scholarly journals Clinical benefits after the implementation of a multimodal perioperative protocol in elderly patients

2010 ◽  
Vol 47 (2) ◽  
pp. 178-183 ◽  
Author(s):  
José Eduardo de Aguilar-Nascimento ◽  
Alberto Bicudo Salomão ◽  
Cervantes Caporossi ◽  
Breno Nadaf Diniz
Keyword(s):  
Elderly Patients ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Perioperative Care ◽  
Length Of Hospital Stay ◽  
Intravenous Fluids ◽  
Site Infection ◽  
Preoperative Fasting ◽  
Historical Cohort ◽  
Abdominal Operations

CONTEXT: Multimodal protocol of perioperative care may enhance recovery after surgery. Based on evidence these new routines of perioperative care changed conventional prescriptions in surgery. OBJECTIVE: To evaluate the results of a multimodal protocol (ACERTO protocol) in elderly patients. METHODS: Non-randomized historical cohort study was performed at the surgical ward of a tertiary university hospital. One hundred seventeen patients aged 60 and older were submitted to elective abdominal operations under either conventional (n = 42; conventional group, January 2004-June 2005) or a fast-track perioperative protocol named ACERTO (n = 75; ACERTO group, July 2005-December 2007). Main endpoints were preoperative fasting time, postoperative day of re-feeding, volume of intravenous fluids, length of hospital stay and morbidity. RESULTS: The implantation of the ACERTO protocol was followed by a decrease in both preoperative fasting (15 [8-20] vs 4 [2-20] hours, P<0.001) and postoperative day of refeeding (1st [1st-10th] vs 0 [0-5th] PO day; P<0.01), and intravenous fluids (10.7 [2.5-57.5] vs 2.5 [0.5-82] L, P<0.001). The changing of protocols reduced the mean length of hospital stay by 4 days (6[1-43] vs 2[1-97] days; P = 0.002) and surgical site infection rate by 85.7% (19%; 8/42 vs 2.7%; 2/75, P<0.001; relative risk = 1.20; 95% confidence interval = 1.03-1.39). Per-protocol analysis showed that hospital stay in major operations diminished only in patients who completed the protocol (P<0.01). CONCLUSION: The implementation of multidisciplinary routines of the ACERTO protocol diminished both hospitalization and surgical site infection in elderly patients submitted to abdominal operations.

EP.TH.959Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer surgery: An ongoing dilemma

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahin Hajibandeh ◽  
Shahab Hajibandeh ◽  
Pratik Bhattacharya ◽  
Reza Zakaria ◽  
Christopher Thompson ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Perioperative Complications ◽  
Loop Ileostomy ◽  
Length Of Hospital Stay ◽  
Ileostomy Closure ◽  
Site Infection ◽  
Cancer Resection

Abstract Aims To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection. Methods We systematic searched MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during (n = 185) or after (n = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82-2.36, p = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47-16.56, p = 0.26), surgical site infection (OR 1.97; 95% CI 0.80-4.90, p = 0.14), ileus (OR 1.22; 95% CI 0.50-2.96, p = 0.66) or length of hospital stay (MD 0.02; 95% CI -0.85-0.89, p = 0.97) between two groups. Between-study heterogeneity was low in all analyses. Conclusions The meta-analysis of best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on completeness of chemotherapy and quality of life which can determine appropriateness of either approach.

Surgical Site Infection in a Tertiary Neonatal Surgery Centre

2018 ◽  
Vol 29 (03) ◽  
pp. 260-265 ◽  
Author(s):  
Adiam Woldemicael ◽  
Sarah Bradley ◽  
Caroline Pardy ◽  
Justin Richards ◽  
Paolo Trerotoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Model ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Logistic Regression Model ◽  
Length Of Hospital Stay ◽  
Neonatal Surgery ◽  
Site Infection ◽  
Increased Risk

Introduction Surgical site infection (SSI) is a key performance indicator to assess the quality of surgical care. Incidence and risk factors for SSI in neonatal surgery are lacking in the literature. Aim To define the incidence of SSI and possible risk factors in a tertiary neonatal surgery centre. Materials and Methods This is a prospective cohort study of all the neonates who underwent abdominal and thoracic surgery between March 2012 and October 2016. The variables analyzed were gender, gestational age, birth weight, age at surgery, preoperative stay in neonatal intensive care unit, type of surgery, length of stay, and microorganisms isolated from the wounds. Statistical analysis was done with chi-square, Student's t- or Mann–Whitney U-tests. A logistic regression model was used to evaluate determinants of risk for SSI; variables were analyzed both with univariate and multivariate models. For the length of hospital stay, a logistic regression model was performed with independent variables. Results A total of 244 neonates underwent 319 surgical procedures. The overall incidence of SSIs was 43/319 (13.5%). The only statistical differences between neonates with and without SSI were preoperative stay (<4 days vs. ≥4 days, p < 0.01) and length of hospital stay (<30 days vs. ≥30 days, p < 0.01). A pre-operative stay longer than 4 days was associated with almost three times increased risk of SSI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.05–8.34, p = 0.0407). Gastrointestinal procedures were associated with more than ten times the risk of SSI compared with other procedures (OR 10.17, 95% CI 3.82–27.10, p < 0.0001). Gastroschisis closure and necrotizing enterocolitis (NEC) laparotomies had the highest incidence SSI (54% and 62%, respectively). The risk of longer length of hospital stay after SSI was more than three times higher (OR = 3.36, 95%CI 1.63–6.94, p = 0.001). Conclusion This is the first article benchmarking the incidence of SSI in neonatal surgery in the United Kingdom. A preoperative stay ≥4 days and gastrointestinal procedures were independent risk factors for SSI. More research is needed to develop strategies to reduce SSI in selected neonatal procedures.

scholarly journals LAPAROSOPIC ASSISTED RIGHT HEMICOLECTOMY

2015 ◽  
Vol 22 (08) ◽  
pp. 1020-1023
Author(s):  
Jahangir Sarwar Khan ◽  
Muhammad Salman Shafique
Keyword(s):  
Surgical Site Infection ◽  
Hospital Stay ◽  
Oral Intake ◽  
Length Of Hospital Stay ◽  
Right Hemicolectomy ◽  
Site Infection ◽  
Carcinoma Colon ◽  
Duration Of Operation ◽  
Age Range ◽  
Surgical Unit

Objective: Experience with Laparosopic assisted Right Hemicolectomy ispresented. Study Design: Prospective study. Setting: Surgical Unit-I, Holy Family Hospital,Rawalpindi, Pakistan. Period: 2010 to 2014. Materials and Methods: 20 patients underwentlaparosopic assisted right hemicolectomy. Duration of operation, postoperative pain, durationof post operative analgesia, frequency of surgical site infection and length of hospital stay werenoted. Results: There were 13 male and 7 female patients with the age range of 25-70 years(45±11years). Eleven (11) patients were suffering from carcinoma colon wheras nine (09)were suffering from Tuberculosis. Mean operative time was about 92 minutes. Only four opiodinjections were required as post-operative analgesia. Oral intake was started after 24 hours. Themean length of hospital stay was 5.5 days with no case of surgical site infection. Conclusion:Laparoscopic assisted right hemicolectomy is a safe and viable option in our setup.

scholarly journals Surgical Site Infection In Laparotomy

2018 ◽  
Vol 4 (1) ◽  
pp. 22-25
Author(s):  
Pashupati N. Bhatta ◽  
Umesh Kumar Yadav ◽  
Gorakh Nath Mishra ◽  
Randhir Jha ◽  
Kumar Shrestha
Keyword(s):  
Risk Factor ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Site Infection ◽  
Median Length ◽  
National Medical College ◽  
Medical College ◽  
National Medical ◽  
Duration Of Surgery

INTRODUCTION: Surgical site infection (ssi) is one of the most common surgical complications which increases the rate of morbidity and mortality and increases the health care cost by prolonging the hospital stay.  AIMS AND OBJECTIVES: The main objective of the study was to find out the incidence of ssi in emergency laparotomy in general surgery and to find out the associated risk factor for ssi.MATERIAL & METHODS: Study was carried out in national medical college, Birgunj from January 2011 to June 2012 after getting ethical clearance from Institutional Review Committee National Medical College. Total 200 cases were included in study and follow up done up to 30 days postoperatively. RESULTS: Out of 200 patients, 76 patients developed ssi. The total incidence of ssi was 38%.The rate ssi in clean-contaminated, contaminated and dirty wound were 18.2%, 33.3% & 45.5% respectively. Age, type of surgical operation and prolonged duration of surgery were the significant risk factor for ssi while sex, BMI were not statistically significant. The median length of hospital stay with ssi was 16 days while the median length of hospital stay without ssi was 10 days.CONCLUSION: The rate of ssi was found to be higher in our study in comparison to western study but neariy same when comparing to study of Asian countries. so, we emphasize for the need of  evidence based infection control and recommend for better surveillance program me for control of ssi in each hospital.Journal of Universal College of Medical Sciences (2016) Vol.04 No.01 Issue 13, Page: 22-25

COMPARISION OF SURGICAL SITE INFECTION BETWEEN OPEN APPENDECTOMY AND LAPAROSCOPIC APPENDECTOMY

2021 ◽  
pp. 25-25
Author(s):  
J. Sudhakar ◽  
Manoj Karthik Gera
Keyword(s):  
Surgical Site Infection ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Length Of Hospital Stay ◽  
Site Infection ◽  
Operative Complications ◽  
Bowel Movements ◽  
Perforated Appendix ◽  
Health Care Associated Infection

Appendectomy is most common surgical procedure in emergency surgery. Inamed appendix can be removed laparoscopically (laparoscopic appendectomy) or openly (open appendectomy). Surgical site infection is representative of health care associated infection in which it may effect on patients' morbidity and mortality. The aim of the study is to compare laparoscopic appendectomy and open appendectomy in terms of surgical site infection. The frequency of 60 patients who underwent appendectomy open appendectomy-40;laparoscopic appendectomy-20 between September 2019- march2020 which were retrospectively reviewed for demographic and pathological characteristic, recovery of bowel movements, length of hospital stay and post-operative complications. The frequency of purulent/gangrenous or perforated appendix were Laparoscopic appendectomy-10% and in open appendectomy 20%. The time of rst atus after surgery were 2.9 days and in open appendectomy were 2.97 days in laparoscopic appendectomy. Length of hospital stay were relatively short in laparoscopic appendectomy group and in open appendectomy group The frequency of overall surgical site infection were not that difference between the two groups laparoscopic appendectomy -15% open appendectomy group were22%But that of supercial surgical site infection was signicantly lower in laparoscopic appendectomy group5% open appendectomy group 15%.

scholarly journals 904. Surgical Site Infection After Bariatric Surgery: a Small Risk that Defines Life and Death of Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S486-S486
Author(s):  
Lucca G Giarola ◽  
Carlos Ernesto Ferreira Starling ◽  
Braulio Roberto Gonçalves Marinho Couto ◽  
Handerson Dias Duarte de Carvalho
Keyword(s):  
Bariatric Surgery ◽  
Logistic Regression ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Site Infection ◽  
Belo Horizonte

Abstract Background Surgical site infection (SSI) in bariatric surgery can lead to devastating outcomes such as peritonitis, sepsis, septic shock and organ space infection. The objective of our study is to answer four questions: a) What is the SSI risk after bariatric surgery? b) What are the risk factors for SSI after bariatric surgery? c) What are the main outcomes to SSI in bariatric surgery? d) What are the main bacteria responsible for SSI in bariatric surgery? Methods A retrospective cohort study assessed 8,672 patients undergoing bariatric surgery between 2014/Jan and 2018/Dec from two hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Outcome: SSI, hospital death and total length of hospital stay. 20 preoperative and operative variables were evaluated by univariate and multivariate analysis (logistic regression). Results 77 SSI were diagnosed (risk = 0.9% [C.I.95% = 0.7%;1.1%]). Mortality rate in patients, without infection was only 0.03% (3/8,589) while hospital death of infected patients was 4% (3/77; RR = 112; p&lt; 0.001). Hospital length of stay in non-infected patients (days): mean = 2, std.dev.= 0.9; hospital stay in infected patients: mean = 7, std. dev. = 15.6 (p&lt; 0.001). Two main factors associated with SSI after bariatric surgery were identified by logistic regression: duration of procedure (hours), OR = 1.4;p=0.001, and laparoscopy procedure, OR = 0.3;p=0.020. From 77 SSIs, in 28 (36%) we identified 34 etiologic agents. The majority of SSI (59%) was caused by species of Streptococcus (32%), Klebsiella (15%), and Enterobacter (12%). Conclusion SSI is rare after bariatric surgery, however, when it happens, it’s a disaster for the patient. The incidence of SSI can be reduced significantly when laparoscopy procedure is used and the surgeon is able to perform a rapid surgery. Disclosures All Authors: No reported disclosures

Impact of Postdischarge Surveillance on the Rate of Surgical Site Infection After Orthopedic Surgery

2006 ◽  
Vol 27 (12) ◽  
pp. 1324-1329 ◽  
Author(s):  
Kaisa Huotari ◽  
Outi Lyytikäinen ◽  
Keyword(s):  
Surgical Site Infection ◽  
Hospital Stay ◽  
Orthopedic Surgery ◽  
Femur Fracture ◽  
Length Of Hospital Stay ◽  
Site Infection ◽  
Median Length ◽  
The Impact ◽  
Incisional Ssis

Objective. To evaluate the impact of postdischarge surveillance on surgical site infection (SSI) rates after orthopedic surgery. Setting. Nine hospitals participating in the Finnish Hospital Infection Program. Patients. All patients who underwent hip or knee arthroplasty or open reduction of a femur fracture during 1999-2002. Results. The date of discharge was available for 11,812 procedures (90%). The median length of hospital stay was 8 days (range per hospital, 6-9 days). The overall SSI rate was 3.3% (range, 0.8%-6.4%). Of 384 SSIs detected, 216 (56%; range, 28%-90%) were detected after discharge: 93 (43%) were detected on readmission to the hospital, 73 (34%) at completion of a postdischarge questionnaire, and 23 (11%) at a follow-up visit. For 27 postdischarge SSIs (13%), the location of detection was unknown. Altogether, 32 (86%) of 37 of organ/space SSIs, 57 (80%) of 71 deep incisional SSIs, and 127 (46%) of 276 superficial incisional SSIs were detected after discharge. Most SSIs (70%) detected on readmission were severe (organ/space or deep incisional), whereas most SSIs (86%) detected at follow-up visits or at completion of a postdischarge questionnaire were superficial. Of all SSIs, 78% (range, 48%-100%) were microbiologically confirmed. Microbiologic confirmation was less common after discharge than during postoperative hospital stay (66% vs 93%; P&lt; .001). Conclusions. Postdischarge surveillance had a large impact on the rate of SSI detected after orthopedic surgery. However, postdischarge surveillance conducted by means of a questionnaire detected only a minority of deep incisional and organ/space SSIs.

scholarly journals Prolonged postoperative ileus after elective colorectal cancer surgery

2018 ◽  
Vol 75 (8) ◽  
pp. 780-786
Author(s):  
Milica Nestorovic ◽  
Goran Stanojevic ◽  
Branko Brankovic ◽  
Vanja Pecic ◽  
Ljiljana Jeremic
Keyword(s):  
Prospective Study ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Postoperative Ileus ◽  
Length Of Hospital Stay ◽  
Site Infection ◽  
Significant Difference ◽  
Prolonged Postoperative Ileus ◽  
The Impact

Background/Aim. Postoperative ileus is a frequent and frustrating occurence for both, patients and surgeons after abdominal surgery. Besides clinical importance of postoperative ileus, its economic aspect is also important. The aim of this prospective study was to analyze development of prolonged postoperative ileus after elective colorectal surgery for cancer and its impact on early postoperative outcome. Methods. This prospective study included all eligible patients, 18 years or older, scheduled for open colorectal resection for cancer from June, 2015 to February, 2016. Patients with metastatic disease, prior hemoirradiation or any resection other then curative were excluded. The study duration was up to 30 days postoperatively. Primary outcome measure was development of prolonged postoperative ileus according to strict definition. The impact of prolonged postoperative ileus on other outcome measures such as postoperative complications, surgical site infections, anastomotic leakage, reoperations, mortality and length of hospital stay were of great interest, too. Results. This prospective study included 103 patients, 64 (37.9%) men and 39 (62.1%) women, mean age 66 years. Prolonged postoperative ileus developed in 12 (11.3%) patients. One third of the patients had some type of surgical site infection, while 47.6% had complications. Ten (9.7%) patients required reoperation. Comparing the group of patients with prolonged postoperative ileus with those without, there were no statistically significant differences in rates of surgical site infection and anastomotic leakage. There was statistically significant difference in terms of complications (_2 = 34.966; p < 0.001), complications grade III (_2 = 23.43; p < 0.001) and reoperations (_2 = 15.724; p <0.001). Patients who developed prolonged postoperative ileus had statistically significant longer postoperative hospital stay (Z = 2.291, p = 0.022) and longer total length of hospital stay (Z = 2.377, p = 0.015). According to regression analyzes prolonged postoperative ileus represents a risk factor for reoperations [odds ratio (OR) = 12.286; p = 0.001]. Conclusion. Prolonged postoperative ileus, although not life-threatening complication effects recovery, increases length of hospital stay and contributes to poor surgical outcome.

scholarly journals Comparative Study of Surgical Site Infection between Laparoscopic Appendectomy and Open Appendectomy

2017 ◽  
Vol 29 (1) ◽  
pp. 6-11
Author(s):  
Md Salim ◽  
Jashim Uddin Ahmed ◽  
Nur Hossain Bhuyian ◽  
Mahmudur Rahman ◽  
Monirul Alam ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Length Of Hospital Stay ◽  
Postoperative Recovery ◽  
Wound Infection Rate ◽  
Site Infection ◽  
College Hospital

Surgical site infection (SSI) is defined as infection at surgical site within 01 month after surgery (or within a year in case of implant). Surgical-site infection requires microbial contamination of the surgical wound to occur. LA provides considerable benefits over OA, including a shorter length of hospital stay, less postoperative pain, earlier postoperative recovery, and a lower complication rate. This was a prospective observational study conducted inpatient department of Chittagong Medical College Hospital and private hospitals and clinics in Chittagong city. The patients were interviewed face to face by the researcher for the purpose of collection of data and were examined by the researcher for certain signs recorded in the fixed protocol. Collected data was classified, edited, coded and entered into the computer for statistical analysis by using SPSS-22. Out of 200 cases mean age was found 33.76 ± 23.35 years in OA group and 32.21 ± 16.51 years in LA group. Male was found 58% in OA group and 53% in LA group. Female was found 42% and 47% in OA and LA group respectively. Mean operative time was found 41.2±8.5 minutes in OA group and 49.3±8.9 minutes in LA group. Alternate pathology were more frequently detected in LA due to wide area of vision. Superficial incisional SSI was found 10% in OA group and 5% in LA group. Deep incisional SSI was found 2% in OA group and 2% in LA group. Organ/space SSI was 2% and 3% in OA group and LA group respectively. Staphylococcus aureus is the commonest organism isolated form the surgical wounds from 41.34% followed by Pseudomonas 21.26%, no growth 11.1%, E.coli 9.6%, others 9.4%, Klebsiella 7.0%. Laparoscopic appendectomy was better than open appendectomy with respect to wound infection rate, postoperative pain, postoperative hospital stay and return to normal activities.Medicine Today 2017 Vol.29(1): 6-11

Predictors and Risk Factors of Surgical Site Infection (SSI) Following Adult Spine Surgery: A Cross-sectional Study

2021 ◽  
pp. 6
Author(s):  
Waleed Awwad ◽  
Abdullah Alnasser ◽  
Abdulrahman Almalki ◽  
Rohail Mumtaz ◽  
Bander Alsubaie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Length Of Hospital Stay ◽  
Cross Sectional Study ◽  
Site Infection ◽  
Sectional Study ◽  
Cross Sectional ◽  
Duration Of Surgery

Introduction: Surgical site infection (SSI) is a major cause of morbidity and mortality as it is known to increase the length of hospital stay, revision surgery, and re-operation. Identifying patients at risk of developing SSI before surgery is the key to prevent SSI. Methodology: This cross-sectional study was performed at the orthopedic department in King Khalid University Hospital, Riyadh, Saudi Arabia. SSIs were defined according to the Centers for Disease Control (CDC) case definition for SSI. Potential risk factors for postoperative wound infection were collected. Data were analyzed using the SPSS, version 23.0, and p-value < 0.05 was considered to be statistically significant. Result: A total of 214 patients were included in the study and the incidence of SSI following spine surgery was 9.81% (N = 21). Obesity, diabetes, location of surgery, ASA score, duration of surgery, length of hospital stay, and location/level of operated vertebrae were all found to have a significant correlation with the SSI (p < 0.05). Conclusion: Having a strong background of SSI risk factors and predictors is core to preventing the incidence of SSI and further enhance and optimize operative outcomes, as well as increasing the cost-effectiveness of the surgical intervention.

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