Biomedical subjects

E Simchen

Publications and source records attributed to E Simchen.

42 records · Page 3Linked to original sources

PubMedDate not supplied

Risk factors for post-operative wound infection in cardiac surgery patients.

In a prospective study of 372 patients undergoing cardiac surgery, we evaluated the relative contribution of host factors and patient care variables to the risk of post-operative wound infection. Host factors studied were age, sex, country of origin, the diagnosis for which the operation was performed and, for coronary artery by-pass operations, the functional cardiac status according to modified New York Heart Association criteria. The performance of more than one operation during a single admission carried the highest risk for infection, followed by a coronary artery by-pass operation lasting for more than six hours or performed on patients 65 years or older. In patients undergoing coronary artery by-pass surgery, host factors (age and cardiac function) were associated with infections in the chest wound, while the length of the operation was found to affect the occurrence of infections at the "donor" site.

Adolescent↗

PubMedDate not supplied

Multivariate analysis of determinants of postoperative wound infection: a possible basis for intervention.

Multivariate analysis of variables hypothetically associated with the development of postoperative wound infection was attempted with use of large groups of patients undergoing certain surgical procedures over periods of 12-36 months. The data were obtained through prospective surveillance by specially trained nurse-epidemiologists. For patients who had colon surgery (n=261), the multivariate analysis showed that only four variables were independently associated with postoperative wound infection: more than one operation during a single episode of hospitalization (adjusted odds ratio, 7.3); Arab ethnicity (adjusted odds ratio, 6.1); prophylaxis according to the recommended protocol not given (adjusted odds ratio, 2.4); and opening of a colostomy as the specific operation (adjusted odds ratio, 2.3). Of all the variables analyzed, more than one operation during an admission was consistently associated with the highest risk of infection in patients who had cardiac and neurosurgery as well as colon surgery. On the other hand, a traditional risk factor, e.g., the presence of drains at the site of the operation, was not found to be independently associated with an increased risk of infection in any of the groups tested. This type of analysis is essential to facilitate the introduction of a more meaningful program for intervention based on proved rather than hypothetical risk factors

Analysis of Variance↗

PubMedDate not supplied

Rationale and methods for a statewide, prospective surveillance system for the identification and prevention of nosocomial infections.

Review of current methods of surveillance for nosocomial infection indicates that prospective surveillance of patients on a daily basis is the most accurate and valid method. In this paper, we detail such a method. Samples of hospitalized patients for surveillance are based on a fixed period of observation in each patient-care area. Data are collected on a detailed, standardized daily log that emphasize the recording of primary clinical data. Such a system is practical and is acceptable to infection control practitioners. Representative samples of patients are obtained. The utility of such a system for identifying preventable risk factors for the development and evaluation of programs of prevention is being tested in 12 acute-care hospitals in Rhode Island.

Cross Infection↗

PubMedDate not supplied

Antibiotic use on the surgical services of two Jerusalem hospitals, as determined by surveillance and influenced by an intervention program.

The use of antimicrobial drugs on the surgical services of two hospitals in Jerusalem, Israel, was surveyed prospectively. At one hospital (C), the use of these drugs was controlled: at the other (N), the use was not controlled. At both hospitals the cephalosporins accounted for approximately 21% of the antimicrobial drug-group courses (AMDGCs), however, they accounted for only 11% of the antimicrobial days (AMDs) at C but 22% at N. Prophylaxis after surgical procedures accounted for the initiation of 36% and 33% of the AMDGCs at C and N, respectively. The geometric mean of the duration of prophylactic courses of drug therapy was 3.2 days at C and 3.9 days at N (P less than 0.01). Excessively prolonged prophylaxis accounted for approximately 61% (388 AMDs) of prophylactic use at N and 55% (646 AMDs) at C. At C the proportion of patients receiving prophylaxis in high-risk surgical operations increased from 39% to 97% after the introduction of protocols for prophylaxis, but the average quantity of antimicrobial drugs administered per patient decreased by 38%.

Adolescent↗

PubMedDate not supplied

Fever following orthopedic operations in children.

One hundred fifty-three orthopedic operations in 129 children were analyzed for the significance of postoperative fever (POF) as a predictive factor for possible complications. In 72% of the operations, a temperature of greater than 37 degrees C was recorded. In 63 operations (41%), the temperature was greater than 38 degrees C. Sixteen children had positive clinical signs that might explain the fever, and all of them had a temperature of greater than 38 degrees C. Duration of operation of greater than 1 h, clubfoot releases, open reduction of fractures, and spine fusion operations gave higher incidences of POF. POF indicates a complication only when associated with positive physical findings. A postoperative temperature of greater than 38 degrees C, therefore, mandates repeated physical examination, which is the most reliable method of discovering the presence of complications.

Adolescent↗

PubMedDate not supplied

A trend for reduced 15-day wound infection and 6 months' mortality in laparoscopic relative to open cholecystectomy: the Israeli Study of Surgical Infections.

OBJECTIVE: To utilize a naturally occurring "experiment," when introduction to laparoscopic cholecystectomy occurred in Israel; to compare the concurrent outcomes (wound infection and mortality) of laparoscopic versus open cholecystectomy; to adjust for patients' characteristics and procedural factors while making the comparisons. DESIGN: Multicenter prospective follow up, including patients' interviews prior to the operation, daily information on postoperative care, a summary of the operation report and postdischarge telephone interview 15 days after surgery. SETTINGS: A sample of 100 consecutive cholecystectomy patients from all 20 acute-care hospitals in the country, where such operations were performed. PATIENTS: 1,785 consecutive patients during 1991 and 1992; 1,184 had open cholecystectomy, and 601 had laparoscopic cholecystectomy. RESULTS: Crude wound infection rates at 15 days were 2.3% for laparoscopic cholecystectomy and 6.3% for open cholecystectomy (odds ratio [OR], 2.8; P < .001). Crude mortality rates at 6 months were 0.17% and 3.0% for laparoscopic and open procedures, respectively (OR, 18.5; P < .004). Logistic models for infection and mortality were used to adjust for case-mix and procedural factors in the comparisons between the two operations. Adjusted ORs for open versus laparoscopic cholecystectomy were 1.9 (P = .06) for wound infection and 4.3 (P = .17) for mortality. Stratification of patients on the basis of the models into high- and low-risk strata indicated that the protective effect of laparoscopic cholecystectomy was mainly evident in the high-risk group: 1.8% versus 8.3% (P < .001) for 15-day infections and 0.6% versus 4.4% (P = .017) for 6 months mortality. CONCLUSION: We conclude that, although the P values for the adjusted comparisons were of borderline significance (due to the small number of deaths in the laparoscopic group), our results suggest advantageous outcomes for laparoscopic cholecystectomy, especially among the high-risk patients.

Adult↗