General Surgery Patients Research Articles

Observational study of the suspected or confirmed cases of sars COV-2 infection needing emergency surgical intervention during the first months of the pandemic in a third level hospital: Case series

Approximately 28, 404, 603 surgical events have been suspended in the 12 peak weeks of the COVID-19 pandemic. The aim of this study was to report all the surgically intervened patients with suspected or confirmed SARS CoV-2 infection from April 1 to July 31, 2020, and to estimate their prognosis in the Surgical Therapy Department of a third level hospital in Mexico. MethodWe conducted an observational study of patients undergoing surgical intervention in the operating room assigned as COVID, where we considered age, sex, treating department, type of intervention, and initial biomarkers (first five days of hospitalization), days of hospital stay, days in the Intensive Care Unit and reason for discharge. Results42 patients have been surgically intervened, with a total of 49 surgeries. For Otolaringology and General Surgery, there were more deceased cases than alive cases; while for Thoracic Surgery, and Obstetrics and Gynecology, there were more alive cases than deceased ones (36% and 0% deceased, respectively), with statistically significant differences (p = 0.014). With regard to mortality for each group of surgical procedure, patients who underwent C-section or pleurostomy had a mortality rate of 0%; the mortality rate for patients who underwent tracheostomy was 52%; patients who underwent laparotomy had a mortality rate of 54%; for those who underwent debridement, the mortality rate was 100%; which show significant differences, with a p value of 0.03. Discussionwe identified an overall mortality rate of 42.8%, with a significant difference between treating departments and type of surgical procedure. This can be explained because many of the General Surgery patients, in addition to their infectious process by COVID-19, had another complication, like sepsis, In the same way, we can say that pregnant patients are healthy and have a physiological condition. Finally, patients undergoing an open tracheostomy had solely pulmonary complications. ConclusionThere is no doubt that we face an unknown condition for which we have been learning tests along the way. This sample of cases undergoing surgery at the beginning of the COVID-19 pandemic can provide clues on relevant results that we must consider for future cases.

Impact of interhospital transfer on patient outcomes in emergency general surgery

BackgroundEmergency general surgery patients are at an increased risk for morbidity and mortality compared to their elective surgery counterparts. The complex nature of emergency general surgery conditions can challenge community hospitals, which may lack appropriate systems and personnel. Outcomes related to transfer have not been well-established. We aimed to compare postoperative outcomes of patients who were transferred from another hospital to a center with dedicated acute care surgery services with patients admitted directly to the acute care surgery centers. MethodsWe performed a secondary analysis of a national, multicenter review of emergency general surgery patients undergoing complex emergency general surgery at 5 centers across Canada. The primary outcome was the development of any complication. The adjusted odds of postoperative complication was assessed using logistic regression, controlling for age, comorbidities, duration of stay before transfer, American Society of Anesthesiologists classification, and booking priority. ResultsA total of 1,846 patients were included in the study, and 176 (9.5%) were transferred. Of these 21% (n = 37) underwent an operative procedure, and 15% (n = 27) underwent an operation at the transferring center. Transferred patients were more likely to have at least 1 comorbidity (68% vs 57%; P = .004), were classified as greater urgency on arrival (<2 hours booking priority, 43% vs 17%; P < .001), had a greater American Society of Anesthesiologists classification (American Society of Anesthesiologists ≥3 = 81% vs 65%; P < .001), a greater duration of operation (119 vs 110 minutes; P = .004), and were more likely to undergo a second operation (28% vs 14%; P < .001) compared to patients directly admitted to an acute care surgery center. On univariate analysis, transferred patients had greater rates of complications (48% vs 31%; P < .001), mortality (14% vs 7%; P = .005), and admission to the intensive care unit (22% vs 12%; P < .001). Transfer status remained an independent predictor of complication (odds ratio 1.9 [95% confidence interval 1.3–2.7]; P < .001) and intensive care unit admission (odds ratio 1.9 [95% confidence interval 1.2–3.0]; P = .007), but not mortality (odds ratio 1.1 [95% confidence interval 0.6–1.9]; P = .79) on regression analysis. ConclusionComplex emergency general surgery patients transferred to acute care surgery centers may have worse outcomes and greater use of resources compared to those admitted directly. This finding has clinically and financially important implications for the design and regionalization of acute care surgery services as well as resource allocation at acute care surgery centers.

Finding the Balance Between Reduced Opioid Prescribing and Patient-Reported Pain Management among General Surgery Patients

Finding the Balance Between Reduced Opioid Prescribing and Patient-Reported Pain Management among General Surgery Patients

Prediction of Surgical Risk in General Surgeries: Process Optimization Through Support Vector Machine (SVM) Algorithm

Background: In 5 hospitals in Belo Horizonte (population, 3 million) between July 2016 and June 2018, a survey was performed regarding surgical site infection (SSI). We statistically evaluated SSI incidents and optimized the power to predict SSI through pattern recognition algorithms based on support vector machines (SVMs). Methods: Data were collected on SSIs at 5 different hospitals. The hospital infection control committees (CCIHs) of the hospitals collected all data used in the analysis during their routine SSI surveillance procedures; these data were sent to the NOIS (Nosocomial Infection Study) Project. NOIS uses SACIH software (an automated hospital infection control system) to collect data from hospitals that participate voluntarily in the project. In the NOIS, 3 procedures were performed: (1) a treatment of the database collected for use of intact samples; (2) a statistical analysis on the profile of the hospitals collected; and (3) an assessment of the predictive power of SVM with a nonlinear separation process varying in configurations including kernel function (Laplace, Radial Basis, Hyperbolic Tangent and Bessel) and the k-fold cross-validation–based resampling process (ie, the use of data varied according to the amount of folders that cross and combine the evaluated data, being k = 3, 5, 6, 7, and 10). The data were compared by measuring the area under the curve (AUC; range, 0–1) for each of the configurations. Results: From 13,383 records, 7,565 were usable, and SSI incidence was 2.0%. Most patients were aged 35–62 years; the average duration of surgery was 101 minutes, but 76% of surgeries lasted &gt;2 hours. The mean hospital length of stay without SSI was 4 days versus 17 days for the SSI cases. The survey data showed that even with a low number of SSI cases, the prediction rate for this specific surgery was 0.74, which was 14% higher than the rate reported in the literature. Conclusions: Despite the high noise index of the database, it was possible to sample relevant data for the evaluation of general surgery patients. For the predictive process, our results were &gt;0.50 and were 14% better than those reported in the literature. However, the database requires more SSI case samples because only 2% of positive samples unbalanced the database. To optimize data collection and to enable other hospitals to use the SSI prediction tool, a mobile application was developed (available at www.sacihweb.com).Funding: NoneDisclosures: None

Working Behind the Scenes: How Transfer Center Nurses Facilitate Interactions and Communication between Providers Regarding Transfers of Emergency General Surgery Patients

Working Behind the Scenes: How Transfer Center Nurses Facilitate Interactions and Communication between Providers Regarding Transfers of Emergency General Surgery Patients

Risk Factors for Mortality in Emergency General Surgery Patients

Reinke, Caroline E. MD, MSHP, FACS; Wade Ross, Samuel MD; KOWALKOWSKI, Marc PhD; Wang, Huaping MPH; William Cunningham, Kyle MD, FACS; Hetherington, Timothy BS; May, Addison MD, MBA, FACS; Duane Matthews, Brent MD, FACS Author Information

Underrepresentation of Racial Minorities in Breast Surgery Literature: A Call for Increased Diversity and Inclusion.

In this study, the extent of racial diversity in images of breast-related plastic surgery published literature was investigated to better understand disparities that exist in breast surgery. The lack of racial diversity in images of skin color in surgery literature can perpetuate implicit bias and stereotypes. Implicit bias can affect the way patients are evaluated, diagnosed, and treated. The visual aspects of plastic surgery make a lack of diversity in imagery especially impactful on patient care and outcomes. Published medical images and graphics depicting human skin were analyzed across 4 major plastic surgery journals. Up to 4 years were chosen a priori to evaluate from each journal and represented the initial year of color image publication, the year of study initiation (2016), and representative years for a given decade (2000 and 2010). Images and graphics were tabulated, rated by Fitzpatrick scale and categorized into "White" or "non-White." Data were evaluated with pair-wise and linear regression statistics. Of the 2774 images and 353 graphics that met inclusion criteria, only 184 (8.18%) images and 9 graphics (6.34%) depicted non-White skin. Temporal analysis showed that there is an increased diversity of images published since 2010 with 0% of images being non-White before and 7.3% to 10.3% after 2010. International and multi-national authors tended to publish more non-White images. There is insufficient racial diversity visually represented in the breast-related plastic surgery literature with a small degree of progress made towards more equitable imagery over time. Increasing awareness of image content, and the need for equitable visual representation may allow for improved racial diversity in surgical literature.

Sugerencias para el manejo de pacientes de cirugía general durante la emergencia sanitaria por COVID-19

El objetivo del presente artículo es brindar sugerencias, para el manejo pre, intra y posoperatorio, de pacientes de cirugía general, durante la emergencia sanitaria por COVID-19; y con ello, minimizar el contagio de cirujanos y disminuir la transmisión intrahospitalaria de la enfermedad. Se realizó una revisión de la literatura a través de PubMed y se consultaron las páginas web de sociedades científicas internacionales, así como, fuentes del Ministerio de Salud del Perú. Se formularon sugerencias para el manejo de estos pacientes, basadas en la experiencia de países donde se tiene un mayor número de casos de COVID-19. Se resalta la importancia del uso adecuado de los equipos de protección personal (EPPs); y la factibilidad de realizar un abordaje abierto o laparoscópico en cirugías de emergencia con los cuidados adecuados para evitar contagios en el paciente y personal de salud. Sin embargo, se debe considerar que las recomendaciones pueden cambiar con el tiempo al generarse nuevos conocimientos.

General surgery in patients with left ventricular assist devices: Do not cross the line!

General surgery in patients with left ventricular assist devices: Do not cross the line!

The Association Between Incorrect Use of Antibiotic Prophylaxis and in-Hospital Surgical Site Infections - A Prospective Observational Study.

BackgroundSurgical site infection (SSI) is the most prevalent in developing countries where 61–90% of cases develop in-hospital. The study aimed to assess the correctness of antibiotic prophylaxis (AP) use, the incidence of in-hospital SSI, and its determinants.Patients and MethodsA 3-month hospital-based prospective observational study design was used on general surgery patients. The criteria for identification of SSI were performed based on the Center for Disease Control and Prevention’s (CDC’s) definition of SSI. The correctness of AP was performed based on the American Society of Health System Pharmacist 2013 guideline (ASHP). Multiple stepwise backward logistic regression analysis was used at p-value <0.05 to predict SSI.ResultsOf 269 adult patients, the type of admission was almost equal between emergency and elective surgery. The mean (± SD) age of the study participants was 41.95±17.764. Only 19.7% of the study participants used AP correctly. The incidence rate of in-hospital SSI was 16.7% (45/269), which corresponds to 45/4736 or 9.5/1000 person-days. Independent predictors for SSI were American Society of Anesthesiology (ASA) class III–IV (p-value <0.0001), patients with age-adjusted Charlson co-morbidity index (CCI) of ≥1 score (p value=0.008), and incorrect use of AP (p-value =0.025).ConclusionIncorrect antibiotic prophylaxis use contributed to an increased risk of SSI, which needs urgent attention in the present study area.

Changes in Emergency General Surgery During Covid-19 in Scotland: A Prospective Cohort Study.

IntroductionCovid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland.MethodsA prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison.ResultsA total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = < 0.05) as did severity (0 per cent > grade 1 vs 58.3 per cent > grade 1, p = < 0.05). The proportion of patients undergoing surgery increased (19.1 vs 42.3 per cent, p = < 0.05) as did the mean operating time (102.4 vs 145.7 min, p = < 0.05). Surgery was performed in 1 confirmed and 1 suspected Covid-19 patient. The latter died within 30 days. There were no 30-day readmissions with Covid-19 symptoms.ConclusionCovid-19 has significantly impacted the number of admissions to emergency general surgery. However, emergency operating continues to be needed at pre-Covid-19 levels and as such provisions need to be made to facilitate this.

BMI and VTE Risk in Emergency General Surgery, Does Size Matter? : An ACS-NSQIP Database Analysis.

Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality. Emergency general surgery (EGS) patients comprise 7% of hospital admissions in America with a reported rate of VTE of 2.5%. Of these, >69% required hospital readmission, making VTE the second most common cause for readmission after infection in EGS patients. We hypothesize a correlation between body mass index (BMI) and VTE in EGS patients. The American College of Surgeons National Surgery Quality Improvement Database (NSQIP) was queried from January 2015 to December 2016. 83 272 patients met inclusion criteria: age ≥18 and underwent an EGS procedure. Patients were stratified by BMI. Descriptive statistics were used for demographic and numerical data. Categorical comparisons between covariates were completed using the chi-square test. Continuous variables were compared using Student's t-test, Mann Whitney U-test, or Kruskal-Wallis H test. 83 272 patients met the inclusion criteria. 1358 patients developed VTE (903 deep vein thrombosis (DVT) only, 335 pulmonary embolism (PE) only, and 120 with DVT and PE). Morbidly obese patients were 1.7 times more likely to be diagnosed with a PE compared with normal BMI (P = .004). Increased BMI was associated with the co-diagnosis of PE and DVT (P = .027). Patients with BMI <18.5 were 1.4 times more likely to experience a VTE compared with normal BMI (P = .018). Patients with a VTE were 3.2 times more likely to die (P < .001) and less likely to be discharged home (P < .001). Our study found that obese and underweight EGS patients had an increased incidence of VTE. Risk recognition and chemoprophylaxis may improve outcomes in this population.

How effective is intra-cuff lignocaine in reducing post-operative sore throat and emergence cough: a comparative study

Background: Sore throat and cough during emergence are common side effects of general anaesthesia and its incidence is reported by 30-70% of patients after tracheal intubation. Also, not to forget the hemodynamic fluctuations associated with it, adds on to the magnitude of the problem. Thinking of a simple and cost-effective way to tackle this problem, this study was undertaken to determine the benefits of using intra-cuff lignocaine to prevent post intubation sore throat and emergence cough. The objective of this study to assess the efficacy of intra-cuff 2% lignocaine solution, in reducing emergence cough and post-operative sore throat after extubation in general surgery patients intubated for 2-4 hours.Methods: A prospective observational study where 100 ASA I and II status patients divided into 2 groups of 50 each was compared. In one group ETT cuff was filled with air, while in the other group, 2% plain lignocaine solution was used. Side effects like sore throat, coughing and blood pressure changes were assessed. Chi square and t-tests were used to compare the findings.Results: Among those patients where intra-cuff lignocaine was used, only 27.5% complained of sore throat and 12.5% had emergence cough, whereas among those patients where intra-cuff air was used, 72.5% had post-operative sore throat and 87.5% of patients had cough on emergence.Conclusions: This study proves that 2% intra-cuff lignocaine is an effective method in reducing post-operative sore throat and emergence cough and thereby beneficial in controlling the hemodynamic changes associated with emergence.

Resuscitative Endovascular Balloon Occlusion of Aaorta Use in Nontrauma Emergency General Surgery: A Multi-institutional Experience

BackgroundThe aim of this study was to determine the current utilization patterns of resuscitative endovascular balloon occlusion of aorta (REBOA) for hemorrhage control in nontrauma patients. MethodsData on REBOA use in nontrauma emergency general surgery patients from six centers, 2014-2019, was pooled for analysis. We performed descriptive analyses using Fisher's exact, Student's t, chi-squared, or Mann–Whitney U tests as appropriate. ResultsThirty-seven patients with acute hemorrhage from nontrauma sources were identified. REBOA placement was primarily performed by trauma attendings (20/37, 54%) and vascular attendings (13/37, 35%). In seven patients (19%), balloons were positioned prophylactically but never inflated. In 24 (65%) of 37 patients, REBOA was placed in the operating room. 28/37 balloons (76%) were advanced to zone 1, 8/37 (22%) were advanced to zone 3, and there was one REBOA use in the inferior vena cava. Most common indications were gastrointestinal and peripartum bleeding. In the 30 cases of balloon inflation, 24 of 30 (80%) resulted in improved hemodynamics. Eleven of 30 patients (37%) died before discharge. One patient developed a distal embolism, but there were no reports of limb loss. Twelve patients (40% of all REBOA inflations and 63% of survivors) were discharged to home. ConclusionsREBOA has been used in a range of acutely hemorrhaging emergency general surgery patients with low rates of access-related complications. Mortality is high in this patient population and further research is needed; however, appropriate patient selection and early use may improve survival in these life-threatening cases.

Impact of pharmacist interventions on drug-related problems in general surgery patients: a randomised controlled trial

ObjectivesThe inappropriate use of medications is harmful and is a common issue in hospitalised patients. Patients hospitalised in general surgery wards are usually at high risk for drug-related problems (DRPs)....

Safety And Efficacy Of Dpp-4 Inhibitors For The Management Of Hospitalized General Medicine And Surgery Patients with Type 2 Diabetes

DPP-4 inhibitors (DPP-4i) have been shown to be effective for the management of inpatient diabetes. We report pooled data from 3 prospective studies using DPP-4i in general medicine and surgery patients with type 2 diabetes (T2D). We combined data from 3 randomized studies comparing DPP-4i alone or in combination with basal insulin or a basal-bolus insulin regimen. Medicine (n = 266) and surgery (n = 319) patients admitted with a blood glucose (BG) between 140 and 400 mg/dL, treated with diet, oral agents, or low-dose insulin therapy were included. Patients received DPP-4i alone (n = 144), DPP-4i plus basal insulin (n = 158) or basal-bolus regimen (n = 283). All groups received correctional doses with rapid-acting insulin for BG >140 mg/dL. The primary endpoint was differences in mean daily BG between groups. Secondary endpoints included differences in hypoglycemia and hospital complications. There were no differences in mean hospital daily BG among patients treated with DPP-4i alone (170 ± 37 mg/dL), DPP-4i plus basal (172 ± 42 mg/dL), or basalbolus (172 ± 43 mg/dL), P = .94; or in the percentage of BG readings within target of 70 to 180 mg/dL (63 ± 32%, 60 ± 31%, and 64 ± 28%, respectively; P = .42). There were no differences in length of stay or complications, but hypoglycemia was less common with DPP-4i alone (2%) compared to DPP-4i plus basal (9%) and basal-bolus (10%); P = .004. Treatment with DPP-4i alone or in combination with basal insulin is effective and results in a lower incidence of hypoglycemia compared to a basal-bolus insulin regimen in general medicine and surgery patients with T2D. BG = blood glucose; BMI = body mass index; CI = confidence interval; DPP-4i = dipeptidyl peptidase-4 inhibitors; HbA1c = hemoglobin A1c; OR = odds ratio; T2D = type 2 diabetes.

Review of COVID-19 Outcomes in Surgical Patients.

Poor outcomes were most frequent in general surgery or oncological surgery patients who were older with chronic comorbidities. In contrast, outcomes among transplant surgery and obstetric patients were not signficantly altered by COVID-19. Surgical societies have released specialty specific guidelines on the managment of patients who require surgical care during the pandemic. COVID-19 is associated with adverse outcomes and increased mortality in surgical patients. Data is currently limited, often restricted to single sites and smaller cohorts. As the sequelae of the virus is better understood, the revisions to the guidelines on managment of surgical patients may help improve outcomes.

Does social isolation cause secondary injury in general surgery patients?

Amac: Pandemi donemlerinde uygulanan sosyal izolasyonun bazi hasta gruplarinda ikincil hasara neden oldugunu gosteren yayinlar mevcuttur. Ikincil hasar gelisebilecegi korkusu ile hastalar ve hekimler tarafindan sosyal izolasyon kurallarina aykiri tavirlar gosterilebilmektedir. Calismadaki amacimiz; COVID-19 pandemisi sirasinda Turkiye’de uygulanan sosyal izolasyonun, genel cerrahi hastalarinda meydana getirdigi ikincil hasarlari degerlendirmekti. Yontemler: Baskent Universitesi Ankara ve Konya Uygulama ve Arastirma Merkezleri eriskin acil servisinden genel cerrahi bolumune konsulte edilen 279 hasta retrospektif olarak incelendi. Hastalar basvuru donemine gore iki grupa ayrildi (Grup 1: 01 Mart - 01 Mayis 2019; n=163, Grup 2: 01 Mart - 01 Mayis 2020; n=116). Hastalarin demografik karakteristikleri, klinik bilgileri ve tedavi ozellikleri hastane otomasyon sistemi araciligi ile kayit edilerek her iki grup karsilastirildi. Bulgular: Grup 2’nin yas ortalamasi (50,4 (19,3)), grup 1 (55,4 (20,4))’e gore daha dusuktu ve bu dusus istatistiksel olarak anlamliydi (P=0,038). Gruplarin cinsiyet (P=0,28), malignite (P=0,53), komorbidite (P=0,27) dagilimlari benzerdi. Gruplar arasinda basvuru sikayetleri (P=0,88) ve sikayet sureleri (P=0,068) acisindan anlamli fark saptanmadi. Gruplarin tanilari karsilastirildiginda Grup 2’de akut kolesistit orani anlamli olarak daha yuksek tespit edildi (P=0,005). Ayrica non-spesifik hasta orani grup 1’de anlamli olarak daha fazla idi (P=0,003). Gruplar arasinda hospitalizasyon (P=0,46), tedavi sekli (P=0,3), yapilan cerrahi prosedur (P=0,27), yatis suresi (P=0,66) ve mortalite orani (P=0,5) acisindan istatistiksel olarak anlamli bir fark saptanmadi. Sonuc: Yaptigimiz arastirma sonuclarina gore merkezimize basvuran hastalarda sosyal izolasyona bagli gelisen ikincil hasarlanma ile karsilasmadik. Bu donemde hastalarin sosyal izolasyonda olmalari ciddi klinik problemleri var iken hastaneye basvurularini azaltmamis sadece gereksiz acil basvurusu sayisini azaltmistir.

Graduated compression stockings in the prevention of postoperative pulmonary embolism. A propensity-matched retrospective case-control study of 24 273 patients

IntroductionRecommendations for venous thromboembolism and deep venous thrombosis (DVT) prophylaxis using graduated compression stockings (GCS) is historically based and has been critically examined in current publications. Existing guidelines are inconclusive as to recommend the general use of GCS.Patients/Methods: 24 273 in-patients (general surgery and orthopedic patients) undergoing surgery between 2006 and 2016 were included in a retrospectively analysis from a single center. From January 2006 to January 2011 perioperative GCS was employed additionally to drug prophylaxis and from February 2011 to March 2016 patients received drug prophylaxis alone. According to german guidelines all patients received venous thromboembolism prophylaxis with weight-adapted LMWH. Risk stratification (low risk, moderate risk, high risk) was based on the guideline of the American College of Chest Physicians. Data analysis was performed before and after propensity matching (PM). The defined primary endpoint was the incidence of symptomatic or fatal pulmonary embolism (PE). A secondary endpoint was the incidence of deep venous thromboembolism (DVT). ResultsAfter risk stratification (low risk n = 16 483; moderate risk n = 4464; high risk n = 3326) a total of 24 273 patient were analyzed. Before to PM the relative risk for the occurrence of a PE or DVT was not increased by abstaining from GCS. After PM two groups of 11 312 patients each, one with and one without GCS application, were formed. When comparing the two groups, the relative risk (RR) for the occurrence of a pulmonary embolism was: Low Risk 0.99 [CI95% 0.998–1.000]; Moderate Risk 0.999 [CI95% 0.95–1.003]; High Risk 0.996 [CI95% 0.992–1.000] (p > 0.05). The incidence of PE in the total group LMWH alone was 0.1% (n = 16). In the total group using LMWH + GCS, the incidence was 0.3% (n = 29). RR after PM was 0.999 [CI95% 0.998–1.00]. ConclusionIn comparison to prior studies with only small numbers of patients our trial shows in a large group of patients with moderate and high risk developing VTE we can support the view that abstaining from GCS-use does not increase the incidence of symptomatic or fatal PE and symptomatic DVT.

Duration of Antibiotic Therapy for General Medicine and General Surgery Patients Throughout Transitions of Care: An Antibiotic Stewardship Opportunity for Noninfectious Disease Pharmacists.

Overuse of antibiotics from the inpatient to outpatient setting is an antibiotic stewardship initiative where noninfectious disease (ID) pharmacists can have a large impact. Our purpose was to evaluate antibiotic durations across transitions of care from the inpatient to outpatient setting. This is a single-center, retrospective cohort analysis evaluating antibiotic durations from the inpatient and outpatient setting in adult patients admitted to general surgery and medicine services at an academic medical center between January 1, 2017 and September 20, 2017. The primary outcome was to assess total antibiotic duration for patients with uncomplicated and complicated urinary tract infections (UTI, cUTI), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP). Outpatient electronic discharge prescriptions were used to calculate intended antibiotic duration upon transitions of care. Excessive duration of therapy was defined as >3 days-UTI, >5 days-CAP, and >7 days-cUTI or HAP. One hundred and one patients met inclusion criteria. Overall, most of the patients (81%) had antibiotics longer than recommended with only 3% receiving less than the recommended duration. Median total duration of therapy compared with recommended duration specified in national guidelines was UTI: 10 days [7 -10], cUTI: 12 days [7.5-12.5], CAP: 7 days [7 -9], HAP: 10 days [8 -12]. The median antibiotic duration was shorter in patients with no cultures or culture negative results compared with patients with positive cultures for all indications (UTI: 10.3 vs 10.8 days, cUTI: 9 vs 12 days, CAP: 8 vs 9.1 days, HAP: 10.5 vs 19.8 days). Overall, the recommended duration of antibiotics was completed while inpatient in 34.7%, but varied by infection. More patients with UTI or cUTI completed recommended duration of therapy while inpatient vs for CAP or HAP (53.8% vs 28%, P = .03). Eighty percent of those with UTI, 18.2% with cUTI, 25.6% with CAP, and 31.2% with HAP had already received the recommended duration of treatment, or more, on day of hospital discharge. The median duration of antibiotic therapy for all indications evaluated was longer than recommended in national guidelines. Opportunities for stewardship by non-ID pharmacists to impact postdischarge antimicrobial use at transitions of care have been identified.