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Preventing SSIs: An Evidence-Based Update

Preventing SSIs: An Evidence-Based Update

According to recent data, surgical site infections (SSIs) are common complications in acute care facilities, occurring in 2% to 5% of patients undergoing inpatient surgery. Approximately 160,000 to 300,000 SSIs occur each year in the United States, making these infections one of the most common and costly healthcare-associated infections (HAIs). “As society continues to age, older patients are increasingly undergoing surgical procedures,” says Keith S. Kaye, MD, MPH. “These patients are particularly vulnerable to SSIs. As surgical advances continue to evolve, we must continue to find ways to further improve our ability to prevent SSIs.” Studies have shown that as many as 60% of SSIs are preventable if clinicians follow evidence-based guidelines. SSIs account for about 20% of all HAIs in hospitalized patients, and each case is associated with at least 7 days of prolonged hospitalization. Research has indicated that SSIs account for $3.5 billion to $10 billion annually in healthcare expenditures. Dr. Kaye notes that the outcomes and costs attributable to SSIs vary depending on the type of operation and the type of infecting pathogen. A Welcome Update In 2008, the Society for Healthcare Epidemiology of America (SHEA) and Infectious Disease Society of America (IDSA) released their Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals. The document was designed to help healthcare institutions prioritize and implement strategies to reduce the number of infections. Recently, SHEA and IDSA released an update of these guidelines and published them in Infection Control and Hospital Epidemiology. The updated evidence-based recommendations are broader and more inclusive than other clinical guidelines that are currently available. They include 15 strategies for prevention...
Hip Fracture Surgery: Costs & Benefits

Hip Fracture Surgery: Costs & Benefits

According to current estimates, more than 300,000 patients—mostly people aged 65 and older—sustain a hip fracture each year in the United States, and the annual incidence is expected to exceed 500,000 by 2040. Hip fractures often result in nursing home stays, higher mortality, and lower quality of life. The expected rising incidence will place a significant financial burden on patients, families, insurers, and other key stakeholders. Surgery is the primary treatment strategy for hip fractures because it can reduce mortality risk and improve physical function, but less is known about the societal cost implications of hip fractures. New Data Little is known about the return on investment of surgery for hip fracture patients, says Lane Koenig, PhD. “Policymakers and payers are increasingly focusing on value, making it critical to understand the return from healthcare spending,” he says. To investigate this further, Dr. Koenig and colleagues conducted a study—published in Clinical Orthopaedics and Related Research—that estimated the impact of surgical and nonsurgical treatment in patients aged 65 and older. The research team reviewed published literature and expert opinions to examine a comprehensive set of outcomes, including long-term medical costs, home modification costs, and costs associated with long-term nursing home care. For the study, Dr. Koenig and colleagues developed a predictive tool to account for various possible outcomes so that they could measure the cost and potential savings of repairing hip fractures with surgery. “Our results showed that surgery provided a significant societal benefit and value by returning patients to active, independent living,” Dr. Koenig says. The average lifetime societal benefits in the U.S. reduced medical and nursing home costs of...

Surgeons Who Can’t Perform Open Surgery

Now I’m really worried about surgical education. Here’s why: A friend told me that a new attending on his staff was having some problems. Although the young surgeon was a graduate of 5 years of general surgery plus 2 years of fellowship, he was unable to do an inguinal hernia or a laparoscopic cholecystectomy by himself. This is just an anecdote, but the issue has been identified by others. Remember the paper from Annals of Surgery in September of 2013 that described a survey of fellowship directors? It stated that 66% of graduates of 5-year general surgery training programs could not conduct a major case unsupervised for 30 minutes, and 30% could not independently perform a laparoscopic cholecystectomy. A study published online in JAMA Surgery in February looked at 20 years of ACGME surgical resident case logs and found that although minimally invasive surgery is being done much more frequently, it is currently performed in more than 50% of cases for only five procedures—cholecystectomy, appendectomy, adult anti-reflex surgery, partial gastric resection, and thoracic wedge resection. In 2007, the Residency Review Committee for Surgery increased the required number of basic laparoscopic surgery cases from a minimum of 34 to 60 and from 0 to 25 for advanced. The authors expressed concern that there might not be enough minimally invasive cases for all of the residents to do. They also pointed out that since all but five operation procedures are still predominantly performed the open way, there was still a need for residents to learn it. However, as laparoscopic cases increase, the number of open cases will decrease because the total...
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