Morbidity and mortality associated with arterial surgery site infections by resistant microorganisms

Lichtenfels, Eduardo; d’Azevedo, Pedro Alves; Frankini, Airton Delduque; Erling, Nilon; Aerts, Newton

doi:10.1590/jvb.2014.020

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…Since patients can develop infections during surgery, reducing PAR utilization prevents some of these infections from occurring. 12 Furthermore, patients now face the potential for exposure to COVID-19 while in a clinical setting. Thus, reducing PAR utilization decreases the extent to which patients experience these negative outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…As patients receiving arterial vascular surgeries can have surgical site infections at rates reported to range from 0.9% to 22%, many patients may be able to avoid infection by forgoing surgery. 12 If nondenial prior authorization can encourage physicians to withdraw PAR orders when other approaches may be safely attempted, it may be possible to reduce PAR utilization without increasing patients’ experiences of downstream IC.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Description of Outcomes Experienced by Patients Whose Orders for Peripheral Artery Revascularization Were Reviewed by a Nondenial Prior Authorization Program

Powell¹,

Lugo²,

Dietrich³

et al. 2022

Vasc Endovascular Surg

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Objective After a nondenial prior authorization program evaluates orders for peripheral artery revascularization (PAR), ordering physicians sometimes withdraw their orders based upon program recommendations. Some patients with withdrawn orders receive PAR if claudication does not resolve. To characterize patient outcomes under this program, we evaluated whether associations existed between the withdrawal of patients’ initial PAR orders and the presence of claims for PAR and claims mentioning intermittent claudication (IC) in the following 16 weeks. Methods Orders for PAR placed from 1/1/19 to 9/30/19 for patients with Medicare Advantage health plans were extracted from a national healthcare organization’s database. Claims data from 0 to 16 weeks following the order were reviewed to determine if patients had downstream PAR claims, or if they had emergency department or hospital claims mentioning IC. Chi-square tests were used to assess the association between order withdrawal and downstream PAR, as well as claims mentioning IC. Multivariate logistic regressions were run to assess the same, controlling for patient age, sex, urbanicity, local median income, state obesity rate, type of PAR, ordering physician specialty, and whether PAR was ordered in a hospital setting. Results Of 1588 orders meeting inclusion criteria, 71.9% (1038/1444) of authorized orders and 61.1% (88/144) of withdrawn orders were followed by PAR within 16 weeks, a significant difference ( P < .01). Relatedly, 69.8% (1008/1444) of authorized orders and 70.8% (102/144) of withdrawn orders were followed by IC claims, an insignificant difference. Multivariate logistic regressions showed patients with withdrawn PAR orders had significantly lower adjusted odds of PAR (OR: 0.63; 95% CI: 0.44–0.91), but an insignificant difference in their adjusted odds of IC (OR: 1.10; CI: 0.76–1.64). Conclusions Although patients with withdrawn PAR orders were significantly less likely to receive PAR in the subsequent 16 weeks, no association was found between withdrawn PAR orders and subsequent claims mentioning IC.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Description of Outcomes Experienced by Patients Whose Orders for Peripheral Artery Revascularization Were Reviewed by a Nondenial Prior Authorization Program

Powell¹,

Lugo²,

Dietrich³

et al. 2022

Vasc Endovascular Surg

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show abstract

“…In the case of vascular surgery, surgical site infection was very risky for massive bleeding because of the loose stitches and open wounds directly connected to arteries. 9, 10 The patient was then treated with a pressure bandage on the bleeding arm to stop the bleeding. Advanced Trauma Life Support (ATLS) recommends compression as the first-line treatment for bleeding extremity wounds; an example of this treatment may include the application of a tight bandage directly over a wound.…”

Section: Case Reportmentioning

confidence: 99%

Rupture infected pseudoaneurysm on brachiocephalic AV-fistula: emergency and definitive management

Putra¹,

Edi²

2022

JINAVascAccess

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Background: Vascular access bleeding is a rare event that can be fatal in hemodialysis patients. It requires emergency and surgical management to reduce the risk of ischemic events in the patient’s forearm and reduce mortality risk. Objective: To describe the clinical presentation, emergency and surgical intervention, and outcome of rupture-infected anastomotic pseudo aneurysm of the brachiocephalic arteriovenous fistula that underwent a definitive surgical procedure. Case Description: A 55-year-old man presented with bleeding on the AV-fistula surgery site, accompanied with pain and swelling on his forearm that occurred 3 hours before admission to the hospital. The Patient had a history of brachiocephalic AV-fistula surgery 3 weeks earlier. On physical examination, It was found that the surgical site wound looked wet and swollen, with lots of necrotic tissue and pus and lost stitches. In Emergency Departments, the patient was administered intravenous normal saline fluids, bleeding inhibitors and pressure bandages to reduce ongoing bleeding. Then the patient had planned for immediate vascular reconstruction surgery. The brachial artery is repaired using great saphenous vein patch plasty. Results: The patient’s postoperative 30-days follow-up went well, and there was no sign of complication, such as pain, infection, paresthesia, bleeding at the surgical site or ischemia in the distal forearm. Conclusion: Vascular access bleeding can be fatal to hemodialysis patients. Optimal treatment for the patient's life and hemodialysis access is a top priority. A good assessment of the condition of AVF and the choice of subsequent therapy greatly affect the patient's prognosis.

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“…3 , 8 These rates are high due to complications caused by antibiotic-resistant microorganisms, which increases morbidity and mortality. 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

“…In Brazil, the public health system – known in the country as SUS ( Sistema Único de Saúde ), has not provided patients with HBOT precisely due to its cost. 9 , 10 , 11 , 12 , 13 It is available in private clinics with access restricted to those who can afford it. 13 Diabetic patients, who frequently present with small wounds on their feet, have limited access to HBOT in Brazil.…”

Section: Introductionmentioning

confidence: 99%

Topical Oxygen Jet Therapy (TOJT) for treating infected chronic surgical wounds

Otaviano

Salles

Ching

et al. 2021

The Brazilian Journal of Infectious Diseases

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Morbidity and mortality associated with arterial surgery site infections by resistant microorganisms

Cited by 5 publications

References 23 publications

A Description of Outcomes Experienced by Patients Whose Orders for Peripheral Artery Revascularization Were Reviewed by a Nondenial Prior Authorization Program

A Description of Outcomes Experienced by Patients Whose Orders for Peripheral Artery Revascularization Were Reviewed by a Nondenial Prior Authorization Program

Rupture infected pseudoaneurysm on brachiocephalic AV-fistula: emergency and definitive management

Topical Oxygen Jet Therapy (TOJT) for treating infected chronic surgical wounds

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