Surgical infections
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Surgical infections · Dec 2012
Bacteriology of acute appendicitis and its implication for the use of prophylactic antibiotics.
To prevent surgical site infection (SSI) after appendectomy, antibiotic prophylaxis has been recommended for all patients, but this approach is based largely on bacteriologic findings that are decades old. The objective of this study was to reevaluate the bacteriology of acute appendicitis in order to assess the usefulness of current antibiotic prophylaxis. ⋯ The most commonly identified aerobic bacteria associated with acute appendicitis were E. coli, followed by K. pneumoniae, Streptococcus, Enterococcus, and P. aeruginosa. Pseudomonas aeruginosa frequently was not covered by the prophylactic antibiotics chosen and might be associated with SSI.
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Surgical infections · Dec 2012
Influence of body mass index and antibiotic dose on the risk of surgical site infections in pediatric clean orthopedic surgery.
To evaluate body mass index (BMI) and antimicrobial dose as risk factors for surgical site infections in pediatric patients. ⋯ Being underweight and undergoing an operation lasting >2 h created significant risks for SSI. Children weighing ≥70 kg receiving a standard 1-g dose of cefazolin had a greater risk of MSSA SSIs than children weighing <70 kg who received an appropriate weight-based dose of this antibiotic.
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Surgical infections · Dec 2012
Nucleated red blood cells are associated with a higher mortality rate in patients with surgical sepsis.
Nucleated red blood cells (NRBCs) are present in certain non-oncologic disease states and are associated with a poor prognosis. The purpose of this study was to evaluate NRBCs as an early prognostic marker for death in patients with surgical sepsis. ⋯ Surgical sepsis patients with detectable NRBCs are at higher risk of ICU and in-hospital death than those with non-detectable NRBCs. The mortality difference is underscored in surgical patients with severe sepsis. This study suggests NRBCs may be a biomarker of outcomes in patients with surgical sepsis.
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Surgical infections · Oct 2012
ReviewDefining, measuring, and improving surgical quality: beyond teamwork and checklists to systems redesign and transformation.
Surgical complications are multifactorial but often are attributable to deficiencies in the quality of care. This review examines how quality is defined in surgery, the modalities employed to measure quality, and the approaches to improving the quality of surgical care. Beyond developing a hospital environment supportive of organizational learning, the next generation of surgical performance improvement will include broader, more innovative approaches. These ideas will create partnerships among patients, clinicians, industry, the arts, hospital leaders, and other sectors to look for ways to reinvent the system rather than simply to make a better hospital. ⋯ The best pathway for surgical quality and performance improvement includes the application of systems engineering and innovation to determine ways to do better what we do currently, and to improve the present system while developing ideas for better delivery of high-quality care in the future.
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Surgical infections · Oct 2012
Impact of infectious complications after elective surgery on hospital readmission and late deaths in the U.S. Medicare population.
Whereas the negative impact of infectious complications (IC) during the index hospitalization after elective surgery is well established, the long-term ramifications of hospital-acquired post-operative infections are not well studied. This analysis evaluated the impact of a hospital-acquired IC after open abdominal vascular surgery on the readmission rate and the mortality rates 30 and 90 days after initial discharge. ⋯ For Medicare beneficiaries undergoing elective open abdominal vascular procedures, the development of any IC significantly increased not only the in-hospital mortality rate but also the mortality rates 30 and 90 days after discharge from the hospital. Index ICs also were associated with a higher 30-day readmission rate. Hospital-acquired infections have a profound late effect on outcomes after discharge. Future programs targeting high-risk patients may improve long-term survival and minimize readmissions.