scholarly journals 892. Meningitis after Ventricular Shunt Operations: Multicenter Study to Identify Etiology, Incidence and Risk Factors

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S481-S481
Author(s):  
Lucca G Giarola ◽  
Handerson Dias Duarte de Carvalho ◽  
Braulio Roberto Gonçalves Marinho Couto ◽  
Carlos Ernesto Ferreira Starling
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Hospital Admission ◽  
Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Communicating Hydrocephalus ◽  
Increased Risk ◽  
Belo Horizonte

Abstract Background A Ventriculoperitoneal shunt is the main treatment for communicating hydrocephalus. Surgical site infection associated with the shunt device is the most common complication and an expressive cause of morbidity and mortality of the treatment. The objective of our study is to answer three questions: a)What is the risk of meningitis after ventricular shunt operations? b) What are the risk factors for meningitis? c) What are the main microorganisms causing meningitis? Methods A retrospective cohort study assessed meningitis and risk factors in patients undergoing ventricular shunt operations between 2015/Jul and 2018/Jun from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Sample size = 926. 26 variables were evaluated by univariate and multivariate analysis (logistic regression). Results 71 patients were diagnosed with meningitis which represent a risk of 7.7% (C.I.95%= 6.1%; 9.6%). From the 26 variables, three were acknoleged as risk factors: age < two years old (OR = 3.20; p < 0.001), preoperative hospital length of stay > four days (OR = 2.02; p = 0.007) and more than one surgical procedure (OR = 3.23; p = 0.043). Patients two or more years old, who had surgery four days after hospital admission, had increased risk of meningitis from 4% to 6% (p = 0.140). If a patient < two years had surgery four days post hospital admission, the risk is increased from 9% to 18% (p = 0.026). 71 meningitis = > 45 (63%) the etiologic agent identified: Staphylococcus aureus (33%), Staphylococcus epidermidis (22%), Acinetobacter sp (7%), Enterococcus sp (7%), Pseudomonas sp (7%), and other (18%). Hospital length of stay in non-infected patients (days): mean = 21 (sd = 28), median = 9; hospital stay in infected patients: mean = 34 (sd = 37), median = 27 (p=0.025). Mortality rate in patients without infection was 10% while hospital death of infected patients was 13% (p=0.544). Conclusion Two intrinsic risk factors for meningitis post ventricular shunt, age under two years old and multiple surgeries, and one extrinsic risk factor, preoperative length of hospital stay, were identified. Incidence of meningitis post VP shunt decreases with urgent surgical treatment. Disclosures All Authors: No reported disclosures

scholarly journals Etiology, Incidence, and Risk Factors for Meningitis after Ventriculoperitoneal Shunt Procedures: A Multicenter Study

2020 ◽  
Vol 41 (S1) ◽  
pp. s221-s222
Author(s):  
Danilo Silva ◽  
Henrique Couto ◽  
Hoberdan Pereira ◽  
Gregory Lauar Souza ◽  
Andressa Silveira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Hospital Admission ◽  
Regression Model ◽  
Hospital Stay ◽  
Ventriculoperitoneal Shunt ◽  
Logistic Regression Model ◽  
Hospital Death ◽  
Communicating Hydrocephalus ◽  
Increased Risk

Background: The ventriculoperitoneal shunt is the main procedure used for to treat communicating hydrocephalus. Surgical site infection associated with the shunt device is the most common complication and a cause of morbidity and mortality of related to the treatment. We sought to answer 3 questions: (1) What is the risk of meningitis after ventricular shunt operations? (2) What are the risk factors for meningitis? (3) What are the main microorganisms causing meningitis? Methods: We conducted a retrospective cohort study of patients undergoing ventricular shunt operations between July 2015 and June 2018 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the CDC NHSN. Our sample size was 926, and we evaluated 26 preoperative and operative variables by univariate and multivariate analysis. Our outcome variables of interest were meningitis and hospital death. Results: In total, 71 cases of meningitis were diagnosed (risk, 7.7%; 95% CI, 6.1%–9.6%). The mortality rate among patients without infection was 10%, whereas hospital mortality of infected patients was 13% (P = .544). The 3 main risk factors for meningitis after ventricular shunt were identified by logistic regression model: age <2 years (OR, 3.20; P < .001), preoperative hospital stay >4 days (OR, 2.02; P = .007) and >1 surgical procedure, in addition to ventricular shunt (OR, 3.23; P = .043). Almost 1 of 3 of all patients was <2 years old (290, 31%). Also, 430 patients had >4 preoperative days (46%). Patients aged ≥2 years who underwent surgery 4 days after hospital admission had an increased risk of meningitis, from 4% to 6% (P = .140). If a patient <2 years old underwent surgery 4 or more days after hospital admission, the risk of meningitis increased from 9% to 18% (P = .026; Fig. 1). We built a risk index using the number of main risk factors based on a logistic regression model (0, 1, 2 or 3; Fig. 2). Conclusions:We identified 2 intrinsic risk factors for meningitis after ventricular shunt, age <2 years and multiple surgical procedures, and 1 extrinsic risk factor, the preoperative length of hospital stay.Funding: NoneDisclosures: None

scholarly journals 1247. Multicenter Study on Risk Factors for Surgical Site Infection After Exploratory Laparotomy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S449-S449
Author(s):  
Túlio Alves Jeangregório Rodrigues ◽  
Guilherme Fernandes de Oliveira ◽  
Júlia G C Dias ◽  
Laís Souza Campos ◽  
Letícia Rodrigues ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Surgical Site Infection ◽  
Exploratory Laparotomy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Site Infection ◽  
The Impact

Abstract Background Exploratory laparotomy surgery is abdominal operations not involving the gastrointestinal tract or biliary system. The objective of our study is to answer three questions: (a) What is the risk of surgical site infection (SSI) after exploratory abdominal surgery? (b) What is the impact of SSI in the hospital length of stay and hospital mortality? (c) What are risk factors for SSI after exploratory abdominal surgery? Methods A retrospective cohort study assessed meningitis and risk factors in patients undergoing exploratory laparotomy between January 2013 and December 2017 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. 26 preoperative and operative categorical and continuous variables were evaluated by univariate and multivariate analysis (logistic regression). Outcome variables: Surgical site infection (SSI), hospital death, hospital length of stay. Variables were analyzed using Epi Info and applying statistical two-tailed test hypothesis with significance level of 5%. Results A sample of 6,591 patients submitted to exploratory laparotomy was analyzed (SSI risk = 4.3%): Hospital length of stay in noninfected patients (days): mean = 16, median = 6, std. dev. = 30; hospital stay in infected patients: mean = 32, median = 22, std. dev. = 30 (P < 0.001). The mortality rate in patients without infection was 14% while hospital death of infected patients was 20% (P = 0.009). Main risk factors for SSI: ügeneral anesthesia (SSI = 4.9%, relative risk – RR = 2.8, P < 0.001); preoperative hospital length of stay more than 4 days (SSI=3.9%, RR=1.8, P = 0.003); wound class contaminated or dirty (SSI = 5.4%, RR = 1.5, P = 0.002); duration of procedure higher than 3 hours (SSI = 7.1%, RR = 2.1, P < 0.001); after trauma laparotomy (SSI = 7.8%, RR = 1.9, P = 0.001). Conclusion We identified patients at high risk of surgical site infection after exploratory laparotomy: trauma patients from contaminated or dirty wound surgery, submitted to a procedure with general anesthesia that last more than 3 hours have 13% SSI. Patients without any of these four risk factors have only 1.2% SSI. Disclosures All authors: No reported disclosures.

scholarly journals 904. Surgical Site Infection After Bariatric Surgery: a Small Risk that Defines Life and Death of Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S486-S486
Author(s):  
Lucca G Giarola ◽  
Carlos Ernesto Ferreira Starling ◽  
Braulio Roberto Gonçalves Marinho Couto ◽  
Handerson Dias Duarte de Carvalho
Keyword(s):  
Bariatric Surgery ◽  
Logistic Regression ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Site Infection ◽  
Belo Horizonte

Abstract Background Surgical site infection (SSI) in bariatric surgery can lead to devastating outcomes such as peritonitis, sepsis, septic shock and organ space infection. The objective of our study is to answer four questions: a) What is the SSI risk after bariatric surgery? b) What are the risk factors for SSI after bariatric surgery? c) What are the main outcomes to SSI in bariatric surgery? d) What are the main bacteria responsible for SSI in bariatric surgery? Methods A retrospective cohort study assessed 8,672 patients undergoing bariatric surgery between 2014/Jan and 2018/Dec from two hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Outcome: SSI, hospital death and total length of hospital stay. 20 preoperative and operative variables were evaluated by univariate and multivariate analysis (logistic regression). Results 77 SSI were diagnosed (risk = 0.9% [C.I.95% = 0.7%;1.1%]). Mortality rate in patients, without infection was only 0.03% (3/8,589) while hospital death of infected patients was 4% (3/77; RR = 112; p&lt; 0.001). Hospital length of stay in non-infected patients (days): mean = 2, std.dev.= 0.9; hospital stay in infected patients: mean = 7, std. dev. = 15.6 (p&lt; 0.001). Two main factors associated with SSI after bariatric surgery were identified by logistic regression: duration of procedure (hours), OR = 1.4;p=0.001, and laparoscopy procedure, OR = 0.3;p=0.020. From 77 SSIs, in 28 (36%) we identified 34 etiologic agents. The majority of SSI (59%) was caused by species of Streptococcus (32%), Klebsiella (15%), and Enterobacter (12%). Conclusion SSI is rare after bariatric surgery, however, when it happens, it’s a disaster for the patient. The incidence of SSI can be reduced significantly when laparoscopy procedure is used and the surgeon is able to perform a rapid surgery. Disclosures All Authors: No reported disclosures

scholarly journals Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery

2016 ◽  
Vol 4 (2) ◽  
pp. 259-263 ◽  
Author(s):  
Nertila Kodra ◽  
Vjollca Shpata ◽  
Ilir Ohri
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Clinical Laboratory ◽  
Multivariate Regression Analysis ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Postoperative Pulmonary Complications ◽  
Increased Risk ◽  
Surgical Ward

BACKGROUND: Incidence of postoperative pulmonary complications (PPC) in patients undergoing non-cardiothoracic surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system.AIM: The aim of the study was to identify risk factors for PPC in patients undergoing abdominal surgical procedures.MATERIALS AND METHODS: A prospective cohort study in abdominal surgical patients, admitted to the emergency and surgical ward of the UHC of Tirana, Albania, was conducted during the period: March 2014-March 2015. We collected data on the occurrence of a symptomatic and clinically significant PPC using clinical, laboratory, and radiology data. We evaluated the relations between PPCs and various pre-operative or intra-operative factors to identify risk factors.RESULTS: A total of 450 postoperative patients admitted to the surgical emergency and surgical ward were studied. The mean age were 59.85 ±13.64 years with 59.3% being male. Incidence of PPC was 27.3% (123 patients) and hospital length of stay was 4.93 ± 4.65 days. Length of stay was substantially prolonged for those patients who developed PPC (7.48 ± 2.89 days versus 3.97± 4.83 days, p < 0.0001. PPC were identified as risk factors for mortality, OR: 21.84; 95%CI: 11.66-40.89; P < 0.0001. The multivariate regression analysis identified as being independently associated with an increased risk of PPC: age ≥ 65 years (OR 11.41; 95% CI: 4.84-26.91, p < 0.0001), duration of operation ≥ 2.5 hours (OR 8.38; 95%CI: 1.52-46.03, p = 0.01, history of previous pulmonary diseases (OR 11.12; 95% CI: 3.28-37.65, P = 0.0001) and ASA > 2 (OR 6.37; 95% CI: 1.54-26.36, P = 0.01). CONCLUSION: We must do some efforts in reducing postoperative pulmonary complications, firstly to identify which patients are at increased risk, and then following more closely high-risk patients because those patients are most likely to benefit.

Pain Assessment and Control in the Injured Elderly

2016 ◽  
Vol 82 (10) ◽  
pp. 867-871 ◽  
Author(s):  
Ara Ko ◽  
Megan Y. Harada ◽  
Eric J.T. Smith ◽  
Michael Scheipe ◽  
Rodrigo F. Alban ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Injury Severity ◽  
Unit Length ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Increased Risk ◽  
Elderly Trauma Patients

Elderly trauma patients may be at increased risk for underassessment and inadequate pain control in the emergency department (ED). We sought to characterize risk factors for oligoanalgesia in the ED in elderly trauma patients and determine whether it impacts outcomes in elderly trauma patients. We included elderly patients (age ≥55 years) with Glasgow Coma Scale scores 13 to 15 and Injury Severity Score (ISS) ≥9 admitted through the ED at a Level I trauma center. Patient characteristics and outcomes were compared between those who reported pain and received analgesics medication in the ED (MED) and those who did not (NO MED). A total of 183 elderly trauma patients were identified over a three-year study period, of whom 63 per cent had pain assessed via verbal pain score; of those who reported pain, 73 per cent received analgesics in the ED. The MED and NO MED groups were similar in gender, race, ED vitals, ISS, and hospital length of stay. However, NO MED was older, with higher head Abbreviated Injury Scale score and longer intensive care unit length of stay. Importantly, as patients aged they reported lower pain and were less likely to receive analgesics at similar ISS. Risk factors for oligoanalgesia may include advanced age and head injury.

scholarly journals Risk factors on admission associated with hospital length of stay in patients with COVID-19: a retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anping Guo ◽  
Jin Lu ◽  
Haizhu Tan ◽  
Zejian Kuang ◽  
Ying Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Liver Disease ◽  
Length Of Stay ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Hospital Length ◽  
Clinical Treatment ◽  
Hospital Length Of Stay ◽  
Female Sex

AbstractTreating patients with COVID-19 is expensive, thus it is essential to identify factors on admission associated with hospital length of stay (LOS) and provide a risk assessment for clinical treatment. To address this, we conduct a retrospective study, which involved patients with laboratory-confirmed COVID-19 infection in Hefei, China and being discharged between January 20 2020 and March 16 2020. Demographic information, clinical treatment, and laboratory data for the participants were extracted from medical records. A prolonged LOS was defined as equal to or greater than the median length of hospitable stay. The median LOS for the 75 patients was 17 days (IQR 13–22). We used univariable and multivariable logistic regressions to explore the risk factors associated with a prolonged hospital LOS. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated. The median age of the 75 patients was 47 years. Approximately 75% of the patients had mild or general disease. The univariate logistic regression model showed that female sex and having a fever on admission were significantly associated with longer duration of hospitalization. The multivariate logistic regression model enhances these associations. Odds of a prolonged LOS were associated with male sex (aOR 0.19, 95% CI 0.05–0.63, p = 0.01), having fever on admission (aOR 8.27, 95% CI 1.47–72.16, p = 0.028) and pre-existing chronic kidney or liver disease (aOR 13.73 95% CI 1.95–145.4, p = 0.015) as well as each 1-unit increase in creatinine level (aOR 0.94, 95% CI 0.9–0.98, p = 0.007). We also found that a prolonged LOS was associated with increased creatinine levels in patients with chronic kidney or liver disease (p < 0.001). In conclusion, female sex, fever, chronic kidney or liver disease before admission and increasing creatinine levels were associated with prolonged LOS in patients with COVID-19.

Infections Acquired by Adults Who Receive Extracorporeal Membrane Oxygenation Risk Factors and Outcome

2013 ◽  
Vol 34 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Cecile Aubron ◽  
Allen C. Cheng ◽  
David Pilcher ◽  
Tim Leong ◽  
Geoff Magrin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Extracorporeal Membrane Oxygenation ◽  
Unit Length ◽  
Severity Of Illness ◽  
Infectious Complications ◽  
Hospital Length ◽  
Interquartile Range ◽  
Hospital Length Of Stay ◽  
Membrane Oxygenation

Objectives.To analyze infectious complications that occur in patients who receive extracorporeal membrane oxygenation (ECMO), associated risk factors, and consequences on patient outcome.Design.Retrospective observational survey from 2005 through 2011.Participants and Setting.Patients who required ECMO in an Australian referral center.Methods.Cases of bloodstream infection (BSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (YAP) that occurred in patients who received ECMO were analyzed.Results.A total of 146 ECMO procedures were performed for more than 48 hours in 139 patients, and 36 patients had a total of 46 infections (30.1 infectious episodes per 1,000 days of ECMO). They included 24 cases of BSI, 6 of them secondary to VAP; 23 cases of VAP; and 5 cases of CAUTI. The most frequent pathogens were Enterobacteriaceae (found in 16 of 46 cases), and Candida was the most common cause of BSI (in 9 of 24 cases). The Sequential Organ Failure Assessment score before ECMO initiation and the number of days of support were independenuy associated with a risk of BSI, with odds ratios of 1.23 (95% confidence interval [CI], 1.03-1.47; P = .019) and 1.08(95% CI, 1.03-1.19]; P = .006), respectively. Infected patients did not have a significantly higher mortality compared with uninfected patients (41.7% vs 32%; P = .315), but intensive care unit length of stay (16 days [interquartile range, 8-26 days] vs 11 days [IQR, 4-19 days]; P = .012) and hospital length of stay (33.5 days [interquartile range, 15.5-55.5] vs 24 days [interquartile range, 9-42 days]; P = .029) were longer.Conclusion.The probability of infection increased with the duration of support and the severity of illness before initiation of ECMO. Infections affected length of stay but did not have an impact on mortality.

scholarly journals Hospital length of stay for COVID-19 patients: Data-driven methods for forward planning

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bindu Vekaria ◽  
Christopher Overton ◽  
Arkadiusz Wiśniowski ◽  
Shazaad Ahmad ◽  
Andrea Aparicio-Castro ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Admission ◽  
Failure Time ◽  
National Level ◽  
Hospital Length ◽  
Survival Model ◽  
Data Driven ◽  
Hospital Length Of Stay ◽  
Similar Data ◽  
Model Complex

Abstract Background Predicting hospital length of stay (LoS) for patients with COVID-19 infection is essential to ensure that adequate bed capacity can be provided without unnecessarily restricting care for patients with other conditions. Here, we demonstrate the utility of three complementary methods for predicting LoS using UK national- and hospital-level data. Method On a national scale, relevant patients were identified from the COVID-19 Hospitalisation in England Surveillance System (CHESS) reports. An Accelerated Failure Time (AFT) survival model and a truncation corrected method (TC), both with underlying Weibull distributions, were fitted to the data to estimate LoS from hospital admission date to an outcome (death or discharge) and from hospital admission date to Intensive Care Unit (ICU) admission date. In a second approach we fit a multi-state (MS) survival model to data directly from the Manchester University NHS Foundation Trust (MFT). We develop a planning tool that uses LoS estimates from these models to predict bed occupancy. Results All methods produced similar overall estimates of LoS for overall hospital stay, given a patient is not admitted to ICU (8.4, 9.1 and 8.0 days for AFT, TC and MS, respectively). Estimates differ more significantly between the local and national level when considering ICU. National estimates for ICU LoS from AFT and TC were 12.4 and 13.4 days, whereas in local data the MS method produced estimates of 18.9 days. Conclusions Given the complexity and partiality of different data sources and the rapidly evolving nature of the COVID-19 pandemic, it is most appropriate to use multiple analysis methods on multiple datasets. The AFT method accounts for censored cases, but does not allow for simultaneous consideration of different outcomes. The TC method does not include censored cases, instead correcting for truncation in the data, but does consider these different outcomes. The MS method can model complex pathways to different outcomes whilst accounting for censoring, but cannot handle non-random case missingness. Overall, we conclude that data-driven modelling approaches of LoS using these methods is useful in epidemic planning and management, and should be considered for widespread adoption throughout healthcare systems internationally where similar data resources exist.

scholarly journals The independent patient factors that affect length of stay following hip fractures

2018 ◽  
Vol 100 (7) ◽  
pp. 556-562 ◽  
Author(s):  
T Richards ◽  
A Glendenning ◽  
D Benson ◽  
S Alexander ◽  
S Thati
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Acute Hospital ◽  
Hospital Length Of Stay ◽  
Patient Factors ◽  
Mobility Status

Introduction Management of hip fractures has evolved over recent years to drive better outcomes including length of hospital stay. We aimed to identify and quantify the effect that patient factors influence acute hospital and total health service length of stay. Methods A retrospective observational study based on National Hip Fracture Database data was conducted from 1 January 2014 to 31 December 2015. A multiple regression analysis of 330 patients was carried out to determine independent factors that affect acute hospital and total hospital length of stay. Results American Society of Anesthesiologists (ASA) grade 3 or above, Abbreviated Mental Test Score (AMTS) less than 8 and poor mobility status were independent factors, significantly increasing length of hospital stay in our population. Acute hospital length of stay can be predicted as 8.9 days longer when AMTS less than 8, 4.2 days longer when ASA grade was 3 or above and 20.4 days longer when unable to mobilise unaided (compared with independently mobile individuals). Other factors including total hip replacement compared with hemiarthroplasty did not independently affect length of stay. Conclusions Our analysis in a representative and generalisable population illustrates the importance of identifying these three patient characteristics in hip fracture patients. When recognised and targeted with orthogeriatric support, the length of hospital stay for these patients can be reduced and overall hip fracture care improved. Screening on admission for ASA grade, AMTS and mobility status allows prediction of length of stay and tailoring of care to match needs.

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