Readmission and reoperation rates after resection of malignant primary brain tumours in England 2013-2017

Abstract Aims Morbidity and mortality following resection of malignant primary brain tumours is high. The benefits of reoperation for recurrent tumours are uncertain and it is not known how frequently patients in England undergo further tumour resections. The aim of this study was to describe 30-day and one-year readmission rates, the clinical reasons for readmission and the rate of resections for recurrent tumours. Method Patient data was extracted from Hospital Episode Statistics (the hospital administrative data for NHS hospitals in England) for all supratentorial, malignant, primary brain tumour resections performed from April 2013 to March 2017. All subsequent non-elective readmissions to any NHS hospital and all readmissions for further tumour resection within 30 days and one year were analysed for the primary clinical diagnosis and primary procedure performed. Results A total of 6,982 patients were identified and the 30-day and one-year readmission rates were 18.6% (n=1,298) and 57.4% (n=4,007), respectively. The rates of reoperation for tumour resection were 0.5% (n=33) and 6.2% (n=432), respectively. The commonest reasons for 30-day readmission were post-operative complications (17.9% of admissions), general medical complications (17.3%) and surgical site infection (9.6%). The most frequently performed neurosurgical procedures were for treatment of surgical site infection (37.6% of procedures). The commonest reasons for readmission within one year were general medical complications (17.4%), seizures (14%), systemic infections (11.4%) and post-operative complications (11%). Almost half of all neurosurgical procedures performed within one year were reoperation for tumour resection (45.6%), while treatment of surgical site infection (17.9%) and CSF shunt insertions and revisions (9.1%) were also common. Conclusion This study provides a descriptive analysis of the rates of readmission, diagnosis on readmission, and the need for further neurosurgical procedures. The rate of non-elective readmissions within one year is high and these data may be useful for service planning and for counselling patients about their treatment. Additionally, these data contribute to the development of quality indicators, for benchmarking and comparing quality of care provision between neurosurgical units. Further research, with linkage to histology data and performance status, would support an analysis of the role of resection of recurrent, malignant, primary brain tumours.

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Dual mobility total hip arthroplasty in the treatment of femoral neck fractures

The Bone & Joint Journal ◽

10.1302/0301-620x.102b11.bjj-2020-0610.r2 ◽

2020 ◽

Vol 102-B (11) ◽

pp. 1457-1466 ◽

Cited By ~ 1

Author(s):

Yong-Han Cha ◽

Jun-Il Yoo ◽

Jung-Taek Kim ◽

Chan-Ho Park ◽

Young-Sun Ahn ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Cohort Studies ◽

Surgical Site Infection ◽

Comparative Studies ◽

Femoral Neck Fractures ◽

Dislocation Rate ◽

Site Infection ◽

Dual Mobility ◽

One Year

Aims To evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced femoral neck fractures, and to compare rates of dislocation, surgical-site infection, reoperation, and one-year mortality between DM-THA and bipolar hemiarthroplasty (BHA). Methods Studies were selected based on the following criteria: 1) study design (retrospective cohort studies, prospective cohort studies, retrospective comparative studies, prospective comparative studies, and randomized controlled studies (RCTs)); 2) study population (patients with femoral neck fracture); 3) intervention (DM-THA or BHA); and 4) outcomes (complications during postoperative follow-up and clinical results). Pooled meta-analysis was carried out to evaluate the dislocation rate after DM-THA and to compare outcomes between DM-THA and BHA. Results A total of 17 studies (ten cohort studies on DM-THA and seven comparative studies of DM-THA and BHA) were selected. These studies included 2,793 patients (2,799 hips), made up of 2,263 DM-THA patients (2,269 hips) and 530 BHA patients (530 hips). In all, 16 studies were analyzed to evaluate dislocation rate after DM-THA. The cumulative dislocation rate was 4% (95% confidence interval (CI) 3 to 5). Seven studies were analyzed to compare the rates dislocation and surgical-site infection. The rate of dislocation was significantly lower in the DM-THA group than in the BHA group (risk ratio (RR) 0.3; 95% CI 0.17 to 0.53, p < 0.001, Z −4.11). There was no significant difference in the rate of surgical-site infection between the two groups (p = 0.580). Six studies reported all-cause reoperations. The rate of reoperation was significantly lower in the DM-THA group than in the BHA group (RR 0.5; 95% CI 0.32 to 0.78, p = 0.003, Z −3.01). Five studies reported one-year mortality. The mortality rate was significantly lower in the DM-THA group than in the BHA group (RR 0.58 95% CI 0.45 to 0.75, p < 0.0001, Z −4.2). Conclusion While the evidence available consisted mainly of non-randomized studies, DM-THA appeared to be a viable option for patients with displaced fractures of the femoral neck, with better reported rates of dislocation, reoperation, and mortality than BHA. Cite this article: Bone Joint J 2020;102-B(11):1457–1466.

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Dual antibiotic prevention bundle is associated with decreased surgical site infections

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001515 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1411-1417

Author(s):

Michelle Kuznicki ◽

Adrianne Mallen ◽

Emily Clair McClung ◽

Sharon E Robertson ◽

Sarah Todd ◽

...

Keyword(s):

Surgical Site Infection ◽

Infection Rate ◽

Infection Prevention ◽

Gynecologic Oncology ◽

Site Infection ◽

Surgical Site Infection Rate ◽

Readmission Rates ◽

Optimal Method ◽

Bundle Versus ◽

Exact Test

BackgroundGynecologic oncology surgery is associated with a wide variation in surgical site infection risk. The optimal method for infection prevention in this heterogeneous population remains uncertain.Study DesignA retrospective cohort study was performed to compare surgical site infection rates for patients undergoing hysterectomy over a 1-year period surrounding the implementation of an institutional infection prevention bundle. The bundle comprised pre-operative, intra-operative, and post-operative interventions including a dual-agent antibiotic surgical prophylaxis with cefazolin and metronidazole. Cohorts consisted of patients undergoing surgery during the 6 months prior to this intervention (pre-bundle) versus those undergoing surgery during the 6 months following the intervention (post-bundle). Secondary outcomes included length of stay, readmission rates, compliance measures, and infection microbiology. Data were compared with pre-specified one-sided exact test, Chi-square test, Fisher’s exact test, or Kruskal–Wallis test as appropriate.ResultsA total of 358 patients were included (178 PRE, 180 POST). Median age was 58 (range 23–90) years. The post-bundle cohort had a 58% reduction in surgical site infection rate, 3.3% POST vs 7.9% PRE (−4.5%, 95% CI −9.3% to −0.2%, p=0.049) as well as reductions in organ space infection, 0.6% POST vs 4.5% PRE (−3.9%, 95% CI −7.2% to −0.7%, p=0.019), and readmission rates, 2.2% POST vs 6.7% PRE (−4.5%, 95% CI −8.7% to −0.2%, p=0.04). Gram-positive, Gram-negative, and anaerobic bacteria were all prevalent in surgical site infection cultures. There were no monomicrobial infections in post-cohort cultures (0% POST vs 58% PRE, p=0.04). No infections contained methicillin-resistant Staphylococcus aureus.ConclusionImplementation of a dual antibiotic infection prevention bundle was associated with a 58% reduction in surgical site infection rate after hysterectomy in a surgically diverse gynecologic oncology practice.

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Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure

Infection Control and Hospital Epidemiology ◽

10.1086/653205 ◽

2010 ◽

Vol 31 (7) ◽

pp. 701-709 ◽

Cited By ~ 20

Author(s):

Deverick J. Anderson ◽

Jean Marie Arduino ◽

Shelby D. Reed ◽

Daniel J. Sexton ◽

Keith S. Kaye ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Surgical Site Infection ◽

Bloodstream Infection ◽

Surgical Procedures ◽

Tertiary Care ◽

Orthopedic Procedures ◽

Neurosurgical Procedures ◽

Site Infection ◽

Incisional Surgical Site Infection ◽

Epidemiological Characteristics

Objective.To determine the epidemiological characteristics of postoperative invasive Staphylococcus aureus infection following 4 types of major surgical procedures.Design.Retrospective cohort study.Setting.Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia.Patients.Adults undergoing orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures.Methods.We used previously validated, prospectively collected surgical surveillance data for surgical site infection and microbiological data for bloodstream infection. The study period was 2003 through 2006. We defined invasive S. aureus infection as either nonsuperficial incisional surgical site infection or bloodstream infection. Nonparametric bootstrapping was used to generate 95% confidence intervals (CIs). P values were generated using the Pearson x2 test, Student t test, or Wilcoxon rank-sum test, as appropriate.Results.In total, 81,267 patients underwent 96,455 procedures during the study period. The overall incidence of invasive S. aureus infection was 0.47 infections per 100 procedures (95% CI, 0.43–0.52); 227 (51%) of 446 infections were due to methicillin-resistant S. aureus. Invasive S. aureus infection was more common after cardiothoracic procedures (incidence, 0.79 infections per 100 procedures [95% CI, 0.62–0.97]) than after orthopedic procedures (0.37 infections per 100 procedures [95% CI, 0.32–0.42]), neurosurgical procedures (0.62 infections per 100 procedures [95% CI, 0.53–0.72]), or plastic surgical procedures (0.32 infections per 100 procedures [95% CI, 0.17¬0.47]) (P < .001). Similarly, S. aureus bloodstream infection was most common after cardiothoracic procedures (incidence, 0.57 infections per 100 procedures [95% CI, 0.43–0.72]; P < .001, compared with other procedure types), comprising almost three-quarters of the invasive S. aureus infections after these procedures. The highest rate of surgical site infection was observed after neurosurgical procedures (incidence, 0.50 infections per 100 procedures [95% CI, 0.42–0.59]; P < .001, compared with other procedure types), comprising 80% of invasive S. aureus infections after these procedures.Conclusion.The frequency and type of postoperative invasive S. aureus infection varied significantly across procedure types. The highest risk procedures, such as cardiothoracic procedures, should be targeted for ongoing preventative interventions.

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Efficacy of Short Course Antibiotic Prophylaxis in Surgical Treatment of Closed Fracture

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i1.23931 ◽

2019 ◽

Vol 4 (1) ◽

pp. 607-610 ◽

Cited By ~ 1

Author(s):

Subash Chandra Jha ◽

Pramod Baral ◽

Prakash Shakya

Keyword(s):

Antibiotic Resistance ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Primary Objective ◽

Site Infection ◽

Long Run ◽

Short Course ◽

Sensitivity Report ◽

One Year ◽

Super Infection

Introduction: Unnecessary and rampant use of antibiotic for perioperative prophylaxis are not only increasing cost of treatment but also are hazardous in terms of increasing antibiotic resistance, super infection with resistant pathogens and antibiotic toxicity. Objective: Our primary objective is to assess the efficacy of short course antibiotic prophylaxis in preventing surgical site infection (SSI) in surgery of closed orthopedic fracture. Methodology: Patients fulfilling all the inclusion criteria and willing and able to give informed consent were included in the study. All participants were treated by standard surgical technique following standard surgical protocol. Short course antibiotic prophylaxis was administered in peri-operative period to all patients in given format: Three divided dose of intravenous 1.5 gram cefuroxime during peri-operative period followed by no intravenous or oral antibiotics; 1st dose half an hour before incision; 2nd and 3rd dose repeated at 12 hours interval. Results: Of total 100 patient included, three developed surgical site infection till one year follow-up. All three patients with surgical site infection were treated successfully with intravenous antibiotic based on the culture sensitivity report. The average cost of antibiotic for short course antibiotic prophylaxis was 1500 NPR for each patient. Conclusions: There was no significant increase in rate of surgical site infection with short course antibiotic prophylaxis, rather it was less expensive and may have less adverse effect, in terms of antibiotic resistance and antibiotic side effects on long run.

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Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.11.peds16455 ◽

2017 ◽

Vol 19 (4) ◽

pp. 421-427 ◽

Cited By ~ 5

Author(s):

Brandon A. Sherrod ◽

Brandon G. Rocque

Keyword(s):

Length Of Stay ◽

Surgical Site Infection ◽

Pediatric Patients ◽

Pediatric Neurosurgery ◽

Neurosurgical Procedures ◽

Site Infection ◽

Improvement Program ◽

Superficial Infection ◽

Index Procedure ◽

Postoperative Length

OBJECTIVE Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. METHODS The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program–Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. RESULTS A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p < 0.001 for each). Post-SSI sepsis rates (6.3% vs 28.0% for superficial versus deep SSI, respectively; p < 0.001), wound disruption rates (4.9% vs 22.4%, p < 0.001), and reoperation rates (23.6% vs 70.1%, p < 0.001) were significantly greater for patients with deep SSIs. Postoperative length of stay in patients discharged before SSI development was not significantly different for deep versus superficial SSI (4.2 ± 2.7 vs 3.6 ± 2.4 days, p = 0.094). No patient with SSI died within 30 days after surgery. CONCLUSIONS Thirty-day SSI is associated with significant 30-day morbidity in pediatric patients undergoing nonshunt neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure.

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The Impact of Pre-Operative Weight Loss on Incidence of Surgical Site Infection and Readmission Rates After Total Joint Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2013.07.030 ◽

2014 ◽

Vol 29 (3) ◽

pp. 458-464.e1 ◽

Cited By ~ 41

Author(s):

Maria C.S. Inacio ◽

Donna Kritz-Silverstein ◽

Rema Raman ◽

Caroline A. Macera ◽

Jeanne F. Nichols ◽

...

Keyword(s):

Weight Loss ◽

Surgical Site Infection ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Site Infection ◽

Readmission Rates ◽

The Impact

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Risk Factors for Pediatric Surgical Site Infection Following Neurosurgical Procedures for Hydrocephalus: A Retrospective Single-Center Cohort Study

10.21203/rs.3.rs-145947/v1 ◽

2021 ◽

Author(s):

Miho Shibamura-Fujiogi ◽

Jennifer Ormsby ◽

Mark Breibart ◽

Benjamin Warf ◽

Thomas Sandora ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Brain Tumor ◽

Surgical Site Infection ◽

Cardiac Disease ◽

Connective Tissue Diseases ◽

Neurosurgical Procedures ◽

Site Infection ◽

Csf Diversion ◽

Univariate Analyses

Abstract Background Infection is a major complication following cerebral spinal fluid (CSF) diversion procedures for hydrocephalus. However, their pediatric risk factors for surgical site infection (SSI) are currently not well defined. Because SSI prevention bundle is increasingly introduced, the purpose of this study was to evaluate risk factors associated with SSIs following CSF diversion surgeries under SSI bundle at a single quaternary care pediatric hospital.Methods We performed a retrospective cohort study of patients undergoing CSF diversion procedures from 2017 to 2019. SSIs were identified prospectively through continuous surveillance. We performed univariate analyses to determine an association between SSIs and patient demographics, comorbidities and perioperative factors, with subsequent multivariate logistic regression analyses to identify independent risk factors for SSI.Results We identified a total of 561 CSF diversion procedures with an overall SSI rate of 3.6%. In univariate analyses, older age, number of previous shunt revisions and comorbid cardiac disease were significantly associated with SSI. In multivariate analyses, history of brain tumor (OR2.75, 95%CI 1.03-7.33, P=0.04) and cardiac comorbidities (OR9.47, 95%CI 2.15-41.73, P=0.003) were significantly associated with SSIs. When endoscopic third ventriculostomy was excluded, only cardiac disease was independently associated with SSI. Cardiac diseases associated with SSI included single ventricle disease with palliative repair and valvulopathy with underlying connective tissue diseases. Conclusion This study showed that comorbid conditions (cardiac disease, brain tumor) were more important than perioperative factors as risk factors for SSI in pediatric patients undergoing CSF diversion procedures. Further investigation is needed to define the mechanisms behind these associations.

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Prevalence of surgical site infection in general surgery in a tertiary care centre in India

International Surgery Journal ◽

10.18203/2349-2902.isj20173896 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3101 ◽

Cited By ~ 3

Author(s):

Ansul Kumar ◽

Arpita Rai

Keyword(s):

Surgical Site Infection ◽

General Surgery ◽

Surgical Procedure ◽

Health Care Systems ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Exploratory Laparotomy ◽

Site Infection ◽

Tertiary Care Centre ◽

One Year

Background: Surgical site infection (SSI) can be defined as an infection that is present up to 30 days after a surgical procedure if no implants are placed and up to one year if an implantable device was placed in the patient. SSI is a significant problem associated with major surgeries and is the 3rd most frequently reported nosocomial infection. This study aims to study the prevalence of SSI in the Department of Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi.Methods: A retrospective study was undertaken at the Department of General Surgery for a period of one year. Retrospective chart review was conducted from the hospital database. The rate of SSI was studied in relation to its type, the type of surgical procedure and elective vs emergency surgeries.Results: The present study revealed 12.5% prevalence of SSI in Department of General Surgery, RIMS. Among the 3 types, superficial incision SSI was most prevalent followed by deep incisional SSI and finally by organ/space SSI. The surgical procedure most commonly associated with SSI was exploratory laparotomy. An alarming 17.7% of SSI was associated with emergency surgeries as compared to 12.5% of elective surgeries.Conclusions: The consequences of SSIs greatly impact patients and the healthcare systems. Prevention of SSI requires a multifaceted approach targeting pre-, intra-, and postoperative factors. It is imperative that facilities have open-minded management teams, regulatory agencies and medical associations that want to provide the foundation required to generate a culture of patient safety in our health care systems.

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Readmissions after Diagnosis of Surgical Site Infection Following Knee and Hip Arthroplasty

Infection Control and Hospital Epidemiology ◽

10.1086/674854 ◽

2014 ◽

Vol 35 (2) ◽

pp. 152-157 ◽

Cited By ~ 17

Author(s):

Kyle G. Miletic ◽

Thomas N. Taylor ◽

Emily T. Martin ◽

Rahul Vaidya ◽

Keith S. Kaye

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Hospital Admissions ◽

Site Infection ◽

Median Cost ◽

Readmission Rates ◽

Total Hip ◽

Hip And Knee Arthroplasty

Context.Surgical site infection (SSI) after total hip and knee arthroplasty is a common postoperative complication. We sought to determine readmission rates and costs for total hip and knee arthroplasty complicated by SSI.Design.The Thomson Reuters MarketScan database was searched for patients who underwent knee or hip arthroplasty in 2007. From these data, patients who received a diagnosis of SSI and were readmitted after diagnosis were identified.Setting.A population of 31 to 45 million individuals receiving insurance coverage. Patients who underwent knee or hip arthroplasty who experienced a hospitalization for SSI in the year after surgery were analyzed.Outcome Measures.Total readmission rates and costs per readmission at 30, 60, and 90 days and 1 year after diagnosis of SSI.Results.Of the 76,289 case patients with hip or knee replacement in 2007, 1,026 (1.3%) had a hospitalization for SSI within the year after surgery. Among these patients, 310 (30.2%) were subsequently rehospitalized in the year after initial hospitalization specifically due to SSI-related issues. These rehospitalizations were associated with a mean hospital stay of 7.4 ± 11.4 days and a median cost of $20,001 (interquartile range [IQR], $14,057-$30,551). A total of 517 subjects had a subsequent “all-cause” hospitalization during the year after SSI. These rehospitalizations were associated with a mean hospital stay of 6.4 ± 10.4 days and a median cost of $19,870 (IQR, $13,913-$29,728).Conclusions.Readmissions during the year after SSI diagnosis accounted for 1,072 hospital admissions and cost over $25.5 million. These readmissions are costly and might be a future target for decreased reimbursement.

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COMPARISION OF SURGICAL SITE INFECTION BETWEEN OPEN APPENDECTOMY AND LAPAROSCOPIC APPENDECTOMY

10.36106/ijar/3400903 ◽

2021 ◽

pp. 25-25

Author(s):

J. Sudhakar ◽

Manoj Karthik Gera

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Laparoscopic Appendectomy ◽

Open Appendectomy ◽

Length Of Hospital Stay ◽

Site Infection ◽

Operative Complications ◽

Bowel Movements ◽

Perforated Appendix ◽

Health Care Associated Infection

Appendectomy is most common surgical procedure in emergency surgery. Inamed appendix can be removed laparoscopically (laparoscopic appendectomy) or openly (open appendectomy). Surgical site infection is representative of health care associated infection in which it may effect on patients' morbidity and mortality. The aim of the study is to compare laparoscopic appendectomy and open appendectomy in terms of surgical site infection. The frequency of 60 patients who underwent appendectomy open appendectomy-40;laparoscopic appendectomy-20 between September 2019- march2020 which were retrospectively reviewed for demographic and pathological characteristic, recovery of bowel movements, length of hospital stay and post-operative complications. The frequency of purulent/gangrenous or perforated appendix were Laparoscopic appendectomy-10% and in open appendectomy 20%. The time of rst atus after surgery were 2.9 days and in open appendectomy were 2.97 days in laparoscopic appendectomy. Length of hospital stay were relatively short in laparoscopic appendectomy group and in open appendectomy group The frequency of overall surgical site infection were not that difference between the two groups laparoscopic appendectomy -15% open appendectomy group were22%But that of supercial surgical site infection was signicantly lower in laparoscopic appendectomy group5% open appendectomy group 15%.

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