Perioperative goal-directed therapy and postoperative complications in different kind of surgical procedures: an updated meta-analysis

Abstract Background Goal-directed therapy (GDT) aims to assure tissue perfusion, by optimizing doses and timing of fluids, inotropes, and vasopressors, through monitoring of cardiac output and other basic hemodynamic parameters. Several meta-analyses confirm that GDT can reduce postoperative complications. However, all recent evidences focused on high-risk patients and on major abdominal surgery. Objectives The aim of the present meta-analysis is to investigate the effect of GDT on postoperative complications (defined as number of patients with a least one postoperative complication) in different kind of surgical procedures. Data sources Randomized controlled trials (RCTs) on perioperative GDT in adult surgical patients were included. The primary outcome measure was complications, defined as number of patients with at least one postoperative complication. A subgroup-analysis was performed considering the kind of surgery: major abdominal (including also major vascular), only vascular, only orthopedic surgery. and so on. Study appraisal and synthesis methods Meta-analytic techniques (analysis software RevMan, version 5.3.5, Cochrane Collaboration, Oxford, England, UK) were used to combine studies using odds ratios (ORs) and 95% confidence intervals (CIs). Results In 52 RCTs, 6325 patients were enrolled. Of these, 3162 were randomized to perioperative GDT and 3153 were randomized to control. In the overall population, 2836 patients developed at least one complication: 1278 (40%) were randomized to perioperative GDT, and 1558 (49%) were randomized to control. Pooled OR was 0.60 and 95% CI was 0.49–0.72. The sensitivity analysis confirmed the main result. The analysis enrolling major abdominal patients showed a significant result (OR 0.72, 95% CI 0.59–0.87, p = 0.0007, 31 RCTs, 4203 patients), both in high- and low-risk patients. A significant effect was observed in those RCTs enrolling exclusively orthopedic procedures (OR 0.53, 95% CI 0.35–0.80, p = 0.002, 7 RCTs, 650 patients. Also neurosurgical procedures seemed to benefit from GDT (OR 0.40, 95% CI 0.21–0.78, p = 0.008, 2 RCTs, 208 patients). In both major abdominal and orthopedic surgery, a strategy adopting fluids and inotropes yielded significant results. The total volume of fluid was not significantly different between the GDT and the control group. Conclusions and implications of key findings The present meta-analysis, within the limits of the existing data, the clinical and statistical heterogeneity, suggests that GDT can reduce postoperative complication rate. Moreover, the beneficial effect of GDT on postoperative morbidity is significant on major abdominal, orthopedic and neurosurgical procedures. Several well-designed RCTs are needed to further explore the effect of GDT in different kind of surgeries.

Download Full-text

Untersuchung zum postoperativen Verlauf bei Patienten mit Hämophilie

Hämostaseologie ◽

10.1055/s-0037-1619775 ◽

2012 ◽

Vol 32 (S 01) ◽

pp. S45-S47 ◽

Cited By ~ 2

Author(s):

S. Krekeler ◽

S. Alesci ◽

W. Miesbach

Keyword(s):

Surgical Procedures ◽

Orthopedic Surgery ◽

Hip Replacement ◽

Orthopedic Procedures ◽

Vein Thrombosis ◽

Major Orthopedic Surgery ◽

Lung Embolism ◽

Total Knee ◽

Deep Vein ◽

Observation Period

SummaryThromboembolic complications may occur in patients with major operations even after routine thromboprophylaxis with low-molecularweight-heparin. In this retrospective, single center survey the post-operative course of patients with haemophilia was investigated. Patients, methods Overall, the postoperative course in 85 patients with haemophilia A and B (median age: 43 years, 18–73 years) and 139 surgical procedures was analyzed. The surgical procedures mainly consist of major orthopedic surgery (58 total knee replacement, 15 hip replacement, 17 other major orthopedic surgery, 15 minor orthopedic procedures). Additional surgical procedures were abdominal-surgical (18), urological (8), neurosurgical (5). Results During the post-operative observation period a small number of wound healing complications occurred (4%). None of the patients developed symptomatic deep vein thrombosis or lung embolism. Conclusion There seems to a decreased risk of postoperative thromboembolism in patients with haemophilia.

Download Full-text

Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure

Infection Control and Hospital Epidemiology ◽

10.1086/653205 ◽

2010 ◽

Vol 31 (7) ◽

pp. 701-709 ◽

Cited By ~ 20

Author(s):

Deverick J. Anderson ◽

Jean Marie Arduino ◽

Shelby D. Reed ◽

Daniel J. Sexton ◽

Keith S. Kaye ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Surgical Site Infection ◽

Bloodstream Infection ◽

Surgical Procedures ◽

Tertiary Care ◽

Orthopedic Procedures ◽

Neurosurgical Procedures ◽

Site Infection ◽

Incisional Surgical Site Infection ◽

Epidemiological Characteristics

Objective.To determine the epidemiological characteristics of postoperative invasive Staphylococcus aureus infection following 4 types of major surgical procedures.Design.Retrospective cohort study.Setting.Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia.Patients.Adults undergoing orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures.Methods.We used previously validated, prospectively collected surgical surveillance data for surgical site infection and microbiological data for bloodstream infection. The study period was 2003 through 2006. We defined invasive S. aureus infection as either nonsuperficial incisional surgical site infection or bloodstream infection. Nonparametric bootstrapping was used to generate 95% confidence intervals (CIs). P values were generated using the Pearson x2 test, Student t test, or Wilcoxon rank-sum test, as appropriate.Results.In total, 81,267 patients underwent 96,455 procedures during the study period. The overall incidence of invasive S. aureus infection was 0.47 infections per 100 procedures (95% CI, 0.43–0.52); 227 (51%) of 446 infections were due to methicillin-resistant S. aureus. Invasive S. aureus infection was more common after cardiothoracic procedures (incidence, 0.79 infections per 100 procedures [95% CI, 0.62–0.97]) than after orthopedic procedures (0.37 infections per 100 procedures [95% CI, 0.32–0.42]), neurosurgical procedures (0.62 infections per 100 procedures [95% CI, 0.53–0.72]), or plastic surgical procedures (0.32 infections per 100 procedures [95% CI, 0.17¬0.47]) (P < .001). Similarly, S. aureus bloodstream infection was most common after cardiothoracic procedures (incidence, 0.57 infections per 100 procedures [95% CI, 0.43–0.72]; P < .001, compared with other procedure types), comprising almost three-quarters of the invasive S. aureus infections after these procedures. The highest rate of surgical site infection was observed after neurosurgical procedures (incidence, 0.50 infections per 100 procedures [95% CI, 0.42–0.59]; P < .001, compared with other procedure types), comprising 80% of invasive S. aureus infections after these procedures.Conclusion.The frequency and type of postoperative invasive S. aureus infection varied significantly across procedure types. The highest risk procedures, such as cardiothoracic procedures, should be targeted for ongoing preventative interventions.

Download Full-text

Complications of Tranexamic Acid in Orthopedic Lower Limb Surgery: A Meta-Analysis of Randomized Controlled Trials

BioMed Research International ◽

10.1155/2021/6961540 ◽

2021 ◽

Vol 2021 ◽

pp. 1-14

Author(s):

Davide Reale ◽

Luca Andriolo ◽

Safa Gursoy ◽

Murat Bozkurt ◽

Giuseppe Filardo ◽

...

Keyword(s):

Tranexamic Acid ◽

Surgical Procedures ◽

Lower Limb ◽

Cruciate Ligament ◽

Meta Analysis ◽

Orthopedic Procedures ◽

Cochrane Library ◽

Complication Rates ◽

Administration Route ◽

Orthopedic Surgical Procedures

Objective. Tranexamic acid (TXA) is increasingly used in orthopedic surgery to reduce blood loss; however, there are concerns about the risk of venous thromboembolic (VTE) complications. The aim of this study was to evaluate TXA safety in patients undergoing lower limb orthopedic surgical procedures. Design. A meta-analysis was performed on the PubMed, Web of Science, and Cochrane Library databases in January 2020 using the following string (Tranexamic acid) AND ((knee) OR (hip) OR (ankle) OR (lower limb)) to identify RCTs about TXA use in patients undergoing every kind of lower limb surgical orthopedic procedures, with IV, IA, or oral administration, and compared with a control arm to quantify the VTE complication rates. Results. A total of 140 articles documenting 9,067 patients receiving TXA were identified. Specifically, 82 studies focused on TKA, 41 on THA, and 17 on other surgeries, including anterior cruciate ligament reconstruction, intertrochanteric fractures, and meniscectomies. The intravenous TXA administration protocol was studied in 111 articles, the intra-articular in 45, and the oral one in 7 articles. No differences in terms of thromboembolic complications were detected between the TXA and control groups neither in the overall population (2.4% and 2.8%, respectively) nor in any subgroup based on the surgical procedure and TXA administration route. Conclusions. There is an increasing interest in TXA use, which has been recently broadened from the most common joint replacement procedures to the other types of surgeries. Overall, TXA did not increase the risk of VTE complications, regardless of the administration route, thus supporting the safety of using TXA for lower limb orthopedic surgical procedures.

Download Full-text

Comparison of effect between dartos fascia and tunica vaginalis fascia in TIP urethroplasty: a meta-analysis of comparative studies

BMC Urology ◽

10.1186/s12894-020-00737-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hao Yang ◽

Xiao-xiao Xuan ◽

Dong-lai Hu ◽

Hang Zhang ◽

Qiang Shu ◽

...

Keyword(s):

Postoperative Complications ◽

Postoperative Complication ◽

Comparative Studies ◽

Meta Analysis ◽

Relevant Information ◽

Cochrane Library ◽

Urethrocutaneous Fistula ◽

Tunica Vaginalis ◽

Cosmetic Outcomes ◽

Secondary Outcomes

Abstract Background Tubularized incised plate (TIP) urethroplasty is the most commonly performed procedure for hypospadias. Several flap procedures have been recommended to decrease the postoperative complication rate in TIP repair, but no single flap procedure is ideal. This study aimed to compare the outcomes of dartos fascia (DF) and tunica vaginalis fascia (TVF) as intermediate layers in TIP urethroplasty. Methods We searched PubMed, EMBASE, the Cochrane Library, Web of Science, clinicaltrials.gov, and other sources for comparative studies up to April 16, 2020. Studies were selected by the predesigned inclusion criteria. The primary outcomes were postoperative complications. The secondary outcomes were functional and cosmetic outcomes. Results The pooled RR with 95% CI were calculated. We extracted the relevant information from the included studies. Only 6 comparative studies were included. No secondary outcomes were reported. The RR of the total complications rate for DF was 2.41 (95% CI 1.42–4.07, P = 0.0001) compared with TVF in TIP repair. For each postoperative complication, the RRs were 6.48 (2.20–19.12, P = 0.0007), 5.95 (1.13–31.30, P = 0.04), 0.62 (0.25–1.52, P = 0.29), and 0.75 (0.23–2.46, P = 0.64) for urethrocutaneous fistula, prepuce-related complications, meatal/urethral stenosis, and wound-related complications, respectively. Conclusions This meta-analysis reveals that compared to DF, TVF is a better option in TIP repair in terms of decreasing the incidence of the total postoperative complications, urethrocutaneous fistula, and prepuce-related complications. However there is limited evidence for functional and cosmetic outcomes. Overall, larger prospective studies and long-term follow-up data are required to further demonstrate the superiority of TVF over DF. Trial registration PROSPERO CRD42019148554.

Download Full-text

Prevention of VTE in orthopedic surgery patients

Farmeconomia Health economics and therapeutic pathways ◽

10.7175/fe.v14i2s.881 ◽

2013 ◽

Vol 14 (2S) ◽

pp. 1-36

Author(s):

Federico Spandonaro ◽

Rossella Letizia Mancusi ◽

Lorenzo Terranova ◽

Diana Giannarelli ◽

Paolo Grossi ◽

...

Keyword(s):

Orthopedic Surgery ◽

Meta Analysis ◽

Oral Anticoagulants ◽

National Level ◽

Financial Impact ◽

Orthopedic Procedures ◽

Thromboembolic Complications ◽

Increased Risk ◽

Major Orthopedic Surgery ◽

The Cost

Venous thromboembolism (VTE) is defined as the obstruction, partial or complete, of one or more veins of deep circulation. It is a condition that can lead to a deterioration in his state of health until death, manifesting as deep vein thrombosis (DVT) or pulmonary embolism (PE). The major orthopedic surgery and the surgical oncology are frequently associated with thromboembolic complications, because of conditions that are often critical in these patients. It is estimated that in Italy DVT has an incidence that varies between 50 and 150 new cases per 100,000 population, while the prevalence would be between 2.5 and 5%. In the absence of thromboprophylaxis, the orthopedic surgery lead to a high increased risk of VTE. In elective hip replacement, in the absence of prophylaxis, the incidence of DVT and of fatal PE is about 50% and 2% respectively. In elective knee arthroplasty the risk of venous thromboembolic complications is even higher. It is estimated that 56.2% of the costs of prophylaxis with Low Molecular Weight Heparin (LMWH) in patients undergoing major orthopedic surgery are attributable to the cost of drugs (about € 200), followed (with 44.8%) by the cost of administration (approximately € 159). The average total cost/day was estimated at € 8 per patient. In Italy, it has been estimated an annual cost for new cases between 215 and 260 million €. The clinical advantages of the New Oral Anticoagulants (NOA) appear to be substantially clear, the major concern with regard to their reimbursement is therefore linked to the financial impact, due to the higher cost per day of the NOA compared with LMWH. To this end, it was built a model of budget impact, in the perspective of the Italian NHS, from the data related to cases of major surgical orthopedic procedures and a meta-analysis on the pivotal RCT, which aims to measure the differential effects in terms of prevention of VTE. The results show that the financial impact of the NOA in the prophylaxis of major orthopedic surgery is not particularly relevant. In fact, the major pharmaceutical costs that, at national level, amount to € 10.8 mil. (€ 15.2 mil. in the case of prolonged prophylaxis in knee operations) would be more than offset by savings in terms of fewer treatments of VTE, which is based on the assumption of more than 4,000 cases, up to about 6,600 in hypothesis best efficacy.

Download Full-text

Developing a Needle-Knife Surgical Device

10.21203/rs.3.rs-806258/v1 ◽

2021 ◽

Author(s):

FABIO RAVAGLIA ◽

ALBERTO CLIQUET JUNIOR

Keyword(s):

Experimental Model ◽

Surgical Procedures ◽

Orthopedic Surgery ◽

Simulation Software ◽

Orthopedic Procedures ◽

Strength Analysis ◽

Intravenous Catheter ◽

Standard Format ◽

Surgical Device ◽

Needle Knife

Abstract Introduction: Nowadays, a new era of orthopedic surgery is taking place. Procedures like video surgery, ultrasound-guided interventions, invasive pain interventions, orthopedic procedures, hydro dissection, dry needling, thermography-assisted pain management, and modern acupuncture started to be widely performed1,2. Background: In 2011 and 2012, Ravaglia & Cliquet presented papers on an Arthroscopic Needle-Knife Surgical Prototype Device (ANKSD)2 in Prague, TWC 20112, and in Dubai, OWC 20123. It was a paper presenting a prototype of a needle-knife for orthopedic procedures based on an 18G11/2 needle. Ravaglia and Cliquet wrote the paper “Comparison of two different needles used as knife on knee arthroscopic portal scalpel procedures”4, which was presented at the XXVI SICOT Triennial World Congress, in Guangzhou, China, in 2015. This research compares arthroscopic portal incisions using an 18G11/2 needle or a metal guide intravenous catheter 14Gx2. They concluded that there were no differences in complications such as infections, wound healing, hematoma, and skin healing time. After this, these researchers started a virtual development of a new needle-knife surgical device. Objective: The aim of the project is a virtual development of a needle-knife surgical device to be useful for minimally invasive ultrasound-assisted orthopedic surgical procedures, videos arthroscopic portals augmentation, and other surgical procedures. Method: Three different needle devices were compared. One is a base model 1 and the other two are experimental models (2 and 3). They are based on a metal guide for intravenous catheter 14Gx2''. The base one model 1 is the metal guide for intravenous catheter 14Gx2''; the experimental model 2 is a flat beveled edge, and experimental model 3 is a board bevel edge6,7,8,9,10,11,12,13,14,15,16. They are all graduated, parylene-coated, with a stop handle needle guard. The devices are multifunctional: Infusion, aspiration, and surgical sever.The devices were developed by 3D Design 3D STEP Standard Format, Catia V5 Format, and 2D Format Design and 3D Model. They were performed through simulation (Software Simulia Abaqus). They were biomechanically simulated with Virtual Biomechanical Strength Simulation17,18,19,20. The Strengths were assessed by Needle Strength Analysis (CAE Simulation)21.Results: For the displacement result, stiffness assessment, we have 7.48 mm for the baseline needle, 8.08mm for model 2, an increase of 8%, and for model 3 we have 7.75 mm, an increase of 3.6%. Conclusion: These devices seem suitable for echo-assisted orthopedic surgery interventions and other procedures according to virtual analysis. Further in vivo procedures shall be performed.

Download Full-text

Postoperative complications of hypospadias repair in patients receiving caudal block vs. non-caudal anesthesia: A meta-analysis

Canadian Urological Association Journal ◽

10.5489/cuaj.5688 ◽

2018 ◽

Vol 13 (8) ◽

Cited By ~ 3

Author(s):

Patrick Pine Tanseco ◽

Harkanwal Randhawa ◽

Michael Erlano Chua ◽

Udi Blankstein ◽

Jin Kyu Kim ◽

...

Keyword(s):

Postoperative Complications ◽

Postoperative Complication ◽

Subgroup Analysis ◽

Meta Analysis ◽

Poor Quality ◽

Complication Rates ◽

Hypospadias Repair ◽

Caudal Block ◽

Inverse Variance ◽

Study Type

Introduction: We performed a meta-analysis of the current literature to assess the association of caudal block and postoperative complication rates following hypospadias repair.Methods: A Systematic literature search was conducted on October 2017. Five reviewers independently screened, identified, and evaluated comparative studies assessing postoperative outcomes following hypospadias repair with and without caudal block. The incidence of post-surgical complications from each study was extracted for caudal block and control groups to generate the odds ratio (OR) and corresponding 95% confidence intervals (CI). Effect estimates were pooled using inverse-variance method with random-effects model. Subgroup analyses were performed according to study type and hypospadias severity.Results: Nine studies (2096patients) of low- to moderate-quality were included for meta-analysis. Overall pooled effect estimates demonstrated increased occurrence of postoperative complication rates among patients with caudal block (OR 2.32; 95% CI 1.29‒4.16). Subgroup analysis according to hypospadias severity revealed that a significant increased OR in complication rate was noted among proximal hypospadias (OR 3.55; 95% CI 1.80‒7.01), but not distal hypospadias (OR 1.31; 95% CI 0.59‒2.88).Conclusions: Our meta-analysis of poor-quality evidence may have revealed a significant association between caudal block and postoperative complications following hypospadias repair. However, subgroup analysis demonstrated that hypospadias severity is important in determining complication rates, suggesting that confounding factors and selection bias may play a central role in characterizing the true effect of the anesthesia approach.

Download Full-text

VP18 Antibiotics And Orthopedic Surgery Without Implant: A Meta-Analysis

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318003422 ◽

2018 ◽

Vol 34 (S1) ◽

pp. 163-163

Author(s):

Sophia Campbell Davies ◽

Chiara Inserra ◽

Gaetana Muserra ◽

Angelo Bignamini ◽

Paola Minghetti

Keyword(s):

High Risk ◽

Antibiotic Prophylaxis ◽

Orthopedic Surgery ◽

Meta Analysis ◽

Intervention Group ◽

Surgical Site Infections ◽

Risk Of Bias ◽

Orthopedic Procedures ◽

Control Group ◽

Effect Estimate

Introduction:According to guidelines, antibiotic prophylaxis in orthopedic surgery without implant is not recommended for the reduction of the incidence of surgical site infections (SSI); however, the evidence level is low. Surveys have shown that preoperative antibiotics for orthopedic procedures without implant are administered routinely by surgeons due to medico-legal concerns. Such practice may have an important impact on costs, side effects and the emergence of antibiotic resistance. Therefore, the objective of the review is to evaluate existing clinical evidence.Methods:A systematic review was performed with the use of Pubmed, EMBASE/MEDLINE, CENTRAL, SBBL-CILEA/METACRAWLER, ISRCTN Registry, ICTRP and ClinicalTrials.gov databases. Trials were initially screened by the title and abstract; secondly, full papers were analysed. The meta-analysis included randomized controlled trials (RCT) with patients undergoing surgery as treatment for any orthopedic impairment that did not need implantation. Heterogeneity analysis of the studies was conducted with chi-square. The statistical analysis of the infection rate was performed using the meta package with the R software. The effect estimate was expressed in risk ratio (RR) and pooled using a random effects model. Study quality assessment was undertaken using the Jadad scale.Results:Of the 184 identified papers, 129 were excluded since they did not meet inclusion criteria and 45 were discarded because they were considered to be duplicate publications. After analyzing the 10 potentially relevant studies, only two were included. The study population consisted of 1,152 patients. No heterogeneity was observed; however, the studies were outdated and associated with a high risk of bias. According to the pooled RR, the incidence of infection in the intervention group was lower than the control group favoring prophylaxis (RR = 0.39, 95% CI: 0.16−0.96, p = 0.040).Conclusions:The meta-analysis demonstrated, in contrast to the guidelines, that antibiotic prophylaxis can reduce the incidence of SSI in elective orthopedic surgeries without implant; however, the low number of available studies and the high risk of bias show that the effect estimate is not statistically significant. Considering that antibiotic prophylaxis is usually administered in clinical practice, RCTs are required to establish whether antibiotic prophylaxis in orthopedic procedures without implant is recommended or if this practice could cause more harm.

Download Full-text

Sarcopenia does not affect postoperative complication rates in oesophageal cancer surgery: a systematic review and meta-analysis

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0113 ◽

2020 ◽

Vol 102 (2) ◽

pp. 120-132 ◽

Cited By ~ 1

Author(s):

D Schizas ◽

M Frountzas ◽

I Lidoriki ◽

E Spartalis ◽

K Toutouzas ◽

...

Keyword(s):

Postoperative Complications ◽

Postoperative Complication ◽

Anastomotic Leakage ◽

Muscle Mass ◽

Oesophageal Cancer ◽

Surgical Complications ◽

Meta Analysis ◽

Cardiovascular Complications ◽

Complication Rates ◽

Respiratory Complications

Introduction The high morbidity and mortality rates after oesophagectomy indicate the need for rigorous patient selection and preoperative risk assessment. Although muscle mass depletion has been proposed as a potential prognostic factor for postoperative complications and decreased survival in gastrointestinal cancer patients, available data are conflicting. The purpose of the present meta-analysis is to determine whether sarcopenia predicts postoperative outcomes in patients undergoing oesophagectomy. Methods The databases MEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar were searched for studies reporting on the effect of sarcopenia on postoperative outcomes following oesophageal cancer surgery. Outcomes included surgical complications, anastomotic leakage, respiratory complications, cardiovascular complications, postoperative infections, major complications and overall complications. The random effects model (DerSimonian–Laird) was used to calculate pooled effect estimates when high heterogeneity was encountered, otherwise the fixed-effects (Mantel–Haenszel) model was implemented. Findings A total of eight studies involving 1488 patients diagnosed with oesophageal cancer and who underwent oesophagectomy were included in the meta-analysis. The presence of sarcopenia did not significantly increase the rate of surgical complications (odds ratio, OR, 0.86, 95% confidence interval, CI, 0.40–1.85), anastomotic leakage (OR 0.75, 95% CI 0.42–1.35), respiratory complications (OR 0.56, 95% CI 0.21–1.48), cardiovascular complications (OR 0.94, 95% CI 0.31–2.83), postoperative infection (OR 1.14, 95% CI 0.52–2.50), major complications (OR 0.81, 95% CI 0.23–2.82) or overall postoperative complications (OR 0.80, 95% 0.32–1.99). Conclusion Sarcopenia does not seem to affect postoperative complication rates of patients undergoing oesophagectomy for oesophageal cancer. Future research should focus on determining whether prognosis differs according to muscle mass in this patient population.

Download Full-text

Improving Compliance with Timely Intraoperative Redosing of Antimicrobials in Surgical Prophylaxis

Infection Control and Hospital Epidemiology ◽

10.1086/678058 ◽

2014 ◽

Vol 35 (10) ◽

pp. 1236-1240 ◽

Cited By ~ 9

Author(s):

Gina Riggi ◽

Mayela Castillo ◽

Margaret Fernandez ◽

Andrew Wawrzyniak ◽

Michael Vigoda ◽

...

Keyword(s):

Real Time ◽

Surgical Procedures ◽

Tissue Concentration ◽

Compliance Rate ◽

Solid Organ Transplantation ◽

Orthopedic Procedures ◽

Neurosurgical Procedures ◽

Solid Organ ◽

Intervention Period ◽

Surgical Prophylaxis

Background.Appropriate use of antimicrobials for surgical prophylaxis is an important patient safety issue. Antimicrobial levels should be present during the duration of the surgical procedure until incision site closure. For prolonged surgical procedures in which the tissue concentration of the prophylactic antimicrobial may decrease to below the necessary minimum inhibitory concentration, intraoperative redosing of antimicrobials may be crucial Objective.To evaluate compliance of appropriate intraoperative antimicrobial surgical prophylaxis using real-time intraoperative antimicrobial dosing reminders at a large teaching hospital.Methods.A retrospective review of electronic records (March 2009–October 2012) was performed. Patients were included if they were at least 18 years of age and underwent a procedure requiring antimicrobial surgical prophylaxis. Compliance was determined by comparing 3 time intervals: baseline (March 2009–March 2010); intervention period 1 (IP-1; April 1, 2010–April 30, 2012), and intervention period 2 (IP-2; May 1, 2012–October 31, 2012). Interventions included a hospital-wide standardized protocol comprising an automated intraoperative paging system to notify when antimicrobials should be redosed.Results.A total of 7,461 of 75,230 surgical procedures required intraoperative redosing of antimicrobials and were analyzed. Patient mean age (± standard deviation) was 45 ± 19 years, and 62.6% were female. The most common procedures that required prophylaxis were solid organ transplantation, neurosurgical procedures, and orthopedic procedures. Baseline compliance (n = 2,183) was 15.8%; compliance significantly improved to 65.3% during IP-1 (n = 4,486; P < .001). The compliance rate improved to 76.7% during IP-2 (P > .001 compared with no reminder).Conclusions.Compliance with redosing of intraoperative antimicrobials was improved with the combined approach of guidelines, education to healthcare providers, and real-time automated paging system.

Download Full-text