Prevention Of Postoperative Pneumonia Research Articles

Risk and Prevention of Postoperative Pneumonia after Esophagectomy

Risk and Prevention of Postoperative Pneumonia after Esophagectomy

Significance of Antimicrobial Prophylaxis for the Prevention of Early-Onset Pneumonia After Radical Esophageal Cancer Resection: A Retrospective Analysis of 356 Patients Undergoing Thoracoscopic Esophagectomy.

Postoperative pneumonia is a common complication after esophagectomy and is associated with a high mortality rate. Although many randomized, controlled trials have been conducted on the prevention of postoperative pneumonia, little attention has been paid to the efficacy of antimicrobial prophylaxis. The purpose of this study was to investigate the impact of antimicrobial prophylaxis on the prevention of postoperative pneumonia. Data of patients with esophageal cancer who underwent thoracoscopic esophagectomy between 2016 and 2020 were collected. Early-period patients received cefazolin (CEZ) per protocol as antimicrobial prophylaxis (n = 250), and later-period patients received ampicillin/sulbactam (ABPC/SBT) (n = 106) because of the unavailability of CEZ in Japan. The incidence of pneumonia was compared between treatments in this quasi-experimental setting. Pneumonia detected by routine computed tomography (CT) on postoperative Days 5-6 was defined as early-onset pneumonia, and pneumonia that developed later was defined as late-onset pneumonia. The incidence of early-onset pneumonia was significantly lower (3.8% vs. 13.6%, P = 0.006), and the median length of postoperative hospital stay was significantly shorter (17 vs. 20 days, P < 0.001) in the ABPC/SBT group than in the CEZ group. The incidence of late-onset pneumonia was similar between groups (9.4% vs. 10.0%, P = 0.870). The incidence of Clostridioides difficile infections and the incidence of multidrug-resistant organisms were similar between groups. Multivariate analyses consistently showed the superiority of ABPC/SBT to CEZ in preventing early-onset pneumonia (odds ratio: 0.20, P = 0.006). ABPC/SBT after esophagectomy was better at preventing early-onset pneumonia compared with CEZ and was feasible regarding the development of antimicrobial resistance.

Surgical Outcomes of Colorectal Cancer Surgery for ≥ 85-year-old Patients in Our Hospital: Retrospective Comparison of Short- and Long-term Outcomes with Younger Patients.

Objectives: To evaluate future problems in colorectal cancer surgery for elderly patients. Methods: We conducted a retrospective review of patients receiving colorectal cancer surgery in our hospital from January 2010 to December 2018. Patients were divided into the ≥ 85-year-old patient group and the younger patient group. We compared patient backgrounds, surgical outcomes (surgical procedure, reduction of lymph node dissection range, operative duration, and blood loss), postoperative short-term outcomes (mortality, morbidity, and postoperative length of stay) and prognosis. Results: We performed colorectal cancer surgery on 1,240 patients during the study period. Of them, 109 (8.7%) were ≥ 85 years old, and 1,131 (91.2%) were < 85 years old. The American Society of Anesthesiologists physical status (ASA-PS) was significantly poorer in the elderly group than in the younger group and patients with a history of cardiac disease and anticoagulant use were significantly more in the elderly group. The rate of reduction of lymph node dissection range was significantly higher in the elderly group (16.8% vs. 3.8%, p < 0.05). Overall morbidity was significantly higher in the elderly group (42.2% vs. 21.9%, p < 0.05), as were the respective frequencies of pneumonia and thromboembolism (8.2% vs. 0.7%, p < 0.05 and 3.6% vs. 0.8%, p < 0.05, respectively). Postoperative hospital stay was significantly longer in the elderly group (17 vs. 12 days, p < 0.05). Overall survival was significantly lower in the elderly group (p < 0.05), but relapse-free survival and colorectal cancer-specific survival were not statistically different between the groups (p = 0.05 and p = 0.15, respectively). Conclusions: Prevention of postoperative pneumonia and thromboembolism remains a problem. After proper assessment and careful management of peri-operative surgical risks, surgery can be indicated in elderly patients.

Cost-Effectiveness Analysis of Perioperative Oral Management after Cancer Surgery and an Examination of the Reduction in Medical Costs Thereafter: A Multicenter Study.

In April 2012, perioperative oral management (POM) was approved for inclusion in the national health insurance system of Japan to prevent the occurrence of pneumonia, a major complication in cancer patients. The subsequent decrease in the incidence of postoperative pneumonia indicated the prophylactic effect of POM. The constant increase in health expenditure necessitates a cost-effectiveness analysis. In addition, the effect of reducing healthcare costs owing to health technologies must be evaluated. In the present multi-institutional study, the cost-effectiveness analysis of POM was conducted by comparing the incidence of postoperative pneumonia and the healthcare costs between patients who received surgery for malignant tumors before (n = 11,886) and after (n = 13,668) the introduction of POM. Additionally, the effect of reducing healthcare costs was evaluated. Reductions in the number of patients who developed pneumonia, duration of hospitalization, and number of deaths were observed after the introduction of POM. The incremental cost-effectiveness ratio was 111,927 yen, hence the prevention of postoperative pneumonia needs 111,927 yen per patient in healthcare costs. Consequently, a maximum reduction of 250,368,129 yen in healthcare costs was observed between the incremental costs for pneumonia treatment and the cost of POM. These findings indicate that improvements in cost-effectiveness can be expected in the future through the development of procedure and system for POM.

Prevention of postoperative pneumonia by perioperative oral care in patients with esophageal cancer undergoing surgery: a multicenter retrospective study of 775 patients.

Postoperative pneumonia is one of the major complications after esophageal cancer surgery. The risk factors associated with postoperative pneumonia are poor general health, smoking, decreased pulmonary function, diabetes mellitus, surgical stress, old age, postoperative aspiration, and oral hygiene. In this study, we examined the effect of perioperative oral care on reducing postoperative pneumonia since the evidence to-date is not clear. A multicenter, retrospective investigation of the relationship between perioperative oral care and incidence of postoperative pneumonia in patients undergoing esophageal cancer surgery was conducted. A total of 775 patients who underwent thoracoscopic esophageal resection at 25 hospitals between 2016 and 2017 were enrolled in the study. Various factors were examined for correlation with development of postoperative pneumonia. Multivariate analysis showed that old age, smoking habit, lower hemoglobin, higher creatinine, postoperative dysphagia, and lack of oral care intervention were independent risk factors for pneumonia. Oral care was more effective in preventing pneumonia in hospitals in which the incidence of postoperative pneumonia was lower than 20%, while it was not effective in hospitals in which the incidence was higher than 20%. Results of the study suggest that it is recommended to carry out perioperative oral care in esophageal cancer surgery.

Effects of perioperative oral care on prevention of postoperative pneumonia after lung resection: Multicenter retrospective study with propensity score matching analysis

BackgroundPostoperative pneumonia can be a fatal complication that may occur after lung resection in cancer patients. Some reports have shown that the incidence of postoperative pneumonia is decreased after esophageal surgery by perioperative oral care; however, there exist no data to suggest that a lack of perioperative oral care can be a risk factor for postoperative pneumonia after lung resection. To investigate the association between the preventive effect of oral care and postoperative pneumonia, we conducted a multicenter, retrospective study of lung cancer patients who underwent lung resection. MethodsBetween January 2014 and December 2016, a total of 721 patients underwent lung resections at 1 of the 6 hospitals included in our study. Among 721 patients, 280 (38.8%) received perioperative oral care, and the remaining 441 (61.2%) did not receive any such care. Propensity score matching was performed to minimize selection biases associated with the comparison of retrospective data between the oral care and control groups. ResultsOf the 721 patients, 54 (7.5%) experienced postoperative pneumonia involving 13 of the 280 patients (4.6%) in the oral care group and 41 of the 441 patients (9.3%) in the control group (P = .02). On propensity score analysis, a significant difference was also found between oral care intervention and incidence of postoperative pneumonia (P = .002). ConclusionOur results suggest that perioperative oral care is an effective method to decrease the occurrence of postoperative pneumonia in patients who have undergone lung resection.

Prevention of Postoperative Pneumonia in Noncardiac Surgical Patients: A Prospective Study Using the National Surgical Quality Improvement Program Database

Postoperative pneumonia increases morbidity, length of stay, and hospital readmission rates. Current data support the use of perioperative chlorhexidine gluconate in elective cardiac surgery patients to prevent postoperative pneumonia. The objectives of this study were to implement a resident-driven quality improvement project and determine the efficacy of an oral care bundle in preventing postoperative pneumonia among noncardiac surgical patients. A retrospective review of postoperative pneumonia occurrences at our hospital captured by the NSQIP database from 2014 to 2016 was conducted. A pre- and postoperative pulmonary care bundle was implemented in all surgical patients undergoing general anesthesia and outcomes were tracked by NSQIP for up to 90 days postoperatively for calendar year 2017. The NSQIP-reported incidence of postoperative pneumonia at our hospital was reduced from 0.8 to 0 per cent (P = 0). The risk-adjusted smoothed rate fell from 1.17 (95% confidence interval 0.77-1.66) in 2014 to 0.33 (95% confidence interval 0.03-0.98) in 2017. We encountered multiple systematic issues while conducting this study, which led to an imbalanced compliance to the preoperative (90%) and postoperative (31%) bundle; however, there was no significant difference between these two groups. Successful implementation of a resident-driven quality project resulted in a decreased rate of postoperative pneumonia.

Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: A multicenter case-control study with propensity score matching analysis.

e16017Background: Postoperative pneumonia is a severe adverse event associated with esophageal cancer surgery. It is thought to be caused by aspiration of oropharyngeal fluid containing pathogens. ...

The Relationship Between Postoperative Pneumonia and Endotracheal Suctioning Under General Anesthesia in Ophthalmic Surgery: A Retrospective Study.

Postoperative pneumonia is the third most common postoperative complication. It may result from aspiration of secretions accumulating in the subglottic space during general anesthesia (GA). However, the relationship between endotracheal suctioning (ETS) during extubation from GA emergence and postoperative pneumonia has not been well investigated. Therefore, the aim of this study was to investigate the effectiveness of ETS during extubation in prevention of postoperative pneumonia in ophthalmic surgery under GA in our medical center from 2011 through 2015. Three thousand, seven hundred and ninety-four patients receiving ophthalmic surgery under GA were included and divided into two groups by the anesthesiologists. The first group underwent the conventional ETS during extubation, while the other group was extubated without ETS. The incidences of postoperative pneumonia were compared between the two groups to find the correlation between ETS during extubation and postoperative pneumonia. In addition, other complication such as postoperative hemorrhage was also recorded. Of the 3,794 patients undergoing ophthalmic surgery under GA, 2,187 (58%) patients underwent extubation with ETS, whilst 1,607 (42%) patients were extubated without ETS. The incidence rates of postoperative pneumonia with or without ETS during extubation were both 0%. Besides, the incidence rates of postoperative hemorrhage were also both 0% in two groups. Extubation from GA without ETS seemed not to increase the risk of postoperative pneumonia. Thus, no routine ETS during extubation seemed not to be a risk factor for postoperative pneumonia under GA in ophthalmic surgery.

Predictors of postoperative pneumonia in patients undergoing oral cancer resections and its management

Background: Head-and-neck resections carry a major risk of postoperative pulmonary complications. It adds to morbidity and mortality, adversely affects recovery, and contributes to financial burden. The objective of this study is to find out the incidence of pneumonia and the utility of our institution protocol in the prevention of postoperative pneumonia (POP). Materials and Methods: Retrospective study including patients undergoing oral cavity resection at the tertiary hospital from August 2017 to July 2018. The patients were analyzed in terms of demographic profile, operative findings, and postoperative course. Diagnosis of pneumonia was established by intensivist based on symptoms and signs. Results: Incidence of pneumonia was 5.79% (15 out of 239). Average age of patients with pneumonia was 64.8 years and 60% were male. All had multiple comorbidities. Average preoperative serum albumin was 3.49. POP was seen commonly in patients who had composite resections involving alveolar arch and tongue (26.67%). Majority had reconstruction in the form of free flap (46.6%) with fibula flap being most common. Average intraoperative time was 10.5 h. The most common isolate was Pseudomonas aeruginosa (40%), followed by Klebsiella pneumonia (33.3%). About 26% were multidrug-resistant strains. Average hospital stay was found to be 30.6 days in patients of pneumonia. Conclusions: Data from our cohort indicated a much lower incidence compared to published literature. We attribute this to our routine practice of intensive care unit care in the immediate postoperative setting with a nursing care ratio of 1:1, postoperative early mobilization, frequent tracheal toileting, chest physiotherapy, early diagnosis of pneumonia, and prompt initiation of treatment.

胸腔鏡下食道切除術後反回神経麻痺の現状と術後肺炎予防における周術期管理チームの意義

胸腔鏡下食道切除術後反回神経麻痺の現状と術後肺炎予防における周術期管理チームの意義

Outcomes following thoracic surgery: the role of preoperative chlorhexidine mouthwash in the prevention of post-operative pneumonia

Background: The oropharynx is a reservoir for a multitude of commensal microorganisms. Natural defences exist to prevent the overgrowth, invasion and the transmission of these pathogens thereby reducing the incidence of respiratory, gastrointestinal and systemic infections. These defences are however breached by the invasive anaesthetic and surgical procedures associated with the thoracic surgery. Decontamination of the oral cavity prior to surgical intervention may potentially reduce the detrimental effects of such breaches. We evaluated the use of the preoperative chlorhexidine antiseptic mouthwash on the incidence of postoperative pneumonia. Methods: Data was collected from a prospective database for the study period (no chlorhexidine group A: 15/09/2008 -15/10/2008, n=195) and for study period (chlorhexidine group B: 16/10/2008-15/11/2008, n=190). Following the surgery, patients were investigated for the development of pneumonia based on the Guidelines for the Management of Hospital Acquired Pneumonia. Results: The incidence of the postoperative pneumonia was significantly reduced in the patients treated with preoperative chlorhexidine mouthwash (group A 10.52% v group B 2.56% p=0.003). The length of hospital stay was also found to be significantly shorter in the chlorhexidine group. Conclusions: The use of preoperative chlorhexidine mouthwash prior to the thoracic surgery results in a reduction in the development of the postoperative pneumonia.

The effect of perioperative oral management on prevention of postoperative pneumonia in patients undergoing esophageal resection

The effect of perioperative oral management on prevention of postoperative pneumonia in patients undergoing esophageal resection

Effectiveness of an outpatient preoperative care bundle in preventing postoperative pneumonia among esophageal cancer patients

This historical case-control study examined the effectiveness of an outpatient preoperative care bundle on the incidence of postoperative pneumonia among patients with esophageal cancer. We implemented a preoperative care bundle that comprised 7 care procedures that previous studies had suggested to be effective for decreasing postoperative respiratory complications, infections, postoperative hospital stay, and mortality. The care bundle group included patients who underwent surgery after the care bundle was implemented, whereas the control group included those who underwent surgery before its implementation. The incidence of postoperative pneumonia was 3.8% in the care bundle group (1/26) and 22.4% in the control group (48/214). A logistic regression model showed that implementation of the care bundle had a significant effect on prevention of postoperative pneumonia (odds ratio, 0.16; 95% confidence interval: 0.01-0.94) after controlling the following confounding factors: sex, blood urea nitrogen, amount of blood loss, recurrent laryngeal nerve palsy, and preoperative hospital stay. Implementation of the procedures of the preoperative care bundle was shown to be effective for preventing postoperative pneumonia in patients with esophageal cancer.

Prevention of Postoperative Pneumonia by Oral Care in Patients with Esophageal Cancer

Prevention of Postoperative Pneumonia by Oral Care in Patients with Esophageal Cancer

Reducing Surgical Complications

One of the 12 interventions that the Institute for Healthcare Improvement (IHI) recommends for its 5 Million Lives Campaign is "Reduce Surgical Complications...by reliably implementing all the changes in care recommended by the Surgical Care Improvement Project (SCIP)." Many surgical patients experience complications from surgery, some of which are preventable with the reliable application of evidence-based medicine. Despite promotion and dissemination of recommendations and practices, overall national compliance remains less than optimal. IHI's 5 Million Lives Campaign is supporting the recommended practices in the SCIP to accelerate adoption for reduction in surgical complications by 25% by December 2008. Practices relate to surgical site infection prevention, prophylaxis for venousthromboembolism, continuation of beta blockers, and prevention of postoperative pneumonia. Strategies used in hospitals that have achieved improvement in the recommended SCIP measures include practices that increase reliability and minimize practice variation. These changes, along with efforts to improve teamwork and communication, are essential to reduce surgical complications. Organizations that strive for high reliability in their processes should see improvement in the associated outcomes and a reduction in harm to patients.

Prevention of postoperative pneumonia

Pneumonia is still a frequent and unexpected postoperative complication, giving a high mortality rate. Regarding the causes of postoperative pneumonia (p.- o.p.), there is no common view both among our and among foreign surgeons.

PROPHYLAXIS OF POSTOPERATIVE PNEUMONIA BY ORAL HYGIENE

For the past two decades, serious consideration has been given to the etiology and prevention of postoperative pneumonia. In a large majority of the well organized hospitals, suggestions made by such men as Whipple, 1 Elwyn 2 and Henderson 3 are now incorporated as a matter of routine. These suggestions include: The better protection of the patient from chills and drafts before, during and after operation and in his journey to and from the operating room. The use for abdominal operation of bandages of a type that will aid in relieving the pain of breathing and permit deeper inhalation. The use of opiates for a few days post operation to facilitate breathing by elimination of pain. The inhalation of carbon dioxide and oxygen at the termination of general anesthesia, for ventilating and removing the anesthetic from the lungs to restore normal breathing. The postponement of operations in the presence of