scholarly journals Pelvic Surgical Site Infections in Gynecologic Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Mark P. Lachiewicz ◽  
Laura J. Moulton ◽  
Oluwatosin Jaiyeoba
Keyword(s):  
Risk Factors ◽  
Surgical Site Infections ◽  
Pelvic Surgery ◽  
Gynecologic Surgery ◽  
Pathogenic Microorganisms ◽  
Common Complication ◽  
Vaginal Cuff ◽  
Unique Challenge ◽  
Gynecologic Surgical Procedures ◽  
Patient Morbidity

The development of surgical site infection (SSI) remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery.

scholarly journals Surgical Site Infections in Gynaecological Surgeries

2021 ◽  
pp. 654-663
Author(s):  
Akshaya Iyengar ◽  
Shiven Nayyar ◽  
Vedika Jajoo
Keyword(s):  
Surgical Site Infections ◽  
Vaginal Cuff ◽  
Gynecologic Surgical Procedures ◽  
Surgical Infection ◽  
Duration Of Surgery ◽  
Extended Duration ◽  
The Common ◽  
Infectious Pathogen ◽  
Hospital Acquired ◽  
And Control

Surgical contaminations are one of the utmost familiar medical management related contamination within the economically developing nations. Gynecologic tactics constitute a completely distinctive venture within which the infectious pathogen arising out of pores and the underlying skin or the vagina and endo-cervix can also relocate up to the area of surgery and may bring about vaginal cuff cellulitis, cellulitis of the  pelvis, and abscesses of the pelvis. Numerous organisms along with operation threat elements were recognized as dangers that grow infectious sequelae after pelvic surgical treatment. The full-size use of antibiotic prophylaxis has decreased however now no longer removed severe postoperative infections; the common anticipated SSIs price being three–15% after c-section. Those costs are multiplied by the existence of various threat elements like surgical infection, which is compounded by untimely rupture of membranes, obstructed labour, chorioamnionitis, large obesity, extended duration of surgery, emergency surgeries, and immunodeficiency, all of that are not uncommon within aid-deficient nations. Other factors linked to physician ability, such as poor operation skills, insufficient hemostasis, and the presence of a useless region, lead to increased injury contamination. Working at the pinnacle, such as those medical conditions that occur during pregnancy and malnutrition, also contribute significantly to the problem. SSIs as the most common motive concerning hospital-acquired contamination in obstetrics, although the present contemporary era, remains as chief residence fitness hassle within growing nations. We may even evaluate the definitions, microbiology, pathogenesis, diagnosis, and control of pelvic SSIs after gynecologic surgical procedures.

What is the real rate of surgical-site infection?

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 171-171
Author(s):  
Jolyn Sharpe Taylor ◽  
Claire Marten ◽  
Kimberly Potts ◽  
Lynn Cloutier ◽  
Katherine Cain ◽  
...  
Keyword(s):  
Chart Review ◽  
Surgical Site Infections ◽  
Healthcare Research ◽  
Gynecologic Surgery ◽  
Improvement Program ◽  
Real Rate ◽  
Exact Test ◽  
Patient Morbidity ◽  
National Organizations ◽  
The Individual

171 Background: Surgical site infections (SSI) are associated with patient morbidity and increased healthcare costs. Although several national organizations monitor SSI including the University Health System Consortium (UHC), National Surgical Quality Improvement Program (NSQIP), National Healthcare Safety Network (NHSN) and Agency for Healthcare Research and Quality (AHRQ), there is no standard reporting methodology. We compared SSI rates from these databases to our own chart review. Methods: We queried the UHC, NSQIP, NHSN and AHRQ databases from 7/2012-6/2014 for SSI following gynecologic surgery at our institution. UHC and AHRQ rely on ICD-9 coding while NSQIP and NHSN employ trained reviewers. Each organization uses different definitions, inclusion and exclusion criteria for SSI. NSQIP reviews 13-17% of cases at our institution while the other agencies include all cases. The rate of SSI was also obtained from chart review for 5/1/2014-6/30/2014 with SSI defined as an infection of the surgical incision or organ space requiring antibiotics. SSI was classified as superficial, deep or organ space (OS). The rates reported by the agencies were compared to the rate obtained by chart review using Fisher’s exact test. Results: The combined UHC/NSQIP/NHSN/AHRQ SSI rate was 5.1% (78/1,540) while the rate found by chart review was 12% (20/166) (p = 0.001). Overall SSI rates for the databases were: UHC 1.6%, NSQIP 8.8%, NHSN 2.9% and AHRQ < 1%. The combined database reported fewer superficial SSI compared to investigator chart review but did not differ significantly when reporting deep and OS: superficial 1.6% v 7.8% (p < 0.001), deep 2.1% v 1.2% (p = 0.57) and OS 2.9% v 3.6% (p = 0.26). The individual databases had wide variation in rate of superficial (UHC 0.7% NSQIP 1.2% NHSN 0.5% AHRQ 0%), deep (UHC 0.7% NSQIP 4.7% NHSN 1.3% AHRQ 0%) and OSI (UHC 0.03% NSQIP 4.4% NHSN 1.4% AHRQ < 1%). Only 19 cases (24.4%) were included in > 1 database. Only one case was included in three databases (1.3%) and no cases were included in all four. Conclusions: There is discordance among national reporting agencies tracking SSI and all agencies reported a different rate of SSI compared to chart review. Adopting standardized metrics across agencies could improve consistency and accuracy in assessing SSI rates.

scholarly journals Iatrogenic Ureterovaginal Fistulae: Difficulties in Diagnosis and Treatment in Our Case series

2019 ◽  
pp. 01-06
Author(s):  
Cristina Palmer, DO ◽  
Bilal Farhan, MD ◽  
Gamal Ghoniem, MD FACS
Keyword(s):  
Case Series ◽  
Ureteral Injury ◽  
Pelvic Surgery ◽  
Fistula Formation ◽  
Gynecologic Surgery ◽  
Ureterovaginal Fistula ◽  
Vaginal Cuff ◽  
Ureterovesical Junction ◽  
Ureteral Injuries ◽  
Damage Risk

Ureteral injury is a known complication of pelvic surgeries, including gynecological, urologic, colorectal, and vascular surgeries. This can occur by transvaginal, laparoscopic, or transabdominal approach [1,2]. Gynecological surgery remains by far the most common means of injury (75%), followed by colorectal surgeries (14%) [3-5], with reports of ureteral injury during gynecologic surgery from 0.35% to 1.5% [4,6]. Total abdominal and laparoscopic hysterectomies are the most common procedures where ureteral injury occurs [1,5]. Injury occurs most often at the level where the ureter courses under the uterine vessels, followed by the ureterovesical junction and the base of the infundibulopelvic ligament [4,7,8]. Many ureteral injuries occur during uncomplicated, routine surgery [8,9]. An abnormal connection between the ureter and vagina, or ureterovaginal fistula, allows for a conduit through which urine can continually leak. This is specific to the combination of ureteral injury and hysterectomy where the urine finds its way to the freshly closed vaginal cuff. Genitourinary fistula formation remains one of the most feared complications of pelvic surgery, with lasting emotional damage, risk for infections, infertility, reoperation, and increased hospital stay [5,10]. Our objective is to present the difficulties encountered in management of our cases and how to rectify them.

Risk factors related to surgical site infections among surgical patients in developing world: a systematic review

2020 ◽  
pp. 1984-1992
Author(s):  
Faihan Alotaibi ◽  
Faisal Alnemari ◽  
Alwaleed Alsufyani ◽  
Aisha Al-sanea ◽  
Abeer Al-Nashri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Developing World ◽  
Surgical Site Infections ◽  
Surgical Patients

Graft detachments in endothelial keratoplasty

2021 ◽  
pp. bjophthalmol-2020-318092
Author(s):  
Rashmi Deshmukh ◽  
Sridevi Nair ◽  
Darren Shu Jeng Ting ◽  
Tushar Agarwal ◽  
Jacqueline Beltz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preventive Measures ◽  
Endothelial Keratoplasty ◽  
Common Complication ◽  
Prevention Measures ◽  
Descemet Stripping Endothelial Keratoplasty ◽  
Secondary Interventions ◽  
Different Types ◽  
Incidence Risk ◽  
Donor Graft

Graft detachment is the most common complication of endothelial keratoplasty. With the ongoing advancements in the field of endothelial keratoplasty, our understanding of risk factors of graft detachments and its management has been evolving. Various prevention measures have been described in literature including presoaking the donor graft, anterior chamber tamponade, venting incisions, sutures to prevent dislocation of graft. Management of a detached graft involves secondary interventions such as rebubbling, suturing and regrafts. In this review, we discuss graft detachment in different types of endothelial keratoplasty techniques including Descemet stripping endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and Descemet’s membrane endothelial keratoplasty; with emphasis on incidence, risk factors, preventive measures and their management.

Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review

2021 ◽  
pp. 175857322110193
Author(s):  
Arjun K Reddy ◽  
Jake X Checketts ◽  
B Joshua Stephens ◽  
J Michael Anderson ◽  
Craig M Cooper ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Revisional Surgery ◽  
Total Shoulder Arthroplasty ◽  
Surgical Site Infections ◽  
Total Sample ◽  
Reverse Total Shoulder Arthroplasty ◽  
Common Complication ◽  
Humeral Component ◽  
Reverse Total Shoulder

Background Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening. Methods This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures). Results The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%. Conclusion This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.

scholarly journals Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Christophe Millien ◽  
Anatole Manzi ◽  
Arlene M. Katz ◽  
Hannah Gilbert ◽  
Mary C. Smith Fawzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mixed Methods ◽  
Black Women ◽  
Uterine Fibroids ◽  
Mixed Methods Study ◽  
University Hospital ◽  
Gynecologic Surgery ◽  
Cross Sectional ◽  
Women's Lives

Abstract Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

231 Breast Lymphedema After Breast Conservative Surgery; An Up-To-Date Systematic Review

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Abouelazayem ◽  
M Elkorety ◽  
S Monib
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Breast Surgery ◽  
Treatment Options ◽  
Conservative Surgery ◽  
Breast Size ◽  
Search Term ◽  
Common Complication ◽  
Breast Conservative Surgery ◽  
Conservative Breast Surgery

Abstract Background While arm lymphedema following breast cancer treatment is a common complication; breast lymphedema following treatment is not uncommon. Several risk factors were found to contribute to breast lymphedema, Aim: We aimed to provide a systematic review to help avoiding or management of breast lymphoedema Method The search term 'breast lymphedema' was combined with 'breast conservative surgery' and was used to conduct literature research in PubMed and Medline. The term lymphedema was combined with breast, conservative and surgery to search Embase database. All papers published in English were included with no exclusion date limits Results A total of 2155 female patients were included in this review; age ranged from 26 to 90. Mean BMI was 28.4, most of the studies included patients who underwent conservative breast surgery. Incidence of breast lymphedema ranged from 24.8% to 90.4%. Several risk factors were linked to breast lymphedema after conservative breast surgery, such as body mass index (BMI), breast size, tumour size, tumour site, type of surgery and adjuvant therapy. Treatment options focused on decongestive lymphatic therapy, including Manual lymphatic drainage (MLD), self-massaging, compression bras or Kinesio taping. Conclusions Breast lymphedema is a relatively common complication, yet there is no clear consensus on the definition or treatment options.

scholarly journals Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan

2020 ◽  
Vol 18 ◽  
pp. 205873922096054
Author(s):  
Faiz Ullah Khan ◽  
Yu Fang ◽  
Zakir Khan ◽  
Farman Ullah Khan ◽  
Zafar Iqbal Malik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Transurethral Resection ◽  
Surgical Site Infections ◽  
Exploratory Laparotomy ◽  
Cross Sectional Study ◽  
Surgical Patients ◽  
Related Factors ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Associated Risk Factors

Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p < 0.05). Pre-operative ( n = 348, 84.5%) and 6 (1.5%) surgical patients did not received the post-operative antibiotics. The P. aeruginosa ( n = 15, 12.1%) and S. aureus (13, 10.5%). Cefoperazone and sulbactam were the most prescribed antibiotics. Associated risk factors and treatment outcomes of surgical patients have a direct association with the incidence of SSI. Hospital-based antimicrobial stewardship, implementation of surgical guidelines, patient care, and education are needed to develop at wards level in hospitals.

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