB images, and one incorporating thermal images. Accuracy and Jaccard Index were the primary metrics by which models were evaluated. RESULTS Only 5 patients in our cohort developed SSIs (2.8%). Models were instead generated to demarcate the wound site. The models had 89-92% accuracy in predicting pixel class. The Jaccard indices for the RGB and RGB + Thermal models were 66% and 64%, respectively. CONCLUSIONS Although the low infection rate precluded the ability of our models to identify surgical site infections, we were able to generate two models to successfully segment wounds. This proof-of-concept study demonstrates that computer vision has the potential to support future surgical applications.
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Affiliation(s)
- Beau J Prey
- Madigan Army Medical Center, Tacoma, WA, USA.
| | | | | | | | - Michael Vu
- Madigan Army Medical Center, Tacoma, WA, USA
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2
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Cho SY, Kim Z, Chung DR, Cho BH, Chung MJ, Kim JH, Jeong J. Development of machine learning models for the surveillance of colon surgical site infections. J Hosp Infect 2024; 146:224-231. [PMID: 37094715 DOI: 10.1016/j.jhin.2023.03.025] [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: 11/10/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Conventional surgical site infection (SSI) surveillance is labour-intensive. We aimed to develop machine learning (ML) models for the surveillance of SSIs for colon surgery and to assess whether the ML could improve surveillance process efficiency. METHODS This study included cases who underwent colon surgery at a tertiary center between 2013 and 2014. Logistic regression and four ML algorithms including random forest (RF), gradient boosting (GB), and neural networks (NNs) with or without recursive feature elimination (RFE) were first trained on the entire cohort, and then re-trained on cases selected based on a previous rule-based algorithm. We assessed model performance based on the area under the curve (AUC), sensitivity, and positive predictive value (PPV). The estimated proportion of reduction in workload for chart review based on the ML models was evaluated and compared with the conventional method. RESULTS At a sensitivity of 95%, the NN with RFE using 29 variables had the best performance with an AUC of 0.963 and PPV of 21.1%. When combining both the rule-based algorithm and ML algorithms, the NN with RFE using 19 variables had a higher PPV (28.9%) than with the ML algorithm alone, which could decrease the number of cases requiring chart review by 83.9% compared with the conventional method. CONCLUSION We demonstrated that ML can improve the efficiency of SSI surveillance for colon surgery by decreasing the burden of chart review while providing high sensitivity. In particular, the hybrid approach of ML with a rule-based algorithm showed the best performance in terms of PPV.
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Affiliation(s)
- S Y Cho
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Z Kim
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - D R Chung
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - B H Cho
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Republic of Korea; Institute of Biomedical Informatics, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - M J Chung
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J H Kim
- Department of Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - J Jeong
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea
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Verberk JDM, van der Werff SD, Weegar R, Henriksson A, Richir MC, Buchli C, van Mourik MSM, Nauclér P. The augmented value of using clinical notes in semi-automated surveillance of deep surgical site infections after colorectal surgery. Antimicrob Resist Infect Control 2023; 12:117. [PMID: 37884948 PMCID: PMC10604406 DOI: 10.1186/s13756-023-01316-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND In patients who underwent colorectal surgery, an existing semi-automated surveillance algorithm based on structured data achieves high sensitivity in detecting deep surgical site infections (SSI), however, generates a significant number of false positives. The inclusion of unstructured, clinical narratives to the algorithm may decrease the number of patients requiring manual chart review. The aim of this study was to investigate the performance of this semi-automated surveillance algorithm augmented with a natural language processing (NLP) component to improve positive predictive value (PPV) and thus workload reduction (WR). METHODS Retrospective, observational cohort study in patients who underwent colorectal surgery from January 1, 2015, through September 30, 2020. NLP was used to detect keyword counts in clinical notes. Several NLP-algorithms were developed with different count input types and classifiers, and added as component to the original semi-automated algorithm. Traditional manual surveillance was compared with the NLP-augmented surveillance algorithms and sensitivity, specificity, PPV and WR were calculated. RESULTS From the NLP-augmented models, the decision tree models with discretized counts or binary counts had the best performance (sensitivity 95.1% (95%CI 83.5-99.4%), WR 60.9%) and improved PPV and WR by only 2.6% and 3.6%, respectively, compared to the original algorithm. CONCLUSIONS The addition of an NLP component to the existing algorithm had modest effect on WR (decrease of 1.4-12.5%), at the cost of sensitivity. For future implementation it will be a trade-off between optimal case-finding techniques versus practical considerations such as acceptability and availability of resources.
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Affiliation(s)
- Janneke D M Verberk
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Utrecht, Utrecht, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Epidemiology and Surveillance, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Suzanne D van der Werff
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | - Rebecka Weegar
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Aron Henriksson
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Milan C Richir
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Christian Buchli
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Maaike S M van Mourik
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Pontus Nauclér
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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4
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Vicentini C, Elhadidy HSMA, Marengo N, Paladini G, Cornio AR, Zotti CM. Mortality and Case Fatality Rates Associated With Surgical Site Infections: A Retrospective Surveillance Study. Surg Infect (Larchmt) 2023; 24:734-740. [PMID: 37669111 DOI: 10.1089/sur.2023.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Background: Surgical site infections (SSIs) have been associated with increases in terms of costs, hospital stay, morbidity, and mortality. We aimed to assess trends in SSIs monitored through 10 years of surveillance activities in our region, and to describe mortality attributable to SSIs in the two most frequently monitored surgical procedures: colorectal surgery and hip arthroplasty. Methods: A retrospective cohort study was conducted among the 42 hospitals participating in the surveillance network of our region in northern Italy. All colorectal and hip arthroplasty procedures performed between January 1st, 2010, and December 31st, 2019, and monitored through the surveillance system were included in the study. Surgical site infection rates, overall mortality, case fatality rates (CFR), and mortality attributable to SSIs were evaluated overall and by year of participation in the surveillance program. Results: In total, 11,417 colon surgery and 20,804 hip arthroplasty procedures were included. Among colon surgery procedures, SSI rates decreased from 9.21% in 2010 to 5.7% in 2019. A significant decreasing trend was found for overall mortality (p = 0.008), which progressively decreased from 4.96% in 2010 to 2.96% in 2019. Among hip arthroplasty procedures, no significant trend emerged for SSI and mortality rates. Considering the 10-year period, the CFR was 6.62% and 3.7% for SSIs after colon surgery and hip arthroplasty procedures, respectively. Conclusions: The impact of SSIs on the clinical outcomes of patients undergoing surgery highlights the importance of SSI surveillance.
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Affiliation(s)
- Costanza Vicentini
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | | | - Noemi Marengo
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Giovanni Paladini
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | | | - Carla Maria Zotti
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
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5
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The Case for Wound Bundles as a Standard for Colorectal Surgery: A Review and Meta-Analysis. AORN J 2023; 117:410-413. [PMID: 37235610 DOI: 10.1002/aorn.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 05/28/2023]
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Royle R, Gillespie BM, Chaboyer W, Byrnes J, Nghiem S. The burden of surgical site infections in Australia: A cost-of-illness study. J Infect Public Health 2023; 16:792-798. [PMID: 36963144 DOI: 10.1016/j.jiph.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/04/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To estimate the cost of surgical site infections in Australian public hospitals in 2018-19, to demonstrate the economic burden of hospital-associated infection in a well-resourced health system. METHODS A cost-of-illness analysis was conducted over a 1-year time horizon based on data from published literature extrapolated using simulation techniques. The direct and indirect costs of SSI were estimated for Australia and each of its states and territories. RESULTS An estimated 16,541 cases of SSI occurred in Australian public hospitals in 2018-19, resulting in a total direct cost of A$323.5 million. The average cost per case was A$18,814, which was 2.5 times the average per capita spending on health. The indirect costs of absenteeism and premature death were valued at A$23.0 million and A$2 948.1 million per annum, respectively. CONCLUSION SSI is a significant but preventable cost with most of the financial burden coming from premature deaths but underreporting means our costs are likely underestimated.
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Affiliation(s)
- Ruth Royle
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Brigid M Gillespie
- NHMRC CRE in Wiser Wounds, MHIQ, Griffith University, Southport, Queensland, Australia.
| | - Wendy Chaboyer
- NHMRC CRE in Wiser Wounds, MHIQ, Griffith University, Southport, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Son Nghiem
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia; Department of Health Economics, Wellbeing and Society, University Drive, Australian National University, ACT 0200, Australia
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Verberk JDM, van Rooden SM, Hetem DJ, Wunderink HF, Vlek ALM, Meijer C, van Ravensbergen EAH, Huijskens EGW, Vainio SJ, Bonten MJM, van Mourik MSM. Reliability and validity of multicentre surveillance of surgical site infections after colorectal surgery. Antimicrob Resist Infect Control 2022; 11:10. [PMID: 35063009 PMCID: PMC8780777 DOI: 10.1186/s13756-022-01050-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/23/2021] [Indexed: 01/23/2023] Open
Abstract
Background Surveillance is the cornerstone of surgical site infection prevention programs. The validity of the data collection and awareness of vulnerability to inter-rater variation is crucial for correct interpretation and use of surveillance data. The aim of this study was to investigate the reliability and validity of surgical site infection (SSI) surveillance after colorectal surgery in the Netherlands. Methods In this multicentre prospective observational study, seven Dutch hospitals performed SSI surveillance after colorectal surgeries performed in 2018 and/or 2019. When executing the surveillance, a local case assessment was performed to calculate the overall percentage agreement between raters within hospitals. Additionally, two case-vignette assessments were performed to estimate intra-rater and inter-rater reliability by calculating a weighted Cohen’s Kappa and Fleiss’ Kappa coefficient. To estimate the validity, answers of the two case-vignettes questionnaires were compared with the answers of an external medical panel. Results 1111 colorectal surgeries were included in this study with an overall SSI incidence of 8.8% (n = 98). From the local case assessment it was estimated that the overall percent agreement between raters within a hospital was good (mean 95%, range 90–100%). The Cohen’s Kappa estimated for the intra-rater reliability of case-vignette review varied from 0.73 to 1.00, indicating substantial to perfect agreement. The inter-rater reliability within hospitals showed more variation, with Kappa estimates ranging between 0.61 and 0.94. In total, 87.9% of the answers given by the raters were in accordance with the medical panel. Conclusions This study showed that raters were consistent in their SSI-ascertainment (good reliability), but improvements can be made regarding the accuracy (moderate validity). Accuracy of surveillance may be improved by providing regular training, adapting definitions to reduce subjectivity, and by supporting surveillance through automation.
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Clayphan B, Dixon L, Biggs S, Jordan L, Pullyblank A. PreciSSIon - a collaborative initiative to reduce surgical site infection after elective colorectal surgery. J Hosp Infect 2022; 130:131-137. [PMID: 36087804 DOI: 10.1016/j.jhin.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Abstract
AIM Surgical site infection (SSI) is common after colorectal surgery but most hospitals do not know their SSI rates. Approximately half of SSI occur after discharge and post-discharge surveillance is needed for accurate measurement. Peri-operative care bundles are known to reduce SSI. PreciSSion is a collaboration between seven hospitals in the West of England. The aims were to establish reliable SSI measurement after elective colorectal surgery using 30-day patient-reported outcome measures and to implement an evidence-based 4-point care bundle that had already demonstrated a reduction in SSI in a local hospital. The bundle included: 2% chlorhexidine skin preparation, a second dose of antibiotic after 4 hours, use of a dual-ring wound protector and antibacterial sutures for abdominal wall closure. METHOD 30-day patient-reported SSI was undertaken using the Public Health England Questionnaire and response rates recorded. Baseline SSI was measured during November 2019 - May 2020 and continued after implementation of the care bundle until March 2021. Bundle compliance was also measured. RESULTS Average questionnaire response rate was 81%. Average compliance was 92%, 96%, 79% and 85% for each element of the bundle respectively. Baseline SSI was 8-30%. Six of seven hospitals reduced SSI and the regional average SSI rate almost halved from 18% (1447 patients) to 9.5% (1247 patients). CONCLUSION We have demonstrated that a care bundle developed in a single hospital can be adopted and spread and the reduction in SSI after elective colorectal surgery can be replicated in other hospitals and deliver results within 18 months.
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Affiliation(s)
- Benjamin Clayphan
- Great Western Hospitals NHS Foundation Trust, Academy, Marlborough Road, Swindon, UK SN3 6BB.
| | - Lauren Dixon
- University Hospitals Bristol and Weston NHS Foundation Trust, Department of Colorectal Surgery, Bristol, UK
| | - Sarah Biggs
- University Hospitals Bristol and Weston NHS Foundation Trust, Department of Colorectal Surgery, Bristol, UK
| | - Lesley Jordan
- Royal United Hospital Bath NHS Trust, Department of Anaesthetics, Bath, Bath and North East Somerset, UK
| | - Anne Pullyblank
- North Bristol NHS Trust, Department of Surgery, Brunel Building, Westbury on Trym, UK BS10 5NB; West of England Academic Health Science Network, Marlborough street Bristol, UK BS1 3NX
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Semiautomated surveillance of deep surgical site infections after colorectal surgeries: A multicenter external validation of two surveillance algorithms. Infect Control Hosp Epidemiol 2022; 44:616-623. [PMID: 35726554 DOI: 10.1017/ice.2022.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Objective:
Automated surveillance methods increasingly replace or support conventional (manual) surveillance; the latter is labor intensive and vulnerable to subjective interpretation. We sought to validate 2 previously developed semiautomated surveillance algorithms to identify deep surgical site infections (SSIs) in patients undergoing colorectal surgeries in Dutch hospitals.
Design:
Multicenter retrospective cohort study.
Methods:
From 4 hospitals, we selected colorectal surgery patients between 2018 and 2019 based on procedure codes, and we extracted routine care data from electronic health records. Per hospital, a classification model and a regression model were applied independently to classify patients into low- or high probability of having developed deep SSI. High-probability patients need manual SSI confirmation; low-probability records are classified as no deep SSI. Sensitivity, positive predictive value (PPV), and workload reduction were calculated compared to conventional surveillance.
Results:
In total, 672 colorectal surgery patients were included, of whom 28 (4.1%) developed deep SSI. Both surveillance models achieved good performance. After adaptation to clinical practice, the classification model had 100% sensitivity and PPV ranged from 11.1% to 45.8% between hospitals. The regression model had 100% sensitivity and 9.0%–14.9% PPV. With both models, <25% of records needed review to confirm SSI. The regression model requires more complex data management skills, partly due to incomplete data.
Conclusions:
In this independent external validation, both surveillance models performed well. The classification model is preferred above the regression model because of source-data availability and less complex data-management requirements. The next step is implementation in infection prevention practices and workflow processes.
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Dixon L, Biggs S, Messenger D, Shabbir J. Surgical Site Infection (SSI) Prevention Bundle in Elective Colorectal Surgery. J Hosp Infect 2022; 122:162-167. [DOI: 10.1016/j.jhin.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
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Evaluating the post-discharge cost of healthcare-associated infection in NHS Scotland. J Hosp Infect 2021; 114:51-58. [PMID: 34301396 DOI: 10.1016/j.jhin.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Whereas the cost burden of healthcare-associated infection (HAI) extends beyond the inpatient stay into the post-discharge period, few studies have focused on post-discharge costs. AIM To investigate the impact of all types of HAI on the magnitude and distribution of post-discharge costs observed in acute and community services for patients who developed HAI during their inpatient stay. METHODS Using data from the Evaluation of Cost of Nosocomial Infection (ECONI) study and regression methods, this study identifies the marginal effect of HAI on the 90-daypost-discharge resource use and costs. To calculate monetary values, unit costs were applied to estimates of excess resource use per case of HAI. FINDINGS Post-discharge costs increase inpatient HAI costs by 36%, with an annual national cost of £10,832,437. The total extra cost per patient with HAI was £1,457 (95% confidence interval: 1,004-4,244) in the 90 days post discharge. Patients with HAI had longer LOS if they were readmitted and were prescribed more antibiotics in the community. The results suggest that HAI did not have an impact on the number of readmissions or repeat surgeries within 90 days of discharge. The majority (95%) of the excess costs was on acute care services after readmission. Bloodstream infection, gastrointestinal infection, and pneumonia had the biggest impact on post-discharge cost. CONCLUSION HAI increases costs and antibiotic consumption in the post-discharge period. Economic evaluations of IPC studies should incorporate post-discharge costs. These findings can be used nationally and internationally to support decision-making on the impact of IPC interventions.
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Newton L, Dewi F, McNair A, Gane D, Rogers J, Dean H, Pullyblank A. The community burden of surgical site infection following elective colorectal resection. Colorectal Dis 2021; 23:724-731. [PMID: 33131179 DOI: 10.1111/codi.15420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/04/2020] [Accepted: 10/17/2020] [Indexed: 12/13/2022]
Abstract
AIM Surgical site infection (SSI) is common after colorectal surgery. Recent attempts to measure SSI have focused on inpatient SSI and readmissions. This study examined patient-reported SSI at 30 days over 8 years. METHODS The Health Protection Agency questionnaire was used to prospectively measure 30-day patient-reported SSI in patients undergoing elective colorectal operations between February 2011 and April 2019. Questionnaires were sent by post and followed up with a phone call. Data relating to hospital stay were prospectively recorded on an enhanced recovery database. RESULTS In all, 80.7% (1268) of 1559 patients responded to the questionnaire with an overall SSI rate of 15.9% (201/1268). The majority of patients who reported SSI presented in the community (66.7%) of whom 65% consulted their general practitioner and 35% saw a community nurse. Patient-reported SSI was validated by a health professional in over 90% of cases. Overall, only 1.5% of readmissions and 2% of ward attendances were due to an isolated wound problem. Patients who developed SSI during their index admission had a longer length of stay (11 days vs. 4 days) but there was no difference in delayed discharge or complications between patients with and without SSI, suggesting that a previously described association between SSI and increased length of stay may be due to observational bias. CONCLUSION Existing surveillance audits are suboptimal for monitoring SSIs following colorectal surgery as most SSIs present after discharge. There is a need for robust 30-day surveillance with a standardized methodology if comparisons are to be made between units.
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Affiliation(s)
- Lydia Newton
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Ffion Dewi
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Angus McNair
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dawn Gane
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Jodie Rogers
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Harry Dean
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Anne Pullyblank
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
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López Barrachina R, de la Cruz Tabares E, Guzmán Collado IDLT. Incidence of surgical site infection in colon surgery according to RENAVE methodology: Prospective study 2017–2019. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.cireng.2020.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Tang Y, Zhang R, Yang W, Li W, Tao K. Prognostic Value of Surgical Site Infection in Patients After Radical Colorectal Cancer Resection. Med Sci Monit 2020; 26:e928054. [PMID: 33040073 PMCID: PMC7559942 DOI: 10.12659/msm.928054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background This study aimed to evaluate the clinicopathological factors associated with surgical site infection (SSI) and the prognostic impact on patients after colorectal cancer (CRC) resection surgery. Material/Methods This retrospective study evaluated the relationships between SSI and various clinicopathological factors and prognostic outcomes in 326 consecutive patients with CRC who underwent radical resection surgery at Wuhan Union Hospital during April 2015–May 2017. Results Among the 326 patients who underwent radical CRC resection surgery, 65 had SSIs, and the incidence rates of incisional and organ/space SSI were 16.0% and 12.9%, respectively. Open surgery, chronic obstructive pulmonary disease (COPD), and a previous abdominal surgical history were identified as risk factors for incisional SSI. During a median follow-up of 40 months (range: 5–62 months), neither simple incisional nor simple organ/space SSI alone significantly affected disease-free survival (DFS) or overall survival (OS), whereas combined incisional and organ/space SSI had a significant negative impact on both the 3-year DFS and OS (P<0.001). A multivariate analysis identified that age ≥60 years, lymph node involvement, tumor depth (T3–T4), and incisional and organ/space SSI were independent predictors of 3-year DFS and OS. In addition, adjuvant chemotherapy and a carbohydrate antigen-125 concentration ≥37 ng/ml were also independent predictors of OS. Conclusions We have identified several clinicopathological factors associated with SSI, and identified incisional and organ/space SSI is an independent prognostic factor after CRC resection. Assessing the SSI classification may help to predict the prognosis of these patients and determine further treatment options.
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Affiliation(s)
- Yu Tang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Ruizhi Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Wenchang Yang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Wei Li
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
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Aasen DM, Bronsert MR, Rozeboom PD, Colborn KL, Henderson WG, Lambert-Kerzner A, Hammermeister KE, Meguid RA. Relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned readmissions in the ACS NSQIP database. Surgery 2020; 169:325-332. [PMID: 32933745 DOI: 10.1016/j.surg.2020.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postoperative complications, length of index hospital stay, and unplanned hospital readmissions are important metrics reflecting surgical care quality. Postoperative infections represent a substantial proportion of all postoperative complications. We examined the relationships between identification of postoperative infection prehospital and posthospital discharge, length of stay, and unplanned readmissions in the American College of Surgeons National Surgical Quality Improvement Program database across nine surgical specialties. METHODS The 30-day postoperative infectious complications including sepsis, surgical site infections, pneumonia, and urinary tract infection were analyzed in the American College of Surgeons National Surgical Quality Improvement Program inpatient data during the period from 2012 to 2017. General, gynecologic, vascular, orthopedic, otolaryngology, plastic, thoracic, urologic, and neurosurgical inpatient operations were selected. RESULTS Postoperative infectious complications were identified in 5.2% (137,014/2,620,450) of cases; 81,929 (59.8%) were postdischarge. The percentage of specific complications identified postdischarge were 73.4% of surgical site infections (range across specialties 63.7-93.1%); 34.9% of sepsis cases (27.4-58.1%); 26.5% of pneumonia cases (18.9%-36.3%); and 53.2% of urinary tract infections (48.3%-88.0%). The relative risk of readmission among patients with postdischarge versus predischarge surgical site infection, sepsis, pneumonia, or urinary tract infection was 5.13 (95% confidence interval: 4.90-5.37), 9.63 (8.93-10.40), 10.79 (10.15-11.45), and 3.32 (3.07-3.60), respectively. Over time, mean length of stay decreased but postdischarge infections and readmission rates significantly increased. CONCLUSION Most postoperative infectious complications were diagnosed postdischarge. These were associated with an increased risk of readmission. The trend toward shorter length of stay over time was observed along with an increase both in the percentage of infections detected after discharge and the rate of unplanned related postoperative readmissions over time. Postoperative surveillance of infections should extend beyond hospital discharge of surgical patients.
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Affiliation(s)
- Davis M Aasen
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, UCONN Health, Farmington, CT; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Paul D Rozeboom
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Kathryn L Colborn
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, CO
| | - William G Henderson
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Anne Lambert-Kerzner
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Karl E Hammermeister
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Robert A Meguid
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO; Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, CO.
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16
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Effect of perioperative hyperglycemia on surgical site infection in abdominal surgery: A prospective cohort study. Am J Infect Control 2020; 48:781-785. [PMID: 31836208 DOI: 10.1016/j.ajic.2019.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Surgical site infection (SSI) remains one of the most frequent complications in abdominal surgery, and hyperglycemia prevention is recommended as a measure to reduce this type of infection. The aims of this study were to estimate the incidence of SSI and to identify the effect of perioperative hyperglycemia on the incidence of this type of infection in patients undergoing abdominal surgery. METHODS We enrolled 484 abdominal surgery patients ≥ 18 years of age, recruited between July 2016 and May 2017. Data were collected through structured interviews and patient assessments in the perioperative period and at the surgical outpatient clinic (30th day after surgery). Crude and adjusted models were built to identify the effect of hyperglycemia on SSI. RESULTS The incidence rate of SSI was 20.25%. The attributable fraction for patients exposed to hyperglycemia was >60%. In the multivariable analysis, patients with hyperglycemia, at the end of the surgery and 12 hours later, were more likely to develop this type of infection (relative risk = 1.89 and 2.17, respectively). CONCLUSIONS Perioperative hyperglycemia was identified as an independent risk factor for SSI. The evidence generated reinforces the importance of proper glycemic control management in the perioperative period for the prevention of SSI.
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17
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López Barrachina R, de la Cruz Tabares E, Guzmán Collado IDLT. Incidence of surgical site infection in colon surgery according to RENAVE methodology: Prospective study 2017-2019. Cir Esp 2020; 99:34-40. [PMID: 32532474 DOI: 10.1016/j.ciresp.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Navarra Hospital Complex has renovated its healthcare-associated infections surveillance and control methods meeting the requirements of the Spanish National Epidemiologic Surveillance Network. Surgical site infections are one of the most relevant adverse outcomes, being the colon surgery one of the mandatory monitored procedures. This system will ease, not only the yearly estimation of the hospital surgical infection rates, but also its comparison at national and European levels. METHODS 416 patients underwent surgery between 2017 and 2019. Clinical variables were gathered during the patient hospitalization and up to 30days from surgery, stratifying the cases by their NHSN (National Health Safety Network) surgical infection risk index. A univariant descriptive analysis was performed and outcome indicators were estimated. RESULTS The cumulative incidence was 10.6%, with 44 cases. The rates were higher among the high-risk subgroups: 25.0% and 42.9%, respectively, for NSHN index categories2 and3. CONCLUSIONS The incidence was similar to the ones found in other studies carried out in analogous conditions. However, the methodologic variability makes it difficult to compare results.
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Affiliation(s)
- Ruth López Barrachina
- Servicio de Medicina Preventiva e Higiene Hospitalaria, Complejo Hospitalario de Navarra, Pamplona, España.
| | - Enrique de la Cruz Tabares
- Servicio de Medicina Preventiva e Higiene Hospitalaria, Complejo Hospitalario de Navarra, Pamplona, España
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18
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Hou TY, Gan HQ, Zhou JF, Gong YJ, Li LY, Zhang XQ, Meng Y, Chen JR, Liu WJ, Ye L, Wang XX, Zhao YH, Zhang Y. Incidence of and risk factors for surgical site infection after colorectal surgery: A multiple-center prospective study of 3,663 consecutive patients in China. Int J Infect Dis 2020; 96:676-681. [PMID: 32505873 DOI: 10.1016/j.ijid.2020.05.124] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) after colorectal surgery (CRS) remains a significant problem for its negative clinical outcomes. However, it is poorly understood in China. This study aims to investigate the incidence, risk factors and microbiology of SSI after CRS. METHODS A nationwide prospective multicenter design was applied. Patients in 19 Chinese hospitals from 2015 to 2018 were prospectively monitored for SSI after CRS. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using univariate and multivariate logistic regression models. RESULTS Among 3,663 study participants, 134(3.66%) episodes of SSI were identified. The incidence rate of SSI decreased from 5.9 infections per 100 procedures in 2015 to 3.1 infections per 100 procedures in 2018 (incidence rate ratio, 0.52; 95% CI, 0.28-0.94). The SSI rates were 1.88, 4.15, 6.27 and 11.58 per 100 operations for the National Nosocomial Infections Surveillance system (NNIS) risk index categories of 0, 1, and 2 or 3, respectively. Escherichia coli (54/134, 40.3%) and Klebsiella pneumoniae (10/134, 7.5%) were the most frequently isolated microorganisms. A high prevalence of antibiotic resistance were observed in our study, with rates of extended spectrum beta-lactamase-producing or carbapenem-resistant Escherichia coli and Klebsiella pneumonia of 50.0%(27/54) and 30.0%(3/10) respectively. Preoperative hospital stay ≥ 48h (OR=2.28, 95% CI: 1.03-5.02, P=0.042) and contaminated or dirty wound (OR=3.38, 95% CI: 1.88-6.06, P=4.50×10-5) were significantly associated with increasing risk of SSI after CRS. CONCLUSION A statistically significant but modest decrease in the incidence rate of CRS SSI over the 4-year study period was observed in this study. Noticeably, the relatively high rates of multidrug-resistant pathogens causing SSI after CRS should be alert, while more studies with large population are needed due to the small number of isolates identified in our survey.
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Affiliation(s)
- Tie-Ying Hou
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Center, China
| | - Hui-Quan Gan
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing-Fang Zhou
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Center, China
| | - Ya-Jie Gong
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Center, China
| | - Liu-Yi Li
- Department of Infection Control, Peking University First Hospital, Beijing, China
| | - Xin-Qiang Zhang
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yue Meng
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jie-Rong Chen
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei-Jiang Liu
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Long Ye
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-Xiao Wang
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Center, China
| | - Yun-Hu Zhao
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Center, China
| | - Yu Zhang
- Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Center, China.
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19
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Affiliation(s)
- Josep M Badia
- Servicio de Cirugía General y Digestiva, Hospital General de Granollers, Granollers, Barcelona, España; Universitat Internacional de Catalunya; Observatorio de Infección en Cirugía.
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20
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Flynn J, Choy A, Leavy K, Connolly L, Alards K, Ranasinha S, Tan PY. Negative Pressure Dressings (PICOTM) on Laparotomy Wounds Do Not Reduce Risk of Surgical Site Infection. Surg Infect (Larchmt) 2020; 21:231-238. [DOI: 10.1089/sur.2019.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Julie Flynn
- Department of Surgery, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Audrey Choy
- Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Kylie Leavy
- Stomal Therapy Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Lisa Connolly
- Stomal Therapy Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Kelly Alards
- Stomal Therapy Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Sanjeeva Ranasinha
- School of Public Health and Preventive Medicine, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Pee Yau Tan
- Department of Surgery, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
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21
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Pagamisse AF, Tanner J, Poveda VDB. Post-discharge surveillance of surgical site infections in teaching hospitals in Brazil. Rev Esc Enferm USP 2020; 54:e03542. [PMID: 32187309 DOI: 10.1590/s1980-220x2018038203542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/11/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Understanding the reality of surgical site infections post-discharge surveillance in Brazilian teaching hospitals. METHOD A cross-sectional study conducted by sending an online questionnaire to nurses from the Hospital Infection Control Committee of Brazilian teaching hospitals registered in the National Registry of Health Establishments. RESULTS Of the 193 teaching hospitals in Brazil, eight declined to take part as they did not conduct post-discharge surveillance and 36 did not respond. Twenty five of the remaining 149 hospitals provided detailed responses and 96% of responding institutions performed surgical site infection surveillance during hospitalization; active search (29.3%) was the main method, while 84% reported performing post-discharge surveillance mainly by telephone (42.8%). Both surveillance actions have nurses as the main responsible professionals. CONCLUSION Nurses play a prominent role in surgical site infection identification/screening actions, and active search during hospitalization allied with post-discharge surveillance by telephone were the preferred methods.
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Affiliation(s)
| | - Judith Tanner
- School of Nursing, University of Nottingham, Nottingham, United Kingdom
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22
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Gomila A, Carratalà J, Badia JM, Camprubí D, Piriz M, Shaw E, Diaz-Brito V, Espejo E, Nicolás C, Brugués M, Perez R, Lérida A, Castro A, Biondo S, Fraccalvieri D, Limón E, Gudiol F, Pujol M. Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: a multicenter prospective cohort study. BMC Infect Dis 2018; 18:507. [PMID: 30290773 PMCID: PMC6173907 DOI: 10.1186/s12879-018-3413-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 09/25/2018] [Indexed: 12/15/2022] Open
Abstract
Background Healthcare-associated infections caused by Pseudomonas aeruginosa are associated with poor outcomes. However, the role of P. aeruginosa in surgical site infections after colorectal surgery has not been evaluated. The aim of this study was to determine the predictive factors and outcomes of surgical site infections caused by P. aeruginosa after colorectal surgery, with special emphasis on the role of preoperative oral antibiotic prophylaxis. Methods We conducted an observational, multicenter, prospective cohort study of all patients undergoing elective colorectal surgery at 10 Spanish hospitals (2011–2014). A logistic regression model was used to identify predictive factors for P. aeruginosa surgical site infections. Results Out of 3701 patients, 669 (18.1%) developed surgical site infections, and 62 (9.3%) of these were due to P. aeruginosa. The following factors were found to differentiate between P. aeruginosa surgical site infections and those caused by other microorganisms: American Society of Anesthesiologists’ score III–IV (67.7% vs 45.5%, p = 0.001, odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.44–4.39), National Nosocomial Infections Surveillance risk index 1–2 (74.2% vs 44.2%, p < 0.001, OR 3.6, 95% CI 2.01–6.56), duration of surgery ≥75thpercentile (61.3% vs 41.4%, p = 0.003, OR 2.2, 95% CI 1.31–3.83) and oral antibiotic prophylaxis (17.7% vs 33.6%, p = 0.01, OR 0.4, 95% CI 0.21–0.83). Patients with P. aeruginosa surgical site infections were administered antibiotic treatment for a longer duration (median 17 days [interquartile range (IQR) 10–24] vs 13d [IQR 8–20], p = 0.015, OR 1.1, 95% CI 1.00–1.12), had a higher treatment failure rate (30.6% vs 20.8%, p = 0.07, OR 1.7, 95% CI 0.96–2.99), and longer hospitalization (median 22 days [IQR 15–42] vs 19d [IQR 12–28], p = 0.02, OR 1.1, 95% CI 1.00–1.17) than those with surgical site infections due to other microorganisms. Independent predictive factors associated with P. aeruginosa surgical site infections were the National Nosocomial Infections Surveillance risk index 1–2 (OR 2.3, 95% CI 1.03–5.40) and the use of oral antibiotic prophylaxis (OR 0.4, 95% CI 0.23–0.90). Conclusions We observed that surgical site infections due to P. aeruginosa are associated with a higher National Nosocomial Infections Surveillance risk index, poor outcomes, and lack of preoperative oral antibiotic prophylaxis. These findings can aid in establishing specific preventive measures and appropriate empirical antibiotic treatment.
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Affiliation(s)
- A Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,VINCat Program, Barcelona, Spain.
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,VINCat Program, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - J M Badia
- VINCat Program, Barcelona, Spain.,Department of General Surgery, Hospital General de Granollers, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - D Camprubí
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,VINCat Program, Barcelona, Spain
| | - M Piriz
- VINCat Program, Barcelona, Spain.,Department of Infectious Diseases, Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - E Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,VINCat Program, Barcelona, Spain
| | - V Diaz-Brito
- VINCat Program, Barcelona, Spain.,Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - E Espejo
- VINCat Program, Barcelona, Spain.,Department of Infectious Diseases, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - C Nicolás
- VINCat Program, Barcelona, Spain.,Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - M Brugués
- VINCat Program, Barcelona, Spain.,Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain
| | - R Perez
- VINCat Program, Barcelona, Spain.,Department of Internal Medicine, Fundació Althaia, Barcelona, Spain
| | - A Lérida
- VINCat Program, Barcelona, Spain.,Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain
| | - A Castro
- VINCat Program, Barcelona, Spain.,Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - S Biondo
- VINCat Program, Barcelona, Spain.,Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - D Fraccalvieri
- VINCat Program, Barcelona, Spain.,Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - E Limón
- VINCat Program, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - F Gudiol
- VINCat Program, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,VINCat Program, Barcelona, Spain
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23
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Shaw E, Gomila A, Piriz M, Perez R, Cuquet J, Vazquez A, Badia JM, Lérida A, Fraccalvieri D, Marron A, Freixas N, Castro A, Cruz A, Limón E, Gudiol F, Biondo S, Carratalà J, Pujol M. Multistate modelling to estimate excess length of stay and risk of death associated with organ/space infection after elective colorectal surgery. J Hosp Infect 2018; 100:400-405. [PMID: 30125586 DOI: 10.1016/j.jhin.2018.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/10/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Accounting for time-dependency and competing events are strongly recommended to estimate excess length of stay (LOS) and risk of death associated with healthcare-associated infections. AIM To assess the effect of organ/space (OS) surgical site infection (SSI) on excess LOS and in-hospital mortality in patients undergoing elective colorectal surgery (ECS). METHODS A multicentre prospective adult cohort undergoing ECS, January 2012 to December 2014, at 10 Spanish hospitals was used. SSI was considered the time-varying exposure and defined as incisional (superficial and deep) or OS. Discharge alive and death were the study endpoints. The mean excess LOS was estimated using a multistate model which provided a weighted average based on the states patients passed through. Multivariate Cox regression models were used to assess the effect of OS-SSI on risk of discharge alive or in-hospital mortality. FINDINGS Of 2778 patients, 343 (12.3%) developed SSI: 194 (7%) OS-SSI and 149 (5.3%) incisional SSI. Compared to incisional SSI or no infection, OS-SSI prolonged LOS by 4.2 days (95% confidence interval (CI): 4.1-4.3) and 9 days (8.9-9.1), respectively, reduced the risk of discharge alive (adjusted hazard ratio (aHR): 0.36 (95% CI: 0.28-0.47) and aHR: 0.17 (0.14-0.21), respectively), and increased the risk of in-hospital mortality (aHR: 8.02 (1.03-62.9) and aHR: 10.7 (3.7-30.9), respectively). CONCLUSION OS-SSI substantially extended LOS and increased risk of death in patients undergoing ECS. These results reinforce OS-SSI as the SSI with the highest health burden in ECS.
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Affiliation(s)
- E Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain.
| | - A Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain
| | - M Piriz
- VINCat Programme, Barcelona, Spain; Infection Control, Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - R Perez
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Fundació Althaia de Manresa, Barcelona, Spain
| | - J Cuquet
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital General de Granollers, Barcelona, Spain
| | - A Vazquez
- Servei d'Estadística Aplicada, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M Badia
- VINCat Programme, Barcelona, Spain; Department of General Surgery, Hospital General de Granollers, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain
| | - A Lérida
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain
| | - D Fraccalvieri
- VINCat Programme, Barcelona, Spain; Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Marron
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain
| | - N Freixas
- VINCat Programme, Barcelona, Spain; Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - A Castro
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - A Cruz
- VINCat Programme, Barcelona, Spain; Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain
| | - E Limón
- VINCat Programme, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - F Gudiol
- VINCat Programme, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - S Biondo
- VINCat Programme, Barcelona, Spain; Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain
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24
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Gomila A, Carratalà J, Biondo S, Badia JM, Fraccalvieri D, Shaw E, Diaz-Brito V, Pagespetit L, Freixas N, Brugués M, Mora L, Perez R, Sanz C, Arroyo N, Iftimie S, Limón E, Gudiol F, Pujol M. Predictive factors for early- and late-onset surgical site infections in patients undergoing elective colorectal surgery. A multicentre, prospective, cohort study. J Hosp Infect 2017; 99:24-30. [PMID: 29288776 DOI: 10.1016/j.jhin.2017.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/20/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are the leading cause of healthcare-associated infections in acute care hospitals in Europe. However, the risk factors for the development of early-onset (EO) and late-onset (LO) SSI have not been elucidated. AIM This study investigated the predictive factors for EO-SSI and LO-SSI in a large cohort of patients undergoing colorectal surgery. METHODS We prospectively followed-up adult patients undergoing elective colorectal surgery in 10 hospitals (2011-2014). Patients were divided into three groups: EO-SSI, LO-SSI, or no infection (no-SSI). The cut-off defining EO-SSI and LO-SSI was seven days (median time to SSI development). Different predictive factors for EO-SSI and LO-SSI were analysed, comparing each group with the no-SSI patients. FINDINGS Of 3701 patients, 320 (8.6%) and 349 (9.4%) developed EO-SSI and LO-SSI, respectively. The rest had no-SSI. Patients with EO-SSI were mostly males, had colon surgery and developed organ-space SSI whereas LO-SSI patients frequently received chemotherapy or radiotherapy and had incisional SSI. Male sex (odds ratio (OR): 1.92; P < 0.001), American Society of Anesthesiologists' physical status >2 (OR: 1.51; P = 0.01), administration of mechanical bowel preparation (OR: 0.7; P = 0.03) and stoma creation (OR: 1.95; P < 0.001) predicted EO-SSI whereas rectal surgery (OR: 1.43; P = 0.03), prolonged surgery (OR: 1.4; P = 0.03) and previous chemotherapy (OR: 1.8; P = 0.03) predicted LO-SSI. CONCLUSION We found distinctive predictive factors for the development of SSI before and after seven days following elective colorectal surgery. These factors could help establish specific preventive measures in each group.
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Affiliation(s)
- A Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain; VINCat Program, Spain.
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain; VINCat Program, Spain; University of Barcelona, Spain
| | - S Biondo
- VINCat Program, Spain; University of Barcelona, Spain; Department of General Surgery, Hospital Universitari de Bellvitge, Spain
| | - J M Badia
- VINCat Program, Spain; Department of General Surgery, Hospital General de Granollers, Spain; Universitat Internacional de Catalunya, Spain
| | - D Fraccalvieri
- VINCat Program, Spain; Department of General Surgery, Hospital Universitari de Bellvitge, Spain
| | - E Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain; VINCat Program, Spain
| | - V Diaz-Brito
- VINCat Program, Spain; Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Spain
| | - L Pagespetit
- VINCat Program, Spain; Department of Infectious Diseases, Consorci Sanitari de Terrassa, Spain
| | - N Freixas
- VINCat Program, Spain; Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Spain
| | - M Brugués
- VINCat Program, Spain; Department of Internal Medicine, Consorci Sanitari de l'Anoia, Spain
| | - L Mora
- VINCat Program, Spain; Department of General Surgery, Corporació Sanitària Parc Taulí, Spain
| | - R Perez
- VINCat Program, Spain; Department of Internal Medicine, Fundació Althaia, Spain
| | - C Sanz
- VINCat Program, Spain; Department of Internal Medicine, Hospital de Viladecans, Spain
| | - N Arroyo
- VINCat Program, Spain; Department of General Surgery, Hospital General de Granollers, Spain
| | - S Iftimie
- VINCat Program, Spain; Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Spain
| | - E Limón
- VINCat Program, Spain; University of Barcelona, Spain
| | - F Gudiol
- VINCat Program, Spain; University of Barcelona, Spain
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain; VINCat Program, Spain
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Association Between Obesity and Wound Infection Following Colorectal Surgery: Systematic Review and Meta-Analysis. J Gastrointest Surg 2017; 21:1700-1712. [PMID: 28785932 DOI: 10.1007/s11605-017-3494-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/30/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this meta-analysis is to comprehensively review and quantify the excess risk of surgical site infections (SSI) in obese patients following colorectal surgery. METHODS A systematic electronic search of the MEDLINE and EMBASE databases identified studies that investigated the association of obesity, defined by body mass index (BMI) with SSI among colorectal surgery patients. RESULTS Twelve studies were included in the final analysis. Patients with BMI ≥30 kg/m2 were at 1.5 times (pooled OR 1.51, 95% CI: 1.39, 1.63, p < 0.001) higher odds of developing SSI after colorectal surgery when compared to BMI <30 kg/m2. Subgroup analysis of the eight studies that investigated only elective procedures showed that the odds of developing SSI when BMI ≥30 kg/m2 is 1.6 times that of those with BMI <30 kg/m2 (pooled OR 1.60; 95% CI 1.34, 1.86; p < 0.001). The odds of having SSI when BMI is 25-29.9 kg/m2 are 1.2 times than those with BMI <25 kg/m2 (pooled OR 1.17; 95% CI 1.07, 1.28; p < 0.001). CONCLUSION Overweight and obese patients carry at least 20% and 50% higher odds of developing SSI after colorectal surgery compared to normal weight patients, respectively.
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Lubitz AL, Chan E, Zarif D, Ross H, Philp M, Goldberg AJ, Pitt HA. American College of Surgeons NSQIP Risk Calculator Accuracy for Emergent and Elective Colorectal Operations. J Am Coll Surg 2017; 225:601-611. [PMID: 28826803 DOI: 10.1016/j.jamcollsurg.2017.07.1069] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND The American College of Surgeons NSQIP has developed a risk calculator (RC) to assist patients and surgeons with difficult decisions. The aim of this analysis was to determine the accuracy of the RC in patients undergoing elective and emergent colorectal operations. STUDY DESIGN From January 2013 through December 2015, seventy-five patients undergoing emergent colorectal operations were paired by date with 75 patients having elective colorectal operations. Patient data were entered into the RC. Actual postoperative outcomes, derived from NSQIP data, were compared with those predicted by the RC. RESULTS Emergent and elective patients differed (p < 0.05) with respect to age, functional status, American Society of Anesthesiologists class, steroid use, wound class, COPD, and chronic renal insufficiency. The RC accurately predicted outcomes in elective patients. Outcomes were significantly worse (p < 0.05) after the emergent operations. In emergent cases, the RC underestimated serious complications and length of stay and overestimated discharge to a skilled nursing facility (all p < 0.05). CONCLUSIONS The American College of Surgeons NSQIP RC accurately predicts outcomes for elective colorectal operations. Predicted and actual outcomes are significantly better in patients undergoing elective colon operations compared with those undergoing emergent procedures. The RC should be used with caution in emergent cases, as it has the potential to underestimate serious complications and length of stay, and overestimate discharge to skilled nursing facility. Refinement of the tool to include procedure complexity and diagnosis terms might improve its accuracy in emergent cases.
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Affiliation(s)
- Andrea L Lubitz
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Elaine Chan
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Daniel Zarif
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Howard Ross
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Matthew Philp
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Amy J Goldberg
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Henry A Pitt
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
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27
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Shah PM, Evans HL, Harrigan A, Sawyer RG, Friel CM, Hedrick TL. Wound Concerns and Healthcare Consumption of Resources after Colorectal Surgery: An Opportunity for Innovation? Surg Infect (Larchmt) 2017; 18:634-640. [PMID: 28486022 DOI: 10.1089/sur.2017.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Significant portions of patients undergoing colorectal surgical procedures have minor incision disturbances, yet very few meet definitions for surgical site infection (SSI). We sought to investigate the natural history of incision disturbances with a focus on the patient experience and resource utilization. We hypothesize that patients who have an incision disturbance consume frequent healthcare resources in the post-operative period despite the fact that most never receive a diagnosis of SSI. METHODS A 24-month prospective observational study was undertaken at an academic institution. Patients undergoing elective colorectal operation by two board-certified colorectal surgeons were followed prospectively for 90 days. Incisions were photographed serially and clinically characterized beginning as early as post-operative day two and at follow-up visits. The primary outcome was patient concern for an incision disturbance. Three surgeons reviewed clinical data and photographs to determine the presence of an incisional surgical infection, and diagnosis required agreement from two of three surgeons. RESULTS There were 171 patients included; 31 (15%) sought evaluation from a healthcare provider for concerns related to their incision including 46 telephone calls, six emergency department visits, seven primary care visits, 10 home health and 40 surgical clinic visits. Incision erythema and drainage were the most common sources of patient concern. Mean body mass index was higher in patients with concern for incision disturbances (34 vs. 28 kg/m2, p < 0.0001). Ultimately, 8% (14/171) received a diagnosis of SSI by study criteria while only 2% (4/171) were captured as having an SSI by the institutional National Surgical Quality Improvement Program database (p < 0.0001). CONCLUSIONS Patients undergoing colorectal surgical procedures commonly are concerned with post-operative incision disturbance, yet few are associated with a diagnosis of SSI, and in-person evaluation yields frequent utilization of healthcare resources. This presents an opportunity for secure electronic communication with the surgical team and the patient to potentially reduce consumption of healthcare resources.
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Affiliation(s)
- Puja M Shah
- Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Heather L Evans
- Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Amy Harrigan
- Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Robert G Sawyer
- Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Charles M Friel
- Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Traci L Hedrick
- Department of Surgery, University of Virginia , Charlottesville, Virginia
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28
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Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect 2017; 96:1-15. [DOI: 10.1016/j.jhin.2017.03.004] [Citation(s) in RCA: 365] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/01/2017] [Indexed: 11/24/2022]
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Gomila A, Carratalà J, Camprubí D, Shaw E, Badia JM, Cruz A, Aguilar F, Nicolás C, Marrón A, Mora L, Perez R, Martin L, Vázquez R, Lopez AF, Limón E, Gudiol F, Pujol M. Risk factors and outcomes of organ-space surgical site infections after elective colon and rectal surgery. Antimicrob Resist Infect Control 2017; 6:40. [PMID: 28439408 PMCID: PMC5401556 DOI: 10.1186/s13756-017-0198-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/18/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Organ-space surgical site infections (SSI) are the most serious and costly infections after colorectal surgery. Most previous studies of risk factors for SSI have analysed colon and rectal procedures together. The aim of the study was to determine whether colon and rectal procedures have different risk factors and outcomes for organ-space SSI. METHODS A multicentre observational prospective cohort study of adults undergoing elective colon and rectal procedures at 10 Spanish hospitals from 2011 to 2014. Patients were followed up until 30 days post-surgery. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Oral antibiotic prophylaxis (OAP) was considered as the administration of oral antibiotics the day before surgery combined with systemic intravenous antibiotic prophylaxis. RESULTS Of 3,701 patients, 2,518 (68%) underwent colon surgery and 1,183 (32%) rectal surgery. In colon surgery, the overall SSI rate was 16.4% and the organ-space SSI rate was 7.9%, while in rectal surgery the rates were 21.6% and 11.5% respectively (p < 0.001). Independent risk factors for organ-space SSI in colon surgery were male sex (Odds ratio -OR-: 1.57, 95% CI: 1.14-2.15) and ostomy creation (OR: 2.65, 95% CI: 1.8-3.92) while laparoscopy (OR: 0.5, 95% CI: 0.38-0.69) and OAP combined with intravenous antibiotic prophylaxis (OR: 0.7, 95% CI: 0.51-0.97) were protective factors. In rectal surgery, independent risk factors for organ-space SSI were male sex (OR: 2.11, 95% CI: 1.34-3.31) and longer surgery (OR: 1.49, 95% CI: 1.03-2.15), whereas OAP with intravenous antibiotic prophylaxis (OR: 0.49, 95% CI: 0.32-0.73) was a protective factor. Among patients with organ-space SSI, we found a significant difference in the overall 30-day mortality, being higher in colon surgery than in rectal surgery (11.5% vs 5.1%, p = 0.04). CONCLUSIONS Organ-space SSI in colon and rectal surgery has some differences in terms of incidence, risk factors and outcomes. These differences could be considered for surveillance purposes and for the implementation of preventive strategies. Administration of OAP would be an important measure to reduce the OS-SSI rate in both colon and rectal surgeries.
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Affiliation(s)
- Aina Gomila
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.,VINCat program, Catalonia, Spain
| | - Jordi Carratalà
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.,VINCat program, Catalonia, Spain.,University of Barcelona, Barcelona, Spain
| | - Daniel Camprubí
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.,VINCat program, Catalonia, Spain
| | - Evelyn Shaw
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.,VINCat program, Catalonia, Spain
| | - Josep Mª Badia
- VINCat program, Catalonia, Spain.,Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Antoni Cruz
- VINCat program, Catalonia, Spain.,Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain
| | - Francesc Aguilar
- VINCat program, Catalonia, Spain.,Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Carmen Nicolás
- VINCat program, Catalonia, Spain.,Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Anna Marrón
- VINCat program, Catalonia, Spain.,Consorci Sanitari de l'Anoia, Barcelona, Spain
| | - Laura Mora
- VINCat program, Catalonia, Spain.,Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - Rafel Perez
- VINCat program, Catalonia, Spain.,Fundació Althaia, Barcelona, Spain
| | - Lydia Martin
- VINCat program, Catalonia, Spain.,Hospital de Viladecans, Barcelona, Spain
| | - Rosa Vázquez
- VINCat program, Catalonia, Spain.,Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ana Felisa Lopez
- VINCat program, Catalonia, Spain.,Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - Enric Limón
- VINCat program, Catalonia, Spain.,University of Barcelona, Barcelona, Spain
| | - Francesc Gudiol
- VINCat program, Catalonia, Spain.,University of Barcelona, Barcelona, Spain
| | - Miquel Pujol
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.,VINCat program, Catalonia, Spain.,Infectious Diseases Department, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
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30
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Gomila A, Badia JM, Carratalà J, Serra-Aracil X, Shaw E, Diaz-Brito V, Castro A, Espejo E, Nicolás C, Piriz M, Brugués M, Obradors J, Lérida A, Cuquet J, Limón E, Gudiol F, Pujol M. Current outcomes and predictors of treatment failure in patients with surgical site infection after elective colorectal surgery. A multicentre prospective cohort study. J Infect 2017; 74:555-563. [PMID: 28315721 DOI: 10.1016/j.jinf.2017.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/27/2017] [Accepted: 03/08/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine current outcomes and predictors of treatment failure among patients with surgical site infection (SSI) after colorectal surgery. METHODS A multicentre observational prospective cohort study of adults undergoing elective colorectal surgery in 10 Spanish hospitals (2011-2014). Treatment failure was defined as persistence of signs/symptoms of SSI or death at 30 days post-surgery. RESULTS Of 3701 patients, 669 (18.1%) developed SSI; 336 (9.1%) were organ-space infections. Among patients with organ-space SSI, 81.2% required source control: 60.4% reoperation and 20.8% percutaneous/transrectal drainage. Overall treatment failure rate was 21.7%: 9% in incisional SSIs and 34.2% in organ-space SSIs (p < 0.001). Median length of stay was 15 days (IQR 9-22) for incisional SSIs and 24 days (IQR 17-35) for organ-space SSIs (p < 0.001). One hundred and twenty-seven patients (19%) required readmission and 35 patients died (5.2%). Risk factors for treatment failure among patients with organ-space SSI were age ≥65 years (OR 1.83, 95% CI: 1.07-1.83), laparoscopy (OR 1.7, 95% CI: 1.06-2.77), and reoperation (OR 2.8, 95% CI: 1.7-4.6). CONCLUSIONS Rates of SSI and treatment failure in organ-space SSI after elective colorectal surgery are notably high. Careful attention should be paid to older patients with previous laparoscopy requiring reoperation for organ-space SSI, so that treatment failure can be identified early.
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Affiliation(s)
- Aina Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
| | - Josep Ma Badia
- Department of General Surgery, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain; VINCat Program, Spain.
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain; University of Barcelona, Barcelona, Spain.
| | - Xavier Serra-Aracil
- Department of Surgery and Infection Control Team, Corporació Sanitària Parc Taulí, Barcelona, Spain; VINCat Program, Spain.
| | - Evelyn Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
| | - Vicens Diaz-Brito
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain.
| | - Antoni Castro
- Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain; VINCat Program, Spain.
| | - Elena Espejo
- Department of Infectious Diseases, Consorci Sanitari de Terrassa, Barcelona, Spain; VINCat Program, Spain.
| | - Carmen Nicolás
- Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; VINCat Program, Spain.
| | - Marta Piriz
- Department of Surgery and Infection Control Team, Corporació Sanitària Parc Taulí, Barcelona, Spain; VINCat Program, Spain.
| | - Montserrat Brugués
- Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain; VINCat Program, Spain.
| | - Josefina Obradors
- Department of Internal Medicine, Fundació Althaia, Barcelona, Spain; VINCat Program, Spain.
| | - Ana Lérida
- Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain; VINCat Program, Spain.
| | - Jordi Cuquet
- Department of General Surgery, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain; VINCat Program, Spain.
| | | | - Francesc Gudiol
- VINCat Program, Spain; University of Barcelona, Barcelona, Spain.
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
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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.
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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
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32
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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
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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.
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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
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Sanger PC, Hartzler A, Lordon RJ, Armstrong CA, Lober WB, Evans HL, Pratt W. A patient-centered system in a provider-centered world: challenges of incorporating post-discharge wound data into practice. J Am Med Inform Assoc 2016; 23:514-25. [PMID: 26977103 DOI: 10.1093/jamia/ocv183] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/31/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The proposed Meaningful Use Stage 3 recommendations require healthcare providers to accept patient-generated health data (PGHD) by 2017. Yet, we know little about the tensions that arise in supporting the needs of both patients and providers in this context. We sought to examine these tensions when designing a novel, patient-centered technology - mobile Post-Operative Wound Evaluator (mPOWEr) - that uses PGHD for post-discharge surgical wound monitoring. MATERIALS AND METHODS As part of the iterative design process of mPOWEr, we conducted semistructured interviews and think-aloud sessions using mockups with surgical patients and providers. We asked participants how mPOWEr could enhance the current post-discharge process for surgical patients, then used grounded theory to develop themes related to conflicts and agreements between patients and providers. RESULTS We identified four areas of agreement: providing contextual metadata, accessible and actionable data presentation, building on existing sociotechnical systems, and process transparency. We identified six areas of conflict, with patients preferring: more flexibility in data input, frequent data transfer, text-based communication, patient input in provider response prioritization, timely and reliable provider responses, and definitive diagnoses. DISCUSSION We present design implications and potential solutions to the identified conflicts for each theme, illustrated using our work on mPOWEr. Our experience highlights the importance of bringing a variety of stakeholders, including patients, into the design process for PGHD applications. CONCLUSION We have identified critical barriers to integrating PGHD into clinical care and describe design implications to help address these barriers. Our work informs future efforts to ensure the smooth integration of essential PGHD into clinical practice.
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Affiliation(s)
- Patrick C Sanger
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, USA
| | - Andrea Hartzler
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - Ross J Lordon
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, USA
| | | | - William B Lober
- Departments of Biobehavioral Nursing and Health Systems, and Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, USA
| | - Heather L Evans
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Wanda Pratt
- Information School and Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, USA
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Postoperative hyperglycemia and adverse outcomes in patients undergoing colorectal surgery: results from the Michigan surgical quality collaborative database. Int J Colorectal Dis 2015. [PMID: 26198996 DOI: 10.1007/s00384-015-2322-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Our objective was to assess the relationship between high blood glucose levels (BG) in the early postoperative period and the incidence of surgical site infections (SSIs), sepsis, and death following colorectal operations. METHODS The Michigan Surgical Quality Collaborative database was queried for colorectal operations from July 2012 to December 2013. Normoglycemic (BG < 180 mg/dL) and hyperglycemic (BG ≥ 180 mg/dL) groups were defined by using the highest BG within the first 72 h postoperatively. Outcomes of interest included the incidence of superficial, deep, and organ/space SSIs, sepsis, and death within 30 days. Initial unadjusted analysis was followed by propensity score matching and multiple logistic regression modeling after adjusting for significant predictors. Separate analyses were performed for previously diagnosed diabetic and non-diabetic patients. RESULTS A total of 5145 cases met inclusion criteria, of which 1072 were diabetic. For diabetic patients, there was a marginally significant association between high BG and superficial SSI in the unadjusted analysis (OR = 1.75, p = 0.056), but not in the adjusted analysis (OR = 1.35, p = 0.39). There was no significant relationship between elevated BG and deep SSI, organ/space SSI, sepsis, or death among diabetic patients. For non-diabetic patients, there was a significant association between high BG and superficial SSI (OR = 1.53, p = 0.03), sepsis (OR = 1.61, p < 0.01), and death (OR = 2.26, p < 0.01), but not deep or organ/space SSI. CONCLUSIONS Following colorectal operations, superficial SSI, sepsis, and death are associated with postoperative serum hyperglycemia in patients without diabetes, but not those with diabetes. Vigilant postoperative BG monitoring is critical for all patients undergoing colorectal surgery.
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Liu X, Duan X, Xu J, Jin Q, Chen F, Wang P, Yang Y, Tang X. Impact of intra-operative intraperitoneal chemotherapy on organ/space surgical site infection in patients with gastric cancer. J Hosp Infect 2015. [PMID: 26215613 DOI: 10.1016/j.jhin.2015.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Various risk factors for surgical site infection (SSI) have been identified such as age, overweight, duration of surgery, blood loss, etc. Intraperitoneal chemotherapy during surgery is a common procedure in patients with gastric cancer, yet its impact on SSI has not been evaluated. AIM To evaluate whether intra-operative intraperitoneal chemotherapy is a key risk factor for organ/space SSI in patients with gastric cancer. METHODS All patients with gastric cancer who underwent surgery at the Department of Gastrointestinal Surgery between January 2008 and December 2013 were studied. The organ/space SSI rates were compared between patients who received intra-operative intraperitoneal chemotherapy and patients who did not receive intra-operative intraperitoneal chemotherapy, and the risk factors for organ/space SSI were analysed by univariate and multi-variate regression analyses. The microbial causes of organ/space SSI were also identified. FINDINGS Of the eligible 845 patients, 356 received intra-operative intraperitoneal chemotherapy, and the organ/space SSI rate was higher in these patients compared with patients who did not receive intra-operative intraperitoneal chemotherapy (9.01% vs 3.88%; P = 0.002). Univariate analysis confirmed the significance of this finding (odds ratio 2.443; P = 0.003). As a result, hospital stay was increased in patients who received intra-operative intraperitoneal chemotherapy {mean 20.91 days [95% confidence interval (CI) 19.76-22.06] vs 29.72 days (95% CI 25.46-33.99); P = 0.000}. The results also suggested that intra-operative intraperitoneal chemotherapy may be associated with more Gram-negative bacterial infections. CONCLUSION Intra-operative intraperitoneal chemotherapy is a significant risk factor for organ/space SSI in patients with gastric cancer.
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Affiliation(s)
- X Liu
- Department of Hospital Infection Management, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - X Duan
- Department of Head and Neck Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - J Xu
- Department of Head and Neck Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.
| | - Q Jin
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - F Chen
- Department of Hospital Network Information Centre, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - P Wang
- Department of Hospital Infection Management, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Y Yang
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - X Tang
- Department of Public Health, Guangxi Medical University, Nanning, China
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Chlorhexidine with isopropyl alcohol versus iodine povacrylex with isopropyl alcohol and alcohol- versus nonalcohol-based skin preparations: the incidence of and readmissions for surgical site infections after colorectal operations. Dis Colon Rectum 2015; 58:588-96. [PMID: 25944431 DOI: 10.1097/dcr.0000000000000379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Surgical site infections are a major cause of morbidity and mortality after colorectal operations. Preparation of the surgical site with antiseptic solutions is an essential part of wound infection prevention. To date, there is no universal consensus regarding which preparation is most efficacious. OBJECTIVE This study compared 2.0% chlorhexidine with 70.0% isopropyl alcohol versus 0.7% iodine povacrylex with 74.0% isopropyl alcohol and alcohol-based versus nonalcohol-based skin preparations with regard to efficacy in preventing postoperative wound infections. DESIGN This is a retrospective study from 2 prospectively collected statewide databases combined. A propensity score model was used to adjust for differences between the groups in patient demographics, characteristics, comorbidities, and laboratory values. SETTINGS The multicenter data set used in this analysis represents a variety of academic and community hospitals within the state of Michigan from January 2010 through June 2012. PATIENTS Patients over the age of 18 years who underwent clean-contaminated colorectal operations were included. MAIN OUTCOME MEASURES The incidence of superficial surgical site infections, any surgical site infection, any wound complication, and readmission within 30 days for surgical site infection were measured. RESULTS When 2.0% chlorhexidine with 70.0% isopropyl alcohol (n = 425) and 0.7% iodine povacrylex with 74.0% isopropyl alcohol (n = 115) were compared, a total of 540 colorectal cases met inclusion criteria. When alcohol-based (n = 610) and nonalcohol-based (n = 177) skin preparations were compared, a total of 787 colorectal cases met inclusion criteria. There was no significant difference in the propensity-adjusted odds for having any of the 4 outcomes of interest when comparing 2.0% chlorhexidine with 70.0% isopropyl alcohol to 0.7% iodine povacrylex with 74.0% isopropyl alcohol and when comparing alcohol-based with nonalcohol-based skin preparations. LIMITATIONS This was a nonrandomized study performed retrospectively based on data collected within the state of Michigan. CONCLUSIONS The use of 2.0% chlorhexidine with 70.0% isopropyl alcohol versus 0.7% iodine povacrylex with 74.0% isopropyl alcohol or alcohol-based versus nonalcohol-based skin preparations does not significantly influence the incidence of surgical site infections or readmission within 30 days for surgical site infection after clean-contaminated colorectal operations.
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Verwilghen D, Singh A. Fighting surgical site infections in small animals: are we getting anywhere? Vet Clin North Am Small Anim Pract 2014; 45:243-76, v. [PMID: 25542615 DOI: 10.1016/j.cvsm.2014.11.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. In this article, current knowledge of SSI risk factors and prevention methods is reviewed. Although new avenues that can be explored in the prevention of SSIs in veterinary medicine are described, the main conclusion drawn is that the best method for prevention of SSI is to adhere to what we already know.
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Affiliation(s)
- Denis Verwilghen
- Department of Large Animal Sciences, University of Copenhagen, Hojbakkegaerd Allé 5, Taatsrup 2630, Denmark.
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
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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] [MESH Headings] [Grants] [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.
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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
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