scholarly journals Prospective Nationwide Surveillance of Surgical Site Infections after Gastric Surgery and Risk Factor Analysis in the Korean Nosocomial Infections Surveillance System (KONIS)

2012 ◽  
Vol 33 (6) ◽  
pp. 572-580 ◽  
Author(s):  
Eu Suk Kim ◽  
Hong Bin Kim ◽  
Kyoung-Ho Song ◽  
Young Keun Kim ◽  
Hyung-Ho Kim, ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nosocomial Infections ◽  
Surveillance System ◽  
Demographic Data ◽  
Risk Index ◽  
Operation Time ◽  
Surgical Site Infections ◽  
Gastric Surgery ◽  
Increased Risk ◽  
Male Sex

Objective.To evaluate the risk factors for surgical site infection (SSI) after gastric surgery in patients in Korea.Design.A nationwide prospective multicenter study.Setting.Twenty university-affiliated hospitals in Korea.Methods.The Korean Nosocomial Infections Surveillance System (KONIS), a Web-based system, was developed. Patients in 20 Korean hospitals from 2007 to 2009 were prospectively monitored for SSI for up to 30 days after gastric surgery. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using multivariate logistic regression models.Results.Of the 4,238 case patients monitored, 64.9% (2,752) were male, and mean age (±SD) was 58.8 (±12.3) years. The SSI rates were 2.92, 6.45, and 10.87 per 100 operations for the National Nosocomial Infections Surveillance system risk index categories of 0, 1, and 2 or 3, respectively. The majority (69.4%) of the SSIs observed were organ or space SSIs. The most frequently isolated microorganisms were Staphylococcus aureus and Klebsiella pneumoniae. Male sex (odds ratio [OR], 1.67 [95% confidence interval (CI), 1.09–2.58]), increased operation time (1.20 [1.07–1.34] per 1-hour increase), reoperation (7.27 [3.68–14.38]), combined multiple procedures (1.79 [1.13–2.83]), prophylactic administration of the first antibiotic dose after skin incision (3.00 [1.09–8.23]), and prolonged duration (≥7 days) of surgical antibiotic prophylaxis (SAP; 2.70 [1.26–5.64]) were independently associated with increased risk of SSI.Conclusions.Male sex, inappropriate SAP, and operation-related variables are independent risk factors for SSI after gastric surgery.

scholarly journals Applicability of the national nosocomial infections surveillance system risk index for the prediction of surgical site infections: a review

2007 ◽  
Vol 11 (1) ◽  
pp. 134-141 ◽  
Author(s):  
Flávia Falci Ercole ◽  
Carlos Ernesto Ferreira Starling ◽  
Tânia Couto Machado Chianca ◽  
Mariângela Carneiro
Keyword(s):  
Nosocomial Infections ◽  
Surveillance System ◽  
Risk Index ◽  
Surgical Site Infections ◽  
System Risk

Incidence of Surgical-Site Infections and the Validity of the National Nosocomial Infections Surveillance System Risk Index in a General Surgical Ward in Santa Cruz, Bolivia

2003 ◽  
Vol 24 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Lorena Soleto ◽  
Marianne Pirard ◽  
Marleen Boelaert ◽  
Remberto Peredo ◽  
Reinerio Vargas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Procedures ◽  
Nosocomial Infections ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Santa Cruz ◽  
Surgical Ward ◽  
System Risk ◽  
Local Risk

AbstractObjectives:To estimate the frequency of and risk factors for surgical-site infections (SSIs) in Bolivia, and to study the performance of the National Nosocomial Infections Surveillance (NNIS) System risk index in a developing country.Design:A prospective study with patient follow-up until the 30th postoperative day.Setting:A general surgical ward of a public hospital in Santa Cruz, Bolivia.Patients:Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed.Results:Follow-up was complete for 91.5% of 376 surgical procedures. The overall SSI rate was 12%. Thirty-four (75.6%) of the 45 SSIs were culture positive. A logistic regression model retained an American Society of Anesthesiologists score of more than 1 (odds ratio [OR], 1.87), a not-clean wound class (OR, 2.28), a procedure duration of more than 1 hour (OR, 1.81), and drain (OR, 1.98) as independent risk factors for SSI. There was no significant association between the NNIS System risk index and SSI rates. However, a “local” risk index constructed with the above cut-off points showed a linear trend with SSI (P < .001) and a relative risk of 3.18 for risk class 3 versus a class of less than 3.Conclusions:SSIs cause considerable morbidity in Santa Cruz. Appropriate nosocomial infection surveillance and control should be introduced. The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting, but a risk score based on local cutoff points performed substantially better.

Validation of a Modified Version of the National Nosocomial Infections Surveillance System Risk Index for Health Services Research

2009 ◽  
Vol 30 (6) ◽  
pp. 563-569 ◽  
Author(s):  
Nick Daneman ◽  
Andrew E. Simor ◽  
Donald A. Redelmeier
Keyword(s):  
Surgical Site Infection ◽  
Nosocomial Infections ◽  
Surveillance System ◽  
Elective Surgery ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Population Based ◽  
Site Infection ◽  
Services Research ◽  
System Risk

Objective.To validate the National Nosocomial Infections Surveillance system risk index through administrative data to predict surgical site infections.Design.Retrospective cohort study.Setting.Population-based analysis in Ontario, Canada.Patients.All elderly patients who underwent elective surgery from April 1, 1992, through March 31, 2006 (n = 469,349).Methods.Data on procedural and patient outcomes were gathered from linked population-wide hospital discharge records and physician claims. The 75th percentile of surgical duration was estimated through anesthesiologist billing fees recorded in 15-minute increments; the American Society of Anesthesiology score of at least 3 out of 5 was estimated by diagnostic codes for severe systemic illness; and all surgeries were classified as clean or clean-contaminated because of their elective nature (thus, the maximum score on the modified index was 2).Results.A total of 147,216 surgeries (31%) had a score of 0;246,592 (53%) had a score of 1; and 75,541 (16%) had a score of 2 on the modified index. The 30-day risk of surgical site infection increased with each increment in the modified index (score of 0, 5.4%; score of 1, 8.0%; score of 2, 14.3%; P < .001). The association was evident for surgical site infection diagnosed during the index admission (score of 0, 2.0%; score of 1, 3.7%; score of 2, 8.9%; P < .001), as well as that associated with reoperation or death (score of 0, 0.04%; score of 1, 0.23%; score of 2, 0.73%; P < .001). The modified index predicted increases in surgical site infection risk within each of 11 surgical subgroups. In accord with past research, the modified index had modest discrimination (C statistic, 0.59), and the majority of surgical site infections (72%) occurred within lower risk strata.Conclusions.The modified index predicts surgical site infection in population-based analyses and is associated with incremental increases in risk.

Risk factors and outcomes associated with surgical site infections after craniotomy or craniectomy

2014 ◽  
Vol 120 (2) ◽  
pp. 509-521 ◽  
Author(s):  
Hsiu-Yin Chiang ◽  
Aparna S. Kamath ◽  
Jean M. Pottinger ◽  
Jeremy D. W. Greenlee ◽  
Matthew A. Howard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Csf Leak ◽  
Care Utilization ◽  
Related Factor ◽  
Average Increase ◽  
University Of Iowa ◽  
C Statistic ◽  
Increased Risk

Object Many studies that have evaluated surgical site infections (SSIs) after craniotomy or craniectomy (CRANI) did not use robust methods to assess risk factors for SSIs or outcomes associated with SSIs. The authors conducted the current study to identify risk factors for SSIs after CRANI procedures and to evaluate outcomes attributed to SSIs. Methods The authors performed a nested case-control study of patients undergoing CRANI procedures between 2006 and 2010 at the University of Iowa Hospitals and Clinics. They identified 104 patients with SSIs and selected 312 controls. They collected data from medical records and used multivariate analyses to identify risk factors and outcomes associated with SSIs. Results Thirty-two percent of SSIs were caused by Staphylococcus aureus, 88% were deep incisional or organ space infections, and 70% were identified after discharge. Preoperative length of stay (LOS) ≥ 1 day was the only significant patient-related factor in the preoperative model (OR 2.1 [95% CI 1.2–3.4]) and in the overall model (OR 1.9 [95% CI 1.1–3.3]). Procedure-related risk factors that were significant in the overall model included Gliadel wafer use (OR 6.7 [95% CI 2.5–18.2]) and postoperative CSF leak (OR 3.5 [95% CI 1.4–8.5]). The preoperative SSI risk index, including body mass index, previous brain operation, chemotherapy on admission, preoperative LOS, procedure reason, and preoperative glucose level, had better predictive efficacy (c-statistic = 0.664) than the National Healthcare Safety Network risk index (c-statistic = 0.547; p = 0.004). Surgical site infections were associated with increased LOS during the initial hospitalizations (average increase of 50%) or readmissions (average increase of 100%) and with an increased risk of readmissions (OR 7.7 [95% CI 4.0–14.9]), reoperations (OR 36 [95% CI 14.9–87]), and death (OR 3.4 [95% CI 1.5–7.4]). Conclusions Surgeons were able to prospectively assess a patient's risk of SSI based on preoperative risk factors and they could modify some processes of care to lower the risk of SSI. Surgical site infections substantially worsened patients' outcomes. Preventing SSIs after CRANI could improve patient outcomes and decrease health care utilization.

scholarly journals COVID-19 mortality in the UK Biobank cohort: revisiting and evaluating risk factors

2021 ◽  
Vol 36 (3) ◽  
pp. 299-309 ◽  
Author(s):  
Joshua Elliott ◽  
Barbara Bodinier ◽  
Matthew Whitaker ◽  
Cyrille Delpierre ◽  
Roel Vermeulen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Vitamin D ◽  
Regression Models ◽  
Oral Steroid ◽  
Uk Biobank ◽  
Steroid Use ◽  
Increased Risk ◽  
Male Sex

AbstractMost studies of severe/fatal COVID-19 risk have used routine/hospitalisation data without detailed pre-morbid characterisation. Using the community-based UK Biobank cohort, we investigate risk factors for COVID-19 mortality in comparison with non-COVID-19 mortality. We investigated demographic, social (education, income, housing, employment), lifestyle (smoking, drinking, body mass index), biological (lipids, cystatin C, vitamin D), medical (comorbidities, medications) and environmental (air pollution) data from UK Biobank (N = 473,550) in relation to 459 COVID-19 and 2626 non-COVID-19 deaths to 21 September 2020. We used univariate, multivariable and penalised regression models. Age (OR = 2.76 [2.18–3.49] per S.D. [8.1 years], p = 2.6 × 10–17), male sex (OR = 1.47 [1.26–1.73], p = 1.3 × 10–6) and Black versus White ethnicity (OR = 1.21 [1.12–1.29], p = 3.0 × 10–7) were independently associated with and jointly explanatory of (area under receiver operating characteristic curve, AUC = 0.79) increased risk of COVID-19 mortality. In multivariable regression, alongside demographic covariates, being a healthcare worker, current smoker, having cardiovascular disease, hypertension, diabetes, autoimmune disease, and oral steroid use at enrolment were independently associated with COVID-19 mortality. Penalised regression models selected income, cardiovascular disease, hypertension, diabetes, cystatin C, and oral steroid use as jointly contributing to COVID-19 mortality risk; Black ethnicity, hypertension and oral steroid use contributed to COVID-19 but not non-COVID-19 mortality. Age, male sex and Black ethnicity, as well as comorbidities and oral steroid use at enrolment were associated with increased risk of COVID-19 death. Our results suggest that previously reported associations of COVID-19 mortality with body mass index, low vitamin D, air pollutants, renin–angiotensin–aldosterone system inhibitors may be explained by the aforementioned factors.

Post-thyroidectomy bleeding: analysis of risk factors from a national registry

2021 ◽  
Author(s):  
H E Doran ◽  
S M Wiseman ◽  
F F Palazzo ◽  
D Chadwick ◽  
S Aspinall
Keyword(s):  
Risk Factors ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Bleeding Risk ◽  
Redo Surgery ◽  
Day Case ◽  
Increased Risk ◽  
Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

Prevalence of Types, Frequency and Risk Factors for Complications after Exodontia

2021 ◽  
Keyword(s):  
Risk Factors ◽  
Oral Surgery ◽  
Demographic Data ◽  
Dental Trauma ◽  
Cross Sectional Study ◽  
Outpatient Department ◽  
Impacted Tooth ◽  
Cross Sectional ◽  
Increased Risk ◽  
Mandibular Third Molars

Background: Exodontia is one of the most frequently carried out procedures by a dental surgeon, mostly on an outpatient department basis. The reasons for performing exodontia include non-restorable teeth, periodontal disease, dental trauma, impacted tooth, orthodontic treatment and toothache. Complications in dental extraction are a commonly encountered problem in dental clinics. This knowledge can help dental surgeons make extractions less invasive, traumatic and complicated, enabling quicker recovery of the socket. The aim of this study was to recognize types, frequency and risk factors for complications after exodontia. Methods: This cross-sectional study enrolled patients who had exodontia done from July- September 2019, visiting OPD of the Oral surgery department of Altamash Institute of Dental Medicine, Karachi. Risk factors included demographic data, general health, past medical and dental history. Spearman’s correlation test was used to establish any relationship of variables with complications. Results: The study patients (126) included 72 females (mean age 39.1±13.39) and 54 males (mean age 41.1±14.93). The overall complications rate was found to be 7.1%, mainly arising from maxillary and mandibular third molars. The most common complications encountered were Hemorrhage, Pain, and Trismus. Increasing age and specific teeth extracted were associated with an increased risk for complications. However, post-operative complications which were encountered most of them were minor and handled on an outpatient department basis. Conclusion: Frequency and risk factors for complications after exodontia were found low3 (37.5%). While age and teeth extracted cannot be directly altered, these factors maybe indirectly modified, resulting in a potential decrease of postoperative complications.

SP1.1.17The relationship between colorectal neoplasia and body composition in a bowel screening population

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Domenic Di Rollo ◽  
Christopher Morton ◽  
Donald McMillan ◽  
Paul Horgan ◽  
David Mansouri
Keyword(s):  
Body Composition ◽  
Virtual Colonoscopy ◽  
Colorectal Neoplasia ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Subcutaneous Fat ◽  
Visceral Obesity ◽  
Visceral Fat Area ◽  
Increased Risk ◽  
Male Sex

Abstract Aims Conflicting evidence exists as to the effect of elevated BMI in the development of colorectal neoplasia. Yet BMI is a crude measure of adiposity. The present study investigates the association between CT derived measures of body composition including sarcopenia, subcutaneous fat index (SFI) and visceral obesity and colorectal neoplasia. Methods 358 consecutive patients undergoing CT virtual colonoscopy (CTC) as part of the Scottish Bowel Screening Programme were eligible for inclusion. Demographic data and the above measures body composition were calculated using previously published CT derived methods. Medical records were examined for colonoscopic findings and pathology reports. Results 121/358 (34%) were males. Median age 65. 126/358 (35%) patients were found to have a colorectal neoplasia. 84/126 (67%) had advanced neoplasia. 26/358 (7%) had adenocarcinoma. On multivariable analysis, both male sex and visceral obesity was associated with the presence of colorectal neoplasia, OR 2.62, [95% CI 1.51-4.55, p = 0.001] and OR 2.83, {95% CI 1.25-6.41, p = 0.01] respectively. The relationship was dose dependent with an increased risk of colorectal neoplasia in the 3rd [OR 2.13 95% CI 1.09-4.14 p &lt; 0.05] and 4th [OR 3.77 95% CI 1.96-7.26 p &lt; 0.001] quartiles of visceral fat area. BMI, SFI and sarcopenia were not associated with colorectal neoplasia in the present study. Conclusions Male sex and in particular, visceral obesity is associated with increased risk of colorectal neoplasia. In addition to the known cardiovascular and metabolic dangers of visceral obesity, the present work suggests that visceral obesity may also play a role in colorectal neoplasia formation.

scholarly journals Risk factors for post-thyroidectomy haemorrhage: a meta-analysis

2017 ◽  
Vol 176 (5) ◽  
pp. 591-602 ◽  
Author(s):  
Jinhao Liu ◽  
Wei Sun ◽  
Wenwu Dong ◽  
Zhihong Wang ◽  
Ping Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neck Dissection ◽  
Thyroid Surgery ◽  
Meta Analysis ◽  
Older Age ◽  
Graves Disease ◽  
Malignant Tumours ◽  
Antithrombotic Agents ◽  
Increased Risk ◽  
Male Sex

BackgroundPost-thyroidectomy haemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. In this study, we analysed the potential risk factors for the occurrence of post-thyroidectomy haemorrhage.MethodsThe PubMed and SCIE databases were comprehensively searched for studies published before June 30, 2016. Studies on patients who underwent an open thyroidectomy with or without neck dissection were included, and RevMan 5.3 software was used to analyse the data.ResultsTwenty-five studies and 424 563 patients were included in this meta-analysis, and post-thyroidectomy haemorrhage occurred in 6277 patients (incidence rate = 1.48%). The following variables were associated with an increased risk of post-thyroidectomy haemorrhage: older age (MD = 4.30, 95% CI = 3.09–5.52,P < 0.00001), male sex (OR = 1.73, 95% CI = 1.54–1.94,P < 0.00001), Graves’ disease (OR = 1.76, 95% CI = 1.44–2.15,P < 0.00001), antithrombotic agents use (OR = 1.96, 95% CI 1.55–2.49,P < 0.00001), bilateral operation (OR = 1.71, 95% CI = 1.50–1.96,P < 0.00001), neck dissection (OR = 1.53, 95% CI = 1.11–2.11,P = 0.01) and previous thyroid surgery (OR = 1.62, 95% CI = 1.12–2.34,P = 0.01). Malignant tumours (OR = 1.07, 95% CI = 0.89–1.28,P = 0.46) and drainage device use (OR = 1.27, 95% CI = 0.74–2.18,P = 0.4) were not associated with post-thyroidectomy haemorrhage.ConclusionOur systematic review identified a number of risk factors for post-thyroidectomy haemorrhage, including older age, male sex, Graves’ disease, antithrombotic agents use, bilateral operation, neck dissection and previous thyroid surgery. Early control of modifiable risk factors could improve patient outcomes and satisfaction.

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