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Fornek ML, Ata S, Jimenez E, Abdallah M, Sunny S, Lee J, Episcopia B, Roudnitsky V, Quale J. Reportable infections following colon surgery in a large public healthcare system in New York City: The consequences of being a level 1 trauma center. Infect Control Hosp Epidemiol 2024; 45:21-26. [PMID: 37462117 PMCID: PMC11018097 DOI: 10.1017/ice.2023.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVES To examine differences in risk factors and outcomes of patients undergoing colon surgery in level 1 trauma centers versus other hospitals and to investigate the potential financial impact of these reportable infections. DESIGN Retrospective cohort study between 2015 and 2022. SETTING Large public healthcare system in New York City. PARTICIPANTS All patients undergoing colon surgery; comparisons were made between (1) all patients undergoing colon surgery at the level 1 trauma centers versus patients at the other hospitals and (2) the nontrauma and trauma patients at the level 1 trauma centers versus the nontrauma patients at other hospitals. RESULTS Of 5,217 colon surgeries reported, 3,531 were at level 1 trauma centers and 1686 at other hospitals. Patients at level 1 trauma centers had significantly increased American Society of Anesthesiology (ASA) scores, durations of surgery, rates of delayed wound closure, and rates of class 4 wounds, resulting in higher SIRs (1.1 ± 0.15 vs 0.75 ± 0.18; P = .0007) compared to the other hospitals. Compared to the nontrauma patients at the other hospitals, both the nontrauma and trauma patients at the level 1 trauma centers had higher ASA scores, rates of delayed wound closure, and of class 4 wounds. The SIRs of the nontrauma patients (1.16 ± 1.29; P = .008) and trauma patients (1.26 ± 2.69; P = .066) at the level 1 trauma center were higher than the SIRs of nontrauma patients in the other hospitals (0.65 ± 1.18). CONCLUSIONS Patients undergoing colon surgery at level 1 trauma centers had increased complexity of surgery compared to the patients in other hospitals. Until there is appropriate adjustment for these risk factors, the use of infections following colon surgery as a reportable quality measure should be re-evaluated.
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Affiliation(s)
- Mary L. Fornek
- Department of Infection Prevention, NYC Health+Hospitals/Central Office, New York, New York
| | - Subhan Ata
- Department of Medicine, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Edwin Jimenez
- Department of Surgery, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Marie Abdallah
- Department of Ambulatory Care, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Subin Sunny
- Department of Ambulatory Care, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Jennifer Lee
- Department of Ambulatory Care, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Briana Episcopia
- Department of Infection Prevention, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Valery Roudnitsky
- Department of Surgery, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - John Quale
- Department of Medicine, NYC Health+Hospitals/Kings County, Brooklyn, New York
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Marzoug OA, Anees A, Malik EM. Assessment of risk factors associated with surgical site infection following abdominal surgery: a systematic review. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2023; 5:e000182. [PMID: 37529828 PMCID: PMC10387634 DOI: 10.1136/bmjsit-2023-000182] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/20/2023] [Indexed: 08/03/2023] Open
Abstract
Objective Surgical site infections (SSIs) are among the most common healthcare-associated infections occurring following 1%-3% of all surgical procedures. Their rates are the highest following abdominal surgery. They are still associated with increased morbidity and healthcare costs despite the advancement in the medical field. Many risk factors for SSIs following abdominal surgery have been identified. The aim of this study is to comprehensively assess these risk factors as published in peer-reviewed journals. Design A systematic review was conducted with accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Setting The databases for search were PubMed and Cochrane Library, in addition to reference lists. Studies were retrieved and assessed for their quality. Data were extracted in a designed form, and a stratified synthesis of data was conducted to report the significant risk factors. Participants Patients undergoing general abdominal surgery. Intervention The intervention of general abdominal surgery. Main outcome measures To identify and assess the risk factors for SSI following abdominal surgery. Results Literature search yielded 813 articles, and the final screening process identified 11 eligible studies. The total number of patients is 11 996. The rates of SSI ranged from 4.09% to 26.7%. Nine studies were assessed to be of high quality, the remaining two studies have moderate quality. Stratified synthesis of data was performed for risk factors using summary measures (OR/risk ratio, 95% CI, and p value). Male sex and increased body mass index (BMI) were identified as significant demographic risk factors, and long operative time was among the major significant procedure-related risk factors. Conclusions Male sex, increased BMI, diabetes, smoking, American Society of Anesthesiologists classification of >2, low albumin level, low haemoglobin level, preoperative hospital stay, long operative time, emergency procedure, open surgical approach, increased wound class, intraoperative blood loss, perioperative infection, perioperative blood transfusion, and use of drains are potential independent risk factors for SSI following abdominal surgery.
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Affiliation(s)
- Omer A Marzoug
- Department of Anatomy, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ahmed Anees
- Department of Anatomy, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Elfatih M Malik
- Department of Community Medicine, University of Khartoum, Khartoum, Sudan
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Zhang Y, Liu C, Nistala KRY, Chong CS. Open versus laparoscopic Hartmann's procedure: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:2421-2430. [PMID: 36416926 DOI: 10.1007/s00384-022-04285-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Hartmann's procedure is traditionally performed in emergency situations where single-step procedures with immediate anastomosis may be unsafe. However, it can be associated with significant morbidity and low colostomy reversal rate. Whilst randomised controlled trials and a Cochrane review have reported strong evidence of laparoscopic over open colectomies, no such reviews have been performed for Hartmann's procedure. Hence, this paper aims to summarise the existing evidence to determine the efficacy of laparoscopic Hartmann's procedure over its open counterpart. METHODS Embase, Medline and Cochrane databases were searched from inception to 15 November 2020 for keywords relating to 'laparoscopy' and 'Hartmann' using strict inclusion and exclusion criteria. Odds ratio was estimated for dichotomous outcomes and weighted mean difference was estimated for continuous outcomes. RESULTS From the 836 articles yielded from the search strategy, 12 articles were selected for meta-analysis. Pooled analysis revealed that laparoscopic Hartmann's procedure (LHP) allows for a shorter length of stay, and a lower risk of overall surgical site infections and superficial surgical site infections. There was no significant difference in other outcomes. Single-arm analysis of LHP also showed an unprecedented high colostomy reversal rate of over 80%. CONCLUSION In clinically suitable patients, laparoscopic Hartmann's procedure has benefits over open Hartmann's procedure. Despite the selection bias of single-arm studies, LHP has reported a high stoma reversal rate of over 80%. Future well-controlled studies should be done to affirm the findings.
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Affiliation(s)
- Yingjia Zhang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chunxi Liu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Choon Seng Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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4
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Sharon CE, Grinberg S, Straker RJ, Mahmoud NN, Kelz RR, Miura JT, Karakousis GC. Trends in infectious complications after partial colectomy for colon cancer over a decade: A national cohort study. Surgery 2022; 172:1622-1628. [PMID: 36655827 DOI: 10.1016/j.surg.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/09/2022] [Accepted: 09/11/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program helps participating hospitals track and report surgical complications with the goal of improving patient care. We sought to determine whether postoperative infectious complications after elective colectomy for malignancy improved among participating centers over time. METHODS Patients with colon malignancies who underwent elective partial colectomy with primary anastomosis (categorized as low or non-low) were identified from the American College of Surgeons National Surgical Quality Improvement Program database (2011-2019). Thirty-day postoperative infectious complications analyzed by year included superficial, deep, and organ space surgical site infections, urinary tract infection, pneumonia, and sepsis. Trends in patient and treatment characteristics were investigated using log-linear regression along with their association with infectious outcomes. RESULTS Of the 78,827 patients identified, 51% were female, and the median age was 68. The majority (84%) underwent partial colectomy without a low anastomosis. There was a decrease in all infectious complications except for organ space infections which increased 35% overall from 2.0 to 2.7% (P = .037), driven by patients without a low anastomosis (1.9%-2.7%, P = .01). There was no change in most patient factors associated with organ space infections, except for a notable increase in American Society of Anesthesiologists class III and IV-V patients over time, both associated with organ space infections (P < .001; P = .002). CONCLUSION Infectious complications have decreased significantly overall after colectomy for colon cancer, whereas there has been an increase in organ space infection rates specifically. Although changing patient characteristics may contribute to this observed trend, further study is needed to better understand its etiology to help mitigate this complication.
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Affiliation(s)
- Cimarron E Sharon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Samuel Grinberg
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Richard J Straker
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Najjia N Mahmoud
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - John T Miura
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Giorgos C Karakousis
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. https://twitter.com/pennsurgery
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Hou Y, Hu Y, Song W, Zhang J, Luo Q, Zhou Q. Surgical site infection following minimally invasive lobectomy: Is robotic surgery superior? Cancer Med 2022; 11:2233-2243. [PMID: 35194968 PMCID: PMC9160803 DOI: 10.1002/cam4.4609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background Surgical site infection (SSI) in thoracic surgery remains a significant cause of morbidity and prolonged hospitalization. Minimally invasive surgery (MIS) has significantly reduced the risk of SSI. We intended to compare whether there was difference between video‐assisted thoracic surgery (VATS) and robotic‐assisted thoracic surgery (RATS) in SSI and highlight possible factors influencing SSI in lobectomy. Methods This retrospective study analyzed patients who underwent minimally invasive lobectomy from January 2018 to December 2019. All patients' clinical characteristics and surgery‐related information which may be related to the likelihood of SSI were recorded. Results A total of 1231 patients' records were reviewed with 806 VATS and 425 RATS. SSI was classified as deep or superficial SSI. Eighty‐six (7.0%) patients were found to develop an SSI with 62 patients having deep infections and 24 had superficial infection. No statistical difference in the incidence rate and category of SSI was observed between patients undergoing VATS and RATS. Conclusions There was no difference in the incidence of SSI between VATS and RATS lobectomy. Male gender, heavy smoking, uncontrolled diabetes mellitus, body mass index (BMI) > 27.9, more blood loss, and the higher National Healthcare Safety Network (NHSN) risk index score (1 or 2) were the independent risk factors of SSI following minimally invasive lobectomy, while male gender, uncontrolled diabetes mellitus, BMI > 27.9, more blood loss and the higher NHSN risk index score (1 or 2) were the main predictors of deep SSI.
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Affiliation(s)
- Yucheng Hou
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Yeyan Hu
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Weijian Song
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Jianfeng Zhang
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Qingquan Luo
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Qianjun Zhou
- Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
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Ennab R, Al-Momani W, Al-Titi R, Elayan A. Antibiotic Profile of Pathogenic Bacteria Isolated from Postsurgical Site Infections in Public Hospitals in Northern Jordan. Infect Drug Resist 2022; 15:359-366. [PMID: 35140481 PMCID: PMC8818773 DOI: 10.2147/idr.s350406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/20/2022] [Indexed: 12/13/2022] Open
Abstract
Background Surgical site infections are hospital-acquired, vary from one hospital to another, and can cause significant postoperative morbidity, mortality, and prolonged hospital stay. Objective The main aim of the study was to identify the bacterial pathogens associated with surgical site infections and their antibiotic susceptibility in a public hospital in northern Jordan. Methods Postsurgical wound samples were collected and processed in a microbiology laboratory using standard microbiological techniques. Antibiotic susceptibility tests were performed using 13 antibiotics covering the gram-positive and gram-negative bacteria using the disc diffusion test. Results The bacterial species that were identified in this study include Escherichia coli 8 (29%), Pseudomonas aeruginosa 3 (11%), Proteus mirabilis 1 (3.5%), Klebsiella pneumoniae 4 (14%), Salmonella enterica 2 (7%), Staphylococcus aureus 8 (29%), Staphylococcus epidermidis 1 (3.5%), and Streptococcus pyogenes 1 (4%). The antibiotic profiles of these bacteria showed high resistance. The MAR indices showed that 17 of 28 bacteria isolated were above 0.2 indicating high resistance. Conclusion Resistant bacteria are becoming more dominant in wound infections with a high prevalence of multidrug resistant isolates. Hospital disinfection and treatment protocols regarding the use of antibiotics should be practiced vigorously and monitored regularly to combat resistance.
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Affiliation(s)
- Raed Ennab
- Department of Clinical Medical Sciences/General Surgery, Faculty of Medicine, Yarmouk University, Irbid, Jordan
- Correspondence: Raed Ennab, Department of Clinical Medical Sciences/General Surgery, Faculty of Medicine, Yarmouk University, Irbid, Jordan, Tel +962797122559, Email
| | - Waleed Al-Momani
- Department of Basic Medical Sciences/Microbiology, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Rama Al-Titi
- Department of Basic Medical Sciences/Microbiology, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Ayah Elayan
- Department of Basic Medical Sciences/Microbiology, Faculty of Medicine, Yarmouk University, Irbid, Jordan
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7
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Risk factors for surgical site infections following open versus laparoscopic colectomies: a cohort study. BMC Surg 2021; 21:376. [PMID: 34696743 PMCID: PMC8543409 DOI: 10.1186/s12893-021-01379-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/15/2021] [Indexed: 12/12/2022] Open
Abstract
Background Surgical site infections (SSIs) are among the most common healthcare-associated infections. Evaluating risk factors for SSIs among patients undergoing laparoscopic and open colorectal resections can aid in selecting appropriate candidates for each modality. Methods A cohort of all consecutive patients undergoing elective colorectal resections during 2008–2017 in a single center was analyzed. SSIs were prospectively assessed by infection control personnel. Patient data were collected from electronic medical records. Risk factors for SSIs were compared between patients who underwent laparoscopic and open surgeries. A multivariate analysis was performed for significant variables. Results During the study period, 865 patients underwent elective colorectal resection: 596 laparoscopic and 269 open surgeries. Mean age was 68.2 ± 15.1 years, weight 72.5 ± 18.3 kg and 441 (51%) were men. The most common indication for surgery was malignancy, in 767 patients (88.7%) with inflammatory bowel diseases and diverticulitis following (4.5% and 3.9%, respectively). Patients undergoing laparoscopic surgery were younger, had fewer comorbidities, shorter pre-operative hospitalizations, lower risk index scores, and lower rates of SSI, compared with open surgery. Independent risk factors for SSI following laparoscopic surgery were chronic obstructive pulmonary disease [odds ratio (OR) 2.655 95% CI (1.267, 5.565)], risk index ≥ 2 [OR 2.079, 95% CI (1.041,4.153)] and conversion of laparoscopic to open surgery [OR 2.056 95%CI (1.212, 3.486)]. Independent risk factors for SSI following open surgery were immunosuppression [OR 3.378 95% CI (1.071, 10.655)], chronic kidney disease [OR 2.643 95% CI (1.008, 6.933)], and need for a second dose of prophylactic antibiotics [OR 2.519 95%CI (1.074, 5.905)]. Conclusions Risk factors for SSIs differ between laparoscopic and open colorectal resections. Knowledge of specific risk factors may inform patient selection for these modalities.
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Bekiari A, Pappas-Gogos G, Dimopoulos D, Priavali E, Gartzonika K, Glantzounis GK. Surgical site infection in a Greek general surgery department: who is at most risk? J Wound Care 2021; 30:268-274. [PMID: 33856911 DOI: 10.12968/jowc.2021.30.4.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Surgical site infections (SSIs) are associated with protracted hospitalisation, antibiotics administration, and increased morbidity and mortality. This work investigated the incidence rate of SSIs in the Department of General Surgery at the University Hospital of Ioannina, Greece, the associated risk factors and pathogens responsible. METHOD In this prospective cohort study, patients who underwent elective procedures under general anaesthesia were enrolled. Risk factors monitored included age, sex, body mass index, smoking, alcohol consumption, preoperative length of stay, chemoprophylaxis, intensive care unit (ICU) stay, American Society of Anesthesiology (ASA) score, and the National Nosocomial Infections Surveillance System (NNIS) basic SSI risk index. RESULTS Of the 1058 enrolled patients, 80 (7.6%) developed SSIs. Of the total cohort, 62.5% of patients received chemoprophylaxis for >24 hours. A total of 20 different pathogens, each with multiple strains (n=108 in total), were identified, 53 (49.5%) Gram-negative rods, 46 (42%) Gram-positive cocci, and nine (8.4%) fungi (Candida spp.). Escherichia coli was the prevalent microorganism (24.3%). SSI-related risk factors, as defined by univariate analysis, included: ICU stay, ASA score >2 (p<0.001), NNIS score >0, and wound classes II, III, and IV. Also, serum albumin levels <3.5g/dl were associated with increased rate of SSIs. The multivariate model identified an NNIS score of >0 and wound classes II, III, and IV as independent SSI-related risk factors. CONCLUSION This study showed high SSI rates. Several factors were associated with increased SSI rates, as well as overuse of prophylactic antibiotics. The results of the present study could be a starting point for the introduction of a system for recording and actively monitoring SSIs in Greek hospitals, and implementation of specific guidelines according to risk factors.
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Affiliation(s)
- Anna Bekiari
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - George Pappas-Gogos
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Dimitrios Dimopoulos
- Department of Medical Physics, School of Medicine, University of Ioannina, Greece
| | - Efthalia Priavali
- Department of Microbiology, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Konstantina Gartzonika
- Department of Microbiology, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Georgios K Glantzounis
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
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Agnes A, Puccioni C, D'Ugo D, Gasbarrini A, Biondi A, Persiani R. The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review. BMC Surg 2021; 21:83. [PMID: 33579260 PMCID: PMC7881582 DOI: 10.1186/s12893-021-01087-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/01/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The gut microbiota (GM) has been proposed as one of the main determinants of colorectal surgery complications and theorized as the "missing factor" that could explain still poorly understood complications. Herein, we investigate this theory and report the current evidence on the role of the GM in colorectal surgery. METHODS We first present the findings associating the role of the GM with the physiological response to surgery. Second, the change in GM composition during and after surgery and its association with colorectal surgery complications (ileus, adhesions, surgical-site infections, anastomotic leak, and diversion colitis) are reviewed. Finally, we present the findings linking GM science to the application of the enhanced recovery after surgery (ERAS) protocol, for the use of oral antibiotics with mechanical bowel preparation and for the administration of probiotics/synbiotics. RESULTS According to preclinical and translational evidence, the GM is capable of influencing colorectal surgery outcomes. Clinical evidence supports the application of an ERAS protocol and the preoperative administration of multistrain probiotics/synbiotics. GM manipulation with oral antibiotics with mechanical bowel preparation still has uncertain benefits in right-sided colic resection but is very promising for left-sided colic resection. CONCLUSIONS The GM may be a determinant of colorectal surgery outcomes. There is an emerging need to implement translational research on the topic. Future clinical studies should clarify the composition of preoperative and postoperative GM and the impact of the GM on different colorectal surgery complications and should assess the validity of GM-targeted measures in effectively reducing complications for all colorectal surgery locations.
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Affiliation(s)
- Annamaria Agnes
- Università Cattolica del Sacro Cuore, Largo F. Vito n.1, 00168, Rome, Italy
- Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli n. 8, 00168, Rome, Italy
| | - Caterina Puccioni
- Università Cattolica del Sacro Cuore, Largo F. Vito n.1, 00168, Rome, Italy
| | - Domenico D'Ugo
- Università Cattolica del Sacro Cuore, Largo F. Vito n.1, 00168, Rome, Italy
- Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli n. 8, 00168, Rome, Italy
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore, Largo F. Vito n.1, 00168, Rome, Italy
- Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli n. 8, 00168, Rome, Italy
| | - Alberto Biondi
- Università Cattolica del Sacro Cuore, Largo F. Vito n.1, 00168, Rome, Italy.
- Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli n. 8, 00168, Rome, Italy.
| | - Roberto Persiani
- Università Cattolica del Sacro Cuore, Largo F. Vito n.1, 00168, Rome, Italy
- Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli n. 8, 00168, Rome, Italy
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Ghuman A, Kasteel N, Brown CJ, Karimuddin AA, Raval MJ, Wexner SD, Phang PT. Surgical site infection in elective colonic and rectal resections: effect of oral antibiotics and mechanical bowel preparation compared with mechanical bowel preparation only. Colorectal Dis 2020; 22:1686-1693. [PMID: 32441804 DOI: 10.1111/codi.15153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/30/2020] [Indexed: 12/08/2022]
Abstract
AIM Surgical site infections are disproportionately common after colorectal surgery and may be largely preventable. The objective of this retrospective cohort study was to determine the effect of oral antibiotics and mechanical bowel preparation on surgical site infections. METHOD A retrospective study of a consecutive series of elective colonic and rectal resections following an Enhanced Recovery After Surgery pathway, which also included mechanical bowel preparation, from 1 September 2014 to 30 September 2017. The addition of oral antibiotics (neomycin and metronidazole) to the mechanical bowel preparation procedure was assessed. Development of surgical site infections within 30 days was the main outcome measured. The secondary outcome was assessment of possible surgical site infection predictors. RESULTS Seven-hundred thirty-two patients were included: 313 (43%) preintervention (mechanical bowel preparation only); and 419 (57%) postintervention (mechanical bowel preparation plus oral antibiotics). Surgical site infection rates preintervention and. postintervention were: overall, 20.8% vs 10.5%, P < 0.001; superficial, 10.9% vs 4.3%, P < 0.001; and organ space, 9.9% vs 6.2%, P = 0.03. Subgroup analysis of colonic resections revealed a significant reduction in overall (17.1% vs 6.8%), superficial (10.7% vs 4.3%) and organ space (6.4% vs. 2.6%) infections. Rectal resections had significant reduction in overall (26.2% vs 15.3%) and superficial (11.1% vs 4.4%) infection rates but not in organ space infections (15.1% vs 10.9%). Multivariate regression analysis revealed open vs minimally invasive surgery (P < 0.001) and omission of oral antibiotics (P = 0.004) as independent predictors of surgical site infections. CONCLUSION Administration of oral antibiotics resulted in significant reduction of superficial and organ space infections after colonic resection; after rectal resection, significant reduction only of superficial infections was found.
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Affiliation(s)
- A Ghuman
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - N Kasteel
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - C J Brown
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - A A Karimuddin
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - M J Raval
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - S D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - P T Phang
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
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11
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Sweigert PJ, Chen C, Fahmy JN, Eguia E, Ban KA, deLahunta D, Peters S, Baker MS, Singer MA. Association of obesity with postoperative outcomes after proctectomy. Am J Surg 2020; 220:1004-1009. [DOI: 10.1016/j.amjsurg.2020.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 01/07/2023]
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Williams RW, Cole S, Holt DE. Microorganisms associated with incisional infections after gastrointestinal surgery in dogs and cats. Vet Surg 2020; 49:1301-1306. [PMID: 32779226 DOI: 10.1111/vsu.13495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/10/2020] [Accepted: 07/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the rate of incisional infections after gastrointestinal surgery in dogs and cats and describe the aerobic bacteria isolated from these infections. STUDY DESIGN Retrospective study. ANIMALS Client-owned dogs (n = 210) and cats (n = 66). METHODS Records of dogs and cats that underwent gastrointestinal surgery at the Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania were reviewed for surgical procedures, presence of an infection, bacterial species isolated, perioperative antimicrobials administered, and outcome. RESULTS The median duration of follow-up was 14 days (4-35). Incisional infections were recorded in 7% (20/276) of cases. Among those 20 cases, culture results were available in 12 of 20 cases. The most common bacterial isolate cultured was Escherichia coli. The most common perioperative antimicrobials administered to treat incisional infection were cefazolin and cefoxitin. Only two of the bacterial isolates were susceptible to these antimicrobials. Bacteria isolated from incisional infections were most often susceptible to chloramphenicol, imipenem, and gentamicin. CONCLUSION Bacterial isolates from incisional infections in this population consisted of native gastrointestinal flora, which was often resistant to the most commonly used perioperative antimicrobials. CLINICAL SIGNIFICANCE Contamination at time of surgery is the most likely source of incisional infection after gastrointestinal surgery. This rate of infection justifies more rigorous intraoperative hygiene protocols and evaluation of the antimicrobials' susceptibility of causative bacteria to guide antimicrobial treatment.
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Affiliation(s)
- Rachel W Williams
- Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Cole
- Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David E Holt
- Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania, Philadelphia, Pennsylvania
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Strashilov SA, Yordanov AD, Konsoulova AA. Two clinical cases of alternative treatment with Theresienöl in surgical site superficial infections. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.05016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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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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Capolupo GT, Lauricella S, Mascianà G, Caricato C, Angeletti S, Ciccozzi M, Coppola R, Caricato M. O-Ring Protector in Prevention of SSIs in Laparoscopic Colorectal Surgery. JSLS 2020; 23:JSLS.2019.00048. [PMID: 31892788 PMCID: PMC6924502 DOI: 10.4293/jsls.2019.00048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Surgical-site infections (SSIs) remain a serious complication of colorectal surgery, causing a significant financial burden to the health care system. The aim of this study is to investigate whether the use of an O-ring retractor can be effective in preventing the incidence of wound infections after elective laparoscopic colorectal surgery. Methods: A retrospective case-control study from January 2014 to June 2018 was performed. Data were analyzed from a retrospective colorectal database. SSI was defined according to criteria published by the European Centre for Disease Prevention and Control and analyzed as a primary outcome. Results: Three hundred twelve consecutive patients (n = 312) were enrolled in our study. Among them, 158 patients (Group A) in which an O-ring retractor device was used during surgery was compared with a control group of 154 patients (Group B) in which an O-ring retractor device was not used. Primary outcome was to determine SSIs rates among the 2 groups. No statistically differences were observed with regard to baseline characteristics between both groups. A total of 9 patients (5.69%) and 24 (15.58%) with SSIs were identified in Group A and B, respectively, and the difference was statistically significant (OR, 0.32; 95% CI, 0.14–0.72; P = .0045). The median postoperative hospital stay length was 6.7 days in group A and 7.6 days in group B (P ≤ .05). Conclusions: SSIs infections rates were significantly higher in patients in which an O-ring retractor device was not used. This study suggests that the use of a wound protector device can be considered for routine use in elective colorectal surgery.
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Affiliation(s)
| | - Sara Lauricella
- Department of Geriatric Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy
| | - Gianluca Mascianà
- Department of Geriatric Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy
| | - Chiara Caricato
- Department of Geriatric Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistic and Epidemiology, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - Roberto Coppola
- General Surgery Unit, Campus Bio-Medico of Rome University, Italy
| | - Marco Caricato
- MD Program, School of Medicine, Catholic University of Sacred Heart, City, State, Country
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Alkaaki A, Al-Radi OO, Khoja A, Alnawawi A, Alnawawi A, Maghrabi A, Altaf A, Aljiffry M. Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg 2019; 62:111-117. [PMID: 30907567 DOI: 10.1503/cjs.004818] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Surgical site infection (SSI) is one of the most common complications of abdominal surgery and is associated with substantial discomfort, morbidity and cost. The goal of this study was to describe the incidence, bacteriology and risk factors associated with SSI in patients undergoing abdominal surgery. Methods In this prospective cohort study, all patients aged 14 years or more undergoing abdominal surgery between Feb. 1 and July 31, 2016, at a single large academic hospital were included. Patients undergoing vascular, gynecological, urological or plastic procedures were excluded. Patients were followed prospectively for 30 days. Wound assessment was done with the Centers for Disease Control and Prevention definition of SSI. We performed multivariate analysis to identify factors associated with SSI. Results A total of 337 patients were included. The overall incidence of SSI was 16.3% (55/337); 5 patients (9%) had deep infections, and 25 (45%) had combined superficial and deep infections. The incidence of SSI in open versus laparoscopic operations was 35% versus 4% (p < 0.001). The bacteria most commonly isolated were extended-spectrum β-lactamase-producing Escherichia coli, followed by Enterococcus species. Only 23% of cultured bacteria were sensitive to the prophylactic antibiotic given preoperatively. The independent predictors of SSI were open surgical approach, emergency operation, longed operation duration and male sex. Conclusion Potentially modifiable independent risk factors for SSI after abdominal surgery including open surgical approach, contaminated wound class and emergency surgery should be addressed systematically. We recommend tailoring the antibiotic prophylactic regimen to target the commonly isolated organisms in patients at higher risk for SSI.
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Affiliation(s)
- Aroub Alkaaki
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osman O. Al-Radi
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Khoja
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anfal Alnawawi
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abrar Alnawawi
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ashraf Maghrabi
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulmalik Altaf
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Murad Aljiffry
- From the Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Tapper J, Arver S, Holm T, Bottai M, Machado M, Jasuja R, Martling A, Buchli C. Acute primary testicular failure due to radiotherapy increases risk of severe postoperative adverse events in rectal cancer patients. Eur J Surg Oncol 2019; 46:98-104. [PMID: 31350073 DOI: 10.1016/j.ejso.2019.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 02/03/2023] Open
Abstract
AIM The aim of this study is to analyze postoperative adverse events (AE) in relation to acute primary testicular failure after radiotherapy (RT) for rectal cancer. METHOD This relation was assessed in 104 men, included in a previous prospective cohort study of men treated with surgical resection of the rectum for rectal cancer stage I-III. Postoperative AE were graded according to Clavien-Dindo (2004). Grade 3 or more was set as cut-off for severe postoperative AE. The impact of primary testicular failure on postoperative AE was related to the cumulative mean testicular dose (TD) and the change in Testosterone (T) and Luteinizing hormone (LH) sampled at baseline and after RT. RESULTS Twenty-six study participants (25%) had severe postoperative AE. Baseline characteristics and endocrine testicular function did not differ significantly between groups with (AE+) and without severe postoperative AE (AE-). After RT, the LH/T-ratio was higher in AE+, 0.603 (0.2-2.5) vs 0.452 (0.127-5.926) (p = 0.035). The longitudinal regression analysis showed that preoperative change in T (OR 0.844, 95% CI 0.720-0.990, p = 0.034), LH/T-ratio (OR 2.020, 95% CI 1.010-4.039, p = 0.047) and low T (<8 nmol/L, OR 2.605, 95 CI 0.951-7.139, p = 0.063) were related to severe postoperative AE. CONCLUSION Preoperative decline in T due to primary testicular failure induced by preoperative RT could be a risk factor regarding short-term outcome of surgery in men with rectal cancer.
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Affiliation(s)
- John Tapper
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
| | - Stefan Arver
- Department of Medicine/Huddinge Karolinska Institutet and ANOVA, Karolinska University Hospital, Stockholm, Sweden
| | - Torbjörn Holm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Ravi Jasuja
- Function Promoting Therapies, Waltham, MA, USA; Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Christian Buchli
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
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Laparoscopic colectomy for diverticulitis in patients with pre-operative respiratory comorbidity: analysis of post-operative outcomes in the United States from 2005 to 2017. Surg Endosc 2019; 34:1665-1677. [PMID: 31286256 DOI: 10.1007/s00464-019-06943-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/26/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current studies suggest that laparoscopic colorectal surgery is an advantageous alternative to open surgery due to improved post-operative outcomes in high-risk patient groups. Limited data is currently available on the benefits of minimally invasive colectomy for diverticulitis in patients with significant pre-operative respiratory comorbidities. STUDY DESIGN The NSQIP 2005-2017 datasets were used to identify patients that underwent partial colectomies due to diverticulitis. Partial colectomy cases were identified using CPT codes and then filtered to include only ICD 9 and 10 codes for diverticulitis. Pre-operative respiratory comorbidities included dyspnea, chronic obstructive pulmonary disease (COPD), and smoking status. Propensity matching was performed based on patient demographic and pre-operative risk factor data to create comparable groups for each respiratory comorbidity subset. Outcomes of interest were 30-day post-operative mortality and morbidity, incidence of return to operating room (ROR), and hospital length of stay (LoS). Laparoscopy and open surgery groups were compared using Chi square tests for categorical variables and t tests for continuous variables. A p value less than 0.05 was considered statistically significant. RESULTS Among 70,420 cases with diverticulitis, 15,237 cases were identified as smokers, 3934 had dyspnea, and 3219 had COPD. Patients that had open procedures had significantly greater odds of mortality (OR 2.624 for smokers; OR 2.698 for dyspnea; OR 2.663 for COPD), morbidity (OR 2.590 for smokers; OR 2.344 for dyspnea; OR 2.883 for COPD), wound complication (OR 1.989 for smokers; OR 1.461 for dyspnea; OR 1.956 for COPD), and ROR (OR 1.184 for smokers; OR 1.634 for dyspnea; OR 1.975 for COPD). Laparoscopic procedures resulted in significantly lower average LoS (5.34 vs. 9.46 days for smokers; 6.84 vs. 11.06 days for dyspnea; 7.41 vs. 12.62 days for COPD; all p < .0001). CONCLUSION Laparoscopic colectomy for diverticulitis diagnosis for a matched cohort of patients with pre-operative respiratory comorbidities such as smoking status, dyspnea, and COPD resulted in significantly improved post-operative outcomes, lower odds of mortality and morbidity, and shorter LoS.
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Kay D, Bhakta A, Patel JA, Hourigan JS, Kumar S, Davenport D, Beck SJ. Novel Technique to Reduce the Incidence of SSI after Colorectal Surgery. Am Surg 2019. [DOI: 10.1177/000313481908500725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
SSI is a leading cause of morbidity and increases health-care cost after colorectal operations. It is a key hospital-level patient safety indicator. Previous literature has identified perioperative risk factors associated with SSI and interventions to decrease rate of infection. The purpose of this study was to evaluate the impact of blowhole closure on the rate of superficial and deep SSI. The ACS-NSQIP database was queried for patients undergoing colectomy at the University of Kentucky from 2013 to 2016. Retrospective chart review was performed to gather demographic data and perioperative variables. Wounds left open and packed were excluded. Rates of postoperative SSI were measured between the groups. One thousand eighty-three patients undergoing elective and emergent colectomy were reviewed. Nine hundred and forty-five had closed incision and 138 had blowhole closure. Patient characteristics between the groups were well matched. Patients with a blowhole closure were more likely to have an open procedure ( P = 0.037) and a higher wound class ( P < 0.001). The rate of superficial and deep SSI was 9.1 per cent in patients with a closed incision and 5.1 per cent in patients with blowhole closure ( P = 0.142). With adjustment for approach and wound class, blowhole closure decreased the incidence of SSI ( P = 0.04). There was no significant difference in morbidity or mortality. Patients undergoing elective and emergent colectomy had decreased incidence of SSI when blowhole closure was used. Given that it does not increase resource usage and its technical ease, blowhole closure should become the standard method of surgical wound closure.
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Affiliation(s)
- Danielle Kay
- Division of General Surgery, Department of Surgery, and the
| | - Avinash Bhakta
- Department of Colorectal Surgery, University of Kentucky, Lexington, Kentucky
| | - Jitesh A. Patel
- Department of Colorectal Surgery, University of Kentucky, Lexington, Kentucky
| | - Jon S. Hourigan
- Department of Colorectal Surgery, University of Kentucky, Lexington, Kentucky
| | - Shyanie Kumar
- Division of General Surgery, Department of Surgery, and the
| | | | - Sandra J. Beck
- Department of Colorectal Surgery, University of Kentucky, Lexington, Kentucky
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The effect of body mass index on the risk of surgical site infection. Infect Control Hosp Epidemiol 2019; 40:991-996. [PMID: 31232239 DOI: 10.1017/ice.2019.165] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Obesity is considered a risk factor for surgical site infection (SSI). We quantified impact of body mass index (BMI) on the risk of SSI for a variety of surgical procedures. METHODS We included 2012-2017 data from the Dutch national surveillance network PREZIES on a selection of frequently performed surgical procedures across different specialties. Patients were stratified into 5 categories: underweight (BMI, <18.5 kg/m2), normal weight (BMI, 18.5-25), overweight (BMI, 25-30), obese (BMI, 30-40) and morbidly obese (BMI, ≥40). Multilevel log binomial regression analyses were performed to assess the effect of BMI category on the risk of superficial, deep (including organ-space) and total SSI. RESULTS Of the 387,919 included patients (ranging from 2,616 for laparoscopic appendectomy to 119,834 for total hip prosthesis), 3,676 (1%) were underweight, 116,778 (30%) had normal weight, 154,339 (40%) were overweight, 104,288 (27%) had obesity, and 8,838 (2%) were morbidly obese. A trend of increasing risk of SSI when BMI increased from normal to morbidly obese was observed for almost all surgery types. The increase was most profound in surgeries with clean wounds, with relative risks for morbidly obese patients ranging up to 7.8 (95% CI, 6.0-10.2) for deep SSI in total hip prosthesis. In chest and abdominal surgeries, the impact was larger for superficial SSI than for deep SSI. CONCLUSIONS The results of our research provide evidence for the need of preventive programs targeting SSI in overweight and obese patients, as well as for the prevention of obesity in the general population.
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Maurer E, Reuss A, Maschuw K, Aminossadati B, Neubert T, Schade-Brittinger C, K. Bartsch D. Superficial Surgical Site Infection Following the Use of Intracutaneous Sutures Versus Staples. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:365-371. [PMID: 31315799 PMCID: PMC6647811 DOI: 10.3238/arztebl.2019.0365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/03/2019] [Accepted: 04/15/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Superficial wound infections after gastrointestinal surgery markedly impair the affected patients' quality of life. As it is still unknown which method of skin closure is best for the reduction of wound infections in elective gastrointestinal sur- gery, we compared the frequency of wound infections after intracutaneous suturing versus skin stapling. METHODS In a prospective, randomized, single-center study, patients undergoing elective gastrointestinal surgery were intraoperatively randomized to skin closure either with an intracutaneous suture or with staples. The primary endpoint-the occurrence of a grade A1 wound infection within 30 days of surgery-was evaluated according to the intention-to-treat principle. RESULTS Out of a total of 280 patients, 141 were randomized to intracutaneous suturing and 139 to stapling. The groups did not differ significantly with respect to age, sex, or ASA classification. 19 of the 141 patients in the intracutaneous suturing group (13.5%) had a grade A1 wound infection, compared with 23 of 139 in the stapling group (16.6%) (odds ratio [OR]: 0.79; 95% confidence interval: [0.41; 1.52]; p = 0.47). A multiple regression analysis revealed that the type of surgery (colorectal vs. other), the approach, and the incision length were independent risk factors for a grade A1 wound infection. When wound dehiscences were additionally considered, wound complications were found to have arisen significantly more often in the stapling group than in the intracutaneous suturing group (16.3% [23/141] versus 30.2% [42/139], OR: 0.45 [0.25; 0.80]; p = 0.006). CONCLUSION In elective gastrointestinal surgery, intracutaneous suturing was not found to be associated with a lower rate of superficial wound infections than skin stapling, but fewer wound dehiscences occurred in the intracutaneous suturing group.
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Affiliation(s)
- Elisabeth Maurer
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
| | - Alexander Reuss
- Clinica Trials Coordination Center (KKS), Philipps-Universität Marburg, Marburg
| | - Katja Maschuw
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
| | - Behnaz Aminossadati
- Clinica Trials Coordination Center (KKS), Philipps-Universität Marburg, Marburg
| | - Thomas Neubert
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
| | | | - Detlef K. Bartsch
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
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Sun L, Liu S, Wang J, Wang L. Analysis of Risk Factors for Multiantibiotic-Resistant Infections Among Surgical Patients at a Children's Hospital. Microb Drug Resist 2019; 25:297-303. [PMID: 30676248 PMCID: PMC6441314 DOI: 10.1089/mdr.2018.0279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To identify the potential risk factors for multiantibiotic-resistant infections and provide sufficient evidence for multiantibiotic resistance prevention and control. MATERIALS AND METHODS We conducted a retrospective study of all patients in pediatric orthopedics, pediatric heart surgery, and pediatric general surgery at a level 3, grade A children's hospital from January to December 2016. The clinical laboratory information monitoring system and the medical record system were used to collect patient information regarding age, surgery type, preoperative length of stay, admission season, incision type, preoperative infection, intraoperative blood loss, postoperative use of invasive equipment, duration of catheter drainage, and timepoint of intraoperative prophylactic antibiotics administration. We used logistic univariate and multivariate regression analysis to analyze the potential risk factors for multiantibiotic-resistant infections among pediatric surgical patients. SPSS 21.0 and Excel software packages were used for the statistical analysis. RESULTS In total, 2,973 patients met the inclusion criteria: 1,247 patients in pediatric orthopedics, 1,089 patients in pediatric heart surgery, and 637 patients in pediatric general surgery. At the end of the study, 113 patients were multiantibiotic-resistant infection cases; the rate of multiantibiotic-resistant infections was 3.80%, and the detection rate was 84.79%. Multivariate analysis indicated that the multiantibiotic-resistant infection cases were influenced by age, department, admission season, incision type, preoperative infection, and duration of catheter drainage. CONCLUSIONS Age, department, admission season, incision type, preoperative infection, and duration of catheter drainage may provide possible evidence for prevention and control strategies of multiantibiotic-resistant infections.
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Affiliation(s)
- Lixin Sun
- Management of Hospital Infection Control, Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Suzhe Liu
- Management of Hospital Infection Control, Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Jingming Wang
- Management of Hospital Infection Control, Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Liqun Wang
- Management of Hospital Infection Control, Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
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Haines K, Rust C, Nguyen BP, Agarwal S. Acute Surgical Decision-Making in Abdominal Trauma Is Not Altered by Race or Socioeconomic Status. Am Surg 2018. [DOI: 10.1177/000313481808401230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Two main procedures are performed on patients suffering from colonic perforation, diverting colostomy and primary tissue repair. We investigated patient race, ethnicity, and socioeconomic status (SES) that predicted surgical outcomes after blunt or penetrating trauma. A retrospective analysis was performed using data from the National Trauma Data Bank for three years (2013–2015). We identified patients who presented with primary colonic injury and subsequent colon operation (n = 5431). Operations were grouped into three classes: colostomy, ileostomy, and nonostomy. Multiple linear and logistic regressions were performed to assess how race and insurance status are associated with the primary outcome of interest (ostomy formation) and secondary outcomes such as length of stay, time spent in ICU, and surgical site infection. Neither race/ethnicity nor insurance status proved to be reliable predictors for the formation of an ostomy. Patients who received either a colostomy or ileostomy were likely to have longer stays (OR [odds ratio]: 5.28; 95% CI [confidence interval]: 3.88–6.69) (OR: 11.24; 95% CI: 8.53–13.95), more time spent in ICU (2.73; 1.70–3.76) (7.98; 6.10–9.87), and increased risk for surgical site infection (1.32; 1.03–1.68) (2.54; 1.71–3.78). Race/ethnicity and SES were not reliable predictors for surgical decision-making on the formation of an ostomy after blunt and penetrating colonic injury. However, the severity of the injury as calculated by Injury Severity Score and the number of abdominal injuries were both associated with higher rates of colostomy and ileostomy. These data suggest that surgical decision-making is dependent on perioperative patient presentation and, not on race, ethnicity, or SES.
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Affiliation(s)
- Krista Haines
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Clayton Rust
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Benjamin Pham Nguyen
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Suresh Agarwal
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Fadayomi AB, Kasumova GG, Tabatabaie O, de Geus SW, Kent TS, Ng SC, Moser AJ, Callery MP, Ashley SW, Tseng JF. Unique predictors and economic burden of superficial and deep/organ space surgical site infections following pancreatectomy. HPB (Oxford) 2018; 20. [PMID: 29526467 PMCID: PMC6046258 DOI: 10.1016/j.hpb.2018.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) are common following pancreatectomy and associated with significant morbidity and economic burden. We sought to identify distinct predictors for superficial versus deep/organ space SSIs and their effects on surgical outcomes. METHODS ACS-NSQIP targeted pancreatectomy 2014 and 2015 databases were queried. Univariate and multivariate models were developed for both types of SSI, length of stay (LOS), and readmission. Costs were estimated based on Centers for Medicare & Medicaid Services (CMS) recommendations. RESULTS Of 8093 patients, there were 422 (5.2%) superficial and 1005 (12.4%) deep/organ space SSIs. On multivariate analyses, preoperative biliary stenting was predictive only for superficial SSI (OR: 2.21), while BMI of 25-29.9 (OR: 1.25) and BMI ≥30 kg/m2 (OR: 1.53), pancreatic duct size <3 mm (OR: 1.30), and intermediate (OR: 1.67) versus hard gland texture were predictors of deep/organ-space SSI. Superficial and deep/organ space SSIs were independent predictors of prolonged LOS (OR: 1.74 vs 1.80) and readmission (OR: 2.59 vs 6.57). Additional readmission costs per patient secondary to superficial SSI and deep/organ space SSI were $7661.37 and $18,409.42, respectively. CONCLUSION Deep/organ space SSI contributes more profoundly to prolonged hospital stay, readmission, and additional costs, suggesting that strategies should focus on preferential prevention of deep/organ space infections.
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Affiliation(s)
- Ayòtúndé B. Fadayomi
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gyulnara G. Kasumova
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Omidreza Tabatabaie
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Susanna W.L. de Geus
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Sing Chau Ng
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - A. James Moser
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark P. Callery
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Stanley W. Ashley
- Brigham and Women’s Hospital, Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer F. Tseng
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Yoshida T, Miyata H, Konno H, Kumamaru H, Tangoku A, Furukita Y, Hirahara N, Wakabayashi G, Gotoh M, Mori M. Risk assessment of morbidities after right hemicolectomy based on the National Clinical Database in Japan. Ann Gastroenterol Surg 2018; 2:220-230. [PMID: 29863168 PMCID: PMC5980426 DOI: 10.1002/ags3.12067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/16/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Nationwide databases are expected to provide critical data to improve medical practice. The present study used such data to develop risk models for clinically important outcomes after right hemicolectomy based on preoperative risk factors. METHODS Japan's National Clinical Database (NCD) identified 38 030 cases of right hemicolectomy in the years 2011 and 2012. These were used to analyze correlations between mortality and eight selected clinical outcomes of interest by Pearson's correlation coefficient (r). To construct risk models for the eight selected clinical outcomes, 80% of all the examined cases were extracted randomly as a development cohort, and preoperative risk factors for each clinical outcome were identified using a forward stepwise selection method. Morbidities predicted from the risk models were used to find areas under the receiver operator curves among the remaining 20% of the testing cohort. RESULTS The following clinical outcomes were identified as highly associated with operative mortality: systemic sepsis (r = .360), renal failure (r = .341), unplanned intubation (r = .316) and central nervous system (CNS) occurrences (r = .301). Risk models containing up to 21 preoperative variables were constructed for these eight postoperative clinical outcomes. Predictive values of the eight models were as follows: surgical site infections (0.634), anastomotic leakage (0.656), systemic sepsis (0.816), pneumonia (0.846), unplanned intubation (0.838), renal failure (0.883), CNS occurrences (0.833) and transfusion >5 units (0.846). CONCLUSIONS This study indicated that the NCD-generated risk models for six of the eight selected critical postoperative outcomes had high discrimination among right hemicolectomy patients. These risk models can accurately identify high-risk patients prior to surgery.
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Affiliation(s)
- Takahiro Yoshida
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
| | - Hiroaki Miyata
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
| | - Hiraku Kumamaru
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Akira Tangoku
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
| | - Yoshihito Furukita
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
| | | | - Go Wakabayashi
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
| | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
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26
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Harris J. Success of a Colorectal Surgical Site Infection Prevention Bundle in a Multihospital System. AORN J 2018; 107:592-600. [DOI: 10.1002/aorn.12124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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27
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Harnoss JC, Assadian O, Kramer A, Probst P, Müller-Lantzsch C, Scheerer L, Bruckner T, Diener MK, Büchler MW, Ulrich AB. Comparison of chlorhexidine–isopropanol with isopropanol skin antisepsis for prevention of surgical-site infection after abdominal surgery. Br J Surg 2018; 105:893-899. [DOI: 10.1002/bjs.10793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/11/2017] [Accepted: 11/17/2017] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Prevention of surgical-site infection (SSI) has received increasing attention. Clinical trials have focused on the role of skin antisepsis in preventing SSI. The benefit of combining antiseptic chlorhexidine with alcohol has not been compared with alcohol-based skin preparation alone in a prospective controlled clinical trial.
Methods
Between August and October 2014, patients undergoing abdominal surgery received preoperative skin antisepsis with 70 per cent isopropanol (PA). Those treated between November 2014 and January 2015 received 2 per cent chlorhexidine with 70 per cent isopropanol (CA). The primary endpoint was SSI on postoperative day (POD) 10, which was evaluated using univariable analysis, and a multivariable logistic regression model correcting for known independent risk factors for SSI. The study protocol was published in the German Registry of Clinical Studies (DRKS00011174).
Results
In total, 500 patients undergoing elective midline laparotomy were included (CA 221, PA 279). The incidence of superficial and deep SSIs was significantly different on POD 10: 14 of 212 (6·6 per cent) among those treated with CA and 32 of 260 (12·3 per cent) in those who received PA (P = 0·038). In the multivariable analysis, skin antisepsis with CA was an independent factor for reduced incidence of SSI on POD 10 (P = 0·034).
Conclusion
This study showed a benefit of adding chlorhexidine to alcohol for skin antisepsis in reducing early SSI compared with alcohol alone.
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Affiliation(s)
- J C Harnoss
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - O Assadian
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - A Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - P Probst
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - C Müller-Lantzsch
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - L Scheerer
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - M K Diener
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - A B Ulrich
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
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Risk of Surgical Site Infection (SSI) following Colorectal Resection Is Higher in Patients With Disseminated Cancer: An NCCN Member Cohort Study. Infect Control Hosp Epidemiol 2018; 39:555-562. [PMID: 29553001 DOI: 10.1017/ice.2018.40] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUNDSurgical site infections (SSIs) following colorectal surgery (CRS) are among the most common healthcare-associated infections (HAIs). Reduction in colorectal SSI rates is an important goal for surgical quality improvement.OBJECTIVETo examine rates of SSI in patients with and without cancer and to identify potential predictors of SSI risk following CRSDESIGNAmerican College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data files for 2011-2013 from a sample of 12 National Comprehensive Cancer Network (NCCN) member institutions were combined. Pooled SSI rates for colorectal procedures were calculated and risk was evaluated. The independent importance of potential risk factors was assessed using logistic regression.SETTINGMulticenter studyPARTICIPANTSOf 22 invited NCCN centers, 11 participated (50%). Colorectal procedures were selected by principal procedure current procedural technology (CPT) code. Cancer was defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes.MAIN OUTCOMEThe primary outcome of interest was 30-day SSI rate.RESULTSA total of 652 SSIs (11.06%) were reported among 5,893 CRSs. Risk of SSI was similar for patients with and without cancer. Among CRS patients with underlying cancer, disseminated cancer (SSI rate, 17.5%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.23-2.26; P=.001), ASA score ≥3 (OR, 1.41; 95% CI, 1.09-1.83; P=.001), chronic obstructive pulmonary disease (COPD; OR, 1.6; 95% CI, 1.06-2.53; P=.02), and longer duration of procedure were associated with development of SSI.CONCLUSIONSPatients with disseminated cancer are at a higher risk for developing SSI. ASA score >3, COPD, and longer duration of surgery predict SSI risk. Disseminated cancer should be further evaluated by the Centers for Disease Control and Prevention (CDC) in generating risk-adjusted outcomes.Infect Control Hosp Epidemiol 2018;39:555-562.
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Contribution of Prior, Multiple-, and Repetitive Surgeries to the Risk of Surgical Site Infections in the Netherlands. Infect Control Hosp Epidemiol 2017; 38:1298-1305. [PMID: 28918773 DOI: 10.1017/ice.2017.195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Surveillance is an important strategy to reduce the incidence of surgical site infections (SSIs). We investigated whether prior, multiple-, or repetitive surgeries are risk factors for SSI and whether they should be preserved in the protocol of the Dutch national SSI surveillance network. METHODS Dutch national SSI surveillance data 2012-2015 were selected, including 34 commonly performed procedures from 8 major surgical specialties. Definitions of SSIs followed international standardized criteria. We used multivariable multilevel logistic regression techniques to evaluate whether prior, multiple-, or repetitive procedure(s) are risk factors for SSIs. We considered surgeries clustered within partnerships of medical specialists and within hospitals (random effects) and different baseline risks between surgical specialties (fixed effects). Several patient and surgical characteristics were considered possible confounders and were included where necessary. We performed analyses for superficial and deep SSIs combined as well as separately. RESULTS In total, 115,943 surgeries were reported by 85 hospitals; among them, 2,960 (2.6%) resulted in SSIs (49.3% deep SSIs). The odds ratio (OR) for having prior surgery was 0.94 (95% confidence interval [CI], 0.74-1.20); the OR for repetitive surgery was 2.39 (95% CI, 2.06-2.77); and the OR for multiple surgeries was1.27 (95% CI, 1.07-1.51). The latter effect was mainly caused by prolonged duration of surgery. CONCLUSIONS Multiple- and repetitive surgeries significantly increased the risk of an SSI, whereas prior surgery did not. Therefore, prior surgery is not an essential data item to include in the national SSI surveillance network. The increased risk of SSIs for multiple surgeries was mainly caused by prolonged duration of surgery, therefore, it may be sufficient to report only duration of surgery to the surveillance network, instead of both (the variables duration of surgery and multiple surgeries). Infect Control Hosp Epidemiol 2017;38:1298-1305.
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Cima RR, Bergquist JR, Hanson KT, Thiels CA, Habermann EB. Outcomes are Local: Patient, Disease, and Procedure-Specific Risk Factors for Colorectal Surgical Site Infections from a Single Institution. J Gastrointest Surg 2017; 21:1142-1152. [PMID: 28470562 DOI: 10.1007/s11605-017-3430-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/10/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Colorectal surgical site infections (SSIs) contribute to postoperative morbidity, mortality, and resource utilization. Risk factors associated with colorectal SSI are well-documented. However, quality improvement efforts are informed by national data, which may not identify institution-specific risk factors. METHOD Retrospective cohort study of colorectal surgery patients uses institutional ACS-NSQIP data from 2006 through 2014. ACS-NSQIP data were enhanced with additional variables from medical records. Multivariable logistic regression identified factors associated with SSI development. RESULTS Of 2376 patients, 213 (9.0%) developed at least one SSI (superficial 4.8%, deep 1.1%, organ space 3.5%). Age < 40, BMI > 30, ASA3+, steroid use, smoking, diabetes, pre-operative sepsis, higher wound class, elevated WBC or serum glutamic-oxalocetic transaminase, low hematocrit or albumin, Crohn's disease, and prolonged incision-to-closure time were associated with increased SSI rate (all P < 0.01). After adjustment, BMI > 30, steroids, diabetes, and wound contamination were associated with SSI. Patients with Crohn's had greater odds of SSI than other indications. CONCLUSION Institutional modeling of SSI suggests that many previously suggested risk factors established on a national level do not contribute to SSIs at our institution. Identification of institution-specific predictors of SSI, rather than relying upon conclusions derived from external data, is a critical endeavor in facilitating quality improvement and maximizing value of quality investments.
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Affiliation(s)
- Robert R Cima
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. .,Surgical Outcomes Program, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
| | - John R Bergquist
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.,Surgical Outcomes Program, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Kristine T Hanson
- Surgical Outcomes Program, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Cornelius A Thiels
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.,Surgical Outcomes Program, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Elizabeth B Habermann
- Surgical Outcomes Program, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Uchida K, Ohtsuka Y, Yoden A, Tajiri H, Kimura H, Isihige T, Yamada H, Arai K, Tomomasa T, Ushijima K, Aomatsu T, Nagata S, Otake K, Matsushita K, Inoue M, Kudo T, Hosoi K, Takeuchi K, Shimizu T. Immunosuppressive medication is not associated with surgical site infection after surgery for intractable ulcerative colitis in children. Intractable Rare Dis Res 2017; 6:106-113. [PMID: 28580210 PMCID: PMC5451741 DOI: 10.5582/irdr.2017.01012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Pediatric ulcerative colitis (UC) sometimes progresses to an intractable condition for medical therapy. The surgical management of UC is challenging because of difficult procedures and frequent infectious complications. The aim of this study was to survey surgical procedures and infectious complications in pediatric patients with UC in Japan and to assess the relationship between preoperatively administered immunosuppressive drugs and postoperative surgical site infection (SSI). A survey of pediatric patients treated from 2000 to 2012 was sent to 683 facilities nationwide. Secondary questionnaires were sent to physicians who followed up patients with UC who had undergone surgery with the aim of assessing the relationships between postoperative SSI and selected preoperative patient characteristics, disease severity, medications, and operative procedures. Data for 136 patients (77 boys and 59 girls) were assessed. Median age at surgery was 14.1 years (range: 2.4-18.9 years). Surgery was performed in one stage in 35 cases, two stages in 57 cases, and three stages in 44 cases. SSI occurred in 36/136 patients (26%). According to multiple logistic regression analysis, there were statistically significant associations between SSI and staged surgery (three/one, OR: 6.7, 95% CI: 2.1-25.5, p = 0.0007; three/two, OR: 3.4, 95% CI: 1.4-8.6, p = 0.0069) and female sex (OR: 2.3, 95% CI: 1.0-5.4, p = 0.0434). Preoperative medications and incidence of SSI were not significantly associated. Preoperative immunosuppressive medication does not affect the incidence of SSI. Three-stage surgery and female sex are independent predictors of development of postoperative SSIs in pediatric patients with UC.
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Affiliation(s)
- Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Address correspondence to: Dr. Keiichi Uchida, Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan. E-mail:
| | - Yoshikazu Ohtsuka
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Yoden
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Hitoshi Tajiri
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Department of Pediatrics, Osaka General Medical Center, Osaka, Japan
| | - Hideaki Kimura
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Kanagawa, Japan
| | - Takashi Isihige
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroyuki Yamada
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Katsuhiro Arai
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Takeshi Tomomasa
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- PAL Children's Clinic, Gunma, Japan
| | - Kosuke Ushijima
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Department of Pediatrics, Kurume University Medical Center, Fukuoka, Japan
| | - Tomoki Aomatsu
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Satoru Nagata
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Department of Pediatrics, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kohei Otake
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kohei Matsushita
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Takahiro Kudo
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenji Hosoi
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Takeuchi
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- General Health Support Center, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Toshiaki Shimizu
- Members of the Japanese Society for Pediatric Inflammatory Bowel Disease Working Group
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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A randomized controlled trial of subcutaneous closed-suction Blake drains for the prevention of incisional surgical site infection after colorectal surgery. Int J Colorectal Dis 2017; 32:391-398. [PMID: 27783162 DOI: 10.1007/s00384-016-2687-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The effects of subcutaneous closed-suction Blake drain for preventing incisional surgical site infections (SSIs) after colorectal surgery have never been evaluated in a randomized controlled trial (RCT). Thus, we performed a RCT to evaluate the clinical benefits of using a subcutaneous closed-suction Blake drain in patients undergoing colorectal surgery. METHOD Consecutive patients who underwent colorectal surgery were enrolled in this study. Patients were randomly assigned to the subcutaneous closed-suction drainage arm or the control (no subcutaneous drainage) arm. The primary endpoint was incidence rate of incisional SSIs. And, we performed logistic regression analysis to detect predictive factors for incisional SSIs after colorectal surgery. RESULTS From November 2012 to September 2014, a total of 240 patients were enrolled in this study. One-hundred-seventeen patients who were treated by the control arm and 112 patients by the subcutaneous drainage arm were judged to be eligible for analysis. The incidence of incisional SSIs rate was 8.7 % in the overall patients. The incidence of incisional SSIs rate was 12.8 % in the control arm and 4.5 % in the subcutaneous drainage arm. There was significantly reduction of the incidence in the subcutaneous drainage arm than in the control arm (p = 0.025). Logistic regression analysis demonstrated that thickness of subcutaneous fat >3.0 cm, forced expiratory volume in 1 s as percent of forced vital capacity (FEV1.0 %) >70 %, and subcutaneous drain were independent predictors of postoperative incisional SSIs (p = 0.008, p = 0.004, and p = 0.017, respectively). CONCLUSION The results of our RCT suggest that a subcutaneous Blake drain is beneficial for preventing incisional SSIs in patients undergoing colorectal surgery.
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Yamamoto H, Maeda K, Arima H, Sonoda H, Shimizu T, Mekata E, Kaida S, Yamaguchi T, Murata S, Miura K, Kadowaki M, Tani M. Perioperative Adiponectin Measurement is Useful for Prediction of Postoperative Infection in Patients with Colorectal Cancer. Ann Surg Oncol 2016; 23:540-545. [PMID: 27364509 DOI: 10.1245/s10434-016-5386-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adiponectin (ADN) is a key molecule associated with obesity and metabolic syndrome, and functions as an immunomodulator. We have shown that the ADN ratio (i.e., postoperative ADN/preoperative ADN) can predict infection after gastrectomy in patients with gastric cancer . In the present study, we evaluated whether the ADN ratio could reliably predict the incidence of postoperative infection in patients undergoing colorectal cancer surgery. METHODS We retrospectively analyzed 131 consecutive patients who underwent colorectal cancer surgery and measured their preoperative and postoperative ADN values. The outcome was postoperative infection, including surgical site and remote infections. The association between the ADN ratio and postoperative infection was assessed using logistic regression models. For the ADN ratio and other significant predictors, we conducted receiver operating characteristics (ROC) analyses. RESULTS Forty-nine patients (37.4 %) experienced postoperative infections. Logistic regression analysis indicated that the ADN ratio was most significantly associated with postoperative infection [odds ratio per one standard deviation (1 SD) decrease 0.36; 95 % confidence interval 0.18-0.71] even after adjustment for diabetes, type of surgery, blood loss, C-reactive protein level, and preoperative ADN level. History of type 2 diabetes mellitus also significantly predicted postoperative infection (odds ratio per 1 SD increase 2.93; 95 % confidence interval 1.03-8.38). When predicting postoperative infection, the area under the ROC curve for the ADN ratio (0.707) was comparable to that for blood loss (0.698; p = 0.975). CONCLUSIONS ADN ratio is a clinically useful predictor of postoperative infection in patients undergoing colorectal cancer.
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Affiliation(s)
- Hiroshi Yamamoto
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan.
| | - Kazuhisa Maeda
- Department of Metabolic Medicine, Osaka University Hospital, Osaka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiromichi Sonoda
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Tomoharu Shimizu
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Eiji Mekata
- Department of Comprehensive Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Tsuyoshi Yamaguchi
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Satoshi Murata
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Makoto Kadowaki
- Division of Gastrointestinal Pathophysiology, Department of Bioscience, Institute of Natural Medicine, University of Toyama, Toyama, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
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Prediction of surgical site infection after colorectal surgery. Am J Infect Control 2016; 44:450-4. [PMID: 27038393 DOI: 10.1016/j.ajic.2015.10.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 10/16/2015] [Accepted: 10/20/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Surgical site infection (SSI) after colorectal surgery is a frequent complication associated with substantial morbidity. Our objective was to identify surgical predictors of SSI in patients undergoing colorectal surgery using a retrospective case-control design. MATERIAL AND METHODS Randomly selected patients from all those undergoing colorectal surgery (2007-2013). Cases were patients who developed SSI within 30 days. Controls were patients who did not develop SSI within 30 days. Patients undergoing multiple procedures during a single surgical intervention were excluded. SSI was diagnosed according to Centers for Disease Control and Prevention definitions. The main outcome measures were SSI, surgical variables, and cumulative survival (Kaplan-Meier method). Variables considered predictors were compared using log-rank test. RESULTS Of 911 patients undergoing colorectal surgery, 221 developed SSI (24.3%; 95% confidence interval, 24.0-24.6). On univariate analysis, significant risk factors for SSI were: female sex (P = .02), >72 hours preoperative stay (P = .04), open surgery (P = .08), incision class: contaminated and dirty (P = .001), and emergency procedures (P = .006). On multivariate analysis, significant independent predictors of SSI and survival were dirty surgery (hazard ratio [HR], 2.12; P = .015), contaminated surgery (HR, 1.74; P = .009), female sex (HR, 1.58; P = .003), open surgery, (HR, 1.51; P = .015) and >72 hours preoperative stay (HR, 1.48; P = .024). CONCLUSIONS Dirty or contaminated surgery, female sex, open surgery, and >72 hours preoperative stay were significant predictors of SSI.
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Bergquist JR, Thiels CA, Etzioni DA, Habermann EB, Cima RR. Failure of Colorectal Surgical Site Infection Predictive Models Applied to an Independent Dataset: Do They Add Value or Just Confusion? J Am Coll Surg 2016; 222:431-8. [DOI: 10.1016/j.jamcollsurg.2015.12.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 02/05/2023]
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36
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Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol 2015; 37:88-99. [PMID: 26503187 DOI: 10.1017/ice.2015.249] [Citation(s) in RCA: 353] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the independent association between diabetes and surgical site infection (SSI) across multiple surgical procedures. DESIGN Systematic review and meta-analysis. METHODS Studies indexed in PubMed published between December 1985 and through July 2015 were identified through the search terms "risk factors" or "glucose" and "surgical site infection." A total of 3,631 abstracts were identified through the initial search terms. Full texts were reviewed for 522 articles. Of these, 94 articles met the criteria for inclusion. Standardized data collection forms were used to extract study-specific estimates for diabetes, blood glucose levels, and body mass index (BMI). A random-effects meta-analysis was used to generate pooled estimates, and meta-regression was used to evaluate specific hypothesized sources of heterogeneity. RESULTS The primary outcome was SSI, as defined by the Centers for Disease Control and Prevention surveillance criteria. The overall effect size for the association between diabetes and SSI was odds ratio (OR)=1.53 (95% predictive interval [PI], 1.11-2.12; I2, 57.2%). SSI class, study design, or patient BMI did not significantly impact study results in a meta-regression model. The association was higher for cardiac surgery 2.03 (95% PI, 1.13-4.05) compared with surgeries of other types (P=.001). CONCLUSIONS These results support the consideration of diabetes as an independent risk factor for SSIs for multiple surgical procedure types. Continued efforts are needed to improve surgical outcomes for diabetic patients. Infect. Control Hosp. Epidemiol. 2015;37(1):88-99.
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