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Yoon S Chun - One of the best experts on this subject based on the ideXlab platform.
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late Surgical Site infection in immediate implant based breast reconstruction
Plastic and Reconstructive Surgery, 2017Co-Authors: Indranil Sinha, Andrea L Pusic, Edwin G Wilkins, Jennifer B Hamill, Xiaoxue Chen, Hyungjin M Kim, Gretchen Guldbrandsen, Yoon S ChunAbstract:Background Surgical-Site infection causes devastating reconstructive failure in implant-based breast reconstructions. Large national database studies offer insights into complication rates, but only capture outcomes within 30 days postoperatively. This study evaluates both early and late Surgical-Site infection in immediate implant-based reconstruction and identifies predictors. Methods As part of the Mastectomy Reconstruction Outcomes Consortium Study, 1662 implant-based breast reconstructions in 1024 patients were evaluated for early versus late Surgical-Site infection. Early Surgical-Site infection was defined as infection occurring within 30 days postoperatively; late Surgical-Site infection was defined as infection occurring 31 days to 1 year postoperatively. Minor infection required oral antibiotics only, and major infection required hospitalization and/or Surgical treatment. Direct-to-implant patients had 1-year follow-up, and tissue expander patients had 1-year post-exchange follow-up. Results Among 1491 tissue expander and 171 direct-to-implant reconstructions, overall Surgical-Site infection rate for tissue expander was 5.7 percent (85 of 1491) after first-stage, 2.5 percent (31 of 1266) after second-stage, and 9.9 percent (17 of 171) for direct-to-implant reconstruction. Over 47 to 71 percent of Surgical-Site infection complications were late Surgical-Site infection. Multivariate analysis identified radiotherapy and increasing body mass index as significant predictors of late Surgical-Site infection. No significant difference between the direct-to-implant and tissue expander groups in the occurrence of early, late, or overall Surgical-Site infection was found. Conclusions The majority of Surgical-Site infection complications in immediate implant-based breast reconstructions occur more than 30 days after both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset Surgical-Site infection. Current studies limited to early complications do not present a complete assessment of infection associated with implant-based breast reconstructions or their long-term clinical outcomes. Clinical question/level of evidence Risk, II.
Victoria J. Fraser - One of the best experts on this subject based on the ideXlab platform.
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Case-control study of pediatric cardiothoracic Surgical Site infections .
Infection control and hospital epidemiology, 2008Co-Authors: Galit Holzmann-pazgal, Diane Hopkins-broyles, Angela Recktenwald, Melinda Hohrein, Patricia Kieffer, Charles B. Huddleston, Sharma Anshuman, Victoria J. FraserAbstract:A retrospective case-control study was performed to determine the risks and outcomes associated with pediatric cardiothoracic Surgical Site infection. Undergoing more than 1 cardiothoracic operative procedure, having preoperative infection, and undergoing surgery on a Monday were significant risk factors. Cardiothoracic Surgical Site infection increased hospital and pediatric intensive care unit length of stay. Deep Surgical Site infection significantly increased mortality.
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risk factors for Surgical Site infection following orthopaedic spinal operations
Journal of Bone and Joint Surgery American Volume, 2008Co-Authors: Margaret A Olsen, Jeffrey J Nepple, Daniel K Riew, Lawrence G Lenke, Keith H Bridwell, Jennie Mayfield, Victoria J. FraserAbstract:Background: Surgical Site infections are not uncommon following spinal operations, and they can be associated with serious morbidity, mortality, and increased resource utilization. The accurate identification of risk factors is essential to develop strategies to prevent these potentially devastating infections. We conducted a case-control study to determine independent risk factors for Surgical Site infection following orthopaedic spinal operations. Methods: We performed a retrospective case-control study of patients who had had an orthopaedic spinal operation performed at a university-affiliated tertiary-care hospital from 1998 to 2002. Forty-six patients with a superficial, deep, or organ-space Surgical Site infection were identified and compared with 227 uninfected control patients. Risk factors for Surgical Site infection were determined with univariate analyses and multivariate logistic regression. Results: The overall rate of spinal Surgical Site infection during the five years of the study was 2.0% (forty-six of 2316). Univariate analyses showed serum glucose levels, preoperatively and within five days after the operation, to be significantly higher in patients in whom Surgical Site infection developed than in uninfected control patients. Independent risk factors for Surgical Site infection that were identified by multivariate analysis were diabetes (odds ratio = 3.5, 95% confidence interval = 1.2, 10.0), suboptimal timing of prophylactic antibiotic therapy (odds ratio = 3.4, 95% confidence interval = 1.5, 7.9), a preoperative serum glucose level of >125 mg/dL (>6.9 mmol/L) or a postoperative serum glucose level of >200 mg/dL (>11.1 mmol/L) (odds ratio = 3.3, 95% confidence interval = 1.4, 7.5), obesity (odds ratio = 2.2, 95% confidence interval = 1.1, 4.7), and two or more Surgical residents participating in the operative procedure (odds ratio = 2.2, 95% confidence interval = 1.0, 4.7). A decreased risk of Surgical Site infection was associated with operations involving the cervical spine (odds ratio = 0.3, 95% confidence interval = 0.1, 0.6). Conclusions: Diabetes was associated with the highest independent risk of spinal Surgical Site infection, and an elevated preoperative or postoperative serum glucose level was also independently associated with an increased risk of Surgical Site infection. The role of hyperglycemia as a risk factor for Surgical Site infection in patients not previously diagnosed with diabetes should be investigated further. Administration of prophylactic antibiotics within one hour before the operation and increasing the antibiotic dosage to adjust for obesity are also important strategies to decrease the risk of Surgical Site infection after spinal operations. Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.
Loreen A. Herwaldt - One of the best experts on this subject based on the ideXlab platform.
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Surgical Site infections and cellulitis after abdominal hysterectomy.
American journal of obstetrics and gynecology, 2013Co-Authors: Mack W. Savage, Jean M. Pottinger, Hsiu-yin Chiang, Katherine R. Yohnke, Noelle C. Bowdler, Loreen A. HerwaldtAbstract:To identify risk factors for and outcomes of Surgical Site infections and cellulitis after abdominal hysterectomies. We used logistic regression analysis to analyze data from a case-control study of 1104 patients undergoing abdominal hysterectomies at a university hospital between Jan. 1, 2007 and Dec. 30, 2010. Factors significantly associated with Surgical Site infections and with cellulitis were: pulmonary disease, operations done in Main Operating Room East, and seroma. Body mass index >35, no private insurance, and fluid and electrolyte disorders were risk factors for Surgical Site infections. The mean prophylactic dose of cefazolin was significantly higher for controls than for patients with Surgical Site infections. Preoperative showers with Hibiclens (Molnlycke Health Care US, LLC, Norcross, GA) and cefazolin prophylaxis were associated with a significantly decreased cellulitis risk. Surgical Site infections and cellulitis were significantly associated with readmissions and return visits and Surgical Site infections were associated with reoperations. Preoperative showers, antimicrobial prophylaxis, Surgical techniques preventing seromas, and the operating room environment may affect the risk of Surgical Site infections and cellulitis after abdominal hysterectomies. Copyright © 2013 Mosby, Inc. All rights reserved.
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Surgical Site infections and cellulitis after abdominal hysterectomy
American Journal of Obstetrics and Gynecology, 2013Co-Authors: Mack W. Savage, Jean M. Pottinger, Hsiu-yin Chiang, Katherine R. Yohnke, Noelle C. Bowdler, Loreen A. HerwaldtAbstract:Objectives To identify risk factors for and outcomes of Surgical Site infections and cellulitis after abdominal hysterectomies. Study Design We used logistic regression analysis to analyze data from a case-control study of 1104 patients undergoing abdominal hysterectomies at a university hospital between Jan. 1, 2007 and Dec. 30, 2010. Results Factors significantly associated with Surgical Site infections and with cellulitis were: pulmonary disease, operations done in Main Operating Room East, and seroma. Body mass index >35, no private insurance, and fluid and electrolyte disorders were risk factors for Surgical Site infections. The mean prophylactic dose of cefazolin was significantly higher for controls than for patients with Surgical Site infections. Preoperative showers with Hibiclens (Molnlycke Health Care US, LLC, Norcross, GA) and cefazolin prophylaxis were associated with a significantly decreased cellulitis risk. Surgical Site infections and cellulitis were significantly associated with readmissions and return visits and Surgical Site infections were associated with reoperations. Conclusion Preoperative showers, antimicrobial prophylaxis, Surgical techniques preventing seromas, and the operating room environment may affect the risk of Surgical Site infections and cellulitis after abdominal hysterectomies.
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Surgical Site infections and cellulitis after abdominal
2013Co-Authors: W. Savage, Jean M. Pottinger, Hsiu-yin Chiang, Katherine R. Yohnke, Noelle C. Bowdler, Loreen A. HerwaldtAbstract:RESULTS: Factors significantly associated with Surgical Site infections and with cellulitis were: pulmonary disease, operations done in Main Operating Room East, and seroma. Body mass index >35, no private insurance, and fluid and electrolyte disorders were risk factors for Surgical Site infections. The mean prophylactic dose of cefazolin was significantly higher for controls than for patients with Surgical Site infections.PreoperativeshowerswithHibiclens(MolnlyckeHealthCare US, LLC, Norcross,GA) and cefazolin prophylaxis were associatedwith a significantly decreased cellulitis risk. Surgical Site infections and cellulitis were significantly associated with readmissions and return visits and Surgical Site infections were associated with reoperations. CONCLUSION: Preoperative showers, antimicrobial prophylaxis, Surgical techniques preventing seromas, and the operating room environment may affect the risk of Surgical Site infections and cellulitis after abdominal hysterectomies.
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Staphylococcus aureus nasal carriage and Surgical-Site infections.
Surgery, 2003Co-Authors: Loreen A. HerwaldtAbstract:The current literature indicates that Surgical-Site infections significantly increase costs and length of stay. Nosocomial infections that are acquired after operative procedures increase mortality rates. Staphylococcus aureus is a major cause of Surgical-Site infections among patients, particularly patients who undergo cardiothoracic surgery. Patients who carry S aureus in their nares are at increased risk for Surgical-Site infections that are caused by this organism. Occasionally, health care workers who carry S aureus in their nares can cause outbreaks of Surgical-Site infections or other nosocomial infections. Persons who carry S aureus in their nares and have upper respiratory tract infections may spread this organism to numerous staff members and patients. Key measures for decreasing rates of these and other nosocomial infections include the appropriate use of prophylactic antimicrobial agents, surveillance and reporting of infections, and surveillance for clusters of infection caused by the same strain of S aureus and culture and surveys, when appropriate, to help identify infected health care workers. Additionally, Surgical masks may prevent health care workers from inadvertent transmission of S aureus from their nares to patients' Surgical Sites.
Trish M. Perl - One of the best experts on this subject based on the ideXlab platform.
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Basics of Surgical-Site infection surveillance.
Infection control and hospital epidemiology, 1997Co-Authors: Marie-claude Roy, Trish M. PerlAbstract:Surgical-Site infections, the third most common class of nosocomial infections, cause substantial morbidity and mortality and increase hospital costs. Surveillance programs can lead to reductions in Surgical-Site infection rates of 35% to 50%. Herein, we will discuss the practical aspects of implementing a hospital-based surveillance program for Surgical-Site infections. We will review surveillance methods, patient populations that should be screened, and interventions that could reduce infection rates.
Indranil Sinha - One of the best experts on this subject based on the ideXlab platform.
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late Surgical Site infection in immediate implant based breast reconstruction
Plastic and Reconstructive Surgery, 2017Co-Authors: Indranil Sinha, Andrea L Pusic, Edwin G Wilkins, Jennifer B Hamill, Xiaoxue Chen, Hyungjin M Kim, Gretchen Guldbrandsen, Yoon S ChunAbstract:Background Surgical-Site infection causes devastating reconstructive failure in implant-based breast reconstructions. Large national database studies offer insights into complication rates, but only capture outcomes within 30 days postoperatively. This study evaluates both early and late Surgical-Site infection in immediate implant-based reconstruction and identifies predictors. Methods As part of the Mastectomy Reconstruction Outcomes Consortium Study, 1662 implant-based breast reconstructions in 1024 patients were evaluated for early versus late Surgical-Site infection. Early Surgical-Site infection was defined as infection occurring within 30 days postoperatively; late Surgical-Site infection was defined as infection occurring 31 days to 1 year postoperatively. Minor infection required oral antibiotics only, and major infection required hospitalization and/or Surgical treatment. Direct-to-implant patients had 1-year follow-up, and tissue expander patients had 1-year post-exchange follow-up. Results Among 1491 tissue expander and 171 direct-to-implant reconstructions, overall Surgical-Site infection rate for tissue expander was 5.7 percent (85 of 1491) after first-stage, 2.5 percent (31 of 1266) after second-stage, and 9.9 percent (17 of 171) for direct-to-implant reconstruction. Over 47 to 71 percent of Surgical-Site infection complications were late Surgical-Site infection. Multivariate analysis identified radiotherapy and increasing body mass index as significant predictors of late Surgical-Site infection. No significant difference between the direct-to-implant and tissue expander groups in the occurrence of early, late, or overall Surgical-Site infection was found. Conclusions The majority of Surgical-Site infection complications in immediate implant-based breast reconstructions occur more than 30 days after both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset Surgical-Site infection. Current studies limited to early complications do not present a complete assessment of infection associated with implant-based breast reconstructions or their long-term clinical outcomes. Clinical question/level of evidence Risk, II.