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

2009 ◽  
Vol 30 (11) ◽  
pp. 1077-1083 ◽  
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.

Statewide Collaboration to Evaluate the Effects of Blood Loss and Transfusion on Surgical Site Infection after Hysterectomy

2012 ◽  
Vol 33 (1) ◽  
pp. 90-93 ◽  
Author(s):  
Heather Young ◽  
Crystal Berumen ◽  
Bryan Knepper ◽  
Amber Miller ◽  
Morgan Silverman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Surgical Site Infection ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Abdominal Hysterectomy ◽  
Public Reporting ◽  
Site Infection

We used mandatory public reporting as an impetus to perform a statewide study to define risk factors for surgical site infection. Among women who underwent abdominal hysterectomy, blood transfusion was a significant risk factor for surgical site infection in patients who experienced blood loss of less than 500 mL.Infect Control Hosp Epidemiol 2012;33(1):90-93

Risk Factors of Surgical Site Infection after Hepatic Resection

2014 ◽  
Vol 35 (3) ◽  
pp. 317-320 ◽  
Author(s):  
Tian Yang ◽  
Ping-An Tu ◽  
Han Zhang ◽  
Jun-Hua Lu ◽  
Yi-Nan Shen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Surgical Site Infection ◽  
Hepatic Resection ◽  
Site Infection ◽  
Independent Risk Factors

A study of 7,388 consecutive patients after hepatic resection between 2011 and 2012 identified hepatolithiasis, cirrhosis, and intraoperative blood transfusion as the only independent risk factors of both incisional and organ/space surgical site infection (SSI). Patients with these conditions should be cared for with caution to lower SSI rates.

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

2016 ◽  
Vol 31 (1) ◽  
pp. 120-126 ◽  
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

scholarly journals Risk Factors for Endometritis after Low Transverse Cesarean Delivery

2010 ◽  
Vol 31 (1) ◽  
pp. 69-77 ◽  
Author(s):  
Margaret A. Olsen ◽  
Anne M. Butler ◽  
Denise M. Willers ◽  
Gilad A. Gross ◽  
Preetishma Devkota ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Insurance ◽  
Cesarean Delivery ◽  
Low Socioeconomic Status ◽  
Private Health Insurance ◽  
Tertiary Care ◽  
Polynomial Method ◽  
Younger Age ◽  
Increased Risk ◽  
Independent Risk Factors

Objective.To determine independent risk factors for endometritis after low transverse cesarean delivery.Study Design.We performed a retrospective case-control study during the period from July 1999 through June 2001 in a large tertiary care academic hospital. Endometritis was defined as fever beginning more than 24 hours or continuing for at least 24 hours after delivery plus fundal tenderness in the absence of other causes for fever. Independent risk factors for endometritis were determined by means of multivariable logistic regression. A fractional polynomial method was used to examine risk of endometritis associated with the continuous variable, duration of rupture of membranes.Results.Endometritis was identified in 124 (7.7%) of 1,605 women within 30 days after low transverse cesarean delivery. Independent risk factors for endometritis included younger age (odds ratio [OR], 0.93 [95% confidence interval {CI}, 0.90-0.97]) and anemia or perioperative blood transfusion (OR, 2.18 [CI, 1.30-3.68] ). Risk of endometritis was marginally associated with a proxy for low socioeconomic status, lack of private health insurance (OR, 1.72 [CI, 0.99-3.00]); with amniotomy (OR, 1.69 [CI, 0.97-2.95]); and with longer duration of rupture of membranes.Conclusion.Risk of endometritis was independently associated with younger age and anemia and was marginally associated with lack of private health insurance and amniotomy. The odds of endometritis increased approximately 1.7-fold within 1 hour after rupture of membranes, but increased duration of rupture was only marginally associated with increased risk. Knowledge of these risk factors can guide selective use of prophylactic antibiotics during labor and heighten awareness of the risk in subgroups at highest risk of infection.

scholarly journals Liberal and Restrictive Blood Transfusion Strategies in Orthopedic Surgery: Risk Factors for Surgical Site Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s313-s314
Author(s):  
Hoberdan Pereira ◽  
Marcelo Perucci ◽  
Lucas de Lima ◽  
Daniel Bodour ◽  
Laura Vieira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Surgical Site Infection ◽  
Surgical Procedures ◽  
Orthopedic Surgery ◽  
Lower Limb ◽  
Blood Transfusions ◽  
Site Infection ◽  
Lower Limb Fractures ◽  
Limb Fractures

Background: The identification of risk factors for infections in surgical patients with lower-limb fractures and blood transfusions has increased in recent years. Surgical site infections (SSIs) increase hospitalization, care costs, and patient suffering. Correction surgery for lower-limb fractures and blood transfusion is quite common between surgical procedures. The aim of this study was to describe the relationship between blood transfusion and SSI in patients undergoing orthopedic surgery on lower limbs. Methods: We conducted a prospective cohort study to identify risk factors for SSI in blood transfused patients undergoing fracture repair in lower-limb surgeries between February 2017 and May 2019 in 2 reference tertiary-care hospitals in Belo Horizonte, a city of 3 million people in Brazil. Data regarding patient characteristics, surgical procedures, blood transfusions, and surgical infections were collected. Patient characterization was performed by calculating the absolute and relative frequencies of categorical variables and calculating mean, median, minimum, maximum, standard deviation, and coefficient of variation for quantitative variables. The incidence of surgical site infection, the risk of postoperative hospital death, and the total length of hospital stay were calculated by point estimates and 95% confidence intervals identified by statistical tests of bilateral hypotheses, considering the level of significance of 5%. A multivariate analysis (logistic regression) was performed to identify SSI risk factors. Results: Patients who had an indication for blood transfusion (n = 38) but who did not receive blood (n = 4) had significantly lower hemoglobin, comparing discharge with admission, than the group who received blood. Intraoperative transfusion was a risk factor for SSI (OR, 4.7) (Fig. 1). Among the 205 patients with no indication for transfusion, 98 received blood even without the indication: there was no difference in hemoglobin outcome when discharge and admission were compared, and the 98 patients were exposed to unnecessary risk. Regarding restrictive versus liberal transfusion strategies, there were differences in the variables, age (P = .000), duration of surgery (P = .003), number of comorbidities (P = .000), body mass index (BMI) (P = .027), previous hemoglobin (P = .000), and high hemoglobin (P = .000), considering the transfusion practice employed (Fig. 2). Conclusions: The indications for and definition of protocols and careful evaluation of blood transfusion are critical to avoid infectious complications in orthopedic patients with lower-limb fractures.Funding: NoneDisclosures: None

Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation

2010 ◽  
Vol 12 (5) ◽  
pp. 540-546 ◽  
Author(s):  
Masahiko Watanabe ◽  
Daisuke Sakai ◽  
Daisuke Matsuyama ◽  
Yukihiro Yamamoto ◽  
Masato Sato ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Patient Characteristics ◽  
Site Infection ◽  
The Mean ◽  
Preoperative Hospital Stay ◽  
Duration Of Operation

Object The purpose of this study was to identify risk factors for surgical site infection after spine surgery, noting the amount of saline used for intraoperative irrigation to minimize wound contamination. Methods The authors studied 223 consecutive spine operations from January 2006 through December 2006 at our institute. For a case to meet inclusion criteria as a site infection, it needed to require surgical incision and drainage and show positive intraoperative cultures. Preoperative and intraoperative data regarding each patient were collected. Patient characteristics recorded included age, sex, and body mass index (BMI). Preoperative risk factors included preoperative hospital stay, history of smoking, presence of diabetes, and an operation for a traumatized spine. Intraoperative factors that might have been risk factors for infection were collected and analyzed; these included type of procedure, estimated blood loss, duration of operation, and mean amount of saline used for irrigation per hour. Data were subjected to univariate and multivariate logistic regression analyses. Results The incidence of surgical site infection in this population was 6.3%. According to the univariate analysis, there was a significant difference in the mean duration of operation and intraoperative blood loss, but not in patient age, BMI, or preoperative hospital stay. The mean amount of saline used for irrigation in the infected group was less than in the noninfected group, but was not significantly different. In the multivariate analysis, sex, advanced age (> 60 years), smoking history, and obesity (BMI > 25 kg/m2) did not show significant differences. In the analysis of patient characteristics, only diabetes (patients receiving any medications or insulin therapy at the time of surgery) was independently associated with an increased risk of surgical site infection (OR 4.88). In the comparison of trauma and elective surgery, trauma showed a significant association with surgical site infection (OR 9.42). In the analysis of surgical factors, a sufficient amount of saline for irrigation (mean > 2000 ml/hour) showed a strong association with the prevention of surgical site infection (OR 0.08), but prolonged operation time (> 3 hours), high blood loss (> 300 g), and instrumentation were not associated with surgical site infection. Conclusions Diabetes, trauma, and insufficient intraoperative irrigation of the surgical wound were independent and direct risk factors for surgical site infection following spine surgery. To prevent surgical site infection in spine surgery, it is important to control the perioperative serum glucose levels in patients with diabetes, avoid any delay of surgery in patients with trauma, and decrease intraoperative contamination by irrigating > 2000 ml/hour of saline in all patients.

scholarly journals Risk Stratification for Organ/Space Surgical Site Infection in Digestive System Cancer: A Prospective Cohort Study

2021 ◽  
Author(s):  
Chen Sun ◽  
Hui Gao ◽  
Yuelun Zhang ◽  
Lijian Pei ◽  
Yuguang Huang
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Risk Stratification ◽  
Surgical Site Infection ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Digestive System ◽  
Site Infection ◽  
Digestive System Cancer ◽  
Risk Stratification Score

Abstract Background: Organ/space surgical site infection (organ/space SSI) is one of the serious postoperative complications, closely related to a poor prognosis. Few studies have attempted to design risk scoring systems for patients with digestive system cancer. This study aimed to develop a simple and practical risk stratification score for these patients to identify a priori risk of organ/space SSI.Methods: This prospective cohort study was based on two prospective studies (NCT02756910, ChiCTR-IPR-17011099), including patients undergoing elective radical resection of digestive system cancer. Logistic regression analysis was used to identify the determinant variables. The incidence of organ/space SSI stratified over perioperative factors was compared and compounded in a risk score.Results: Among the 839 patients, 51 developed organ/space SSI (6.1%) within 30 days after surgery. Patients undergoing gastrectomy (OR=8.466, 95% CI: 2.728-26.270, P<0.001), colorectal resection (OR=11.180, 95% CI: 3.921-31.881, P<0.001) and pancreatoduodenectomy (OR=9.054, 95% CI: 3.329-24.624, P<0.001) with an anaesthesia time > 4 h (OR=2.335, 95% CI: 1.035-5.271, P=0.041) and prolonged intensive care unit (ICU) stays > 24 h (OR=4.243, 95% CI: 1.715-10.498, P=0.002) had a significantly higher risk of organ/space SSI. These risk factors (procedure type, anaesthesia time, prolonged ICU stays) were also associated with an increase in organ/space SSI rates based on a compounded score (P<0.001). Comparisons with the overall population revealed that patients with 0 or 1 risk factor (n=602) had an organ/space SSI rate of 2.8% (RR=0.197, 95% CI: 0.112-0.345), those with 2 risk factors (n=223) had an organ/space SSI rate of 13.0% (RR=3.641; 95% CI: 2.138-6.202), and those with 3 risk factors (n=14) had an organ/space SSI rate of 35.7% (RR=6.405, 95% CI: 3.005-13.653).Conclusion: The risk stratification score in this study provides a simple and practical tool to stratify patients with digestive system cancer so that the relative risk of developing postoperative organ/space SSIs can be predicted.Trial Registration: This study was based on one randomized controlled trial (NCT02756910) registered at ClinicalTrials.gov on April 29, 2016 and one prospective cohort study (ChiCTR-IPR-17011099) registered at the Chinese Clinical Trial Registry on April 9, 2017.

scholarly journals Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Chen Sun ◽  
Hui Gao ◽  
Yuelun Zhang ◽  
Lijian Pei ◽  
Yuguang Huang
Keyword(s):  
Risk Factors ◽  
Clinical Trial ◽  
Logistic Regression ◽  
Risk Stratification ◽  
Surgical Site Infection ◽  
Digestive System ◽  
Logistic Regression Model ◽  
Site Infection ◽  
Multivariable Logistic Regression Model ◽  
Digestive System Cancer

BackgroundOrgan/space surgical site infection (organ/space SSI) is a serious postoperative complication, closely related to a poor prognosis. Few studies have attempted to stratify the risk of organ/space SSI for patients with advanced digestive system cancer. This study aimed to identify a simple risk stratification for these patients based on perioperative factors.MethodsThe study was based on two randomized controlled trials (RCT) (NCT02715076, ChiCTR-IPR-17011099), including 839 patients undergoing elective radical resection of advanced digestive system cancer. The primary outcome was organ/space SSI within 30 days after surgery. Multivariable logistic regression model was used to identify risk factors. The risk of organ/space SSI stratified over those risk factors was compared using chi-square tests and the relative risk (RR) was estimated.ResultsAmong the 839 patients, 51 developed organ/space SSI (6.1%) within 30 days after surgery. According to the multivariable logistic regression model, 3 procedure types, including gastrectomy (OR=8.22, 95% CI: 2.71-24.87, P&lt;0.001), colorectal resection (OR=8.65, 95% CI: 3.13-23.85, P&lt;0.001) and pancreatoduodenectomy (OR=7.72, 95% CI: 2.95-20.21, P&lt;0.001), as well as anaesthesia time &gt; 4 h (OR=2.38, 95% CI: 1.08-5.27, P=0.032) and prolonged ICU stay (OR=4.10, 95% CI: 1.67-10.10, P=0.002), were risk factors for postoperative organ/space SSI. The number of risk factors was significantly associated with an increased risk of organ/space SSI (P&lt;0.001), which was 2.8% in patients with 0-1 risk factor (RR=0.20, 95% CI: 0.11-0.35), 13.0% in patients with 2 risk factors (RR=3.64, 95% CI: 2.14-6.20) and 35.7% in patients with 3 risk factors (RR=6.41, 95% CI: 3.01-13.65).ConclusionThis study is a preliminary exploratory and provides a simple risk stratification to identify the risk of postoperative organ/space SSI for patients with advanced digestive system cancer. Further research is needed to validate and generalize the results in a wider population.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT02715076; Chinese Clinical Trial Registry [https://www.chictr.org.cn/enindex.aspx], identifier ChiCTR-IPR-17011099.

Risk Factors for Surgical Site Infection Complicating Laminectomy

2007 ◽  
Vol 28 (9) ◽  
pp. 1060-1065 ◽  
Author(s):  
N. Deborah Friedman ◽  
Daniel J. Sexton ◽  
Sarah M. Connelly ◽  
Keith S. Kaye
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Risk Index ◽  
Tertiary Care ◽  
Operating Experience ◽  
Care Facility ◽  
Site Infection ◽  
Surgical Specialty ◽  
Tertiary Care Facility ◽  
Independent Risk Factors

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.

Sign in / Sign up

Export Citation Format

Share Document