scholarly journals A 5-Year Audit of Accidental Dural Punctures, Postdural Puncture Headaches, and Failed Regional Anesthetics at a Tertiary-Care Medical Center

2009 ◽  
Vol 9 ◽  
pp. 715-722 ◽  
Author(s):  
Sukhdip Singh ◽  
Shagufta Y. Chaudry ◽  
Amy L. Phelps ◽  
Manuel C Vallejo

Obstetric anesthesia-related complications occur as a result of labor epidural or spinal placement. The purpose of this continuous quality-improvement audit was to review the occurrence of accidental dural punctures (ADPs), postdural puncture headaches (PDPHs), and failed regional anesthetics at an academic tertiary-care medical center over a 5-year period. Obstetric anesthesia complications contained in three databases consisting of ADPs, PDPHs, and failed regional anesthetics were matched to a perinatal database, with no complications serving as controls. Of the 40,894 consecutive parturients, there were 765 documented complications. Complication rates were 0.73% (95% CI: 0.65–0.82) for ADP, 0.49% (95% CI: 0.43–0.56) for PDPH, and 0.65% (95% CI: 0.57–0.73) for failed regional anesthetic. When compared to the no complication group, factors associated with obstetric anesthesia complications included increased weight and BMI (p< 0.01), epidural block (p< 0.01), and vaginal delivery (p< 0.01).

1999 ◽  
Vol 20 (9) ◽  
pp. 604-606 ◽  
Author(s):  
Christian Ruef

AbstractObjective:Assessment of the distribution of tasks and consultations provided by the hospital epidemiologist (HE) at University Hospital of Zurich (UHZ).Design:Prospective collection of data on hospital epidemiology consultations over a 3-year period (1995-1997). Time spent per consultation and activities of infection control practitioners were not recorded.Setting:A 1,040-bed tertiary-care university hospital in Zurich, Switzerland.Results:Between January 1, 1995, and December 31, 1997, the HE received 1,660 requests for consultation. Advice or action was sought in the following areas: epidemiology (27.5% of requests); quality assurance, including antibiotic utilization and technology assessment (24.8%); infection control and practice guidelines (22.5%); disinfection and sterilization (11.6%); clinical infectious diseases (13.4%). During 1997, 35% of epidemiology consults were related to methicillin-resistant Staphylococcus aureus and 5.8% to tuberculosis. Public or private hospitals not affiliated with UHZ requested 40% of all consults.Conclusions:This study shows that HEs are involved in many different activities. Only 27.5% of hospital epidemiology consultations were directly related to issues of epidemiology. Practical knowledge of the methodologies for continuous quality improvement and assessment of various new technologies is important for HEs. The results of this study may be useful in discussions between HEs and administrators about allocation of resources or issues of reimbursement.


2021 ◽  
Vol 77 (18) ◽  
pp. 3123
Author(s):  
Anish Samuel ◽  
Ashesha Mechineni ◽  
Robin Craven ◽  
Wilbert Aronow ◽  
Mourad Ismail ◽  
...  

2021 ◽  
Vol 09 (06) ◽  
pp. E888-E894
Author(s):  
Nichol S. Martinez ◽  
Sumant Inamdar ◽  
Sheila N. Firoozan ◽  
Stephanie Izard ◽  
Calvin Lee ◽  
...  

Abstract Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.


2016 ◽  
Vol 127 (10) ◽  
pp. 3335-3340 ◽  
Author(s):  
Kapil Gururangan ◽  
Babak Razavi ◽  
Josef Parvizi

1999 ◽  
Vol 20 (6) ◽  
pp. 408-411 ◽  
Author(s):  
Murray A. Abramson ◽  
Daniel J. Sexton

Objective:To determine the attributable hospital stay and costs for nosocomial methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistantS aureus(MRSA) primary bloodstream infections (BSIs).Design:Pairwise-matched (1:1) nested case-control study.Setting:University-based tertiary-care medical center.Patients:Patients admitted between December 1993 and March 1995 were eligible. Cases were defined as patients with a primary nosocomialS aureusBSI; controls were selected according to a priori matching criteria.Measurements:Length of hospital stay and total and variable direct costs of hospitalization.Results:The median hospital stay attributable to primary nosocomial MSSA BSI was 4 days, compared with 12 days for MRSA (P=.023). Attributable median total cost for MSSA primary nosocomial BSIs was $9,661 versus $27,083 for MRSA nosocomial infections (P=.043).Conclusion:Nosocomial primary BSI due toS aureussignificantly prolongs the hospital stay. Primary nosocomial BSIs due to MRSA result in an approximate threefold increase in direct cost, compared with those due to MSSA.


2016 ◽  
Vol 31 (1) ◽  
pp. 120-126 ◽  
Author(s):  
Manuel C. Vallejo ◽  
Ahmed F. Attaallah ◽  
Robert E. Shapiro ◽  
Osama M. Elzamzamy ◽  
Michael G. Mueller ◽  
...  

2014 ◽  
Vol 25 (2) ◽  
pp. 705-716 ◽  
Author(s):  
Sabrina A. Assoumou ◽  
Wei Huang ◽  
C. Robert Horsburgh ◽  
Mus ◽  
Benjamin P. Linas

2001 ◽  
Vol 81 (5) ◽  
pp. 530-535 ◽  
Author(s):  
L. K. Ngutter ◽  
J. M. Koler ◽  
C. H. McCollough ◽  
R. J. Vetter

2011 ◽  
pp. P3-450-P3-450
Author(s):  
Jeremy R Grogg ◽  
Pooja Singal ◽  
Abhilasha Jarori ◽  
James P Walsh

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