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Khalfay N, Markovic D, Holschneider C, Dejbakhsh S, Escher K, Han M. The Role of Preoperative Antibiotics in Surgical Site Infection (SSI) Rate after Class I/Clean Gynaecologic Surgery at an Academic Safety Net Hospital. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102404. [PMID: 38336006 DOI: 10.1016/j.jogc.2024.102404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES Examine whether preoperative antibiotics in class I/clean abdominal gynaecologic surgery decrease the incidence of surgical site infections (SSI). METHODS Retrospective cohort study at academic safety net hospital of patients undergoing class I laparoscopic or open gynaecologic surgery between November 2013 and September 2017. Performance improvement initiative to administer preoperative antibiotics to all surgical patients starting July 2016. RESULTS In total, 510 patients were included: 283 in the antibiotic group and 227 in the no-antibiotic group. PRIMARY OUTCOME incidence of SSI. Baseline characteristics were similar between groups once balanced by propensity score method. In unweighted analysis, incidence of SSI decreased from 9.3% (21/227) in the no-antibiotics group to 4.9% (14/283) in antibiotics group, but this was not statistically significant (odds ratio (OR) 0.51 CI 0.25-1.03, P = 0.0598). Following of inverse probability of treatment weighting adjustments in weighted analysis, incidence of SSI was found to be significantly lower in patients who received antibiotics compared to patients who did not receive antibiotics across entry types (4.6% vs. 9.8%, OR 0.45; CI 0.22-0.90, P = 0.023). Weighted analysis demonstrated in the exploratory laparotomy group patients who received antibiotics had a lower incidence of SSI compared to patients who did not receive antibiotics (5.1% vs. 18.7%, OR 0.23; CI 0.08-0.68, P = 0.008). In the laparoscopy group, there was no difference between groups (4.4% vs. 5.4%, OR 0.81; CI 0.3-2.16, P = 0.675). CONCLUSIONS There is limited literature on SSI prevention/preoperative antibiotic use in class I gynaecologic surgeries. This study demonstrates antibiotics in class I procedures decrease SSI rates, specifically in open procedures. There was a lack of demonstrated benefit in laparoscopy.
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Affiliation(s)
- Nuha Khalfay
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Daniela Markovic
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Department of Medicine Statistics Core, Los Angeles, CA, USA
| | - Christine Holschneider
- David Geffen School of Medicine at UCLA, Department of Obstetrics and Gynecology, Olive View UCLA Medical Center, Los Angeles, CA, USA
| | | | - Kirin Escher
- Department of Family Medicine, Martin Luther King Hospital, Los Angeles, CA, USA
| | - Michelle Han
- David Geffen School of Medicine at UCLA, Department of Obstetrics and Gynecology, Olive View UCLA Medical Center, Los Angeles, CA, USA.
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Edmiston CE, Bond-Smith G, Spencer M, Chitnis AS, Holy CE, Po-Han Chen B, Leaper DJ. Assessment of risk and economic burden of surgical site infection (SSI) posthysterectomy using a U.S. longitudinal database. Surgery 2021; 171:1320-1330. [PMID: 34973811 DOI: 10.1016/j.surg.2021.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgical site infection posthysterectomy has significant impact on patient morbidity, mortality, and health care costs. This study evaluates incidence, risk factors, and total payer costs of surgical site infection after hysterectomy in commercial, Medicare, and Medicaid populations using a nationwide claims database. METHODS IBM MarketScan databases identified women having hysterectomy between 2014 and 2018. Deep-incisional/organ space (DI/OS) and superficial infections were identified over 6 months postoperatively with risk factors and direct infection-associated payments by insurance type over a 24-month postoperative period. RESULTS Analysis identified 141,869 women; 7.8% Medicaid, 5.8% Medicare, and 3.9% commercially insured women developed deep-incisional/organ space surgical site infection, whereas 3.9% Medicaid, 3.2% Medicare, and 2.1% commercially insured women developed superficial infection within 6 months of index procedure. Deep-incisional/organ space risk factors were open approach (hazard ratio, 1.6; 95% confidence interval, 1.5-1.8) and payer type (Medicaid versus commercial [hazard ratio, 1.4; 95% confidence interval, 1.3-1.5]); superficial risk factors were payer type (Medicaid versus commercial [hazard ratio, 1.4; 95% confidence interval, 1.3-1.6]) and solid tumor without metastasis (hazard ratio, 1.4; 95% confidence interval, 1.3-1.6). Highest payments occurred with Medicare ($44,436, 95% confidence interval: $33,967-$56,422) followed by commercial ($27,140, 95% confidence interval: $25,990-$28,317) and Medicaid patients ($17,265, 95% confidence interval: $15,247-$19,426) for deep-incisional/organ space infection at 24-month posthysterectomy. CONCLUSIONS Real-world cost of managing superficial, deep-incisional/organ space infection after hysterectomy was significantly higher than previously reported. Surgical approach, payer type, and comorbid risk factors contributed to increased risk of infection and economic burden. Medicaid patients experienced the highest risk of infection, followed by Medicare patients. The study suggests adoption of a robust evidence-based surgical care bundle to mitigate risk of surgical site infection and economic burden is warranted.
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Affiliation(s)
| | | | | | - Abhishek S Chitnis
- Medical Device Epidemiology, Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ
| | - Chantal E Holy
- Medical Device Epidemiology, Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ
| | | | - David J Leaper
- University of Newcastle and Emeritus Professor of Clinical Sciences, University of Huddersfield, UK
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Lee CS, Han SR, Kye BH, Bae JH, Koh W, Lee IK, Lee DS, Lee YS. Surgical skin adhesive bond is safe and feasible wound closure method to reduce surgical site infection following minimally invasive colorectal cancer surgery. Ann Surg Treat Res 2020; 99:146-152. [PMID: 32908846 PMCID: PMC7463045 DOI: 10.4174/astr.2020.99.3.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/01/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose Minimally invasive colorectal surgery had reduced the rate of surgical site infection. The use of surgical skin adhesive bond (2-octyl cyanoacrylate) for wound closure reduces postoperative pain and provides better cosmetic effect compared to conventional sutures or staples. But role of surgical skin adhesive bond for reducing surgical site infection is unclear. Our objective in this study was to evaluate the role of surgical skin adhesive bond in reducing surgical site infection following minimally invasive colorectal surgery. Methods We performed a retrospective analysis of 492 patients treated using minimally invasive surgery for colorectal cancer at Seoul St. Mary's Hospital, the Catholic University of Korea. Of these, surgical skin adhesive bond was used for wound closure in 284 cases and skin stapling in 208. The rate of surgical site infection including deep or organ/space level infections was compared between the 2 groups. Results The rate of superficial surgical site infection was significantly lower in the group using skin adhesive (P = 0.024), and total costs for wound care were significantly lower in the skin adhesive group (P < 0.001). Conclusion This study showed that surgical skin adhesive bond reduced surgical site infection and total cost for wound care following minimally invasive colorectal cancer surgery compared to conventional skin stapler technique. Surgical skin adhesive bond is a safe and feasible alternative surgical wound closure technique following minimally invasive colorectal cancer surgery.
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Affiliation(s)
- Chul Seung Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Rim Han
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong-Hyeon Kye
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hoon Bae
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wooree Koh
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Kyu Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Do-Sang Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Suk Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Mantoani CC, Margatho AS, Dantas RAS, Galvão CM, de Campos Pereira Silveira RC. Perioperative Blood Transfusion and Occurrence of Surgical Site Infection: An Integrative Review. AORN J 2019; 110:626-634. [PMID: 31774169 DOI: 10.1002/aorn.12861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of this integrative review was to locate, assess, and synthesize available evidence of the relationship between perioperative allogeneic blood transfusion and the occurrence of surgical site infection among adult patients undergoing elective surgery. After a comprehensive search of relevant databases and a review of the studies this yielded, we used a validated instrument to extract data from the 25 studies in our final sample. The clinical and surgical variables that were significantly and more frequently associated with the occurrence of surgical site infection among patients who received blood transfusions during the perioperative period were female sex, older age, and higher body mass index. Our findings indicate a lack of consensus on the hemoglobin levels that indicate a blood transfusion is necessary.
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Surgical Site Infections and Associated Operative Characteristics. Surg Infect (Larchmt) 2017; 18:447-450. [DOI: 10.1089/sur.2017.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Morgan DM, Swenson CW, Streifel KM, Kamdar NS, Uppal S, Burgunder-Zdravkovski L, Pearlman MD, Fenner DE, Campbell DA. Surgical site infection following hysterectomy: adjusted rankings in a regional collaborative. Am J Obstet Gynecol 2016; 214:259.e1-259.e8. [PMID: 26475423 DOI: 10.1016/j.ajog.2015.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/16/2015] [Accepted: 10/06/2015] [Indexed: 12/15/2022]
Abstract
BACKROUND Surgical site infection after abdominal hysterectomy (defined as open and laparoscopic) will be a metric used to rank and penalize hospitals in the Hospital Acquired Condition Reduction program. Hospitals whose Hospital Acquired Condition Reduction score places them in the bottom quartile will lose 1% of reimbursement from the Centers of Medicaid and Medicare Services. OBJECTIVES The objectives of this analysis were to develop a risk adjustment model for surgical site infection after hysterectomy, to calculate adjusted surgical site infection rates, to rank hospitals by the predicted to expected (P/E) ratio, and to compare the number of outlier hospitals with the number in the bottom quartile. STUDY DESIGN This was a retrospective analysis of hysterectomies from the Michigan Surgical Quality Collaborative performed between July 1, 2012, and July 1, 2014. Superficial, deep, and organ space surgical site infections were categorized according to Centers for Disease Control and Prevention criteria. Deep and organ space surgical site infections were considered 1 group for this analysis because these spaces are contiguous after hysterectomy. Hospital rankings focused on deep/organ space events because the Hospital Acquired Condition Reduction program will rank and penalize based on them, not superficial surgical site infection. Hierarchical multivariable logistic regression, which takes into account hospital effects, was used to identify risk factors for all surgical site infections and deep/organ space surgical site infections. Predicted to expected ratios for deep surgical site infection were calculated for each hospital and used to determine hospital rankings. Outliers were defined as those hospitals who predicted to expected confidence intervals crossed the reference line of 1. The number of outlier hospitals was compared with the number in the bottom quartile. RESULTS The overall surgical site infection rate following hysterectomy was 2.1% (351 of 16,548). Deep/organ space surgical site infection accounted for 1.0% (n = 167 of 16,548). Deep surgical site infection was associated independently with younger age, longer surgical times, gynecological cancer, and open hysterectomy. There was a marginal association with blood transfusion. After risk adjustment of rates and ranking by the predicted to expected ratio, there was a change in quartile rank for 42.8% of hospitals (21 of 49). Two hospitals were identified as outliers. However, if the bottom quartile was identified, as called for by the Hospital Acquired Condition Reduction program, 10 additional hospitals would be targeted for a penalty. Hospitals with < 300 beds were most likely to see their quartile rank worsen, whereas those > 500 beds were most likely to see their quartile rank improve (P = .01). CONCLUSION After adjusting for patient-related factors and site variation, more than 40% of hospitals will change quartile rank with respect to deep surgical site infection. Identifying a quartile of hospitals that are statistically different from others was not feasible in our collaborative because only 2 of 12 hospitals were outliers. These findings suggest that under the Hospital Acquired Condition Reduction program, many hospitals will be unjustly penalized.
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Affiliation(s)
- Daniel M Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - Carolyn W Swenson
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Kristin M Streifel
- Department of Obstetrics and Gynecology, St Joseph Mercy Hospital, Ypsilanti, MI
| | - Neil S Kamdar
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Shitanshu Uppal
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | | | - Mark D Pearlman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Dee E Fenner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Tuomi T, Pasanen A, Leminen A, Bützow R, Loukovaara M. Incidence of and risk factors for surgical site infections in women undergoing hysterectomy for endometrial carcinoma. Acta Obstet Gynecol Scand 2016; 95:480-5. [PMID: 26661044 DOI: 10.1111/aogs.12838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to determine the incidence of, and risk factors for, surgical site infections in a contemporary cohort of women with endometrial carcinoma. MATERIAL AND METHODS We retrospectively studied 1164 women treated for endometrial carcinoma by hysterectomy at a single institution in 2007-2013. In all, 912 women (78.4%) had minimally invasive hysterectomy. Data on surgical site infections were collected from medical records. Univariate and multivariate analyses were used to identify risk factors for incisional and organ/space infections. RESULTS Ninety-four women (8.1%) were diagnosed with a surgical site infection. Twenty women (1.7%) had an incisional infection and 74 (6.4%) had an organ/space infection. The associations of 17 clinico-pathologic and surgical variables were tested by univariate analyses. Those variables that were identified as potential risk factors in univariate analyses (p < 0.15) were used in logistic regression models with incisional and organ/space infections as dependent variables. Obesity (body mass index ≥ 30 kg/m(2)), diabetes, and long operative time (>80th centile) were independently associated with a higher risk of incisional infection, whereas minimally invasive surgery was associated with a smaller risk. Smoking, conversion to laparotomy, and lymphadenectomy were associated with a higher risk of organ/space infection. CONCLUSIONS Organ/space infections comprised the majority of surgical site infections. Risk factors for incisional and organ/space infections differed. Minimally invasive hysterectomy was associated with a smaller risk of incisional infections but not of organ/space infections.
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Affiliation(s)
- Taru Tuomi
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annukka Pasanen
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Arto Leminen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ralf Bützow
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Loukovaara
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Colling KP, Glover JK, Statz CA, Geller MA, Beilman GJ. Abdominal Hysterectomy: Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique. Surg Infect (Larchmt) 2015; 16:498-503. [PMID: 26070101 DOI: 10.1089/sur.2014.203] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hysterectomy is one of the most common procedures performed in the United States. New techniques utilizing laparoscopic and robotic technology are becoming increasingly common. It is unknown if these minimally invasive surgical techniques alter the risk of surgical site infections (SSI). METHODS We performed a retrospective review of all patients undergoing abdominal hysterectomy at our institution between January 2011 and June 2013. International Classification of Diseases, Ninth edition (ICD-9) codes and chart review were used to identify patients undergoing hysterectomy by open, laparoscopic, or robotic approach and to identify patients who developed SSI subsequently. Chi-square and analysis of variance (ANOVA) tests were used to identify univariate risk factors and logistic regression was used to perform multivariable analysis. RESULTS During this time period, 986 patients were identified who had undergone abdominal hysterectomy, with 433 receiving open technique (44%), 116 laparoscopic (12%), 407 robotic (41%), and 30 cases that were converted from minimally invasive to open (3%). Patients undergoing laparoscopic-assisted hysterectomy were significantly younger and had lower body mass index (BMI) and American Society of Anesthesiologists (ASA) scores than those undergoing open or robotic hysterectomy. There were no significant differences between patients undergoing open versus robotic hysterectomy. The post-operative hospital stay was significantly longer for open procedures compared with those using laparoscopic or robotic techniques (5.1, 1.7, and 1.6 d, respectively; p<0.0001). The overall rate of SSI after all hysterectomy procedures was 4.2%. More SSI occurred in open cases (6.5%) than laparoscopic (0%) or robotic (2.2%) (p<0.0001). Cases converted to open also had an increased rate of SSI (13.3%). In both univariate and multivariable analyses, open technique, wound class of III/IV, age greater than 75 y, and morbid obesity were all associated with increased risk of SSI. CONCLUSION Laparoscopic and robotic hysterectomies were associated with a significantly lower risk of SSI and shorter hospital stays. Body mass index, advanced age, and wound class were also independent risk factors for SSI.
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Affiliation(s)
- Kristin P Colling
- 1 Department of Surgery, University of Minnesota Medical Center , Minneapolis, Minnesota
| | - James K Glover
- 1 Department of Surgery, University of Minnesota Medical Center , Minneapolis, Minnesota
| | - Catherine A Statz
- 1 Department of Surgery, University of Minnesota Medical Center , Minneapolis, Minnesota
| | - Melissa A Geller
- 2 Department of Obstetrics and Gynecology, University of Minnesota Medical Center , Minneapolis, Minnesota
| | - Greg J Beilman
- 1 Department of Surgery, University of Minnesota Medical Center , Minneapolis, Minnesota
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Curry CS, Smith KA, Allyn JW. Evaluation of anesthetic technique on surgical site infections (SSIs) at a single institution. J Clin Anesth 2014; 26:601-5. [DOI: 10.1016/j.jclinane.2014.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/16/2014] [Accepted: 04/24/2014] [Indexed: 10/24/2022]
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Mouch CA, Regenbogen SE, Revels SL, Wong SL, Lemak CH, Morris AM. The quality of surgical care in safety net hospitals: A systematic review. Surgery 2014; 155:826-38. [DOI: 10.1016/j.surg.2013.12.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/06/2013] [Indexed: 10/25/2022]
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Lake AG, McPencow AM, Dick-Biascoechea MA, Martin DK, Erekson EA. Surgical site infection after hysterectomy. Am J Obstet Gynecol 2013; 209:490.e1-9. [PMID: 23770467 DOI: 10.1016/j.ajog.2013.06.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 05/16/2013] [Accepted: 06/10/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective was to estimate the occurrence of surgical site infections (SSI) after hysterectomy and the associated risk factors. STUDY DESIGN We conducted a cross-sectional analysis of the 2005-2009 American College of Surgeons National Surgical Quality Improvement Program participant use data files to analyze hysterectomies. Different routes of hysterectomy were compared. The primary outcome was to identify the occurrence of 30-day superficial SSI (cellulitis) after hysterectomy. Secondary outcomes were the occurrence of deep and organ-space SSI after hysterectomy. Logistic regression models were conducted to further explore the associations of risks factors with SSI after hysterectomy. RESULTS A total of 13,822 women were included in our final analysis. The occurrence of postoperative cellulitis after hysterectomy was 1.6% (n = 221 women). Risk factors that were associated with cellulitis were route of hysterectomy with an adjusted odds ratio (AOR) of 3.74 (95% confidence interval [CI], 2.26-6.22) for laparotomy compared with the vaginal approach, operative time >75th percentile (AOR, 1.84; 95% CI, 1.40-2.44), American Society of Anesthesia class ≥ 3 (AOR, 1.79; 95% CI, 1.31-2.43), body mass index ≥40 kg/m(2) (AOR, 2.65; 95% CI, 1.85-3.80), and diabetes mellitus (AOR, 1.54; 95% CI, 1.06-2.24) The occurrence of deep and organ-space SSI was 1.1% (n = 154 women) after hysterectomy. CONCLUSION Our finding of the decreased occurrence of superficial SSI after the vaginal approach for hysterectomy reaffirms the role for vaginal hysterectomy as the route of choice for hysterectomy.
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Young H, Knepper B, Vigil C, Miller A, Carey JC, Price CS. Sustained Reduction in Surgical Site Infection after Abdominal Hysterectomy. Surg Infect (Larchmt) 2013; 14:460-3. [DOI: 10.1089/sur.2012.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Heather Young
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado Denver, Denver, Colorado
| | - Bryan Knepper
- Departments of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado
| | - Cathy Vigil
- Departments of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado
| | - Amber Miller
- Departments of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado
| | - J. Chris Carey
- Department of Obstetrics and Gynecology, Denver Health Medical Center and University of Colorado Denver, Denver, Colorado
| | - Connie S. Price
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado Denver, Denver, Colorado
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Savage MW, Pottinger JM, Chiang HY, Yohnke KR, Bowdler NC, Herwaldt LA. Surgical site infections and cellulitis after abdominal hysterectomy. Am J Obstet Gynecol 2013; 209:108.e1-10. [PMID: 23711665 DOI: 10.1016/j.ajog.2013.05.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/14/2013] [Accepted: 05/21/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To identify risk factors for and outcomes of surgical site infections and cellulitis after abdominal hysterectomies. STUDY DESIGN We used logistic regression analysis to analyze data from a case-control study of 1104 patients undergoing abdominal hysterectomies at a university hospital between Jan. 1, 2007 and Dec. 30, 2010. RESULTS Factors significantly associated with surgical site infections and with cellulitis were: pulmonary disease, operations done in Main Operating Room East, and seroma. Body mass index >35, no private insurance, and fluid and electrolyte disorders were risk factors for surgical site infections. The mean prophylactic dose of cefazolin was significantly higher for controls than for patients with surgical site infections. Preoperative showers with Hibiclens (Molnlycke Health Care US, LLC, Norcross, GA) and cefazolin prophylaxis were associated with a significantly decreased cellulitis risk. Surgical site infections and cellulitis were significantly associated with readmissions and return visits and surgical site infections were associated with reoperations. CONCLUSION Preoperative showers, antimicrobial prophylaxis, surgical techniques preventing seromas, and the operating room environment may affect the risk of surgical site infections and cellulitis after abdominal hysterectomies.
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Affiliation(s)
- Mack W Savage
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Khavanin N, Lovecchio FC, Hanwright PJ, Brill E, Milad M, Bilimoria KY, Kim JYS. The influence of BMI on perioperative morbidity following abdominal hysterectomy. Am J Obstet Gynecol 2013; 208:449.e1-6. [PMID: 23453882 DOI: 10.1016/j.ajog.2013.02.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/29/2013] [Accepted: 02/18/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of the study was to assess the impact of body mass index (BMI) on 30 day perioperative morbidity following abdominal hysterectomy. STUDY DESIGN The 2006-2010 National Surgical Quality Improvement Program data registry was retrospectively reviewed for patients undergoing abdominal hysterectomy. Logistic regression was used to investigate the relationship between BMI and postoperative complications. RESULTS A total of 9917 patients were captured, of which, 2219 were of an ideal BMI, 2765 were overweight, and 4933 were obese. Complications occurred in 11.3% of the procedures, with obese patients experiencing significantly higher rates of morbidity compared with overweight and nonobese patients (13.2%, 9.7%, and 9.0%, respectively; P < .001). Surgical complications were rare; however, a significant step-wise progression was observed with increasing BMI (P < .001). The rate of reoperations and overall medical complication did not differ among cohorts, although the incidence of deep vein thromboses (DVTs) was notably elevated in obese and overweight patients (P = .032). Adjusted odds ratios (ORs) found both overweight and obese patients to be at a significantly higher risk of surgical complications (OR, 1.6 and 3.0, respectively) and wound infections (OR, 1.7 and 3.0, respectively). Overweight patients were also at higher risk for DVTs (OR, 4.6) and obese patients for overall morbidity (OR, 1.4) and wound disruption (OR, 3.6). CONCLUSION Obese and overweight patients demonstrated an increased risk for periorperative morbidity following abdominal hysterectomies.
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Affiliation(s)
- Nima Khavanin
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Giri S, Kandel BP, Pant S, Lakhey PJ, Singh YP, Vaidya P. Risk factors for surgical site infections in abdominal surgery: a study in Nepal. Surg Infect (Larchmt) 2013; 14:313-8. [PMID: 23672239 DOI: 10.1089/sur.2012.108] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) remains a major clinical problem for developing countries in terms of morbidity, mortality, and hospital cost. Little is known about the epidemiology of SSI in Nepal. We conducted a study in Nepal to identify the various pre- and intra-operative risk factors for SSIs that are accessible to interventions. METHODS The study was a prospective study done on all eligible patients who underwent abdominal surgery in the surgical wards of Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal, from January 2011 to June 2011. We evaluated some patient-related as well as intra-operative variables that could be risk factors for SSIs. We assessed the association between these risk factors and SSI with the Fisher exact test and logistic regression analysis. RESULTS Of the 230 patients included in the study, 53 were identified as having a SSI, resulting in an overall rate of SSI of 23%. Multivariable analysis identified the following factors as independent risk factors for SSI: (1) Low hemoglobin concentrations (<12 g/dL) (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.1-6.1); (2) overweight (OR 7.6; 95% CI 2.1-27.0); and (3) surgery performed by residents (OR 3.4; 95% CI 1.4-8.3). CONCLUSIONS Surgical site infection is common among patients undergoing abdominal surgery at TUTH. This study identified some preventable risk factors associated with SSI at TUTH. Identification of such risk factors is expected to help surgeons improve patient care and decrease mortality and morbidity as well as the hospital-care cost of surgical patients.
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Affiliation(s)
- Smith Giri
- Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31827525d3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt) 2012; 13:234-7. [PMID: 22913334 DOI: 10.1089/sur.2012.131] [Citation(s) in RCA: 152] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is unequivocally morbid and costly. The estimated 300,000 SSIs annually in the United States represent the second most common infection among surgical patients, prolong hospitalization by 7-10 days, and have an estimated annual incremental cost of $1 billion. The mortality rate associated with SSI is 3%, with about three quarters of deaths being attributable directly to the infection. Prevention is possible for the most part, and concerted effort has been made to limit these infections, arguably to little effect. METHODS Review of pertinent English-language literature. RESULTS Numerous risk factors for SSI and tactics for prevention have been described, but efforts to bundle these tactics into an effective, comprehensive prevention program have been disappointing. Numerous studies now demonstrate that the Surgical Care Improvement Program (SCIP), which focused on process improvement rather than outcomes, has been ineffective despite governmental support, financial penalties for non-compliance, and consequent widespread implementation. CONCLUSION Required reporting has increased awareness of the problem of SSI, but just as the complexity of SSI risk, pathogenesis, and preventions reflects the complexity of the disease, many other factors must be taken into account, including the skill and knowledge of the surgical team and promulgation of a culture of quality and safety in surgical patient care.
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Affiliation(s)
- Samir S Awad
- Section of Surgical Critical Care, Baylor College of Medicine, and Department of Surgery and Surgical Intensive Care Unit, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 77030, USA.
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Uysal A, Taner CE, Mun S, Aydemir S. Prevention of infectious morbidity after elective abdominal hysterectomy. Arch Gynecol Obstet 2012; 286:959-63. [DOI: 10.1007/s00404-012-2382-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 05/08/2012] [Indexed: 11/29/2022]
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Spratt D, Dutton RP, Dellinger EP, Bird B, Guglielmi CL, Farber M, Groah L. The Role of the Health Care Professions in Preventing Surgical Site Infection. AORN J 2012. [DOI: 10.1016/j.aorn.2012.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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