This study identifies risk factors for readmission within 30 days of discharge from a general surgery service.
A man in his mid-50s was referred to our hospital because he had a cystic mass in his spleen that was discovered incidentally during a routine physical examination. He had no history of abdominal trauma, infection, or surgery. What is your diagnosis?
This prospective analysis showed that time to irrigation and debridement did not affect the development of local infectious complications, provided it was performed within 24 hours of arrival.
This retrospective review shows that mandated reporting for ventilator-associated pneumonia bundle and catheter-related bloodstream infection bundle compliance is poorly correlated with decreased infection rates.
Bhayani et al compared rates of pulmonary and overall morbidity, infection, and thromboembolic complications between patients undergoing transhiatal esophagectomy and those undergoing esophagectomy with the Ivor Lewis or McKeown technique. See the invited commentary by Chang.
To determine if an evidence-based practice bundle would result in a significantly lower rate of surgical site infections (SSIs) when compared with standard practice.
Single-institution, randomized controlled trial with blinded assessment of main outcome. The trial opened in April 2007 and was closed in January 2010.
Veterans Administration teaching hospital.
Patients who required elective transabdominal colorectal surgery were eligible. A total of 241 subjects were approached, 211 subjects were randomly allocated to 1 of 2 interventions, and 197 were included in an intention-to-treat analysis.
Subjects received either a combination of 5 evidenced-based practices (extended arm) or were treated according to our current practice (standard arm). The interventions in the extended arm included (1) omission of mechanical bowel preparation; (2) preoperative and intraoperative warming; (3) supplemental oxygen during and immediately after surgery; (4) intraoperative intravenous fluid restriction; and (5) use of a surgical wound protector.
Overall SSI rate at 30 days assessed by blinded infection control coordinators using standardized definitions.
The overall rate of SSI was 45% in the extended arm of the study and 24% in the standard arm (P = .003). Most of the increased number of infections in the extended arm were superficial incisional SSIs (36% extended arm vs 19% standard arm; P = .004). Multivariate analysis suggested that allocation to the extended arm of the trial conferred a 2.49-fold risk (95% confidence interval, 1.36-4.56; P = .003) independent of other factors traditionally associated with SSI.
An evidence-based intervention bundle did not reduce SSIs. The bundling of interventions, even when the constituent interventions have been individually tested, does not have a predictable effect on outcome. Formal testing of bundled approaches should occur prior to implementation.
clinicaltrials.gov Identifier: NCT00953784