Perioperative Antibiotic Use in Sleep Surgery: Clinical Relevance

2021 ◽  
pp. 019459982110487
Author(s):  
Mohamed Abdelwahab ◽  
Sandro Marques ◽  
Isolde Previdelli ◽  
Robson Capasso
Keyword(s):  
Surgical Site Infection ◽  
Hospital Readmission ◽  
Antibiotic Prescription ◽  
Postoperative Bleeding ◽  
Upper Airway ◽  
National Database ◽  
Complication Rates ◽  
Site Infection ◽  
Tertiary Referral Center ◽  
Obstructive Sleep

Objective Upper airway surgery is a common therapeutic approach recommended for patients with obstructive sleep apnea (OSA) to decrease disease burden. We aimed to evaluate the effect of perioperative antibiotic prescription on complication rates. Study Design Retrospective cohort (national database). Setting Tertiary referral center. Methods This is a retrospective study of a large national health care insurance database (Truven MarketScan) from 2007 to 2015. Subjects diagnosed with OSA who had uvulopalatopharyngoplasty (UPPP) were included and stratified in single versus multilevel surgery. Other variables included smoking, age, sex, antibiotic prescription, and comorbidities based on the Elixhauser index. Evaluated outcomes were postoperative bleeding, intubation, pneumonia, superficial surgical site infection, tracheostomy, and hospital readmission. A multivariate regression model was created to assess each complication. Results A total of 5,798,528 subjects received a diagnosis of OSA, of which 39,916 were >18 years old and underwent UPPP, either alone or with additional procedures. The mean age was 43 years, and 73.4% were male. Antibiotic prescription was associated with less bleeding in UPPP alone, UPPP with nasal surgery, and UPPP with nasal and tongue surgery ( P < .001, P < .001, and P = .006, respectively). It was also associated with a lower prevalence of surgical site infection, pneumonia, tracheostomy, intubation, and hospital readmission ( P < .001). On a multivariate model, antibiotic prescription was significantly associated with a decreased rate of complications. Conclusions Although former studies recommended against the use of antibiotics after tonsillectomy, our results suggest that antibiotic prescription after UPPP for OSA was associated with less bleeding, surgical site infection, pneumonia, intubation, tracheostomy, and hospital readmission 30 days postoperatively.

Impact of pelvic lymph node dissection during radical prostatectomy on 30-day post operative complications: Results from a large national database.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 238-238
Author(s):  
Nicola Pavan ◽  
Samarpit Rai ◽  
Nachiketh Soodana-Prakash ◽  
Raymond R Balise ◽  
Maria Carmen Mir ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Surgical Site Infection ◽  
Lymph Node Dissection ◽  
Surgical Approach ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
National Database ◽  
Site Infection ◽  
Node Dissection

238 Background: Pelvic lymph node dissection (PLND) during radical prostatectomy (RP) is the most effective method for detecting lymph node metastases in patients with prostate cancer. The association between PLND during RP and morbidity, especially thromboembolic adverse events (AEs), remains unclear. We assessed the effect of PLND on 30−day postoperative AEs in patients undergoing RP using the American College of Surgeons’ National Surgical Quality Improvement Program database (NSQIP). Methods: A total of 21,895 men undergoing RP between 2006 and 2013 were classified into two groups according to surgical approach (MIS−RP vs. ORP) and whether PLND was performed. Multivariate logistic regression adjusting for approach and demographic features was performed to assess the impact of PLND for predicting two primary endpoints (overall complications and major complications defined as Clavien−Dindo ≥ 3) and for 17 types of complications. P−values were adjusted to maintain an experiment−wise p < 0.05. Results: MIS−RP and ORP was performed in 17,354 (79.3%) and 4,541 (20.7%) patients, respectively. PLND was performed in 7,579 (43.7%) and 3,597 (79.2%) patients in the MIS−RP and ORP groups, respectively. The overall postoperative complication rate was 8.7% (5.5% for MIS−RP and 21.0% for ORP). PLND was not associated with a higher risk of DVT (OR 0.99; p= 0.98) or PE (OR 1.02; p= 0.91). However, PLND was associated with a higher risk of superficial surgical site infection (OR 1.68; p = 0.013), organ space surgical site infection (OR 1.77; p = 0.02), and perioperative transfusion (OR 1.32; p = 0.002) regardless of surgical approach. PLND was not associated with overall or major AEs on multivariable analysis. ORP was associated with a significantly higher risk of overall (OR 4.64, p < 0.0001) and major (OR 1.6, p = 0.0004) AEs compared to MIS−RP. Conclusions: PLND during RP is associated with a significantly increased risk of certain types of AEs within the 30−day post−operative period. However, there appears to be no significant association between PLND and thromboembolic AEs.

scholarly journals The Impact of Comorbid Renal Dysfunction in Patients with Hepatocellular Carcinoma on Long-Term Outcomes after Curative Resection

2021 ◽  
Author(s):  
Yuzuru Sakamoto ◽  
Shingo Shimada ◽  
Toshiya Kamiyama ◽  
Ko Sugiyama ◽  
Yoh Asahi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Site Infection ◽  
Renal Dysfunction ◽  
Postoperative Bleeding ◽  
Patient Characteristics ◽  
Rank Test ◽  
Serum Total Bilirubin ◽  
Site Infection ◽  
Number Of Patients ◽  
The Impact

Abstract Background:Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. However, the number of patients with chronic kidney disease (CKD) is also on the rise because of the increase in lifestyle-related diseases. To establish a tailored management strategy for HCC patients, we evaluated the impact of comorbid renal dysfunction (RD), as stratified by using the estimated glomerular filtration rate (eGFR), and assessed the oncologic validity of hepatectomy for HCC patients with RD.Methods:We enrolled 800 HCC patients who underwent hepatectomy between 1997 and 2015 in our university hospital. We categorized patients into two (RD, eGFR < 60 mL/min/1.73m2; non-RD, 60 ≤ eGFR) and three groups (severe CKD, eGFR < 30; mild CKD, 30 ≤ eGFR < 60; control, 60 ≤ eGFR) according to renal function as defined by the eGFR. Overall survival (OS) and recurrence-free survival (RFS) were compared among these groups with the log-rank test, and we also analyzed survival by using a propensity score matching (PSM) model for excluding the influence of patient characteristics. The mean of postoperative observation period was 64.7 ± 53.0 months.Results:RD patients were significantly older and had lower serum total bilirubin, AST, and ALT levels than those in non-RD patients (P < 0.0001, P < 0.001, < 0.05, and < 0.01, respectively). No patient was introduced to maintenance hemodialysis after surgery. Although the overall postoperative complications rates were similar between RD and non-RD patients, the proportions of postoperative bleeding and surgical site infection were significantly higher in RD patients (5.5% vs. 1.8%; P < 0.05, 3.9% vs. 1.8%; P < 0.05, respectively), and postoperative bleeding was the highest in severe CKD group (P < 0.05). Regardless of the degree of comorbid RD, OS and RFS were comparative, even when using PSM between RD and non-RD groups to exclude the influence of patient characteristics, liver function, and other causes of death.Conclusions:Comorbid RD had a negligible impact on the prognosis of HCC patients who underwent curative hepatectomy with appropriate perioperative management, and close attention to severe CKD is necessary to prevent postoperative bleeding and surgical site infection. Hokkaido University Graduate School of Medicine under Clinical Research Number 016-0354

scholarly journals Burden and outcome of neonatal surgical conditions in Nigeria: A countrywide multicenter cohort study

2022 ◽  
Vol 11 ◽  
pp. 3
Author(s):  
Hyginus Okechukwu Ekwunife ◽  
Emmanuel Ameh ◽  
Lukman Abdur-Rahman ◽  
Adesoji Ademuyiwa ◽  
Emem Akpanudo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Surgical Site Infection ◽  
Postoperative Complication ◽  
Outcome Measure ◽  
Postoperative Mortality ◽  
Sub Saharan Africa ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Complication Rates ◽  
Site Infection

Background:  Despite a decreasing global neonatal mortality, the rate in sub-Saharan Africa is still high. The contribution and the burden of surgical illness to this high mortality rate have not been fully ascertained. This study is performed to determine the overall and disease-specific mortality and morbidity rates following neonatal surgeries; and the pre, intra, and post-operative factors affecting these outcomes.  Methods: This was a prospective observational cohort study; a country-wide, multi-center observational study of neonatal surgeries in 17 tertiary hospitals in Nigeria. The participants were 304 neonates that had surgery within 28 days of life. The primary outcome measure was 30-day postoperative mortality and the secondary outcome measure was 30-day postoperative complication rates. Results: There were 200 (65.8%) boys and 104 (34.2%) girls, aged 1-28 days (mean of 12.1 ± 10.1 days) and 99(31.6%) were preterm. Sepsis was the most frequent major postoperative complication occurring in 97(32%) neonates. Others were surgical site infection (88, 29.2%) and malnutrition (76, 25.2%). Mortality occurred in 81 (26.6%) neonates. Case-specific mortalities were: gastroschisis (14, 58.3%), esophageal atresia (13, 56.5%) and intestinal atresia (25, 37.2%). Complications significantly correlated with 30-day mortality (p <0.05). The major risk predictors of mortality were apnea (OR=10.8), severe malnutrition (OR =6.9), sepsis (OR =7. I), deep surgical site infection (OR=3.5), and re-operation (OR=2.9).  Conclusion: Neonatal surgical mortality is high at 26.2%. Significant mortality risk factors include prematurity, apnea, malnutrition, and sepsis.

Risk Factors for Complications, Longer Hospital Stay, and Readmission After Total Ankle Arthroplasty

2020 ◽  
pp. 193864002095014
Author(s):  
Matthew J. Best ◽  
Son Nguyen ◽  
Babar Shafiq ◽  
James R. Ficke
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Hospital Readmission ◽  
Total Ankle Arthroplasty ◽  
Site Infection ◽  
Common Complication ◽  
Ankle Arthroplasty ◽  
Hospital Stays ◽  
Poor Outcomes

Background Studies have shown conflicting results regarding associations of preoperative comorbidities with outcomes after total ankle arthroplasty (TAA). Our aim was to analyze preoperative risk factors for complications, longer hospital stay, and readmission within 30 days after TAA. Methods We conducted a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database. We included 294 patients who underwent TAA from 2009 through 2012. We used multivariate logistic regression to identify risk factors for complications, longer hospital stay, and hospital readmission. Results Surgical site infection was the most common complication. Diabetes was associated with greater odds of complications as was current smoker status. Notably, obesity was not associated with greater odds of complications. Age, chronic obstructive pulmonary disease, and diabetes mellitus were associated with longer hospital stays. Surgical site infection was the most common reason for hospital readmission. Conclusions TAA has a low complication rate, with surgical site infection being the most common complication and the most common reason for hospital readmission. Patients with diabetes have greater odds of poor outcomes and prolonged hospital stays after TAA than patients without diabetes. Obesity was not associated with poor outcomes after TAA. Levels of Evidence: Level III

scholarly journals A prospective randomized controlled trial comparing laparoscopic versus open Whipple’s procedure for periampullary malignancy

2019 ◽  
Vol 6 (3) ◽  
pp. 679 ◽  
Author(s):  
Pravin Bhingare ◽  
Sunil Wankhade ◽  
Brajesh B. Gupta ◽  
Sanjay Dakhore
Keyword(s):  
Blood Loss ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Open Surgery ◽  
Outcome Variable ◽  
Complication Rates ◽  
Site Infection ◽  
Operative Duration ◽  
Whipple’S Procedure ◽  
Periampullary Region

Background: Laparoscopic surgery in cases of periampullary region malignancies has been emerging as a preferable alternative to open pancreatoduodenectomy due to their benefits such as early mobilization and shorter duration of hospital stay. We conducted this study to determine whether laparoscopic approach is comparable to open pancreatoduodenectomy in terms of hospital stay, blood loss, complications, pathological radicality with oncological safety and overall postoperative short-term outcomes.Methods: This was a single-center, non-stratified, balanced allocation, open-label, parallel-group randomized control study in which patients who had undergone  Whipple’s procedure were included. Patients were randomized after confirmation of non-metastatic status into either the laparoscopy (N=15) or open surgery group (N=15). The primary outcome variable was duration of postoperative hospital stays. Secondary outcomes were duration of surgery, blood loss, complication rates (using definitions of the international study group of pancreatic surgery) and pathological radicality of resection.Results: Pain in abdomen was the predominant complaint which was seen in 12 (80%) and 10 (66%) patients each. The other common symptoms were weight loss, vomiting and jaundice. Surgical site infection, mean blood loss and mean operative duration was significantly lower in laparoscopic group (P<0.05). Mean tumor size was more in open group. Mortality was comparable in both the groups.Conclusions: Laparoscopic pancreatoduodenectomy offers significant benefit in terms of hospital stay, surgical site infection, mean blood loss, mean operative duration and mean interval of duration receiving chemo/radiotherapy as compared to open surgery in cases of periampullary region malignancy.

scholarly journals Surgical site infection after trans urethral resection of the prostate (TURP): 2008–2013 French national SSI surveillance ISO-RAISIN

2018 ◽  
Vol 19 (4) ◽  
pp. 178-183
Author(s):  
Franck Bruyère ◽  
Marion Perennec-Olivie ◽  
Juliette Tanguy ◽  
Martine Aupee ◽  
Pascal Astagneau ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Surgical Intervention ◽  
National Database ◽  
Transurethral Resection Of Prostate ◽  
Site Infection ◽  
Crude Incidence ◽  
Asa Score ◽  
Mean Delay ◽  
The Mean

Objective: To describe surgical site infection (SSI) after transurethral resection of prostate (TURP) from the French national database. Methods: A national SSI surveillance system was implemented in 1999. Each year, the network included urology departments that included at least two months plus one month follow-up, or at least 100 consecutive targeted surgical procedures. A dataset of patients who underwent urology procedures during the six-year period 2008–2013 was made available. SSI diagnosis was made according to standardised CDC criteria. Descriptive analyses were performed using SAS software version 9.4. Results: A total of 12,897 TURPs were performed by 89 urology departments. The crude incidence SSI rate was 2.43 (95% confidence interval = 2.16–2.79). The mean delay for diagnosis was 11.9 ± 8.9 days. The treatment of the SSI required a new surgical intervention in 1.35%. In the multilevel multivariate analysis, ASA score and duration of follow-up were the only parameters correlated with the SSI rate. Conclusions: On more than 12,000 TURPs surveyed, the SSI rate was 2.43. ASA score and duration of follow-up were the only parameters correlated with the SSI rate.

scholarly journals Epidemiology and risk factors associated with surgical site infection following surgery on thoracic aorta

2018 ◽  
Vol 146 (14) ◽  
pp. 1841-1844
Author(s):  
K. Morikane
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Thoracic Aorta ◽  
Artery Bypass ◽  
Univariate Analysis ◽  
National Database ◽  
Site Infection ◽  
Factors Associated ◽  
American Society ◽  
American Society Of Anesthesiologists

AbstractSurgical site infection (SSI) following cardiovascular surgery has been well documented, possibly owing to its highly invasive nature, but SSI following surgery on the thoracic aorta has not. This study aimed to describe the epidemiology and assess risk factors associated with the latter in Japan using a national database for SSI. Data on surgery on thoracic aorta performed between 2012 and 2014 were extracted from the Japan Nosocomial Infections Surveillance (JANIS) database. Risk factors were assessed initially by univariate analysis, and then entered into a logistic regression model for final evaluation. The cumulative incidence of SSI was 4.1% (146/3538) and staphylococci were the most frequent pathogens isolated. Factors such as the duration of operation, emergency surgery and male gender were significantly associated with SSI. These findings differ from previous studies on open heart and coronary artery bypass surgery, in which the American Society of Anesthesiologists (ASA) score was significantly associated with SSI, but gender was not. This study suggests that risk stratification in the JANIS system might be improved by incorporating additionally identified factors for risk adjustment, when comparing the incidence of SSI between hospitals.

scholarly journals Predictors of perioperative complications following single or combination nasal-palatopharyngeal surgery for severe obstructive sleep apnoea

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Zamzil Amin Asha'ari ◽  
Jamalludin Ab Rahman ◽  
Wan Ishlah Wan Leman
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Perioperative Complications ◽  
Upper Airway ◽  
Cardiovascular Complications ◽  
Sleep Apnoea ◽  
Complication Rates ◽  
Tertiary Referral Hospital ◽  
Upper Airway Surgery ◽  
Airway Surgery ◽  
Obstructive Sleep

Introduction: To assess the relationship between perioperative complications and upper airway surgeries for obstructive sleep apnoea (OSA). Methods: The records of 118 adult patients, diagnosed with obstructive sleep apnoea (apnoea-hypopnoea index (AHI) >5), who underwent upper airway surgery at a single tertiary referral hospital from 2007 to 2015 were reviewed. Pulmonary, surgical, and cardiovascular complications within the first 30 postoperative days were analyzed according to types of upper airway surgery. Upper airway surgery types were single surgery or combinations of surgeries to the tonsils, pharyngeal adenoids, soft palate, tongue base and nose. Logistic regression was used to assess the multivariable association of age, sex, BMI, OSA severity, medical comorbidity, and types of upper airway surgery with postoperative complications. Results: At least one perioperative complications occurred in 48 of 128 patients (37.5%). In a multivariable model, the overall complication rate was increased with age, obesity, smoking and underlying comorbid medical problems. Complication rates were not associated with AHI severity, types of procedures performed and whether the surgery was a single or combination surgery. Conclusions: In OSA patients undergoing upper airway surgery, the severity of OSA as assessed by the AHI, and the sites and numbers of concurrent surgery performed were not associated with the rate of perioperative complications.

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