Incidence of Surgical Site Infections after Thyroid and Parathyroid Surgery: No Role for Antimicrobial Prophylaxis

2018 ◽  
Vol 84 (6) ◽  
pp. 897-901 ◽  
Author(s):  
Marina Moskalenko ◽  
Megumi Asai ◽  
Karen Beem ◽  
Todd A. Pezzi ◽  
Cynthia L. Brophy ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Prophylaxis ◽  
Surgical Site Infections ◽  
Quality Improvement Program ◽  
Parathyroid Surgery ◽  
Improvement Program ◽  
Skin Preparation ◽  
Surgical Quality ◽  
Patient Demographics ◽  
Wound Classification

To better define the value of antimicrobial prophylaxis (AMP) and antiseptic skin preparation (ASP) in thyroid and parathyroid surgery, we examined the rate of surgical site infections (SSIs) with and without AMP. Retrospective analysis was performed using the National Surgical Quality Improvement Program database at a single institution. Patients undergoing thyroid or parathyroid surgery with data entered into the National Surgical Quality Improvement Program database at our institution between November 2007 and June 2015 were studied, including patient demographics, wound classification, other risk factors for SSI, and wound outcome. Charts were retrospectively reviewed for AMP, ASP, and use of drains. Of the 534 patients who underwent thyroid (n = 358) or parathyroid (n = 176) surgery, 58 (10.9%) were diabetic, 54 (10.1%) used tobacco, and 14 (2.6%) were on steroids. Most wounds were classified as “clean” (99.6%). Betadine was used for ASP in 96 per cent. AMP was given to 141 patients (26%) using cefazolin, vancomycin, or clindamycin. The remaining 393 patients (74%) received no AMP. Zero infections occurred in the group who did not receive AMP. One (0.7%) superficial, nonpurulent SSI occurred in the group that received AMP which was not statistically significantly different (P = 0.319). The rates of SSI after thyroid and parathyroid surgery are extremely low, around two per 1000 cases, and do not decrease with AMP. Therefore, AMP is not necessary in thyroid and parathyroid surgery and should be avoided to reduce costs, adverse reactions, and antibiotic resistance.

scholarly journals Surgical site infection metrics: Dissecting the differences between the National Health and Safety Network and the National Surgical Quality Improvement Program

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Alaia M. M. Christensen ◽  
Karen Dowler ◽  
Shira Doron
Keyword(s):  
Quality Improvement ◽  
Health And Safety ◽  
Surgical Site Infections ◽  
Cost Of Care ◽  
Quality Improvement Program ◽  
Surveillance Systems ◽  
Improvement Program ◽  
Surgical Quality ◽  
National Healthcare Safety Network ◽  
Hospital Acquired

Abstract Surgical site infections (SSIs) are associated with readmissions, reoperations, increased cost of care, and overall morbidity and mortality risk. The National Healthcare Safety Network (NHSN) and the National Surgical Quality Improvement Program (NSQIP) have developed an array of metrics to monitor hospital-acquired complications. The only metric collected by both is SSI, but performance as benchmarked against peer hospitals is often discordant between the 2 systems. In this commentary, we outline the differences between these 2 surveillance systems as they relate to this potential for discordance.

Validation of an Electronic Surveillance Algorithm to Identify Patients With Post-Operative Surgical Site Infections Using National Surgical Quality Improvement Program Pediatric Data

2019 ◽  
Author(s):  
Claudia Berrondo ◽  
Brendan Bettinger ◽  
Cindy B Katz ◽  
Jennifer Bauer ◽  
Margarett Shnorhavorian ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Predictive Value ◽  
Surgical Site Infections ◽  
Quality Improvement Program ◽  
Electronic Surveillance ◽  
Diagnosis Code ◽  
Improvement Program ◽  
Cohen’S Kappa ◽  
Surgical Quality ◽  
Cohen's Kappa

Abstract Background Surgical site infections (SSIs) are common, but data related to these infections maybe difficult to capture. We developed an electronic surveillance algorithm to identify patients with SSIs. Our objective was to validate our algorithm by comparing it with our institutional National Surgical Quality Improvement Program Pediatric (NSQIP Peds) data. Methods We applied our algorithm to our institutional NSQIP Peds 2015–2017 cohort. The algorithm consisted of the presence of a diagnosis code for post-operative infection or the presence of 4 criteria: diagnosis code for infection, antibiotic administration, positive culture, and readmission/surgery related to infection. We compared the algorithm’s SSI rate to the NSQIP Peds identified SSI. Algorithm performance was assessed using sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and Cohen’s kappa. The charts of discordant patients were reviewed to understand limitations of the algorithm. Results Of 3879 patients included, 2.5% had SSIs by NSQIP Peds definition and 1.9% had SSIs by our algorithm. Our algorithm achieved a sensitivity of 44%, specificity of 99%, NPV of 99%, PPV of 59%, and Cohen’s kappa of 0.5. Of the 54 false negatives, 37% were diagnosed/treated as outpatients, 31% had tracheitis, and 17% developed SSIs during their post-operative admission. Of the 30 false positives, 33% had an infection at index surgery and 33% had SSIs related to other surgeries/procedures. Conclusions Our algorithm achieved high specificity and NPV compared with NSQIP Peds reported SSIs and may be useful when identifying SSIs in patient populations that are not actively monitored for SSIs.

Can Laparoscopic Ileocolic Resection be Performed with Comparable Safety to Open Surgery for Regional Enteritis: Data from National Surgical Quality Improvement Program

2010 ◽  
Vol 76 (12) ◽  
pp. 1393-1396
Author(s):  
Hasan T. Kirat ◽  
Naveen Pokala ◽  
Jon D. Vogel ◽  
Victor W. Fazio ◽  
Ravi P. Kiran
Keyword(s):  
Quality Improvement ◽  
Hospital Stay ◽  
Open Surgery ◽  
Regional Enteritis ◽  
Surgical Site Infections ◽  
Quality Improvement Program ◽  
Smoking History ◽  
Ileocolic Resection ◽  
Improvement Program ◽  
Surgical Quality

Laparoscopic ileocolic resection is feasible for Crohn's disease but few studies adjust for the various preoperative, intraoperative, and postoperative variables that may confound comparisons with open surgery. The aim of this study is to compare outcomes after laparoscopic (LICR) and open ileocolic resection (OICR) performed for regional enteritis using National Surgical Quality Improvement Program (NSQIP) data. Retrospective evaluation of data prospectively accrued into the NSQIP database for patients undergoing ileocolic resection for Crohn's by LICR and OICR was performed. LICR (n = 104) and OICR (n = 203) groups had similar age ( P = 0.1), body mass index ( P = 0.9), smoking history ( P = 0.6), steroid use ( P = 0.7), diabetes ( P = 0.3), serum albumin ( P = 0.07), and American Society of Anesthesiologists class ( P = 0.13). LICR group had more female patients ( P = 0.005). Complications including surgical site infections ( P = 0.5), wound dehiscence ( P = 1), pneumonia ( P = 0.1), deep vein thrombosis ( P = 0.3), pulmonary embolism ( P = 1), urinary infection ( P = 0.1), and return to the operating room ( P = 0.2) were similar. LICR had shorter length of hospital stay than OICR ( P < 0.001). In current practice, as observed with the NSQIP data, LICR, performed by experienced surgeons, is comparable in safety to OICR and is associated with a shorter hospital stay.

American College of Surgeons National Surgical Quality Improvement Program as a Quality Improvement Tool: A Single Institution's Experience with Vascular Surgical Site Infections

2013 ◽  
Vol 79 (3) ◽  
pp. 274-278 ◽  
Author(s):  
John M. Compoginis ◽  
Steven G. Katz
Keyword(s):  
Quality Improvement ◽  
Surgical Site Infections ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Quality ◽  
Patient Morbidity ◽  
American College Of Surgeons ◽  
Before And After ◽  
Surgical Preparation ◽  
High Level

Vascular surgical site infections (VSSIs) result in significant patient morbidity and hospital cost. The objective of this study is to report a single hospital's experience using the National Surgical Quality Improvement Program (NSQIP) as an instrument to decrease VSSIs. After review of initial NSQIP data, changes in antibiotic dosage and timing, surgical preparation, patient warming, and oxygenation were put into practice. Records of all patients undergoing vascular surgical operations during a two-year period were reviewed and VSSIs were identified. Statistical comparisons were made between groups before and after implementation of these changes. A total of 478 cases met our criteria. Practice changes were introduced in October 2009 and fully implemented by January 2010. Two hundred forty-three cases were performed in 2009 and 235 in 2010. When operations during the two time periods were compared, significantly fewer VSSIs were identified in 2010 than in 2009 ( P = 0.036). NSQIP enabled our institution to identify an unacceptably high level of VSSIs. By implementing changes in our clinical practice, we were able to significantly lower our rate of VSSI.

Solutions to Intraoperative Wound Classification Miscoding in a Subset of American College of Surgeons National Surgical Quality Improvement Program Patients

2015 ◽  
Vol 81 (2) ◽  
pp. 193-197 ◽  
Author(s):  
Florence E. Turrentine ◽  
Sarah B. Giballa ◽  
Puja M. Shah ◽  
David R. Jones ◽  
Traci L. Hedrick ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Program ◽  
P Value ◽  
Improvement Program ◽  
Surgical Quality ◽  
Acs Nsqip ◽  
American College Of Surgeons ◽  
Before And After ◽  
Wound Classification ◽  
Operating Room Staff

Intraoperative wound classification is a predictor of postoperative infection. Therefore, accurately assigning the correct classification to a surgical wound is of particular importance. Our institution participates in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), a national outcomes database that collects wound classification for all qualifying operative procedures, and we noted discrepancies when comparing ACS NSQIP wound classification coding with perioperative coding in our electronic medical record. We tested the effectiveness of an intervention that included staff educational sessions, informational posters, and postoperative debriefings on improving the accuracy of documented intraoperative wound classification. The χ2 test was used to compare proportions of wound classification miscodings before and after educational sessions and debriefings commenced. Baseline data revealed misclassification of wounds occurred 21 per cent (30 of 141) of the time in predominately colorectal procedures performed by two surgeons from April through August 2012. Errors decreased to 9 per cent (13 of 147) from August to December 2012, after our intervention of education sessions with operating room staff and the surgeons incorporating a statement confirming the wound classification at the end of the case debriefing. The χ2 statistic was 8.7589. The P value was significant at 0.003. Ensuring concordance of classification between the surgeon and nurse during a post-procedure debriefing as well as education of perioperative nursing staff through posters and seminars significantly improved the accuracy of intraoperative wound classification coding.

Postoperative respiratory failure after thyroid and parathyroid surgery: Analysis of national surgical quality improvement program

Head & Neck ◽  
2011 ◽  
Vol 34 (3) ◽  
pp. 321-327 ◽  
Author(s):  
Prateek K. Gupta ◽  
Himani Gupta ◽  
Bala Natarajan ◽  
Shreya Shetty ◽  
Russell B. Smith ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Respiratory Failure ◽  
Quality Improvement Program ◽  
Parathyroid Surgery ◽  
Improvement Program ◽  
Surgical Quality ◽  
Postoperative Respiratory Failure
Sign in / Sign up

Export Citation Format

Share Document