Risk Factors for Surgical Site Infection Complicating Laminectomy

Objective.To examine risk factors for surgical site infection (SSI) following spinal surgery and to analyze the associations between a surgeon's years of operating experience and surgical specialty and patients' SSI risk.Design.Case-control study.Setting.A tertiary care facility and a community hospital in Durham, North Carolina.Patients.Each case patient who developed an SSI complicating laminectomy was matched with 2 noninfected control patients by hospital, year of surgery, and National Nosocomial Infection Surveillance System risk index score.Results.Forty-one case patients with SSI complicating laminectomy and 82 matched control patients were analyzed. Nonwhite race, diabetes and an elevated body mass index (BMI) were more common among case patients than among control patients. Subjects with a BMI greater than 35 were more likely to undergo a prolonged procedure, compared with case patients who had a BMI of 35 or less. The SSI rate for patients operated on by neurosurgeons was 28%, compared with 43% for patients operated on by orthopedic surgeons (odds ratio [OR], 0.5; P = .12). The number of years of operating experience were not associated with SSI risk. Multivariate analysis revealed diabetes (OR, 4.2 [95% confidence interval {CI}, 1.1-16.3]; P = .04), BMI greater than 35 (OR, 7.1 [95% CI, 1.8-28.3]; P = .005), and laminectomy at a level other than cervical (OR, 6.7 [95% CI, 1.4-33.3]; P = .02) as independent risk factors for SSI following laminectomy.Conclusion.Diabetes, obesity, and laminectomy at a level other than cervical are independent risk factors for SSI following laminectomy. Preoperative weight loss and tight perioperative control of blood glucose levels may reduce the risk of SSI in laminectomy patients.

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Independent risk factors for surgical site infection after cesarean delivery in a rural tertiary care medical center

Journal of Anesthesia ◽

10.1007/s00540-016-2266-2 ◽

2016 ◽

Vol 31 (1) ◽

pp. 120-126 ◽

Cited By ~ 6

Author(s):

Manuel C. Vallejo ◽

Ahmed F. Attaallah ◽

Robert E. Shapiro ◽

Osama M. Elzamzamy ◽

Michael G. Mueller ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Cesarean Delivery ◽

Medical Center ◽

Tertiary Care ◽

Site Infection ◽

Tertiary Care Medical Center ◽

Independent Risk Factors

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Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country

The Journal of South Asian Federation of Menopause Societies ◽

10.5005/jp-journals-10032-1100 ◽

2017 ◽

Vol 5 (1) ◽

pp. 23-27

Author(s):

Erum S Khan ◽

Sheikh Irfan ◽

Natasha Khalid

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Cancer Patients ◽

Developing Country ◽

Gynecologic Oncology ◽

Tertiary Care ◽

Gynecologic Cancer ◽

Care Facility ◽

Site Infection ◽

Tertiary Care Facility

ABSTRACT Introduction Surgical site infections (SSIs) are among the most common complications in surgical patients and have serious consequences for outcomes and costs. There is a dearth of information on risk factors for developing SSI in patients undergoing gynecologic cancer surgery, and this has not been studied using national data. Objectives The objectives of this study were to estimate the prevalence, preoperative and operative risk factors associated with the higher risk of SSIs in gynecologic cancer patients undergoing surgery in a tertiary care facility in a developing country. Setting Department of Obstetrics and Gynaecology, Aga Khan University Hospitals, Karachi, Sindh, Pakistan. Materials and methods Retrospective record review of gynecologic oncology patients admitted for surgery from January 2015 to December 2015 was performed. Results A total of 100 patients met the inclusion criteria. Of these, 15 were identified with SSIs, which were all found to be of the superficial type. Approximately, 44, 40, and 7% were diagnosed with endometrial, ovarian, and cervical cancers respectively. The mean time from surgery to developing SSI was 12.9 days. Among endometrial cancer, 22.7% (10/44) had SSI compared with 7.5% (3/40) for ovarian cancer and 14.2% (1/7) for cervical cancer. The significant predictors of SSI were body mass index ≥35 (p-value <0.004), endometrial cancer diagnosis, the American Society of Anesthesiologists class more than 3, modified surgical complexity scoring system 3 to 4, and blood sugar levels more than 180 mg/dL within 48 hours after surgery in known diabetics. Conclusion About 15% of patients undergoing laparotomy for gynecologic malignancy developed SSIs. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSIs, and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery. How to cite this article Khan ES, Irfan S, Khalid N. Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country. J South Asian Feder Menopause Soc 2017;5(1):23-27.

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Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section

Infection Control and Hospital Epidemiology ◽

10.1086/587810 ◽

2008 ◽

Vol 29 (6) ◽

pp. 477-484 ◽

Cited By ~ 103

Author(s):

Margaret A. Olsen ◽

Anne M. Butler ◽

Denise M. Willers ◽

Preetishma Devkota ◽

Gilad A. Gross ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Surgical Site Infection ◽

Tertiary Care ◽

University Teaching ◽

Skin Closure ◽

Care Hospital ◽

Site Infection ◽

Increased Risk ◽

Independent Risk Factors

Background.Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI.Objective.To determine independent risk factors for SSI after low transverse cesarean section.Design.Retrospective case-control study.Setting.Barnes-Jewish Hospital, a 1,250-bed tertiary care hospital.Patients.A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001.Methods.Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department, we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System. Control patients without SSI or endomyometritis were randomly selected from the population of patients who underwent cesarean section. Independent risk factors for SSI were determined by logistic regression.Results.SSIs were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section. Independent risk factors for SSI included development of subcutaneous hematoma after the procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval {CI}, 4.1–33.2]), operation performed by the university teaching service (aOR, 2.7 [95% CI, 1.4–5.2]), and a higher body mass index at admission (aOR, 1.1 [95% CI, 1.0–1.1]). Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1–0.5]). Use of staples for skin closure was associated with a marginally increased risk of SSI.Conclusions.These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery.

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Developing a Risk Stratification Model for Surgical Site Infection after Abdominal Hysterectomy

Infection Control and Hospital Epidemiology ◽

10.1086/606166 ◽

2009 ◽

Vol 30 (11) ◽

pp. 1077-1083 ◽

Cited By ~ 47

Author(s):

Margaret A. Olsen ◽

James Higham-Kessler ◽

Deborah S. Yokoe ◽

Anne M. Butler ◽

Johanna Vostok ◽

...

Keyword(s):

Risk Factors ◽

Health Insurance ◽

Blood Transfusion ◽

Risk Stratification ◽

Surgical Site Infection ◽

Private Health Insurance ◽

Abdominal Hysterectomy ◽

Site Infection ◽

Independent Risk Factors ◽

Duration Of Operation

Objective.The incidence of surgical site infection (SSI) after hysterectomy ranges widely from 2% to 21%. A specific risk stratification index could help to predict more accurately the risk of incisional SSI following abdominal hysterectomy and would help determine the reasons for the wide range of reported SSI rates in individual studies. To increase our understanding of the risk factors needed to build a specific risk stratification index, we performed a retrospective multihospital analysis of risk factors for SSI after abdominal hysterectomy.Methods.Retrospective case-control study of 545 abdominal and 275 vaginal hysterectomies from July 1, 2003, to June 30, 2005, at 4 institutions. SSIs were defined by using Centers for Disease Control and Prevention/National Nosocomial Infections Surveillance criteria. Independent risk factors for abdominal hysterectomy were identified by using logistic regression.Results.There were 13 deep incisional, 53 superficial incisional, and 18 organ-space SSIs after abdominal hysterectomy and 14 organ-space SSIs after vaginal hysterectomy. Because risk factors for organ-space SSI were different according to univariate analysis, we focused further analyses on incisional SSI after abdominal hysterectomy. The maximum serum glucose level within 5 days after operation was highest in patients with deep incisional SSI, lower in patients with superficial incisional SSI, and lowest in uninfected patients (median, 189, 156, and 141 mg/dL, respectively; P = .005). Independent risk factors for incisional SSI included blood transfusion (odds ratio [OR], 2.4) and morbid obesity (body mass index [BMI], >35; OR, 5.7). Duration of operation greater than the 75th percentile (OR, 1.7), obesity (BMI, 30–35; OR, 3.0), and lack of private health insurance (OR, 1.7) were marginally associated with increased odds of SSI.Conclusions.Incisional SSI after abdominal hysterectomy was associated with increased BMI and blood transfusion. Longer duration of operation and lack of private health insurance were marginally associated with SSI.

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Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

BMC Infectious Diseases ◽

10.1186/s12879-020-05567-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xufei Zhang ◽

Zhiwei Wang ◽

Jun Chen ◽

Peige Wang ◽

Suming Luo ◽

...

Keyword(s):

Risk Factors ◽

Colorectal Surgery ◽

Surgical Site Infection ◽

Large Scale ◽

Risk Index ◽

Cross Sectional Study ◽

Site Infection ◽

Cross Sectional ◽

Medical Expenses ◽

Related Risk

Abstract Purposes Surgical site infection (SSI) after colorectal surgery is a frequent complication associated with the increase in morbidity, medical expenses, and mortality. To date, there is no nationwide large-scale database of SSI after colorectal surgery in China. The aim of this study was to determine the incidence of SSI after colorectal surgery in China and to further evaluate the related risk factors. Methods Two multicenter, prospective, cross-sectional studies covering 55 hospitals in China and enrolling adult patients undergoing colorectal surgery were conducted from May 1 to June 30 of 2018 and the same time of 2019. The demographic and perioperative characteristics were collected, and the main outcome was SSI within postoperative 30 days. Multivariable logistic regressions were conducted to predict risk factors of SSI after colorectal surgery. Results In total, 1046 patients were enrolled and SSI occurred in 74 patients (7.1%). In the multivariate analysis with adjustments, significant factors associated with SSI were the prior diagnosis of hypertension (OR, 1.903; 95% confidence interval [CI], 1.088–3.327, P = 0.025), national nosocomial infection surveillance risk index score of 2 or 3 (OR, 3.840; 95% CI, 1.926–7.658, P < 0.001), laparoscopic or robotic surgery (OR, 0.363; 95% CI, 0.200–0.659, P < 0.001), and adhesive incise drapes (OR, 0.400; 95% CI, 0.187–0.855, P = 0.018). In addition, SSI group had remarkably increased length of postoperative stays (median, 15.0 d versus 9.0d, P < 0.001), medical expenses (median, 74,620 yuan versus 57,827 yuan, P < 0.001), and the mortality (4.1% versus 0.3%, P = 0.006), compared with those of non-SSI group. Conclusion This study provides the newest data of SSI after colorectal surgery in China and finds some predictors of SSI. The data presented in our study can be a tool to develop optimal preventive measures and improve surgical quality in China.

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Incidence and risk factors for surgical site infection post-hysterectomy in a tertiary care center

American Journal of Infection Control ◽

10.1016/j.ajic.2016.10.008 ◽

2017 ◽

Vol 45 (3) ◽

pp. 284-287 ◽

Cited By ~ 10

Author(s):

Aurora Pop-Vicas ◽

Jackson S. Musuuza ◽

Michelle Schmitz ◽

Ahmed Al-Niaimi ◽

Nasia Safdar

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Site Infection

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DEMOGRAPHICS AND CORRELATION OF RISK FACTORS FOR HEPATOCELLULAR CARCINOMA IN PATIENTS PRESENTING TO A TERTIARY CARE FACILITY IN PAKISTAN

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i2.2724 ◽

2021 ◽

Vol 71 (2) ◽

pp. 614-18

Author(s):

Hafsa Rashid ◽

Laima Alam ◽

Muhammad Asif Farooq ◽

Muhammad Zafar Ali

Keyword(s):

Risk Factors ◽

Tumor Staging ◽

Tertiary Care ◽

Care Facility ◽

Decompensated Cirrhosis ◽

Military Hospital ◽

Continuous Variables ◽

Male Population ◽

Cross Sectional ◽

Tertiary Care Facility

Objective: Demographics of HCC in Pakistan. Correlation of HCC with its possible etiology. Correlation of tumoraggressiveness with PCR status and anti-viral treatment. Study Design: Cross sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi from Jul 2017 to Jun 2018. Methodology: Patients with age >18 years presenting with space occupying lesion(s) of liver were confirmed to be HCC according to standard guidelines. The variables such as age, gender, presence of cirrhosis, etiology of cirrhosis, tumor staging, viral status through PCR study and the treatment offered were documented. Baseline descriptive data was reported as mean with SD for continuous variables. Chi square test was used to compare qualitative data. Results: A total of 195 patients were enrolled for one year. Male population with HCC was in predominance (75.9%). Sixty one percent of the afflicted population was having liver cirrhosis, 34.9% had decompensated cirrhosis and 3.8% had no cirrhosis. HCV accounted for the bulk of patients with cirrhosis (82%) followed by HBV (9.2%), HBV and HCV co-infection (3.1%), NASH and cryptogenic cirrhosis (1.5% each). Majority got diagnosed with triphasic CECT scan Abdomen, only 3.6% needed liver biopsy for diagnosis. Majority (43.6%) belonged to BCLC B. Viral PCR was positive for 58.5% and 73.8% of the patients were treatment naïve. Conclusion: HCC shows highest rates seen in male patients presenting in old age. Gender, classes of cirrhosis, number of lesions, portal vein thrombosis and extrahepatic metastasis correlated with possible risk factors of HCC. Tumor aggressiveness correlated with PCR status..............

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Incidence of Surgical Site Infection among Post C Section Women Presented in Surgical Emergency of tertiary care hospital

10.53350/pjmhs211581836 ◽

2021 ◽

Vol 15 (8) ◽

pp. 1836-1837

Author(s):

S Aliza Z Bokhari ◽

M. Irfan Fazal ◽

Maha Naseem ◽

M. Adnan Mumtaz ◽

S. Mahum Z Bokhari ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Surgical Site Infection ◽

Tertiary Care ◽

Care Hospital ◽

Site Infection ◽

Surgical Emergency ◽

Key Factor ◽

Questionnaire Form ◽

Aseptic Conditions

Aim: To rule out incidence and risk factors that are associated with infection at site of surgery after cesarean section. Method: A type of retrospective study was conducted on 100 women who underwent cesarean delivery procedures within a period of 8 month from September 2020 to April 2021 and presented in surgical emergency at Mayo Hospital Lahore. The socioeconomic, demographic and clinical parameters of patients were collected by a questionnaire form. A program known as SPSS version 20 was used for analysis of data that is collected in study. Result: After analyzing the data following factors are identified that causes surgical site infection: Higher BMI (more than 30kg/m2), loss of blood during cesarean section(more than 500mL), poor hygienic care after cesarean section, poor socioeconomic status leads to malnutrition of patient and that leads to poor wound healing and surgical site infection. Lack of education is also a key factor in SSIs. Cesarean done in emergency under improper aseptic conditions also promote SSIs. All these factors are associated with incidence of SSI. Conclusion: SSIS are conventional among women presented in surgical emergency of Mayo Hospital Lahore within 30 days of cesarean section. Management of risk factors causing SSIs in women after cesarean section may decrease the incidence of such infections. Keywords: Cesarean section, risk factors, infection at surgery site.

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Prevalence and risk factors for surgical site infection after colorectal surgery: a multiple-center prospective study of 3,663 consecutive patients in China

10.21203/rs.2.20226/v1 ◽

2020 ◽

Author(s):

Yu Zhang ◽

Hui-Quan Gan ◽

Jing-Fang Zhou ◽

Ya-Jie Gong ◽

Liu-Yi Li ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Colorectal Surgery ◽

Surgical Site Infection ◽

Prevalence Rate ◽

Demographic Data ◽

Risk Index ◽

Klebsiella Pneumonia ◽

Site Infection ◽

Extended Spectrum Beta Lactamase

Abstract Background: Surgical site infection (SSI) after colorectal surgery (CRS) remains a significant problem for its negative clinical outcomes. However, it is poorly understood in China . This study aims to investigate the prevalence, risk factors and microbiology of SSI after CRS. Methods: A nationwide prospective multicenter design was applied. Patients in 19 Chinese hospitals from 2015 to 2018 were prospectively monitored for SSI after CRS. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using univariate and multivariate logistic regression models. Results: Among 3,663 study participants, 134(3.66%) episodes of SSI were identified. The prevalence rate of SSI decreased from 5.9 infections per 100 procedures in 2014 to 3.1 infections per 100 procedures in 2017 (prevalence rate ratio [PRR], 0.52; 95% CI, 0.28–0.94). The SSI rates were 1.88, 4.15, 6.27 and 11.58 per 100 operations for the National Nosocomial Infections Surveillance system (NNIS) risk index categories of 0, 1, and 2 or 3, respectively. Escherichia coli (54/134, 40.3%) and Klebsiella pneumoniae (10/134, 7.5%) were the most frequently isolated microorganisms. A high prevalence of antibiotic resistance were observed in our study, with rates of extended spectrum beta-lactamase-producing or carbapenem-resistant Escherichia coli and Klebsiella pneumonia of 50.0%(27/54) and 30.0%(3/10) respectively. Preoperative hospital stay ≥ 48h (OR=2.28, 95% CI: 1.03–5.02) and contaminated or dirty wound (OR=3.38, 95% CI: 1.88–6.06) were significantly associated with increasing risk of SSI after CRS. Conclusion: A statistically significant but modest decrease in the prevalence rate of CRS SSI over the 4-year study period was observed in this study. Noticeably, the relatively high rates of multidrug-resistant pathogens causing SSI after CRS should be alert despite of the small number of isolates identified in our survey.

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