scholarly journals The Impact of Comorbid Renal Dysfunction in Patients with Hepatocellular Carcinoma on Long-Term Outcomes after Curative Resection

2021 ◽  
Author(s):  
Yuzuru Sakamoto ◽  
Shingo Shimada ◽  
Toshiya Kamiyama ◽  
Ko Sugiyama ◽  
Yoh Asahi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Site Infection ◽  
Renal Dysfunction ◽  
Postoperative Bleeding ◽  
Patient Characteristics ◽  
Rank Test ◽  
Serum Total Bilirubin ◽  
Site Infection ◽  
Number Of Patients ◽  
The Impact

Abstract Background:Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. However, the number of patients with chronic kidney disease (CKD) is also on the rise because of the increase in lifestyle-related diseases. To establish a tailored management strategy for HCC patients, we evaluated the impact of comorbid renal dysfunction (RD), as stratified by using the estimated glomerular filtration rate (eGFR), and assessed the oncologic validity of hepatectomy for HCC patients with RD.Methods:We enrolled 800 HCC patients who underwent hepatectomy between 1997 and 2015 in our university hospital. We categorized patients into two (RD, eGFR < 60 mL/min/1.73m2; non-RD, 60 ≤ eGFR) and three groups (severe CKD, eGFR < 30; mild CKD, 30 ≤ eGFR < 60; control, 60 ≤ eGFR) according to renal function as defined by the eGFR. Overall survival (OS) and recurrence-free survival (RFS) were compared among these groups with the log-rank test, and we also analyzed survival by using a propensity score matching (PSM) model for excluding the influence of patient characteristics. The mean of postoperative observation period was 64.7 ± 53.0 months.Results:RD patients were significantly older and had lower serum total bilirubin, AST, and ALT levels than those in non-RD patients (P < 0.0001, P < 0.001, < 0.05, and < 0.01, respectively). No patient was introduced to maintenance hemodialysis after surgery. Although the overall postoperative complications rates were similar between RD and non-RD patients, the proportions of postoperative bleeding and surgical site infection were significantly higher in RD patients (5.5% vs. 1.8%; P < 0.05, 3.9% vs. 1.8%; P < 0.05, respectively), and postoperative bleeding was the highest in severe CKD group (P < 0.05). Regardless of the degree of comorbid RD, OS and RFS were comparative, even when using PSM between RD and non-RD groups to exclude the influence of patient characteristics, liver function, and other causes of death.Conclusions:Comorbid RD had a negligible impact on the prognosis of HCC patients who underwent curative hepatectomy with appropriate perioperative management, and close attention to severe CKD is necessary to prevent postoperative bleeding and surgical site infection. Hokkaido University Graduate School of Medicine under Clinical Research Number 016-0354

Correlation of perioperative risk scores with hospital costs in neurosurgical patients

2020 ◽  
Vol 132 (3) ◽  
pp. 818-824
Author(s):  
Sasha Vaziri ◽  
Joseph M. Abbatematteo ◽  
Max S. Fleisher ◽  
Alexander B. Dru ◽  
Dennis T. Lockney ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
Risk Scores ◽  
Site Infection ◽  
Risk Calculator ◽  
Surgical Risk ◽  
Acs Nsqip ◽  
Neurosurgical Patients ◽  
Predicted Risk

OBJECTIVEThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online surgical risk calculator uses inherent patient characteristics to provide predictive risk scores for adverse postoperative events. The purpose of this study was to determine if predicted perioperative risk scores correlate with actual hospital costs.METHODSA single-center retrospective review of 1005 neurosurgical patients treated between September 1, 2011, and December 31, 2014, was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted risk scores were compared with actual in-hospital costs obtained from a billing database. Correlational statistics were used to determine if patients with higher risk scores were associated with increased in-hospital costs.RESULTSThe Pearson correlation coefficient (R) was used to assess the correlation between 11 types of predicted complication risk scores and 5 types of encounter costs from 1005 health encounters involving neurosurgical procedures. Risk scores in categories such as any complication, serious complication, pneumonia, cardiac complication, surgical site infection, urinary tract infection, venous thromboembolism, renal failure, return to operating room, death, and discharge to nursing home or rehabilitation facility were obtained. Patients with higher predicted risk scores in all measures except surgical site infection were found to have a statistically significant association with increased actual in-hospital costs (p < 0.0005).CONCLUSIONSPrevious work has demonstrated that the ACS NSQIP surgical risk calculator can accurately predict mortality after neurosurgery but is poorly predictive of other potential adverse events and clinical outcomes. However, this study demonstrates that predicted high-risk patients identified by the ACS NSQIP surgical risk calculator have a statistically significant moderate correlation to increased actual in-hospital costs. The NSQIP calculator may not accurately predict the occurrence of surgical complications (as demonstrated previously), but future iterations of the ACS universal risk calculator may be effective in predicting actual in-hospital costs, which could be advantageous in the current value-based healthcare environment.

scholarly journals Cerebrospinal Fluid Shunt-Associated Surgical Site Infection With Three- Versus Twelve-Month Follow-Up in Canadian Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s157-s157
Author(s):  
Kelly Baekyung Choi ◽  
John Conly ◽  
Blanda Chow ◽  
Joanne Embree ◽  
Bonita Lee ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Age Distribution ◽  
Patient Characteristics ◽  
Csf Shunt ◽  
Surveillance Program ◽  
Site Infection ◽  
Infection Surveillance ◽  
Surgical Manipulation ◽  
National Systems

Background: Surgical site infection (SSI) after cerebrospinal fluids (CSF) shunt surgery is thought to be acquired intraoperatively. Biomaterial-associated infection can present up to 1 year after surgery, but many national systems have shortened follow-up to 90 days. We compared 3- versus 12-month follow-up periods to determine the nature of case ascertainment in the 2 periods. Methods: Participants of any age with placement of an internal CSF shunt or revision surgical manipulation of an existing internal shunt identified in the Canadian Nosocomial Infection Surveillance Program (CNISP) participating hospitals between 2006 and 2018 were eligible. We excluded patients with external shunting devices or culture-positive CSF at the time of surgery. Patients were followed for 12 months after surgery for the primary outcome of a CSF infection with a positive CSF culture by review of laboratory and health records. Patients were categorized as adult (aged ≥18 years) or pediatric (aged < 18 years). The infection rate was expressed as the number of CSF shunt-associated infections divided by the number of shunt surgeries per 100 procedures. Results: In total, 325 patients (53% female) met inclusion criteria in 14 hospitals from 7 provinces were identified. Overall, 46.1% of surgeries were shunt revisions and 90.3% of shunts were ventriculoperitoneal. For pediatric patients, the median age was 0.7 years (IQR, 0.2–7.0). For adult patients, the median age was 47.9 years (IQR, 29.6–64.6). The SSI rates per 100 procedures were 3.69 for adults and 3.65 for pediatrics. The overall SSI rates per 100 procedures at 3 and 12 months were 2.74 (n = 265) and 3.48 (n = 323), respectively. By 3 months (90 days), 82% of infection cases were identified (Fig. 1). The median time from procedure to SSI detection was 30 days (IQR, 10–65). No difference was found in the microbiology of the shunt infections at 3- and 12-month follow-ups. The most common pathogens were coagulase-negative Staphylococcus (43.6 %), followed by S. aureus (24.8 %) and Propionibacterium spp (6.5 %). No differences in age distribution, gender, surgery type (new or revision), shunt type, or infecting organisms were observed when 3- and 12-month periods were compared. Conclusions: CSF-SSI surveillance for 3 versus 12 months would capture 82.0% (95% CI, 77.5–86.0) of cases, with no significant differences in the patient characteristics, surgery types, or pathogens. A 3-month follow-up can reduce resources and allow for more timely reporting of infection rates.Funding: NoneDisclosures: None

58 Use of Abdominal Wall or Sucutaneous Drain to Reduce the Risk of Surgical Site Infections

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Mistry ◽  
B Woolner ◽  
A John
Keyword(s):  
Surgical Site Infection ◽  
Open Cholecystectomy ◽  
Surgical Site Infections ◽  
Standard Operating Procedure ◽  
Site Infection ◽  
Infection Rates ◽  
Local Evidence ◽  
Audit Data ◽  
The Impact ◽  
To Receive

Abstract Introduction Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections. Method Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records. Results 84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures. Conclusions Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.

scholarly journals Surgical Site Infection Following Caesarean Section by Acinetobacter Species: A Report from a Hyperendemic Setting in the Brazilian Amazon Region

2021 ◽  
Vol 9 (4) ◽  
pp. 743
Author(s):  
Blenda Gonçalves Cabral ◽  
Danielle Murici Brasiliense ◽  
Ismari Perini Furlaneto ◽  
Yan Corrêa Rodrigues ◽  
Karla Valéria Batista Lima
Keyword(s):  
Caesarean Section ◽  
Surgical Site Infection ◽  
Carbapenem Resistance ◽  
Brazilian Amazon ◽  
Amazon Region ◽  
Site Infection ◽  
Acinetobacter Species ◽  
Brazilian Amazon Region ◽  
Acinetobacter Spp ◽  
The Impact

Surgical site infection (SSI) following caesarean section is associated with increased morbidity, mortality, and significant health care costs. This study evaluated the epidemiological, clinical, and microbiological features of Acinetobacter spp. in women with SSIs who have undergone caesarean section at a referral hospital in the Brazilian Amazon region. This study included 69 women with post-caesarean SSI by Acinetobacter spp. admitted to the hospital between January 2012 and May 2015. The 69 Acinetobacter isolates were subjected to molecular species identification, antimicrobial susceptibility testing, detection of carbapenemase-encoding genes, and genotyping. The main complications of post-caesarean SSI by Acinetobacter were inadequate and prolonged antibiotic therapy, sepsis, prolonged hospitalization, and re-suture procedures. A. baumannii, A. nosocomialis and A. colistiniresistens species were identified among the isolates. Carbapenem resistance was associated with OXA-23-producing A. baumannii isolates and IMP-1-producing A. nosocomialis isolate. Patients with multidrug-resistant A. baumannii infection showed worse clinical courses. Dissemination of persistent epidemic clones was observed, and the main clonal complexes (CC) for A. baumannii were CC231 and CC236 (Oxford scheme) and CC1 and CC15 (Pasteur scheme). This is the first report of a long-term Acinetobacter spp. outbreak in women who underwent caesarean section at a Brazilian hospital. This study demonstrates the impact of multidrug resistance on the clinical course of post-caesarean infections.

scholarly journals Incidence of Surgical Site Infection After Spine Surgery: What Is the Impact of the Definition of Infection?

2014 ◽  
Vol 473 (5) ◽  
pp. 1612-1619 ◽  
Author(s):  
Sjoerd P. F. T. Nota ◽  
Yvonne Braun ◽  
David Ring ◽  
Joseph H. Schwab
Keyword(s):  
Surgical Site Infection ◽  
Spine Surgery ◽  
Site Infection ◽  
Definition Of ◽  
The Impact

Perioperative Antibiotic Use in Sleep Surgery: Clinical Relevance

2021 ◽  
pp. 019459982110487
Author(s):  
Mohamed Abdelwahab ◽  
Sandro Marques ◽  
Isolde Previdelli ◽  
Robson Capasso
Keyword(s):  
Surgical Site Infection ◽  
Hospital Readmission ◽  
Antibiotic Prescription ◽  
Postoperative Bleeding ◽  
Upper Airway ◽  
National Database ◽  
Complication Rates ◽  
Site Infection ◽  
Tertiary Referral Center ◽  
Obstructive Sleep

Objective Upper airway surgery is a common therapeutic approach recommended for patients with obstructive sleep apnea (OSA) to decrease disease burden. We aimed to evaluate the effect of perioperative antibiotic prescription on complication rates. Study Design Retrospective cohort (national database). Setting Tertiary referral center. Methods This is a retrospective study of a large national health care insurance database (Truven MarketScan) from 2007 to 2015. Subjects diagnosed with OSA who had uvulopalatopharyngoplasty (UPPP) were included and stratified in single versus multilevel surgery. Other variables included smoking, age, sex, antibiotic prescription, and comorbidities based on the Elixhauser index. Evaluated outcomes were postoperative bleeding, intubation, pneumonia, superficial surgical site infection, tracheostomy, and hospital readmission. A multivariate regression model was created to assess each complication. Results A total of 5,798,528 subjects received a diagnosis of OSA, of which 39,916 were >18 years old and underwent UPPP, either alone or with additional procedures. The mean age was 43 years, and 73.4% were male. Antibiotic prescription was associated with less bleeding in UPPP alone, UPPP with nasal surgery, and UPPP with nasal and tongue surgery ( P < .001, P < .001, and P = .006, respectively). It was also associated with a lower prevalence of surgical site infection, pneumonia, tracheostomy, intubation, and hospital readmission ( P < .001). On a multivariate model, antibiotic prescription was significantly associated with a decreased rate of complications. Conclusions Although former studies recommended against the use of antibiotics after tonsillectomy, our results suggest that antibiotic prescription after UPPP for OSA was associated with less bleeding, surgical site infection, pneumonia, intubation, tracheostomy, and hospital readmission 30 days postoperatively.

scholarly journals Standardising intraoperative irrigation with 0.05% chlorhexidine gluconate in caesarean delivery to reduce surgical site infections: A single institution experience

2019 ◽  
Vol 30 (1-2) ◽  
pp. 24-33
Author(s):  
Theresa Mangold ◽  
Erin Kinzel Hamilton ◽  
Helen Boehm Johnson ◽  
Rene Perez
Keyword(s):  
Treatment Group ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Caesarean Delivery ◽  
Chlorhexidine Gluconate ◽  
Control Group ◽  
Antibiotic Administration ◽  
Site Infection ◽  
Infection Rates ◽  
The Impact

Background Surgical site infection is a significant cause of morbidity and mortality following caesarean delivery. Objective To determine whether standardising intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery could decrease infection rates. Methods This was a process improvement project involving 742 women, 343 of whom received low-pressured 0.05% chlorhexidine gluconate irrigation during caesarean delivery over a one-year period. Infection rates were compared with a standard-of-care control group (399 women) undergoing caesarean delivery the preceding year. Results The treatment group infection rate met the study goal by achieving a lower infection rate than the control group, though this was not statistically significant. A significant interaction effect between irrigation with 0.05% chlorhexidine gluconate and antibiotic administration time existed, such that infection occurrence in the treatment group was not dependent on antibiotic timing, as opposed to the control group infection occurrence, which was dependent on antibiotic timing. Conclusion Intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery did not statistically significantly reduce the rate of infections. It did render the impact of antibiotic administration timing irrelevant in prevention of surgical site infection. This suggests a role for 0.05% chlorhexidine gluconate irrigation in mitigating infection risk whether antibiotic prophylaxis timing is suboptimal or ideal.

KNOWLEDGE ON PREVENTION OF SURGICAL SITE INFECTION AMONG MEDICAL STAFF IN SON TAY GENERAL HOSPITAL, 2021

2021 ◽  
Vol 62 (5) ◽  
Author(s):  
Tran Quynh Anh ◽  
Bui Van Tung ◽  
Nguyen Tuan Tai ◽  
Chu Van Thang ◽  
Dang Duc Hoan ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
General Hospital ◽  
Medical Staff ◽  
Surgical Site Infections ◽  
Cross Sectional Study ◽  
Site Infection ◽  
Cross Sectional ◽  
Ongoing Training ◽  
Number Of Patients ◽  
Objective Description

Objective: Description of knowledge on prevention of surgical site infections (SSIs) among medical staff in Son Tay general hospital, 2021 and some related factors.Method: A cross-sectional study was conducted on 151 medical staff.Results: The rate of medical staff with fully knowledge of SSI prevention is 36.42%, in which the rate of doctors is 38.3% and of nurses is 35.58%. Age group ≥30 (OR=2.82; 95%CI: 1.12 – 7.13);Department of Surgery (OR=13.61; 95%CI: 5.14 – 35.98); working year ≥10 (OR=2.54; 95%CI: 1.26 – 5.11) and number of patients cared for/day <8 (OR=3.43; 95%CI: 1.26 – 9 ,34) are factorsrelated to the knowledge of medical staff about regarding SSIs.Conclusion: The medical staff’s knowledge of surgical site infection prevention is suboptimal; relevant factors should be considered when conducting ongoing training in the prevention of surgical site infections in hospitals.

scholarly journals Assessment of risk factors for surgical site infection following caesarean section

2019 ◽  
Vol 8 (11) ◽  
pp. 4518
Author(s):  
Aditi Sangwan ◽  
Vani Malhotra
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Surgical Site Infection ◽  
Site Infection ◽  
Emergency Caesarean ◽  
Group I ◽  
Number Of Patients ◽  
Duration Of Surgery ◽  
Wound Discharge ◽  
Group Ii

Background: Assessment of surgical site infection is an important factor to determine the functioning of the health care system. Objectives of this study was to estimate the incidence of surgical site infection among caesarean section cases and to determine the risk factors associated with surgical site infection and comparison with patients having healthy wounds.Methods: One thousand pregnant women who underwent caesarean section were divided into two groups: Group 1 (cases): Those who had SSI within 30 days of caesarean section and Group 2 (controls): Those who didn’t have SSI.Results: Mean age of group I was 25.35±4.40 and 21.12±3.60 years in group II (p >0.05). Mean gestational age of group I cases was 38.07±1.88 weeks and in group II, it was 38.17±2.06 weeks (p >0.05). A total of 37 (82.5%) women in group I and 931 (96.98%) women in group II underwent emergency caesarean section (p <0.05). In group I, mean duration of surgery was 1.0±0.13 hours and 1.02±0.21 hours in group II (p <0.05). Maximum number of patients i.e. 22 (55%) had wound discharge between 4-7 days followed by 11 (27.5%) between 8-10 days. Mean wound discharge was 7.32±3.45 days in group I. Majority of women, i.e. 27 (67%) found to be sterile in the present study followed by 7 (17.5%) women were found to have staphylococcus aureus.      Mean duration of resuturing was 17.42±6.98 days.  Mean baby weight in group I was 2.72±0.53 kg and in group II it was 2.95±0.53 kg (p <0.001).Conclusions: Risk of developing SSI after caesarean section is multi-factorial and found to be influenced by emergency surgery, PROM, pre-operative anaemia, multiple vaginal examinations, interrupted skin suturing, raised BMI, nulliparity, emergency caesarean, duration of surgery.

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