A breast prosthesis infection update: Two-year incidence, risk factors and management at single institution

ABSTRACT Background: Infection following augmentation and prosthetic-based breast reconstruction can cause significant physical and psychological distress for patients. It may delay adjuvant therapies and compromise aesthetic outcomes. The aim of this study is to identify modifiable risk factors for infection and identify common bacterial isolates to achieve optimal outcomes for patients. Methods: A retrospective cohort study was performed for patients undergoing implant-based breast reconstruction over a 2-year period. In each case, we documented demographics, co-morbidities, complications and antibiotic use. We reviewed treatments, infectious species cultured where applicable and all outcomes. Results: A total of 292 patients met the inclusion criteria. Fifty-five patients (19%) developed an infection. Univariate analysis showed a significantly increased infection rate with longer operative times (P = 0.001) and use of tissue expanders (P = 0.001). Multiple logistic regression analysis confirmed drain use and elevated body mass index (BMI) as risk factors (odds ratio [OR] 2.427 and 1.061, respectively). After controlling for BMI, smoking status and radiation, we found an increased odd of infection with allograft use (OR 1.838) and a decreased odd with skin preparation using 2% chlorhexidine gluconate in 70% isopropyl (OR 0.554), though not statistically significant. Forty of 55 patients with infections had cultures, with 62.5% of isolates being Gram-positive species and 30% Gram-negative species. The median time to clinical infection was 25 days. Implant salvage with surgical interventions was achieved in 61.5% of patients. Conclusions: This study identified judicious use of drains and efficiency in the operating room as modifiable risk factors for infections following implant-based breast reconstruction. Prospective trials to analyse techniques for infection prevention are warranted. Implant salvage following infection is a possible end-point in the appropriate patient.

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2425. Correlating Use of High-Risk Antimicrobials and the Incidence of Hospital-Onset Clostridium difficile Infection: Targeting Prescribing Trends for Antimicrobial Stewardship

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2103 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S838-S838

Author(s):

Elizabeth Thottacherry ◽

Philip L Whitfield ◽

Taylor D Steuber ◽

Chao Li ◽

Adam J Sawyer ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

High Risk ◽

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Univariate Analysis ◽

Antibiotic Use ◽

Financial Strain ◽

Modifiable Risk Factors ◽

Prescribing Trends

Abstract Background Hospital-onset Clostridium difficile infection (HO-CDI) has a significant morbidity and mortality risk. It also poses increasing financial strain on the healthcare system. Certain antibiotics have been associated with increased HO-CDI incidence and novel strategies are needed to determine what modifiable risk factors exist. Choices of antibiotic have changed overtime time to overcome potential side effects, leading to a possibility that changed prescribing trends could be linked to significant differences in the rate of HO-CDI. Methods This study took place at a 971-bed community hospital from January 2016 to January 2018. Monthly utilization (grams) of 11 antimicrobials considered high risk of HO-CDI was collected, along with monthly HO-CDI rate. Antimicrobials included cephalosporins, carbapenems, fluoroquinolones and clindamycin. Correlational (Pearson’s) and logistic regression analyses were completed to identify association with HO-CDI. A P-value of < 0.05 was considered statistically significant. Results 215 cases of HO-CDI were identified during the study period with 30 being classified as severe. The average HO-CDI rate was 4.3 cases/1000 patient-days. There were no significant correlations identified for any antimicrobials and HO-CDI rate (p> 0.05 for all interactions). Pearson’s correlation coefficients were not significant for any antimicrobial. The multivariable logistic regression model including all antimicrobials, indicated that only ceftazidime had a statistically significant positive effect on the HO-CDI rate. Bearing in mind that only a small number of ceftazidime was prescribed, additional univariate analysis was performed indicating that there was no significant linear association between the HO-CDI rate and ceftazidime utilization (P = 0.3527). Conclusion Our study shows that there is no significant correlation between specific antimicrobial use and HO-CDI rates, even though there has been a general increase in HO-CDI rates. Additional analysis involving control groups of antibiotic use in patients without HO-CDI as well as incidence of HO-CDI in patients without antibiotic use at all is required to further assess possible modifiable risk factors in the inpatient population. Disclosures All authors: No reported disclosures.

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Is it possible to predict outcome in cardiac ECMO? Analysis of preoperative risk factors

Perfusion ◽

10.1177/0267659107083241 ◽

2007 ◽

Vol 22 (4) ◽

pp. 225-229 ◽

Cited By ~ 8

Author(s):

Kari Wagner ◽

Ivar Risnes ◽

Michael Abdelnoor ◽

Harald M. Karlsen ◽

Jan Ludvig Svennevig

Keyword(s):

Risk Factors ◽

Cardiac Failure ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Early Mortality ◽

Cardiac Insufficiency ◽

Preoperative Risk ◽

Preoperative Risk Factors ◽

Va Ecmo ◽

Ecmo Treatment

Background. Serious heart failure may be treated with extracorporeal membrane oxygenation (ECMO) when other treatment fails. The aim of the present study was to analyse preoperative risk factors of early mortality in patients treated with veno-arterial (VA)-ECMO. Methods. We studied a total of 18 possible risk factors in 80 patients with severe cardiac insufficiency treated with VA-ECMO. All consecutive cases treated at our institution between Sept.1990 and May 2006 were included. Univariate analysis and multiple logistic regression analysis were performed on 16 risk factors. The endpoint was early mortality (any death within 30 days of ECMO treatment). Results. Thirty patients (37.5%) died within 30 days. Age, gender, cause of cardiac failure, pre-ECMO treatment (ventilator, NO, IABP) did not significantly influence early mortality. A higher SvO2 was associated with survival and remained significant in the multivariate analysis. Conclusion. Treatment with VA-ECMO in patients with severe cardiac failure may save lives. It is, however, difficult to predict outcome. In this study, only SvO2 values prior to ECMO were positively associated with survival. Perfusion (2007) 22, 225—229.

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Case control study of gastrointestinal complications after cardiopulmonary bypass heart surgery

Perfusion ◽

10.1177/0267659109346665 ◽

2009 ◽

Vol 24 (3) ◽

pp. 173-178 ◽

Cited By ~ 3

Author(s):

Guowei Zhang ◽

Naishi Wu ◽

Hongyu Liu ◽

Hang Lv ◽

Zhifa Yao ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cardiopulmonary Bypass ◽

Heart Surgery ◽

Perfusion Pressure ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Multiple Logistic Regression ◽

Gastrointestinal Complications ◽

Preoperative Serum

Background: Gastrointestinal complications (GIC) after cardiopulmonary bypass (CPB) surgery are rare, but, nevertheless, extremely dangerous.The identification of risks for GIC may be helpful in planning appropriate perioperative management strategies. The aim of the present study was to analyze perioperative factors of GIC in patients undergoing CPB surgery. Methods: We retrospectively analysed 206 patients who underwent GIC after cardiopulmonary bypass surgery from 2000 to 2007 and compared them with 206 matched control patients (matched for surgery, temperature, hemodilution and date). Univariate analysis and multiple logistic regression analysis were performed on 12 risk factors. Result: Sex and types of cardioplegia perfusate did not significantly influence the GIC after CPB surgery. Multiple logistic regression revealed that CPB time, preoperative serum creatinine (PSC) ≥ 179 mg/dL, emergency surgery, perfusion pressure ≤40mmHg, low cardiac output syndrome (LCOS), age ≥ 61, mechanical ventilation ≥96 h, New York Heart Association (NYHA) class III and IV were predictors of the occurrence of GIC after CPB surgery. Perfusion pressure and aprotinin administration were protective factors. Conclusion: Gastrointestinal complications after CPB surgery could be predictive in the presence of the above risk factors. This study suggests that GIC can be reduced by maintenance of higher perfusion pressure and shortening the time on CPB and ventilation.

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Lung cancer as a subsequent neoplasm: A report from the Childhood Cancer Survivor Study (CCSS).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.10551 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 10551-10551

Author(s):

Taumoha Ghosh ◽

Yan Chen ◽

Andrew C Dietz ◽

Gregory T. Armstrong ◽

Rebecca M. Howell ◽

...

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Childhood Cancer ◽

Smoking Status ◽

Univariate Analysis ◽

Bone Cancer ◽

Age At Diagnosis ◽

Field Size ◽

P Value ◽

Increased Risk

10551 Background: Lung cancer has been reported as a subsequent neoplasm (SN) in childhood cancer survivors. We aimed to assess the prevalence of and risk factors for lung cancer in the CCSS. Methods: Among 25,654 five-year survivors participating in the CCSS, lung cancer was self-reported and then confirmed by pathologic record review. Cancer treatment exposures were evaluated including chemotherapy and chest radiation by field size (none, small, large) and in a dose group (0-10 Gy, 10-30 Gy, 30-40 Gy, and > 40 Gy). Standardized incidence ratios (SIR) were calculated using rates from the Surveillance, Epidemiology, and End Results program. Hazard ratios (HR) were estimated for demographic and treatment variables using Cox proportional-hazards models. Results: Forty-two survivors developed subsequent malignant lung cancer (SIR 4.0, 95% CI 2.9-5.4), including 25 carcinomas, 7 mesotheliomas and 10 others. Two additional benign neoplasms were also identified. The cumulative incidence of lung SNs was 0.18% at 30 years (95% CI 0.10-0.25). Median time from primary diagnosis was 28 years (range 11-46); median age at diagnosis was 45 years of age (range 15-65). A multivariable model, including all covariates with a p-value < 0.2 in univariate analysis, showed significant associations between lung cancer and older age at diagnosis (HR 10.5, 95% CI 1.4-76.4, for 15-21 years vs. 0-4 years), as well as with primary diagnoses (relative to leukemia, HR 8.7, 95% CI 1.1-66.0, for Hodgkin lymphoma; HR 20.7, 95% CI 1.3-331.0 for neuroblastoma; and HR 21.4, 95% CI 2.3-202.7, for bone cancer). In a treatment model, maximum chest radiation dose (HR 4.1, 95% CI 1.4-11.7, for 30-40 Gy; and HR 8.1, 95% CI 3.0-22.2, for > 40 Gy, relative to 0-10Gy), but not sex, smoking status, or chemotherapy exposures, was associated with lung cancer. Notably, six survivors who developed lung cancer received no radiation and of these, five had a primary bone cancer. At the end of follow-up, 65.9% of survivors with lung cancer were deceased vs. 14.1% of survivors without lung cancer ( p < 0.001). Conclusions: Survivors of childhood cancer are at increased risk for developing lung cancer associated with exposure to high doses of chest radiotherapy. To our knowledge, this is the first study to describe associations with neuroblastoma and bone cancer. Future studies to understand additional treatment-related risk factors beyond chest radiotherapy dose are needed.

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Risk Factor and Surgical Outcome of Petersen’s Hernia After Gastrectomy in Gastric Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.765509 ◽

2021 ◽

Vol 11 ◽

Author(s):

Song Liu ◽

Qiongyuan Hu ◽

Peng Song ◽

Liang Tao ◽

Shichao Ai ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Risk Factor ◽

Distal Gastrectomy ◽

Univariate Analysis ◽

Time Interval ◽

Bowel Necrosis ◽

Surgical Interventions ◽

Petersen’S Hernia ◽

Factor Evaluation

BackgroundPetersen’s hernia is a life-threatening complication after gastrectomy. This study is dedicated to identify risk factors for Petersen’s hernia and compare clinical outcomes between patients receiving early or delayed surgical interventions.MethodsData from all patients who received gastrectomy due to gastric cancer were collected. Clinical characteristics were compared between Petersen and non-Petersen groups, bowel necrosis and non-necrotic groups. Propensity score matching (PSM) was conducted to generate two comparative groups. Univariate analysis and multivariate logistic regression were performed for risk factor evaluation.ResultsA total of 24 cases of Petersen’s hernia were identified from 1,481 cases of gastrectomy. PSM demonstrated that lower body mass index [BMI; odds ratio (OR) = 0.2, p < 0.01] and distal gastrectomy (OR = 6.2, p = 0.011) were risk factors for Petersen’s hernia. Longer time interval from emergence visit to laparotomy (p = 0.042) and elevated preoperative procalcitonin (p = 0.033) and C-reactive protein (CRP; p = 0.012) were associated with higher risk of bowel necrosis in Petersen’s hernia. Early surgical intervention resulted in less bowel necrosis rate (p = 0.012) and shorter length of necrotic bowel (p = 0.0041).ConclusionsLow BMI and distal gastrectomy are independent risk factor for Petersen’s hernia after gastrectomy. Curtailing observing time and executing prompt surgery are associated with bowel viability and better outcome in patients with Petersen’s hernia.

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THE DESCRIPTION OF MODIFIABLE RISK FACTORS IN CORONARY HEART DISEASE AT DR. SOETOMO REGIONAL PUBLIC HOSPITAL

Jurnal Berkala Epidemiologi ◽

10.20473/jbe.v7i22019.85-93 ◽

2019 ◽

Vol 7 (2) ◽

pp. 85

Author(s):

Mayla Renata Sandi ◽

Santi Martini ◽

Kurnia Dwi Artanti ◽

Sri Widati

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Public Hospital ◽

Communicable Disease ◽

Univariate Analysis ◽

Sampling Technique ◽

Primary Data ◽

Modifiable Risk Factors ◽

Cross Sectional

Background: Coronary heart disease (CHD) is a non-communicable disease that causes the highest mortality in the world, including in Indonesia. Risk factors for CHD are divided into modifiable and non- modifiable risk factors. Purpose: This study aims to discover the description of risk factors that are modifiable in coronary heart disease patients at Dr Soetomo Regional Public Hospital. Methods: It was a descriptive observational study with cross sectional study design. The study population was coronary heart disease patients who were doing outpatient treatment at the Integrated Heart Service Center (PPJT) of Dr. Soetomo Regional Public Hospital. The number of study sample was 72 respondents using accidental sampling technique. Data sources used are primary data using questionnaires and secondary data using medical record. Data were collected during November 2018. The location of this study was Dr. Soetomo Regional Public Hospital. The data analysis technique chosen was univariate analysis and presented in the form of a frequency distribution table. Results: The results of the study showed that the characteristics of respondents were mostly between 56-65 years old (43,05%) and male (70,84%). Risk factors found on the respondents were smoking (84,72%), hypertension (72,22%), hyperlipidemia (68,05%), diabetes mellitus (81,94%) and poor physical activity (77,77%). Conclusion: Modifiable risk factor that was mostly found on coronary heart patients was smoking, while least one was hiperlipidemia.

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The prevention of infection

The Bone & Joint Journal ◽

10.1302/0301-620x.101b1.bjj-2018-0233.r1 ◽

2019 ◽

Vol 101-B (1_Supple_A) ◽

pp. 3-9 ◽

Cited By ~ 24

Author(s):

V. K. Alamanda ◽

B. D. Springer

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Vitamin D ◽

Glycaemic Control ◽

Operating Room ◽

Joint Infection ◽

High Morbidity ◽

Modifiable Risk Factors ◽

Skin Preparation ◽

Vitamin D Levels

AimsProsthetic joint infection (PJI) remains a serious complication that is associated with high morbidity and costs. The aim of this study was to prepare a systematic review to examine patient-related and perioperative risk factors that can be modified in an attempt to reduce the rate of PJI.Materials and MethodsA search of PubMed and MEDLINE was conducted for articles published between January 1990 and February 2018 with a combination of search terms to identify studies that dealt with modifiable risk factors for reducing the rate of PJI. An evidence-based review was performed on 12 specific risk factors: glycaemic control, obesity, malnutrition, smoking, vitamin D levels, preoperative Staphylococcus aureus screening, the management of anti-rheumatic medication, perioperative antibiotic prophylaxis, presurgical skin preparation, the operating room environment, irrigant options, and anticoagulation.ResultsPoor glycaemic control, obesity, malnutrition, and smoking are all associated with increased rates of PJI. Vitamin D replacement has been shown in preliminary animal studies to decrease rates of PJI. Preoperative Staphylococcus aureus screening and appropriate treatment results in decreased rates of PJI. Perioperative variables, such as timely and appropriate dosage of prophylactic antibiotics, skin preparation with chlorohexidine-based solution, and irrigation with dilute betadine at the conclusion of the operation, have all been associated with reduced rates of PJI. Similarly, aggressive anticoagulation and increased operating room traffic should be avoided to help minimize risk of PJI.ConclusionPJI remains a serious complication of arthroplasty. Surgeons should be vigilant of the modifiable risk factors that can be addressed in an attempt to reduce the risk of PJI.

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Analysis of pancreatic fistula risk in patients with laparoscopic pancreatoduodenectomy: what matters

Journal of International Medical Research ◽

10.1177/0300060520943422 ◽

2020 ◽

Vol 48 (7) ◽

pp. 030006052094342

Author(s):

Kate Nong ◽

Yue Zhang ◽

Shengyong Liu ◽

Yue Yang ◽

Donglin Sun ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Bilirubin Level ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Amylase Level ◽

Drainage Fluid ◽

Soft Pancreas ◽

Laparoscopic Pancreatoduodenectomy ◽

Potential Risk Factors

Objective To analyse potential risk factors for postoperative pancreatic fistula (POPF). Methods A retrospective study on risk factors for POPF was conducted in patients undergoing laparoscopic pancreatoduodenectomy. Basic characteristics, and preoperative, intraoperative and postoperative patient data were collected and analysed. Results A total of 268 patients were enrolled in this study, including 54 patients with POPF following surgery (POPF incidence, 20.15%). Univariate analysis indicated that patient’s age, body mass index (BMI), preoperative bilirubin level, pancreas texture, and drainage fluid amylase level on day 1 following surgery were associated with POPF. Multiple logistic regression analysis indicated that preoperative bilirubin level ≥170 µmol/l, soft pancreas texture, BMI ≥25, and age ≥65 years were independent risk factors associated with POPF. Conclusions For patients with preoperative bilirubin level ≥170 µmol/l, soft pancreas texture, BMI ≥25 and age ≥65 years, clinically relevant measures should be taken as early as possible for the prophylaxis of POPF.

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Cardio-metabolic risk factors among healthcare staff: a cross-sectional study at the hospitals in six cities of Ukraine dedicated to World Heart Day 2020

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.213 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

I Sulska ◽

L Mishchenko ◽

A Sorokolietova ◽

M Hordina ◽

S Zhulinska

Keyword(s):

Risk Factors ◽

Family History ◽

High Risk ◽

Smoking Status ◽

Cross Sectional Study ◽

Metabolic Risk Factors ◽

Modifiable Risk Factors ◽

Metabolic Risk ◽

Sectional Study ◽

Cross Sectional

Abstract Funding Acknowledgements Type of funding sources: None. Background. There is a little information on the prevalence of cardio-metabolic risk factors in the Ukrainian medical staff. The aim of investigation was to determine the abundance of certain risk factors for cardiovascular (CV) diseases among the medical personnel in the six cities of Ukraine, a study dedicated to World Heart Day 2020. Purpose. To establish the presence of cardio-metabolic risk factors among medical workers in Ukraine. Materials and methods. A hospital-based cross-sectional study including 471 participants (415 female and 56 male) between the age of 19 and 79 years surveyed. The cardio-metabolic risk markers assessed were non-modifiable risk factors (family history) and modifiable risk factors (obesity, hypertension, dyslipidemia, diabetes, prediabetes, smoking status). The prevalence of hypertension (HTN) estimated by ESC 2018 recommendations, diabetes and prediabetes by ADA 2019, ESC 2019 and body mass index WHO criteria for obesity classifications. Using standard methods were assessed: fasting glucose concentration, glycosylated hemoglobin (HbA1c) and blood lipids (total cholesterol, LDL-C, triglycerides, HDL-C). Results The median age of participants was 53,3 ± 11,77 years. Positive smoking status reported by 66 persons (14,0%). Analysis of family history showed that 51,4% of the participants had of HTN, 14,9% of myocardial infarction and 25,1% of stroke. The prevalence of modifiable risk factors: HTN registered in 51,4% cases. Around 34,8% of participants were overweight, and 34,6% were obese, 70,7% had waist circumference more than 94 cm (men) and > 80 cm (woman). Prediabetes glycemic levels and diabetes incidence were 42,8% and 12,6%, accordingly. Atherogenic dyslipidemia estimated by increased level of LDL-C more than 4,9 mmol/l, which determinate high risk of CV disorders, estimated in 13,6% participants. Also high triglycerides levels were defined as those of at least 2,3 mmol/l were in 14,9%. Low level of aerobic activity (less than 150 min in week) had 33,4% participants. 30,7% of participants older than 40 years presented high CV risk and 23,9% were in very high risk. Conclusion. Cardio-metabolic risk factors prevail among medical workers in Ukraine. The results point to the relevance of public health recommendations to contribute lifestyle changes and early identification of risk factors for prevention of CV outcomes.

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Antibiotic Prophylaxis in Alloplastic Breast Reconstruction: Regimens and Outcomes: La prophylaxie antibiotique en cas de reconstruction mammaire alloplastique : les posologies et les pronostics

Plastic Surgery ◽

10.1177/2292550321995730 ◽

2021 ◽

pp. 229255032199573

Author(s):

Edward H. Liu ◽

Mary Tong ◽

Grace Y. Kim ◽

Forough Farrokhyar ◽

Arianna Dal Cin

Keyword(s):

Risk Factors ◽

Breast Reconstruction ◽

Radiation Treatment ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Prior History ◽

Tertiary Centre ◽

Control And Prevention ◽

Reconstruction Mammaire ◽

Alloplastic Breast Reconstruction

Purpose: Surgical site infections (SSI) in prosthesis-based breast reconstruction can have a significant impact on patient outcome. Despite current CDC (Centers for Disease Control and Prevention) guidelines recommending 24 hours of postoperative antibiotics, various perioperative antimicrobial regimens are reported in the literature. Consensus on the optimal duration of antibiotics remains unclear. In this study, the aim is to compare the incidence of surgical site infections following different antibiotic durations in alloplastic breast reconstruction. Methods: In this retrospective cohort study, all consecutive patients who underwent expander/implant-based breast reconstruction between January 2009 and December 2014 at a tertiary centre were included. Data on patient demographics, risk factors, operative time, choice and timing of antibiotic used before surgery, and the duration of postoperative antibiotic use were collected. The primary outcome, SSI, is defined according to CDC criteria. Results: A total of 507 consecutive expander/implant-based cases were included. Minimum follow-up time was 1 year. The overall infection incidence was 14% (95% CI: 11%-17%), and the rate of subsequent explantation was 8%. Of the infected cases, 80% (45/56) received 1 week of postoperative antibiotic, while 20% (11/56) had a prolonged course of antibiotics (2-3 weeks; P = .003, odds ratio [OR] = 2.9; 95% CI: 1.4-5.8). Most infections were superficial (65%). Prior history of radiation treatment was identified as a risk factor for developing surgical site infection ( P = .02). Conclusion: Overall infection rate and risk factors for infections are in keeping with current literature. Prescribing one week of postoperative antibiotic was found to be associated with a higher incidence of SSI compared to a more prolonged antibiotic regimen.

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