scholarly journals EP.FRI.16 Use of Pulsed Lavage Reduces the Rate of Surgical Site Infection After Laparotomy

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Michael Bath ◽  
Jordan Powell ◽  
Ismail Ismail ◽  
Michael Machesney
Keyword(s):  
Risk Factors ◽  
General Surgery ◽  
Effective Means ◽  
Multivariate Logistic Regression Analysis ◽  
Surgical Site Infections ◽  
Cost Effective ◽  
Control Group ◽  
Potential Cost ◽  
Operative Complication ◽  
Pulsed Lavage

Abstract Aims Surgical site infections (SSIs) are a preventable and common post-operative complication within general surgery. Intra-operative irrigation of surgical incisions is an inexpensive method to reduce post-operative SSI rates, however its use is currently limited to orthopaedic surgery. We aimed to assess the effects of pulsed lavage (PL) irrigation on SSI rates following elective and emergency laparotomies. Methods Elective and emergency patients who underwent a laparotomy between 2018 and 2019 were included. Relevant demographic and peri-operative risk factors collected retrospectively, following STROBE criteria. The primary outcome was rate of superficial SSIs within 30 days of the operation. Independent risk factors were assessed via multivariate logistic regression analysis. Results 176 patients were identified, with an average age of 60.7 ±19.1 years. 82.4% (145/176) were emergencies and the mean ASA grade was 2.8. Fifty two patients (29.5%) had PL used during their operation. Thirty seven patients (29.8%, 37/124) in the control group developed a SSI, compared to seven patients (13.5%, 7/52) in the PL group (p = 0.022). At multi-variate analysis, the use PL conferring an Odds Ratio 0.36 (CI 0.12-0.94, p = 0.047) for developing a SSI. Conclusions PL appears to significantly reduced the rate of SSI following laparotomy. There remains scope to reduce the incidence of this common and expensive post-operative complication, and PL could provide a potential cost-effective means to deliver improved outcomes. Future prospective randomised trials are essential to fully assess its benefits and wider use within general surgery.

scholarly journals The Use of Vancomycin Powder for Surgical Prophylaxis Following Craniotomy

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 754-758 ◽  
Author(s):  
Vinod Ravikumar ◽  
Allen L. Ho ◽  
Arjun V. Pendharkar ◽  
Eric S. Sussman ◽  
Kevin Kwong-hon Chow ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Cost Savings ◽  
Surgical Site Infections ◽  
Control Group ◽  
Infection Prophylaxis ◽  
Potential Cost Saving ◽  
Infection Rates ◽  
Surgical Prophylaxis ◽  
Potential Cost ◽  
Vancomycin Powder

Abstract BACKGROUND: Intrawound vancomycin powder has been studied extensively in spinal fusion surgeries and been found to reduce rates of surgical site infections (SSIs) significantly. Despite its success in spinal surgeries, topical vancomycin has not been extensively studied with respect to cranial neurosurgery. OBJECTIVE: To evaluate the efficacy of intrawound topical vancomycin for prevention of SSIs following open craniotomies. METHODS: We retrospectively analyzed a large series of 350 patients from 2011 to 2015 in a pre/postintervention study of use of topical vancomycin to reduce postoperative craniotomy infection rates. We had a preintervention control group of 225 patients and a postintervention group of 125 patients that received intrawound topical vancomycin. RESULTS: Our preintervention incidence of SSI was 2.2% and this was significantly reduced to 0% following introduction of topical vancomycin (P < .5). An ad hoc cost analysis suggested a cost savings of ${\$}$59 965 with the use of topical vancomycin for craniotomies. CONCLUSION: Our study found a significant reduction in SSI rates after introduction of topical vancomycin. Thus, this simple intervention should be considered in all open craniotomy patients as both infection prophylaxis and a potential cost saving intervention.

P692Chemoradiation therapy to patients with lung cancer exacerbates thoracic aortic calcification

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Miki ◽  
T Miyoshi ◽  
K Ichikawa ◽  
S Miyauchi ◽  
J Soh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Cardiovascular Events ◽  
Multivariate Logistic Regression Analysis ◽  
Aortic Calcification ◽  
Control Group ◽  
Multivariate Logistic Regression ◽  
Annual Percent Change ◽  
Percent Change ◽  
Thoracic Aortic Calcification

Abstract Introduction Development of chemoradiation therapy (CRT) has improved mortality in patients with cancer. Whereas, it is emerging problem that cancer-survivors suffer from cardiovascular diseases, and the association between modern CRT and the increase in future cardiovascular events is suggested. Meanwhile, previous studies showed that thoracic aortic calcification (TAC) detected by computed tomography (CT), a marker of atherosclerosis, was associated with all-cause mortality and cardiovascular events. However, the influence of CRT on TAC progression remains unclear. Purpose The purpose of this study was to evaluate whether CRT would exacerbate TAC. Methods A total of 68 patients who treated lung cancer at our hospital between 2011 and 2015 were retrospectively analyzed (mean 62 year-old, male 78%): 35 patients underwent surgical treatment after induction CRT (CRT group) and 33 patients underwent surgical treatment alone (control group), extracted by propensity score matching by age, sex, smoking status, and diseased side. The volume of TAC between 2nd and 12th thoracic vertebrae was quantitatively measured with CT imaging, at baseline and at 1 year follow-up. The annual percent change in TAC was compared between the CRT and the control group. Moreover, the independent relationship between implementation of CRT and the progression of TAC was assessed by multivariate logistic regression analysis, adjusting for age, gender, conventional atherosclerotic risk factors and baseline aortic calcification volume. Results Patients in the CRT group received radiation (mean 47.3±4.0 Gy) and chemotherapy: 2 courses of cisplatin with docetaxel (34 cases) or vinorelbine (1 case). The prevalence of dyslipidemia, taking statins and diabetes drugs were significantly higher in the control groups (17% vs. 39%; p=0.041, 11% vs. 33%; p=0.029, 3% vs. 18%; p=0.044, respectively). Baseline C-reactive protein level was significantly higher in the CRT group (0.255 vs. 0.115; p=0.034). In univariate analysis, the annual percent change in TAC volume was significantly increased in the CRT group compared with the control group (37.6% vs. 23.3%; p=0.006). Multivariate logistic regression analysis demonstrated that CRT was an independent factor associated with the progression of TAC volume, even after adjustment for baseline calcification volume and coronary risk factors (OR, 3.90; 95% CI, 1.32–11.47; p=0.014). Conclusion CRT to patients with lung cancer exacerbates thoracic aortic calcification, which may result in future cardiovascular events.

scholarly journals Promoting Healthy Family Behaviors in the Primary Care Setting

PRiMER ◽  
2017 ◽  
Vol 1 ◽  
Author(s):  
Katrina Weirauch ◽  
Julie Phillips
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Usual Care ◽  
Pediatric Obesity ◽  
Screening Tool ◽  
Effective Means ◽  
Randomized Study ◽  
Intervention Group ◽  
Control Group ◽  
Significant Difference

Introduction: Pediatric obesity is an increasingly prevalent problem. Several studies have examined prevention and treatment strategies. The majority of effective studies involved school or community interventions. With health care becoming more collaborative, we hypothesized that a behavioral health specialist may be effective in executing multifaceted interventions with families of at-risk patients. Methods: This is a prospective randomized study, evaluating impact of intervention with a behavioral specialist on lifestyle risk factors for pediatric obesity in children. At-risk behaviors were identified with a screening tool from the Healthy Kids, Healthy Michigan Clinical Decision Tools, based on the 2007 American Academy of Pediatrics guidelines on pediatric obesity. An intervention group received ongoing care from the behavioral specialist over three months, including motivational interviewing and cognitive behavioral therapy. Participants were compared with a control group receiving usual care. Results: There was no significant difference between the intervention and control group regarding change in number of risk factors. However, both groups had a reduced number of risk factors at follow-up. The control group had a significant change in number of risk factors after the intervention. Conclusion: There was no statistically significant difference between the two groups. However, it is notable that both groups saw significant decreases in total number of risk factors. The only addition to usual care provided to the control group was use of the screening tool. Our results indicate that the use of a screening tool and brief physician intervention may be an effective means for improving healthy behaviors within families.

scholarly journals Analysis of Risk Factors for Non-Union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects

2020 ◽  
Author(s):  
Qiang Xu ◽  
Bin Zhang ◽  
Min Dai ◽  
Xuqiang Liu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Internal Fixation ◽  
Weight Bearing ◽  
Multivariate Logistic Regression Analysis ◽  
Control Group ◽  
Fracture Type ◽  
Multivariate Logistic Regression ◽  
Non Union ◽  
Limb Fractures

Abstract Objective: Although a large number of clinical and animal experimental studies have explored factors affecting fracture healing, there are only a few examples of systematic research on these factors for limb fractures. The purpose of this study was to analyse the risk factors for limb fracture non-union in order to improve non-union prevention and early detection.Methods: A total of 223 patients with non-union after surgery for limb fractures performed at our institution from January 2005 to June 2017 were included as the case group, while a computer-generated random list was created to select 446 patients with successful bone healing who were treated during the same period as the control group, thus achieving a ratio of 1:2. The medical records of these patients were reviewed retrospectively. Age, sex, body mass index, obesity, smoking, alcohol, diabetes, hypertension, osteoporosis, fracture type, multiple fractures, non-steroidal anti-inflammatory drugs (NSAIDs) use, delayed weight bearing, internal fixation failure, and infection data were analysed and compared between the two groups. A multivariate logistic regression model was constructed to determine relevant factors associated with non-union.Results: The multivariate logistic regression analysis revealed that osteoporosis, open fractures, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were independent risk factors for non-union after surgery for limb fractures.Conclusions: Osteoporosis, open fracture type, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were found to be the main causes of bone non-union; clinicians should, therefore, take targeted measures to intervene in high-risk groups early.

scholarly journals Do the Severity of Peritonitis and Stoma Creation Influence the Occurrence of Incisional Surgical Site Infections in Patients With Colorectal Perforation?

2019 ◽  
Vol 104 (7-8) ◽  
pp. 338-343
Author(s):  
Takehito Yamamoto ◽  
Takeshi Morimoto ◽  
Hiroki Hashida ◽  
Satoshi Kaihara ◽  
Ryo Hosotani
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Emergency Surgery ◽  
Independent Risk Factor ◽  
Multivariate Logistic Regression Analysis ◽  
Surgical Site Infections ◽  
Wound Management ◽  
Colorectal Perforation ◽  
Stoma Creation ◽  
Incisional Surgical Site Infection

Objective To identify the risk factors for incisional surgical site infection (SSI) in patients undergoing emergency surgery for colorectal perforation. Summary of Background Data Emergency surgery for colorectal perforation carries an especially high risk of incisional SSI. Although the risk factors of incisional SSI after colorectal surgery have been analyzed, no study has focused exclusively on patients with colorectal perforation. Methods Patients with colorectal perforation who underwent emergent surgery from 2010 to 2015 were enrolled. The factors associated with the occurrence of postoperative incisional SSI were evaluated. Results We enrolled 108 patients with colorectal perforation who underwent an emergency operation. Of these, 13 patients who died within 30 days after surgery were excluded. The mean age of the 95 study patients was 70 ± 13 years; 48 (51%) patients were male. The incisional SSI group comprised 26 patients (27%). Multivariate logistic regression analysis showed that stoma creation [odds ratio: 11.34; 95% confidence interval: 2.06–214.14] was an independent risk factor for incisional SSI. However, none of the clinical indicators of severe peritonitis and sepsis, including body temperature, systolic blood pressure, heart rate, preoperative white blood cell count, and C-reactive protein, were associated with the occurrence of incisional SSI. Conclusions Stoma creation was an independent risk factor for postoperative incisional SSI. Therefore, in this patient population, meticulous postoperative wound management is essential.

Surgical Site Infections

2019 ◽  
pp. 85-122
Author(s):  
Aqsa Shakoor ◽  
William Middlesworth ◽  
Lisa Saiman
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
General Surgery ◽  
Surgical Procedure ◽  
Healthcare Costs ◽  
Surgical Site Infections ◽  
Patient Risk ◽  
Healthcare Facilities ◽  
Pediatric Healthcare ◽  
Type Of Surgery

Surgical site infections (SSIs) not only increase morbidity and healthcare costs, they also impose emotional and physical burdens on patients and families. The SSI risk for patients undergoing a surgical procedure is specific to the type of surgery, degree of contamination of the operative field, and underlying patient risk factors (both modifiable and non-modifiable. This chapter reviews strategies to prevent surgical site infections in pediatric patients following general surgery, spine surgery for scoliosis, neurosurgical ventricular shunts, and cardiovascular surgery. Best practices and bundles used in leading pediatric healthcare facilities are described, including recommendations for perioperative antibiotic prophylaxis.

scholarly journals Collagen type 1A1, type 3A1, and LOXL1/4 polymorphisms as risk factors of pelvic organ prolapse

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Asuka Ashikari ◽  
Tetsuji Suda ◽  
Minoru Miyazato
Keyword(s):  
Risk Factors ◽  
Pelvic Organ Prolapse ◽  
Collagen Type ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Pelvic Organ ◽  
Japanese Women ◽  
Control Group ◽  
Matrix Remodeling ◽  
Nucleotide Polymorphisms

Abstract Objective Collagen and elastin are the main components of the female pelvic tissue. We investigated whether single nucleotide polymorphisms (SNPs) of collagen type 1 alpha 1 (COL1A1), collagen type 3 alpha 1 (COL3A1), and lysyl oxidase-like (LOXL) 1 and 4 were associated with the onset of pelvic organ prolapse (POP) in Japanese women. Fifty-two women with POP and 28 women without POP were included. SNPs were identified using the TaqMan® SNP genotyping assay. Results Age, parity, and lower urinary tract symptoms were significantly higher in the POP group than in the control group. The prevalence of genotypes with rs2862296 polymorphism of LOXL4, an enzyme essential for extracellular matrix remodeling, was different between the POP (26.9% for GG, 51.9% for AG) and control groups (14.8% for GG, 33.3% for AG). However, polymorphisms of COL1A1, COL3A1, and LOXL1 were not related to the onset of POP. In the multivariate logistic regression analysis, age was significantly associated with the occurrence of POP. In the univariate analysis, LOXL4 polymorphism was associated with the onset of POP in Japanese women. The knowledge of acquired risk factors and polymorphisms in the genomic background of patients with POP may help prevent POP via early conservative interventions.

scholarly journals Prognostic Analysis and Risk Factors Associated with Fetal Ventriculomegaly

2021 ◽  
pp. 1-9
Author(s):  
Qi-Ming Li ◽  
Hong-Zhan Liao ◽  
Wen-Bo Wang ◽  
Shi-Yi Zeng ◽  
Xian-Sheng Qiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Multivariate Logistic Regression Analysis ◽  
Control Group ◽  
Width Ratio ◽  
Case Group ◽  
Multivariate Logistic Regression ◽  
Prognostic Analysis ◽  
Fetal Ventriculomegaly

<b><i>Background:</i></b> This study aimed to investigate the clinical outcome and related risk factors of fetal lateral ventriculomegaly (VM). <b><i>Methods:</i></b> A retrospective analysis was performed on 255 cases diagnosed as fetal VM. Prenatal imaging examination was carried out. The pregnancy outcomes were investigated through follow-up. According to the prognosis of children, they were divided into case group and control group. Multivariate logistic regression was used to analyze the factors influencing the prognosis of hydrocephalus. <b><i>Results:</i></b> After excluding the cases with either loss of follow-up or incomplete information, 102 cases were followed up. Twelve cases with poor prognosis were set as the case group. According to the maternal age, gestational age, gender of children, and follow-up time, 3 cases were selected from the other 90 cases for each child in the case group, respectively, and selected as the control group. Paired comparative analysis was performed on 48 cases. Using prognosis as a dependent variable, multivariate logistic regression analysis of the statistically significant factors indicated that the change speed of width ratio (CSWR) and maximum lateral ventricular width (MW) were associated with fetal prognosis. <b><i>Conclusions:</i></b> Our results suggested that CSWR and MW may have the value of predicting fetal prognosis.

scholarly journals The Preventive Effects of Perioperative Oral Care On Surgical Site Infections After Pancreatic Cancer Surgery: A Retrospective Study

2021 ◽  
Author(s):  
Hiroshi Nobuhara ◽  
Yasuhiro Matsugu ◽  
Junko Tanaka ◽  
Tomoyuki Akita ◽  
Keiko Ito
Keyword(s):  
Risk Factors ◽  
Pancreatic Cancer ◽  
Retrospective Study ◽  
Oral Care ◽  
Surgical Site Infections ◽  
Cancer Surgery ◽  
Care Group ◽  
Control Group ◽  
Care Intervention ◽  
Preventive Effects

Abstract Purpose: Pancreatic ductal adenocarcinoma (PDAC) is the most malignant cancer of the gastrointestinal tract, and is associated with high rates of postoperative complications, including surgical site infections (SSIs). Perioperative oral care is an effective measure for preventing postoperative pneumonia. However, the preventive effects of perioperative oral care on SSIs have not been reported. We investigated the preventive effects of perioperative oral care on SSIs after pancreatic cancer surgery.Methods: A total of 103 patients with PDAC who underwent radical resection at Hiroshima Prefectural Hospital (2011–2018) were enrolled in this retrospective study. Of the 103 patients, 75 received perioperative oral care by dentists and dental hygienists (oral care group), whereas 28 did not (control group). Univariate and multivariate analyses with propensity score as a covariate were used to investigate the incidence and risk factors of SSIs in the oral care and control groups. Results: The incidence of SSIs was significantly lower in the oral care group than in the control group (12.0% vs. 39.3%, P = 0.004). Logistic regression analysis revealed that a soft pancreas, the surgical procedure (pancreaticoduodenectomy), blood transfusion, diabetes mellitus, and the absence of oral care intervention were risk factors for SSIs. The odds ratio for oral care intervention was 0.164 (95% confidence interval: 0.047–0.571; P = 0.004). Conclusion: Perioperative oral care reduced the risk of developing SSIs after pancreatic cancer surgery. Our findings indicate that perioperative oral care is a safe and effective infection prevention strategy that should be implemented in future perioperative management.UMIN registration number: UMIN000042082; October 15, 2020, retrospectively registered.

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