Health care‐associated infections after major cancer surgery

Abstract

BACKGROUND: Approximately 1.7 million individuals per year are affected with health care-associated infections (HAIs) in the United States. The authors examined trends in the incidence of HAI after major cancer surgery (MCS) and risk factors for HAI to describe the effects of HAI on mortality after MCS. METHODS: Patients undergoing 1 of 8 MCS procedures within the Nationwide Inpatient Sample between 1999 and 2009 were identified (n ¼ 2,502,686). Generalized linear regression models were used to estimate the impact of the primary predictors (procedure type, age, sex, race, insurance status, Charlson comorbidity index, hospital volume, and hospital bed size) on the odds of HAI and in-hospital mortality. Trends in incidence were evaluated with linear regression. RESULTS: Overall, MCS-associated HAI incidence increased 2.7% per year (P < .001), whereas mortality decreased 1.3% per year (P < .001). (OR, 8.66; 95% CI,. CONCLUSIONS: Between 1999 and 2009, the incidence of MCS-associated HAI events increased; however, HAI-associated mortality decreased. That said, significant disparities exist in the hospital and demographic attributes associated with MCS-associated HAI, with attendant health policy implications. Moreover, HAI remains detrimentally linked to mortality during hospitalization.

Aromatase inhibitor associated arthralgia: the importance of oncology provider-patient communication about side effects and potential management through physical activity

“…Our findings also underscore the need for oncology providers to take a more active role in encouraging guideline-recommended levels of physical activity to improve quality of life both during and after cancer treatment and enhance their patients’ overall prognosis and survival [36–40]. As AI-associated joint symptoms can take anywhere from weeks to years to manifest and increase in severity, it is important for the oncologist to explain the potential time course of arthralgia [21]. …”

“…Having these discussions earlier rather than later – after symptoms started – was important. Because joint pain side effects can take months and even years to start or increase in severity [21], participants welcomed specific inquiries from their oncology provider about joint symptoms during routine clinic visits. Monitoring joint symptoms over time would help them clarify if the pain was new, increasing in intensity, potentially AI-associated or more likely related to non-AI issues, such as arthritis or joint injury.…”

The Perfect Storm: Emerging Trends and Pathogens in Healthcare

“…The incidence of healthcare-associated infections in cancer patients is likely under-reported due to the high-risk nature of acquisition among the patient population. 5 Cancer treatment often requires surgical removal of the affected tissue. Surgery, independent of the underlying associated condition in itself, is a risk factor for the development of a healthcare-associated infection.…”

“…In a 10 year study of healthcare-associated infections following major surgery for the removal of cancer 2,502,686 patients underwent procedures; 10.5% of the surgical patients developed one or more HAI. 5 In a multivariable analysis in the same study, it was determined that any occurrence of HAI resulted in an 8.7 fold increased odds of in-hospital mortality with up to a 17.3 fold likelihood of dying in a postoperative setting from an acquired blood stream infection. 5 Cancer is a disease that modern medicine will continue to battle, but the incidence and effect on the patient's immune system are uncontrollable.…”

“…5 In a multivariable analysis in the same study, it was determined that any occurrence of HAI resulted in an 8.7 fold increased odds of in-hospital mortality with up to a 17.3 fold likelihood of dying in a postoperative setting from an acquired blood stream infection. 5 Cancer is a disease that modern medicine will continue to battle, but the incidence and effect on the patient's immune system are uncontrollable. However, new technologies and breakthroughs in medicine such as organ transplantation, which utilizes immunosuppressive therapy to minimize rejection of the organs, have also created a population of immunosuppressed patients at risk for healthcareassociated infections.…”