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Bahl A, Mielke N, Gibson SM, George J. The use of procedural kits may reduce unscheduled central line dressing changes: A matched pre-post intervention study. J Infect Prev 2024; 25:73-81. [PMID: 38584709 PMCID: PMC10998547 DOI: 10.1177/17571774241232063] [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: 02/28/2023] [Accepted: 01/25/2024] [Indexed: 04/09/2024] Open
Abstract
Background Unscheduled dressing changes for central venous lines (CVLs) have been shown to increase the risk of bloodstream infections. Objective The objective of this study is to determine if the use of an innovative dressing change kit reduces the rate of unscheduled dressing changes. Methods This pre-post interventional study took place at a large, academic, tertiary care center in metro Detroit, Michigan, the United States. We assessed the impact of the interventional dressing change procedure kit on the rate of unscheduled dressing changes for adult patients who underwent placement of a CVL inclusive of a central catheter, peripherally inserted central catheter, or hemodialysis catheter. Data was collected for the pre-intervention cohort through electronic health records (EHRs), while data for the post-intervention cohort were collected by direct observation by trained research staff in combination with EHR data. The primary outcome was the rate of unscheduled dressing changes. Secondary outcomes included rate of unscheduled dressing changes based on admission floor type, etiology of unscheduled dressing changes, and central line-associated bloodstream infections (CLABSIs). Results The study included a convenience sample of 1548 CVLs placed between May 2018 and June 2022 with a matched analysis including 488 catheters in each of the pre- and post-intervention groups. The results showed that the unadjusted rate of unscheduled dressing evaluations was significantly reduced from the pre-intervention group (0.21 per day) to the post-intervention group (0.13 per day) (p < .001). The adjusted rate ratio demonstrated the same trend at 1.00 pre- and 0.60 post-intervention (p < .001). Stratifying the analysis based on the highest level of care showed that the intervention was effective in reducing the unadjusted rate of unscheduled dressing evaluations for both the advanced and regular medical floor subgroups pre- to post-intervention; the advanced subgroup had an reduction from 0.22 to 0.15 per day (p = .001), while the regular medical floor subgroup had a reduction from 0.21 to 0.09 per day (p < .001). CLABSIs were similar in both groups (0.6% vs 0.8%; p = 1.00) in pre- and post-intervention groups, respectively. Discussion Procedural kits for central line dressing changes are effective in reducing unscheduled dressing changes and may have a role in reducing CLABSI. Further studies assessing the impact of dressing change kits on cost, procedural compliance, and the precise impact on CLABSI are needed.
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Affiliation(s)
- Amit Bahl
- William Beaumont Hospitals Corp, Royal Oak, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | | | - Julie George
- William Beaumont Hospitals Corp, Royal Oak, MI, USA
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2
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Khachfe HH, Hammad AY, AlMasri S, Nassour I, ElAsmar R, Liu H, de Silva A, Kraftician J, Lee KK, Zureikat AH, Paniccia A. Postoperative infectious complications worsen oncologic outcomes following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Surg Oncol 2024; 129:1097-1105. [PMID: 38316936 DOI: 10.1002/jso.27595] [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: 07/29/2023] [Revised: 12/18/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) remains the only curative option for patients with pancreatic adenocarcinoma (PDAC). Infectious complications (IC) can negatively impact patient outcomes and delay adjuvant therapy in most patients. This study aims to determine IC effect on overall survival (OS) following PD for PDAC. STUDY DESIGN Patients who underwent PD for PDAC between 2010 and 2020 were identified from a single institutional database. Patients were categorized into two groups based on whether they experienced IC or not. The relationship between postoperative IC and OS was investigated using Kaplan-Meier and Cox-regression multivariate analysis. RESULTS Among 655 patients who underwent PD for PDAC, 197 (30%) experienced a postoperative IC. Superficial wound infection was the most common type of infectious complication (n = 125, 63.4%). Patients with IC had significantly more minor complications (Clavien-Dindo [CD] < 3; [59.4% vs. 40.2%, p < 0.001]), major complications (CD ≥ 3; [37.6% vs. 18.8%, p < 0.001]), prolonged LOS (47.2% vs 20.3%, p < 0.001), biochemical leak (6.1% vs. 2.8%, p = 0.046), postoperative bleeding (4.1% vs. 1.3%, p = 0.026) and reoperation (9.6% vs. 2.2%, p < 0.001). Time to adjuvant chemotherapy was delayed in patients with IC versus those without (10 vs. 8 weeks, p < 0.001). Median OS for patients who experienced no complication, noninfectious complication, and infectious complication was 33.3 months, 29.06 months, and 27.58 months respectively (p = 0.023). On multivariate analysis, postoperative IC were an independent predictor of worse OS (HR 1.32, p = 0.049). CONCLUSIONS IC following PD for PDAC independently predict worse oncologic outcomes. Thus, efforts to prevent and manage IC should be a priority in the care of patients undergoing PD for PDAC.
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Affiliation(s)
- Hussein H Khachfe
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Abdulrahman Y Hammad
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Samer AlMasri
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Nassour
- Department of Surgery, Division of Surgical Oncology, University of Florida, Gainesville, Florida, USA
| | - Rudy ElAsmar
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hao Liu
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Annissa de Silva
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jasmine Kraftician
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kenneth K Lee
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amer H Zureikat
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alessandro Paniccia
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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3
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Blair WO, Ellis MA, Fada M, Wiggins AA, Wolfe RC, Patel GP, Brockhaus KK, Droege M, Ebbitt LM, Kramer B, Likar E, Petrucci K, Shah S, Taylor J, Bingham P, Krabacher S, Moon JH, Rogoz M, Jean-Jacques E, Cleary RK, Eke R, Findley R, Parrish RH. Effect of Pharmacoprophylaxis on Postoperative Outcomes in Adult Elective Colorectal Surgery: A Multi-Center Retrospective Cohort Study within an Enhanced Recovery after Surgery Framework. Healthcare (Basel) 2023; 11:3060. [PMID: 38063628 PMCID: PMC10706554 DOI: 10.3390/healthcare11233060] [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: 10/20/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The application of enhanced recovery after surgery principles decreases postoperative complications (POCs), length of stay (LOS), and readmissions. Pharmacoprophylaxis decreases morbidity, but the effect of specific regimens on clinical outcomes is unclear. METHODS AND MATERIALS Records of 476 randomly selected adult patients who underwent elective colorectal surgeries (ECRS) at 10 US hospitals were abstracted. Primary outcomes were surgical site infection (SSI), venous thromboembolism (VTE), postoperative nausea and vomiting (PONV), pain, and ileus rates. Secondary outcomes included LOS and 7- and 30-day readmission rates. RESULTS POC rates were SSI (3.4%), VTE (1.5%), PONV (47.9%), pain (58.1%), and ileus (16.1%). Cefazolin 2 g/metronidazole 500 mg and ertapenem 1 g were associated with the shortest LOS; cefotetan 2 g and cefoxitin 2 g with the longest LOS. No SSI occurred with ertapenem and cefotetan. More Caucasians than Blacks received oral antibiotics before intravenous antibiotics without impact. Enoxaparin 40 mg subcutaneously daily was the most common inpatient and discharge VTE prophylaxis. All in-hospital VTEs occurred with unfractionated heparin. Most received rescue rather than around-the-clock antiemetics. Scopolamine patches, spinal opioids, and IV lidocaine continuous infusion were associated with lower PONV. Transversus abdominis plane block with long-acting local anesthetics, celecoxib, non-anesthetic ketamine bolus, ketorolac IV, lidocaine IV, and pregabalin were associated with lower in-hospital pain severity rates. Gabapentinoids and alvimopan were associated with lower ileus rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches were associated with shorter LOS. CONCLUSIONS Significant differences in pharmacotherapy regimens that may improve primary and secondary outcomes in ECRS were identified. In adult ECRS, cefotetan or ertapenem may be better regimens for preventing in-hospital SSI, while ertapenem or C/M may lead to shorter LOS. The value of OA to prevent SSI was not demonstrated. Inpatient enoxaparin, compared to UFH, may reduce VTE rates with a similar LOS. A minority of patients had a documented PONV risk assessment, and a majority used as-needed rather than around-the-clock strategies. Preoperative scopolamine patches continued postoperatively may lower PONV and PDNV severity and shorter LOS. Alvimopan may reduce ileus and shorten LOS. Anesthesia that includes TAP block, ketorolac IV, and pregabalin use may lead to reduced pain rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches may shorten LOS. Given the challenges of pain management and the incidence of PONV/PDNV found in this study, additional studies should be conducted to determine optimal opioid-free anesthesia and the benefit of newer antiemetics on patient outcomes. Moreover, future research should identify latent pharmacotherapy variables that impact patient outcomes, correlate pertinent laboratory results, and examine the impact of order or care sets used for ECRS at study hospitals.
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Affiliation(s)
- William Olin Blair
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Mary Allison Ellis
- Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY 40536, USA; (M.A.E.); (L.M.E.)
| | - Maria Fada
- Heritage School of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA;
| | - Austin Allen Wiggins
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Rachel C. Wolfe
- Department of Pharmacy Services, Barnes-Jewish Hospital, St. Louis, MO 63110, USA;
| | - Gourang P. Patel
- Department of Pharmacy Services, University of Chicago Hospitals, Chicago, IL 60637, USA; (G.P.P.); (K.P.)
| | - Kara K. Brockhaus
- Department of Pharmacy Services and Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, MI 48104, USA; (K.K.B.); (R.K.C.)
| | - Molly Droege
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Laura M. Ebbitt
- Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY 40536, USA; (M.A.E.); (L.M.E.)
| | - Brian Kramer
- Department of Pharmacy Services, OhioHealth/Grant Medical Center, Columbus, OH 43215, USA;
| | - Eric Likar
- Department of Pharmacy Services, West Virginia University Medicine, Morgantown, WV 26506, USA;
| | - Kerilyn Petrucci
- Department of Pharmacy Services, University of Chicago Hospitals, Chicago, IL 60637, USA; (G.P.P.); (K.P.)
| | - Sapna Shah
- Department of Pharmacy Services, Beaumont Hospital—Troy, Troy, MI 48085, USA;
| | - Jerusha Taylor
- Department of Pharmacy Services, Legacy Good Samaritan Hospital, Portland, OR 97210, USA; (J.T.); (M.R.)
| | - Paula Bingham
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Samuel Krabacher
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Jin Hyung Moon
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Monica Rogoz
- Department of Pharmacy Services, Legacy Good Samaritan Hospital, Portland, OR 97210, USA; (J.T.); (M.R.)
| | - Edson Jean-Jacques
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Robert K. Cleary
- Department of Pharmacy Services and Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, MI 48104, USA; (K.K.B.); (R.K.C.)
| | - Ransome Eke
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Rachelle Findley
- Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Richard H. Parrish
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
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Theiss LM, Wood T, McLeod MC, Shao C, Santos Marques ID, Bajpai S, Lopez E, Duong AM, Hollis R, Morris MS, Chu DI. The association of health literacy and postoperative complications after colorectal surgery: A cohort study. Am J Surg 2021; 223:1047-1052. [PMID: 34728069 DOI: 10.1016/j.amjsurg.2021.10.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/15/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Health literacy is a determinant of health. Few studies characterize its association with surgical outcomes. METHODS Retrospective cohort study of patients undergoing elective colorectal surgery 2015-2020. Health literacy assessed using Brief Health Literacy Screening Tool. Outcomes were postoperative complications, LOS, readmissions, mortality. RESULTS Of 552 patients, 46 (8.3%) had limited health literacy, 506 (91.7%) non-limited. Median age 57.7 years, 305 (55.1%) patients were female, 148 (26.8%) were Black. Limited patients had higher rates of overall complications (43.5% vs. 24.3%, p = 0.004), especially surgical site infections (21.7% vs. 11.3%, p = 0.04). Limited patients had longer LOS (5 vs 3.5 days, p = 0.006). Readmissions and mortality did not differ. On multivariable analysis, limited health literacy was independently associated with increased risk of complications (OR 2.03, p = 0.046), not LOS (IRR 1.05, p = 0.67). CONCLUSION Limited health literacy is associated with increased likelihood of complications after colorectal surgery. Opportunities exist for health literate surgical care to improve outcomes for limited health literacy patients.
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Affiliation(s)
- Lauren M Theiss
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara Wood
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marshall C McLeod
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Connie Shao
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Swara Bajpai
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Lopez
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anh M Duong
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Hollis
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melanie S Morris
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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5
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Sargent RE, Jacobsen J, Cole K, Olson R, Gibbs DM, Amaya R, Kahaku D, Dalton FV, Sener SF. Association of Pre-Operative Full-Body Surgical Preparation with Reduced Incidence of Surgical Site Infection at a Large, Urban Safety-Net Medical Center. Surg Infect (Larchmt) 2021; 23:1-4. [PMID: 34612706 DOI: 10.1089/sur.2021.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Surgical site infections (SSIs) continue to represent a substantial source of morbidity, mortality, and healthcare costs. The purpose of this study was to determine the effect of implementing a protocol using home pre-operative surgical preparation on the SSI rate at a large, urban safety-net medical center. Patients and Methods: From July through December 2020, Nose-to-Toes® (N2T; Sage Products-Stryker Corporation, Cary, IL) full-body preparation was applied by patients at home on the morning of scheduled surgical procedures. This study was a single-institution, retrospective observational analysis to determine the rates of SSI ≤30 days after an operation. Patients having skin preparation during 2020 (post-N2T) were compared with patients having the same operation during 2019 without having skin preparation (pre-N2T). Results: For gynecology, 10 (7.4%) of 135 pre-N2T and three (2.2%) of 135 post-N2T patients had SSIs. For surgical and gynecologic oncology, 13 (15.1%) of 86 pre-N2T and four (4.7%) of 86 post-N2T patients had SSIs. For orthopedics, four (4.3%) of 94 pre-N2T and zerp of 94 post-N2T patients had SSIs. Overall, 27 (8.6%) of 315 pre-N2T and seven (2.2%) of 315 post-N2T patients had SSIs (p = 0.0004). Conclusions: The implementation of pre-operative full-body preparation was associated with a substantial reduction in the incidence of SSI.
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Affiliation(s)
- Rachel E Sargent
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California, USA.,Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Jace Jacobsen
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California, USA.,Department of Anesthesiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Kari Cole
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California, USA.,Department of Anesthesiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Robert Olson
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California, USA.,Department of Anesthesiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Dolores M Gibbs
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California, USA.,Department of Anesthesiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Rodolfo Amaya
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California, USA.,Department of Anesthesiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Deborah Kahaku
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California, USA
| | - Florence V Dalton
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California, USA
| | - Stephen F Sener
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California, USA.,Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
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Watson EGR, Cobden EJ, Vasey CE. A pilot randomised controlled trial of patient education to improve umbilical cleanliness prior to laparoscopic surgery. ANZ J Surg 2021; 91:2650-2655. [PMID: 34467629 DOI: 10.1111/ans.17172] [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: 07/17/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Before laparoscopic abdominal surgery, surgeons frequently remove debris from patients' umbilici to prevent it from passing into the abdomen and optimise skin antisepsis. This task irritates the skin, takes time and contaminates sterile equipment. This pilot randomised controlled trial aimed to inform a definitive study investigating whether patient education improves umbilical cleanliness in these patients. METHODS To generate data on effect size and sample size, adult patients undergoing elective and emergency laparoscopic abdominal surgery were randomised to an intervention group, who received an education pack to clean their umbilicus prior to surgery, or a control group, who received no pack. Umbilical cleanliness was measured using a novel scale. To assess scale validity and reliability, all umbilici were scored by nine surgeons and surgical trainees using photographs and umbilici were swabbed to estimate bacterial load. Intervention acceptability was assessed via study consent and withdrawal rates and trial feasibility was evaluated using qualitative insights documented by investigators. RESULTS Seventy-one percent (22/31) of the intervention group had clean umbilici versus 61% (19/31) in the control group. A definitive trial would require 712 participants to show statistical significance between study groups. The umbilical cleanliness scale had excellent interrater and test-retest reliability and a moderate degree of convergent validity with respect to bacterial load. The intervention was highly acceptable to participants, and theatre nurses and surgical trainees were central to trial feasibility. CONCLUSION A definitive trial is warranted and would contribute to an evidence-based, standardised approach to preoperative care. Trial registration no. ACTRN12620000278932.
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Affiliation(s)
- Eleanor G R Watson
- Division of Surgery, Ballarat Base Hospital, Ballarat Central, Victoria, Australia
| | - Elizabeth J Cobden
- Division of Surgery, Ballarat Base Hospital, Ballarat Central, Victoria, Australia
| | - Carolyn E Vasey
- Division of Surgery, Ballarat Base Hospital, Ballarat Central, Victoria, Australia
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7
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Booth AT, Curran T. Preoperative optimization and enhanced recovery for colorectal surgery. SEMINARS IN COLON AND RECTAL SURGERY 2021. [DOI: 10.1016/j.scrs.2021.100827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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8
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Wei T, Zhang XF, Bagante F, Ratti F, Marques HP, Silva S, Soubrane O, Lam V, Poultsides GA, Popescu I, Grigorie R, Alexandrescu S, Martel G, Workneh A, Guglielmi A, Hugh T, Aldrighetti L, Endo I, Pawlik TM. Postoperative Infectious Complications Worsen Long-Term Survival After Curative-Intent Resection for Hepatocellular Carcinoma. Ann Surg Oncol 2021; 29:315-324. [PMID: 34378089 DOI: 10.1245/s10434-021-10565-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postoperative infectious complications may be associated with a worse long-term prognosis for patients undergoing surgery for a malignant indication. The current study aimed to characterize the impact of postoperative infectious complications on long-term oncologic outcomes among patients undergoing resection for hepatocellular carcinoma (HCC). METHODS Patients who underwent curative-intent resection for HCC between 2000 and 2017 were identified from an international multi-institutional database. The relationship between postoperative infectious complications, overall survival (OS), and recurrence-free survival (RFS) was analyzed. RESULTS Among 734 patients who underwent HCC resection, 269 (36.6%) experienced a postoperative complication (Clavien-Dindo grade 1 or 2 [n = 197, 73.2%] vs grade 3 and 4 [n = 69, 25.7%]). An infectious complication was noted in 81 patients (11.0%) and 188 patients (25.6%) had non-infectious complications. The patients with infectious complications had worse OS (median: infectious complications [46.5 months] vs no complications [106.4 months] [p < 0.001] and non-infectious complications [85.7 months] [p < 0.05]) and RFS (median: infectious complications [22.1 months] vs no complications [45.5 months] [p < 0.05] and non-infectious complications [38.3 months] [p = 0.139]) than the patients who had no complication or non-infectious complications. In the multivariable analysis, infectious complications remained an independent risk factor for OS (hazard ratio [HR], 1.7; p = 0.016) and RFS (HR, 1.6; p = 0.013). Among the patients with infectious complications, patients with non-surgical-site infection (SSI) had even worse OS and RFS than patients with SSI (median OS: 19.5 vs 70.9 months [p = 0.010]; median RFS: 12.8 vs 33.9 months [p = 0.033]). CONCLUSION Infectious complications were independently associated with an increased long-term risk of tumor recurrence and death. Patients with non-SSI versus SSI had a particularly worse oncologic outcome.
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Affiliation(s)
- Tao Wei
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Fabio Bagante
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.,Department of Surgery, University of Verona, Verona, Italy
| | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Silvia Silva
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery, Beaujon Hospital, Clichy, France
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, Australia
| | | | - Irinel Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Razvan Grigorie
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | - Aklile Workneh
- Department of Surgery, University of Ottawa, Ottawa, Canada
| | | | - Tom Hugh
- Department of Surgery, The University of Sydney, School of Medicine, Sydney, Australia
| | | | - Itaru Endo
- Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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9
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deKay K, Wright R. Clinical Issues—June 2021. AORN J 2021. [DOI: 10.1002/aorn.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Ma R, He J, Xu B, Zhao C, Zhang Y, Li X, Sun S, Zhang Q. Nomogram prediction of surgical site infection of HIV-infected patients following orthopedic surgery: a retrospective study. BMC Infect Dis 2020; 20:896. [PMID: 33243159 PMCID: PMC7690143 DOI: 10.1186/s12879-020-05613-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is a devastating complication of orthopedic surgery, related with increased morbidity and mortality. This study was performed with the aim to compare the SSI rate in human immunodeficiency virus HIV-positive patients, to identify other risk factors for SSI and to establish a nomogram model to predict the risk of SSI. METHODS A total of 101 HIV-positive individuals following orthopedic surgery patients admitted to Beijing Ditan Hospital. Their characteristics were gathered. The univariate and multiple logistic regression analysis were performed to explore the risk factors of SSI. And the Nomogram prediction model was constructed and verified. RESULTS The independent predictive factors of SSI included CD4 (Odds ratio [OR], 0.041; P = 0.040), erythrocyte sedimentation rate (ESR) (OR, 89.773; P = 0.030), and procalcitonin (PCT) (OR, 220.746; P = 0.006). The scoring nomogram model was as follows: Logit (SSI) = - 2.63589-0.00314*CD4 < 430.75 = 1) + 0.04695*(ESR < 17.46 = 1) + 2.93694*(PCT < 0.22 = 1). The area under the Receiver Operating Characteristic (ROC) curve was 0.946. The cutoff score was - 2.1026 with a sensitivity of 93.33% and a specificity of 84.88%. CONCLUSIONS CD4, ESR, PCT might affect the occurrence of SSI after orthopedic surgery. The nomogram model constructed in this study is helpful for predicting the probability of SSI.
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Affiliation(s)
- Rui Ma
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Jie He
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Biao Xu
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Changsong Zhao
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yao Zhang
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Xin Li
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Sheng Sun
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Qiang Zhang
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China.
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Aasen DM, Wiedel C, Maroni P, Cohen ME, Meng X, Meguid RA. Association of Hospital Altitude and Postoperative Infectious Complications After Major Operations. High Alt Med Biol 2019; 20:421-426. [DOI: 10.1089/ham.2019.0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Davis M. Aasen
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Cole Wiedel
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul Maroni
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Robert A. Meguid
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
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Collins CR, Wick EC. Reflections on the Complexity of Surgical Site Infection Prevention and Detection from an Organizational Lens. Surg Infect (Larchmt) 2019; 20:577-580. [DOI: 10.1089/sur.2019.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Caitlin R. Collins
- Department of Surgery, University of California San Francisco Medical Center at Parnassus, San Francisco, California
| | - Elizabeth C. Wick
- Department of Surgery, University of California San Francisco Medical Center at Parnassus, San Francisco, California
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Abstract
Application of antiseptic products to the skin plays an important role in prevention of a variety of health care-associated infections. Preoperative bathing or showering is widely recommended to reduce the risk of surgical site infections. Evidence of the impact of this measure on surgical site infection rates is mixed, and further prospective trials comparing standardized protocols for showering with plain soap or chlorhexidine gluconate (CHG)-containing soap, or bathing with 2% CHG-impregnated cloths are needed to establish the most effective approach. Current evidence favors the use of alcohol-containing solutions, often containing CHG or povidone-iodine, for surgical site preparation of the skin. Preparation of vaginal mucosa prior to gynecologic surgery may be performed using either povidone-iodine or CHG. Surgical hand antisepsis can be performed by scrubbing with an antimicrobial soap or by handrubbing using an alcohol-based handrub. Addition of CHG to alcohol-based handrubs intended for surgical hand antisepsis is not necessary if they meet recommended efficacy criteria. Daily CHG bathing of intensive care unit patients has been shown to reduce a variety of health care-associated infections, most commonly bloodstream infections (BSIs). Achieving and maintaining optimum application protocols may be challenging, suggesting the need for ongoing staff education, monitoring, and feedback. Additional studies are needed to determine the impact of daily CHG bathing of non-intensive care unit patients. Alcoholic CHG is currently the preferred antiseptic for skin preparation prior to insertion of central and arterial intravascular catheters. CHG-impregnated dressings have been shown to reduce catheter-associated BSI. Because of the widespread use of antiseptics, especially CHG, surveillance for emergence of increased tolerance or resistance is warranted. Antiseptics are applied to the skin for a variety of purposes in health care. Common scenarios in which topical antiseptics are used include preoperative bathing, surgical site preparation, surgical hand hygiene, daily bathing of intensive care unit patients, and prevention of intravascular catheter-associated BSI. The purpose of this article is to review recent evidence regarding the best products for skin antisepsis.
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