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Shao H, Wang X, Feng L. Construction and validation of nomogram to predict surgical site infection after hysterectomy: a retrospective study. Sci Rep 2024; 14:20538. [PMID: 39232052 PMCID: PMC11375043 DOI: 10.1038/s41598-024-71592-z] [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: 12/25/2023] [Accepted: 08/29/2024] [Indexed: 09/06/2024] Open
Abstract
This study aimed to develop a predictive tool for surgical site infections (SSI) following hysterectomy and propose strategies for their prevention and control. We conducted a retrospective analysis at a tertiary maternity and child specialist hospital in Zhejiang Province, focusing on patients who underwent hysterectomy between January 2018 and December 2023 for gynecological malignancies or benign reproductive system diseases resistant to medical treatment. Risk factors associated with surgical site infections (SSI) following hysterectomy were identified using LASSO regression analysis on data from 2018 to 2022 as the training set. Independent risk factors were then used to develop a nomogram. The model was validated using data from 2023 as the validation set. Model performance was assessed using the area under the receiver operating characteristic curve (ROC), while calibration curves were employed to gauge model accuracy. Furthermore, clinical utility was evaluated through clinical decision curve analysis (DCA) and clinical impact curve analysis (CIC), providing insights into the practical application of the nomogram. Multivariate analysis identified six independent risk factors associated with SSI development after hysterectomy: BMI ≥ 24 kg/m2 (OR: 2.58; 95% CI 1.14-6.19; P < 0.05), hypoproteinaemia diagnosis (OR: 4.99; 95% CI 1.95-13.02; P < 0.05), postoperative antibiotic use for ≥ 3 days (OR: 49.53; 95% CI 9.73-91.01; P < 0.05), history of previous abdominal surgery (OR: 7.46; 95% CI 2.93-20.01; P < 0.05), hospital stay ≥ 10 days (OR: 9.67; 95% CI 2.06-76.46; P < 0.05), and malignant pathological type (OR: 4.62; 95% CI 1.78-12.76; P < 0.05). A nomogram model was constructed using these variables. ROC and calibration curves demonstrated good model calibration and discrimination in both training and validation sets. Analysis with DCA and CIC confirmed the clinical utility of the nomogram. Personalized nomogram mapping for SSI after hysterectomy enables early identification of high-risk patients, facilitating timely interventions to reduce SSI incidence post-surgery.
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Affiliation(s)
- Hui Shao
- Department of Infectology, Shaoxing Maternity and ChildHealth Care Hospital, Shaoxing, China
| | - Xiujuan Wang
- Department of Infectology, Shaoxing Maternity and ChildHealth Care Hospital, Shaoxing, China
| | - Lili Feng
- Department of Anesthesiology, Shaoxing Maternity and ChildHealth Care Hospital, Shaoxing, China.
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De Nagy J, Youssef Y, Moawad G. Strategies and factors to maximize cost-effectiveness of robotic surgery in benign gynecological disease. Best Pract Res Clin Obstet Gynaecol 2023; 90:102380. [PMID: 37481892 DOI: 10.1016/j.bpobgyn.2023.102380] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/05/2023] [Accepted: 06/24/2023] [Indexed: 07/25/2023]
Abstract
Operating room procedures account for half of the gross hospital cost in the United States per annum. Hysterectomy is the eighth most common surgery nationally, with more than 300,000 cases every year. Since the introduction of robotic surgery in benign gynecology, concern has been raised regarding the increased cost without significant improvements in outcomes or practice. Surgeon volume, complication rates, length of hospital stay, and selected intraoperative instrumentation are all factors that have a direct effect on cost in robotic surgery. Cost is indirectly influenced by the OR team workflow, postoperative processes to expedite discharge, and converting surgery to the ambulatory setting. More research is needed to develop evidence-based practices for cost containment in robotic surgery.
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Affiliation(s)
- Joseph De Nagy
- Department of Obstetrics and Gynecology, Adventist Health White Memorial, Loma Linda University, Los Angeles, Loma Linda, CA, USA
| | - Youssef Youssef
- Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University College of Human Medicine, Flint, MI, USA
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC, USA.
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Laurence Yehouenou C, Bogaerts B, Vanneste K, De Keersmaecker SCJ, Roosens NHC, Kpangon AA, Affolabi D, Simon A, Dossou FM, Dalleur O. Whole-Genome Sequencing-Based Screening of MRSA in Patients and Healthcare Workers in Public Hospitals in Benin. Microorganisms 2023; 11:1954. [PMID: 37630513 PMCID: PMC10459514 DOI: 10.3390/microorganisms11081954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 08/27/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) constitutes a serious public health concern, with a considerable impact on patients' health, and substantial healthcare costs. In this study, patients and healthcare workers (HCWs) from six public hospitals in Benin were screened for MRSA. Strains were identified as MRSA using conventional microbiological methods in Benin, and confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in Belgium. Whole-genome sequencing (WGS) was used on the confirmed MRSA isolates, to characterize their genomic content and study their relatedness. Amongst the 305 isolates (304 wound swabs and 61 nasal swabs) that were collected from patients and HCWs, we detected 32 and 15 cases of MRSA, respectively. From this collection, 27 high-quality WGS datasets were obtained, which carried numerous genes and mutations associated with antimicrobial resistance. The mecA gene was detected in all the sequenced isolates. These isolates were assigned to five sequence types (STs), with ST8 (55.56%, n = 15/27), ST152 (18.52%, n = 5/27), and ST121 (18.52%, n = 5/27) being the most common. These 27 isolates carried multiple virulence genes, including the genes encoding the Panton-Valentine leukocidin toxin (48.15%, n = 13/27), and the tst gene (29.63%, n = 8/27), associated with toxic shock syndrome. This study highlights the need to implement a multimodal strategy for reducing the risk of the cross-transmission of MRSA in hospitals.
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Affiliation(s)
- Carine Laurence Yehouenou
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain UCLouvain, Avenue Mounier 73, 1200 Brussels, Belgium;
- Laboratoire de Référence des Mycobactéries (LRM), Cotonou BP 817, Benin;
- Faculté des Sciences de la Santé (FSS), Université d’Abomey Calavi (UAC), Cotonou 01 BP 188, Benin
| | - Bert Bogaerts
- Transversal Activities in Applied Genomics, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium; (B.B.); (K.V.); (S.C.J.D.K.); (N.H.C.R.)
| | - Kevin Vanneste
- Transversal Activities in Applied Genomics, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium; (B.B.); (K.V.); (S.C.J.D.K.); (N.H.C.R.)
| | - Sigrid C. J. De Keersmaecker
- Transversal Activities in Applied Genomics, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium; (B.B.); (K.V.); (S.C.J.D.K.); (N.H.C.R.)
| | - Nancy H. C. Roosens
- Transversal Activities in Applied Genomics, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium; (B.B.); (K.V.); (S.C.J.D.K.); (N.H.C.R.)
| | - Arsène A. Kpangon
- Ecole Nationale des Techniciens Supérieurs en Santé Publique et Surveillance Épidémiologique, Université de Parakou, Parakou, Benin;
| | - Dissou Affolabi
- Laboratoire de Référence des Mycobactéries (LRM), Cotonou BP 817, Benin;
- Faculté des Sciences de la Santé (FSS), Université d’Abomey Calavi (UAC), Cotonou 01 BP 188, Benin
- Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM), Cotonou BP 386, Benin
| | - Anne Simon
- Centres Hospitaliers Jolimont, Prévention et Contrôle des Infections, Groupe Jolimont Asbl, Rue Ferrer 159, 7100 Haine-Saint-Paul, Belgium;
| | - Francis Moise Dossou
- Department of Surgery and Surgical Specialties, Faculty of Health Sciences, Campus Universitaire, Champs de Foire, Cotonou 01 BP 118, Benin;
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain UCLouvain, Avenue Mounier 73, 1200 Brussels, Belgium;
- Pharmacy, Clinique Universitaire Saint-Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200 Brussels, Belgium
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Tserenpuntsag B, Haley V, Ann Hazamy P, Eramo A, Knab R, Tsivitis M, Clement EJ. Risk factors for surgical site infection after abdominal hysterectomy, New York State, 2015-2018. Am J Infect Control 2023; 51:539-543. [PMID: 37003562 DOI: 10.1016/j.ajic.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To identify risk factors for surgical site infections (SSIs) after abdominal hysterectomy (HYST) procedures using National Healthcare Safety Network (NHSN) data augmented with diagnosis codes available using administrative data. METHODS We analyzed 66,001 HYST procedures in 166 New York State hospitals between January 2015 and December 2018, reported in NHSN, and matched to billing data. Risks factors for SSI after abdominal hysterectomy were identified using logistic regression models. RESULTS A total of 66,001 HYST procedures were analyzed. SSI was reported following 1,093 procedures, resulting in an infection rate of 1.66%. Risk factors associated with SSIs were open approach (not laparoscopic) with an adjusted odds ratio (AOR) of 2.72 and 95% confidence interval (CI) of 2.37-3.12, contaminated or dirty wound class (AOR 2.28, 95% CI 1.61-3.24), body mass index ≥30 (AOR 1.78, 95% CI 1.56-2.02), procedures lasting 186 minutes or more (AOR 1.78, 95% CI 1.56-2.02), American Society of Anesthesia (ASA) score ≥3 (AOR 1.74, 95% CI 1.52-1.99), gynecological cancer (AOR 1.54, 95% CI 1.32-1.80), and diabetes mellitus (AOR 1.46, 95% CI 1.24-1.70). CONCLUSION Obesity, prolonged procedure duration, diabetes mellitus, wound contamination, open approach, ASA score ≥3, and gynecological cancer were significant independent risk factors associated with SSI after hysterectomy.
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Affiliation(s)
| | - Valerie Haley
- New York State Hospital Acquired Infection Reporting Program, New York State Department of Health
| | - Peggy Ann Hazamy
- New York State Hospital Acquired Infection Reporting Program, New York State Department of Health
| | - Antonella Eramo
- New York State Hospital Acquired Infection Reporting Program, New York State Department of Health
| | - Robin Knab
- New York State Hospital Acquired Infection Reporting Program, New York State Department of Health
| | - Marie Tsivitis
- New York State Hospital Acquired Infection Reporting Program, New York State Department of Health
| | - Ernest J Clement
- Bureau of Healthcare Associated Infections, New York State Department of Health
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Chaiken SR, Bohn JA, Bruegl AS, Caughey AB, Munro EG. Hysterectomy with a General Gynecologist vs. Gynecologic Oncologist in the Setting of Endometrial Intraepithelial Neoplasia: A Cost-Effectiveness Analysis. Am J Obstet Gynecol 2022; 227:609.e1-609.e8. [PMID: 35662547 DOI: 10.1016/j.ajog.2022.05.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Standard treatment for patients with endometrial intraepithelial neoplasia (EIN) is a hysterectomy, which has a 43% risk of concomitant endometrial cancer on final pathology. General gynecologists and gynecologic oncologists perform hysterectomies; however, patients who have a hysterectomy for EIN with a general gynecologist and are found to have cancer may require a second surgery by a gynecologic oncologist to complete staging. There is current ongoing discussion regarding whether patients with EIN should be provided the option to receive the initial hysterectomy with a gynecologic oncologist. OBJECTIVE To better understand if patients with EIN should be initially referred to a gynecologic oncologist for treatment, we examined the cost-effectiveness of hysterectomy by general gynecologists versus gynecologic oncologists for patients with EIN. STUDY DESIGN We created a decision-analytic model using TreeAge Pro software to compare outcomes between patients with EIN undergoing hysterectomy by a general gynecologist versus a gynecologic oncologist. Our theoretical cohort contained 200,000 patients, an estimate of the number of individuals diagnosed with EIN each year in the United States. Outcomes included costs, quality-adjusted life years (QALYs), primary lymph node dissection (LND), secondary LND, surgical site infection, and perioperative mortality. We assumed that surgical morbidity and mortality were the same under generalist and specialist care and applied costs of travel and lost work for those seeing a gynecologic oncologist. We performed univariable sensitivity analyses as well as multivariable probabilistic sensitivity analysis to assess the model's robustness given the uncertainty of model inputs. RESULTS In our theoretical cohort of 200,000 patients with EIN, hysterectomy with a gynecologic oncologist was associated with a decrease in 10,811 second surgeries for LND, 87 surgical site infections, and 9 perioperative mortalities. When hysterectomy was performed by a general gynecologist, 9 fewer patients had a LND due to perioperative mortalities that occurred prior to LND with a gynecologic oncologist. Hysterectomy with a gynecologic oncologist was the dominant, cost-effective strategy as it saved $116 million and increased QALYs by 180. In our univariable analyses, hysterectomy with a gynecologic oncologist was cost-saving and increased QALYs over a wide range of probabilities and costs for LND, surgical site infection, and perioperative mortality. However, hysterectomy with a gynecologic oncologist is only a cost-effective and cost-saving saving strategy in just over 50% of multivariable simulations, demonstrating that that there is significant uncertainty in the model's cost-effectiveness. CONCLUSIONS In our model, hysterectomy with a gynecologic oncologist for patients with EIN was associated with cost savings and increased QALYs. Our study supports that patients undergoing hysterectomy for EIN at institutions using Mayo criteria to determine need for lymphadenectomy may benefit from surgery with a gynecologic oncologist rather than a general gynecologist to reduce costs and adverse events associated with a second surgery.
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Bohn JA, Hernandez-Zepeda ML, Hersh AR, Munro EG, Kahn JM, Caughey AB, Bruegl A. Does obesity influence the preferred treatment approach for early-stage cervical cancer? A cost-effectiveness analysis. Int J Gynecol Cancer 2021; 32:133-140. [PMID: 34887286 DOI: 10.1136/ijgc-2021-003004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Abdominal radical hysterectomy in early-stage cervical cancer has higher rates of disease-free and overall survival compared with minimally invasive radical hysterectomy. Abdominal radical hysterectomy may be technically challenging at higher body mass index levels resulting in poorer surgical outcomes. This study sought to examine the influence of body mass index on outcomes and cost effectiveness between different treatments for early-stage cervical cancer. METHODS A Markov decision-analytic model was designed using TreeAge Pro software to compare the outcomes and costs of primary chemoradiation versus surgery in women with early-stage cervical cancer. The study used a theoretical cohort of 6000 women who were treated with abdominal radical hysterectomy, minimally invasive radical hysterectomy, or primary chemoradiation therapy. We compared the results for three body mass index groups: less than 30 kg/m2, 30-39.9 kg/m2, and 40 kg/m2 or higher. Model inputs were derived from the literature. Outcomes included complications, recurrence, death, costs, and quality-adjusted life years. An incremental cost-effectiveness ratio of less than $100 000 per quality-adjusted life year was used as our willingness-to-pay threshold. Sensitivity analyses were performed broadly to determine the robustness of the results. RESULTS Comparing abdominal radical hysterectomy with minimally invasive radical hysterectomy, abdominal radical hysterectomy was associated with 526 fewer recurrences and 382 fewer deaths compared with minimally invasive radical hysterectomy; however, abdominal radical hysterectomy resulted in more complications for each body mass index category. When the body mass index was 40 kg/m2 or higher, abdominal radical hysterectomy became the dominant strategy because it led to better outcomes with lower costs than minimally invasive radical hysterectomy. Comparing abdominal radical hysterectomy with primary chemoradiation therapy, recurrence rates were similar, with more deaths associated with surgery across each body mass index category. Chemoradiation therapy became cost effective when the body mass index was 40 kg/m2 or higher. CONCLUSION When the body mass index is 40 kg/m2 or higher, abdominal radical hysterectomy is cost saving compared with minimally invasive radical hysterectomy and primary chemoradiation is cost effective compared with abdominal radical hysterectomy. Primary chemoradiation may be the optimal management strategy at higher body mass indexes.
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Affiliation(s)
- Jacqueline A Bohn
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
| | | | - Alyssa R Hersh
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Elizabeth G Munro
- Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jenna M Kahn
- Department of Radiation Oncology, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Amanda Bruegl
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
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Evaluation of the costing methodology of published studies estimating costs of surgical site infections: A systematic review. Infect Control Hosp Epidemiol 2021; 43:898-914. [PMID: 34551830 DOI: 10.1017/ice.2021.381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Surgical site infections (SSIs) are associated with increased length of hospitalization and costs. Epidemiologists and infection control practitioners, who are in charge of implementing infection control measures, have to assess the quality and relevance of the published SSI cost estimates before using them to support their decisions. In this review, we aimed to determine the distribution and trend of analytical methodologies used to estimate cost of SSIs, to evaluate the quality of costing methods and the transparency of cost estimates, and to assess whether researchers were more inclined to use transferable studies. METHODS We searched MEDLINE to identify published studies that estimated costs of SSIs from 2007 to March 2021, determined the analytical methodologies, and evaluated transferability of studies based on 2 evaluation axes. We compared the number of citations by transferability axes. RESULTS We included 70 studies in our review. Matching and regression analysis represented 83% of analytical methodologies used without change over time. Most studies adopted a hospital perspective, included inpatient costs, and excluded postdischarge costs (borne by patients, caregivers, and community health services). Few studies had high transferability. Studies with high transferability levels were more likely to be cited. CONCLUSIONS Most of the studies used methodologies that control for confounding factors to minimize bias. After the article by Fukuda et al, there was no significant improvement in the transferability of published studies; however, transferable studies became more likely to be cited, indicating increased awareness about fundamentals in costing methodologies.
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Poliquin V, Singh PK, Leylek M, Dean E, Liu M, Altman AD. The Risk of Postoperative Infectious Complications Following Massive Intraoperative Blood Loss During Gynaecologic Laparotomy: Retrospective Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:19-25. [PMID: 33153939 DOI: 10.1016/j.jogc.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine whether massive intraoperative blood loss (MIBL) was independently associated with postoperative infectious complications after gynaecologic laparotomy. METHODS We conducted a retrospective cohort study of patients undergoing gynaecologic laparotomy who were exposed or not exposed to MIBL. The outcome of interest was composite postoperative febrile morbidity. Multiple logistic regression was used to determine the association between exposure and outcome while controlling for measured covariates. RESULTS The primary outcome was identified to have occurred in 48% (144 of 298) of surgeries with MIBL compared with 12% (51 of 413) of surgeries without MIBL (P < 0.0001). MIBL was found to be strongly and independently associated with primary outcome (adjusted odds ratio 7.04; 95% confidence interval 4.62-10.74; P < 0.0001) after adjusting for age, body mass index, diabetes, immunosuppression, type of procedure, incision type, drains left in situ, and bowel complications. CONCLUSION MIBL is strongly and independently associated with postoperative febrile morbidity after gynaecologic laparotomy.
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Affiliation(s)
- Vanessa Poliquin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Prabjot K Singh
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - Melike Leylek
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Erin Dean
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Michelle Liu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Alon D Altman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB.
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van Niekerk JM, Vos MC, Stein A, Braakman-Jansen LMA, Voor in ‘t holt AF, van Gemert-Pijnen JEWC. Risk factors for surgical site infections using a data-driven approach. PLoS One 2020; 15:e0240995. [PMID: 33112893 PMCID: PMC7592760 DOI: 10.1371/journal.pone.0240995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Objective The objective of this study was to identify risk factors for surgical site infection from digestive, thoracic and orthopaedic system surgeries using clinical and data-driven cut-off values. A second objective was to compare the identified risk factors in this study to risk factors identified in literature. Summary background data Retrospective data of 3 250 surgical procedures performed in large tertiary care hospital in The Netherlands during January 2013 to June 2014 were used. Methods Potential risk factors were identified using a literature scan and univariate analysis. A multivariate forward-step logistic regression model was used to identify risk factors. Standard medical cut-off values were compared with cut-offs determined from the data. Results For digestive, orthopaedic and thoracic system surgical procedures, the risk factors identified were preoperative temperature of ≥38°C and antibiotics used at the time of surgery. C-reactive protein and the duration of the surgery were identified as a risk factors for digestive surgical procedures. Being an adult (age ≥18) was identified as a protective effect for thoracic surgical procedures. Data-driven cut-off values were identified for temperature, age and CRP which can explain the SSI outcome up to 19.5% better than generic cut-off values. Conclusions This study identified risk factors for digestive, orthopaedic and thoracic system surgical procedures and illustrated how data-driven cut-offs can add value in the process. Future studies should investigate if data-driven cut-offs can add value to explain the outcome being modelled and not solely rely on standard medical cut-off values to identify risk factors.
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Affiliation(s)
- J. M. van Niekerk
- Department of Psychology, Health and Technology/Centre for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands
- Department of Earth Observation Sciences, Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - M. C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - A. Stein
- Department of Earth Observation Sciences, Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
| | - L. M. A. Braakman-Jansen
- Department of Psychology, Health and Technology/Centre for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands
- * E-mail:
| | - A. F. Voor in ‘t holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - J. E. W. C. van Gemert-Pijnen
- Department of Psychology, Health and Technology/Centre for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands
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Brennfleck FW, Bachmeier T, Simet W, Zeman F, Junger HHG, Schlitt HJ, Dahlke MH, Brunner SM. Surgical Site Infections and their economic significance in hepatopancreatobiliary surgery: A retrospective incidence, cost, and reimbursement analysis in a German centre of the highest level of care. Int Wound J 2020; 18:17-23. [PMID: 33006236 PMCID: PMC7948679 DOI: 10.1111/iwj.13511] [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: 07/28/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022] Open
Abstract
Surgical site infections (SSI) in open Hepatopancreatobiliary (HPB) surgery are common complications. They worsen patients’ outcomes and prolong hospital stays. Their economic significance in the German diagnosis related groups (DRG) system is mostly unknown. To investigate their economic importance, we evaluated all cases for SSIs as well as clinical and financial parameters undergoing surgery in our centre from 2015 and 2016. Subsequently, we carried out a cost‐revenue calculation by assessing our billing data and the cost matrix of the InEK (German Institute for the Payment System in Hospitals). A total of 13.5% of the patients developed a superficial, 9% a deep incisional, and 2.4% of the patients an organ space SSI. Compared with Patients without SSI, Patients with SSI had more comorbidities, were older, and their average length of stay was extended by 19 days (P < .001). The financial loss per SSI‐case was €‐7035.65 despite increased reimbursement, which resulted in a calculated total loss for the hospital of €‐802 064.62 in 2015 and 2016. Surgical site infections are common complications of open HPB surgery, which lead to a significant increase in the cost per case. Further prevention strategies need to be developed. Besides, an adjustment of revenues must be demanded.
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Affiliation(s)
| | - Tanja Bachmeier
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wolfgang Simet
- Financial Department, University Medical Center Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | | | - Hans Jürgen Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Marc-Hendrik Dahlke
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany.,Department of Surgery, Robert-Bosch-Klinikum, Stuttgart, Germany
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Brown O, Geynisman-Tan J, Gillingham A, Collins S, Lewicky-Gaupp C, Kenton K, Mueller M. Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2020; 27:1370-1376.e1. [DOI: 10.1016/j.jmig.2019.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/30/2022]
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12
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Guo XM, Runge M, Miller D, Aaby D, Milad M. A bundled intervention lowers surgical site infection in hysterectomy for benign and malignant indications. Int J Gynaecol Obstet 2020; 150:392-397. [DOI: 10.1002/ijgo.13257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/22/2020] [Accepted: 06/01/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Xiaoyue Mona Guo
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Megan Runge
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Deborah Miller
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - David Aaby
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Magdy Milad
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
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13
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Gil-Conesa M, Del-Moral-Luque JA, Climent-Martínez N, Delgado-Iribarren A, Riera-Pérez R, Martín-Caballero C, Campello-Gutiérrez C, Durán-Poveda M, Rodríguez-Caravaca G, Gil-de-Miguel A, Rodríguez-Villar D. [Evaluation of compliance with the antibiotic prophylaxis protocol in hysterectomy. Prospective cohort study]. REVISTA ESPANOLA DE QUIMIOTERAPIA 2020; 33:180-186. [PMID: 32232318 PMCID: PMC7262387 DOI: 10.37201/req/098.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objetivo Las infecciones relacionadas con la asistencia sanitaria (IRAS) son un problema de salud pública, siendo las infecciones de localización quirúrgica (ILQ) las más frecuentes a nivel hospitalario. El objetivo de este estudio fue evaluar el efecto de la adecuación de la profilaxis antibiótica en la incidencia de infección quirúrgica en pacientes histerectomizadas. Material y métodos Se realizó un estudio de cohortes prospectivo entre octubre de 2009 y diciembre de 2018. Se estudió la incidencia de ILQ durante los primeros 30 días tras la cirugía. Se evaluó el grado de adecuación de la profilaxis antibiótica en histerectomía y el efecto de su inadecuación en la incidencia de infección con el riesgo relativo (RR) ajustado mediante un modelo de regresión logística. Resultados Se estudiaron 1.025 intervenciones en 1.022 mujeres. La incidencia acumulada de ILQ fue del 2,1% (n=22) y la etiología más frecuente Escherichia coli (23,1%) y Proteus mirabilis (23,1%). La profilaxis antibiótica estaba indicada en 1.014 intervenciones (98,9%) administrándose en 1.009 de ellas (99,5%), con una adecuación general al protocolo del 92,5%. La causa principal de no cumplimiento fue el tiempo de inicio (40,9%), seguida por la elección del antibiótico (35,2%). El efecto de la inadecuación de la profilaxis sobre la incidencia de infección fue de RR=0,9; IC95% 0,2-3,9; p>0,05. Conclusiones La adecuación de la profilaxis antibiótica fue muy alta, con una baja incidencia de infección quirúrgica. No se encontró asociación entre adecuación de la profilaxis e incidencia de infección en histerectomía. Se debe insistir en la mejora continua de la vigilancia epidemiológica en ginecología.
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Affiliation(s)
| | | | | | | | | | | | | | | | - G Rodríguez-Caravaca
- Gil Rodríguez-Caravaca, Unidad de Medicina Preventiva, Hospital Universitario Fundación Alcorcón C/ Budapest 1, 28922 Alcorcón (Madrid). Spain.
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14
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Rastogi S, Glaser L, Friedman J, Carter IV, Milad MP. Tolerance of Chlorhexidine Gluconate Vaginal Cleansing Solution: A Randomized Controlled Trial. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Supriya Rastogi
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Laura Glaser
- Department of Obstetrics and Gynecology, Northwestern Prentice Women's Hospital, Chicago, IL
| | - Jaclyn Friedman
- Department of Obstetrics and Gynecology, Northwestern Prentice Women's Hospital, Chicago, IL
| | - Isabelle V. Carter
- Department of Obstetrics and Gynecology, Northwestern Prentice Women's Hospital, Chicago, IL
| | - Magdy P. Milad
- Department of Obstetrics and Gynecology, Northwestern Prentice Women's Hospital, Chicago, IL
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15
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Dave A, Yi J, Boothe A, Brashear H, Byrne J, Gad Y. Listening to the HysterSisters: A Retrospective Keyword Frequency Analysis of Conversations About Hysterectomy Recovery. JMIR Perioper Med 2019; 2:e10728. [PMID: 33393919 PMCID: PMC7735658 DOI: 10.2196/10728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 01/23/2019] [Accepted: 07/28/2019] [Indexed: 11/13/2022] Open
Abstract
Background In the postoperative period, individual patient experiences vary widely and are based on a diverse set of input variables influenced by all stakeholders in and throughout the surgical process. Although clinical research has primarily focused on clinical and administrative datasets to characterize the postoperative recovery experience, there is increasing interest in patient-reported outcome measures (PROMs). The growth of online communities in which patients themselves participate provides a venue to study PROMs directly. One such forum-based community is HysterSisters, dedicated to helping individuals through the experience of hysterectomy, a major surgery which removes the uterus. The surgery can be performed by a variety of methods such as minimally invasive approaches or the traditional abdominal approach using a larger incision. The community offers support for “medical and emotional issues [...] from diagnosis, to treatment, to recovery.” Users can specify when and what type of hysterectomy they underwent. They can discuss their shared experience of hysterectomy and provide, among other interactions, feedback, reassurance, sympathy, or advice, thus providing a unique view into conversations surrounding the hysterectomy experience. Objective We aimed to characterize conversations about hysterectomy recovery as experienced by users of the HysterSisters online community. Methods A retrospective keyword frequency analysis of the HysterSisters Hysterectomy Recovery forum was performed. Results Within the Hysterectomy Recovery forum, 33,311 unique users declared their hysterectomy date and type and posted during the first 12 weeks postsurgery. A taxonomy of 8 primary symptom groups was created using a seed list of keywords generated from a term frequency analysis of these threads. Pain and bleeding were the two most mentioned symptom groups and account for almost half of all symptom mentions (19,965/40,127). For symptoms categories such as pain and hormones and emotions, there was no difference in the proportion of users mentioning related keywords, regardless of the type of hysterectomy, whereas bleeding-related or intimacy-related keywords were mentioned more frequently by users undergoing certain minimally invasive approaches when compared with those undergoing abdominal hysterectomy. Temporal patterns in symptom mentions were noted as well. The majority of all posting activity occurred in the first 3 weeks. Across all keyword groups, individuals reporting minimally invasive procedures ceased forum use of these keywords significantly earlier than those reporting abdominal hysterectomy. Peaks in conversation volume surrounding particular symptom categories were also identified at 1, 3, and 6 weeks postoperatively. Conclusions The HysterSisters Hysterectomy Recovery forum and other such forums centered on users’ health care experience can provide novel actionable insights that can improve patient-centered care during the postoperative period. This study adds another dimension to the utility of social media analytics by demonstrating that measurement of post volumes and distribution of symptom mentions over time reveal key opportunities for beneficial symptom-specific patient engagement.
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Affiliation(s)
- Arpit Dave
- Mayo Clinic Arizona, Department of Gynecology, Phoenix, AZ, United States
| | - Johnny Yi
- Mayo Clinic Arizona, Department of Gynecology, Phoenix, AZ, United States
| | | | | | | | - Yash Gad
- W2O Group, Austin, TX, United States
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16
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Monsour MA, Wiley W, Le CH, Lee J, Brown KP, Robinson M, Elsamadicy EA. Infectious Causes of 30-Day Unplanned Hospital Encounters and Readmissions After Hysterectomies: A Single Institutional Study. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Meredith A. Monsour
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Whittney Wiley
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Chi H. Le
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Jaclyn Lee
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Kelsei P. Brown
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Marc Robinson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Emad A. Elsamadicy
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
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17
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Nguyen JMV, Sadeghi M, Gien LT, Covens A, Kupets R, Nathens AB, Vicus D. Impact of a preventive bundle to reduce surgical site infections in gynecologic oncology. Gynecol Oncol 2019; 152:480-485. [DOI: 10.1016/j.ygyno.2018.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/12/2018] [Accepted: 09/06/2018] [Indexed: 12/13/2022]
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Cefazolin as surgical antimicrobial prophylaxis in hysterectomy: A systematic review and meta-analysis of randomized controlled trials. Infect Control Hosp Epidemiol 2018; 40:142-149. [PMID: 30516122 DOI: 10.1017/ice.2018.286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Current practice guidelines recommend cefazolin, cefoxitin, cefotetan, or ampicillin-sulbactam as first-line antibiotic prophylaxis in hysterectomy. We undertook this systematic review and meta-analysis of randomized controlled trials (RCTs) to determine whether cefazolin, with limited antianaerobic spectrum, is as effective in preventing surgical site-infection (SSI) as the other first-choice antimicrobials that have more extensive antianaerobic activity. METHODS We searched PubMed, Scopus, Web of Science, Cochrane Central, and EMBASE for relevant randomized controlled trials (RCT) in any language up to January 23, 2018. We only included trials that measured SSI (our primary outcome) defined as superficial, deep, or organ space. We excluded trials of β-lactams no longer in clinical use. RESULTS In terms of SSI incidence, cefazolin use was not inferior to its comparator in 12 of 13 individual RCTs included in the analysis. The meta-analysis summary estimate showed a significantly higher SSI risk with cefazolin versus cefoxitin or cefotetan (risk ratio, 1.7; 95% CI, 1.04-2.77; P = .03). However, most studies included nonstandardized dosing and duration of antimicrobial prophylaxis, had indeterminate or high risk of bias, did not include patients with gynecological malignancies, and/or were older RCTs not reflective of current clinical practices. CONCLUSION Due to inherent limitations associated with old RCTs with limited relevance to contemporary surgery, an RCT of cefazolin versus regimens with significant antianaerobic spectrum is needed to establish the optimal choice for SSI prevention in hysterectomy.
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19
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Type of Pelvic Disease as a Risk Factor for Surgical Site Infectionin Women Undergoing Hysterectomy. J Minim Invasive Gynecol 2018; 26:1149-1156. [PMID: 30508651 DOI: 10.1016/j.jmig.2018.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 02/01/2023]
Abstract
STUDY OBJECTIVE To quantify the relationship between type of benign pelvic disease and risk of surgical site infection (SSI) after hysterectomy. DESIGN Retrospective cohort study (Canadian Task Force classification II-2). SETTING Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). PATIENTS Women who underwent hysterectomy from 2006-2015 and recorded in NSQIP database. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS SSI risk was compared for type of benign pelvic disease, patient characteristics (i.e., age, race, and selected comorbidities) and process of care variables (i.e., admission status, type of hysterectomy, and operative time). SSI occurred in 2.48% of the 125,337 women who underwent hysterectomy. SSI was most frequent in patients with endometriosis and least frequent in those with genital prolapse (3.13% vs 1.39%; p <.0001). Following adjustment for potential confounders, the odds of SSI were higher in women undergoing hysterectomy for endometriosis (adjusted odds ratio [aOR], 1.79; 95% confidence interval [CI], 1.43- 2.25), uterine myomas (aOR, 1.28; 95% CI, 1.05-1.55), menstrual disorders (aOR, 1.46; 95% CI, 1.20-1.78), and pelvic pain (aOR, 1.75; 95% CI, 1.34-2.27) compared with women undergoing hysterectomy for genital prolapse. Other patient factors associated with SSI included age, body mass index, smoking, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and American Society of Anesthesiologists classification. Among process-of-care factors, inpatient status, route of hysterectomy, total vs subtotal hysterectomy, and operative time were also associated with SSI. CONCLUSION In addition to various patient and process-of-care factors known to be associated with SSI, type of underlying pelvic disease is an independent risk factor for SSI in women undergoing hysterectomy for benign indications.
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20
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Toba M, Moriwaki M, Oshima N, Aiso Y, Shima M, Nukui Y, Obayashi S, Fushimi K. Prevention of surgical site infection via antibiotic administration according to guidelines after gynecological surgery. J Obstet Gynaecol Res 2018; 44:1800-1807. [PMID: 30051538 DOI: 10.1111/jog.13714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/25/2018] [Indexed: 12/13/2022]
Abstract
AIM We modified the antimicrobial prophylaxis of surgical site infection (SSI) according to the guidelines of the Japanese Society of Chemotherapy and Japan Society of Infectious Diseases (hereinafter referred to as optimization) and measured outcomes. METHODS From April 2016 to March 2017, we performed cesarean section and open hysterectomy with optimization, and compared the outcome to that of surgery performed without optimization between April 2014 and March 2016. We measured the rates of antibiotic discontinuation, appropriate antibiotic selection, SSI incidence, resumption of antibiotic therapy and fever incidence, as well as the length of postoperative hospital stay and medical expenses for antibiotics to evaluate the appropriateness and outcomes of antibiotic prophylaxis. RESULTS Optimization resulted in a change in the method of selecting antibiotics for cesarean section, but there was no change in SSI incidence rate (0.74% vs 0.0%, P = 0.36). Optimization reduced the use of antibiotics and medical expenses of hysterectomy (median reduction of 50% and 78% for hysterectomy without or with lymphadenectomy, respectively). However, there was no change in outcome regarding SSI incidence (5.7% vs 0.0%, P = 0.11 and 7.8% vs 9.5%, P = 0.77, respectively). CONCLUSION Appropriate use of antibiotics according to guidelines reduced antibiotic dose and medical expenses, but there was no change in outcome regarding SSI incidence rate. These findings suggested that implementation of dosing regimens according to the guidelines would be useful to reduce antibiotic medicine costs and prevent resistant bacteria and complications associated with antibiotics.
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Affiliation(s)
- Mikayo Toba
- Quality Management Center, Tokyo Medical and Dental University, Tokyo, Japan.,Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mutsuko Moriwaki
- Quality Management Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriko Oshima
- Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshibumi Aiso
- Division of Infection Control and Prevention, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mari Shima
- Division of Infection Control and Prevention, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoko Nukui
- Division of Infection Control and Prevention, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoshi Obayashi
- Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Quality Management Center, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
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21
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22
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Ohno M, Shimada Y, Satoh M, Kojima Y, Sakamoto K, Hori S. Evaluation of economic burden of colonic surgical site infection at a Japanese hospital. J Hosp Infect 2017; 99:31-35. [PMID: 29258919 DOI: 10.1016/j.jhin.2017.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Several reports have been published regarding cost increases attributable to surgical site infections (SSIs) in Europe and the USA. However, such studies have been limited in Japan. AIM To evaluate the economic burden of colorectal SSIs on hospitals in Japan. METHODS This study was undertaken at a Japanese university hospital. Amongst 265 patients who had undergone colorectal surgery in the Department of Coloproctological Surgery between November 2014 and March 2016, 16 patients who developed SSIs and could be allocated a diagnosis procedure combination code were selected as SSI cases. Individual SSI cases were matched to non-SSI cases based on a combination of surgical category, age band, sex, wound class, presence of stoma and risk index. Median length of stay (LOS) and piecework reference cost were compared between SSI episodes and non-SSI episodes. FINDINGS The median LOS for patients with SSI and without SSI was 25.5 [interquartile range (IQR) 21.5-39.3] and 16.5 (IQR 12.5-18.5) days, respectively (P<0.01). The median piecework reference cost for patients with SSI and without SSI was ¥842,155 (IQR ¥716,423-1,388,968) and ¥575,795 (IQR ¥529,638-680,105), respectively (P<0.01). CONCLUSION SSIs led to a significant increase in LOS and economic burden. Although the SSI episodes appear to be more profitable than the non-SSI episodes, the economic profit for SSI episodes was less than that for non-SSI episodes in the observation period, when opportunity costs were taken into account.
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Affiliation(s)
- M Ohno
- Intelligent Systems Laboratory, SECOM Co. Ltd, Mitaka, Tokyo, Japan; Medical Informatics Department, Juntendo University Graduate School, Bunkyo, Tokyo, Japan.
| | - Y Shimada
- Intelligent Systems Laboratory, SECOM Co. Ltd, Mitaka, Tokyo, Japan; Medical Informatics Department, Juntendo University Graduate School, Bunkyo, Tokyo, Japan
| | - M Satoh
- Medical Informatics Department, Juntendo University Graduate School, Bunkyo, Tokyo, Japan
| | - Y Kojima
- Department of Coloproctological Surgery, Juntendo University Graduate School, Bunkyo, Tokyo, Japan
| | - K Sakamoto
- Department of Coloproctological Surgery, Juntendo University Graduate School, Bunkyo, Tokyo, Japan
| | - S Hori
- Department of Infection Control Science, Juntendo University Graduate School, Bunkyo, Tokyo, Japan; Medical Informatics Department, Juntendo University Graduate School, Bunkyo, Tokyo, Japan
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23
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Surgical-site infection in gynecologic surgery: pathophysiology and prevention. Am J Obstet Gynecol 2017; 217:121-128. [PMID: 28209490 DOI: 10.1016/j.ajog.2017.02.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/25/2017] [Accepted: 02/07/2017] [Indexed: 11/21/2022]
Abstract
Surgical-site infections (SSIs) represent a well-known cause of patient morbidity as well as added health care costs. In gynecologic surgery, particularly hysterectomy, SSIs are often the result of a number of risk factors that may or may not be modifiable. As both the Centers for Medicaid and Medicare Services and the Joint Commission on the Accreditation of Healthcare Organizations have identified SSIs as a patient safety priority, gynecologic surgeons continue to seek out the most effective interventions for SSI prevention. This review studies the epidemiology and pathophysiology of SSIs in gynecologic surgery and evaluates the current literature regarding possible interventions for SSI prevention, both as individual measures and as bundles. Data from the obstetrical and general surgery literature will be reviewed when gynecological data are either unclear or unavailable. Practitioners and hospitals may use this information as they develop strategies for SSI prevention in their own practice.
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Pathak A, Mahadik K, Swami MB, Roy PK, Sharma M, Mahadik VK, Lundborg CS. Incidence and risk factors for surgical site infections in obstetric and gynecological surgeries from a teaching hospital in rural India. Antimicrob Resist Infect Control 2017. [PMID: 28630690 PMCID: PMC5471730 DOI: 10.1186/s13756-017-0223-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Surgical site infections (SSI) are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital. METHODS Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC) definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds. RESULTS A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30-9.38). Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively). The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03), vaginal examination (OR 1.31); presence of vaginal discharge (OR 4.04); medical disease (OR 5.76); American Society of Anesthesia score greater than 3 (OR 12.8); concurrent surgical procedure (OR 3.26); each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%. CONCLUSIONS Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries compared to Gynecological surgeries. Multiple risk factors identified in the present study can be helpful for SSI risk stratification in low-middle income countries.
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Affiliation(s)
- Ashish Pathak
- Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh India.,Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden.,Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Kalpana Mahadik
- Department of Obstetrics and Gynecology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh India
| | - Manmat B Swami
- Department of Obstetrics and Gynecology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh India
| | - Pulak K Roy
- Department of Obstetrics and Gynecology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh India
| | - Megha Sharma
- Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh India
| | - Vijay K Mahadik
- Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh India
| | - Cecilia Stålsby Lundborg
- Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Pop-Vicas A, Musuuza JS, Schmitz M, Al-Niaimi A, Safdar N. Incidence and risk factors for surgical site infection post-hysterectomy in a tertiary care center. Am J Infect Control 2017; 45:284-287. [PMID: 27938988 DOI: 10.1016/j.ajic.2016.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Preoperative antibiotic prophylaxis and surgical technological advances have greatly reduced, but not totally eliminated surgical site infection (SSI) posthysterectomy. We aimed to identify risk factors for SSI posthysterectomy among women with a high prevalence of gynecologic malignancies, in a tertiary care setting where compliance with the Joint Commission's Surgical Care Improvement Project core measures is excellent. METHODS The study was a matched case-control, 2 controls per case, matched on date of surgery. Study time was January 2, 2012-December 31, 2015. Procedures included abdominal and vaginal hysterectomies (open, laparoscopic, and robotic). SSI (superficial incisional or deep/organ/space) was defined as within 30 days postoperatively, per Centers for Disease Control and Prevention criteria. Statistical analysis included bivariate analysis and conditional logistic regression controlling for demographic and clinical variables, both patient-related and surgery-related, including detailed prophylactic antibiotic exposure. RESULTS Of the total 1,531 hysterectomies performed, we identified 52 SSIs (3%), with 60% being deep incisional or organ/space infections. All case patients received appropriate preoperative antibiotics (timing, choice, and weight-based dosing). Bivariate analysis showed that higher median weight, higher median Charlson comorbidity index, immune suppressed state, American Society of Anesthesiologists score ≥ 3, prior surgery within 60 days, clindamycin/gentamicin prophylaxis, surgery involving the omentum or gastrointestinal tract, longer surgery duration, ≥4 surgeons present in the operating room, higher median blood loss, ≥7 catheters or invasive devices in the operating room, and higher median length of hospital stay increased SSI risk (P < .05 for all). Cefazolin preoperative prophylaxis, robot-assisted surgery, and laparoscopic surgery were protective (P < .05 for all). Duration of surgery was the only independent risk factor for SSI identified on multivariate analysis (odds ratio, 3.45; 95% confidence interval, 1.21-9.76; P = .02). CONCLUSIONS In our population of women with multimorbidity and hysterectomies largely due to underlying gynecologic malignancies, duration of surgery, presumed a marker of surgical complexity, is a significant SSI risk factor. The choice of preoperative antibiotic did not alter SSI risk in our study.
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Affiliation(s)
- Aurora Pop-Vicas
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Jackson S Musuuza
- Institute of Clinical and Translational Research, University of Wisconsin, Madison, WI
| | - Michelle Schmitz
- Department of Infection Control, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Ahmed Al-Niaimi
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Infection Control, University of Wisconsin Hospital and Clinics, Madison, WI; Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI
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26
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Comparison of robotic and other minimally invasive routes of hysterectomy for benign indications. Am J Obstet Gynecol 2016; 215:650.e1-650.e8. [PMID: 27343568 DOI: 10.1016/j.ajog.2016.06.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/27/2016] [Accepted: 06/15/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite a lack of evidence showing improved clinical outcomes with robotic-assisted hysterectomy over other minimally invasive routes for benign indications, this route has increased in popularity over the last decade. OBJECTIVE We sought to compare clinical outcomes and estimated cost of robotic-assisted vs other routes of minimally invasive hysterectomy for benign indications. STUDY DESIGN A statewide database was used to analyze utilization and outcomes of minimally invasive hysterectomy performed for benign indications from Jan. 1, 2013, through July 1, 2014. A 1-to-1 propensity score-match analysis was performed between women who had a hysterectomy with robotic assistance vs other minimally invasive routes (laparoscopic and vaginal, with or without laparoscopy). Perioperative outcomes, intraoperative bowel and bladder injury, 30-day postoperative complications, readmissions, and reoperations were compared. Cost estimates of hysterectomy routes, surgical site infection, and postoperative blood transfusion were derived from published data. RESULTS In all, 8313 hysterectomy cases were identified: 4527 performed using robotic assistance and 3786 performed using other minimally invasive routes. A total of 1338 women from each group were successfully matched using propensity score matching. Robotic-assisted hysterectomies had lower estimated blood loss (94.2 ± 124.3 vs 175.3 ± 198.9 mL, P < .001), longer surgical time (2.3 ± 1.0 vs 2.0 ± 1.0 hours, P < .001), larger specimen weights (178.9 ± 186.3 vs 160.5 ± 190 g, P = .007), and shorter length of stay (14.1% [189] vs 21.9% [293] ≥2 days, P < .001). Overall, the rate of any postoperative complication was lower with the robotic-assisted route (3.5% [47] vs 5.6% [75], P = .01) and driven by lower rates of superficial surgical site infection (0.07% [1] vs 0.7% [9], P = .01) and blood transfusion (0.8% [11] vs 1.9% [25], P = .02). Major postoperative complications, intraoperative bowel and bladder injury, readmissions, and reoperations were similar between groups. Using hospital cost estimates of hysterectomy routes and considering the incremental costs associated with surgical site infections and blood transfusions, nonrobotic minimally invasive routes had an average net savings of $3269 per case, or 24% lower cost, compared to robotic-assisted hysterectomy ($10,160 vs $13,429). CONCLUSION Robotic-assisted laparoscopy does not decrease major morbidity following hysterectomy for benign indications when compared to other minimally invasive routes. While superficial surgical site infection and blood transfusion rates were statistically lower in the robotic-assisted group, in the absence of substantial reductions in clinically and financially burdensome complications, it will be challenging to find a scenario in which robotic-assisted hysterectomy is clinically superior and cost-effective.
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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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Perioperative outcome and female sexual function after laparoscopic transvaginal NOTES-assisted nephrectomy. World J Urol 2015; 33:2009-14. [DOI: 10.1007/s00345-015-1573-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022] Open
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