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Background
Surgical site infections (SSI) are a major cause of morbidity and mortality in surgical patients. Postoperative and total hospital length of stay (LOS) are known to be prolonged by the occurrence of SSI. Preoperative LOS may increase the risk of SSI. This study aims at identifying the associations of pre- and postoperative LOS in hospital and intensive care with the occurrence of SSI.Methods
This observational cohort study includes general, orthopedic trauma and vascular surgery patients at two tertiary referral centers in Switzerland between February 2013 and August 2015. The outcome of interest was the 30-day SSI rate.Results
We included 4596 patients, 234 of whom (5.1%) experienced SSI. Being admitted at least 1 day before surgery compared to same-day surgery was associated with a significant increase in the odds of SSI in univariate analysis (OR 1.65, 95% CI 1.25–2.21, p?<?0.001). More than 1 day compared to 1 day of preoperative hospital stay did not further increase the odds of SSI (OR 1.08, 95% CI 0.77–1.50, p?=?0.658). Preoperative admission to an intensive care unit (ICU) increased the odds of SSI as compared to hospital admission outside of an ICU (OR 2.19, 95% CI 0.89–4.59, p?=?0.057). Adjusting for potential confounders in multivariable analysis weakened the effects of both preoperative admission to hospital (OR 1.38, 95% CI 0.99–1.93, p?=?0.061) and to the ICU (OR 1.89, 95% CI 0.73–4.24, p?=?0.149).Conclusion
There was no significant independent association between preoperative length of stay and risk of SSI while SSI and postoperative LOS were significantly associated.2.
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Candida
infections have become a major source of morbidity and mortality in the modern surgical intensive care unit. The most common
risks for invasion and dissemination are the use of antibiotics, central venous lines, total parenteral nutrition, burns,
immunosuppression, and other markers for severity of illness (APACHE > 10, ventilatory use for > 48 hours). Data suggest that
colonization can be a late predictor of invasive disease in today’s critically ill surgical patient and that prophylaxis or
early treatment in high risk patients is warranted, particularly before invasive/disseminated disease becomes life-threatening.
When advanced disease is present, the diagnosis of invasive or disseminated
Candida
infection is often prompted by clinical suspicion and supported by consistent clinical data; laboratory tests alone lack
sufficient sensitivity and specificity to direct therapeutic decision-making. Once the diagnosis of invasive or disseminated
Candida
infection is ascertained, early systemic treatment, along with treatment of localized infection, is as fundamental as with
any other serious infectious disease. Reported toxicity and efficacy supports the use of fluconazole for most patients with
invasive/disseminated
Candida
infections. For the most critically ill surgical patient amphotericin B remains the treatment of choice. Prophylaxis and
early treatment strategies with minimally toxic agents may diminish the need to use more toxic therapy in the most severely
ill patients. 相似文献
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Impact of an Institutional Antimicrobial Stewardship Program on Bacteriology of Surgical Site Infections in Cardiac Surgery 下载免费PDF全文
Adeel Ashfaq M.P.H. Allen Zhu B.S. Amit Iyengar M.S. Hoover Wu B.S. Romney Humphries Ph.D. James A. McKinnell M.D. Richard Shemin M.D. Peyman Benharash M.D. 《Journal of cardiac surgery》2016,31(6):367-372
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Rachel Rosenthal Walter P. Weber Marcel Zwahlen Heidi Misteli Stefan Reck Daniel Oertli Andreas F. Widmer Walter R. Marti 《World journal of surgery》2009,33(6):1165-1173
Background Despite availability of other training forms, tutorial assistance cannot be entirely replaced in surgical education. Concerns
exist that tutorial assistance may lead to an increased rate of surgical site infection (SSI). The purpose of the present
study was to investigate whether the risk of SSI is higher after surgery with tutorial assistance than after surgery performed
autonomously by a fully trained surgeon.
Methods All consecutive visceral, vascular, and traumatological inpatient procedures at a Swiss University Hospital were prospectively
recorded during a 24-month period, and the patients were followed for 12 months to ascertain the occurrence of SSI. Using
univariable and multivariable logistic regressions, we assessed the association of tutorial assistance surgery with SSI in
6,103 interventions.
Results Autonomously performed surgery was associated with SSI in univariable analysis (5.36% SSI vs. 3.81% for tutorial assistance,
p = 0.006). In multivariable analysis, the odds of SSI for tutorial assistance was no longer significantly lower (Odds Ratio
[OR] = 0.82; 95% Confidence Interval [CI]: 0.62–1.09; p = 0.163).
Conclusions Surgical training does not lead to higher SSI rate if trainees are adequately supervised and interventions are carefully selected.
Although other forms of training are useful, tutorial assistance in the operating room continues to be the mainstay of surgical
education. 相似文献
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Chris A. Anthony Ryan A. Peterson Daniel K. Sewell Linnea A. Polgreen Jacob E. Simmering John J. Callaghan Philip M. Polgreen 《The Journal of arthroplasty》2018,33(2):510-514.e1
Background
Surgical site infections (SSIs) after total knee (TKA) and total hip (THA) arthroplasty are devastating to patients and costly to healthcare systems. The purpose of this study is to investigate the seasonality of TKA and THA SSIs at a national level.Methods
All data were extracted from the National Readmission Database for 2013 and 2014. Patients were included if they had undergone TKA or THA. We modeled the odds of having a primary diagnosis of SSI as a function of discharge date by month, payer status, hospital size, and various patient co-morbidities. SSI status was defined as patients who were readmitted to the hospital with a primary diagnosis of SSI within 30 days of their arthroplasty procedure.Results
There were 760,283 procedures (TKA 424,104, THA 336,179) in our sample. Our models indicate that SSI risk was highest for patients discharged from their surgery in June and lowest for December discharges. For TKA, the odds of a 30-day readmission for SSI were 30.5% higher at the peak compared to the nadir time (95% confidence interval [CI] 20-42). For THA, the seasonal increase in SSI was 19% (95% CI 9-30). Compared to Medicare, patients with Medicaid as the primary payer had a 49% higher odds of 30-day SSI after TKA (95% CI 32-68).Conclusion
SSIs following TKA and THA are seasonal peaking in summer months. Payer status was also a significant risk factor for SSIs. Future studies should investigate potential factors that could relate to the associations demonstrated in this study. 相似文献12.
Xin Lu Tyson P. Hagen Mary S. Vaughan-Sarrazin Peter Cram 《Clinical orthopaedics and related research》2009,467(10):2577-2586
Published studies of physician-owned specialty hospitals have typically examined the impact of these hospitals on disparities,
quality, and utilization at a national level. Our objective was to examine the impact of newly opened physician-owned specialty
orthopaedic hospitals on individual competing general hospitals. We used Medicare Part A administrative data to identify all
physician-owned specialty orthopaedic hospitals performing total hip arthroplasty (THA) and total knee arthroplasty (TKA)
between 1991 and 2005. We identified newly opened specialty hospitals in three representative markets (Durham, NC, Kansas
City, and Oklahoma City) and assessed their impact on surgical volume and patient case complexity for the five competing general
hospitals located closest to each specialty hospital. The average general hospital maintained THA and TKA volume following
the opening of the specialty hospitals. The average general hospital also did not experience an increase in patient case complexity.
Thus, based on these three markets, we found no clear evidence that entry of physician-owned specialty orthopaedic hospitals
resulted in declines in THA or TKA volume or increases in patient case complexity for the average competing general hospital. 相似文献
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Diana M Hübner M Eisenring MC Zanetti G Troillet N Demartines N 《World journal of surgery》2011,35(2):280-288