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Oka T, Kouda K, Okada N, Saisyo A, Kashibe K, Hirano Y, Hiraki S, Yamasaki H, Ishida H, Kitahara T. A low prognostic nutritional index is associated with increased remote infections within 30 days of colorectal surgery: A retrospective cohort study. Am J Infect Control 2023; 51:1218-1224. [PMID: 37075854 DOI: 10.1016/j.ajic.2023.04.161] [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: 12/13/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE This study aimed to identify risk factors for remote infection (RI) within 30 days after colorectal surgery. METHODS This retrospective study included 660 patients who underwent colorectal surgery at Yamaguchi University Hospital or Ube Kosan Central Hospital between April 2015 and March 2019. Using electronic medical records, we identified the incidence of surgical site infection and RI within 30 days after surgery and obtained information on associated factors. Univariate and multivariable analyses were performed to identify significant risk factors in 607 (median age, 71 years) patients. RESULTS Seventy-eight (13%) and 38 (6.3%) patients had surgical site infection and RI, respectively. Of the 38 patients diagnosed with RI, 14 (36.8%) had a bloodstream infection, 13 (34.2%) had a urinary tract infection, 8 (21.1%) had a Clostridioides difficile infection, and 7 (18.4%) had respiratory tract infections. Multivariable analysis showed that a preoperative prognostic nutritional index of ≤40 (OR, 2.30; 95% CI, 1.07-4.92; P = .032), intraoperative blood transfusion (OR (odds ratio), 3.06; 95% CI, 1.25-7.47; P = .014), and concomitant stoma creation (OR, 4.13; 95% CI, 1.93-8.83; P = .0002) were significant RI predictors. CONCLUSIONS Nutritional interventions prompted by low preoperative prognostic nutritional index in colorectal surgery may lead to decreases in postoperative RI.
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Affiliation(s)
- Tomoyuki Oka
- Pharmacy Department, Ube-Kohsan Central Hospital, Ube, Yamaguchi, Japan; Clinical Pharmacology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kyoji Kouda
- Pharmacy Department, Hofu Institute of Gastroenterology, Hofu, Yamaguchi, Japan
| | - Naoto Okada
- Pharmacy Department, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Atsuyuki Saisyo
- Pharmacy Department, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Kouichi Kashibe
- Medical Informatics and Decision Sciences, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Yasushi Hirano
- Medical Informatics and Decision Sciences, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Sakurao Hiraki
- Department of Surgery, Ube-Kohsan Central Hospital, Ube, Yamaguchi, Japan
| | - Hirofumi Yamasaki
- Pharmacy Department, Ube-Kohsan Central Hospital, Ube, Yamaguchi, Japan
| | - Haku Ishida
- Medical Informatics and Decision Sciences, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Takashi Kitahara
- Pharmacy Department, Yamaguchi University Hospital, Ube, Yamaguchi, Japan; Clinical Pharmacology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
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McLean KA, Goel T, Lawday S, Riad A, Simoes J, Knight SR, Ghosh D, Glasbey JC, Bhangu A, Harrison EM. Prognostic models for surgical-site infection in gastrointestinal surgery: systematic review. Br J Surg 2023; 110:1441-1450. [PMID: 37433918 PMCID: PMC10564404 DOI: 10.1093/bjs/znad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/11/2023] [Accepted: 05/20/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Identification of patients at high risk of surgical-site infection may allow clinicians to target interventions and monitoring to minimize associated morbidity. The aim of this systematic review was to identify and evaluate prognostic tools for the prediction of surgical-site infection in gastrointestinal surgery. METHODS This systematic review sought to identify original studies describing the development and validation of prognostic models for 30-day SSI after gastrointestinal surgery (PROSPERO: CRD42022311019). MEDLINE, Embase, Global Health, and IEEE Xplore were searched from 1 January 2000 to 24 February 2022. Studies were excluded if prognostic models included postoperative parameters or were procedure specific. A narrative synthesis was performed, with sample-size sufficiency, discriminative ability (area under the receiver operating characteristic curve), and prognostic accuracy compared. RESULTS Of 2249 records reviewed, 23 eligible prognostic models were identified. A total of 13 (57 per cent) reported no internal validation and only 4 (17 per cent) had undergone external validation. Most identified operative contamination (57 per cent, 13 of 23) and duration (52 per cent, 12 of 23) as important predictors; however, there remained substantial heterogeneity in other predictors identified (range 2-28). All models demonstrated a high risk of bias due to the analytic approach, with overall low applicability to an undifferentiated gastrointestinal surgical population. Model discrimination was reported in most studies (83 per cent, 19 of 23); however, calibration (22 per cent, 5 of 23) and prognostic accuracy (17 per cent, 4 of 23) were infrequently assessed. Of externally validated models (of which there were four), none displayed 'good' discrimination (area under the receiver operating characteristic curve greater than or equal to 0.7). CONCLUSION The risk of surgical-site infection after gastrointestinal surgery is insufficiently described by existing risk-prediction tools, which are not suitable for routine use. Novel risk-stratification tools are required to target perioperative interventions and mitigate modifiable risk factors.
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Affiliation(s)
- Kenneth A McLean
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tanvi Goel
- India Hub, NIHR Global Health Research Unit on Global Surgery, Ludhiana, India
| | - Samuel Lawday
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Aya Riad
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Joana Simoes
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Stephen R Knight
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Dhruva Ghosh
- India Hub, NIHR Global Health Research Unit on Global Surgery, Ludhiana, India
| | - James C Glasbey
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Aneel Bhangu
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Ewen M Harrison
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
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Alaidaroos OA, Almuhaydib MN, Alhossan MA, Aldossari AN, Fallatta MO, Alotaibi SM, Alowid FK, Salem AA, Alsaygh KA, Alshammary HS. Unexpected Benefits of Coronavirus Disease 2019: Impact of Coronavirus Disease 2019 Pandemic on Surgical Site Infection: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2023; 24:119-130. [PMID: 36847343 DOI: 10.1089/sur.2022.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Background: We aimed to summarize and synthesize the current evidence regarding the indirect impact of the coronavirus disease 2019 (COVID-19) pandemic and its associated measures on the surgical site infection (SSI) rate compared with the pre-pandemic period. Methods: A computerized search was conducted on MEDLINE via PubMed, Web of Science, and Scopus using the relevant keywords. Two-stage screening and data extraction were done. The National Institutes of Health (NIH) tools were used for the quality assessment. The Review Manager 5.4.1 program was used for the analysis. Results: Sixteen articles (n = 157,426 patients) were included. The COVID-19 pandemic and lockdown were associated with reduced risk of SSIs after surgery (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.56-0.75; p < 0.00001) and (OR, 0.49; 95% CI, 0.29-0.84; p = 0.009), respectively. There was no significant reduction in the SSIs rate after applying the extended use of masks (OR, 0.73; 95% CI, 0.30-1.73; p = 0.47). A reduction in the superficial SSI rate during the COVID-19 pandemic compared with the pre-COVID-19 pandemic period was observed (OR, 0.58; 95% CI, 0.45-0.75; p < 0.0001). Conclusions: The current evidence suggests that the COVID-19 pandemic may have some unexpected benefits, including improved infection control protocols, which resulted in reduced SSI rates, especially superficial SSIs. In contrast to extended mask use, the lockdown was associated with reduced rates of SSIs.
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Affiliation(s)
| | | | - Mashari Ahmed Alhossan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulkarem Naif Aldossari
- College of Medicine, Najran University, Najran, Saudi Arabia.,Emergency Department, King Khalid Hospital, Najran, Saudi Arabia
| | - Mawadda Omar Fallatta
- College of Medicine, Umm Al Qura University, Makkah, Saudi Arabia.,General Surgery Department, Althaghr Hospital, Jeddah, Saudi Arabia
| | | | - Fay Khalid Alowid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Miwa S, Yamamoto N, Hayashi K, Takeuchi A, Igarashi K, Tsuchiya H. Surgical Site Infection after Bone Tumor Surgery: Risk Factors and New Preventive Techniques. Cancers (Basel) 2022; 14:cancers14184527. [PMID: 36139686 PMCID: PMC9497226 DOI: 10.3390/cancers14184527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
The management of malignant bone tumors requires multidisciplinary interventions including chemotherapy, radiation therapy, and surgical tumor resection and reconstruction. Surgical site infection (SSI) is a serious complication in the treatment of malignant bone tumors. Compared to other orthopedic surgeries, the surgical treatment of malignant bone tumors is associated with higher rates of SSIs. In patients with SSIs, additional surgeries, long-term administrations of antibiotics, extended hospital stays, and the postponement of scheduled adjuvant treatments are required. Therefore, SSI may adversely affect functional and oncological outcomes. To improve surgical outcomes in patients with malignant bone tumors, preoperative risk assessments for SSIs, new preventive techniques against SSIs, and the optimal use of prophylactic antibiotics are often required. Previous reports have demonstrated that age, tumor site (pelvis and tibia), extended operative time, implant use, body mass index, leukocytopenia, and reconstruction procedures are associated with an increased risk for SSIs. Furthermore, prophylactic techniques, such as silver and iodine coatings on implants, have been developed and proven to be efficacious and safe in clinical studies. In this review, predictive factors of SSIs and new prophylactic techniques are discussed.
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Takeda S, Enomoto K, Hiraoka M, Kumashiro N, Miyamoto M, Hirayama S, Kimura T, Tamagawa S, Kono M, Sugita G, Ohtani M, Hotomi M. Lateral approach contributes to shortened surgical time in video-assisted neck surgery (VANS) for thyroid nodule. Surg Open Sci 2022; 9:19-23. [PMID: 35519290 PMCID: PMC9065734 DOI: 10.1016/j.sopen.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/22/2022] [Accepted: 03/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background Despite endoscopic thyroid surgery contributing to excellent cosmetic outcomes, it requires longer surgical time than open surgery. This study evaluates the factors associated with operative time in video-assisted neck surgery. Methods We retrospectively reviewed patients who underwent hemithyroidectomy by video-assisted neck surgery at a single hospital between 2017 and 2021. The clinical parameters were evaluated: age, sex, body weight, body mass index, coexistence of Hashimoto thyroiditis, side of operation, surgical approach to thyroid (midline approach or lateral approach), operation time, amount of blood loss during surgery, maximum tumor diameter and tumor volume, and postoperative complications. These parameters were compared to investigate the association of operative time and surgical approach. Results Seventy consecutive patients were enrolled in this study, the median age at operation was 50 years, and there were 6 (8.6%) men and 64 (91.4%) women. The median body weight and body mass index at operation were 56.6 kg and 21.5, respectively. Coexistence of Hashimoto thyroiditis was found in 17 (24.3%) patients. Significant differences were found between the groups with longer and shorter operation time than median 201 minutes in surgical approaches to the thyroid (P < .001) and the amount of bleeding during surgery (P = .039). There were no differences in other candidates between the groups. Median operation times were 242 minutes in midline approach and 131 minutes in lateral approach (P < .001). Conclusion The lateral approach of video-assisted neck surgery to the thyroid can contribute to shortened surgical time in the case of benign thyroid nodules. VANS has contributed to excellent cosmetic outcomes for hemithyroidectomy, but significantly extended compared with conventional surgery. The lateral approach should be selected to shorten surgical time for hemithyroidectomy in VANS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Muneki Hotomi
- Corresponding author. Tel.: + 81-73-441-0651 (business phone); fax: + 81-73-446-3846.
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Pantvaidya G, Joshi S, Nayak P, Kannan S, DeSouza A, Poddar P, Prakash G, Vijaykumaran P, Nair D, Vaish R, Patkar S, Niyogi D, Joshi P, Chaudhari V, Singh V, Mathews S, Pramesh CS, Badwe RA, Puri A. Surgical Site Infections in patients undergoing major oncological surgery during the COVID-19 paNdemic (SCION): A propensity-matched analysis. J Surg Oncol 2021; 125:327-335. [PMID: 34729779 PMCID: PMC8661874 DOI: 10.1002/jso.26738] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 11/10/2022]
Abstract
Background and Objectives There are reports of outcomes of elective major cancer surgery during the COVID‐19 pandemic. We evaluated if reinforcement of hand hygiene, universal masking, and distancing as a part of pandemic precautions led to a decrease in the incidence of surgical site infections (SSIs) in major oncologic resections. Methods Propensity score matching using the nearest neighbor algorithm was performed on 3123 patients over seven covariates (age, comorbidities, surgery duration, prior treatment, disease stage, reconstruction, and surgical wound type) yielding 2614 matched (pre‐COVID 1612 and COVID 1002) patients. Conditional logistic regression was used to identify if SSI incidence was lower amongst patients operated during the pandemic. Results There was a 4.2% (p = 0.006) decrease in SSI in patients operated during the pandemic. On multivariate regression, surgery during the COVID‐19 period (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.61–0.98; p = 0.03), prior chemoradiation (OR = 2.46; CI = 1.45–4.17; p < 0.001), duration of surgery >4 h (OR = 2.17; 95%CI = 1.55–3.05; p < 0.001) and clean contaminated wounds (OR = 2.50; 95% CI = 1.09–2.18; p = 0.012) were significantly associated with SSI. Conclusion Increased compliance with hand hygiene, near‐universal mask usage, and social distancing during the COVID‐19 pandemic possibly led to a 23% decreased odds of SSI in major oncologic resections. Extending these low‐cost interventions in the post‐pandemic era can decrease morbidity associated with SSI in cancer surgery.
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Affiliation(s)
- Gouri Pantvaidya
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Shalaka Joshi
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Prakash Nayak
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Sadhana Kannan
- Clinical Research Secreteriat, Advanced Centre for Treatment, Research and Education in Cancer, Mumbai, India
| | - Ashwin DeSouza
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Pabashi Poddar
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Gagan Prakash
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Preeti Vijaykumaran
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Deepa Nair
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Richa Vaish
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Shraddha Patkar
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Devayani Niyogi
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Poonam Joshi
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Vikram Chaudhari
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Vikas Singh
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Saumya Mathews
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Rajendra A Badwe
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Ajay Puri
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
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Prospective Creation and Validation of the PREVENTT (Prediction and Enaction of Prevention Treatments Trigger) Scale for Surgical Site Infections (SSIs) in Patients With Diverticulitis. Ann Surg 2020; 270:1124-1130. [PMID: 29916880 DOI: 10.1097/sla.0000000000002859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Create and validate diverticulitis surgical site infection prediction scale. BACKGROUND Surgical site infections cause significant morbidity after colorectal surgery. An infection prediction scale could target infection prevention bundles to high-risk patients. METHODS Prospectively collected National Surgical Quality Improvement Program and electronic medical record data obtained on diverticulitis colectomy patients across a Healthcare Network-wide Colorectal Surgery Collaborative (5 hospitals). Patients with and without surgical site infections were compared. Predictive variables were identified using logistic regression model; model estimates obtained through 1000 bootstrap replications for scale validation. RESULTS A total of 1737 colectomies were performed (2010-2016): mean age 59.9 years (SD 12.7), 56.4% female; 93.4% Caucasian; smokers 16.3%, diabetics 7.7%, steroid use 6.0%. Two hundred thirty-one (13.3%) were presented to operating room emergently and 138 (7.9%) with abscess at time of disease admission. Two hundred ninety-six patients underwent Hartman procedures, and 113 (6.5%) received diverted primary anastomosis. Average length of stay was 6.9 days (standard deviation 7.01), 30-day mortality was 1.5%, anastomotic leak rate was 3.1%. Twenty-one percent of patients (n = 366) developed a surgical site infection. Several predictors for infection were identified: obesity (body mass index >30), advanced age (>70 years), diabetes mellitus, preoperative abscess, open surgery, emergent operations, and prolonged operations (>3 h). Creation of protected anastomosis in emergent settings was associated with increased infection rates. Presence of more than 5 risk factors was associated with infection rates of 45.8% (c = 0.69). CONCLUSIONS Patients with diverticulitis have high surgical site infection rates due to nonmodifiable risk factors. Our Prediction and Enaction of Prevention Treatments Trigger scale can risk stratify patients for targeting surgical site infection prevention bundles and outcomes risk adjustments.
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Hagihara M, Kusachi S, Kato Y, Yamagishi Y, Niitsuma T, Mikamo H, Takesue Y, Sumiyama Y. Current status of post-operative infections due to antimicrobial-resistant bacteria after digestive tract surgery in Japan: Japan Postoperative Infectious Complications Survey in 2015 (JPICS'15). Surg Today 2019; 50:56-67. [PMID: 31399783 DOI: 10.1007/s00595-019-01857-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/01/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE We herein report the findings of the Japan Postoperative Infectious Complication Survey in 2015 (JPICS'15), which evaluated the rate of post-operative infections and colonization due to antimicrobial-resistant (AMR) bacteria after digestive tract surgery. METHODS This survey by the Japan Society of Surgical Infection included patients undergoing digestive tract surgery at 28 centers between September 2015 and March 2016. Data included patient background characteristics, type of surgery, contamination status, and type of post-operative infections, including surgical site infections (SSIs), remote infections (RIs), and colonization. RESULTS During the study period, 7,565 surgeries (of 896 types) were performed; among them, 905 cases demonstrated bacteria after digestive tract surgery. The survey revealed that post-operative infections or colonization by AMR bacteria occurred in 0.9% of the patient cohort, constituting 7.5% of post-operative infections, including 5.6% of SSIs and 1.8% of RIs. Extended-spectrum β-lactamase-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus were the predominant AMR bacteria isolated from patients after digestive tract surgery. Patients infected with AMR bacteria had a poor prognosis. CONCLUSION Our results reveal that 7.5% of the post-operative infections were due to AMR bacteria, indicating the need for antibacterial coverage against AMR bacteria in patients with critical post-operative infections.
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Affiliation(s)
- Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Shinya Kusachi
- Department of Surgery, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Yukiko Kato
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Toru Niitsuma
- Department of Surgery, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan.
| | - Yoshio Takesue
- Department of Infection Prevention and Control, Hyogo College of Medicine, Hyogo, Japan
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Niitsuma T, Kusachi S, Takesue Y, Mikamo H, Asai K, Watanabe M. Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015. Ann Gastroenterol Surg 2019; 3:276-284. [PMID: 31131356 PMCID: PMC6524110 DOI: 10.1002/ags3.12236] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/08/2018] [Accepted: 01/03/2019] [Indexed: 01/27/2023] Open
Abstract
AIM To survey postoperative infections (PI) after digestive surgery. METHODS This survey, conducted by the Japan Society of Surgical Infection, included patients undergoing digestive surgery at 28 centers between September 2015 and March 2016. Data collected included patient background characteristics, type of surgery, contamination status, and type of PI, including surgical site infection (SSI), remote infection (RI), and antimicrobial-resistant (AMR) bacterial infections and colonization. RESULTS Postoperative infections occurred in 10.7% of 6582 patients who underwent digestive surgery (6.8% for endoscopic surgery and 18.7% for open surgery). SSI and RI, including respiratory tract infection, urinary tract infection, antibiotic-associated diarrhea, drain infection, and catheter-related bloodstream infection, occurred in 8.9% and 3.7% of patients, respectively. Among all PI, 13.2% were overlapping infections. The most common overlapping infections were incisional and organ/space SSI, which occurred in 4.2% of patients. AMR bacterial infections occurred in 1.2% of patients after digestive surgery and comprised 11.5% of all PI. Rate of AMR bacterial colonization after digestive surgery was only 0.3%. CONCLUSION Periodic surveillance of PI, including AMR bacteria, is necessary for a detailed evaluation of nosocomial infections.
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Affiliation(s)
- Toru Niitsuma
- Department of SurgeryToho University Graduate School of MedicineTokyoJapan
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Shinya Kusachi
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Yoshio Takesue
- Department of Infection Prevention and ControlHyogo College of MedicineHyogoJapan
| | - Hiroshige Mikamo
- Department of Clinical Infectious DiseasesAichi Medical UniversityAichiJapan
| | - Koji Asai
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Manabu Watanabe
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
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10
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Huh JW, Lee WY, Park YA, Cho YB, Kim HC, Yun SH, Chun HK. Oncological outcome of surgical site infection after colorectal cancer surgery. Int J Colorectal Dis 2019; 34:277-283. [PMID: 30426197 DOI: 10.1007/s00384-018-3194-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study evaluated the oncological outcome of surgical site infection (SSI) after colorectal cancer surgery. METHODS A total of 3675 consecutive patients with colorectal cancer who underwent curative resection from January 2009 to December 2011 were analyzed. The prognostic significance of SSI was evaluated. Risk factors for SSI were also identified using multivariate regression analysis. RESULTS Overall SSI rate was 9.6%, in which 5.5% was superficial or deep SSI and 4.1% was organ/space SSI. Incidence of SSI varied significantly with tumor location (P < 0.001): 7.1% in colon cancer and 14.0% in rectal cancer. With a median follow-up period of 49.8 months, the 5-year disease-free survival rates of patients without and with SSI were 87% and 83%, respectively (P = 0.018). SSI predicted disease-free survival in univariate analysis. However, SSI was not an independent predictor of survival in multivariate analysis. Body mass index, ASA score, preoperative WBC count, rectal tumor, open surgery, operation time, and transfusion during surgery were independent predictors of SSI. CONCLUSION SSI predicted disease-free survival in colorectal cancer patients following curative surgery. Patient' demographics, tumor characteristics, and perioperative conditions were independently associated with an increased likelihood of SSI.
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Affiliation(s)
- Jung Wook Huh
- Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Woo Yong Lee
- Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Yoon Ah Park
- Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Yong Beom Cho
- Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hee Cheol Kim
- Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Seong Hyeon Yun
- Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Lachance S, Abou-Khalil M, Vasilevsky CA, Ghitulescu G, Morin N, Faria J, Boutros M. Outcomes of Ileal Pouch Excision: an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Analysis. J Gastrointest Surg 2018; 22:2142-2149. [PMID: 30066066 DOI: 10.1007/s11605-018-3844-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/13/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study aimed to define the incidence and risk factors of postoperative morbidity and mortality after pouch excision (PE). METHODS ACS-NSQIP database was queried for patients who underwent PE between 2005 and 2015. Main outcome measures were 30-day mortality, major morbidity, overall surgical site infections (SSI), reoperation, and length of stay (LOS). Risk factors associated with these outcomes were assessed using multivariate logistic or quantile regression. RESULTS Three hundred eighty-one patients underwent PE (mean age 47.7(±15.3) years; 51.7% female). Mean body mass index (BMI) was 24.6(±5.7) kg/m2, 55.4% were ASA class 1-2 and 18.4% were immunosuppressed. Mean operative time was 252(±112.7) min, 98% were elective cases, and median LOS was 7(5-11) days. Twenty-eight percent experienced major morbidity, including SSIs (21.5% overall, 9.2% superficial, 3.7% deep, 10.3% organ space), sepsis (9.5%), urinary tract infection (5.8%), and postoperative pneumonia (2.4%). The observed venous thromboembolism rate was low, with 0.5 and 0.8% of patients suffering pulmonary embolism and deep vein thrombosis, respectively; 5.5% required reoperation. Postoperative mortality was 0.8%. On multivariate logistic regression, smoking (OR 3.03 [95% CI 1.56, 5.88]) and operative time (OR 1.003 [95% CI 1.0003, 1.0005) were associated with increased odds of major morbidity. Smoking (OR 3.29 [95% CI 1.65, 6.54]) and operative time (OR 1.002 [95% CI 1.000, 1.004]) were independent risk factors for overall SSI. LOS was significantly increased in patients with major morbidity (3.29 days [95% CI 1.60, 4.99]) and increased operative time (0.013 days [95% CI 0.007, 0.018]). CONCLUSIONS PE is an operation with significant risk of morbidity. However, mortality was low in the present cohort of patients. Patients who were smokers and had longer operative time had increased risk of overall infectious complications and major morbidity. Furthermore, major morbidity and operative time were associated with increased hospital length of stay following PE.
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Affiliation(s)
- Sebastien Lachance
- Division of Colorectal Surgery, Jewish General Hospital, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Maria Abou-Khalil
- Division of Colorectal Surgery, Jewish General Hospital, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Carol-Ann Vasilevsky
- Division of Colorectal Surgery, Jewish General Hospital, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Gabriela Ghitulescu
- Division of Colorectal Surgery, Jewish General Hospital, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Nancy Morin
- Division of Colorectal Surgery, Jewish General Hospital, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Julio Faria
- Division of Colorectal Surgery, Jewish General Hospital, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Marylise Boutros
- Division of Colorectal Surgery, Jewish General Hospital, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada.
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Gill A, Farwell DG, Moore MG. Nutrition and Perioperative Care for the Patient with Head and Neck Cancer. Oral Maxillofac Surg Clin North Am 2018; 30:411-420. [DOI: 10.1016/j.coms.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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13
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Cheng H, Chen BPH, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt) 2017; 18:722-735. [PMID: 28832271 PMCID: PMC5685201 DOI: 10.1089/sur.2017.089] [Citation(s) in RCA: 419] [Impact Index Per Article: 59.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: The incidence of surgical site infection (SSI) across surgical procedures, specialties, and conditions is reported to vary from 0.1% to 50%. Operative duration is often cited as an independent and potentially modifiable risk factor for SSI. The objective of this systematic review was to provide an in-depth understanding of the relation between operating time and SSI. Patients and Methods: This review included 81 prospective and retrospective studies. Along with study design, likelihood of SSI, mean operative times, time thresholds, effect measures, confidence intervals, and p values were extracted. Three meta-analyses were conducted, whereby odds ratios were pooled by hourly operative time thresholds, increments of increasing operative time, and surgical specialty. Results: Pooled analyses demonstrated that the association between extended operative time and SSI typically remained statistically significant, with close to twice the likelihood of SSI observed across various time thresholds. The likelihood of SSI increased with increasing time increments; for example, a 13%, 17%, and 37% increased likelihood for every 15 min, 30 min, and 60 min of surgery, respectively. On average, across various procedures, the mean operative time was approximately 30 min longer in patients with SSIs compared with those patients without. Conclusions: Prolonged operative time can increase the risk of SSI. Given the importance of SSIs on patient outcomes and health care economics, hospitals should focus efforts to reduce operative time.
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Affiliation(s)
| | | | | | - Nicole C Ferko
- 2 Cornerstone Research Group , Burlington, Ontario, Canada
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Yamashita K, Takeno S, Hoshino S, Shiwaku H, Aisu N, Yoshida Y, Tanimura S, Yamashita Y. Triclosan sutures for surgical site infection in colorectal cancer. J Surg Res 2016; 206:16-21. [DOI: 10.1016/j.jss.2016.06.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/31/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
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Nurain AM, Bilal NE, Ibrahim ME. The frequency and antimicrobial resistance patterns of nosocomial pathogens recovered from cancer patients and hospital environments. Asian Pac J Trop Biomed 2015. [DOI: 10.1016/j.apjtb.2015.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol 2015; 37:88-99. [PMID: 26503187 DOI: 10.1017/ice.2015.249] [Citation(s) in RCA: 341] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the independent association between diabetes and surgical site infection (SSI) across multiple surgical procedures. DESIGN Systematic review and meta-analysis. METHODS Studies indexed in PubMed published between December 1985 and through July 2015 were identified through the search terms "risk factors" or "glucose" and "surgical site infection." A total of 3,631 abstracts were identified through the initial search terms. Full texts were reviewed for 522 articles. Of these, 94 articles met the criteria for inclusion. Standardized data collection forms were used to extract study-specific estimates for diabetes, blood glucose levels, and body mass index (BMI). A random-effects meta-analysis was used to generate pooled estimates, and meta-regression was used to evaluate specific hypothesized sources of heterogeneity. RESULTS The primary outcome was SSI, as defined by the Centers for Disease Control and Prevention surveillance criteria. The overall effect size for the association between diabetes and SSI was odds ratio (OR)=1.53 (95% predictive interval [PI], 1.11-2.12; I2, 57.2%). SSI class, study design, or patient BMI did not significantly impact study results in a meta-regression model. The association was higher for cardiac surgery 2.03 (95% PI, 1.13-4.05) compared with surgeries of other types (P=.001). CONCLUSIONS These results support the consideration of diabetes as an independent risk factor for SSIs for multiple surgical procedure types. Continued efforts are needed to improve surgical outcomes for diabetic patients. Infect. Control Hosp. Epidemiol. 2015;37(1):88-99.
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Segal CG, Waller DK, Tilley B, Piller L, Bilimoria K. An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery. Surgery 2014; 156:1253-60. [PMID: 25178993 DOI: 10.1016/j.surg.2014.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/12/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most studies and national programs aggregate the different types of surgical site infections (SSIs) potentially masking and misattributing risk. Determining that risk factors for superficial, deep, and organ space SSIs are unique is essential to improve SSI rates. METHODS This cohort study utilized data of 59,365 patients who underwent colon resection at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2007 to 2009. Four independent, multivariable, predictive models were developed to assess the unique associations between risk factors and each SSI group: Superficial, deep, organ space, and an aggregate of all 3 types of SSIs. RESULTS Overall, 13% of colon cases developed SSIs: Superficial (8%), deep (1.4%), and organ space (3.8%). Each model was different. Morbidly obese patients were more likely to develop SSIs than normal weight patients across all models; however, risk factors common to all models (eg, body mass index [BMI], duration of operation, wound class, laparoscopic approach) had very different levels of risk. Unique risks for superficial SSIs include diabetes, chronic obstructive pulmonary disease, and dyspnea. Deep SSIs had the greatest magnitude of association with BMI and the greatest incidence of wound disruption (19.8%). Organ space SSIs were often owing to anastomotic leaks and were uniquely associated with disseminated cancer, preoperative dialysis, preoperative radiation treatment, and a bleeding disorder, suggesting a physically frail or compromised patient may put the anastomosis at risk. CONCLUSION Risk factors for superficial, deep, and organ space SSI differ. More effective prevention strategies may be developed by reporting and examining each type of SSI separately.
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Affiliation(s)
- Cynthia G Segal
- University of Texas at MD Anderson Cancer Center, Houston, TX.
| | | | - Barbara Tilley
- The University of Texas School of Public Health, Houston, TX
| | - Linda Piller
- The University of Texas School of Public Health, Houston, TX
| | - Karl Bilimoria
- Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Evanston, IL
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Mallol M, Sabaté A, Dalmau A, Koo M. Risk factors and mortality after elective and emergent laparatomies for oncological procedures in 899 patients in the intensive care unit: a retrospective observational cohort study. Patient Saf Surg 2013; 7:29. [PMID: 24007279 PMCID: PMC3847296 DOI: 10.1186/1754-9493-7-29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/28/2013] [Indexed: 11/17/2022] Open
Abstract
Background Abdominal surgeries for cancer are associated with postoperative complications and mortality. A view of the success of anaesthetic, surgical and critical care can be gained by analyzing factors associated with mortality in patients admitted to intensive care units (ICUs). The objective of this study was to identify the postoperative mortality rate and the causes of perioperative death in high-risk patients after abdominal surgery for cancer. A secondary objective was to explore possible risk factors for death in scheduled and emergency surgeries, with a view to finding guidance on preventable risk factors. Methods An observational study, in a 12-bed surgical ICU of a tertiary hospital. Patients admitted after abdominal surgery for cancer to the ICU for more than 24 hours’ care were included from January 1, 2008–December 31, 2009. Data were extracted from the minimum basic dataset. The main outcome considered was 90-day mortality. Results Of 899 patients included, 80 (8.9%) died. Seven died within 48 hours of surgery, 18 died between 2 and 7 days, and 55 died after 7 days. Non-survivors were older and had more respiratory comorbidity, chronic liver disease, metastasis, and underwent more palliative procedures. 112 patients underwent emergency surgery; mortality in these patients for resection surgery was 32.5%; in the 787 patients who underwent scheduled surgery, mortality was 4.7% for resection procedures. The estimated odds ratios (95% confidence interval) of preoperative patient factors in emergency surgery confirmed a negative association between survival and older age 0.96 (0.91–1), the presence of respiratory comorbidity 0.14 (0.02–0.77) and metastasis 0.18 (0.05–0.6). After scheduled surgery, survival was negatively associated with age 0.93 (0.90–0.96) and chronic liver disease 0.40 (0.17–0.91). Analysis of complications after emergency surgery also indicated a negative association with sepsis 0.03 (0.003–0.32), respiratory events 0.043 (0.011–0.17) and cardiac events 0.11 (0.027–0.45); after scheduled surgery, respiratory 0.03 (0.01–0.08) and cardiac 0.11 (0.02–0.45) events, renal failure 0.02 (0.006–0.14) and neurological events 0.06 (0.007–0.5). Conclusions As most deaths occurred after discharge from the ICU, postoperative sepsis, respiratory and cardiac events should be watched carefully on the ward.
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Affiliation(s)
- Montserrat Mallol
- Department of Anaesthesia, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona Health Campus, Barcelona, Spain.
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Predictive model for surgical site infection risk after surgery for high-energy lower-extremity fractures: development of the risk of infection in orthopedic trauma surgery score. J Trauma Acute Care Surg 2013; 74:1521-7. [PMID: 23694882 DOI: 10.1097/ta.0b013e318292158d] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current infection risk scores are not designed to predict the likelihood of surgical site infection after orthopedic fracture surgery. We hypothesized that the National Nosocomial Infections Surveillance (NNIS) System and the Study on the Efficacy of Nosocomial Infection Control (SENIC) scores are not predictive of infection after orthopedic fracture surgery and that risk factors for infection can be identified and a new score created (Emerg Infect Dis. 2003;9:196-203). METHODS We conducted a secondary analysis of data from a trial involving internal fixation of 235 tibial plateau, pilon, and calcaneus fractures treated between 2007 and 2010 at a Level I trauma center. The predictive value of the NNIS System and SENIC scores was evaluated based on areas under the receiver operating characteristic (ROC) curve. Bivariate and multiple logistic regression analyses were used to build an improved prediction model, creating the Risk of Infection in Orthopedic Trauma Surgery (RIOTS) score. The predictive value of the RIOTS score was evaluated via the ROC curve. RESULTS NNIS System and SENIC scores were not predictive of surgical site infection after orthopedic fracture surgery. In our final regression model, the relative odds of infection among patients with AO [Arbeitsgemeinschaft für Osteosynthesefragen] type C3 or Sanders type 4 fractures compared with fractures of lower classification was 5.40. American Society of Anesthesiologists class 3 or higher and body mass index less than 30 were also predictive of infection, with odds ratios of 2.87 and 3.49, respectively. The area under the ROC curve for the RIOTS score was 0.75, significantly higher than the areas for the NNIS System and SENIC scores. CONCLUSION The NNIS System and SENIC scores were not useful in predicting the risk of infection after fixation of fractures. We propose a new score that incorporates fracture classification, American Society of Anesthesiologists classification, and body mass index as predictors of infection. LEVEL OF EVIDENCE Prognostic study, level II.
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Current World Literature. Curr Opin Support Palliat Care 2013; 7:116-28. [DOI: 10.1097/spc.0b013e32835e749d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hübner M, Cima RR. Colorectal Surgical Site Infections: Risk Factors and a Systematic Review of Prevention Strategies. SEMINARS IN COLON AND RECTAL SURGERY 2012. [DOI: 10.1053/j.scrs.2012.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cima R, Dankbar E, Lovely J, Pendlimari R, Aronhalt K, Nehring S, Hyke R, Tyndale D, Rogers J, Quast L. Colorectal surgery surgical site infection reduction program: a national surgical quality improvement program--driven multidisciplinary single-institution experience. J Am Coll Surg 2012; 216:23-33. [PMID: 23127793 DOI: 10.1016/j.jamcollsurg.2012.09.009] [Citation(s) in RCA: 188] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 08/31/2012] [Accepted: 09/12/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical site infections (SSI) are a major cause of morbidity in surgical patients and they increase health care costs considerably. Colorectal surgery is consistently associated with high SSI rates. No single intervention has demonstrated efficacy in reducing colorectal SSIs. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a nationally validated system that uses clinically abstracted data on surgical patients and their outcomes to assist participating institutions drive quality improvement. STUDY DESIGN A multidisciplinary team was assembled to develop a colorectal SSI-reduction bundle at an academic tertiary care medical center. The ACS NSQIP data were used to identify patterns of SSIs during a 2-year period. Multiple interventions across the entire surgical episode of care were developed and implemented in January 2011. Monthly ACS NSQIP data were used to track progress. RESULTS Our ACS NSQIP overall colorectal SSI rate for 2009 and 2010 was 9.8%. One year after implementation of the SSI reduction bundle, we demonstrated a significant decline (p < 0.05) in both overall and superficial SSIs, to 4.0% and 1.5%, respectively. Organ space infections declined to 2.6%, which was not a significant change (p = 0.10). During the entire analysis period (2009 to 2011), there was no change in our colorectal-specific Surgical Care Improvement Program performance. CONCLUSIONS Using our ACS NSQIP colorectal SSI outcomes, a multidisciplinary team designed a colorectal SSI reduction bundle that resulted in a substantial and sustained reduction in SSIs. Our study is not able to identify which specific elements contributed to the reduction.
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Affiliation(s)
- Robert Cima
- Department of Surgery, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Evidence for Practice. AORN J 2012. [DOI: 10.1016/j.aorn.2012.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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