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AlRiyami FM, Al-Rawajfah OM, Al Sabei S, Al Sabti HA, Khalaf A. Healthcare costs and outcomes associated with surgical site infections after coronary artery bypass grafting surgeries in Oman. Ann Med 2023; 55:793-799. [PMID: 36856585 PMCID: PMC9980033 DOI: 10.1080/07853890.2023.2184486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) after coronary artery bypass graft (CABG) surgeries is considered a key indicator of the quality of healthcare services. OBJECTIVE This study aimed to estimate the healthcare outcomes associated with SSIs after CABG surgeries in Oman in terms of mortality rate, case-fatality rate, LOS, readmission rate and healthcare costs. METHODS The nested case-control study design was used based on retrospective data, which was conducted from 2016 to 2017. The case group encompassed all CABG patients with confirmed SSIs within 30 days of the surgery (n = 104) while controls were CABG patients without SSIs (n = 404). RESULTS Forty-four (42.3%) of the SSI patients were readmitted to the hospital compared to eight (2%) of the control group (p < .001). Patients in the case group had a longer LOS (M = 24.4, SD = 44.6 days) compared to those in the control group (M = 11, SD = 21 days, p = .003). The mean healthcare costs of cases (M = Omani Rial [OMR] 3823, SD = OMR 2516) were significantly greater than controls (M = OMR 3154, SD = OMR 1415, p = .010). CONCLUSION Results from this study can be baseline data for formulating new hypotheses and testing the causal relationship between SSIs after CABG surgeries and the readmission rate, LOS and health care costs.Key messagesSurgical Site Infections (SSIs) are still a major complication after cardiac surgeries in Oman.SSIs after cardiac surgeries are associated with substantially increased healthcare costs and length of stay.SSIs after cardiac surgeries are associated with negative outcomes such as mortality and case-fatality rates.
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Affiliation(s)
- Fatma M AlRiyami
- Cardiothoracic Unit, Sultan Qaboos University Hospital, Muscat, Oman
| | | | | | - Hilal A Al Sabti
- Cardiothoracic Unit, Sultan Qaboos University Hospital, Muscat, Oman
| | - Atika Khalaf
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.,Department of Nursing, Fatima College of Health Sciences, Ajman, United Arab Emirates
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Akintoye OO, Fasina OP, Adiat TS, Nwosu PU, Olubodun MO, Adu BG. Outcomes of Coronary Artery Bypass Graft Surgery in Africa: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e47541. [PMID: 37881326 PMCID: PMC10597594 DOI: 10.7759/cureus.47541] [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] [Accepted: 10/18/2023] [Indexed: 10/27/2023] Open
Abstract
Coronary artery bypass graft (CABG) surgery has been in practice for many decades, and it is one of the most commonly performed cardiac surgeries worldwide. While there are several studies reporting data on perioperative outcomes following CABG in developed countries, there is a staggering paucity of data and evidence reporting the outcomes in developing areas such as Africa. Thus, it is important to study the practice and outcome of CABG in Africa to establish its clinical efficacy and safety in this region and identify factors that might be limiting its practice. The overall aim of this study is to identify all relevant clinical data on CABG in Africa and report on the perioperative outcomes and practice of CABG in the African population. Electronic search was performed using three online databases, PubMed, African Journal Online, and Research Gate, from inception to June 2023. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline was utilised for this study. Relevant studies fulfilling predefined eligibility criteria were included in the study. Intraoperative details, such as the number of grafts performed, operative, bypass, and cross-clamp time, were reported. The primary endpoint assessed were early mortality and overall mortality. The secondary endpoints included length of hospital stay, intensive care unit stay, and postoperative complications, such as renal impairment, atrial fibrillation, and surgical site infection. The data were pooled together and meta-analyzed using a random effect model for proportions and mean for meta-analysis with R software (version 4.3.1 (2023-06-16); R Development Core Team, Vienna, Austria). This systematic review identified 42 studies that fulfilled the study eligibility criteria, including 21 randomised controlled trials, 20 observational studies, and one cross-sectional study. Only four out of the 54 countries in Africa had studies carried out that met the criteria for this review; they included Algeria, Egypt, Nigeria, and South Africa, with a majority from Egypt. Meta-analysis reported a pooled early mortality and pooled overall mortality of 3.51% and 3.73%, respectively, for the total cohort of patients. The result of this meta-analysis suggests that mortality outcomes following CABG in Africa are relatively higher than those in developed nations. Several issues, such as lack of financial resources and poor infrastructure, continue to hinder the optimal practice of CABG procedures in many parts of Africa. Further studies focused on finding factors associated with outcomes following CABG should be done. Though there were a few limitations to the study largely from a lack of data from several regions and countries in Africa, the result from this meta-analysis can serve as a benchmark for future studies until more relevant data are reported.
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Affiliation(s)
| | - Oyinlola P Fasina
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
| | - Tijani S Adiat
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
| | - Promise U Nwosu
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
| | | | - Bukola G Adu
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
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Hweidi IM, Zytoon AM, Hayajneh AA, Al Obeisat SM, Hweidi AI. The effect of intraoperative glycemic control on surgical site infections among diabetic patients undergoing coronary artery bypass graft (CABG) surgery. Heliyon 2021; 7:e08529. [PMID: 34926859 PMCID: PMC8646993 DOI: 10.1016/j.heliyon.2021.e08529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/06/2021] [Accepted: 11/29/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Perioperative poor glycemic control in diabetic patients undergoing Coronary Artery Bypass Graft (CABG) surgery has been associated with infectious complications, particularly surgical site infections that are linked with adverse health surgical outcomes. The purpose of this study was to investigate the effect of two different intraoperative glycemic control protocol, tight and conventional, on thirty-day postoperative surgical site infection (SSI) rates among diabetic patients undergoing CABG surgery. DESIGN A randomized controlled trial (RCT) design was employed in the study, with a convenience sample of 144 adult patients who were scheduled to undergo coronary artery bypass grafting surgery. SETTING A main referral heart institute in Amman, Jordan. PARTICIPANTS Subjects were randomly assigned to either the tight glycemic control group (n = 72), which maintained an intraoperative blood glucose level of 110-149 mg/dl via continuous intravenous insulin infusion, or the conventional glycemic control group (n = 72), which maintained an intraoperative blood glucose level of 150-180 mg/dl via continuous intravenous insulin infusion. The postoperative SSIs among both groups were evaluated and compared by independent blinded physicians. RESULTS The primary findings of this study indicated no statistically significant difference between the two treatment groups in terms of SSI rates and their potential adverse surgical outcomes (p = 0.512). CONCLUSION Nurses should consider the glycemic stability and glycemic control approach to minimize adverse surgical outcomes post CABG surgery. Healthcare providers should also carefully consider diabetic patients who have undergone CABG surgery and are at risk of developing postoperative SSIs. CLINICALTRIALSGOV IDENTIFIER NCT04451655 was retrospectively registered in 30/06/2020.
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Affiliation(s)
- Issa M. Hweidi
- Faculty of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, P. O. Box 3030, Irbid 22110, Jordan
| | - Ala M. Zytoon
- Faculty of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, P. O. Box 3030, Irbid 22110, Jordan
| | - Audai A. Hayajneh
- Faculty of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, P. O. Box 3030, Irbid 22110, Jordan
| | - Salwa M. Al Obeisat
- Faculty of Nursing, Maternal-Child Health Nursing Department, Jordan University of Science and Technology, P. O. Box 3030, Irbid 22110, Jordan
| | - Aysam I. Hweidi
- Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan
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Al-Kharabsheh R, Ahmad M. Skin and mucous membranes colonisation with Staphylococcus aureus or MRSA as a risk factor for surgical site infections in elective Caesarean Section. J OBSTET GYNAECOL 2021; 42:888-893. [PMID: 34558382 DOI: 10.1080/01443615.2021.1954147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to determine if skin and mucous membrane colonisation with Staphylococcus aureus (S. aureus) and methicillin-resistant Staphylococcus aureus (MRSA) increases the incidence of surgical site infection (SSI) post-elective Caesarean Sections. A prospective study was conducted at a major centre in Jordan, involving 127 patients who underwent elective Caesarean Section surgeries during 2019. Participants were screened for skin and mucous membranes colonisation for S. aureus preoperatively and were followed for 90 days for any signs of SSI. The screening sites were on three parts of the patients' bodies; nose, throat, and groyne. The total SSI incidence was 18.9%. Among participants with SSI; 66.7% had a superficial infection and 33.3% had deep tissue infection. Skin and mucous membrane colonisation was positive in 42 participants (33.1%) in one of the three screening sites. Participants with positive skin and mucous membrane colonisation were found to have SSI incidence 2.43 times more than the non-colonised participants (Fisher's Exact test = 3.832, p = .05, CI: 0.098-6.02). Participants with S. aureus skin and mucous membranes colonisation were significantly 2.94 times with more SSI incidence than those who were not colonised (Fisher's Exact test = 5.485, p = .02, CI: 1.164-7.439). Skin and mucous membrane colonisation was found to increase the incidence of SSI. More attention should be performed to screen for skin and mucous membranes colonisation and subsequent selective skin decolonisation to decrease SSI incidence.IMPACT STATEMENTWhat is already known on this subject? Surgical site infection (SSI) is a challenge that increases the costs of health care. Surgical site infection is associated with high costs mainly due to the increase in the length of hospital stay. Skin screening for S. aureus or MRSA colonisation was found to be important for selective skin decolonisation using appropriate antiseptic preparation and preoperative antibiotic prophylaxis.What do the results of this study add? The incidence of SSI in the colonised group was found to be 2.43 times higher than in the non-colonised group.What are the implications of these findings for clinical practice and/or further research? Screening for colonisation and subsequent selective skin decolonisation should be a part of SSI prevention policies.
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Affiliation(s)
- Randa Al-Kharabsheh
- Critical Care Nursing, Jordanian Royal Medical Services/Army Forces, Amman, Jordan
| | - Muayyad Ahmad
- Clinical Nursing, Department School of Nursing, The University of Jordan, Amman, Jordan
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Monahan M, Jowett S, Pinkney T, Brocklehurst P, Morton DG, Abdali Z, Roberts TE. Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden. PLoS One 2020; 15:e0232960. [PMID: 32497086 PMCID: PMC7272045 DOI: 10.1371/journal.pone.0232960] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/24/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is a worldwide problem which has morbidity, mortality and financial consequences. The incidence rate of SSI is high in Low- and Middle-Income countries (LMICs) compared to high income countries, and the costly surgical complication can raise the potential risk of financial catastrophe. OBJECTIVE The aim of the study is to critically appraise studies on the cost of SSI in a range of LMIC studies and compare these estimates with a reference standard of high income European studies who have explored similar SSI costs. METHODS A systematic review was undertaken using searches of two electronic databases, EMBASE and MEDLINE In-Process & Other Non-Indexed Citations, up to February 2019. Study characteristics, comparator group, methods and results were extracted by using a standard template. RESULTS Studies from 15 LMIC and 16 European countries were identified and reviewed in full. The additional cost of SSI range (presented in 2017 international dollars) was similar in the LMIC ($174-$29,610) and European countries ($21-$34,000). Huge study design heterogeneity was encountered across the two settings. DISCUSSION SSIs were revealed to have a significant cost burden in both LMICs and High Income Countries in Europe. The magnitude of the costs depends on the SSI definition used, severity of SSI, patient population, choice of comparator, hospital setting, and cost items included. Differences in study design affected the comparability across studies. There is need for multicentre studies with standardized data collection methods to capture relevant costs and consequences of the infection across income settings.
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Affiliation(s)
- Mark Monahan
- NIHR Global Health and Global Surgery Unit, Institute of Translational Medicine, Heritage Building, University of Birmingham, Birmingham, England, United Kingdom
- Health Economics Unit, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Susan Jowett
- Health Economics Unit, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Thomas Pinkney
- Birmingham Surgical Trials Consortium, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Peter Brocklehurst
- NIHR Global Health and Global Surgery Unit, Institute of Translational Medicine, Heritage Building, University of Birmingham, Birmingham, England, United Kingdom
- Birmingham Surgical Trials Consortium, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Dion G. Morton
- NIHR Global Health and Global Surgery Unit, Institute of Translational Medicine, Heritage Building, University of Birmingham, Birmingham, England, United Kingdom
- Birmingham Surgical Trials Consortium, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Zainab Abdali
- Health Economics Unit, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Tracy E. Roberts
- NIHR Global Health and Global Surgery Unit, Institute of Translational Medicine, Heritage Building, University of Birmingham, Birmingham, England, United Kingdom
- Health Economics Unit, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
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Hweidi IM, Barbarawi MA, Tawalbeh LI, Al-Hassan MA, Al-Ibraheem SW. Surgical site infections after craniotomy: a matched health-care cost and length of stay study. J Wound Care 2019; 27:885-890. [PMID: 30557106 DOI: 10.12968/jowc.2018.27.12.885] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess the extra health-care costs and length of stay resulting from surgical site infection (SSI), as well as to identify the most frequent aetiological microorganisms of SSIs among Jordanian craniotomy surgery patients. METHOD A retrospective, descriptive, correlational and nested 1:1 matched case-control design was used. A computerised list of patients, who underwent surgery between May 2009 and March 2015, was generated in the targeted hospital. A final bill for every selected patient was also determined. Patients were divided equally into two groups: patients with an SSI and patients without an SSI. RESULTS A total of 64 patients were recruited. The SSI-group had a significant higher mean health-care cost of $7,899.08 (p=0.001) and a longer stay in hospital (mean additional days: 23.17) than the non-SSI group. Furthermore, Acinetobacter baumannii and Staphylococcus aureus were determined as the most predominant causative agents of SSI, at 39.1% and 26.1% of SSI patients, respectively. CONCLUSION The results of this study can be considered as a baseline for national benchmarking to evaluate the quality of care provided to targeted patients. This study should encourage nurse administrators to adopt protocols and strategies that promote infection control measures, as well as to develop new methods of surveillance on universal precautions adherence. This may limit pathogen contamination in the surgical wound, shorten length of stay and decrease health-care costs.
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Affiliation(s)
- Issa M Hweidi
- Associate Professor; Faculty of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, Jordan
| | - Mohammed Al Barbarawi
- Professor of Neurosurgery; Faculty of Medicine, Department of Neurosurgery, Jordan University of Science and Technology, Jordan
| | - Loai Issa Tawalbeh
- Assistant Professor; Faculty of Nursing, Adult Health Nurisng Department, Al-Albayt University, Jordan
| | - Musa A Al-Hassan
- Associate Professor; Faculty of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, Jordan
| | - Saba W Al-Ibraheem
- Clinical Nurse Instructor, Faculty of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, Jordan
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Abdou E, Westercamp M, Girgis S, Sabry M, Sayyouh O, Talaat M. Sternal surgical site infection in Egypt following coronary artery bypass graft surgery: incidence and risk factors. J Hosp Infect 2018; 100:456-458. [PMID: 29981777 PMCID: PMC11360105 DOI: 10.1016/j.jhin.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022]
Affiliation(s)
- E Abdou
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Cairo, Egypt.
| | - M Westercamp
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Girgis
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M Sabry
- Ain Shams University Hospitals, Cairo, Egypt
| | - O Sayyouh
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Cairo, Egypt
| | - M Talaat
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Cairo, Egypt
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Musallam E. The predictors of surgical site infection post cardiac surgery: A systematic review. JOURNAL OF VASCULAR NURSING 2014; 32:105-18. [DOI: 10.1016/j.jvn.2014.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/04/2014] [Accepted: 01/06/2014] [Indexed: 11/29/2022]
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