Patient-Related Risk Factors for Postoperative Infection After Cholecystectomy.
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ABSTRACT:
SUBMITTER: Jaafar G
PROVIDER: S-EPMC5544799 | biostudies-other | 2017 Sep
REPOSITORIES: biostudies-other
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Project description:BackgroundThere are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy.MethodsA retrospective cohort of commercially insured persons aged 18-64 years was assembled using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition codes for cholecystectomy from December 31, 2004 to December 31, 2010. Complex procedures and patients (eg, cancer, end-stage renal disease) and procedures with pre-existing infection were excluded. Surgical site infections within 90 days after cholecystectomy were identified by ICD-9-CM diagnosis codes. A Cox proportional hazards model was used to identify independent risk factors for SSI.ResultsSurgical site infections were identified after 472 of 66566 (0.71%) cholecystectomies; incidence was higher after open (n = 51, 4.93%) versus laparoscopic procedures (n = 421, 0.64%; P < .001). Independent risk factors for SSI included male gender, preoperative chronic anemia, diabetes, drug abuse, malnutrition/weight loss, obesity, smoking-related diseases, previous Staphylococcus aureus infection, laparoscopic approach with acute cholecystitis/obstruction (hazards ratio [HR], 1.58; 95% confidence interval [CI], 1.27-1.96), open approach with (HR, 4.29; 95% CI, 2.45-7.52) or without acute cholecystitis/obstruction (HR, 4.04; 95% CI, 1.96-8.34), conversion to open approach with (HR, 4.71; 95% CI, 2.74-8.10) or without acute cholecystitis/obstruction (HR, 7.11; 95% CI, 3.87-13.08), bile duct exploration, postoperative chronic anemia, and postoperative pneumonia or urinary tract infection.ConclusionsAcute cholecystitis or obstruction was associated with significantly increased risk of SSI with laparoscopic but not open cholecystectomy. The risk of SSI was similar for planned open and converted procedures. These findings suggest that stratification by operative factors is important when comparing SSI rates between facilities.
| S-EPMC5419069 | biostudies-literature
Project description:Stress-related cardiomyopathy can develop during the postoperative period due to surgery-related stress factors. However, the prevalence and risk factors for this condition are not yet known. During a retrospective, observational study, patients older than 19 years who underwent procedures from January 2011 to December 2015 at a tertiary hospital were included. The main aim was to identify the prevalence and related risk factors for postoperative stress-related cardiomyopathy. To estimate the incidence per risk factor, univariate and multivariate Poisson regression analyses were performed. During the 5-year period, 95,840 patients older than 19 years underwent 125,314 procedures, and the prevalence of postoperative stress-related cardiomyopathy was 17.74 per 100,000 (95% confidence interval, 9.31-26.17), with an in-hospital mortality of 23.5%. As a result, three risk factors were significantly associated: preoperative American Society of Anesthesiologists classification (incidence rate ratio, 5.901 for American Society of Anesthesiologists class 1-2 [ref] versus 3-6; 95% confidence interval,1.289-27.002; P = 0.022); preoperative body mass index (incidence rate ratio, 1.247 for increases of 18.5 [ref] to 30; 95% confidence interval, 1.067-1.458; P = 0.006); and preoperative serum sodium (incidence rate ratio, 0.830 for each increase of 10 mmol/L from 130; 95% confidence interval, 0.731-0.942; P = 0.004). The incidence rate ratio for age for each increase of 10 years from 50 years was 1.057, but it was not statistically significant (P = 0.064). Our study found that the prevalence of postoperative stress-related cardiomyopathy was 17.74 patients per 100,000 adult patients over the course of 5 years, with four cases of in-hospital mortality. Factors that increased the risk of postoperative stress-related cardiomyopathy included higher American Society of Anesthesiologists class (≥3), preoperative hyponatremia, and higher preoperative body mass index.
| S-EPMC5738130 | biostudies-literature
Project description:BackgroundStudies on postoperative infection (POI) after surgery for ischemic cardiomyopathy are still lacking. This study aimed to investigate the risk factors of POI and its influence on clinical outcomes in patients undergoing ischemic cardiomyopathy surgery.MethodsThe Surgical Treatment for Ischemic Heart Failure (STICH) trial randomized patients with ischemic cardiomyopathy [coronary artery disease (CAD) with left ventricular ejection fraction ≤35%] to surgical and medical therapy. In this study, a post hoc analysis of the STICH trial was performed to assess the risk factors and clinical outcomes of POI in those undergoing coronary artery bypass graft (CABG). Patients were divided according to whether POI developed during hospitalization or within 30 days from operation.ResultsOf the 2,136 patients randomized, 1,460 patients undergoing CABG per-protocol was included, with a POI rate of 10.2% (149/1,460). By multivariable analysis, POI was significantly related to patients' age, body mass index, depression, chronic renal insufficiency, Duke CAD Index, and mitral valve procedure. Compared to patients without POI, patients with POI had significantly longer durations of intubation, CCU/ICU and hospital stay, and higher rates of re-operation, in-hospital death and failed discharge within 30 days postoperatively. In addition, these patients had significantly higher risks of all-cause death, cardiovascular death, heart failure death, and all-cause hospitalization during long-term follow-up. However, the influence of POI on all-cause death was mainly found during the first year after operation, and the influence was not significant for patients surviving for more than 1 year.ConclusionsPOI was prevalent after surgery for ischemic cardiomyopathy and was closely related to short-term and long-term clinical outcomes, and the effect of POI mainly occurred within the first postoperative year. This study first reported and clarified the relationship between POI and long-term prognosis and the predictors for POI after surgery for ischemic cardiomyopathy worldwide, which may have certain guiding significance for clinical practice.Clinical trial registrationhttps://www.clinicaltrials.gov, identifier (NCT00023595).
| S-EPMC10483997 | biostudies-literature
Project description:Background:Odontogenic cysts associated with lower third molar are common. The prognosis for surgical treatment is relatively good. However, postoperative infection discourages the clinicians. Hence, we would like to investigate the factors associated with infection after surgical treatment of cysts associated with the mandibular third molar. Methods:We retrospectively reviewed the medical and radiographic records of 81 patients who were diagnosed with dentigerous cyst or odontogenic keratocyst and underwent cyst enucleation. The factors affecting postoperative infection were divided into host factor, treatment factor, and cystic lesion factor. To identify the factors associated with postoperative infection, we attempted to find out the variables with significant differences between the groups with and without infection. Results:A total of 81 patients (64 male and 17 female) were enrolled in this study. There was no statistical relationship about the postoperative infection between all variables (gender, smoking, diabetes mellitus, age, bone grafting, related tooth extraction, previous marsupialization or decompression, type of antibiotics, cortical perforation associated with cystic lesion, preoperative infection, preoperative cyst size). Conclusions:The results of this study suggest that it is not necessary to avoid bone grafts that are concerned about postoperative infection.
| S-EPMC7028876 | biostudies-literature
Project description:Postoperative infection is an important factor contributing to poor prognosis after surgical treatment of cerebral cavernous malformations (CCM). However, the predictive factors of postoperative infection-related complications in adult patients with CCM have still not been well established. To identify possible predictive factors of postoperative infection after CCM surgery, we retrospectively evaluated the data of CCM patients who were enrolled into our prospective registry database. The relationship between preoperative characteristics of patients and postoperative infection-related complications was analyzed. A total of 167 CCM patients were included in this study. The average age was 39.69?±?15.27 years old, and 21 of them had postoperative infection. For patients with postoperative infection, the Glasgow Coma Scale (GCS), Modified Rankin Scale (mRS), white blood cell (WBC) count, and neutrophil (NEU) count were all significantly higher than those of the group without infection. Our preliminary results showed that NEU count might have significant predictive value of intracranial infection, and GCS, mRS and CCM presenting with hemorrhage were all factors significantly related to postoperative pneumonia. Preoperative GCS, mRS and CCM presenting with hemorrhage might be used as predictive factors for postoperative pneumonia after CCM surgery, while preoperative NEU count can be used as an important predictive factor for postoperative intracranial infection after CCM surgery. Further large-scale studies are still needed to confirm this finding.
| S-EPMC6972745 | biostudies-literature
Project description:BackgroundPeriprosthetic joint infections (PJIs) are dreaded complications of total joint arthroplasties. The risk of developing PJIs is likely to be influenced by several patient factors such as sociodemographic characteristics, body mass index (BMI), and medical and surgical histories. However, the nature and magnitude of the long-term longitudinal associations between these patient-related factors and risk of developing PJIs are uncertain.ObjectiveTo conduct a systematic review and meta-analysis to assess the associations between several patient-related factors and PJI.Data sourcesMEDLINE, EMBASE, Web of Science, Cochrane Library, and reference lists of relevant studies from inception to September 2015.Study selectionLongitudinal studies with at least one-year of follow-up for PJIs after total joint arthroplasty.Data extraction and synthesisTwo investigators extracted data on study characteristics, methods, and outcomes. A consensus was reached with involvement of a third. The relative risk (RR) with 95% confidence intervals was used as the summary measure of association across studies. Study-specific RRs with 95% confidence intervals were meta-analysed using random effect models and were grouped by study-level characteristics.ResultsSixty-six observational (23 prospective cohort and 43 retrospective cohort or case-control) studies with data on 512,508 participants were included. Comparing males to females and smokers to non-smokers, the pooled RRs for PJI were 1.36 (1.18-1.57) and 1.83 (1.24-2.70) respectively. There was no evidence of any significant associations of PJI with age and high alcohol intake. Comparing BMI ≥ 30 versus < 30 kg/m(2); ≥ 35 versus < 35 kg/m(2); and ≥ 40 versus < 40 kg/m(2); the pooled RRs were 1.60 (1.29-1.99); 1.53 (1.22-1.92); and 3.68 (2.25-6.01) respectively. Histories of diabetes, rheumatoid arthritis, depression, steroid use, and previous joint surgery were also associated with increased risk of PJI. The results remained similar when grouped by relevant study level characteristics.ConclusionsSeveral potentially modifiable patient-related factors are associated with the risk of developing PJIs. Identifying patients with these risk factors who are due to have arthroplasty surgery and modulating these risk factors might be essential in reducing the incidence of PJI. Further research is however warranted to assess the potential clinical utility of these risk factors as risk assessment tools for PJI.Systematic review registrationPROSPERO 2015: CRD42015023485.
| S-EPMC4777569 | biostudies-literature
Project description:In 2016, Zika virus disease developed in a man (patient A) who had no known risk factors beyond caring for a relative who died of this disease (index patient). We investigated the source of infection for patient A by surveying other family contacts, healthcare personnel, and community members, and testing samples for Zika virus. We identified 19 family contacts who had similar exposures to the index patient; 86 healthcare personnel had contact with the index patient, including 57 (66%) who had contact with body fluids. Of 218 community members interviewed, 28 (13%) reported signs/symptoms and 132 (61%) provided a sample. Except for patient A, no other persons tested had laboratory evidence of recent Zika virus infection. Of 5,875 mosquitoes collected, none were known vectors of Zika virus and all were negative for Zika virus. The mechanism of transmission to patient A remains unknown but was likely person-to-person contact with the index patient.
| S-EPMC5547791 | biostudies-other
Project description:Background and objectivesInfection-related hospitalizations have increased dramatically over the last 10 years in patients receiving in-center hemodialysis. Patient and dialysis facility characteristics associated with the rate of infection-related hospitalization were examined, with consideration of the region of care, rural-urban residence, and socioeconomic status.Design, setting, participants, & measurementsThe US Renal Data System linked to the American Community Survey and Rural-Urban Commuting Area codes was used to examine factors associated with hospitalization for infection among Medicare beneficiaries starting in-center hemodialysis between 2005 and 2008. A Poisson mixed effects model was used to examine the associations among patient and dialysis facility characteristics and the rate of infection-related hospitalization.ResultsAmong 135,545 Medicare beneficiaries, 38,475 (28%) had at least one infection-related hospitalization. The overall rate of infection-related hospitalization was 40.2 per 100 person-years. Age ≥ 85 years old, cancer, chronic obstructive pulmonary disease, inability to ambulate or transfer, drug dependence, residence in a care facility, serum albumin <3.5 g/dl at dialysis initiation, and dialysis initiation with an access other than a fistula were associated with a ≥ 20% increase in the rate of infection-related hospitalization. Patients residing in isolated small rural compared with urban areas had lower rates of hospitalization for infection (rate ratio, 0.91; 95% confidence interval, 0.86 to 0.97), and rates of hospitalization for infection varied across the ESRD networks. Measures of socioeconomic status (at the zip code level), total facility staffing, and the composition of staff (percentage of nurses) were not associated with the rate of hospitalization for infection.ConclusionsPatient and facility factors associated with higher rates of infection-related hospitalization were identified. The findings from this study can be used to identify patients at higher risk for infection and inform the design of infection prevention strategies.
| S-EPMC4670763 | biostudies-literature
Project description:The average rate of surgical site infections (SSIs) for laparoscopic cholecystectomy (LC) has been reported in the literature to be between 0.4% and 6.3%. Also, these recent reviews have concluded that a prophylactic antibiotics for elective LCs in low-risk patients is not useful, but there were no results in high-risk patients.The aim of this study was to investigate the role of a single dose of first-generation cephalosporin as a prophylactic antibiotic for patients undergoing elective LC, regardless of patient risk. This randomized clinical trial was conducted from October 2013 to December 2014 by single surgeon at our hospital. Patients were randomized into two groups by following method. Odd-numbered patients (group A) received 1-g cefazolin intravenously within 30 minutes before incision, whereas even-numbered patients (group B) received normal saline intravenously instead of prophylactic antibiotics, with the aim of including 100 patients in each group. SSIs were recorded and compared between the groups.There were no differences in preoperative demographics and postoperative findings between the groups. There were no superficial and deep SSIs in either group, 9 cases of superficial seromas developed (4.5%) in the cohort: 4 in group A (4%) and 5 in group B (5%). There were no significant associations between SSIs and the use of prophylactic antibiotics in either group. Additionally, the high-risk group did not show a significantly increased rate of SSIs.Based on our study, prophylactic antibiotics are not necessary in elective LC, regardless of patient risk.
| S-EPMC5566750 | biostudies-other
Project description:ImportanceIdentification of risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy is necessary for evidence-based risk reduction and adequate patient counseling.ObjectivesTo identify risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy and stratify the risk of such outcomes.Design, setting, and participantsA cohort study was conducted using the Nationwide Inpatient Sample, a nationally representative sample of patients discharged from community hospitals in the United States, from January 1, 2003, to December 31, 2012. Multivariable analysis of risk factors for adverse obstetric outcomes was performed for 19 926 women undergoing appendectomy or cholecystectomy during pregnancy and a scoring system for such risk factors was developed. Data analysis was conducted from January 1, 2015, to July 31, 2016.Main outcomes and measuresA composite measure including 7 adverse obstetrical outcomes throughout pregnancy and occurring before hospital discharge.ResultsOf the 19 926 women (mean [SD] age, 26 [6] years) in the study, 1018 adverse obstetrical events were recorded in 953 pregnant women (4.8%). The 3 most frequent adverse events were preterm delivery (360 [35.4%]), preterm labor without preterm delivery (269 [26.4%]), and miscarriage (262 [25.7%]). The risk factors associated most strongly with an adverse obstetrical outcome included cervical incompetence (adjusted odds ratio, 24.29; 95% CI, 7.48-78.81), preterm labor during current pregnancy (adjusted odds ratio, 18.34; 95% CI, 4.95-67.96), vaginitis or vulvovaginitis (adjusted odds ratio, 5.17; 95% CI, 2.19-12.23), and sepsis (adjusted odds ratio, 3.39; 95% CI, 2.08-5.51). A scoring system based on statistically significant variables classified the study sample into 3 risk groups corresponding to predicted probabilities of adverse obstetrical outcomes of 2.5% (≤4 points), 8.2% (5-8 points), and 21.8% (≥9 points).Conclusions and relevanceApproximately 5% of women experience adverse obstetrical outcomes after appendectomy or cholecystectomy during pregnancy. The major risk factors for such outcomes are cervical incompetence, preterm labor during current pregnancy, vaginitis or vulvovaginitis, and sepsis.
| S-EPMC5831452 | biostudies-literature