Prediction tool for high risk of surgical site infection in spinal surgery

2020 ◽  
Vol 41 (7) ◽  
pp. 799-804
Author(s):  
Takanori Namba ◽  
Masaki Ueno ◽  
Gen Inoue ◽  
Takayuki Imura ◽  
Wataru Saito ◽  
...  
Keyword(s):  
High Risk ◽  
Surgical Site Infection ◽  
Spinal Surgery ◽  
Scoring System ◽  
Univariate Analysis ◽  
Risk Scores ◽  
Total Serum ◽  
Site Infection ◽  
Prevention Strategies ◽  
University Hospitals

AbstractObjective:The incidence of surgical site infection (SSI) is higher in spinal surgeries than in general orthopedic operations. In this study, we aimed to develop a scoring system with reduced health care costs for detecting spinal surgery patients at high risk for SSI.Design:Retrospective cohort study.Patients:In total, 824 patients who underwent spinal surgery at 2 university hospitals from September 2005 to May 2011.Methods:We reviewed the medical records of 824 patients, and we examined 19 risk factors to identify high-risk patients. After narrowing down the variables by univariate analysis, multiple logistic analysis was performed for factors with P values <.2, using SSI as a dependent variable. Only factors that showed P values <.05 were included in the final models, and each factor was scored based on the β coefficient values obtained. The clinical prediction rules were thereby prepared.Results:“Emergency operation,” “blood loss >400 mL,” “presence of diabetes,” “presence of skin disease,” and “total serum albumin value <3.2 g/dL” were detected by multivariable modeling and were incorporated into the risk scores. Applying these 5 independent predictive factors, we were able to predict the infection incidence after spinal surgery.Conclusions:Our present study could aid physicians in making decisions regarding prevention strategies in patients undergoing spinal surgery. Stratification of risks employing this scoring system will facilitate the identification of patients most likely to benefit from complex, time-consuming and expensive infection prevention strategies, thereby possibly reducing healthcare costs.

MD Anderson Scoring System (MDACC) Predicts Outcomes After Hematopoietic Stem Cell Transplantation (HSCT) Better Than Other Prognostic Classifications In MDS

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3340-3340
Author(s):  
Piyanuch Kongtim ◽  
Uday R Popat ◽  
Marcos de Lima ◽  
Guillermo Garcia-Manero ◽  
Elias J. Jabbour ◽  
...  
Keyword(s):  
High Risk ◽  
Scoring System ◽  
Risk Group ◽  
Univariate Analysis ◽  
Scoring Systems ◽  
Risk Groups ◽  
High Risk Group ◽  
Risk Scores ◽  
Hematopoietic Stem ◽  
Very High

Abstract MDS is a heterogeneous group of hematopoietic stem cell disorders. Various prognostic models have been established to categorize patients with MDS including the International Prognostic Scoring System (IPSS), the Revised-IPSS (r-IPSS) and MDACC Scoring System. In this analysis, we compared those three classification schemas for their outcome predictability after HSCT. We analyzed 291 MDS patients with a median age of 55 (interquartile range (IQR) 47-60.7 years) who underwent HSCT between January 2001 and December 2011. Histology by WHO classification included RA/RARS 48 (16.5%), RCMD 28 (9.6%), RAEB-1 59 (20.2%), RAEB-2 63 (21.7%), MDS unclassified 67 (23%), and CMML 26 (9%). Of 291, 117 patients (40.2%) had therapy related MDS (t-MDS). Conditioning regimen was myeloablative in 201 patients (69.1%) and reduced intensity in 90 patients (30.9%). Donors were matched related (MRD), matched unrelated (MUD), mismatched (MMD) in 131 (45%), 114 (39.2%) and 46 (15.8%) patients respectively. Risk categorization was performed by IPSS, r-IPSS and MDACC scoring systems at the time of diagnosis. IPSS, r-IPSS and MDACC scoring systems could be assessed in 239 (82.1%), 241 (82.8%) and 231 (79.4%) patients respectively. The median follow up time of 109 survivors was 45 months. The median time from diagnosis to HSCT was 7.3 months (IQR 4.6-12.4 months). Three-year overall survival (OS) was 38.1% (95%CI 32.3-43.9) with 3-year event free survival (EFS) of 34.2% (95%CI 28.4-40). Cumulative relapse incidence (RI) at 3-year was 28.8% (95%CI 23.3-34.5). Cumulative incidence of treatment related mortality (TRM) at 3 year post-transplant was 27.9% (95%CI 22.6-33.6). In univariate analysis, IPSS and r-IPSS were able to differentiate 2 risk groups for OS and EFS. High risk group per IPSS and very high risk group per r-IPSS had lower OS with hazard ratio (HR) of 2.4 to 3.1, lower EFS with HR of 2.2 to 2.7. While IPSS could not predict RI, very high risk group by r-IPSS had higher RI with HR of 3.6 compared with lower risk groups. Both IPSS and r-IPSS did not identify different risk groups for TRM. On the other hand, MDACC scoring system was able to identify 4 different risk groups for EFS and OS in univariate analysis. Three-year OS was 68%, 46.1%, 30.3% and 11.4% for patients with MDACC risk score of 0-4, 5-6, 7-8 and ≥9 respectively (p<0.001) (figure1). Three-year EFS with MDACC risk score of 0-4, 5-6, 7-8 and ≥9 was 61.7%, 40.8%, 28.1% and 7.4% respectively (p<0.001). For RI and TRM, only MDACC risk scores of ≥9 was associated with poor outcomes with 3-year RI of 38.9% and 3-year TRM of 41.7% compared with 13.3% and 15.5% in risk scores of 0-4 (p=0.01 and p=0.01 respectively). In multivariate analysis, MDACC score, matched unrelated and mismatched donors were associated with inferior OS (table1). As a summary, MDACC risk scoring system for MDS better differentiates prognostic groups than IPSS or r-IPSS. Considering the high frequency of t-MDS among transplanted MDS patients, we propose that MDACC scoring system should be used for prognostic classification for hematopoietic transplantation. Disclosures: No relevant conflicts of interest to declare.

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 Surgical Site Infection and Validity of Staged Surgical Procedure in Emergent/Urgent Surgery for Ulcerative Colitis

2013 ◽  
Vol 98 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Motoi Uchino ◽  
Hiroki Ikeuchi ◽  
Hiroki Matsuoka ◽  
Yoshiko Takahashi ◽  
Naohiro Tomita ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Risk Factor ◽  
Surgical Site Infection ◽  
Restorative Proctocolectomy ◽  
Odds Ratio ◽  
Standard Procedure ◽  
Univariate Analysis ◽  
Site Infection ◽  
Wound Class ◽  
Mucous Fistula

Abstract Although restorative proctocolectomy is recognized as a standard procedure for ulcerative colitis, infectious complications after surgery cannot be disregarded. The aim of this study was to define predictors of surgical site infection (SSI) in urgent/emergent surgery for ulcerative colitis. We performed prospective SSI surveillance for 90 consecutive patients. Possible risk factors were analyzed by logistic regression analyses. Incidences of incisional SSI (i-SSI) and organ/space SSI were 31.1% and 6.9%, respectively, and increased significantly with higher wound class (P &lt; 0.01). Multivariate analysis showed wound class ≥3 as an independent risk factor for i-SSI. In univariate analysis, although the mucous fistula procedure was a risk factor for i-SSI (odds ratio, 3.45; P &lt; 0.01), Hartmann procedure also represented a risk factor for o-SSI (odds ratio, 12.8; P &lt; 0.01). Urgent restorative proctocolectomy for patients without high wound class and emergent total colectomy with mucous fistula for patients with high wound class appear to represent feasible options.

Correlation between surgical site infection and obesity after exploratory laparotomy in trauma patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Abdelaziz ◽  
Ahmed Sabry ◽  
Mohamed Fayek
Keyword(s):  
Surgical Site Infection ◽  
Abdominal Trauma ◽  
Damage Control ◽  
Exploratory Laparotomy ◽  
Fascial Closure ◽  
Wound Complications ◽  
Trauma Patients ◽  
Obese Patients ◽  
Site Infection ◽  
University Hospitals

Abstract Background Obesity has become a major contributor to the global burden of chronic disease and disability. Understanding the effect of obesity on the incidence of wound infections and other wound complications remains incomplete despite considerable attention to both the growing ‘‘epidemic’’ of obesity and the frequent occurrence of surgical site infection (SSI) after surgical procedures. Damage-control laparotomy specifically has been associated with a higher rate of infectious complications and a lower rate of primary fascial closure in obese patients. Aim of the work The aim of the study is to evaluate the correlation between obesity and surgical site infection (SSI) in patients undergoing exploratory laparotomy after abdominal trauma. Patients and methods A retrospective study performed on obese patients of both genders aged between 18 and 60 years old undergoing exploratory laparotomy after abdominal trauma at the surgery departments of Ain Shams University Hospitals, Al-Bank Al-Ahly Hospital, Al-Mataria Hospital and Al-Salam Hospital, Cairo, Egypt for two years (1st of January 2018 to 1st of January 2020). Patients with infected wounds, receiving antibiotic therapy at the time of injury, those with a known immunodeficiency, who died within 48 hours after injury, who had sustained burn injuries, who underwent surgery at another institution before admission to our hospital were excluded. The rate of 30-day SSI post-operatively among obese and non-obese patients were compared. Statistical analysis was also done. Results Out of 782 patients, only 480 of those patients for whom BMI data were available, 360 (75%) were males and 120 (25%) were females. Out of the 480 patients: 168 patients had BMI more than 30; 114 patients (67.8%) had SSI (P &lt; 0.05), 312 patients had BMI less than 30; 61 patients (19.5%) had SSI. All of the included patients were fulfilling the inclusion and the exclusion criteria. On multivariate analysis, obesity was the strongest predictor of SSI (odds ratio = 1.59; 95% confidence interval, 1.32-1.91) after adjustment for sex and age. Obese patients with SSI compared with the non-obese had longer hospital stays (mean, 9.5 vs 8.1 days, respectively; P &lt; .001) and markedly higher rates of hospital readmission (27.1% vs 6.5%, respectively; P &lt; .001). Conclusion Obesity is considered as one of the risk factors in causing surgical site infection. Thus, this study showed the relation of BMI and obesity with surgical site infection in case of exploratory laparotomy after abdominal trauma.

scholarly journals Management of late-onset deep surgical site infection after instrumented spinal surgery

BMC Surgery ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Dong Yin ◽  
Bin Liu ◽  
Yunbing Chang ◽  
Honglin Gu ◽  
Xiaoqing Zheng
Keyword(s):  
Surgical Site Infection ◽  
Spinal Surgery ◽  
Late Onset ◽  
Site Infection ◽  
Deep Surgical Site Infection

Chlorhexidine Showers are Associated With a Reduction in Surgical Site Infection Following Spine Surgery: An Analysis of 4266 Consecutive Surgeries

Neurosurgery ◽  
2018 ◽  
Vol 85 (6) ◽  
pp. 817-826 ◽  
Author(s):  
Andrew K Chan ◽  
Simon G Ammanuel ◽  
Alvin Y Chan ◽  
Taemin Oh ◽  
Henry C Skrehot ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Subgroup Analysis ◽  
Spinal Surgery ◽  
Site Infection ◽  
Safe Patient Care ◽  
Significant Difference ◽  
Additional Costs ◽  
Procedure Type

Abstract BACKGROUND Surgical site infection (SSI) is a common complication following spinal surgery. Prevention is critical to maintaining safe patient care and reducing additional costs associated with treatment. OBJECTIVE To determine the efficacy of preoperative chlorhexidine (CHG) showers on SSI rates following fusion and nonfusion spine surgery. METHODS A mandatory preoperative CHG shower protocol was implemented at our institution in November 2013. A cohort comparison of 4266 consecutive patients assessed differences in SSI rates for the pre- and postimplementation periods. Subgroup analysis was performed on the type of spinal surgery (eg, fusion vs nonfusion). Data represent all spine surgeries performed between April 2012 and April 2016. RESULTS The overall mean SSI rate was 0.4%. There was no significant difference between the pre- (0.7%) and postimplementation periods (0.2%; P = .08). Subgroup analysis stratified by procedure type showed that the SSI rate for the nonfusion patients was significantly lower in the post- (0.1%) than the preimplementation group (0.7%; P = .02). There was no significant difference between SSI rates for the pre- (0.8%) and postimplementation groups (0.3%) for the fusion cohort (P = .21). In multivariate analysis, the implementation of preoperative CHG showers were associated with significantly decreased odds of SSI (odds ratio = 0.15, 95% confidence interval [0.03-0.55], P &lt; .01). CONCLUSION This is the largest study investigating the efficacy of preoperative CHG showers on SSI following spinal surgery. In adjusted multivariate analysis, CHG showering was associated with a significant decrease in SSI following spinal surgery.

scholarly journals Effect of intrawound vancomycin application in spinal surgery on the incidence of surgical site infection: a meta-analysis

2018 ◽  
Vol Volume 14 ◽  
pp. 2149-2159 ◽  
Author(s):  
Abuduwufuer Tailaiti ◽  
Jun Shang ◽  
Shuo Shan ◽  
Aikeremujiang Muheremu
Keyword(s):  
Surgical Site Infection ◽  
Spinal Surgery ◽  
Meta Analysis ◽  
Site Infection

Scoring System to Predict the Risk of Surgical Site Infection in Patients with Esophageal Cancer after Esophagectomy with Cervical Anastomosis

2018 ◽  
Vol 19 (7) ◽  
pp. 696-703 ◽  
Author(s):  
Li-xia Yin ◽  
Bao-min Chen ◽  
Ge-fei Zhao ◽  
Qi-feng Yuan ◽  
Qi Xue ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Surgical Site Infection ◽  
Scoring System ◽  
Site Infection ◽  
Cervical Anastomosis
Sign in / Sign up

Export Citation Format

Share Document