Risk factors for surgical site infections in neurosurgery

Introduction Surgical site infections (SSIs) are of profound significance in neurosurgical departments, resulting in high morbidity and mortality. There are limited public data regarding the incidence of SSIs in neurosurgery. The aim of this study was to determine the rate of SSIs (particularly those requiring reoperation) over a seven-year period and identify factors leading to an increased risk. Methods An age matched retrospective analysis was undertaken of a series of 16,513 patients at a single centre. All patients who required reoperation for suspected SSIs within a 7-year period were identified. Exclusion criteria comprised absence of infective material intraoperatively and patients presenting with primary infections. Clinical notes were reviewed to confirm presence or absence of suspected risk factors. Results Of the 16,513 patients in the study, 1.20% required at least one further operation to treat a SSI. Wound leak (odds ratio [OR]: 27.41), dexamethasone use (OR: 3.55), instrumentation (OR: 2.74) and operative duration >180 minutes (OR: 1.85) were statistically significant risk factors for reoperation. Conclusions This is the first UK study of such a duration that has documented a SSI reoperation rate in a cohort of this size. Various risk factors are associated with the development of SSIs, making it essential to have robust auditing and monitoring of high risk patients to ensure excellent standards of healthcare. Departmental and public registers to record all SSIs may be beneficial, particularly for those treated solely by general practitioners, allowing units to address potential risk factors prior to surgical intervention.

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Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa067 ◽

2020 ◽

Vol 41 (1) ◽

pp. 59-71 ◽

Cited By ~ 3

Author(s):

Torsten Schlosshauer ◽

Marcus Kiehlmann ◽

Diana Jung ◽

Robert Sader ◽

Ulrich M Rieger

Keyword(s):

Risk Factors ◽

Wound Healing ◽

Surgical Technique ◽

Significant Risk ◽

Level Of Evidence ◽

Increased Risk ◽

Potential Risk Factors ◽

Wound Healing Problems ◽

Bariatric Patients

Abstract Background Post-bariatric patients present a surgical challenge within abdominoplasty because of residual obesity and major comorbidities. In this study, we analyzed complications following abdominoplasty in post-bariatric patients and evaluated potential risk factors associated with these complications. Objectives The authors sought to determine the complications and risk factors following abdominoplasty in post-bariatric patients. Methods A retrospective study of patients who underwent abdominoplasty was performed from January 2009 to December 2018 at our institution. Variables analyzed were sex, age, body mass index (BMI), smoking, surgical technique, operative time, resection weight, drain output, and complications. Results A total of 406 patients were included in this study (320 female and 86 male) with a mean age of 44.4 years and a BMI of 30.6 kg/m2. Abdominoplasty techniques consisted of traditional (64.3%), fleur-de-lis technique (27.3%), and panniculectomy without umbilical displacement (8.4%). Overall complications recorded were 41.9%, the majority of these being wound-healing problems (32%). Minor and major complications were found in 29.1% and 12.8% of patients, respectively. A BMI value of ≥30 kg/m2 was associated with an increased risk for wound-healing problems (P = 0.001). The frequency of total complications was significantly related to age (P = 0.007), BMI (P = 0.004), and resection weight (P = 0.001). Abdominoplasty technique tended to influence total complications. Conclusions This study demonstrates in a fairly large sample of post-bariatric patients (n = 406) that abdominoplasty alone can be performed safely, with an acceptable complication rate. Age, BMI, and resection weight are shown to be significant risk factors for total complications. The role of surgical technique needs to be evaluated further. Level of Evidence: 4

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Risk factors for surgical site infections and assessment of vancomycin powder as a preventive measure in patients undergoing first-time cranioplasty

Journal of Neurosurgery ◽

10.3171/2016.12.jns161967 ◽

2018 ◽

Vol 128 (4) ◽

pp. 1241-1249 ◽

Cited By ~ 10

Author(s):

Kingsley O. Abode-Iyamah ◽

Hsiu-Yin Chiang ◽

Nolan Winslow ◽

Brian Park ◽

Mario Zanaty ◽

...

Keyword(s):

Risk Factors ◽

Multivariable Analysis ◽

Significant Risk ◽

Preventive Measure ◽

Surgical Site Infections ◽

Smoking History ◽

Prosthetic Implants ◽

Increased Risk ◽

Vancomycin Powder ◽

First Time

OBJECTIVECraniectomy is often performed to decrease intracranial pressure following trauma and vascular injuries. The subsequent cranioplasty procedures may be complicated by surgical site infections (SSIs) due to prior trauma, foreign implants, and multiple surgeries through a common incision. Several studies have found that intrawound vancomycin powder (VP) is associated with decreased risk of SSIs after spine operations. However, no previously published study has evaluated the effectiveness of VP in cranioplasty procedures. The purpose of this study was to determine whether intrawound VP is associated with decreased risk of SSIs, to evaluate VP’s safety, and to identify risk factors for SSIs after cranioplasty among patients undergoing first-time cranioplasty.METHODSThe authors conducted a retrospective cohort study of adult patients undergoing first-time cranioplasty for indications other than infections from January 1, 2008, to July 31, 2014, at an academic health center. Data on demographics, possible risk factors for SSIs, and treatment with VP were collected from the patients’ electronic health records.RESULTSDuring the study period, 258 patients underwent first-time cranioplasties, and 15 (5.8%) of these patients acquired SSIs. Ninety-two patients (35.7%) received intrawound VP (VP group) and 166 (64.3%) did not (no-VP group). Patients in the VP group and the no-VP group were similar with respect to age, sex, smoking history, body mass index, and SSI rates (VP group 6.5%, no-VP group 5.4%, p = 0.72). Patients in the VP group were less likely than those in the no-VP group to have undergone craniectomy for tumors and were more likely to have an American Society of Anesthesiologists physical status score > 2. Intrawound VP was not associated with other postoperative complications. Risk factors for SSI from the bivariable analyses were diabetes (odds ratio [OR] 3.65, 95% CI 1.07–12.44), multiple craniotomy procedures before the cranioplasty (OR 4.39, 95% CI 1.47–13.18), prior same-side craniotomy (OR 4.73, 95% CI 1.57–14.24), and prosthetic implants (OR 4.51, 95% CI 1.40–14.59). The multivariable analysis identified prior same-side craniotomy (OR 3.37, 95% CI 1.06–10.79) and prosthetic implants (OR 3.93, 95% CI 1.15–13.40) as significant risk factors for SSIs. After adjusting for potential confounders, patients with SSIs were more likely than those without SSIs to be readmitted (OR 7.28, 95% CI 2.07–25.60).CONCLUSIONSIn this study, intrawound VP was not associated with a decreased risk of SSIs or with an increased risk of complications. Prior same-side craniotomy and prosthetic implants were risk factors for SSI after first-time cranioplasty.

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Risk factors and protective factors of depression in older people 65+. A systematic review

PLoS ONE ◽

10.1371/journal.pone.0251326 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251326

Author(s):

Alexander Maier ◽

Steffi G. Riedel-Heller ◽

Alexander Pabst ◽

Melanie Luppa

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Older People ◽

Smoking Behavior ◽

Significant Risk ◽

Female Gender ◽

Assessment Tools ◽

Mobility Impairment ◽

Increased Risk ◽

Potential Risk Factors

Objectives Identifying risk factors of depression can provide a better understanding of the disorder in older people. However, to minimize bias due to the influence of confounders and to detect reverse influence, a focus on longitudinal studies using multivariate analysis is required. Design A systematic literature search was conducted by searching the databases MEDLINE, Cochrane, PsycINFO and Web of Science for all relevant articles published from January 2000 to the end of March 2020. The following inclusion criteria were used: prospective design, nationally or regionally representative sample, published in English or German, analyzed risk factors for depression of individuals 65+ identified by multivariate analysis, and provided validity of diagnostic instrument. All results of multivariate analysis were reported and summarized. Results Thirty articles were identified. Heterogeneous results were found for education, female gender, self-rated health, cognitive impairment and older age, although significant in several studies. Findings hinted at a protective quality of physical activity. In terms of physical health, chronic disease and difficulty initiating sleep homogeneously increased risk of depression. Mobility impairment resulted as a risk factor in three studies. IADL impairment and vision impairment were mostly identified as significant risk factors. Alcohol consumption and smoking behavior yielded heterogenous results. Psychosocial factors were assessed similarly in multiple studies and yielded heterogenous results. Limitations Research was limited to articles published in English or German. Length of follow up was not considered for the presentation of results. Adjustments for and inclusion of different variables in the studies may distort results. Conclusion Our findings demonstrate the necessity of refined, more comparable assessment tools for evaluating potential risk factors.

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Characteristics of SARS-CoV-2 positive and complicated COVID-19 patient cohorts in Israel: A comparative analysis

10.1101/2020.05.07.20091652 ◽

2020 ◽

Cited By ~ 3

Author(s):

Chen Yanover ◽

Barak Mizrahi ◽

Nir Kalkstein ◽

Karni Marcus ◽

Pinchas Akiva ◽

...

Keyword(s):

Risk Factors ◽

Kidney Diseases ◽

Significant Risk ◽

P Value ◽

Public Health Policies ◽

Global Pandemic ◽

Increased Risk ◽

Risk Patients ◽

Risk Of Disease

AbstractReliably identifying patients at increased risk for COVID-19 complications could guide clinical decisions, public health policies, and preparedness efforts. The most globally accepted definitions of at-risk patients rely, primarily, on epidemiological characterization of hospitalized COVID-19 patients. However, such characterization overlooks, and fails to correct for, the prevalence of existing conditions in the wider SARS-CoV-2 positive population. Here, we use the complete medical records of 4,353 Israeli SARS-CoV-2 positive individuals, of whom 173 experienced moderate or severe symptoms of COVID-19, to identify the conditions that increase the risk of disease complications, in various age and sex strata. Our analysis suggests that cardiovascular and kidney diseases, obesity, and hypertension are significant risk factors for COVID-19 complications, as previously reported. Interestingly, it also indicates that depression (e.g., odds ratio, OR, for males 65 years or older: 2.94, 95% confidence intervals [1.55, 5.58]; P-value = 0.014) as well cognitive and neurological disorder (e.g., OR for individuals ≥ 65 year old: 2.65 [1.69, 4.17]; P-value < 0.001) are significant risk factors; and that smoking and background of respiratory diseases do not significantly increase the risk of complications. Adjusting existing risk definitions following these observations may improve their accuracy and impact the global pandemic containment efforts.

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Mediastinal Mass, Triglycerides Level Above 1000mg/Dl and Intensive Dexamethasone and Asparaginase Treatment Are Risk Factors for Cerebral Sinus Venous Thrombosis in Children Treated for Acute Lymphoblastic Leukemia at the Children's Cancer Center of Lebanon

Blood ◽

10.1182/blood-2018-99-119638 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5163-5163

Author(s):

Habib El-Khoury ◽

Khaled M Ghanem ◽

Yaacoub Mubarak ◽

Nidale Tarek ◽

Hassan El Solh ◽

...

Keyword(s):

Risk Factors ◽

Acute Lymphoblastic Leukemia ◽

Mediastinal Mass ◽

Lymphoblastic Leukemia ◽

Significant Risk ◽

Cancer Center ◽

Group I ◽

Increased Risk ◽

Cerebral Sinus Venous Thrombosis ◽

Risk Patients

Abstract Background: Cerebral sinus venous thrombosis (CSVT) is a serious complication of childhood acute lymphoblastic leukemia (ALL) therapy. No universal consensus exists regarding its risk factors due to rarity of cases. The effect of CSVT on outcome is not limited to its own complications but extends to its possible negative impact on ALL therapy. Age above 10 years, T-cell immunophenotype and risk stratification (intermediate/high risk) were previously shown to be statistically significant risk factors for CSVT in our cohort of patients with an odds ratio of 3.56, 2.32 and 3.40 respectively and a P-Value of 0.03, 0.02 and 0.04 respectively (Ghanem et al. 2017). Aims and Methods: This is a prospective study of a pediatric cohort of children between 1 and 18 years of age treated for Acute Lymphoblastic Leukemia at the Children's Cancer Center of Lebanon (CCCL) between 2007 and 2017 with a protocol adopted from St Jude TOT XV. The aim of this analysis is to study the effect of decreasing asparginase and dexamethasone doses on the incidence of CSVT in addition to studying the effect of the following potential risk factors: presence of mediastinal mass at diagnosis, triglycerides level above 1000mg/dL and elevated initial blast count. In 2015, L-asparginase doses were decreased during induction from 10,000IU/m2/dose to 6,000IU/m2/dose and Dexamethasone doses were decreased from 12mg/m2/dose to 8mg/m2/dose for intermediate/high risk patients and from 8mg/m2/dose to 6mg/m2/dose for low risk patients. Patients were divided into two groups: group I for individuals treated between 2007 and 2015 and group I for individuals treated between 2015 and 2017. Results: A total of 202 patients were recruited (Group I, N=126 and Group II, N=76). The incidence of CSVT was 10.3% in group I and 1.3 % in group II. Univariate analysis showed that, treatment with intensive dexamethasone and asparginase in group I was a significant risk factor for CSVT (OR: 9.3, 95% CI: 1.2 - 72, P=0.03). Initial mediastinal mass (OR: 19.3, 95% CI: 5.4 - 68.6, P<0.0001) and triglycerides level above 1000mg/dL (OR: 3.4, 95% CI: 0.98 - 12, P=0.05) were also associated with increased risk of CSVT. Initial peripheral blast count ≥10,000 (OR: 0.57, 95% CI: 0.19 - 1.7, P=0.31), ≥50,000 (OR: 0.7, 95% CI: 0.14-3.35, P=0.66), and ≥100,000 (OR: 1.53, 95% CI: 0.29-7.82, P=0.61) were not risk factors for CSVT in our cohort. Conclusion: Decreasing the doses of dexamethasone and asparginase significantly lowered the risk of CSVT in our patient population. Initial mediatinal mass and triglycerides levels above 1000mg/dL during asaparginase therapy were significantly associated with increased risk of developing CSVT. If future studies confirm our findings, mediastinal mass and elevated triglycerides level may be considered amongst other factors predisposing to CSVT and may help identify candidates for thromboprophylaxis in the future. Disclosures No relevant conflicts of interest to declare.

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Risk factors for pregnancy-associated venous thromboembolism in Singapore

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0298 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Sandra Lynn Jaya-Bodestyne ◽

Lai Heng Lee ◽

Lay Kok Tan ◽

Kok Hian Tan ◽

Truls Østbye ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Significant Risk ◽

International Classification Of Diseases ◽

Prospective Longitudinal Study ◽

Mortality And Morbidity ◽

Singapore General Hospital ◽

Increased Risk ◽

Potential Risk Factors ◽

Prospective Longitudinal

AbstractObjectivesPregnancy-associated venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with increased risk of maternal mortality and morbidity. This study aimed to assess potential risk factors for pregnancy-associated VTE.MethodsIn this case-control study, women with pregnancy-associated VTE were identified via International Classification of Diseases codes and included if they had been objectively diagnosed with VTE during pregnancy or within six weeks postpartum, from 2004 to 2016, at KK Women’s and Children’s Hospital or Singapore General Hospital in Singapore. Controls, i.e. pregnant women without VTE, were selected from a prospective longitudinal study. The odds ratio (OR) for VTE was computed for a range of maternal and obstetric factors.Results and conclusionsFrom 2004 to 2016, 89 cases of pregnancy-associated VTE and 926 controls were identifed and analysed using logistic regression. The most significant risk factors for pregnancy-associated VTE were smoking (OR 5.44, p=0.0002) and preterm delivery (OR 5.06, p=0.023). Malay race, multiparity, non-O blood group and caesarean section, were also identified to be of higher risk. These risk factors should be useful in the development of thromboprophylaxis strategies for pregnancy and the postpartum period, especially in Singapore.

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Renal Failure after Coronary Bypass Surgery and the Associated Risk Factors

The Heart Surgery Forum ◽

10.1532/hsf.1216 ◽

2015 ◽

Vol 18 (1) ◽

pp. 006

Author(s):

Hasan Reyhanoglu ◽

Kaan Ozcan ◽

Murat Erturk ◽

Fatih İslamoglu ◽

İsa Durmaz

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Failure ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Bypass Surgery ◽

Artery Bypass ◽

Significant Risk ◽

High Morbidity ◽

Factors Associated

Objective: We aimed to evaluate the risk factors associated with acute renal failure in patients who underwent coronary artery bypass surgery. Methods: One hundred and six patients who developed renal failure after coronary artery bypass grafting (CABG) constituted the study group (RF group), while 110 patients who did not develop renal failure served as a control group (C group). In addition, the RF group was divided into two subgroups: patients that were treated with conservative methods without the need for hemodialysis (NH group) and patients that required hemodialysis (HR group). Risk factors associated with renal failure were investigated. Results: Among the 106 patients that developed renal failure (RF), 80 patients were treated with conservative methods without any need for hemodialysis (NH group); while 26 patients required hemodialysis in the postoperative period (HR group). The multivariate analysis showed that diabetes mellitus and the postoperative use of positive inotropes and adrenaline were significant risk factors associated with development of renal failure. In addition, carotid stenosis and postoperative use of adrenaline were found to be significant risk factors associated with hemodialysis-dependent renal failure (P < .05). The mortality in the RF group was determined as 13.2%, while the mortality rate in patients who did not require hemodialysis and those who required hemodialysis was 6.2% and 34%, respectively. Conclusion: Renal failure requiring hemodialysis after CABG often results in high morbidity and mortality. Factors affecting microcirculation and atherosclerosis, like diabetes mellitus, carotid artery stenosis, and postoperative vasopressor use remain the major risk factors for the development of renal failure.

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Correlation between Potential Risk Factors and Pulmonary Embolism in Sarcoidosis Patients Timely Treated

Journal of Clinical Medicine ◽

10.3390/jcm10112462 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2462

Author(s):

Barbara Ruaro ◽

Paola Confalonieri ◽

Mario Santagiuliana ◽

Barbara Wade ◽

Elisa Baratella ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Potential Risk ◽

Smoking Habit ◽

Age At Diagnosis ◽

Antiphospholipid Antibody ◽

Increased Risk ◽

Significant Difference ◽

Antibody Positivity ◽

Potential Risk Factors

Background. Some studies with inconclusive results have reported a link between sarcoidosis and an increased risk of pulmonary embolism (PE). This study aimed at assessing a possible correlation between potential risk factors and PE in sarcoidosis patients. Methods. A total of 256 sarcoidosis patients (84 males and 172 females; mean age at diagnosis 49 ± 13) were enrolled after giving written informed consent. Clinical evaluations, laboratory and radiology tests were performed to evaluate the presence of pulmonary embolism. Results. Fifteen sarcoidosis patients with PE (4 males and 11 females; mean age at diagnosis 50 ± 11), diagnosed by lung scintigraphy and 241 sarcoidosis patients without PE (80 males and 161 females; mean age at diagnosis 47 ± 13), were observed. There was a statistically significant increase of the presence of antiphospholipid antibodies in the sarcoidosis group with pulmonary embolism. There was no statistically significant difference between the two groups as to smoking habit, obesity or hereditary thrombophilia frequency (p > 0.05, respectively). Conclusions. This study demonstrates a significant correlation between the presence of antiphospholipid antibody positivity and the pulmonary embolism events in our sarcoidosis patients. Furthermore, we propose screening for these antibodies and monitoring, aimed at timely treatment.

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Problem-Orientated Antenatal Notekeeping: A Useful Primary Health Care Tool

Curationis ◽

10.4102/curationis.v1i3.179 ◽

1978 ◽

Vol 1 (3) ◽

Author(s):

J.V. Larsen

Keyword(s):

Risk Factors ◽

South Africa ◽

Health Care ◽

Primary Health Care ◽

High Risk ◽

Significant Risk ◽

Obstetric Care ◽

Antenatal Screening ◽

Primary Health ◽

Risk Patients

It has recently been demonstrated that about 56 percent of patients delivering in a rural obstetric unit had significant risk factors, and that 85 percent of these could have been detected by meticulous antenatal screening before the onset of labour. These figures show that the average rural obstetric unit in South Africa is dealing with a large percentage of high risk patients. In this work, it is hampered by: 1. Communications problems: i.e. bad roads, long distances. and unpredictable telephones. 2. A serious shortage of medical staff resulting in primary obstetric care being delivered by midwives with minimal medical supervision.

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Post-thyroidectomy bleeding: analysis of risk factors from a national registry

British Journal of Surgery ◽

10.1093/bjs/znab015 ◽

2021 ◽

Author(s):

H E Doran ◽

S M Wiseman ◽

F F Palazzo ◽

D Chadwick ◽

S Aspinall

Keyword(s):

Risk Factors ◽

Total Thyroidectomy ◽

Thyroid Surgery ◽

Multivariable Analysis ◽

Significant Risk ◽

Bleeding Risk ◽

Redo Surgery ◽

Day Case ◽

Increased Risk ◽

Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

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