1
|
Chehrassan M, Nikouei F, Shakeri M, Behnamnia A, Mahabadi EA, Ghandhari H. The role of environmental and seasonal factors in spine deep surgical site infection: the air pollution, a factor that may be underestimated. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3148-3153. [PMID: 38461454 DOI: 10.1007/s00586-024-08183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/13/2023] [Accepted: 02/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Different strategies have been described in order to reduce spine deep surgical site infection (SSI); however, non-intervenable items such as environmental factors remain as one of the main concerns for spine surgeons. METHODS A retrospective cohort study was designed in order to evaluate the effect of environmental factors such as temperature, humidity and particularly the air pollution index (PM 2.5) on spine surgical site infection. The files of 3609 patients who underwent spinal surgery from April 2019 to March 2022 were reviewed, and 121 patients with spine SSI were detected. RESULTS There was no significant relationship between mean temperature and humidity of each month with infection and type of bacteria. However, there was a significant relation between warmer season periods and infection. The rate of infection among patients was 3.25% ranged from 2.5% to 4% in colder and warmer seasons accordingly. It was determined that air pollution had a significant relationship with the infection and the type of bacteria. (p value < 0.05, R-Squared = 0.249). CONCLUSIONS Our study revealed a 60% increase in spine SSI during warmer seasons. There was a significant correlation between air pollution and the rate of infection. These may suggest the necessity to reduce the number of elective spine surgeries during warmer seasons and when the level of air pollutant is high.
Collapse
Affiliation(s)
- Mohammadreza Chehrassan
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Farshad Nikouei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shakeri
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Behnamnia
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Ameri Mahabadi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Ghandhari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Zhang T, Yan L, Wang S, Chen M, Jiao Y, Sheng Z, Liu J, Liu L. Temporal patterns and clinical characteristics of healthcare-associated infections in surgery patients: A retrospective study in a major Chinese tertiary hospital. INFECTIOUS MEDICINE 2024; 3:100103. [PMID: 38764728 PMCID: PMC11096939 DOI: 10.1016/j.imj.2024.100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/29/2023] [Accepted: 03/15/2024] [Indexed: 05/21/2024]
Abstract
Background Given the preventable nature of most healthcare-associated infections (HAIs), it is crucial to understand their characteristics and temporal patterns to reduce their occurrence. Methods A retrospective analysis of medical record cover pages from a Chinese hospital information system was conducted for surgery inpatients from 2010 to 2019. Association rules mining (ARM) was employed to explore the association between disease, procedure, and HAIs. Joinpoint models were used to estimate the annual HAI trend. The time series of each type of HAI was decomposed to analyze the temporal patterns of HAIs. Results The study included data from 623,290 surgery inpatients over 10 years, and a significant decline in the HAI rate was observed. Compared with patients without HAIs, those with HAIs had a longer length of stay (29 days vs. 9 days), higher medical costs (96226.57 CNY vs. 22351.98 CNY), and an increased risk of death (6.42% vs. 0.18%). The most common diseases for each type of HAI differed, although bone marrow and spleen operations were the most frequent procedures for most HAI types. ARM detected that some uncommon diagnoses could strongly associate with HAIs. The time series pattern varied for each type of HAI, with the peak occurring in January for respiratory system infections, and in August and July for surgical site and bloodstream infections, respectively. Conclusions Our findings demonstrate that HAIs impose a significant burden on surgery patients. The differing time series patterns for each type of HAI highlight the importance of tailored surveillance strategies for specific types of HAI.
Collapse
Affiliation(s)
- Tianyi Zhang
- Institution of Hospital Management, Department of Medical Innovation and Research, Chinese PLA General Hospital, Beijing 100853, China
| | - Li Yan
- Cadet Company One, Graduate School of Chinese PLA General Hospital, Beijing 100853, China
| | - Shan Wang
- Department of Medical Innovation and Research, Chinese PLA General Hospital, Beijing 100853, China
| | - Ming Chen
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Yunda Jiao
- Institution of Hospital Management, Department of Medical Innovation and Research, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhuoqi Sheng
- Institution of Hospital Management, Department of Medical Innovation and Research, Chinese PLA General Hospital, Beijing 100853, China
| | - Jianchao Liu
- Institution of Hospital Management, Department of Medical Innovation and Research, Chinese PLA General Hospital, Beijing 100853, China
- School of Humanities and Social Sciences, North China Electric Power University, Beijing 102206, China
| | - Lihua Liu
- Institution of Hospital Management, Department of Medical Innovation and Research, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|
3
|
Zhan B, Fang S, Lv X, Xie X, Wang X. Effect of drain placement in short-level spinal surgery on postoperative wound infection: A meta-analysis. Int Wound J 2024; 21:e14508. [PMID: 38037852 PMCID: PMC10898379 DOI: 10.1111/iwj.14508] [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: 10/25/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023] Open
Abstract
In the meta-analysis, we evaluated the efficacy of placing drainage channels following single- or double-level spine surgery in order to decrease the incidence of postoperative injury. We conducted the analysis with the help of four databases: PubMed, Embase, Cochrane Library and Web of Science. A review of related studies was carried out after evaluating the quality of the literature against the classification and exclusion criteria set for the trial. Calculation of 95% CI, OR and MD was performed with fixed-effect models. A meta-analysis of the data was carried out with RevMan 5.3. Meta-analyses of randomized controlled trial (RCT) did not indicate that there were a statistically significantly different incidence of postoperative wound infections among those who received drainage compared to those who did not receive drainage (OR, 2.29; 95% CI, 0.50, 10.41 p = 0.28). Moreover, there were no statistically significant differences in post-operation hematoma (OR, 1.20; 95% CI, 0.27, 5.28 p = 0.81) and visual analogue scale score (MD, -0.01; 95% CI, -1.34, 1.33 p = 0.99). Thus, placing drainage in short-levels of spine operation did not significantly influence the outcome of postoperative wound complications. Nevertheless, because of the limited sample size chosen for this meta-analysis, caution should be exercised when treating these data. More high-quality RCT trials with a large number of samples are required to confirm the findings.
Collapse
Affiliation(s)
- Baoming Zhan
- Department of Spinal SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Shiqiang Fang
- Department of Spinal SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Xiuhong Lv
- Department of Spinal SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Xuesheng Xie
- Department of Spinal SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Xing Wang
- Department of Trauma and OrthopedicsPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| |
Collapse
|
4
|
Lachance AD, Call C, Radford Z, Stoddard H, Sturgeon C, Babikian G, Rana A, McGrory BJ. The Association of Season of Surgery and Patient Reported Outcomes following Total Hip Arthroplasty. Geriatr Orthop Surg Rehabil 2024; 15:21514593241227805. [PMID: 38221927 PMCID: PMC10787533 DOI: 10.1177/21514593241227805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/13/2023] [Accepted: 01/05/2023] [Indexed: 01/16/2024] Open
Abstract
Background Understanding the impact of situational variables on surgical recovery can improve outcomes in total hip arthroplasty (THA). Literature examining hospital outcomes by season remains inconclusive, with limited focus on patient experience. The aim of this study is to investigate if there are differences in hospital and patient-reported outcomes measures (PROMS) after THA depending on the season of the index procedure to improve surgeon preoperative counseling. Methods A retrospective chart review was performed on patients undergoing primary THA at a single large academic center between January 2013 and August 2020. Demographic, operative, hospital, and PROMs were gathered from the institutional electronic medical record and our institutional joint replacement outcomes database. Results 6418 patients underwent primary THA and met inclusion criteria. Of this patient population, 1636 underwent surgery in winter, 1543 in spring, 1811 in summer, and 1428 in fall. PROMs were equivalent across seasons at nearly time points. The average age of patients was 65 (+/- 10) years, with an average BMI of 29.3 (+/- 6). Rates of complications including ED visits within 30 days, readmission within 90 days, unplanned readmission, dislocation, fracture, or wound infection were not significantly different by season (P > .05). Conclusion Our findings indicate no differences in complications and PROMs at 1 year in patients undergoing THA during 4 distinct seasons. Notably, patients had functional differences at the second follow-up visit, suggesting variation in short-term recovery. Patients could be counseled that they have similar rates of complications and postoperative recovery regardless of season.
Collapse
Affiliation(s)
| | | | - Zachary Radford
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Henry Stoddard
- Maine Health Institute for Research, Scarborough, ME, USA
| | | | | | - Adam Rana
- Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Maine Medical Center, Portland, ME, USA
| | - Brian J. McGrory
- Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Maine Medical Center, Portland, ME, USA
| |
Collapse
|
5
|
Martins RS, Poulikidis K, Razi SS, Latif MJ, Tafuri K, Bhora FY. From emissions to incisions and beyond: the repercussions of climate change on surgical disease in low- and-middle-income countries. BMC Surg 2023; 23:348. [PMID: 37974149 PMCID: PMC10655255 DOI: 10.1186/s12893-023-02260-8] [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: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
Climate change has far-reaching repercussions for surgical healthcare in low- and middle-income countries. Natural disasters cause injuries and infrastructural damage, while air pollution and global warming may increase surgical disease and predispose to worse outcomes. Socioeconomic ramifications further strain healthcare systems, highlighting the need for integrated climate and healthcare policies.
Collapse
Affiliation(s)
- Russell Seth Martins
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network - Central Region, Edison, NJ, 08820, United States of America.
| | - Kostantinos Poulikidis
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network - Central Region, Edison, NJ, 08820, United States of America
| | - Syed Shahzad Razi
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network - Central Region, Edison, NJ, 08820, United States of America
| | - M Jawad Latif
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network - Central Region, Edison, NJ, 08820, United States of America
| | - Kyle Tafuri
- Hackensack Meridian Health Network, Nutley, NJ, 08820, United States of America
| | - Faiz Y Bhora
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network - Central Region, Edison, NJ, 08820, United States of America.
| |
Collapse
|
6
|
Hawkins AD, Scott EJ, De Guzman J, Ratcliffe SJ, Mehaffey JH, Hawkins RB, Strobel RJ, Speir A, Joseph M, Yarboro LT, Teman NR. Temporal Cluster Analysis of Deep Sternal Wound Infection in a Regional Quality Collaborative. J Surg Res 2023; 291:67-72. [PMID: 37352738 DOI: 10.1016/j.jss.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/31/2023] [Accepted: 05/15/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Deep sternal wound infection (DSWI) is a rare complication associated with high mortality. Seasonal variability in surgical site infections has been demonstrated, however, these patterns have not been applied to DSWI. The purpose of this study was to assess temporal clustering of DSWIs. METHODS All cardiac surgery patients who underwent sternotomy were queried from a regional Society of Thoracic Surgeons database from 17 centers from 2001 to 2019. All patients with the diagnosis of DSWI were then identified. Cluster analysis was performed at varying time intervals (monthly, quarterly, and yearly) at the hospital and regional level. DSWI rates were calculated by year and month, and compared using mixed-effects negative binomial regression. RESULTS A total of 134,959 patients underwent a sternotomy for cardiac surgery, of whom 469 (0.35%) developed a DSWI. Rates of DSWI per hospital across all years ranged from 0.12% to 0.69%. Collaborative-level rates of DSWIs were the greatest in September (0.44%) and the lowest in January (0.30%). Temporal clustering was not seen across seasonal quarters (high rate in preceeding quarter was not associated with a high rate in the next quarter) (P = 0.39). There were yearly differences across all institutions in the DSWI rates. A downward trend in DSWI rates was seen from 2001 to 2019 (P < 0.001). A difference among hospitals in the cohort was observed (P < 0.001). CONCLUSIONS DSWI are a rare event within our region. Unlike other surgical site infection, there does not appear to be a seasonal pattern associated with DSWI.
Collapse
Affiliation(s)
- Andrew D Hawkins
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Erik J Scott
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Jeison De Guzman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Sarah J Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Raymond J Strobel
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alan Speir
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Mark Joseph
- Division of Cardiothoracic Surgery, Virginia Tech Carillion School of Medicine, Roanoke, Virginia
| | - Leora T Yarboro
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
| |
Collapse
|
7
|
Shah D, Padshala R, Chaudhary SR, Khan S, Mallik S, Varrassi G. Predicting Superficial Surgical Site Infections: A Study of the Risk Factors and an Assessment Scale From Western India. Cureus 2023; 15:e47657. [PMID: 38021607 PMCID: PMC10669653 DOI: 10.7759/cureus.47657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Superficial surgical site infections (SSSIs) are very common nosocomial infections that can complicate a range of surgeries, resulting in increased morbidity and mortality, and an overall decreased benefit of surgical interventions, along with exorbitant expenditure of healthcare resources. An assessment scale could help in the segregation of the high-risk patient population, and appropriate resources could be directed toward them. Methods A prospective observational study was carried out in a tertiary care hospital in Western India with 200 participants. Certain probable preoperative, intraoperative, and postoperative risk factors for SSSIs were assessed for significance of association, and each patient was given a score according to the assessment scale. The predictive power of the scale was calculated. Results Body mass index (BMI), preoperative laboratory investigations, and preoperative hospital stay showed a significant association with the complication. Clean-contaminated wounds had a higher incidence of postoperative SSSIs as compared to clean wounds. Postoperatively, fever and the presence of open drains predisposed the patient to complications. The assessment scale was found to have a positive predictive value of 40.94% and a negative predictive value (NPV) of 86.30%. Conclusion The factors that could significantly prevent the development of SSSIs are normal preoperative laboratory investigations, less than three days of preoperative hospital stay, and avoiding the use of open drains. The high NPV of the assessment scale means that it can be used as a screening tool to segregate high-risk patients.
Collapse
Affiliation(s)
- Dharmendra Shah
- Department of General Surgery, Medical College Baroda, Vadodara, IND
| | - Renish Padshala
- Department of General Surgery, Medical College Baroda, Vadodara, IND
| | | | - Shahin Khan
- Department of General Surgery, Medical College Baroda, Vadodara, IND
| | - Shashwat Mallik
- Department of General Surgery, Medical College Baroda, Vadodara, IND
| | | |
Collapse
|
8
|
Liu X, Hou Y, Shi H, Zhao T, Shi H, Shi J, Shi G. A meta-analysis of risk factors for non-superficial surgical site infection following spinal surgery. BMC Surg 2023; 23:129. [PMID: 37194060 DOI: 10.1186/s12893-023-02026-2] [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: 12/05/2022] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is the most common complications in spinal surgery. In SSI, non-superficial surgical site infections are more likely to result in poor clinical outcomes. It has been reported that there are multiple factors contributing to postoperative non-superficial SSI, but still remains controversial. Therefore, the aim of this meta-analysis is to investigate the potential risk factors for non-superficial SSI following spinal surgery. METHODS A systematic database search of PubMed, Embase, Web of Science, Cochrane Library and Clinical Trials was performed for relevant articles published until September 2022. According to the inclusion and exclusion criteria, two evaluators independently conducted literature screening, data extraction and quality evaluation of the obtained literature. The Newcastle-Ottawa Scale (NOS) score was used for quality evaluation, and meta-analysis was performed by STATA 14.0 software. RESULTS A total of 3660 relevant articles were initially identified and 11 articles were finally included in this study for data extraction and meta-analysis. The results of meta-analysis showed that the diabetes mellitus, obesity, using steroids, drainage time and operative time were related to the non-superficial SSI. The OR values (95%CI) of these five factors were 1.527 (1.196, 1.949); 1.314 (1.128, 1.532); 1.687(1.317, 2.162); 1.531(1.313, 1.786) and 4.255(2.612, 6.932) respectively. CONCLUSIONS Diabetes mellitus, obesity, using steroids, drainage time and operative time are the current risk factors for non-superficial SSI following spinal surgery. In this study, operative time is the most important risk factor resulting in postoperative SSI.
Collapse
Affiliation(s)
- Xiaowen Liu
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Yang Hou
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Hongyang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Tianyi Zhao
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Haoyang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Jiangang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Guodong Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China.
| |
Collapse
|
9
|
Stelzner S, Keller G, Gockel I, Herrmann M. [Climate change and (surgical) health in context]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:191-198. [PMID: 36688970 DOI: 10.1007/s00104-022-01795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The impacts of the climate crisis will result in a health crisis in addition to loss of habitats and increasing supply uncertainty. In this context, the health sector and especially surgery are relevant emitters of greenhouse gases, thus contributing to the magnitude of the climate crisis. Many reviews regarding the impacts on human health are available; however, a view from the surgical perspective has so far been underrepresented. MATERIAL AND METHODS This narrative review summarizes the relevance of climate-related changes for the surgical disciplines based on a literature search. RESULTS Immediate impacts are expected by the increasing number of extreme weather events, e.g., floods, droughts and wildfires. In these settings, surgery is a part of the disaster medicine chain but simultaneously the functionality of surgical departments can be impaired or even break down when they are themselves affected by extreme weather events. Heat waves cause an increase in surgical site infections, which may lead to postponement of elective surgery for patients at high risk. Collateral impacts are mirrored by an increase in the incidence of lung and skin cancers, which often need surgical treatment within a multidisciplinary setting. Additionally, there are indirect impacts that are of a very different nature, e.g., inadequate diet which leads to further deterioration of the greenhouse gas footprint of the health sector due to the necessity of bariatric surgical capacities. CONCLUSION The climate crisis represents a major challenge in surgery and all other medical disciplines. At the same time is it indispensable that the health sector and therefore surgery, take steps towards a zero emission pathway.
Collapse
Affiliation(s)
- Sigmar Stelzner
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | | | - Ines Gockel
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Martin Herrmann
- KLUG - Deutsche Allianz Klimawandel und Gesundheit e. V., Berlin, Deutschland
| |
Collapse
|
10
|
Klietz ML, Mewe C, Wiebringhaus P, Hirsch T, Aitzetmüller MM, Kückelhaus M. Seasonal Impact on Free Flap Surgery in Terms of Flap Loss and Wound Healing Disorders: A Retrospective Cohort Study of 158 Free Flaps. Healthcare (Basel) 2023; 11:healthcare11030403. [PMID: 36766977 PMCID: PMC9914697 DOI: 10.3390/healthcare11030403] [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: 12/11/2022] [Revised: 01/18/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Postoperative flap loss and wound healing disorders are severe complications after microsurgical free flap surgery. Despite multiple clinical observations, a possible influence of season and external temperature on outcome are largely missing. (2) Methods: Retrospectively, data were collected from 151 patients receiving microsurgical free flaps from March 2018 to August 2019. Patients were divided into two cohorts. The winter group includes all patients who underwent surgery from October 2018 to March 2019 and the summer group al those who underwent surgery from April 2018 to September 2018. Data included demographic information, pre-existing conditions, flap characteristics, and postoperative complications like flap losses and wound healing problems. External temperatures during the first 14 postoperative days were documented and the predictor of flap loss and wound healing disorders was detected. (3) Results: In the winter group (October-March; Ø 7.24 °C) 72 patients (46 female, 24 males; Ø 57.0 years) and in the summer group (April-September; Ø 18.79 °C) 81 patients (48 female, 33 males; Ø 56.0 years) received free flap surgery. There were no significant differences in demography (age: p = 0.593; gender: p = 0.419; BMI: p = 0.141). We found a significant increase in flap loss during summer (χ2(1) = 6.626; p = 0.010; V = 0.209) strengthened by logistic regression analysis (p = 0.037; Exp(B) = 9.655). Additionally higher average temperatures 14 days postoperatively represents another main driver (p = 0.023, Exp(B) = 1.161) for postoperative flap loss. (4) Conclusions: The data confirm a significantly higher postoperative flap loss in the summer group. This information may potentially contribute to optimization of perioperative management and planning of elective and semi-elective surgeries.
Collapse
Affiliation(s)
- Marie-Luise Klietz
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
- Division for Plastic Surgery, Department for Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Chiara Mewe
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
| | - Philipp Wiebringhaus
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
- Division for Plastic Surgery, Department for Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Tobias Hirsch
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
- Division for Plastic Surgery, Department for Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Matthias Michael Aitzetmüller
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
- Division for Plastic Surgery, Department for Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Maximilian Kückelhaus
- Department for Plastic and Reconstructive Surgery, Institut for Muskuloskeletal Medicine, Westfälische Wilhelms-University, 48149 Münster, Germany
- Department for Plastic and Reconstructive Surgery, Fachklinik Hornheide, 48157 Münster, Germany
- Division for Plastic Surgery, Department for Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Correspondence:
| |
Collapse
|