A Simple Novel Model to Predict Hospital Mortality, Surgical Site Infection, and Pneumonia in Elderly Patients Undergoing Operation

CONTEXT: Multimodal protocol of perioperative care may enhance recovery after surgery. Based on evidence these new routines of perioperative care changed conventional prescriptions in surgery. OBJECTIVE: To evaluate the results of a multimodal protocol (ACERTO protocol) in elderly patients. METHODS: Non-randomized historical cohort study was performed at the surgical ward of a tertiary university hospital. One hundred seventeen patients aged 60 and older were submitted to elective abdominal operations under either conventional (n = 42; conventional group, January 2004-June 2005) or a fast-track perioperative protocol named ACERTO (n = 75; ACERTO group, July 2005-December 2007). Main endpoints were preoperative fasting time, postoperative day of re-feeding, volume of intravenous fluids, length of hospital stay and morbidity. RESULTS: The implantation of the ACERTO protocol was followed by a decrease in both preoperative fasting (15 [8-20] vs 4 [2-20] hours, P<0.001) and postoperative day of refeeding (1st [1st-10th] vs 0 [0-5th] PO day; P<0.01), and intravenous fluids (10.7 [2.5-57.5] vs 2.5 [0.5-82] L, P<0.001). The changing of protocols reduced the mean length of hospital stay by 4 days (6[1-43] vs 2[1-97] days; P = 0.002) and surgical site infection rate by 85.7% (19%; 8/42 vs 2.7%; 2/75, P<0.001; relative risk = 1.20; 95% confidence interval = 1.03-1.39). Per-protocol analysis showed that hospital stay in major operations diminished only in patients who completed the protocol (P<0.01). CONCLUSION: The implementation of multidisciplinary routines of the ACERTO protocol diminished both hospitalization and surgical site infection in elderly patients submitted to abdominal operations.

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Studying the effects of primary arthroplasty on post-treatment results among elderly patients with pertrochanteric fracture

Clinics and Practice ◽

10.4081/cp.2018.1055 ◽

2018 ◽

Author(s):

Mostafa Shahrezaee ◽

Mohammad Ali Okhovatpour ◽

Mohammad Banasiri ◽

Seyyed Reza Sharifzadeh

Keyword(s):

Elderly Patients ◽

Surgical Site Infection ◽

Pertrochanteric Fracture ◽

Walking Ability ◽

Site Infection ◽

Aseptic Necrosis ◽

Advantages And Disadvantages ◽

Standard Operation ◽

Primary Arthroplasty ◽

Significant Difference

Various therapeutic methods are available to treat patients with intertrochantric fracture, which is usually caused by falling down. This complication is usually observed among the elderly, particularly old women. The choice of the proper therapeutic method depends on many factors including patient’s condition, type of fracture, and the amount of movement. Hip arthroplasty is one of these therapeutic methods, which have certain advantages and disadvantages. Immediate resumption of walking with the ability of weight toleration and absence of complications such as aseptic necrosis are some advantages of this method. Sixtyeight elderly patients with pertrochanteric fracture who had resorted to Iranian Army’s hospitals and had undergone arthroplasty. These cases were examined with due comparison with historical and external controls. Variables such a type of operation, age, post-operation pain, the pace of resuming walking ability, embolism, surgical site infection, bedsore and DVT were studied and compared against standard operation. The results achieved through assessment of variables showed a significant difference with standard operation in terms of variables such as post-operative movement ability, pain scale in various times, surgical complications, embolism, surgical site infection, bedsore, and DVT. Post-operative pain within the first 3 months following it are some complications with not much attention is paid to them, but they are important complications which can cause many negative and influential effects on patients. Arthroplasty is more expensive than standard operation and the patient may initially feel more pain.

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Surgical site infection in elderly patients

BMC Geriatrics ◽

10.1186/1471-2318-11-s1-a37 ◽

2011 ◽

Vol 11 (Suppl 1) ◽

pp. A37

Author(s):

M Minutolo ◽

G Blandino ◽

R Lanteri ◽

S Puleo ◽

V Minutolo

Keyword(s):

Elderly Patients ◽

Surgical Site Infection ◽

Site Infection

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Risk Stratification of Elderly Patients Undergoing Spinal Surgery Using the Modified Frailty Index

Global Spine Journal ◽

10.1177/2192568221999650 ◽

2021 ◽

pp. 219256822199965

Author(s):

Barry Ting Sheen Kweh ◽

Hui Qing Lee ◽

Terence Tan ◽

Kim Siong Tew ◽

Ronald Leong ◽

...

Keyword(s):

Risk Stratification ◽

Elderly Patients ◽

Surgical Site Infection ◽

Spine Surgery ◽

Complication Rate ◽

Frailty Index ◽

Major Complication ◽

Site Infection ◽

Modified Frailty Index ◽

Major Complication Rate

Study Design: Retrospective cohort. Objectives: To validate the 11-item modified Frailty Index (mFI) as a perioperative risk stratification tool in elderly patients undergoing spine surgery. Methods: All consecutive cases of spine surgery in patients aged 65 years or older between July 2016 and June 2018 at a state-wide trauma center were retrospectively reviewed. The primary outcome was post-operative major complication rate (Clavien-Dindo Classification ≥ III). Secondary outcome measures included the rate of all complications, 6-month mortality and surgical site infection. Results: A total of 348 cases were identified. The major complication rate was significantly lower in patients with an mFI of 0 compared to ≥ 0.45 (18.3% versus 42.5%, P = .049). As the mFI increased from 0 to ≥ 0.45 there was a stepwise increase in risk of major complications ( P < .001). Additionally, 6-month mortality rate was considerably lower when the mFI was 0 rather than ≥ 0.27 (4.2% versus 20.4%, P = .007). Multivariate analysis demonstrated an mFI ≥ 0.27 was significantly associated with an increased incidence of major complication (OR 2.80, 95% CI 1.46-5.35, P = .002), all complication (OR 2.93, 95% CI 1.70-15.11, P < .001), 6-month mortality (OR 7.39, 95% CI 2.55-21.43, P < .001) and surgical site infection (OR 4.43, 95% CI 1.71-11.51, P = .002). The American Society of Anesthesiologists’ (ASA) index did not share a stepwise relationship with any outcome. Conclusion: The mFI is significantly associated in a gradated fashion with increased morbidity and mortality. Patients with an mFI ≥ 0.27 are at greater risk of major complications, all-complications, 6-monthy mortality, and surgical site infection.

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A Prospective Study of Tobacco Smoking as a Predictor of Complications in General Surgery

Infection Control and Hospital Epidemiology ◽

10.1086/502113 ◽

2003 ◽

Vol 24 (1) ◽

pp. 37-43 ◽

Cited By ~ 40

Author(s):

Miguel Delgado-Rodríguez ◽

Marcelino Medina-Cuadros ◽

Gabriel Martínez-Gallego ◽

Antonio Gómez-Ortega ◽

Marcial Mariscal-Ortiz ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tract Infection ◽

Nosocomial Infection ◽

Respiratory Tract ◽

Hospital Mortality ◽

Surgical Site Infection ◽

Lower Respiratory Tract ◽

Site Infection ◽

Current Smoking

AbstractObjective:To analyze whether tobacco smoking is related to nosocomial infection, admission to the intensive care unit, in-hospital death, and length of stay.Design:A prospective cohort study.Setting:The Service of General Surgery of a tertiary-care hospital.Patients:A consecutive series of patients admitted for more than 1 day (N = 2,989).Results:Sixty-two (2.1%) patients died and 503 (16.8%) acquired a nosocomial infection, of which 378 (12.6%) were surgical site and 44 (1.5%) were lower respiratory tract. Smoking (mainly past smoking) was associated with a worse health status (eg, longer preoperative stay and higher American Society of Anesthesiologists score). A long history of smoking (≥ 51 pack-years) increased post-operative admission to the intensive care unit (adjusted odds ratio [OR] = 2.86; 95% confidence interval [CI95], 1.21 to 6.77) and in-hospital mortality (adjusted OR = 2.56; CI95, 1.10 to 5.97). There was no relationship between current smoking and surgical-site infection (adjusted OR = 0.99; CI95, 0.72 to 1.35), whereas a relationship was observed between past smoking and surgical-site infection (adjusted OR = 1.46; CI95, 1.02 to 2.09). Current smoking and, to a lesser degree, past smoking augmented the risk of lower respiratory tract infection (adjusted OR = 3.21; CI95, 1.21 to 8.51). Smokers did not undergo additional surgical procedures more frequently during hospitalization. In the multivariate analysis, length of stay was similar for smokers and nonsmokers.Conclusion:Smoking increases in-hospital mortality, admission to the intensive care unit, and lower respiratory tract infection, but not surgical-site infection. Deleterious effects of smoking are also observed in past smokers and they cannot be counteracted by hospital cessation programs.

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Surgical site infection in elderly patients with hip fractures, silver-coated versus regular dressings: a randomised prospective trial

Journal of Wound Care ◽

10.12968/jowc.2015.24.10.441 ◽

2015 ◽

Vol 24 (10) ◽

pp. 441-445 ◽

Cited By ~ 11

Author(s):

A. Kadar ◽

G. Eisenberg ◽

E. Yahav ◽

M. Drexler ◽

M. Salai ◽

...

Keyword(s):

Elderly Patients ◽

Surgical Site Infection ◽

Hip Fractures ◽

Prospective Trial ◽

Site Infection

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Elevated serum lactate as a predictor of outcomes in patients following major abdominal surgery at a tertiary hospital in Uganda

BMC Surgery ◽

10.1186/s12893-021-01315-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kiyemba Henry ◽

Kadondi Merab ◽

Muyanja Leonard ◽

Kintu-Luwaga Ronald ◽

Kakembo Nasser ◽

...

Keyword(s):

Abdominal Surgery ◽

Hospital Mortality ◽

Surgical Site Infection ◽

Hospital Stay ◽

Elevated Serum ◽

Length Of Hospital Stay ◽

Serum Lactate ◽

Major Abdominal Surgery ◽

Site Infection ◽

Lactate Levels

Abstract Introduction Major abdominal surgery is still a great contributor to postoperative morbidity and mortality in developing countries. Major abdominal surgery leads to hypoperfusion, which has an impact on postoperative morbidity and mortality. Lactate, a biomarker for hypoperfusion is under utilized in Uganda. The study aimed to investigate the association between elevated serum lactate and outcomes (in-hospital mortality, SSI and length of hospital stay) in patients following major abdominal surgery. Methods A prospective observational cohort study was done with 246 eligible patients recruited. Stratified sampling was carried out till desired sample size was achieved. Demographic and perioperative data were collected, serum lactate levels were measured at induction and immediately after surgery with serial measurements being done after 12, 24 h post operatively. Participants were followed up to assess outcomes. Data analysis was done using STATA version 14.0. Results A total of 130 patients (52.8%) had elevated serum lactate levels. Elevated serum lactate predicted in-hospital mortality and surgical site infection. The accuracy of elevated serum lactate to predict mortality with AUROC of 0.7898 was exhibited by the 24 h lactate values. Elevated serum lactate predicted surgical site infection accurately with AUROC 0.6432. Length of hospital is strongly associated with elevated serum lactate with p-value of 0.043. Patients with elevated serum lactate on average have a longer length of hospital stay at 5.34 ± 0.69. Conclusion Elevated serum lactate was associated with in-hospital mortality, surgical site infection and longer length of hospital stay. Serum lactate levels done at 24 h were most predictive of mortality and surgical site infection.

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