scholarly journals Economic Burden of Surgical Site Infections at a European University Hospital

2008 ◽  
Vol 29 (7) ◽  
pp. 623-629 ◽  
Author(s):  
Walter P. Weber ◽  
Marcel Zwahlen ◽  
Stefan Reck ◽  
Chantal Feder-Mengus ◽  
Heidi Misteli ◽  
...  
Keyword(s):  
Control Patient ◽  
Economic Burden ◽  
Risk Index ◽  
Hospital Setting ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Case Control ◽  
University Hospital ◽  
The Mean ◽  
European University

Objective.To quantify the economic burden of in-hospital surgical site infections (SSIs) at a European university hospital.Design.Matched case-control study nested in a prospective observational cohort study.Setting.Basel University Hospital in Switzerland, where an average of 28,000 surgical procedures are performed per year.Methods.All in-hospital occurrences of SSI associated with surgeries performed between January 1, 2000, and December 31, 2001, by the visceral, vascular, and traumatology divisions at Basel University Hospital were prospectively recorded. Each case patient was matched to a control patient by age, procedure code, and National Nosocomial Infection Surveillance System risk index. The case-control pairs were analyzed for differences in cost of hospital care and in provision of specialized care.Results.A total of 6,283 procedures were performed:187 SSIs were detected in inpatients, 168 of whom were successfully matched with a control patient. For case patients, the mean additional hospital cost was SwF19,638 (95% confidence interval [CI], SwF8,492–SwF30,784); the mean additional postoperative length of hospital stay was 16.8 days (95% CI, 13–20.6 days); and the mean additional in-hospital duration of antibiotic therapy was 7.4 days (95% CI, 5.1–9.6 days). Differences were primarily attributable to organ space SSIs (n = 76).Conclusions.Ina European university hospital setting, SSIs are costly and constitute a heavy and potentially preventable burden on both patients and healthcare providers.

scholarly journals The Economic Burden of Coronavirus Disease 2019 (COVID-19): Evidence from Iran

2020 ◽  
Author(s):  
Mohsen Ghaffari Darab ◽  
Khosro Keshavarz ◽  
Elnaz Sadeghi ◽  
Javad Shahmohamadi ◽  
Zahra Kavosi
Keyword(s):  
Economic Burden ◽  
Indirect Costs ◽  
Premature Death ◽  
University Hospital ◽  
Fars Province ◽  
Income Loss ◽  
Cross Sectional ◽  
Accounting Information Systems ◽  
Economic Production ◽  
The Mean

Abstract This study aimed to estimate both direct medical and indirect costs of treating the Coronavirus disease 2019 (COVID-19) from a societal perspective in the patients at a referral hospital in Fars province as well as the economic burden of COVID-19 in Iran in 2020.Methods:This is a partial economic evaluation and a cross-sectional cost-description study conducted descriptively-analytically and based on the data of the COVID-19 patients referred to a referral university hospital in Fars province between March and July 2020. The data were collected by examining the patients' records and accounting information systems. The subjects included all the inpatients with COVID-19 (477 individuals) who admitted to the medical centre during the four months. Bottom-up costing, incidence-based and income-based human capital approaches were used as the main methodological features of this study.Results: The mean direct medical costs were estimated 28,240,025,968 Rials ($ 1,791,172) in total and 59,203,409 Rials ($ 3,755) per person, a significant part of which (41 %) was that of intensive and general care beds (11,596,217,487 Rials equal to $ 735,510. (The second to which were the costs of medicines and medical consumables (28 %). The mean indirect costs including income loss due to premature death, economic production loss due to hospitalization and job absenteeism during recovery course were estimated 129,870,974 Rials ($ 11634) per person. Furthermore, the economic burden of the disease in the country for inpatient cases with the definitive diagnosis was 22,688,925,933,095 Rial equal to $ 1,439,083,784.Conclusion: The results of this study showed that the severe status of the disease would bring about the extremely high cost of illness in this case. It is estimated that the high prevalence rate of COVID-19 has been imposing a heavy economic burden on the country and health system directly that may result in rationing or painful cost-control approaches.

scholarly journals Roux-en-Y Gastric Bypass as a Treatment for Barrett’s Esophagus after Sleeve Gastrectomy

2019 ◽  
Vol 30 (4) ◽  
pp. 1273-1279 ◽  
Author(s):  
Daniel M. Felsenreich ◽  
Felix B. Langer ◽  
Christoph Bichler ◽  
Magdalena Eilenberg ◽  
Julia Jedamzik ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Hospital Setting ◽  
University Hospital ◽  
Demeester Score ◽  
The Mean ◽  
Multi Center Study ◽  
Acid Exposure Time

Abstract Background Laparoscopic sleeve gastrectomy (SG) is the most frequently performed bariatric procedure today. While an increasing number of long-term studies report the occurrence of Barrett’s esophagus (BE) after SG, its treatment has not been studied, yet. Objectives The aim of this study was to evaluate Roux-en-Y gastric bypass (RYGB) as treatment for BE and reflux after SG. Setting University hospital setting, Austria Methods This multi-center study includes all patients (n = 10) that were converted to RYGB due to BE after SG in Austria. The mean interval between SG and RYGB was 42.7 months. The follow-up after RYGB in this study was 33.4 months. Gastroscopy, 24 h pH-metry, and manometry were performed and patients were asked to complete the BAROS and GIQLI questionnaires. Results Weight and BMI at the time of SG was 120.8 kg and 45.1 kg/m2. Eight patients (80.0%) went into remission of BE after the conversion to RYGB. Two patients had RYGB combined with hiatoplasty. The mean acid exposure time in 24 h decreased from 36.8 to 3.8% and the mean DeMeester score from 110.0 to 16.3. Patients scored 5.1 on average in the BAROS after conversion from SG to RYGB which denotes a very good outcome. Conclusions RYGB is an effective therapy for patients with BE and reflux after SG. Its outcomes in the current study were BE remission in the majority of cases as well as a decrease in reflux activity. Further studies with larger cohorts are necessary to confirm these findings.

scholarly journals EPIDEMIOLOGICAL PROFILE OF MOTORCYCLE ACCIDENT VICTIMS IN UNIVERSITY HOSPITAL

2020 ◽  
Vol 28 (2) ◽  
pp. 97-99
Author(s):  
CINTIA KELLY BITTAR ◽  
ALBERTO CLIQUET JÚNIOR ◽  
VINÍCIUS SAMUEL DIAS ALVES DA COSTA ◽  
ANA CAROLINA DE FREITAS PACHECO ◽  
RENATO LAZARIN RICCI
Keyword(s):  
Medical Records ◽  
Tibial Fracture ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
University Hospital ◽  
Multiple Fractures ◽  
Level Of Evidence ◽  
Motorcycle Accident ◽  
The Mean ◽  
Epidemiological Profile

ABSTRACT Objective: To evaluate the epidemiological profile of motorcycle accident victims in a metropolis with more than one million inhabitants attended in a university hospital of reference in 2017. Methods: a retrospective study through the analysis of medical records of 105 motorcycle accident victims in Campinas (SP) attended in a university hospital of reference and who needed surgical procedure in 2017. Results: 87 patients (82.9%) were men. Multiple fractures were observed in 61 patients (58.1%) and polytrauma was found in 14 patients (13.3%). Tibial fracture was the most frequent, present in 65 cases (61.9%). Exposed fractures occurred in 68 patients (64.7%). Among the polytrauma victims, the most frequent injury was traumatic brain injury (TBI), present in seven patients (6.6%). The mean age was 29.8 years (range 6-63 years). The average length of hospital stay was 14 days (1-87). Conclusion: It is essential to investigate and evaluate the victims’ epidemiological profile, as well as the resulting injuries, in order to provide adequate support for the implementation of measures aimed at primary prevention and awareness of the most affected groups. Level of Evidence II, Prognostic studies - Investigating the effect of a patient characteristic on the outcome of disease.

Prolongation of Hospital Stay and Additional Costs Due to Nosocomial Bloodstream Infection in an Algerian Neonatal Care Unit

2008 ◽  
Vol 29 (11) ◽  
pp. 1066-1070 ◽  
Author(s):  
Mohamed Lamine Atif ◽  
Fetta Sadaoui ◽  
Abdeldjallil Bezzaoucha ◽  
Chawki Ahmed Kaddache ◽  
Rachida Boukari ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Bloodstream Infection ◽  
Length Of Hospital Stay ◽  
Developed Countries ◽  
Neonatal Care ◽  
Additional Cost ◽  
University Hospital ◽  
Nosocomial Bloodstream Infection ◽  
The Mean

Background.Previous studies from developed countries reported that nosocomial bloodstream infection (BSI) in neonatal care units (NCUs) increases length of stay and costs. However, no such information is available for Algerian NCUs.Objective.To evaluate the influence of BSI in neonates on additional charges and length of hospital stay.Design.Prospective, nested case-control study.Setting.The 47-bed NCU of the University Hospital of Blida, Algeria.Patients and Methods.A total of 83 neonates with BSIs (case patients) and 166 neonates without BSIs (control patients), admitted to the NCU during the study period (April 2004 through December 2007), were matched for sex, birth weight, length of NCU stay, and year of hospital admission. Each patient's length of stay in the NCU was obtained prospectively on daily rounds. The estimated cost of each NCU-day was provided by the hospital's finance department. The cost of antibiotics prescribed was provided by the hospital's pharmacy department.Results.The mean additional length of NCU stay for case patients, compared with control patients, was 9.2 days (24.3 vs 15.1 days). The mean additional cost of antibiotics was $546. The mean cumulative additional cost was $1,315.Conclusion.This study highlights the effect of BSI on extra costs for NCU patients, especially costs due to prolongation of hospital stay and increased antibiotic use, and suggests that NCUs in Algeria have a financial interest in reducing the rate of BSI.

Intraoperatively Testing the Anastomotic Integrity of Esophagojejunostomy Using Methylene Blue

2016 ◽  
Vol 106 (1) ◽  
pp. 62-67 ◽  
Author(s):  
S. Celik ◽  
N. Almalı ◽  
A. Aras ◽  
Ö. Yılmaz ◽  
R. Kızıltan
Keyword(s):  
Methylene Blue ◽  
Hospital Setting ◽  
Length Of Hospital Stay ◽  
Leakage Rate ◽  
University Hospital ◽  
Nasojejunal Tube ◽  
Methylene Blue Test ◽  
Group 2 ◽  
Clinical Leakage ◽  
Group 1

Background: Intraoperative testing of gastrointestinal anastomosis effectively ensures anastomotic integrity. This study investigated whether the routine use of methylene blue intraoperatively identified leaks to reduce the postoperative proportion of clinical leaks. Methods: This study retrospectively analyzed consecutive total gastrectomies performed from January 2007 to December 2014 in a university hospital setting by a general surgical group that exclusively used the methylene blue test. All surgeries were performed for gastric or junctional cancers (n = 198). All reconstructions (Roux-en Y esophagojejunostomy) were performed using a stapler. The methylene blue test was used in 108 cases (group 1) via a nasojejunal tube. No test was performed for the other 90 cases (group 2). Intraoperative leakage rate, postoperative clinical leakage rate, length of hospitalization, and mortality rate were the outcome measures. Results: The intraoperative leakage rate was 7.4% in group 1. The postoperative clinical leakage rate was 8.6%. The postoperative clinical leakage rate was 3.7% in group 1 and 14.4% in group 2 (p = 0.007). There were no postoperative clinical leaks when an intraoperative leak led to concomitant intraoperative repair. The median length of hospital stay was 6 days in group 1 and 8 days in group 2 (p < 0.001). One death occurred in each group. No test-related complications were observed. Conclusion: The methylene blue test for esophagojejunostomy is a safe and reliable method for the assessment of anastomosis integrity, especially in cases with difficult esophagojejunostomic construction.

scholarly journals The Socioeconomic Impact of Surgical Site Infections

2021 ◽  
Vol 9 ◽  
Author(s):  
Emmanuel Piednoir ◽  
Joan Robert-Yap ◽  
Patrice Baillet ◽  
Emilie Lermite ◽  
Niki Christou
Keyword(s):  
Economic Burden ◽  
Surgical Site Infections ◽  
Socioeconomic Impact ◽  
Risk Of Infection ◽  
Control And Prevention ◽  
Prevention Guidelines ◽  
The Mean ◽  
Mean Cost ◽  
French Cohort ◽  
Type Of Surgery

Précis: Surgical site infections are an ever-increasing phenomenon worldwide due to different factors. This brief report aimeds to highlight at a glance, for both physicians and political and institutional leaders, the economic burden of surgical site infections.Objectives: This brief report aimed to highlight the economic burden of surgical site infections (SSIs).Methods: A narrative review focusing on this subject has been carried out.Results: Surgical site infections are responsible for generating important costs. In 2017, a French cohort highlighted a mean cost of each SSI treatment to be around €1,814; the same year, the Centers for Disease Control and Prevention guidelines evaluated the mean cost caused by SSI treatment to be from $10,443 to $25,546 per SSI. This cost depends on many factors including the patient himself and the type of surgery.Conclusions: Prevention of the risk of infection is, therefore, a profitable concept for surgery that must be integrated within all healthcare managements worldwide.

scholarly journals Epidemiology of Surgical Site Infections With Staphylococcus aureus in Europe: Protocol for a Retrospective, Multicenter Study (Preprint)

2017 ◽  
Author(s):  
Sibylle C Mellinghoff ◽  
Jörg Janne Vehreschild ◽  
Blasius J Liss ◽  
Oliver A Cornely
Keyword(s):  
Staphylococcus Aureus ◽  
Surgical Procedures ◽  
Economic Burden ◽  
Surgical Site Infections ◽  
Case Control ◽  
Control Population ◽  
Surgical Patient ◽  
Hernia Surgery ◽  
Multicenter Cohort Study ◽  
Number Of Patients

BACKGROUND Surgical site infections (SSIs) are among the most common hospital acquired infections. While the incidence of SSI in certain indicator procedures is the subject of ongoing surveillance efforts in hospitals and health care systems around the world, SSI rates vary markedly within surgical categories and are poorly represented by routinely monitored indicator procedures (eg, mastectomy or hernia surgery). Therefore, relying on indicator procedures to estimate the burden of SSI is imprecise and introduces bias as hospitals may take special precautions to achieve lower SSI rates. The most common cause of SSI is Staphylococcus aureus (S. aureus), as recently confirmed by a Europe-wide point-prevalence study conducted by the European Centre for Disease Prevention and Control (ECDC). OBJECTIVE The primary objective of this study is to determine the overall and procedure-specific incidence of S. aureus SSI in Europe. Secondary objectives are the overall and procedure-specific outcomes as well as the economic burden of S. aureus SSI in Europe. Explorative objectives are to characterize the composition of the surgical patient population and to estimate the number of patients at risk for S. aureus SSI. METHODS A retrospective, multinational, multicenter cohort study (Staphylococcus aureus Surgical Site Infection Multinational Epidemiology in Europe [SALT] study) with a nested case-control part will be conducted. The study will include all surgical procedures at a participating center in order to prevent selection bias and strengthen the understanding of SSI risk by determining the incidence for all common surgical procedures. Data will be assessed in the cohort population, including 150,000 adult patients who underwent any surgical procedure in 2016, and the case-control population. We will match patients establishing S. aureus SSI 1:1 with controls from the same center. Data on demographics, surgery, and microbiology will be exported from electronic files. More detailed data will be captured from the case-control population. The SALT study will include 13 major or academic surgical centers in Europe, comprising 3 in France, 4 in Germany, 2 in Italy, 3 in Spain, and 1 in the United Kingdom. Sites were selected using a feasibility questionnaire. RESULTS The SALT study is currently recruiting patients. The aim is to complete recruitment in February 2018 and to close the database in September 2018. The final results are expected by the end of 2018. CONCLUSIONS Results of the SALT study will help to better understand the precise risk of certain procedures. They will also provide insight into the overall and procedure-specific incidence and outcome as well as the economic burden of S. aureus SSI in Europe. Findings of the study may help guide the design of clinical trials for S. aureus vaccines. CLINICALTRIAL ClinicalTrials.gov NCT03353532; https://clinicaltrials.gov/ct2/show/NCT03353532 (Archived by WebCite at http://www.webcitation.org/6xAK3gVmO)

scholarly journals Surgical site infections in adults patients undergoing of clean and contaminated surgeries at a university Brazilian hospital

2010 ◽  
Vol 47 (4) ◽  
pp. 383-387 ◽  
Author(s):  
Maria de Lourdes Gonçalves Santos ◽  
Renata Rezende Teixeira ◽  
Augusto Diogo-Filho
Keyword(s):  
Surgical Site Infection ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Infection Risk ◽  
University Hospital ◽  
Site Infection ◽  
Global Index ◽  
Post Discharge ◽  
Infection Surveillance

CONTEXT: Surgical site infections are a risk inherent to surgical procedures, especially after digestive surgeries. They occur up to 30 days after surgery, or up to a year later if a prosthesis is implanted. The Surgical-site Infection Risk Index (SIRI), NISS (National Nosocomial Infection Surveillance) methodology, is a method to evaluate the risk of surgical site infections, which takes into account the potential contamination of the surgery, the patient's health status and surgery duration. OBJECTIVES: To evaluate the correlation between the surgical-site infection risk index score on the 1st day postoperatively, and the development of surgical site infection up to 30 days postoperatively. METHODS: The postoperative surgical site infections (NNIS) was evaluated by following-up in hospital and as an outpatient. The patients followed prospectively were those submitted to elective surgeries, clean (hernioplasties) or contaminated (colorretal), performed by conventional approach at a university hospital, during the period from June 2007 to August 2008. The mean age of the patients was 55.5 years, 133 (65.5%) male; 120 (59.1%) submitted to clean surgeries and 83 (40.9%) contaminated. RESULTS: The global index of surgical site infections was 10.3%; 10 (8.3%) in clean procedures and 111(3.2%) in contaminated ones. Four (19.1%) of the surgical site infections were diagnosed at the time of hospitalization and 17 (80.9%) at post-discharge follow-up. Twelve (57.1%) of the surgical site infections were superficial, 2 (9.5%) deep and 7 (33.3%) at a specific site. Of these, 5 (6.6%) were in patients classified as SIRI 0 (76); 9 (15%) for SIRI 1 (60); 5 (9.1%) for SIRI 2 (55) and 2 (16.7%) for SIRI 3. CONCLUSION: The global index of surgical site infections and its incidence among contaminated procedures are within the expected limits. On the other hand according to SIRI, the surgical site infection indexes are above the expected standards both for the clean and for the contaminated procedures.

Pain prevalence in a university hospital in Iceland

2012 ◽  
Vol 3 (3) ◽  
pp. 184-184
Author(s):  
S. Zoëga ◽  
S. Ward ◽  
T. Aspelund ◽  
H. Sveinsdóttir ◽  
G. Sigurdsson ◽  
...  
Keyword(s):  
Pain Management ◽  
Severe Pain ◽  
Hospital Setting ◽  
Pain Severity ◽  
University Hospital ◽  
Surgical Services ◽  
Pain Prevalence ◽  
The Mean ◽  
And Gender

Abstract Background/aims Despite multiple efforts to improve practice, pain is prevalent in many hospital settings causing unnecessary complications and suffering. The aim of the study was to explore the epidemiology of pain in a university hospital in Iceland. Methods A point prevalence study was conducted in 23 departments in medical and surgical services in a 650 bed university hospital in January 2011. Data was collected from medical charts and with a questionnaire (APS-POQ-R) assessing pain severity and quality of pain management. Participants had to be 18 years or older, hospitalized for at least 24 h, speak Icelandic, alert, and able to participate. Results Of the 369 participants the mean (SD) age was 67.9 (17.6) years (range 18–100) and gender proportions were equal. Response rate was 80%. Of patients in pain (scoring ≥1 on a 0–10 scale) the mean (SD) worst pain severity was 5.6 (2.5). Total pain prevalence was 80.4%, but of patients in pain 36.5% had mild (1–4) pain, 22.6% moderate (5–6) and 40.9% had severe (7–10) pain. The mean (SD) proportion of time spent in severe pain was 25.9% (27.0%). Pain was both more prevalent, [χ2(1, N= 367) = 7.05, p = 0.008] and severe [t(365) =−4.16, p = 0.000] in women compared to men. Similarly, pain was more prevalent [χ2(1, N= 368) = 9.71, p = 0.002] and severe [t(216,2) =−3.18, p = 0.002] in surgical services compared to medical. Worst pain severity was weakly negatively associated with age [r(369) =−0.23, p = 0.000]. Worst pain severity was higher in patients receiving pain medications [t(357) =−9.84, p = 0.000] and in patients using non-pharmacological methods to treat their pain [t(311.7) =−5.76, p = 0.000]. Conclusions Pain was prevalent in the hospital and an unsatisfactory proportion of patients experienced moderate to severe pain. The quality of pain management in the hospital needs to be improved. Further studies are needed to test and evaluate the efficacy and effectiveness of interventions aimed at advancing pain practice in the hospital setting.

Extra-abdominal removal of placenta during cesarean section: a prospective randomized controlled trial of a novel technique

2016 ◽  
Vol 44 (5) ◽  
Author(s):  
Baris Kaya ◽  
Onur Guralp ◽  
Korkut Daglar ◽  
Abdullah Tuten ◽  
Aygul Demirol ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Cesarean Section ◽  
Controlled Trial ◽  
Abdominal Cavity ◽  
Length Of Hospital Stay ◽  
University Hospital ◽  
Estimated Blood Loss ◽  
Delivery Technique ◽  
The Mean

AbstractTo evaluate intraoperative and early postoperative outcomes of a novel placenta delivery technique; extra-abdominal removal vs. intra-abdominal removal of the placenta during cesarean section (CS).A total of 210 women delivering by CS at term in a tertiary university hospital between March 2014 and January 2015 were randomized to extra-abdominal removal vs. intra-abdominal removal of the placenta. The women were randomly allocated to the extra- (group 1) or intra-abdominal removal group (group 2) according to random sampling method, where women with even and odd numbers were allocated to intra- and extra-abdominal groups, respectively. The amount of intra-abdominal hemorrhagic fluid accumulation, the duration of operation and estimated blood loss during operation were the primary outcomes. The secondary outcomes included the mean difference between pre- and post-operative hemoglobin and hematocrit levels, the mean postoperative pain score, any additional need of analgesia, postoperative bowel function, postoperative endometritis and wound infections.The amount of aspirated hemorrhagic fluid was significantly higher in the intra-abdominal group compared to the extra-abdominal group (34.6±22.2 mL vs. 9.4±4.8 mL, P<0.001). Mean duration of the operation, intraoperative blood loss, postoperative requirement of additional analgesia, postoperative pain scores, postoperative endometritis or wound infection, and length of hospital stay were not significantly different between the intra- and extra-abdominal placental removal groups.By extra-abdominal removal of the placenta, the accumulation of bloody fluid in the abdominal cavity is significantly less compared to the intra-abdominal removal method, which, in turn, provides avoidance of excessive mounted-gauze use, intra-abdominal manipulations, or iatrogenic trauma.

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