Causes of Hospital Readmissions Within 7 Days From the Neurosurgical Service of a Quaternary Referral Hospital

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Enyinna L Nwachuku
Keyword(s):  
Postoperative Complications ◽  
Surgical Site Infection ◽  
Mental Status ◽  
Medical Center ◽  
Perioperative Complications ◽  
Demographic Data ◽  
Hospital Readmissions ◽  
Altered Mental Status ◽  
Csf Leak ◽  
Site Infection

Abstract INTRODUCTION Unplanned hospital readmission after discharge is an important quality metric. Such readmissions are associated with greater healthcare costs, decreased patient satisfaction, decreased clinical outcomes, and sometimes financial penalties. A large amount of data has been documented regarding 30-d readmissions for neurosurgical populations. However, a focus on 7-d readmissions may provide an insight into the causes of unplanned readmissions, perhaps translate into decreases in 30-d readmissions. This study was performed in order to determine the causes of 7-d readmissions and to define risk factors that, if addressed, would allow for a reduction of such readmissions. METHODS All patients readmitted after discharge within 7 d from the neurosurgical service from the University of Pittsburgh Medical Center, Presbyterian Hospital, during 2018 were evaluated. There were 18 different providers. Demographic data were collected for all patients. The primary reason for readmission was organized using a 5-category system: surgical site infection, pain, altered mental status/seizures, other postoperative complications [eg, venous thromboembolism (VTE), urinary tract infection, pneumonia, CSF leak, hematoma, shunt failure] and “unrelated.” RESULTS Of 5184 discharges, 169 patients (3.3%) were readmitted within 7 d (55% men; mean age 62 yr). A total of 65% had undergone care for cranial pathology and 35% for spine (versus 55% and 45%, respectively, in the total discharge population). Other postoperative complications were the leading cause of readmission (40%), followed by altered mental status/seizure and unrelated (20% each). Surgical site infection and postoperative pain exhibited the lowest rates of 10% each. CONCLUSION The overall 7-d readmission rate was 3.3%. There was nearly a 2:1 ratio for cranial versus spinal patients for 7-d readmissions. The majority of readmissions were related to postoperative complications, whether directly related to surgical intervention or perioperative complications. Focal efforts to decrease specific postoperative complications should translate into a reduction in both 7- and 30-d unplanned readmissions.

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

The incidence of complications in elective cranial neurosurgery associated with dural closure material

2014 ◽  
Vol 120 (1) ◽  
pp. 278-284 ◽  
Author(s):  
Brian P. Walcott ◽  
Jonathan B. Neal ◽  
Sameer A. Sheth ◽  
Kristopher T. Kahle ◽  
Emad N. Eskandar ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Corticosteroid Treatment ◽  
Csf Leak ◽  
Site Infection ◽  
Exclusion Criteria ◽  
Dural Closure ◽  
Estimated Blood Loss ◽  
Dural Graft ◽  
Synthetic Grafts

Object Dural closure with synthetic grafts has been suggested to contribute to the incidence of infection and CSF leak. The objective of this study was to assess the contribution of choice of dural closure material, as well as other factors, to the incidence of infection and CSF leak. Methods A retrospective, consecutive cohort study of adult patients undergoing elective craniotomy was established between April 2010 and March 2011 at a single center. Exclusion criteria consisted of trauma, bur hole placement alone, and temporary CSF fluid diversion. Results Three hundred ninety-nine patients were included (mean follow-up 396.6 days). Nonautologous (synthetic) dural substitute was more likely to be used (n = 106) in cases of reoperation (p = 0.001). Seventeen patients developed a surgical site infection and 12 patients developed a CSF leak. Multivariate logistic regression modeling identified estimated blood loss (OR 1.002, 95% CI 1.001–1.003; p < 0.001) and cigarette smoking (OR 2.198, 95% CI 1.109–4.238; p = 0.019) as significant predictors of infection. Synthetic dural graft was not a predictor of infection in multivariate analysis. Infratentorial surgery (OR 4.348, 95% CI 1.234–16.722; p = 0.024) and more than 8 days of postoperative corticosteroid treatment (OR 3.886, 95% CI 1.052–16.607; p = 0.048) were significant predictors for the development of CSF leak. Synthetic dural graft was associated with a lower likelihood of CSF leak (OR 0.072, 95% CI 0.003–0.552; p = 0.036). Conclusions The use of synthetic dural closure material is not associated with surgical site infection and is associated with a reduced incidence of CSF leak. Modifiable risk factors exist for craniotomy complications that warrant vigilance and further study.

Validation of semiautomated surgical site infection surveillance using electronic screening algorithms in 38 surgery categories

2018 ◽  
Vol 39 (8) ◽  
pp. 931-935 ◽  
Author(s):  
Sun Young Cho ◽  
Doo Ryeon Chung ◽  
Jong Rim Choi ◽  
Doo Mi Kim ◽  
Si-Ho Kim ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Surveillance System ◽  
Chart Review ◽  
Medical Center ◽  
Tertiary Care ◽  
Microbial Culture ◽  
Site Infection ◽  
Electronic Screening ◽  
Sensitivity Specificity ◽  
Infection Preventionists

ObjectiveTo verify the validity of a semiautomated surgical site infection (SSI) surveillance system using electronic screening algorithms in 38 categories of surgery.DesignA cohort study for validation of semiautomated SSI surveillance system using screening algorithms.SettingA 1,989-bed tertiary-care referral center in Seoul, Republic of Korea.MethodsA dataset of 40,516 surgical procedures in 38 categories stored in the conventional SSI surveillance registry at the Samsung Medical Center between January 2013 and December 2014 was used as the reference standard. In the semiautomated surveillance system, electronic screening algorithms flagged cases meeting at least 1 of 3 criteria: antibiotic prescription, microbial culture, and infectious disease consultation. Flagged cases were audited by infection preventionists. Analyses of sensitivity, specificity, and positive predictive value (PPV) were conducted for the semiautomated surveillance system, and its effect on reducing the workload for chart review was evaluated.ResultsA total of 575 SSI events (1·42%) were identified by conventional SSI surveillance. The sensitivity of the semiautomated SSI surveillance was 96·7%, and the PPV of the screening algorithms alone was 4·1%. Semiautomated SSI surveillance reduced the chart review workload of the infection preventionists from 1,283 to 482 person hours per year (a 62·4% decrease).ConclusionsCompared to conventional surveillance, semiautomated surveillance using electronic screening algorithms followed by chart review of selected cases can provide high-validity surveillance results and can significantly reduce the workload of infection preventionists.

ASA Physical Status Classification and Complications Following Facial Fracture Repair

2021 ◽  
pp. 000348942110595
Author(s):  
Parisorn Thepmankorn ◽  
Chris B. Choi ◽  
Sean Z. Haimowitz ◽  
Aksha Parray ◽  
Jordon G. Grube ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Site Infection ◽  
Fracture Repair ◽  
Site Infection ◽  
Class Iii ◽  
Facial Fracture ◽  
Asa Classification ◽  
Physical Status Classification ◽  
Deep Surgical Site Infection ◽  
Status Classification

Background: To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. Methods: Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher’s exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. Results: A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection ( P = .012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications ( P < .001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay ( P < .001) and risk of overall complications ( P = .032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection ( P = .049), postoperative bleeding ( P = .036), and failure to wean off ventilator ( P = .027). Conclusions: Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification.

EP.TH.959Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer surgery: An ongoing dilemma

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahin Hajibandeh ◽  
Shahab Hajibandeh ◽  
Pratik Bhattacharya ◽  
Reza Zakaria ◽  
Christopher Thompson ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Perioperative Complications ◽  
Loop Ileostomy ◽  
Length Of Hospital Stay ◽  
Ileostomy Closure ◽  
Site Infection ◽  
Cancer Resection

Abstract Aims To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection. Methods We systematic searched MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during (n = 185) or after (n = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82-2.36, p = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47-16.56, p = 0.26), surgical site infection (OR 1.97; 95% CI 0.80-4.90, p = 0.14), ileus (OR 1.22; 95% CI 0.50-2.96, p = 0.66) or length of hospital stay (MD 0.02; 95% CI -0.85-0.89, p = 0.97) between two groups. Between-study heterogeneity was low in all analyses. Conclusions The meta-analysis of best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on completeness of chemotherapy and quality of life which can determine appropriateness of either approach.

scholarly journals Surgical site infection leading to gangrene and amputation after ambulatory surgical care of an ingrown toenail: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Aimé Gilbert Mbonda Noula ◽  
Joel Noutakdie Tochie ◽  
Landry W. Tchuenkam ◽  
Desmond Aji Abang ◽  
René Essomba
Keyword(s):  
Postoperative Complications ◽  
Surgical Site Infection ◽  
Surgical Management ◽  
Wound Care ◽  
Rare Complication ◽  
Surgical Care ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Surgical Department ◽  
Ingrown Toenail

Abstract Background Currently, the management of ingrown toenail (onychocryptosis) ranges from conservative medical management to surgical treatment. Surgical management is typically performed as an outpatient procedure due to it numerous advantages such as the simplicity of the technique and the low incidence of postoperative complications. The most common postoperative complications are recurrences and surgical site infections, whereas gangrene complicating a surgical site infection has been scarcely reported. We are reporting a rare complication following ambulatory surgery untimely requiring amputation. Case presentation A twelve-year-old boy was referred to our orthopedic surgical department for a surgical site infection complicating an initial surgical management of a left ingrown big toenail leading to a dry gangrene of the affected toe. The gangrene toe was amputated under peripheral nerve block and the patient was discharged home the same day on antibiotics, analgesics and with sessions of rehabilitation and psychological support planned. The postoperative course was uneventful at 6 months of follow-up. Conclusion The authors report this case to draw clinicians’ attention, especially wound care specialists, orthopedists and podiatrists to this rare but potentially debilitating disease.

scholarly journals Surgical site infection after transoral versus posterior approach for atlantoaxial fusion: a matched-cohort study

2018 ◽  
Vol 28 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Mohamed Macki ◽  
Azam Basheer ◽  
Ian Lee ◽  
Ryan Kather ◽  
Ilan Rubinfeld ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Site Infection ◽  
Posterior Approach ◽  
Transoral Approach ◽  
Source Population ◽  
Site Infection ◽  
Improvement Program ◽  
Posterior Surgery ◽  
Atlantoaxial Fusion ◽  
Comorbidity Burden

OBJECTIVEIn the past, spine surgeons have avoided the transoral approach to the atlantoaxial segment because of concerns for unacceptable patient morbidity. The objective of this study was to measure 30-day postoperative complications, especially surgical site infection (SSI), after transoral versus posterior approach to atlantoaxial fusion.METHODSThe source population was provided by the American College of Surgeons National Surgical Quality Improvement Program database, which was queried for all patients who underwent atlantoaxial fusion for degenerative/spondylotic disease and/or trauma between 2005 and 2014. To eliminate bias from unequal sample sizes, patients who underwent the transoral approach were matched with patients who underwent the posterior approach (generally 1:5 ratio) based on age ± 5 years and modified frailty index score (a measure of preoperative comorbidity burden). Because of rare SSI incidence, adjusted odds ratios (ORadj) of SSI were calculated using penalized maximum likelihood estimation.RESULTSA total of 318 patients were included in the study. There were no statistically significant differences between the transoral cohort (n = 56) and the posterior cohort (n = 262) in terms of 30-day postoperative individual complications, including SSI (1.79% vs 1.91%; p = 0.951) and composite complications (10.71% vs 6.87%; p = 0.323). Controlling for sex and smoking, the odds of SSI in the transoral approach were almost equal to the odds in the posterior approach (ORadj 1.17; p = 0.866). While the unplanned reoperation rate of 5.36% after transoral surgery was higher than the 1.53% rate after posterior surgery, the difference approached, but did not reach, statistical significance (p = 0.076).CONCLUSIONSTransoral versus posterior surgery for atlantoaxial fusion did not differ in 30-day unexpected outcomes. Therefore, spinal pathology, rather than concern for postoperative complications, should adjudicate the technical approach to the atlantoaxial segment.

Does aberrant hepatic arterial anatomy impact the complication rate or survival following resection of pancreatic adenocarcinoma?

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 775-775
Author(s):  
Nicketti M Handy ◽  
Angelena Crown ◽  
Kimberly A. Bertens ◽  
Jesse Clanton ◽  
Adnan Alseidi ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Site Infection ◽  
Pancreatic Fistula ◽  
Pancreatic Head ◽  
Ductal Adenocarcinoma ◽  
Perioperative Outcomes ◽  
Rank Test ◽  
Site Infection ◽  
Chyle Leak ◽  
Arterial Anatomy

775 Background: Patients with aberrant hepatic arterial anatomy (AHAA) are susceptible to tumor invasion and/or ligation during resection of the pancreatic head. The purpose of this study is to determine if AHAA negatively impacts perioperative outcomes or survival. Methods: All patients who underwent either pancreaticoduodenectomy or total pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) between 2005 and 2014 at our center were retrospectively reviewed. Univariate logistic regression was used to compare outcomes between patients with conventional hepatic arterial anatomy to those with AHAA. Survival analysis was performed by Kaplan-Meier method with log rank test. Results: During the study period, 330 patients underwent resection for PDAC, 69 (20.9%) with aberrant hepatic arterial anatomy. The presence of AHAA does not significantly increase operative time (p= 0.110) or length of stay (p=0.518). The overall frequency of complications (49.3% vs 37.9%, p=0.088) was higher in the AHAA group, but not significantly so. Certain postoperative complications are more common in the AHAA group, namely superficial surgical site infection (18.8% vs. 8.8%, p=0.018) and pancreatic fistula (18.8% vs. 10.0%, p=0.042). However, deep SSI, need for blood transfusion, respiratory failure, DGE, bleed from GDA/pseudoaneurysm, biliary fistula, chyle leak, PV thrombus, fascial dehiscence, and reoperation are not statistically different between the two groups. There is a trend for reduced overall survival in the AHAA group that is not statistically significant (p=0.11). Conclusions: Aberrant hepatic arterial anatomy is encountered in greater than 20% of pancreatic surgery patients, and its presence may increase the rate of certain postoperative complications such as superficial surgical site infection and pancreatic fistula.

Man with headache and altered mental status

2021 ◽  
Vol 38 (7) ◽  
pp. 519-528
Author(s):  
Christiana K Prucnal ◽  
Paul S Jansson
Keyword(s):  
Ct Scan ◽  
Mental Status ◽  
Endoscopic Sinus Surgery ◽  
Altered Mental Status ◽  
Sinus Surgery ◽  
Csf Leak ◽  
Nasal Discharge ◽  
List Type ◽  
Ischaemic Damage ◽  
Contrast Ct

PresentationAn 83-year-old man presented for headache and altered mental status. Four days prior, he underwent endoscopic sinus surgery for nasal polyps. Over the two previous days, he gradually developed a headache and was brought to the emergency department when his wife noted mild confusion and generalised weakness. His examination was notable for a heart rate of 101 beats per minute, clear nasal discharge, meningismus and confusion to the date with generalised weakness. A lumbar puncture revealed cloudy cerebrospinal fluid (CSF) with a white blood cell count of 3519x10ˆ9/L (95% neutrophils). A CT scan of the head was obtained (figure 1).Figure 1Non-contrast CT scan of the head in axial plane.QuestionWhat is the appropriate next step in management?Obtain MRI of the brain to localise ischaemic damage.Administer broad-spectrum antibiotics, including pseudomonal coverage.Consult otolaryngology to arrange functional endoscopic sinus surgery for CSF leak closure.Consult neurosurgery for surgical decompression of mass lesion(s).

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