In 2016, a total of 48,771 hospital-acquired conditions (HACs) were reported in U.S. hospitals. These incidents resulted in an excess cost of >$2 billion, which translates to roughly $40,000 per patient with an HAC.Current guidelines for the prevention of venous thromboembolism and surgical site infection consist primarily of antithrombotic prophylaxis and antiseptic technique, respectively.The prevention of catheter-associated urinary tract infection (CA-UTI) and in-hospital falls and trauma is done best via education. In the case of CA-UTI, this consists of training staff about the indications for catheters and their timely removal when they are no longer necessary, and in the case of in-hospital falls and trauma, advising the patient and family about the patient’s fall risk and communicating the fall risk to the health-care team.Blood incompatibility is best prevented by implementation of a pretransfusion testing protocol. Pressure ulcers can be prevented via patient positioning, especially during surgery, and via postoperative skin checks.
The number of orthopedic procedures, especially prosthesis implantation, continues to increase annually, making it imperative to understand the risks of perioperative complications. These risks include a variety of patient-specific factors, including genetic profiles. This review assessed the current literature for associations between patient-specific genetic risk factors and perioperative infection. The PRISMA guidelines were used to conduct a literature review using the PubMed and Cochrane databases. Following title and abstract review and full-text screening, eight articles remained to be reviewed—all of which compared single nucleotide polymorphisms (SNPs) to periprosthetic joint infection (PJI) in total joint arthroplasty (TJA). The following cytokine-related genes were found to have polymorphisms associated with PJI: TNFα (p < 0.006), IL-6 (p < 0.035), GCSF3R (p < 0.02), IL-1 RN-VNTR (p = 0.002), and IL-1B (p = 0.037). Protein- and enzyme-related genes that were found to be associated with PJI included: MBL (p < 0.01, p < 0.05) and MBL2 (p < 0.01, p < 0.016). The only receptor-related gene found to be associated with PJI was VDR (p < 0.007, p < 0.028). This review compiled a variety of genetic polymorphisms that were associated with periprosthetic joint infections. However, the power of these studies is low. More research must be conducted to further understand the genetic risk factors for this serious outcome.
Background: Cirrhotic patients are at increased risk of postoperative complications and mortality following any surgical procedure. One of the independent predators of adverse outcomes is intraoperative transfusion (IOT). In this study we examine the profile of cirrhotic patients requiring IOT to determine its predictors. Methods: The Veterans Affairs Surgical Quality Improvement Program (VASQIP) was utilized to identify all patients with cirrhosis and ascites who underwent any non-liver transplant procedures from 2008 to 2015. Univariate and multivariate regression were used to identify predictors of increased risk of IOT and associated outcomes. Results: A total of 1,957 cirrhotic patients were identified, of which only 358 (18.8%) required IOT ≥1 unit. IOT group were older, more frail, higher Model for End-stage Liver Disease (MELD) score, anemic (hematocrit <30%), hypoalbuminemic. This group also had more emergent procedures, higher rates of preoperative sepsis, longer operative time, longer postoperative length of stay, and higher morbidity and mortality rates. On multivariate logistic regression, pancreatic resections, open hernia repair, anemia, gastric resections, hypoalbuminemia, acute renal failure, emergency procedure, preoperative sepsis, and preoperative weight loss >10% were significant predictors of IOT. Conclusion: IOT in cirrhotic patients is associated with worse outcomes. Pancreatic procedures, open hernia repair, and gastric resection were associated with increased IOT. This aid in preoperative planning and blood products preparation.
Background Total joint arthroplasties are among the most common surgical procedures performed in the United States. Although numerous safeguards are in place to optimize patient health and safety pre-, intra-, and postoperatively, patient frailty is often incompletely assessed or not assessed at all. Frailty has been shown to increase rates of adverse events and length of stay. We discuss the impact of frailty on patient outcomes and healthcare economics as well as provide widely accepted models to assess frailty and their optimal usage. Methods Several databases were searched using the keywords “frailty,” “TJA,” “THA,” “frailty index,” “frailty assessment,” and “frailty risk.” A total of 45 articles were used in this literature review. Results It is estimated that nearly half of patients over the age of 85 meet criteria for frailty. Frailty in surgical patients has been shown to increase total costs as well as length of stay. Additionally, increased rates of numerous adverse events are associated with increased frailty. Conclusions The literature demonstrates that frailty poses increased risk of adverse events, increased length of stay, and increased cost. There are several models that accurately assess frailty and can feasibly be implemented into preoperative screening.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.