Preoperative chemotherapy and corticosteroids: independent predictors of cranial surgical-site infections

OBJECT Preoperative corticosteroids and chemotherapy are frequently prescribed for patients undergoing cranial neurosurgery but may pose a risk of postoperative infection. Postoperative surgical-site infections (SSIs) have significant morbidity and mortality, dramatically increase the length and cost of hospitalization, and are a major cause of 30-day readmission. In patients undergoing cranial neurosurgery, there is a lack of data on the role of patient-specific risk factors in the development of SSIs. The authors of this study sought to determine whether chemotherapy and prolonged steroid use before surgery increase the risk of an SSI at postoperative Day 30. METHODS Using the national prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for 2006–2012, the authors calculated the rates of superficial, deep-incisional, and organ-space SSIs at postoperative Day 30 for neurosurgery patients who had undergone chemotherapy or had significant steroid use within 30 days before undergoing cranial surgery. Trauma patients, patients younger than 18 years, and patients with a preoperative infection were excluded. Univariate analysis was performed for 25 variables considered risk factors for superficial and organ-space SSIs. To identify independent predictors of SSIs, the authors then conducted a multivariate analysis in which they controlled for duration of operation, wound class, white blood cell count, and other potential confounders that were significant on the univariate analysis. RESULTS A total of 8215 patients who had undergone cranial surgery were identified. There were 158 SSIs at 30 days (frequency 1.92%), of which 52 were superficial, 27 were deep-incisional, and 79 were organ-space infections. Preoperative chemotherapy was an independent predictor of organ-space SSIs in the multivariate model (OR 5.20, 95% CI 2.33–11.62, p < 0.0001), as was corticosteroid use (OR 1.86, 95% CI 1.03–3.37, p = 0.04), but neither was a predictor of superficial or deep-incisional SSIs. Other independent predictors of organ-space SSIs were longer duration of operation (OR 1.16), wound class of ≥ 2 (clean-contaminated and further contaminated) (OR 3.17), and morbid obesity (body mass index ≥ 40 kg/m2) (OR 3.05). Among superficial SSIs, wound class of 3 (contaminated) (OR 6.89), operative duration (OR 1.13), and infratentorial surgical approach (OR 2.20) were predictors. CONCLUSIONS Preoperative chemotherapy and corticosteroid use are independent predictors of organ-space SSIs, even when data are controlled for leukopenia. This indicates that the disease process in organ-space SSIs may differ from that in superficial SSIs. In effect, this study provides one of the largest analyses of risk factors for SSIs after cranial surgery. The results suggest that, in certain circumstances, modulation of preoperative chemotherapy or steroid regimens may reduce the risk of organ-space SSIs and should be considered in the preoperative care of this population. Future studies are needed to determine optimal timing and dosing of these medications.

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Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program–Pediatrics

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.10.peds16414 ◽

2017 ◽

Vol 19 (3) ◽

pp. 361-371 ◽

Cited By ~ 11

Author(s):

Benjamin J. Kuo ◽

Joao Ricardo N. Vissoci ◽

Joseph R. Egger ◽

Emily R. Smith ◽

Gerald A. Grant ◽

...

Keyword(s):

Risk Factors ◽

Quality Improvement ◽

Univariate Analysis ◽

Patient Characteristics ◽

Quality Improvement Program ◽

Neurosurgical Procedures ◽

Continuous Variables ◽

Improvement Program ◽

Surgical Quality ◽

Defect Repair

OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program–Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012–2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas admission from outside hospital transfer was a significant predictor of any AE for all procedure groups except craniotomy/craniectomy. CONCLUSIONS This analysis of NSQIP-Peds, a large risk-adjusted national data set, confirms low perioperative mortality but high morbidity for pediatric neurosurgical procedures. These data provide a baseline understanding of current expected clinical outcomes for pediatric neurosurgical procedures, identify the need for collecting neurosurgery-specific risk factors and complications, and should support targeted QI programs and clinical management interventions to improve care of children.

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Improving Quality of Surgical Care and Outcomes: Factors Impacting Surgical Site Infection after Colorectal Resection

The American Surgeon ◽

10.1177/000313481408000823 ◽

2014 ◽

Vol 80 (8) ◽

pp. 759-763 ◽

Cited By ~ 5

Author(s):

Virginia Oliva Shaffer ◽

Caitlin D. Baptiste ◽

Yuan Liu ◽

Jahnavi K. Srinivasan ◽

John R. Galloway ◽

...

Keyword(s):

Risk Factors ◽

Glucose Level ◽

Univariate Analysis ◽

Significant Risk ◽

Surgical Care ◽

Surgical Site Infections ◽

Case Volume ◽

Improvement Project ◽

Combining Data

Surgical site infections (SSIs) result in patient morbidity and increased costs. The purpose of this study was to determine reasons underlying SSI to enable interventions addressing identified factors. Combining data from the American College of Surgeons National Surgical Quality Improvement Project with medical record extraction, we evaluated 365 patients who underwent colon resection from January 2009 to December 2012 at a single institution. Of the 365 patients, 84 (23%) developed SSI. On univariate analysis, significant risk factors included disseminated cancer, ileostomy, patient temperature less than 36°C for greater than 60 minutes, and higher glucose level. The median number of cases per surgeon was 36, and a case volume below the median was associated with a higher risk of SSI. On multivariate analysis, significant risks associated with SSI included disseminated cancer (odds ratio [OR], 4.31; P < .001); surgery performed by a surgeon with less than 36 cases (OR, 2.19; P = .008); higher glucose level (OR, 1.06; P 5.017); and transfusion of five units or more of blood (OR, 3.26; P 5.029). In this study we found both modifiable and unmodifiable factors associated with increased SSI. Identifying modifiable risk factors enables targeting specific areas to improve the quality of care and patient outcomes.

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Surgical site infection incidence and risk factors in thoracic surgical procedures: A 12-year prospective cohort study

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11240 ◽

2019 ◽

Vol 13 (03) ◽

pp. 212-218

Author(s):

Vlado S Cvijanovic ◽

Aleksandar S Ristanović ◽

Nebojsa T Maric ◽

Natasa V Vesovic ◽

Vanja V Kostovski ◽

...

Keyword(s):

Risk Factors ◽

Thoracic Surgery ◽

Surgical Procedures ◽

Surgical Site Infections ◽

Thoracic Surgical Procedures ◽

Wound Contamination ◽

Surgical Site Infection Incidence ◽

Independent Risk Factors ◽

American Society ◽

Duration Of Operation

Introduction: Surgical site infections (SSI) continue to be a major problem for thoracic surgery patients. We aimed to determine incidence rate (IR) and risk factors for SSI in patients with thoracic surgical procedures. Methodology: During 12 years of hospital surveillance of patients with thoracic surgical procedures, we prospectively identified SSI. Patients with SSI were compared with patients without SSI. Results: We operated 3,370 patients and 205 (6.1%) developed SSI postoperatively. We detected 190 SSI among open thoracic surgical procedures (IR 7.1%) and 15 SSI after video-assisted thoracic surgery (IR 2.1%). Five independent risk factors for SSI were identified: wound contamination (p = 0.013; relative risk (RR) 2.496; 95%, confidence interval (CI): 1.208-5.156), American Society of Anesthesiologist (ASA) score (p = 0.012; RR: 1.795; 95% CI: 1.136-2.834), duration of drainage (p < 0.001; RR: 1.117; 95% CI: 1.085-1.150), age (p = 0.036; RR: 1.018; 95% CI: 1.001-1.035) and duration of operation (p < 0.001; RR:1.005; 95% CI:1.002-1.008). Conclusion: The results are valuable in documenting risk factors for SSI in patients undergoing thoracic surgery. The knowledge and prevention of controllable risk factors is necessary in order to reduce the incidence of SSI.

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Myocardial injury after gynecologic oncology surgery in septuagenarians and octogenarians: Is there a role for routine postoperative cardiac biomarker monitoring?

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.220 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 220-220

Author(s):

Tharani Anpalagan ◽

Kathy Huang ◽

Maura Marcucci ◽

Sarah Mah ◽

Millie Walker ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Injury ◽

Angiotensin Receptor Blockers ◽

Frailty Index ◽

Gynecologic Oncology ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Cardiac Risk ◽

Improvement Program ◽

Surgical Complexity

220 Background: Accumulating evidence correlates myocardial injury after noncardiac surgery (MINS), even when asymptomatic, with increased cardiac and non-cardiac morbidity and mortality. There is no literature on MINS specific to Gynecologic Oncology. We sought to evaluate the incidence and risk factors of MINS in patients aged ≥70. Methods: Elective laparotomies between 01/2016-09/2020 for patients aged≥70 at a tertiary hospital in ON, Canada, were reviewed using prospectively-collected National Surgical Quality Improvement Program (NSQIP) data. MINS was defined as peak serum high-sensitivity troponin-T concentration ≥0.04ng/mL within 30 days postoperatively. Logistic regression analysis was performed. Results: In this cohort of 258 patients, of 242 (93.8%) who underwent postoperative troponin screening, 40 (16.5%) experienced MINS without exhibiting ischemic symptoms or ECG changes. The diagnosis of MINS led to a prescription or optimization of cardiovascular medications for 35 patients (87.5%). On univariate analysis, Revised Cardiac Risk Index (RCRI) of 3-5(p = 0.002), history of coronary artery disease (p = 0.003) or insulin-dependent diabetes (p = 0.006), preoperative use of antiplatelets (p = 0.009), beta-blockers (p = 0.02), ACE-inhibitors (ACEI) or angiotensin-receptor blockers (ARB)(p = 0.002) and frailty as defined by the NSQIP modified frailty index-5 (p = 0.02), were associated with greater risk of MINS. Factors reflecting surgical complexity including surgical complexity score, operative duration, blood loss and advanced oncologic stage were not predictive. Multivariable analysis using backward selection procedure identified elevated RCRI and preoperative ACE/ARB as significant risk factors (OR 5.93, 95% CI 1.52-24.31, p = 0.01 and OR 2.4, 95% CI 1.18-5.06, p = 0.02). Conclusions: One in 6 patients in our cohort experienced asymptomatic MINS irrespective of surgical complexity. Our analysis highlights a possible opportunity to optimize cardiac risk factors and to potentially improve perioperative patient safety by reducing morbidity. Routine preoperative cardiac risk-stratification and postoperative cardiac biomarkers monitoring should be considered in elderly patients with gynecologic malignancies.[Table: see text]

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Risk factors associated with surgical site infections following vascular surgery at a German university hospital

Epidemiology and Infection ◽

10.1017/s095026881200180x ◽

2012 ◽

Vol 141 (6) ◽

pp. 1207-1213 ◽

Cited By ~ 15

Author(s):

E. OTT ◽

F.-Ch. BANGE ◽

D. SOHR ◽

O. TEEBKEN ◽

F. MATTNER

Keyword(s):

Risk Factors ◽

Vascular Surgery ◽

Infection Prevention ◽

Protective Factor ◽

Surgical Site Infections ◽

University Hospital ◽

Coagulase Negative Staphylococci ◽

Postoperative Drainage ◽

Independent Risk Factors ◽

Duration Of Operation

SUMMARYSurgical site infection (SSI) after vascular surgery is a serious complication increasing morbidity, mortality, and costs for healthcare systems. A 4-year retrospective cohort study was performed in a university hospital with patients who had undergone arterial vascular surgery below the aortic arch. Investigated variables included demographics and clinical data. Forty-four of 756 patients experienced SSI, 29 of which were superficial, five were deep, and 10 had organ/space infections. Coagulase-negative staphylococci (22%), enterococci (20%), and Staphylococcus aureus (18%) were the most common pathogens. Independent risk factors for SSIs were femoral grafting [odds ratio (OR) 6·7], peripheral atherosclerotic disease, Fontaine stages III–IV (OR 4·1), postoperative drainage >5 days (OR 3·6), immunosuppression (OR 2·8), duration of operation >214 min (OR 2·8), and body mass index >29 (OR 2·6). The application of perioperative antibiotic prophylaxis was an independent protective factor (OR 0·2). Patients with certain risk factors for SSIs warrant special attention for infection prevention.

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Risk factors for postoperative meningitis after microsurgery for vestibular schwannoma

10.1101/633149 ◽

2019 ◽

Author(s):

Bowen Huang ◽

Yanming Ren ◽

Chenghong Wang ◽

Zhigang Lan ◽

Xuhui Hui ◽

...

Keyword(s):

Risk Factors ◽

Vestibular Schwannoma ◽

Univariate Analysis ◽

High Morbidity ◽

Intraoperative Bleeding ◽

Bleeding Volume ◽

Independent Risk Factors ◽

Postoperative Meningitis ◽

Prolonged Hospital ◽

Duration Of Operation

AbstractOBJECTIVEMeningitis after microsurgery for vestibular schwannoma (VS) is a severe complication and result in high morbidity. But few studies have focused on meningitis after VS surgery alone. The purpose of this study was to identify the risk factors for meningitis after VS surgery.METHODSWe undertook a retrospective analysis of all VS patients, who underwent microsurgery of VS and at least live for 7 days after surgery, between 1st June 2015 and 30st November 2018 at West China Hospital of Sichuan University. Univariate and multivariate analyses were performed to identify the risk factors for postoperative meningitis (POM).RESULTSWe collected 410 patients, 27 of whom had POM. Through univariate analysis, hydrocephalus (p=0. 018), Koos grade IV (p=0.04), The operative duration (> 3 hours p=0.03) and intraoperative bleeding volume (≥ 400ml p=0. 02) were significantly correlated to POM. Multivariate analysis showed that Koos grade IV (p=0.04; OR=3.19; 95% CI 1.032-3.190), operation duration (> 3 hours p=0.03 OR= 7.927; 95% CI 1.043-60.265), and intraoperative bleeding volume (≥ 400ml p=0.02; OR=2.551; 95% CI 1.112-5.850) are the independent influencing factors of POM.CONCLUSIONSKoos grade IV, the duration of operation, and the amount of bleeding were identified as independent risk factors for POM after microsurgery of VS. POM caused a prolonged hospital stay.

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What clinical factors predict the incidence of deep venous thrombosis and pulmonary embolism in neurosurgical patients?

Journal of Neurosurgery ◽

10.3171/2014.6.jns131419 ◽

2014 ◽

Vol 121 (4) ◽

pp. 908-918 ◽

Cited By ~ 35

Author(s):

John D. Rolston ◽

Seunggu J. Han ◽

Orin Bloch ◽

Andrew T. Parsa

Keyword(s):

Risk Factors ◽

Binary Logistic Regression ◽

Improvement Program ◽

Chi Square ◽

Surgical Specialty ◽

Steroid Use ◽

Ventilator Dependence ◽

Neurosurgical Patients ◽

Chi Square Test ◽

Postoperative Setting

Object Venous thromboembolisms (VTEs) occur frequently in surgical patients and can manifest as pulmonary emboli (PEs) or deep venous thromboses (DVTs). While many medical therapies have been shown to prevent VTEs, neurosurgeons are concerned about the use of anticoagulants in the postoperative setting. To better understand the prevalence of and the patient-level risk factors for VTE, the authors analyzed data from the National Surgical Quality Improvement Program (NSQIP). Methods Retrospective data on 1,777,035 patients for the years from 2006 to 2011 were acquired from the American College of Surgeons NSQIP database. Neurosurgical cases were extracted by querying the data for which the surgical specialty was listed as “neurological surgery.” Univariate statistics were calculated using the chi-square test, with 95% confidence intervals used for the resultant risk ratios. Multivariate models were constructed using binary logistic regression with a maximum number of 20 iterations. Results Venous thromboembolisms were found in 1.7% of neurosurgical patients, with DVTs roughly twice as common as PEs (1.3% vs 0.6%, respectively). Significant independent predictors included ventilator dependence, immobility (that is, quadriparesis, hemiparesis, or paraparesis), chronic steroid use, and sepsis. The risk of VTE was significantly higher in patients who had undergone cranial procedures (3.4%) than in those who had undergone spinal procedures (1.1%). Conclusions Venous thromboembolism is a common complication in neurosurgical patients, and the frequency has not changed appreciably over the past several years. Many factors were identified as independently predictive of VTEs in this population: ventilator dependence, immobility, and malignancy. Less anticipated predictors included chronic steroid use and sepsis. Venous thromboembolisms appear significantly more likely to occur in patients undergoing cranial procedures than in those undergoing spinal procedures. A better appreciation of the prevalence of and the risk factors for VTEs in neurosurgical patients will allow targeting of interventions and a better understanding of which patients are most at risk.

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Case–control Study Evaluating Risk Factors and Treatment Outcomes for Community-Acquired Urinary Tract Infections (UTI) Caused by Extended-Spectrum Β-Lactamase (ESBL)-Producing Pathogens

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.826 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S345-S345

Author(s):

Stephen Lee ◽

Douglas N Fish ◽

Gerard Barber ◽

Michelle Barron

Keyword(s):

Risk Factors ◽

Treatment Outcomes ◽

Univariate Analysis ◽

Patient Specific ◽

Control Group ◽

Healthcare Facilities ◽

Nursing Home Stay ◽

Tract Infections ◽

Research Grant

Abstract Background Community-acquired (CA) infections caused by ESBL-producing pathogens are becoming more common. Risk factors (RFs) for CA ESBLs have not been as extensively studied and remain relatively undefined. Recognition of patient-specific RFs for CA ESBL infections such as UTI can potentially improve patient outcomes through selection of more appropriate initial drug therapy. The objectives of this study were to identify RFs and associated treatment outcomes for CA UTI involving ESBLs. Methods Adult patients with CA ESBL UTI (cystitis) seen in the Emergency Department (ED) from 2009 through 2013 were retrospectively matched 1:1 with a control group of non-ESBL CA UTI based on age within 5 years, gender, and organism. The primary outcome was identification of RFs predictive of CA ESBL UTI. Secondary outcomes included comparison of ESBLs and controls in risk of inappropriate initial antibiotic therapy and need for additional follow-up to healthcare facilities (clinics, ED) within 14 days of initial treatment. Results Eighty-five patients were matched into each group. Compared with controls, CA ESBL UTI was associated with nursing home stay (P = 0.04), congestive heart failure (CHF, P = 0.04), hospitalization within the previous year (P = 0.04), and receipt of either any antibiotics or specifically, fluoroquinolones within the previous 3 months (P < 0.01 for both) by univariate analysis. Multivariate logistic regression identified hospitalization within 1 year (OR 3.8, 95% CI 1.7–8.7; P < 0.001), antibiotics within 3 months (OR 3.5, 95% CI 1.7–7.6; P < 0.001), and CHF (OR 4.9, 95% CI 1.3–24.7; P = 0.02) as significant RFs for ESBL CA UTI. Patients with CA ESBL infections were more likely to receive inappropriate initial antibiotics (OR 8.9, 95% CI 4.2–18.6; P < 0.0001) and, if treated inappropriately, to require repeat visits to healthcare facilities within 14 days (OR 11.4, 95% CI 2.6–50.8). Conclusion Previous hospitalization, previous antibiotics, and CHF were RFs associated with CA ESBL UTI. These patients were significantly more likely to be treated inappropriately and to require additional healthcare follow-up. Recognition of RFs for CA ESBL UTI may facilitate appropriate ED-based management and avoid additional resource utilization. Disclosures D. N. Fish, Merck & Co.: Grant Investigator, Research grant M. Barron, Merck & Co.: Grant Investigator, Research grant

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General Complications after Endoscopic Sinus Surgery in Smokers: A 2005-2016 NSQIP Analysis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420952481 ◽

2020 ◽

pp. 000348942095248

Author(s):

Jordan I. Teitelbaum ◽

Catie Grasse ◽

Dennis Quan ◽

Ralph Abi Hachem ◽

Bradley J. Goldstein ◽

...

Keyword(s):

Cigarette Smoke ◽

Endoscopic Sinus Surgery ◽

Univariate Analysis ◽

Surgical Site Infections ◽

Sinus Surgery ◽

National Database ◽

Complication Rates ◽

Improvement Program ◽

Level Of Evidence ◽

American College Of Surgeons

Background: Exposure to cigarette smoke has been associated with a higher incidence of postoperative complications across a variety of surgical specialties. However, it is unclear if smoking increases this risk after endoscopic sinus surgery (ESS). Because complication rates after ESS are relatively low, a large national database allows for a statistically meaningful study of this topic. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset from 2005 to 2016 was analyzed. Patients who underwent ESS were identified. Thirty-day postoperative complication rates between smokers and nonsmokers were compared. Complications included infection, thromboembolic events, reintubation, readmission, acute renal failure, and cardiovascular events. Results: 921 patients who underwent ESS were identified. 182 (20%) were smokers and 739 (80%) were nonsmokers. 609 patients underwent outpatient ESS, while 312 patients underwent inpatient ESS. A total of 12 patients experienced postoperative surgical site infections involving the deeper tissues beyond the wound (organ/space SSI). On univariate analysis, smoking was associated with a higher incidence of organ/space SSI ( P = .0067) and pulmonary embolism ( P = .0321) after ESS. On multivariate logistic regression, smoking was associated with increased odds (4.495, 1.11- 8.17, P = .0347) of organ/space SSI after ESS. Conclusions: This study demonstrates an association between exposure to cigarette smoke and potentially serious surgical site infections in the 30-day postoperative period after ESS. Our findings may help when counseling smokers who are considering ESS. Further study is required to understand the nature of these infections and ways to prevent them. Level of Evidence: 2c (“health outcomes”)

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