Morbidity and mortality associated with arterial surgery site infections by resistant microorganisms

Background:Surgical site infection is a severe complication of peripheral vascular surgery with high morbidity and mortality rates.Objective:To evaluate the morbidity and mortality of infections of peripheral artery surgery sites caused by resistant microorganisms.Methods:This was a prospective study of a cohort of patients who underwent peripheral artery revascularization procedures and developed surgical site infections between March 2007 and March 2011.Results:Mean age was 63.7 years; males accounted for 64.3% of all cases. The overall prevalence of bacterial resistance to antimicrobials was 65.7%. The most common microorganism identified was Staphylococcus aureus (30%). Comparison of the demographic and surgical characteristics of both subsets (resistant versus non-resistant) detected a significant difference in length of preoperative hospital stay (9.3 days vs. 3.7 days). The subset of patients with infections by resistant microorganisms had higher rates of reoperation, lower numbers of limb amputations and lower mortality, but the differences compared to the subset without resistant infections were not significant. Long-term survival was similar.Conclusions:This study detected no statistically significant differences in morbidity or mortality between subsets with surgical wound infections caused by resistant and not-resistant microorganisms.

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Total Abdominal Colectomy: Patient Satisfaction and Outcomes

The American Surgeon ◽

10.1177/000313480707300715 ◽

2007 ◽

Vol 73 (7) ◽

pp. 709-711 ◽

Cited By ~ 1

Author(s):

Jason A. Payne ◽

David C. Snyder ◽

Jacob Olivier ◽

Jihad R. Salameh

Keyword(s):

High Frequency ◽

Morbidity And Mortality ◽

High Morbidity ◽

Colonic Diseases ◽

Total Blood ◽

Total Abdominal Colectomy ◽

Bowel Movements ◽

Inflammatory Bowel ◽

Preoperative Hospital Stay

Total abdominal colectomy is required for many colonic diseases. The authors studied the outcomes of this operation and the quality of life based on the decision to perform an ileostomy or an anastomosis. Patients who underwent total abdominal colectomy (excluding those with inflammatory bowel disease and chronic constipation) had either ileoproctostomy or ileostomy and were compared. Patients were surveyed to assess satisfaction. Thirty-seven patients with ileo-proctostomy and 23 patients with ileostomy were identified. There were no significant differences between groups with regard to urgency of operation, preoperative and total blood units received, and preoperative hospital stay. Morbidity and mortality were higher in the ileostomy group (38 vs 57% and 5 vs 17%), with odds ratios of 2.14 and 3.68 respectively; this was not, however, statistically significant ( P = 0.157 and 0.132, power = 20% and 6%). All (14 of 14) surveyed ileostomy patients were at least satisfied versus 90 per cent (19 of 21) of ileoproctostomy patients. Of the latter, only 15 of 20 patients were continent, with 6.85 average daily bowel movements. Total abdominal colectomy has high morbidity and mortality rates. Performing an ileoproctostomy does not influence outcome but may lead to a high frequency of bowel movements and incontinence in some patients.

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Cardiovascular and Metabolic Consequences of Liver Transplantation: A Review

Medicina ◽

10.3390/medicina55080489 ◽

2019 ◽

Vol 55 (8) ◽

pp. 489

Author(s):

Plotogea ◽

Ilie ◽

Sandru ◽

Chiotoroiu ◽

Bratu ◽

...

Keyword(s):

Metabolic Syndrome ◽

Liver Transplantation ◽

De Novo ◽

Current Knowledge ◽

Morbidity And Mortality ◽

High Morbidity ◽

Term Survival ◽

The Metabolic Syndrome ◽

Acute Liver Disease

Liver transplantation (LT) is considered the curative treatment option for selected patients who suffer from end-stage or acute liver disease or hepatic malignancy (primary). After LT, patients should be carefully monitored for complications that may appear, partially due to immunosuppressive therapy, but not entirely. Cardiovascular diseases are frequently encountered in patients with LT, being responsible for high morbidity and mortality. Patients with underlying cardiovascular and metabolic pathologies are prone to complications after the transplant, but these complications can also appear de novo, mostly associated with immunosuppressants. Metabolic syndrome, defined by obesity, hypertension, dyslipidemia, and hyperglycemia, is diagnosed among LT recipients and is aggravated after LT, influencing the long-term survival. In this review, our purpose was to summarize the current knowledge regarding cardiovascular (CV) diseases and the metabolic syndrome associated with LT and to assess their impact on short and long-term morbidity and mortality.

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Morbidity and Mortality of C2 Fractures in the Elderly

Neurosurgery ◽

10.1227/neu.0b013e3182446742 ◽

2011 ◽

Vol 70 (5) ◽

pp. 1055-1059 ◽

Cited By ~ 12

Author(s):

Yi-Ren Chen ◽

Maxwell Boakye ◽

Robert T. Arrigo ◽

Paul S. A. Kalanithi ◽

Ivan Cheng ◽

...

Keyword(s):

Elderly Patients ◽

Hospital Stay ◽

Treatment Modality ◽

The Elderly ◽

Morbidity And Mortality ◽

High Morbidity ◽

Complication Rates ◽

Term Survival ◽

Cord Injury

Abstract BACKGROUND: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients. OBJECTIVE: To compare outcomes for elderly patients with closed C2 fractures by treatment modality. METHODS: We retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival. RESULTS: Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups. CONCLUSION: The 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

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Short Courses of Antibiotics Are Safe in Necrotizing Soft Tissue Infections

The American Surgeon ◽

10.1177/00031348211051700 ◽

2021 ◽

pp. 000313482110517

Author(s):

Maria G. Valadez ◽

Neil Patel ◽

Vince Chong ◽

Brant A. Putnam ◽

Ashkan Moazzez ◽

...

Keyword(s):

Soft Tissue ◽

Surgical Debridement ◽

Morbidity And Mortality ◽

Source Control ◽

High Morbidity ◽

Soft Tissue Infections ◽

Short Course ◽

Significant Difference ◽

Necrotizing Soft Tissue Infections ◽

Antibiotic Courses

Introduction Necrotizing soft tissue infections (NSTIs) carry high morbidity and mortality. While early aggressive surgical debridement is well-accepted treatment for NSTIs, the optimum duration of adjunct antibiotic therapy is unclear. An increasing focus on safety and evidence-based antimicrobial stewardship suggests a value in addressing this knowledge gap. Objective To determine whether shorter antibiotic courses have similar outcomes compared to longer courses in patients with NSTI following adequate source control. Population 142 consecutive patients with surgically managed NSTI were identified on retrospective chart review between December 2014 and December 2018 at two academic medical centers. Results Patients were predominately male (74%) with a median age of 52 and similar baseline characteristics. The median number of debridements to definitive source control was 2 (IQR 1-3) with the short course group undergoing a greater number of debridements control 2.57 ± 1.8 vs 1.9 ± 1.2, ( P = .01). Of 142 patients, 34.5% received a short course and the remaining 65.5% received a longer course of antibiotics. There was no significant difference in the incidence of bacteremia or wound culture positivity between groups. There was also no significant difference in in-hospital mortality, 8% vs 6, ( P = .74), incidence of C. difficile infection, median length of stay, or 30-day readmission. Conclusion Provided adequate surgical debridement, similar outcomes in morbidity and mortality suggest antibiotic courses of 7 days or less are equally safe compared to longer courses.

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En Bloc Pancreaticoduodenectomy for Locally Advanced Right Colon Cancers

International Journal of Surgical Oncology ◽

10.1155/2017/5179686 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

Cihan Ağalar ◽

Aras Emre Canda ◽

Tarkan Unek ◽

Selman Sokmen

Keyword(s):

Survival Time ◽

Locally Advanced ◽

Multivisceral Resection ◽

Right Colectomy ◽

Morbidity And Mortality ◽

High Morbidity ◽

Right Colon ◽

En Bloc ◽

Term Survival ◽

Colon Cancers

Locally advanced right colon cancer may invade adjacent tissue and organs. Direct invasion of the duodenum and pancreas necessitates an en bloc resection. Previously, this challenging procedure was associated with high morbidity and mortality; however, today, this procedure can be done more safely in experienced centers. The aim of this study is to report our experience on en bloc right colectomy with pancreaticoduodenectomy for locally advanced right colon cancers. Between 2000 and 2012, 5 patients underwent en bloc multivisceral resection. No major morbidities or perioperative mortalities were observed. Median disease-free survival time was 24.5 months and median overall survival time was 42.1 (range: 4.5–70.4) months in our series. One patient lived 70 months after multivisceral resection and underwent cytoreductive surgery and total pelvic exenteration during the follow-up period. In locally advanced right colon tumors, all adhesions should be considered as malign invasion and separation should not be done. The reasonable option for this patient is to perform en bloc pancreaticoduodenectomy and right colectomy. This procedure may result in long-term survival with acceptable morbidity and mortality rates. Multidisciplinary teamwork and multimodality treatment alternatives may improve the results.

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Long-term Survival Rates of Implants Supporting Overdentures

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-12-00178 ◽

2015 ◽

Vol 41 (2) ◽

pp. 173-177 ◽

Cited By ~ 10

Author(s):

José Balaguer ◽

Javier Ata-Ali ◽

David Peñarrocha-Oltra ◽

Berta García ◽

María Peñarrocha-Diago

Keyword(s):

Survival Rate ◽

Survival Rates ◽

Long Term Results ◽

Dental Arch ◽

Term Survival ◽

Lower Survival Rate ◽

Significant Difference ◽

A Prospective Study

The study aims were to evaluate survival rates of dental implants in patients wearing maxillary and mandibular overdentures in relation to age, sex, smoking, implant splinting or non-splinting, the maxilla rehabilitated, and number of implants per dental arch. This was a prospective study of patients who were completely edentulous in either mandible or maxilla or both, rehabilitated with implant-retained overdentures, with a follow-up of at least 3 years. 95 patients with 107 overdentures were supported by 360 implants were included in the study. Rehabilitations were monitored over an average of 95 ± 20.3 months (range 36–159). Implant survival in the maxilla was 91.9% and in the mandible 98.6%, representing a statistically significant difference (P < .05). Age, sex and implant splinting did not influence survival rates significantly. Smokers presented a lower survival rate. Implant numbers in the maxilla had a significant influence on survival, 100% for 6 but 85.7% for 4. Three mandibular implants achieved higher survival rates (100%) but with 2 (96.6%) or 4 (99%) survival was lower, although without significant difference. Long-term results suggest that 3-implant mandibular overdentures have an equivalent survival rate to 4-implant overdentures. In the maxilla, results showed that 6 implants may be the best treatment strategy. For smokers with fewer implants retaining the overdentures, there were higher numbers of implant failures.

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Factors associated with antibiotic prescription among healthcare workers at tertiary hospitals in Nairobi County, Kenya

Annals of Health Research ◽

10.30442/ahr.0602-05-78 ◽

2020 ◽

Vol 6 (2) ◽

pp. 158-170

Author(s):

OW Mbuthia ◽

EN Ndonga ◽

SO Odiwour ◽

MW Muraguri

Keyword(s):

Healthcare Workers ◽

Bacterial Resistance ◽

Antibiotic Prescription ◽

Antibiotic Use ◽

Essential Medicines ◽

High Morbidity ◽

Prescription Practices ◽

Significant Difference ◽

Tertiary Hospitals ◽

Outpatient Departments

Background: Globally, there has been an overall decline in the effectiveness of antibiotics resulting in an upsurge in bacterial resistance, increased cost of healthcare and consequent high morbidity and mortality rates. Objective: To determine antibiotic prescription practices among healthcare workers at the Kenyatta National Hospital, Mbagathi, Pumwani Maternity and Mama Lucy Kibaki Hospitals, Nairobi, Kenya. Methods: The study design was a mixture of quantitative and qualitative methods. Self-administered questionnaires were used to gather information from 230 prescribing healthcare workers. Interviews and Focus Group Discussions (FGDs) were conducted purposively with the prescribing healthcare workers and patients to obtain qualitative data. Results: There was a significant difference in the distribution of study participants with regards to the availability of antibiotics prescribing policy (p = 0.05). Only 53 (23%) prescribers prescribed antibiotics as per the policy guide while 51 (22.2%) did not and 126 (54.8%) were not sure. Oral antibiotics (OR = 0.5, 95%CI 0.3-0.9), always referring to the 2016 Kenya Essential Medicines List (KEML) to prescribe antibiotics (OR = 4.2, 95%CI 1.3-13.1), separating antibiograms for inpatient and outpatient departments (OR = 4.3, 95%CI 1.11-15.5), and confidence of healthcare workers to prescribe antibiotics without laboratory tests (OR = 0.3, 95%CI 0.2-0.8) were associated with the prescription of antibiotics. Conclusion: There is need to improve antibiotic prescription practices among healthcare workers in public tertiary hospitals in Nairobi County to promote rational antibiotic use and control bacterial resistance.

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P79 CRITICAL APPRAISAL ON THE IMPACT OF SMOKING STATUS ON PERIOPERATIVE MORBIDITY, MORTALITY AND LONG-TERM SURVIVAL FOLLOWING OESOPHAGECTOMY FOR OESOPHAGEAL CANCERS: A TERTIARY UNIT ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doz092.79 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

K Kamarajah Sivesh ◽

Navidi Maziar ◽

Griffin S Michael ◽

W Phillips Alexander

Keyword(s):

Smoking Status ◽

Pulmonary Complications ◽

Morbidity And Mortality ◽

Anastomotic Leaks ◽

Term Survival ◽

Long Term Survival ◽

Perioperative Morbidity ◽

Significant Difference ◽

The Impact

Abstract Aim This study aimed to characterise morbidity and mortality profile by smoking status in patients undergoing oesophagectomy for oesophageal cancers. Background Oesophagectomy remains the mainstay for curative treatment of oesophageal cancer. Despite improvements in perioperative care, little is understood on the impact of smoking status on perioperative morbidity and mortality following oesophagectomy for oesophageal cancers. Methods Consecutive patients undergoing oesophagectomy cancer (adenocarcinoma or squamous cell carcinoma) between 1997 - 2016 at the Northern Oesophagogastric Unit were included from a contemporaneously maintained database. Primary outcome was overall survival. Secondary outcomes include overall complications, anastomotic leaks and pulmonary complications. Results During the study period, 1207 patients underwent oesophagectomy for cancer. Of these 1207 patients, most were current (74%) smokers with only 20% non-smokers. Median survival of current smokers was significantly shorter than ex-smokers and non-smokers (median: 35 vs 42 vs 44 months, p=0.031). On adjusted analysis, there were no significant difference in survival between non-smokers and ex-smokers with current smokers. Rates of overall complications were significantly higher with current smokers compared to ex-smokers or non-smokers (73% vs 66% vs 62%, p=0.015). There were no significant differences in anastomotic leaks and pulmonary complications between the groups. Conclusion In summary, this study demonstrated that current smokers have significantly reduced long-term survival compared to ex-smokers or never smokers, specifically patients undergoing surgery only or those with SCC. Future studies in patients with neoadjuvant therapy to further delineate genetic landscape of oesophageal cancers to identify high risk groups that may warrant further multimodality therapy.

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Natural History of Non-CNS Disseminated Coccidioidomycosis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.015 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S77-S77

Author(s):

Derek Bays ◽

George R Thompson ◽

Susan Reef ◽

Linda Snyder ◽

Milton Huppert ◽

...

Keyword(s):

Mortality Rate ◽

Median Survival ◽

Armed Forces ◽

Single Site ◽

Morbidity And Mortality ◽

High Morbidity ◽

Multiple Site ◽

Number Of Patients ◽

Significant Difference ◽

Disseminated Disease

Abstract Background The number of patients with coccidioidomycosis continues to increase yearly. Patients with CNS disease require lifelong antifungal therapy due to the high morbidity and mortality of this disease. However, the morbidity and mortality in non-CNS disseminated disease has not been well characterized. Methods We conducted a retrospective study of 373 VA-armed forces coccidioidomycosis patients diagnosed between 1955 and 1958 and followed to 1966. Groups were identified as non-disseminated disease, non-CNS disseminated disease with and without multisite dissemination, and disseminated disease to the CNS with and without multisite dissemination. Clinical variables including demographic information, duration and severity of symptoms, coccidioidal serologies, type of infection and complications, time to disseminated disease, and mortality were abstracted from patient charts. Results Mortality attributed to coccidioidomycosis in the non-disseminated group was 0.3% (1/297) compared with the non-CNS disseminated group of 8.5% (4/47, median survival 12 months, range 12–24 months, P = 0.0002). Mortality in the CNS disseminated group was 86% (19/22, median survival of 12 months, range 12–156 months, P < 0.0001 compared with non-CNS disseminated). The single site non-CNS disseminated group had a mortality of 4.1% (1/24, survival of 12months) compared with the multiple site non-CNS disseminated group of 13% (3/23, median survival of 18 months, range of 12–24 months, P = 0.57). Conclusion This retrospective cohort study demonstrates significant mortality differences between different forms of disseminated coccidioidomycosis. CNS dissemination exhibited the highest mortality rate; however, non-CNS dissemination also exhibited an unacceptably high mortality rate. There was no significant difference in mortality between single site non-CNS disseminated disease and multiple site non-CNS disseminated disease. Disclosures All authors: No reported disclosures.

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A prospective study of 20 cases of maternal outcome in morbidly adherent placenta in tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170384 ◽

2017 ◽

Vol 6 (2) ◽

pp. 571

Author(s):

Krishna Vora ◽

Pallavi Chandana ◽

Amrita Patel ◽

Mahima Jain

Keyword(s):

Prospective Study ◽

Maternal Outcome ◽

Placenta Praevia ◽

Morbidity And Mortality ◽

High Morbidity ◽

Care Hospital ◽

Morbidly Adherent Placenta ◽

Adherent Placenta ◽

One Year ◽

A Prospective Study

Background: Morbidly adherent placenta with its variants is one of the most feared complication causing high morbidity and mortality in obstetrics. Aim of this study is to help in identifying high risk pregnancies, planning line of management of morbidly adherent placenta. The objective of the study wad to evaluate the risk factors, different modes of management, maternal outcome in case of morbidly adherent placenta.Methods: A prospective study for one year was done to describe the incidence, causes, treatment, complications, and maternal morbidity and mortality associated with morbidly adherent placenta.Results: A total of 20 cases of morbidly adherent placenta were studied over one-year span at our Institute. Most of the women with morbidly adherent placenta were in the age group of 26-30years (55%).The most common aetiology of morbidly adherent placenta was previous caesarean scar with placenta praevia (85%). In majority, placenta accreta found. Total abdominal hysterectomy done in 12 patient and subtotal hysterectomy in 6 cases. Trial haemostasis with uterine sparing in 2 cases out of which one case underwent total hysterectomy due to massive haemorrhage on same day. Associated Bladder repair in adherent placenta with invasion of bladder was needed in 10% cases. There was 1 maternal death noted in this study.Conclusions: Leading cause of morbidly adherent placenta is previous caesarean section with placenta praevia, high index of suspicion, early antenatal diagnosis, planned surgery at high care centre with multi-disciplinary expertise, anticipation of blood volume transfusion, Delivery of foetus without manipulating placenta are key steps to reduce morbidity and mortality in morbidly adherent placenta. The decision to perform hysterectomy and conservative management to be individualized. Timely decision is the key to get success in morbidly adherent placenta as in other obstetric emergencies.

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