scholarly journals Novel Closing Method Using Subcutaneous Continuous Drain for Preventing Surgical Site Infections in Radical Cystectomy

ISRN Urology ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Yasuhiko Hirose ◽  
Taku Naiki ◽  
Ryosuke Ando ◽  
Akihiro Nakane ◽  
Toshiki Etani ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
Radical Cystectomy ◽  
Dead Space ◽  
Odds Ratio ◽  
Wound Dressing ◽  
Subcutaneous Fat ◽  
Surgical Site Infections ◽  
New Method ◽  
Site Infection

To reduce the incidence of surgical site infection (SSI) after radical cystectomy, a new closing method using subcutaneous continuous aspiration drain was developed and compared to the conventional closing method. The new method involved (a) closed aspiration with an indwelling aspiration drain without suture of the subcutaneous fat and (b) covering with hydrocolloid wound dressing after suture of the dermis with 4-0 absorbable thread and reinforcement using strips. The incidence of SSI was significantly improved by using the new method. Furthermore, univariate and multivariate analysis associated with SSI revealed that the new closing method was statistically correlated with 85% reduction of SSI (odds ratio: 0.15, 95% confidence interval: 0.03–0.69).Our new method using continuous aspiration with subcutaneous drain is useful for preventing SSI through removal of effusions and reduction of dead space by apposition of the subcutaneous fat.

Hypercoagulability in Septic Shock Patients With Thrombocytopenia

2021 ◽  
pp. 088506662110241
Author(s):  
Sang-Min Kim ◽  
Sang-Il Kim ◽  
Gina Yu ◽  
June-Sung Kim ◽  
Seok In Hong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Multivariate Analysis ◽  
Platelet Count ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Sofa Score ◽  
Odds Ratio ◽  
Fibrinogen Level ◽  
Limited Information

Background: Despite thrombocytopenia, patients with sepsis often experience hypercoagulability. However, limited information is available on the prevalence and effect of hypercoagulability in patients with sepsis-induced thrombocytopenia. Hence, we evaluated the prevalence of hypercoagulability and the association between hypercoagulability and clinical outcomes in septic shock patients with thrombocytopenia. Methods: Thromboelastography (TEG) was performed prospectively in 1294 patients with septic shock at the emergency department (ED) between January 2016 and December 2019. After excluding 405 patients who did not require resuscitation, refused enrollment, or developed septic shock after ED presentation, 889 patients were included. We defined thrombocytopenia as an admission platelet count lower than 150,000/µl according to SOFA score. We defined hypocoagulability and hypercoagulability as coagulation index (CI)< −3 and >3 on TEG, respectively. Results: Of the 889 septic shock patients (mean age 65.6 ± 12.7 years, 58.6% male), 473 (53.2%) had thrombocytopenia. Eighty-five (18.0%) patients showed hypercoagulable TEG and73 (15.4%) patients showed hypocoagulable TEG. The hypercoagulable TEG group had a significantly higher fibrinogen level and a lower 28-day mortality rate than the normal and hypocoagulable TEG groups (518 vs. 347 and 315 mg/dL; 7.1% vs. 21.1% and 36.8%, P < 0.01, respectively). In multivariate analysis, hypercoagulable TEG was associated with a decreased mortality rate (odds ratio: 0.395; 95% confidence interval, 0.162-0.965). Conclusions: In septic shock patients with thrombocytopenia, hypercoagulability was not uncommon. TEG can quickly distinguish the hypercoagulability and hypocoagulability states and serve as a valuable tool for evaluating the degree and risk in septic shock patients with thrombocytopenia.

The Effect of Sarcopenia on Outcomes in Geriatric Blunt Trauma

2017 ◽  
Vol 83 (11) ◽  
pp. 1203-1208 ◽  
Author(s):  
Mahdi Malekpour ◽  
Kelly Bridgham ◽  
Kathryn Jaap ◽  
Ryan Erwin ◽  
Kenneth Widom ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
Blunt Trauma ◽  
Odds Ratio ◽  
Lumbar Vertebra ◽  
Objective Measure ◽  
Trauma Patients ◽  
The Third ◽  
Increased Risk ◽  
Axial Ct

Elderly patients are at a higher risk of morbidity and mortality after trauma, which is reflected through higher frailty indices. Data collection using existing frailty indices is often not possible because of brain injury, dementia, or inability to communicate with the patient. Sarcopenia is a reliable objective measure for frailty that can be readily assessed in CT imaging. In this study, we aimed to evaluate the effect of sarcopenia on the outcomes of geriatric blunt trauma patients. Left psoas area (LPA) was measured at the level of the third lumbar vertebra on the axial CT images. LPA was normalized for height (LPA mm2/m2) and after stratification by gender, sarcopenia was defined as LPA measurements in the lowest quartile. A total of 1175 patients consisting of 597 males and 578 females were studied. LPAs below 242.6 mm2/m2 in males and below 187.8 mm2/m2 in females were considered to be sarcopenic. We found sarcopenia in 149 males and 145 females. In multivariate analysis, sarcopenia was associated with a higher risk of in-hospital mortality (odds ratio [OR]: 1.61, 95% confidence interval [CI]: 1.01–2.56) and a higher risk of discharge to less favorable destinations (OR: 1.42, 95% CI: 1.05–1.97). Lastly, sarcopenic patients had an increased risk of prolonged hospitalization (hazard ratio: 1.21, 95% CI: 1.04–1.40).

Stent-Associated Flow Remodeling Causes Further Occlusion of Incompletely Coiled Aneurysms

Neurosurgery ◽  
2011 ◽  
Vol 69 (3) ◽  
pp. 598-604 ◽  
Author(s):  
Matthew F. Lawson ◽  
William C. Newman ◽  
Yueh-Yun Chi ◽  
J. D. Mocco ◽  
Brian L. Hoh
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
Packing Density ◽  
Odds Ratio ◽  
Senior Author ◽  
Neck Size ◽  
Increased Risk ◽  
Coil Occlusion ◽  
Stented Group

Abstract BACKGROUND: Incomplete coil occlusion is associated with increased risk of aneurysm recurrence. We hypothesize that intracranial stents can cause flow remodeling, which promotes further occlusion of an incompletely coiled aneurysm. OBJECTIVE: To study our hypothesis by comparing the follow-up angiographic outcomes of stented and nonstented incompletely coiled aneurysms. METHODS: From January 2006 through December 2009, the senior author performed 324 initial coilings of previously untreated aneurysms, 145 of which were Raymond classification 2 and 3. Follow-up angiographic studies were available for 109 of these aneurysms (75%). Angiographic outcomes for stented vs nonstented incompletely coiled aneurysms were compared. A multivariate analysis was performed to identify factors related to the progression of occlusion at follow-up, with adjustment for aneurysm location, size, neck size, Hunt-Hess grade, stent use, initial Raymond score, packing density, age, sex, and medical comorbidities. RESULTS: Of the 109 aneurysms, 37 were stented and 72 were not stented. With a median follow-up time of 15.4 months, 33 stented aneurysms (89%) progressed to complete occlusion compared with 29 nonstented aneurysms (40%). Recanalization rates were lower in the stented group (8.1%) compared with the nonstented group (37.5%; P &lt; .001). On multivariate analysis, stent use (odds ratio, 18.5; 95% confidence interval, 4.3-76.9) and packing density (odds ratio, 1.093; 95% confidence interval, 1.021-1.170) were significant predictors of the progression of occlusion. Aneurysm size was negatively correlated with the progression of occlusion (odds ratio, 0.844; 95% confidence interval, 0.724-0.983). CONCLUSION: Stent-assisted coiling causes progression of occlusion, possibly by a flow remodeling effect. The odds of progression of occlusion of stent-coiled aneurysms were 18.5 times that of nonstented aneurysms.

Nonjudicious Dispensing of Antibiotics by Drug Stores in Pratumthani, Thailand

2008 ◽  
Vol 29 (6) ◽  
pp. 572-575 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Jeeraluk Tunpornchai ◽  
Korakot Tanawitt ◽  
Linda M. Mundy
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
Antibiotic Therapy ◽  
Odds Ratio ◽  
Adjusted Odds Ratio

Mock patient presentations of 6 common syndromic ailments to drug stores in Pratumthani, Thailand, were conducted. Appropriate dispensing of antibiotic therapy for all 6 presentations occurred at 56 (20%) of 280 drug stores. By multivariate analysis, drug stores' proximity to a hospital was associated with appropriate dispensing of antibiotics (adjusted odds ratio, 34 [95% confidence interval, 15–83]; P < .001).

Use of Maximal Sterile Barrier Precautions and/or Antimicrobial-Coated Catheters to Reduce the Risk of Central Venous Catheter-Related Bloodstream Infection

2008 ◽  
Vol 29 (10) ◽  
pp. 947-950 ◽  
Author(s):  
Duk-hee Lee ◽  
Koo Young Jung ◽  
Yoon-Hee Choi
Keyword(s):  
Multivariate Analysis ◽  
Mortality Rate ◽  
Central Venous Catheter ◽  
Confidence Interval ◽  
Bloodstream Infection ◽  
Odds Ratio ◽  
Venous Catheter ◽  
Central Venous ◽  
Factors Associated ◽  
Catheter Related Bloodstream Infection

Central venous catheter-related bloodstream infection is clinically important because of its high mortality rate. This prospective study shows by multivariate analysis that the use of maximal sterile barrier precautions (odds ratio, 5.205 [95% confidence interval, 0.015-1.136]; P= .023) and the use of antimicrobial-coated catheters (odds ratio, 5.269 [95% confidence interval, 0.073-0.814]; P = .022) are independent factors associated with a lowered risk of acquiring a central venous catheter-related bloodstream infection.

scholarly journals Doctor! Will I be dry? Factors determining recurrence after vesicovaginal fistula repair

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Aziz Abdullah ◽  
Sher Shah Syed ◽  
Nuzhat Farooqui ◽  
Sajjad Siddiqui
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Vesicovaginal Fistula ◽  
Surgical Repair ◽  
Recurrence Risk ◽  
Fistula Repair ◽  
Careful Evaluation ◽  
Delayed Reconstruction

Aims: To evaluate various prognostic factors which determine outcome after surgical repair of VVF. Methods: A retrospective analysis of the record of 640 patients which underwent surgical repair of VVF during a period from Jan 2006 to June 2011. Multivariate analysis of the record was done using SPSS-19 software determining odds ratio with 95% confidence interval. Results: 640 patients underwent surgical repair of VVF. Overall success rate was 87.2%. Multivariate analysis determined that recurrence of VVF was significantly related to multiplicity (5 fold recurrence risk), pre-operative size of VVF (3 fold risk), secondary repair (3 fold risk) and etiology of the fistula (2 fold risk). Interposition of flap and delayed reconstruction was related to successful surgical outcome. Age, parity, route of repair and location of fistula were not significant prognostic factors for recurrence. Conclusions: Successful surgical repair of VVF require careful evaluation of various factors including number, size, previous attempts to surgical repair and etiology of VVF. One should opt for transabdominal route with delayed reconstruction and interposition of flap if above mentioned factors are present. 

scholarly journals Smoking increases the risk of surgical site infection after hydrocelectomy in adults: a retrospective cohort study in Brazil

2018 ◽  
Vol 11 (12) ◽  
pp. 950-956
Author(s):  
Thiago Silva Da Costa ◽  
Paulo José De Medeiros ◽  
Mauro José Costa Salles
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Confidence Interval ◽  
Surgical Site Infection ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Univariate Analysis ◽  
Smoking Habits ◽  
Site Infection

Introduction: Surgical site infection (SSI) following hydrocelectomy is relatively uncommon, but it is one of the main post-operative problems. We aimed to describe the prevalence of SSI following hydrocelectomy among adult patients, and to assess predisposing risk factors for infection. Methodology: This retrospective cohort study was carried out at a university hospital and included hydrocelectomies performed between January 2007 and December 2014. Diagnosis of SSI was performed according to the Center for Diseases Control (CDC) guidelines. Multivariable logistic regression analysis was used to identify independent risk factors. Results: A total of 196 patients were included in the analysis. Overall, 30 patients were diagnosed with SSI (15.3%) and of these, 63.3% (19/30) were classified as having superficial SSI, while 36.7% (11/30) had deep SSI. The main signs and symptoms of infection were the presence of surgical wound secretion (70%) and inflammatory superficial signs such as hyperemia, edema and pain (60%). Among the 53 patients presenting chronic smoking habits, 26.4% (14⁄53) developed SSI, which was associated with a higher risk for SSI (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.27 to 6.35, p < 0.01) in the univariate analysis. In the adjusted multivariable analysis, smoking habits were also statistically associated with SSI after hydrocelectomy (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.30 to 6.24, p = 0.01). No pre-, intra-, or post-operative variable analyzed showed an independent association to SSI following hydrocelectomy. Conclusions: Smoking was the only independent modifiable risk factor for SSI in the multivariate analysis.

scholarly journals Predictors of technical difficulty with duodenal ESD

2019 ◽  
Vol 07 (12) ◽  
pp. E1755-E1760 ◽  
Author(s):  
Motohiko Kato ◽  
Motoki Sasaki ◽  
Mari Mizutani ◽  
Koshiro Tsutsumi ◽  
Yoshiyuki Kiguchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Observational Study ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Scoring System ◽  
Technical Difficulty ◽  
Lesion Size ◽  
Procedure Time ◽  
Lesion Location

Abstract Background and study aims Duodenal endoscopic submucosal dissection (ESD) is still considered technically challenging; however, few studies have objectively analyzed predictors of the technical difficulty. Therefore, the aim of the current study was to elucidate predictors of the technical difficulty of duodenal ESD. Patients and methods This was a retrospective observational study. From June 2010 to June 2017, a total of 174 consecutive patients with superficial duodenal epithelial neoplasia who underwent ESD were included in this study. We tried to identify predictors for technical difficulty of ESD by defining technical difficulty as either procedure time > 100 minutes or intraprocedural perforation. Moreover, we constructed a scoring system consisting of factors that were significant in the multivariate analysis. Results The proportion of patients with technical difficulty was 34.5 %. In the multivariate analysis, lesion location in flexural part [odds ratio (OR), 2.61; 95 % confidence interval (CI), 1.02 – 6.68], larger lesion size (> 40 mm) (OR, 5.26; 95% CI, 2.15 – 12.9), and occupied circumference > 50 % of the duodenum (OR, 5.80; 95 % CI, 1.83 – 18.4) were associated with technical difficulty. Conclusion A lesion location in flexural part, lesion size >40 mm and occupied circumference > 50 % were risk factors for technical difficulty of duodenal ESD.

Rates of Surgical-Site Infection: An International Comparison

2005 ◽  
Vol 26 (5) ◽  
pp. 442-448 ◽  
Author(s):  
Maria Luisa Moro ◽  
Filomena Morsillo ◽  
Marilena Tangenti ◽  
Maria Mongardi ◽  
Maria Cristina Pirazzini ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Prospective Study ◽  
Surgical Site Infections ◽  
Public Hospitals ◽  
Operative Procedures ◽  
Surgical Patients ◽  
Site Infection ◽  
Italian Region ◽  
Convenience Sample ◽  
Study Population

AbstractObjectives:To quantify the occurrence of surgical-site infections (SSIs) in an Italian region and to estimate the proportion of potentially avoidable infections through benchmarking comparison.Design:Prospective study during 1 month based on a convenience sample of surgical patients admitted to 31 public hospitals. All of the patients undergoing an intervention included among the 44 operative procedures of the National Nosocomial Infections Surveillance (NNIS) System were enrolled. Ninety-five percent of the patients were actively observed after discharge for up to 30 days for all of the operations and for up to 1 year for operations involving implantation.Results:Among the 6,167 operative procedures studied, 290 infections were recorded (4.7 per 100 procedures), 206 (71%) of which were SSIs (3.3 per 100 procedures; 95% confidence interval, 2.9–3.9). One hundred thirty-five SSIs (65.5%) were superficial infections, 53 (25.7%) were deep infections, and 12 (5.8%) were organ–space infections; in 6 cases (2.9%), the type of SSI was not recorded. The frequency of SSIs observed in this study was significantly higher for several procedures than that expected when the NNIS System rates (standardized infection ratio [SIR] ranging from 1.77 to 6.42) or the Hungarian rates (SIR ranging from 1.28 to 3.04) were applied to the study population.Conclusions:The high intensity of postdischarge surveillance can in part explain the differences observed. To allow for meaningful benchmarking comparison, in addition to intrinsic patient risk, data on the intensity of postdischarge surveillance should be included in published reports.

scholarly journals Incisional Surgical Site Infection after Elective Open Surgery for Colorectal Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Kosuke Ishikawa ◽  
Takaya Kusumi ◽  
Masao Hosokawa ◽  
Yasunori Nishida ◽  
Sosuke Sumikawa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Odds Ratio ◽  
Open Surgery ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Prospective Surveillance ◽  
Intraoperative Hypotension ◽  
Incisional Surgical Site Infection ◽  
The Mean ◽  
Colorectal Resections

Background.The purpose of this study was to clarify the incidence and risk factors for incisional surgical site infections (SSI) in patients undergoing elective open surgery for colorectal cancer.Methods.We conducted prospective surveillance of incisional SSI after elective colorectal resections performed by a single surgeon for a 1-year period. Variables associated with infection, as identified in the literature, were collected and statistically analyzed for their association with incisional SSI development.Results.A total of 224 patients were identified for evaluation. The mean patient age was 67 years, and 120 (55%) were male. Thirty-three (14.7%) patients were diagnosed with incisional SSI. Multivariate analysis suggested that incisional SSI was independently associated with TNM stages III and IV (odds ratio [OR], 2.4) and intraoperative hypotension (OR, 3.4).Conclusions.The incidence of incisional SSI in our cohort was well within values generally reported in the literature. Our data suggest the importance of the maintenance of intraoperative normotension to reduce the development of incisional SSI.

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