scholarly journals Liberal and Restrictive Blood Transfusion Strategies in Orthopedic Surgery: Risk Factors for Surgical Site Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s313-s314
Author(s):  
Hoberdan Pereira ◽  
Marcelo Perucci ◽  
Lucas de Lima ◽  
Daniel Bodour ◽  
Laura Vieira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Surgical Site Infection ◽  
Surgical Procedures ◽  
Orthopedic Surgery ◽  
Lower Limb ◽  
Blood Transfusions ◽  
Site Infection ◽  
Lower Limb Fractures ◽  
Limb Fractures

Background: The identification of risk factors for infections in surgical patients with lower-limb fractures and blood transfusions has increased in recent years. Surgical site infections (SSIs) increase hospitalization, care costs, and patient suffering. Correction surgery for lower-limb fractures and blood transfusion is quite common between surgical procedures. The aim of this study was to describe the relationship between blood transfusion and SSI in patients undergoing orthopedic surgery on lower limbs. Methods: We conducted a prospective cohort study to identify risk factors for SSI in blood transfused patients undergoing fracture repair in lower-limb surgeries between February 2017 and May 2019 in 2 reference tertiary-care hospitals in Belo Horizonte, a city of 3 million people in Brazil. Data regarding patient characteristics, surgical procedures, blood transfusions, and surgical infections were collected. Patient characterization was performed by calculating the absolute and relative frequencies of categorical variables and calculating mean, median, minimum, maximum, standard deviation, and coefficient of variation for quantitative variables. The incidence of surgical site infection, the risk of postoperative hospital death, and the total length of hospital stay were calculated by point estimates and 95% confidence intervals identified by statistical tests of bilateral hypotheses, considering the level of significance of 5%. A multivariate analysis (logistic regression) was performed to identify SSI risk factors. Results: Patients who had an indication for blood transfusion (n = 38) but who did not receive blood (n = 4) had significantly lower hemoglobin, comparing discharge with admission, than the group who received blood. Intraoperative transfusion was a risk factor for SSI (OR, 4.7) (Fig. 1). Among the 205 patients with no indication for transfusion, 98 received blood even without the indication: there was no difference in hemoglobin outcome when discharge and admission were compared, and the 98 patients were exposed to unnecessary risk. Regarding restrictive versus liberal transfusion strategies, there were differences in the variables, age (P = .000), duration of surgery (P = .003), number of comorbidities (P = .000), body mass index (BMI) (P = .027), previous hemoglobin (P = .000), and high hemoglobin (P = .000), considering the transfusion practice employed (Fig. 2). Conclusions: The indications for and definition of protocols and careful evaluation of blood transfusion are critical to avoid infectious complications in orthopedic patients with lower-limb fractures.Funding: NoneDisclosures: None

scholarly journals Microbiology and Risk Factors of Surgical Site Infection in Limb Fractures

2020 ◽  
Author(s):  
Junchao Luo ◽  
Xinji Chen ◽  
Yu Tong ◽  
Yin Zhang ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Open Fractures ◽  
Site Infection ◽  
Chi Square ◽  
Orthopedic Surgeons ◽  
Lower Limb Fractures ◽  
Microbiological Characteristics ◽  
Zhejiang Provincial ◽  
Limb Fractures

Abstract Background: Limb fractures are becoming more common, and implant implants increase the risk of surgical site infection.The purpose of this study was to identify risk factors and microbiological characteristics for surgical site infection of limb fractures.Methods: We reviewed the data of 4,478 patients with limb fractures treated at Zhejiang Provincial People's Hospital from January 2010 to January 2020, including demographic, fracture, and microbiological characteristics. Chi-square tests and multivariate logistic regression were used to identify risk factors.Results: Staphylococcus aureus is a major threat to surgical site infection of limb fractures (26.46%). Open fractures are a risk factor for gram-negative infections. The following factors are considered as risk factors for surgical site infection: lower limb fractures, diabetes mellitus (OR 2.911 ; 95% CI 1.767-4.793), hypoproteinemia (OR 5.153 ; 95% CI 2.478-10.714), vascular injury(OR 8.531 ; 95% CI 4.028-18.070), nerve injury(OR 1.966 ; 95% CI 1.132-3.414) and open fractures (OR 9.561 ; 95% CI 6.565-13.925).Conclusions: Patients with these factors are at risk of surgical site infection after open reduction and internal fixation, and orthopedic surgeons should pay attention to these patients.

scholarly journals Nomogram prediction of surgical site infection of HIV-infected patients following orthopedic surgery: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rui Ma ◽  
Jie He ◽  
Biao Xu ◽  
Changsong Zhao ◽  
Yao Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Orthopedic Surgery ◽  
Operating Characteristic ◽  
Multiple Logistic Regression Analysis ◽  
Hiv Positive ◽  
Cutoff Score ◽  
Site Infection ◽  
Erythrocyte Sedimentation ◽  
Immunodeficiency Virus

Abstract Background Surgical site infection (SSI) is a devastating complication of orthopedic surgery, related with increased morbidity and mortality. This study was performed with the aim to compare the SSI rate in human immunodeficiency virus HIV-positive patients, to identify other risk factors for SSI and to establish a nomogram model to predict the risk of SSI. Methods A total of 101 HIV-positive individuals following orthopedic surgery patients admitted to Beijing Ditan Hospital. Their characteristics were gathered. The univariate and multiple logistic regression analysis were performed to explore the risk factors of SSI. And the Nomogram prediction model was constructed and verified. Results The independent predictive factors of SSI included CD4 (Odds ratio [OR], 0.041; P = 0.040), erythrocyte sedimentation rate (ESR) (OR, 89.773; P = 0.030), and procalcitonin (PCT) (OR, 220.746; P = 0.006). The scoring nomogram model was as follows: Logit (SSI) = − 2.63589–0.00314*CD4 < 430.75 = 1) + 0.04695*(ESR < 17.46 = 1) + 2.93694*(PCT < 0.22 = 1). The area under the Receiver Operating Characteristic (ROC) curve was 0.946. The cutoff score was − 2.1026 with a sensitivity of 93.33% and a specificity of 84.88%. Conclusions CD4, ESR, PCT might affect the occurrence of SSI after orthopedic surgery. The nomogram model constructed in this study is helpful for predicting the probability of SSI.

scholarly journals Developing a Risk Stratification Model for Surgical Site Infection after Abdominal Hysterectomy

2009 ◽  
Vol 30 (11) ◽  
pp. 1077-1083 ◽  
Author(s):  
Margaret A. Olsen ◽  
James Higham-Kessler ◽  
Deborah S. Yokoe ◽  
Anne M. Butler ◽  
Johanna Vostok ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Insurance ◽  
Blood Transfusion ◽  
Risk Stratification ◽  
Surgical Site Infection ◽  
Private Health Insurance ◽  
Abdominal Hysterectomy ◽  
Site Infection ◽  
Independent Risk Factors ◽  
Duration Of Operation

Objective.The incidence of surgical site infection (SSI) after hysterectomy ranges widely from 2% to 21%. A specific risk stratification index could help to predict more accurately the risk of incisional SSI following abdominal hysterectomy and would help determine the reasons for the wide range of reported SSI rates in individual studies. To increase our understanding of the risk factors needed to build a specific risk stratification index, we performed a retrospective multihospital analysis of risk factors for SSI after abdominal hysterectomy.Methods.Retrospective case-control study of 545 abdominal and 275 vaginal hysterectomies from July 1, 2003, to June 30, 2005, at 4 institutions. SSIs were defined by using Centers for Disease Control and Prevention/National Nosocomial Infections Surveillance criteria. Independent risk factors for abdominal hysterectomy were identified by using logistic regression.Results.There were 13 deep incisional, 53 superficial incisional, and 18 organ-space SSIs after abdominal hysterectomy and 14 organ-space SSIs after vaginal hysterectomy. Because risk factors for organ-space SSI were different according to univariate analysis, we focused further analyses on incisional SSI after abdominal hysterectomy. The maximum serum glucose level within 5 days after operation was highest in patients with deep incisional SSI, lower in patients with superficial incisional SSI, and lowest in uninfected patients (median, 189, 156, and 141 mg/dL, respectively; P = .005). Independent risk factors for incisional SSI included blood transfusion (odds ratio [OR], 2.4) and morbid obesity (body mass index [BMI], >35; OR, 5.7). Duration of operation greater than the 75th percentile (OR, 1.7), obesity (BMI, 30–35; OR, 3.0), and lack of private health insurance (OR, 1.7) were marginally associated with increased odds of SSI.Conclusions.Incisional SSI after abdominal hysterectomy was associated with increased BMI and blood transfusion. Longer duration of operation and lack of private health insurance were marginally associated with SSI.

scholarly journals Risk Factors For Traumatic Open Fracture in Children and Adolescents Presenting With Traumatic Fractures

2021 ◽  
Author(s):  
Hongwei Wang ◽  
Jun Liu ◽  
Deluo Wu ◽  
Lan Ou ◽  
Changqing Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Children And Adolescents ◽  
Lower Limb ◽  
Open Fracture ◽  
Fracture Site ◽  
Open Fractures ◽  
Multiple Fractures ◽  
Lower Limb Fractures ◽  
Limb Fractures ◽  
Upper Limb Fractures

Abstract Background: To investigate the risk factors for open fractures in children and adolescents (≤18 years old) presenting with traumatic fractures.Methods: We retrospectively reviewed the records of 2418 children and adolescents who presented with traumatic fractures and were admitted to our university-affiliated hospitals, among which 206 patients (8.5%) presented with open fractures.Results: This study enrolled 1789 males (74.0%) and 629 females (26.0%) with an average age of 11.2±5.0 years. There were 206 patients (8.5%) who presented with open fractures. The five most common fracture sites were the tibia (31.1%, 64/206), fibula (20.9%, 43/206), phalanx (15.5%, 32/206), humerus (11.2%, 23/206) and ulna (9.7%, 20/206). Univariate logistic regression analysis showed that the aetiology (P﹤0.001) and fracture site (P﹤0.001) were risk factors for open fracture. Multivariate logistic regression analysis indicated that mechanical trauma (OR=64.229, P﹤0.001), being hurt/cut by others (OR=26.757, P﹤0.001), and being struck by an object (OR=15.345, P﹤0.001) were stronger risk factors for open fracture than were low falls; additionally, lower limb fractures (OR=5.970, P﹤0.001), upper limb fractures (OR=5.865, P﹤0.001) and multiple fractures (OR=5.414, P﹤0.001) were stronger risk factors than craniofacial fractures for open fractures.Conclusions: Aetiology (especially being injured by a machine or being hurt/cut by others) and the fracture site (including lower limb fractures, upper limb fractures and multiple fractures) were independent risk factors for open fractures.

Clinical effects and risk factors of far cortical locking system in the treatment of lower limb fractures

Injury ◽  
2019 ◽  
Vol 50 (2) ◽  
pp. 432-437 ◽  
Author(s):  
Renkai Wang ◽  
Hao Zhang ◽  
Haocheng Cui ◽  
Zhenyu Fan ◽  
Kaihang Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lower Limb ◽  
Clinical Effects ◽  
Lower Limb Fractures ◽  
Limb Fractures
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