scholarly journals Longer Operative Time in Elderly Patients Undergoing Posterior Lumbar Fusion Is Independently Associated With Increased Complication Rate

2018 ◽  
Vol 9 (2) ◽  
pp. 179-184 ◽  
Author(s):  
Alicia E. Hersey ◽  
Wesley M. Durand ◽  
Adam E. M. Eltorai ◽  
J. Mason DePasse ◽  
Alan H. Daniels
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Postoperative Complications ◽  
Tract Infection ◽  
Complication Rate ◽  
Operative Time ◽  
Lumbar Fusion ◽  
Improvement Program ◽  
Posterior Lumbar Fusion ◽  
Operative Duration

Study Design: Retrospective cohort study. Objective: To determine the effects of operative time on postoperative complications in patients age 65 and older undergoing posterior lumbar fusion. Methods: All patients age 65 and older undergoing posterior lumbar fusion were identified in the 2012 to 2015 American College of Surgeons National Surgical Quality Improvement Program database. The primary outcome measures were complications occurring up to 30 days postoperatively, including death, any complication, and complication subtypes. The primary independent variable was operative duration. Both bivariate and multivariate analyses utilized logistic regression and analyzed operative duration as a continuous variable. Statistical significance was considered P < .05. Results: A total of 4947 patients age 65 and older undergoing posterior lumbar fusion were identified. The mean operative time was 3.3 hours (SD 1.7). The overall complication rate was 13.4% (n = 665). In multivariate analysis, each incremental hour of operative time was associated with increased risk of postoperative thromboembolism (odds ratio [OR] = 1.23; 95% confidence interval [CI] = 1.10-1.37), transfusion (OR= 1.25; 95% CI = 1.18-1.32), urinary tract infection (OR = 1.21; 95% CI = 1.10-1.32), and total postoperative complications (OR = 1.22; 95% CI = 1.16-1.27). Conclusion: For patients age 65 and older undergoing posterior lumbar fusion, longer operative time is associated with greater risk for thromboembolism, transfusion, intubation, kidney injury, urinary tract infection, surgical site infection, and overall postoperative complications. This data highlights several specific complications that are influenced by operative time in older patients, and further supports the need for future protocols that seek to safely minimize operative time for posterior lumbar fusion.

Urinary Tract Infection Following Posterior Lumbar Fusion Procedures

Spine ◽  
2015 ◽  
Vol 40 (22) ◽  
pp. 1785-1791 ◽  
Author(s):  
Daniel D. Bohl ◽  
Junyoung Ahn ◽  
Ehsan Tabaraee ◽  
Junho Ahn ◽  
Akshay Jain ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Lumbar Fusion ◽  
Posterior Lumbar Fusion

Antibiotic prescribing pattern in cesarean section

Mediscope ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 8-15
Author(s):  
S Nazrina ◽  
S Chisty ◽  
AA Maruf
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Postoperative Complications ◽  
Caesarean Section ◽  
Tract Infection ◽  
Cesarean Section ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
The Mean ◽  
The Difference

Use of antimicrobials in caesarean section has become an accepted practice to minimize the incidence of postoperative complications. Not many studies are available in Bangladesh regarding the using pattern of antibiotics in caesarean section. The objectives of the study was to find out the pattern of use of antibiotic prophylaxis in caesarean section and also the frequency of postoperative morbidity. The prospective cross-sectional study included 356 patients undergoing caesarean section in Prime Medical College Hospital, Rangpur and 10 different private clinics in Rangpur city. Patients demographics, perioperative data, antibiotic used with dosage and schedules were recorded. Investigations like pus, blood and urine culture and sensitivity were recorded for patients with postoperative complications. Change of antimicrobial following culture sensitivity report was noted. Most of the patients, 197 (55.3%), came from lower middle socioeconomic status. Major indication of cesarean section was emergency in 314 (88.2%) patients. The use of third generation cephalosporin (ceftriaxone) in majority of the patients, 209 (58.7%), was observed. Two drugs combination commonly included third generation cephalosporin and metronidazole, and in addition gentamicin was added when three drugs combination was used. Fifty five (15.5%) patients had postoperative complications which included fever, wound infection, urinary tract infection and endometritis. The mean duration (SD) of antibiotic administration was 12.4 (3.5) days in infected patients and 8.0 (2.1) days in non-infected patients, and the difference was statistically significant (p < 0.01). The mean duration (SD) of hospital stay was 15.4 (5.5) and 9.1 (3.9) days for infected and non-infected patients, respectively; and the difference was statistically significant (p < 0.01). Isolated micro-organisms from wound infection, urinary tract infection and lochia were gram-negative, and Escherichia coli, 16 (41.0%), was the common which was resistant to third generation cephalosporin and sensitive to amikacin. Obstetricians should utilize clinically effective antibiotics. Whenever possible, single drug rather than combination therapy should be used. Periodic surveillance of antimicrobial prophylaxis is essential to detect the emergence of antibiotic resistance.Mediscope Vol. 3, No. 1: January 2016, Pages 8-15

scholarly journals Antibiotic Prophylaxis with Trimethoprim-Sulfamethoxazole versus No Treatment after Mid-to-Distal Hypospadias Repair: A Prospective, Randomized Study

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Elizabeth B. Roth ◽  
John V. Kryger ◽  
Charles T. Durkee ◽  
Melissa A. Lingongo ◽  
Ruth M. Swedler ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Postoperative Complications ◽  
Tract Infection ◽  
Antibiotic Prophylaxis ◽  
Randomized Study ◽  
Hypospadias Repair ◽  
Symptomatic Urinary Tract Infection ◽  
Distal Hypospadias ◽  
The Impact

Purpose. To evaluate the impact of prophylactic antibiotics after distal hypospadias repair on postoperative bacteriuria, symptomatic urinary tract infection, and postoperative complications in a prospective, randomized trial. Materials and Methods. Consecutive patients aged 6 months to 2 years were enrolled at our institution between June 2013 and May 2017. Consenting patients were randomized to antibiotic prophylaxis with trimethoprim-sulfamethoxazole versus no antibiotic. Patients had catheterized urine samples obtained at surgery and 6–10 days postoperatively. The primary outcome was bacteriuria and pyuria at postoperative urine collection. Secondary outcomes included symptomatic urinary tract infection and postoperative complications. Results. 70 patients consented to the study, of which 35 were randomized to receive antibiotics compared to 32 who did not. Demographics, severity of hypospadias, and type of repair were similar between the groups. Patients in the treatment group had significantly less pyuria (18%) and bacteriuria (11%) present at stent removal compared to the nontreatment group (55% and 63%; p=0.01 and p<0.001, resp.). No patient had a symptomatic urinary tract infection. There were 11 postoperative complications. Conclusions. Routine antibiotic prophylaxis appears to significantly decrease bacteriuria and pyuria in the immediate postoperative period; however, no difference was observed in symptomatic urinary tract infection or postoperative complications. Clinical Trial Registration Number NCT02593903.

scholarly journals Technique of Intravesical Laparoscopy for Ureteric Reimplantation to Treat VUR

2008 ◽  
Vol 2008 ◽  
pp. 1-3 ◽  
Author(s):  
Atul A. Thakre ◽  
C. K. Yeung
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Surgical Technique ◽  
Tract Infection ◽  
Success Rate ◽  
Complication Rate ◽  
Pediatric Population ◽  
Ureteral Reimplantation ◽  
Ureteric Reimplantation ◽  
Very High

The prevalence of vesicoureteral reflux (VUR) has been estimated as 0.4 to 1.8% among the pediatric population. In children with urinary tract infection, the prevalence is typically from 30–50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of presenting oursurgical technique: laparoscopic intravesical ureteric reimplantationis to highlight the use of laparoscopy to perform ureteric reimplantation for the management of pediatric VUR.

Standardisation of perioperative urinary catheter use to reduce postsurgical urinary tract infection: an interrupted time series study

2018 ◽  
Vol 28 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Mahsa Sadeghi ◽  
Jerome A Leis ◽  
Claude Laflamme ◽  
Darrel Sparkes ◽  
Wendy Ditrani ◽  
...  
Keyword(s):  
Time Series ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Operating Room ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Improvement Program ◽  
Acs Nsqip ◽  
Surgical Units

BackgroundPrevention of healthcare-associated urinary tract infection (UTI) has been the focus of a national effort, yet appropriate indications for insertion and removal of urinary catheters (UC) among surgical patients remain poorly defined.MethodsWe developed and implemented a standardised approach to perioperative UC use to reduce postsurgical UTI including standard criteria for catheter insertion, training of staff to insert UC using sterile technique and standardised removal in the operating room and surgical unit using a nurse-initiated medical directive. We performed an interrupted time series analysis up to 2 years following intervention. The primary outcome was the proportion of patients who developed postsurgical UTI within 30 days as measured by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Process measures included monthly UC insertions, removals in the operating room and UC days per patient-days on surgical units.ResultsAt baseline, 22.5% of patients were catheterised for surgery, none were removed in the operating room and catheter-days per patient-days were 17.4% on surgical units. Following implementation of intervention, monthly catheter removal in the operating room immediately increased (range 12.2%–30.0%) while monthly UC insertion decreased more slowly before being sustained below baseline for 12 months (range 8.4%–15.6%). Monthly catheter-days per patient-days decreased to 8.3% immediately following intervention with a sustained shift below the mean in the final 8 months. Postsurgical UTI decreased from 2.5% (95% CI 2.0-3.1%) to 1.4% (95% CI 1.1-1.9; p=0.002) during the intervention period.ConclusionsStandardised perioperative UC practices resulted in measurable improvement in postsurgical UTI. These appropriateness criteria for perioperative UC use among a broad range of surgical services could inform best practices for hospitals participating in ACS NSQIP.

scholarly journals Postoperative Complications Associated With rhBMP2 Use in Posterior/Posterolateral Lumbar Fusion

2017 ◽  
Vol 8 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Nabil Esmail ◽  
Zorica Buser ◽  
Jeremiah R. Cohen ◽  
Darrel S. Brodke ◽  
Hans-Joerg Meisel ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Retention ◽  
Lumbar Fusion ◽  
Wound Complications ◽  
Cardiac Complications ◽  
Complication Rates ◽  
Posterolateral Lumbar Fusion ◽  
Chi Square Analysis

Study Design: Retrospective database review. Objective: Posterior/posterolateral lumbar fusion (PLF) is an effective treatment for a variety of spinal disorders; however, variations in surgical technique have different complication profiles. The aim of our study was to quantify the frequency of various complications in patients undergoing PLF with and without human recombinant bone morphogenetic protein 2 (rhBMP2). Methods: We queried the orthopedic subset of the Medicare database (PearlDiver) between 2005 and 2011 for patients undergoing PLF procedures with and without rhBMP2. Complication and reoperation rates were analyzed within 1 year of the index procedure. Complications assessed include: acute renal failure, deep vein thrombosis, dural tear, hematoma, heterotopic ossification, incision and drainage, cardiac complications, nervous system complications, osteolysis, pneumonia, pseudarthrosis, pulmonary embolism, radiculopathy, respiratory complications, sepsis, urinary retention, urinary tract infection, mechanical, and wound complications. Chi-square analysis was used to calculate the complication differences between the groups. Results: Our data revealed higher overall complication rates in patients undergoing PLF with rhBMP2 versus no_rhBMP2 (76.9% vs 68.8%, P < .05). Stratified by gender, rhBMP2 males had higher rates of mechanical complications, pseudarthrosis, and reoperations compared with no_rhBMP2 males ( P < .05), whereas rhBMP2 females had higher rates of pseudarthrosis, urinary tract infection, and urinary retention compared with no_rhBMP2 females ( P < .05). Conclusion: Our data revealed higher overall complication rates in PLF patients given rhBMP2 compared with no_rhBMP2. Furthermore, our data suggests that rhBMP2-associated complications may be gender specific.

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