scholarly journals Outcome impact of individualized fluid management during spine surgery A before-after prospective comparison study

2020 ◽  
Author(s):  
Lu Che ◽  
Xiu H Zhang ◽  
Xu Li ◽  
Yue L Zhang ◽  
Yu G Huang ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Fluid Management ◽  
Postoperative Outcome ◽  
Surgical Site Infections ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Orthopaedic Patients ◽  
Prospective Comparison ◽  
Post Operative Nausea ◽  
Tract Infections

Abstract Background: Individualized fluid management (IFM) has been shown to be useful to improve the postoperative outcome of patients undergoing major abdominal surgery. A limited number of clinical studies have been done in orthopaedic patients and have yielded conflicting results. We designed the present study to investigate the clinical impact of IFM in patients undergoing major spine surgery. Methods: This is a before-after study done in 300 patients undergoing posterior spine arthrodesis. Postoperative outcomes were compared between control group implementing standard fluid management (n = 150) and IFM group (n = 150) guided by fluid protocol based on continuous stroke volume monitoring and optimization. The primary outcome measure was the proportion of patients who developed one or more complications within 30 days following surgery.Results: During surgery, patients received on average the same volume of crystalloids (7.4 vs 7.2 ml/kg/h) and colloids (1.6 vs 1.6 ml/kg/h) before and after the implementation of IFM. During 30 days following surgery, the proportion of patients who developed one or more complications was lower in the IFM group (32 vs 48%, p<0.01). This difference was mainly explained by a significant decrease in post-operative nausea and vomiting (from 38 to 19%, p<0.01), urinary tract infections (from 9 to 1%, p<0.01) and surgical site infections (from 5 to 1%, p<0.05). Median hospital length of stay was not affected by the implementation of IFM. Conclusions: In patients undergoing major spine surgery, the implementation of IFM was associated with a significant decrease in postoperative morbidity.

scholarly journals Outcome impact of individualized fluid management during spine surgery A before-after prospective comparison study

2020 ◽  
Author(s):  
Lu Che ◽  
Xiu H Zhang ◽  
Xu Li ◽  
Yue L Zhang ◽  
Yu G Huang ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Fluid Management ◽  
Postoperative Outcome ◽  
Surgical Site Infections ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Orthopaedic Patients ◽  
Prospective Comparison ◽  
Post Operative Nausea ◽  
Tract Infections

Abstract Background Individualized fluid management (IFM) has been shown to be useful to improve the postoperative outcome of patients undergoing major abdominal surgery. A limited number of clinical studies have been done in orthopaedic patients and have yielded conflicting results. We designed the present study to investigate the clinical impact of IFM in patients undergoing major spine surgery. Methods This is a before-after study done in 300 patients undergoing posterior spine arthrodesis. Postoperative outcomes were compared between control group implementing standard fluid management (n = 150) and IFM group (n = 150) guided by fluid protocol based on continuous stroke volume monitoring and optimization. The primary outcome measure was the proportion of patients who developed one or more complications within 30 days following surgery. Results During surgery, patients received on average the same volume of crystalloids (7.4 vs 7.2 ml/kg/h) and colloids (1.6 vs 1.6 ml/kg/h) before and after the implementation of IFM. During 30 days following surgery, the proportion of patients who developed one or more complications was lower in the IFM group (32 vs 48%, p<0.01). This difference was mainly explained by a significant decrease in post-operative nausea and vomiting (from 38 to 19%, p<0.01), urinary tract infections (from 9 to 1%, p<0.01) and surgical site infections (from 5 to 1%, p<0.05). Median hospital length of stay was not affected by the implementation of IFM. Conclusions In patients undergoing major spine surgery, the implementation of IFM was associated with a significant decrease in postoperative morbidity.

scholarly journals Protocol-driven prevention of perioperative hypothermia in the pediatric neurosurgical population

2020 ◽  
Vol 25 (5) ◽  
pp. 548-554
Author(s):  
Ian Mutchnick ◽  
Meena Thatikunta ◽  
Julianne Braun ◽  
Martha Bohn ◽  
Barbara Polivka ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Pediatric Neurosurgery ◽  
Perioperative Period ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Postanesthesia Care Unit ◽  
Control Group ◽  
Time Interval ◽  
Perioperative Hypothermia ◽  
Forced Air

OBJECTIVEPerioperative hypothermia (PH) is a preventable, pathological, and iatrogenic state that has been shown to result in increased surgical blood loss, increased surgical site infections, increased hospital length of stay, and patient discomfort. Maintenance of normothermia is recommended by multiple surgical quality organizations; however, no group yet provides an ergonomic, evidence-based protocol to reduce PH for pediatric neurosurgery patients. The authors’ aim was to evaluate the efficacy of a PH prevention protocol in the pediatric neurosurgery population.METHODSA prospective, nonrandomized study of 120 pediatric neurosurgery patients was performed. Thirty-eight patients received targeted warming interventions throughout their perioperative phases of care (warming group—WG). The remaining 82 patients received no extra warming care during their perioperative period (control group—CG). Patients were well matched for age, sex, and preparation time intraoperatively. Hypothermia was defined as < 36°C. The primary outcome of the study was maintenance of normothermia preoperatively, intraoperatively, and postoperatively.RESULTSWG patients were significantly warmer on arrival to the operating room (OR) and were 60% less likely to develop PH (p < 0.001). Preoperative forced air warmer use both reduced the risk of PH at time 0 intraoperatively and significantly reduced the risk of any PH intraoperatively (p < 0.001). All patients, regardless of group, experienced a drop in core temperature until a nadir occurred at 30 minutes intraoperatively for the WG and 45 minutes for the CG. At every time interval, from preoperatively to 120 minutes intraoperatively, CG patients were between 2 and 3 times more likely to experience PH (p < 0.001). All patients were warm on arrival to the postanesthesia care unit regardless of patient group.CONCLUSIONSPreoperative forced air warmer use significantly increases the average intraoperative time 0 temperature, helping to prevent a fall into PH at the intraoperative nadir. Intraoperatively, a strictly and consistently applied warming protocol made intraoperative hypothermia significantly less likely as well as less severe when it did occur. Implementation of a warming protocol necessitated only limited resources and an OR culture change, and was well tolerated by OR staff.

scholarly journals Induced hypernatremia in patients with moderate-to-severe ARDS: a randomized controlled study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Shailesh Bihari ◽  
Shivesh Prakash ◽  
Dani L. Dixon ◽  
Elena Cavallaro ◽  
Andrew D. Bersten
Keyword(s):  
Lung Injury ◽  
Hypertonic Saline ◽  
Fluid Management ◽  
Hospital Length Of Stay ◽  
Lung Injury Score ◽  
Controlled Study ◽  
Lung Protective Ventilation ◽  
Control Group ◽  
Plasma Sodium ◽  
Point Reduction

Abstract Background Induced hypernatremia and hyperosmolarity is protective in animal models of lung injury. We hypothesized that increasing and maintaining plasma sodium between 145 and 150 mmol/l in patients with moderate-to-severe ARDS would be safe and will reduce lung injury. This was a prospective randomized feasibility study in moderate-to-severe ARDS, comparing standard care with intravenous hypertonic saline to achieve and maintain plasma sodium between 145 and 150 mmol/l for 7 days (HTS group). Both groups of patients were managed with lung protective ventilation and conservative fluid management. The primary outcome was 1-point reduction in lung injury score (LIS) or successful extubation by day 7. Results Forty patients were randomized with 20 in each group. Baseline characteristics of severity of illness were well balanced. Patients in the HTS group had higher plasma sodium levels during the first 7 days after randomization when compared with the control group (p = 0.04). Seventy five percent (15/20) of patients in the HTS group were extubated or had ≥ 1-point reduction in LIS compared with 35% (7/20) in the control group (p = 0.02). There was also a decrease in length of mechanical ventilation and hospital length of stay in the HTS group. Conclusion We have shown clinical improvement in patients with moderate-to-severe ARDS following induced hypernatremia, suggesting that administration of hypertonic saline is a safe and feasible intervention in patients with moderate-to-severe ARDS. This suggests progress to a phase II study. Clinical Trial Registration Australian and New Zealand Clinical Trials Registry (ACTRN12615001282572)

scholarly journals 113. Accuracy of the NHSN Central Line-Associated Bloodstream Infection (CLABSI) Definition

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S3-S3 ◽  
Author(s):  
Ahmed Al Hammadi ◽  
Luis Ostrosky-Zeichner ◽  
Kelley Boston ◽  
Tawanna McInnis-Cole ◽  
John Butler
Keyword(s):  
Clinical Review ◽  
Healthcare System ◽  
Surgical Site Infections ◽  
Blood Stream ◽  
Central Line ◽  
Left Ventricular ◽  
Hospital Length Of Stay ◽  
Mucosal Barrier ◽  
Gastrointestinal Infections ◽  
Tract Infections

Abstract Background CLABSIs are serious infections that cause prolonged hospital length of stay, increased cost, and mortality. Acute care hospitals must report CLABSIs to NHSN to participate in CMS programs. NHSN definitions must be met to attribute a secondary BSI (SBSI), or bacteremia is defaulted to CLABSI if a central line is present. The lack of CDC/NHSN definitions for certain secondary sites of infections or problems in the definitions may lead to over-labeling CLABSIs. We reviewed the accuracy of NHSN definitions in a large healthcare system. Methods We retrospectively reviewed medical records of 279 patients with positive blood cultures on or after hospital day 3 and a central line from 15 hospitals belonging to a large healthcare system from January 1 to November 27, 2017. A team of centralized infection preventionists (IPs) adjudicated each case as a CLABSI or as SBSI through routine surveillance following NHSN methodology. A clinical review was performed by a PGY6 infectious diseases fellow. Descriptive statistics are presented. Results A total of 279 bacteremia cases were analyzed. Of those 279 patients, 237 (85%) were ≥18 years old, 162 (58%) were males, 92 (33%) were white, 62 (22.2%) were black, 5 (1.8%) were Asian, and 12 (4.3%) were “other.” Ninety-seven (34.8%) were from the reference hospital. IPs classified 171 CLABSIs and 108 as SBSI. Of the 171 CLABSIs classified by IPs, in 62 patients (36.3%), a primary site infection clinically explaining the BSI, but which did not meet the NHSN infection criteria, could be attributed as follows during the clinical review: 30 pneumonia, 6 urinary tract infections, 4 surgical site infections, 2 vascular infections, 2 mucosal barrier injury associated blood stream infections, 7 gastrointestinal infections, 1 decubitus ulcer infection, 4 skin and soft-tissue infections, 2 left ventricular-assisted device infections, 2 endocarditis, and 2 infected thrombi. Misclassification most often occurred due to missing elements of the definitions or infections not defined by NHSN. Conclusion Current NHSN definitions may overestimate CLABSIs by nearly 30%. As hospitals continue to work in CLABSI reduction, accurate and precise definitions/methodology will be key in focusing efforts and attention of the engaged parties and avoiding penalties. Disclosures L. Ostrosky-Zeichner, Cidara Therapeutics: Grant Investigator, Research grant.

scholarly journals Outcome impact of individualized fluid management during spine surgery: a before-after prospective comparison study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lu Che ◽  
Xiu H. Zhang ◽  
Xu Li ◽  
Yue L. Zhang ◽  
Li Xu ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Fluid Management ◽  
Comparison Study ◽  
Prospective Comparison

scholarly journals The effect of prophylactic vancomycin powder on infections following spinal surgeries: a systematic review

2019 ◽  
Vol 46 (1) ◽  
pp. E11 ◽  
Author(s):  
Vincent Dodson ◽  
Neil Majmundar ◽  
Vanessa Swantic ◽  
Rachid Assina
Keyword(s):  
Systematic Review ◽  
Spine Surgery ◽  
Surgical Site Infections ◽  
Control Group ◽  
Control Groups ◽  
Gram Negative ◽  
Number Of Patients ◽  
Vancomycin Powder ◽  
Meta Analyses ◽  
Experimental Group

OBJECTIVEThe use of vancomycin powder in spine surgery for prophylaxis against surgical site infections (SSIs) is well debated in the literature, with the majority of studies demonstrating improvement and some studies demonstrating no significant reduction in infection rate. It is well known in certain populations that vancomycin powder reduces the general rate of infection, but its effects on reducing the rate of infection due to gram-negative pathogens are not well reviewed. The goal of this paper was to review studies that investigated the efficacy of vancomycin powder as a prophylactic agent against SSI and demonstrate whether the rate of infections by gram-negative pathogens is impacted.METHODSAn electronic search of the published literature was performed using PubMed and Google Scholar in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A variety of combinations of the search terms “vancomycin powder,” “infection,” “spine,” “gram-negative,” “prophylaxis,” and “surgical site” was used. Inclusion criteria were studies that 1) described an experimental group that received intraoperative intrawound vancomycin powder; 2) included adequately controlled groups that did not receive intraoperative intrawound vancomycin powder; 3) included the number of patients in both the experimental and control groups who developed infection after their spine surgery; and 4) identified the pathogen-causing infection. Studies not directly related to this review’s investigation were excluded from the initial screen. Among the studies that met the criteria of the initial screen, additional reasons for exclusion from the systematic review included lack of a control group, unspecified size of control groups, and inconsistent use of vancomycin powder in the experimental group.RESULTSThis systematic review includes 21 studies with control groups. Vancomycin powder significantly reduced the relative risk of developing an SSI (RR 0.55, 95% CI 0.45–0.67, p < 0.0001). In addition, the use of vancomycin powder did not significantly increase the risk of infection by gram-negative pathogens (RR 1.11, 95% CI 0.66–1.86, p = 0.701).CONCLUSIONSThe results of this systematic review suggest that intrawound vancomycin powder is protective against SSI. It is less clear if this treatment increases the risk of gram-negative infection. Further studies are required to investigate whether rates of infection due to gram-negative pathogens are affected by the use of vancomycin powder.

scholarly journals Multidrug-Resistant Microorganisms Associated with Urinary Tract Infections Following Orthopaedic Patients: A Laboratory-Based Analysis of 5239 Patients

2020 ◽  
Author(s):  
Grzegorz Ziółkowski ◽  
Iwona Pawłowska ◽  
Michał Stasiowski ◽  
Estera Jachowicz ◽  
Tomasz Bielecki
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Surgical Site Infections ◽  
Incidence Density ◽  
Utilization Rate ◽  
Microbiological Analysis ◽  
Gram Negative ◽  
Orthopaedic Patients ◽  
Tract Infections ◽  
Orthopedic Patients

Abstract Background: The risk of healthcare associated infections (HAI) in surgical wards remains closely related to the type of surgery and procedures performed on patients. They also condition the risk of various, apart from the most common, surgical site infections, forms of clinical infections, especially urinary tract infections (UTIs). Their occurrence in orthopedic patients is most often – in about 70%-80%, associated with the use of the bladder catheter in the perioperative period. The aim of this study was the epidemiological and microbiological analysis of UTIs following orthopedic patients, especially MDR in 2013-2015.Methods: The study was conducted in 38-bed Department of Orthopedic-Traumatic Surgery in Sosnowiec, Poland. 5 239 patients surgery included in the study, the urinary catheter utilization rate was 30.7 %. Laboratory based study using the UTI definition of the HAI-Net program, MDR was defined as resistant to at least one antibiotic from 2< antibiotics groups. The results were analyzed using the statistical package PQStat ver. 1.6.0.428 using the chi-square test (chi ^ 2) or Fisher's exact test.Results The UTI incidence was 3.2% (168 cases), CA-UTI incidence density was 9.6/1 000 catheter-days. The highest risk of UTI was found in patients aged 75 years and older. Gram-negative flora prevailed among microorganisms: 76.1%. Predominantly isolated Enterobacterales were: Escherichia coli, Klebsiella pneumoniae. Isolated microorganisms were fully sensitive to carbapenems. Gram-negative bacilli showed the lowest sensitivity to extended substrate spectrum penicillins and fluoroquinolones: 37-64%, trimethoprim-sulfamethoxazole: 50%; MDR prevalence: 24.4%.Conclusions The presented data indicate that UTI incidence is a significant problem in studied population, as well as antimicrobialresistance, especially to quinolones and extended spectrum cephalosporins, as first-line therapy remains a major challenge. To reduce the problem of high UTI incidence and MDR prevalence, the priority should be the reduction of UTI risk – which exceeded the expected values.

Dynamics of symptoms of genitourinary menopausal syndrome and the frequency of recurrence of lower urinary tract infection in women in periand postmenopausal patients with combined therapy with Trioginal®

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 67-72
Author(s):  
D Yu Pushkar ◽  
M Yu Gvozdev
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Urine Culture ◽  
Objective Assessment ◽  
Control Group ◽  
Urination Disorders ◽  
Menopausal Syndrome ◽  
Tract Infections ◽  
Two Stages ◽  
Lower Urinary

Material and methods. The study included patients (n=164) in peri- and postmenopause, having a laboratory-confirmed picture of the genitourinary menopausal syndrome - atrophic vulvovaginitis and suffering from recurrent lower urinary tract infections (UTI) - cystitis and urethritis. All patients underwent standard antibacterial therapy (ABT) UTI in accordance with the results of bacteriological urine culture according to Russian clinical guidelines on urology. Against the background of ABT, 164 patients received additional therapy with Trioginal® (the study group - SG) containing estriol, micronized progesterone and Lactobacillus casei rhamnosus Doderleini 35 (LCR 35) lactobacillus strain. Trioginal® was administered intravaginally in two stages: for 20 days, 2 capsules per day, then for 10 days, 1 capsule per day. In the comparison group - CG (n=67) with ABT, Ovipol Klio® (estriol monopreparation) was additionally intravaginally used in two stages: for 14 days, 1 suppository per day, then for 2 weeks, 1 suppository 2 times a week. The control group consisted of 30 patients receiving only standard ABT UTI, local hormone therapy for vulvovaginal atrophy (VVA) was not performed. The observation period was 12 months after the end of the course of therapy. At all stages of treatment, a subjective and objective assessment of the severity of urination disorders and urogenital atrophy (UDI-6 questionnaire), their impact on the quality of life of patients (questionnaire IIQ-7), indicators of bacteriuria, bacterial urine culture and vaginal biocenosis, frequency of undesirable phenomena were carried out. According to the initial characteristics of the group of patients were comparable. Results. At all stages of the study, in the group of patients who received therapy with the use of the Trioginal® drug, there was a significant improvement in the clinical picture of urination disorders compared to the CG and the control (main) group - MG (in SG - 18% at the end of therapy versus 100% before the start of therapy; CG - 26 % versus 100% respectively; Ledger - 58% versus 100% respectively; p

RESULTS OF LOWER GENITAL TRACT INFECTION INTERVENTION AMONG KHMER WOMEN OF CHILDBEARING AGE IN CAN THO IN 2016

2018 ◽  
pp. 83-89
Author(s):  
Trung Thuan Phan ◽  
Dinh Binh Tran ◽  
Thanh Hue Dinh ◽  
Phong Son Dinh ◽  
Kieu Oanh Truong ◽  
...  
Keyword(s):  
Genital Tract ◽  
Common Knowledge ◽  
Intervention Group ◽  
Effective Intervention ◽  
Control Group ◽  
Childbearing Age ◽  
Lower Genital Tract ◽  
Genital Tract Infections ◽  
Tract Infections ◽  
Can Tho City

Objectives: To find a model that is effective intervention to reduce the incidence of lower genital tract infections in Khmer women. Subjects and Methods: The intervention study is carried which compared the test group with the control group of 400 Khmer women, aged 15 to 49 in Can Tho city. Results: The common knowledge of the prevention of lower genital tract infections in the intervention group increased from 30.9% in the control group to 54.5% in the intervention group. The general attitude toward the use of lower genital tract infections increased from 22.3% in the control group to 78.0% in the intervention group. This is a very significant improvement. The prevalence of subclinical infection of the intervention group (26.0%) was significantly lower than that of the control group (39.3%), the difference was statistically significant. Conclusion: Intervention effectiveness is good in both knowledge, attitudes and practices, especially the effectiveness of interventions in practice in Khmer women. Key words: Effective intervention, lower genital tract infections, Khmer women, Can Tho city

Implementation of a patient-specific tapering protocol at discharge decreases total opioid dose prescribed for 6 weeks after elective primary spine surgery

2020 ◽  
Vol 45 (6) ◽  
pp. 474-478
Author(s):  
Sarah S Joo ◽  
Oluwatobi O Hunter ◽  
Mallika Tamboli ◽  
Jody C Leng ◽  
T Kyle Harrison ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Joint Replacement ◽  
Oral Morphine ◽  
Hospital Length ◽  
Opioid Consumption ◽  
Hospital Length Of Stay ◽  
Patient Specific ◽  
Opioid Dose ◽  
Before And After ◽  
Primary Spine

Background and objectivesAt our institution, we developed an individualized discharge opioid prescribing and tapering protocol for joint replacement patients and implemented the same protocol for neurosurgical spine patients. We then tested the hypothesis that this protocol will decrease the oral morphine milligram equivalent (MME) dose of opioid prescribed postdischarge after elective primary spine surgery.MethodsIn this retrospective cohort study, we identified all consecutive elective primary spine surgery cases 1 year before and after introduction of the protocol. This protocol used the patient’s prior 24-hour inpatient opioid consumption to determine discharge opioid pill count and tapering schedule. The primary outcome was total opioid dose prescribed in oral MME from discharge through 6 weeks. Secondary outcomes included in-hospital opioid consumption in MME, hospital length of stay, MME prescribed at discharge, opioid refills, and rates of minor and major adverse events.ResultsEighty-three cases comprised the final sample (45 preintervention and 38 postintervention). There were no differences in baseline characteristics. The total oral MME (median (IQR)) from discharge through 6 weeks postoperatively was 900 (420–1440) preintervention compared with 300 (112–806) postintervention (p<0.01, Mann-Whitney U test), and opioid refill rates were not different between groups. There were no differences in other outcomes.ConclusionsThis patient-specific prescribing and tapering protocol effectively decreases the total opioid dose prescribed for 6 weeks postdischarge after elective primary spine surgery. Our experience also demonstrates the potential generalizability of this protocol, which was originally designed for joint replacement patients, to other surgical populations.

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