Frequent Door Openings During Cardiac Surgery Are Associated With Increased Risk for Surgical Site Infection: A Prospective Observational Study

2018 ◽  
Vol 69 (2) ◽  
pp. 290-294 ◽  
Author(s):  
Jan A Roth ◽  
Fabrice Juchler ◽  
Marc Dangel ◽  
Friedrich S Eckstein ◽  
Manuel Battegay ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Observational Study ◽  
Surgical Site Infection ◽  
Prospective Observational Study ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Skin Closure ◽  
Site Infection ◽  
Door Opening ◽  
Increased Risk

Abstract Background Preliminary studies that analyzed surrogate markers have suggested that operating room (OR) door openings may be a risk factor for surgical site infection (SSI). We therefore aimed to estimate the effect of OR door openings on SSI risk in patients undergoing cardiac surgery. Methods This prospective, observational study involved consecutive patients undergoing cardiac surgery in 2 prespecified ORs equipped with automatic door-counting devices from June 2016 to October 2017. Occurrence of an SSI within 30 days after cardiac surgery was our primary outcome measure. Respective outcome data were obtained from a national SSI surveillance cohort. We analyzed the relationship between mean OR door opening frequencies and SSI risk by use of uni- and multivariable Cox regression models. Results A total of 301 594 OR door openings were recorded during the study period, with 87 676 eligible door openings being logged between incision and skin closure. There were 688 patients included in the study, of whom 24 (3.5%) developed an SSI within 30 days after surgery. In uni- and multivariable analysis, an increased mean door opening frequency during cardiac surgery was associated with higher risk for consecutive SSI (adjusted hazard ratio per 5-unit increment, 1.49; 95% confidence interval, 1.11–2.00; P = .008). The observed effect was driven by internal OR door openings toward the clean instrument preparation room. Conclusions Frequent door openings during cardiac surgery were independently associated with an increased risk for SSI. This finding warrants further study to establish a potentially causal relationship between OR door openings and the occurrence of SSI.

scholarly journals Experience with modified radical mastectomy in a low-income country: a multi-center prospective observational study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Giziew Bawoke ◽  
Segni Kejela ◽  
Abebe Alemayehu ◽  
Girmaye Tamirat Bogale
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Observational Study ◽  
Surgical Site Infection ◽  
Low Income ◽  
Prospective Observational Study ◽  
Radical Mastectomy ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Modified Radical Mastectomy ◽  
Retroviral Infections

Abstract Background Modified radical mastectomy is the procedure of choice in centers with little to no radiotherapy services. Studying the in-hospital outcome and complications associated with the procedure is important in low-income countries. Methods This is a multi-center prospective observational study involving all patients operated with modified radical mastectomy with curative intent. Results A total of 87 patients were studied with 10.3% of which were male and 54% were between the age of 30–49 years. Clinical stage IIB and IIIA were reported in 33 (37.9%) and 25 (28.7%) respectively and 62.1% had clinically positive lymph nodes at presentation. All of the studied patients underwent curative surgery, with an average lymph node dissection of 10.2 ± 0.83. Seroma rate was 17.2% and was significantly associated with diabetes (AOR: 6.2 (CI 1.5–8.7)) and neoadjuvant chemotherapy (AOR: 8.9 (CI 1.2–14.2)). Surgical site infection occurred in 14.9% and was significantly associated with Retroviral infections (AOR: 4.2 (CI 2.1–5.8)) and neoadjuvant chemotherapy (AOR: 1.8 (CI 1.3–3.9)). No in-hospital mortality occurred during the course of the study. Conclusion Seroma rate was lower than published studies while surgical site infections rate was higher. Neoadjuvant chemotherapy was associated with increase in seroma and surgical site infection rates. Additionally, diabetes increased the rate of seroma. Surgical site infections were higher in patients with retroviral infections.

scholarly journals Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Zhen-Feng Zhang ◽  
Qing-Chun Sun ◽  
Yi-Fan Xu ◽  
Ke Ding ◽  
Meng-Meng Dong ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Observational Study ◽  
Elderly Patients ◽  
Sex Education ◽  
Prospective Observational Study ◽  
Cognitive Disorders ◽  
Vitamin B ◽  
Link Type ◽  
Preoperative Serum ◽  
Increased Risk

Abstract Background Homocysteine, folate, and vitamin B12 involved in 1-carbon metabolism are associated with cognitive disorders. We sought to investigate the relationships between these factors and delayed neurocognitive recovery (dNCR) after non-cardiac surgery. Methods This was a prospective observational study of patients (n = 175) who were ≥ 60 years of age undergoing non-cardiac surgery. Patients were evaluated preoperatively and for 1 week postoperatively by using neuropsychological tests and were divided into dNCR or non-dNCR groups according to a Z-score ≤ − 1.96 on at least two of the tests. The relationship between the occurrence of dNCR and preoperative levels of homocysteine, folate, and vitamin B12 was analyzed. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with dNCR. Results Delayed neurocognitive recovery was observed in 36 of 175 patients (20.6%; 95% confidence interval [CI], 14.5–26.6%) 1 week postoperatively. Patients who developed dNCR had significantly higher median [interquartile range (IQR)] homocysteine concentrations (12.8 [10.9,14.4] μmol/L vs 10.6 [8.6,14.7] μmol/L; P = 0.02) and lower folate concentrations (5.3 [4.2,7.3] ng/mL vs 6.9 [5.3,9.5] ng/mL; P = 0.01) than those without dNCR. Compared to the lowest tertile, the highest homocysteine tertile predicted dNCR onset (odds ratio [OR], 3.9; 95% CI, 1. 3 to 11.6; P = 0.02), even after adjusting for age, sex, education, and baseline Mini Mental State Examination. Conclusions Elderly patients with high homocysteine levels who underwent general anesthesia for non-cardiac surgery have an increased risk of dNCR. This knowledge could potentially assist in the development of preventative and/or therapeutic measures. Trial registration NCT03084393 (https://www.clinicaltrials.gov)

Risk Factors for Gram-Negative Bacterial Surgical Site Infection Do Allergies to Antibiotics Increase Risk?

2009 ◽  
Vol 30 (5) ◽  
pp. 440-446 ◽  
Author(s):  
Jane V. Trinh ◽  
Luke F. Chen ◽  
Daniel J. Sexton ◽  
Deverick J. Anderson
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Site Infection ◽  
Antimicrobial Prophylaxis ◽  
Multivariable Analysis ◽  
Patient Data ◽  
Site Infection ◽  
Gram Negative ◽  
Increased Risk ◽  
Patient Groups ◽  
The Relationship

Objective.To determine the relationship between indequate antimicrobial prophylaxis and development of gram-negative bacterial (GNB) surgical site infection (SSI).Design.Retrospective case-control study.Setting.A 369-bed acute care community hospital in Durham, North Carolina.Patients.Case patients were defined as patients who developed a GNB SSI after undergoing a surgical procedure during the period from January 1, 1998, through January 1, 2007. Control patients were uninfected patients who underwent surgery during the same study period and were matched to case patients by surgeon and type of procedure. Both patient groups were selected on the basis of prospectively collected data on patients who underwent surgery.Methods.Patient data were collected from patient medical records. Multivariable analysis was performed using logistic regression with backward selection, to identify variables independently associated with GNB SSI.Results.Case patients were similar to control patients with respect to demographics and comorbid conditions, but were older (P = .04), more obese (P = .03), and more likely to have diabetes mellitus (P = .03). Inappropriate timing of antimicrobial prophylaxis was the predominant reason that prophylaxis was deemed inadequate for both patient groups (59.1% of case patients vs 64.0% of control patients; P = .56). Case patients who had a history of allergic reactions to antimicrobial prophylaxis were significantly less likely to receive antimicrobial prophylaxis in a timely manner (P = .03). Variables independently associated with GNB SSI in multivariable analysis included urinary catheterization before surgery (odds ratio [OR], 3.74 [95% confidence interval {CI}, 1.11-12.62), diabetes mellitus (OR, 2.25 [95% CI, 1.02-4.94]), and an American Society of Anesthesiologists score greater than 2 (OR, 2.14 [95% CI, 1.13-4.06]).Conclusions.A β-lactam allergy was not associated with increased risk for GNB SSI. Further studies, using patient data from larger hospital databases, are needed to examine the relationship between use of urinary catheter before surgery and risk of GNB SSI.

scholarly journals Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section

2008 ◽  
Vol 29 (6) ◽  
pp. 477-484 ◽  
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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