The impact of long-term corticosteroid use on acute postoperative complications following lumbar decompression surgery

BackgroundCorticosteroids have a negative impact on the human immune system’s ability to function at an optimal level. Studies have shown that patients on long-term corticosteroids have higher infection rates. However, the rates of infection and other complications following lumbar decompression surgery remains under-investigated. The aim of our study was to determine the impact of preoperative long-term corticosteroid usage on acute, 30-day postoperative complications in a subset of patients undergoing lumbar spine decompression surgery, without fusion or instrumentation. We hypothesize that patients on long-term corticosteroids will have higher rates of infection and other postoperative complications after undergoing lumbar decompression surgery of the spine.MethodsA retrospective cohort study was conducted using data collected from the National Surgical Quality Improvement Program database data from 2005 to 2016. Lumbar decompression surgeries, including discectomies, laminectomies, and others were identified using CPT codes. Chi-square analysis was used to evaluate differences among the corticosteroid and non-corticosteroid groups for demographics, preoperative comorbidities, and postoperative complications. Logistic regression analysis was done to determine if long-term corticosteroid use predicts incidence of postoperative infections following adjustment.Results26,734 subjects met inclusion criteria. A total of 1044 patients (3.9%) were on long-term corticosteroids prior to surgical intervention, and 25,690 patients (96.1%) were not on long-term corticosteroids. Patients on long-term corticosteroids were more likely to be older (p < 0.001), female (p < 0.001), nonsmokers (p < 0.001), and have a higher American Society of Anesthesiologist class (p < 0.001). Multivariate analysis demonstrated that long-term corticosteroid usage was associated with increased overall complications (odds ratio [OR]: 1.543; p < 0.001), and an independent risk factor for the development of minor complications (OR: 1.808; p < 0.001), urinary tract infection (OR: 2.033; p = 0.002), extended length of stay (OR: 1.244; p = 0.039), thromboembolic complications (OR: 1.919; p = 0.023), and sepsis complications (OR: 2.032; p = 0.024).ConclusionLong-term corticosteroid usage is associated with a significant increased risk of acute postoperative complication development, including urinary tract infection, sepsis and septic shock, thromboembolic complications, and extended length of hospital stay, but not with superficial or deep infection in patients undergoing lumbar decompression procedures. Spine surgeons should remain vigilant regarding postoperative complications in patients on long-term corticosteroids, especially as it relates to UTI and propensity to decompensate into sepsis or septic shock. Thromboembolic risk attenuation is also imperative in this patient group during the postoperative period and the surgeon should weigh the risks and benefits of more intensive anticoagulation measures.     

关节镜下灌洗联合手术切开清创治疗关节镜下肩袖修补术后感染

目的探讨关节镜下灌洗联合手术切开清创治疗关节镜下肩袖修补术后感染的临床疗效。方法回顾性分析2016年1月至2019年6月采用关节镜下灌洗联合手术切开清创治疗4例关节镜下肩袖修补术后感染患者资料,男3例,女1例;年龄55岁(范围,51~61岁)。4例患者均于术后1个月内出现手术部位不同程度的红肿、疼痛等症状,同时伴有发热、脓肿、窦道形成。入院后完善血液学及放射学检查,使用抗生素治疗,并根据微生物培养结果调整使用抗生素。同时采用关节镜下灌洗联合手术切开清创进行治疗。术后继续使用抗生素抗感染治疗。术后复查血常规、红细胞沉降率、C反应蛋白,X线片等,评估感染症状是否缓解及预后情况。术前及随访时均采用视觉模拟评分(visual analogue scale,VAS)和美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分评估疼痛及肩关节功能。结果4例患者手术均顺利完成,其中1例进行负压吸引1周后再关闭伤口。微生物培养结果显示,4例患者中,2例结核分枝杆菌(+)、1例铜绿假单胞菌(+)、1例金黄色葡萄球菌(+)。经治疗后患者肩部窦道均顺利愈合,患肩红肿、疼痛等症状消失。4例患者随访时间分别为3、4、32、33个月。末次随访时均未出现感染复发,肩关节活动度及评分均较清创术前好转,其中2例术后出现肩关节感染症状1个月的早期清创患者VAS及ASES评分分别由术前的5分及40分、6分及23分,分别提升至1分及80分、1分及73分;另2例术后出现肩关节感染症状病程超过6个月的患者VAS评分及ASES评分分别由术前的6分及28分、6分及32分,分别改善至1分及62分、2分及65分。4例患者均对治疗结果表示满意。结论肩关节感染病程不超过1个月时,采用关节镜灌洗联合手术切开清创的方法治疗关节镜下肩袖修补术后感染可取得较好临床疗效。     

慢加急性肝衰竭患者发生肺部感染的现状及影响因素研究

目的 探讨乙型肝炎病毒相关慢加急性肝衰竭（HBV related acute-on-chronic liver failure,HBV-ACLF）患者发生肺部感染的现状及其影响因素。 方法 回顾性分析2017年1月—2019年12月于上海市某三级甲等医院传染科住院治疗的238例HBV-ACLF患者的病历资料,统计HBV-ACLF患者发生肺部感染的情况,并分析其影响因素。结果238例HBV-ACLF患者,发生肺部感染患者53例,感染率为22.27%;Logistic回归分析显示,高龄、使用激素、长期使用抗生素是HBV-ACLF患者发生肺部感染的独立危险因素。结论 HBV-ACLF患者年龄越大、使用激素、长期使用抗生素导致其肺部感染率增高,在HBV-ACLF患者的治疗及护理过程中,应结合发生肺部感染的相关影响因素,采取针对性干预措施,从而降低HBV-ACLF患者的肺部感染率。     

Recomendaciones prácticas para el manejo perioperatorio del paciente con sospecha o infección grave por coronavirus SARS-CoV-2

In December 2019, the Wuhan Municipal Health and health Commission (Hubei Province, China) reported a series of cases of pneumonia of unknown etiology. On January 7, 2020, the Chinese authorities identified as a causative agent of the outbreak a new type of virus of the Coronaviridiae family, called SARS-CoV-2. Since then, thounsands of cases have been reported with global dissemination. Infections in humans cause a broad clinical spectrum ranging from mild upper respiratory tract infection, to severe acute respiratory distress syndrome and sepsis. There is not specific treatment for SARS-CoV-2, which is why the fundamental aspects are to establish adequate prevention measures and support treatment and management of complications.     

Microbiology and clinical characteristics of industrial oil burns

IntroductionInfections complicating burns generally transition from Gram-positive to Gram-negatives over the first couple weeks, but this depends on multiple factors. The microbiology of infections complicating crude oil (CO) and hydraulic fracturing (FRAC) burns is unknown.MethodsWe performed a retrospective study of patients with industrial thermal burns hospitalized >2 days with ≥1 day in the ICU between 4/2011–11/2016. Burns were oil-related (ORB; CO or FRAC) or non-oil related (NORB). Epidemiology and microbiology during the first 15 hospital days was compared.Results149 patients were included, with 11 FRAC and 24 CO. CO burns were more severely burned than those with FRAC and NORB (p < 0.05). Mortality was 17% and 18% for CO and FRAC burns compared to 3% in NORB (p < 0.01). More cultures were obtained from ORB than NORB (p < 0.05). ORB were associated with Stenotrophomonas maltophilia and FRAC associated with Serratia marcescens and Candida glabrata. Patients with FRAC, CO and NORB had a median of 13, 3.5, and 4 days to first positive culture respectively (p = 0.03).ConclusionORB were associated with more severe burns and unique microbiology. FRAC burns had longer to initial positive culture, potentially suggesting our current methodology is inadequate to diagnose infections associated with FRAC.