RESUMO
A positive linear trend (P<.001) between the National Noscomial Infection Surveillance system (NNIS) risk index and mortality was observed in 2,848 general surgery patients followed up 6 years after discharge. In stratified analyses, the NNIS risk index predicted mortality in patients with chronic disease (P=.007, by test for trend) but not in the remaining patients.
Assuntos
Infecção Hospitalar/mortalidade , Hospitais Gerais/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Infecção da Ferida Cirúrgica/mortalidade , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Espanha/epidemiologiaRESUMO
OBJECTIVE: To assess which adverse postsurgical outcomes are best predicted by the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance system (NNIS) index. DESIGN: Prospective cohort study. SETTING: The service of general surgery at a tertiary care hospital. PATIENTS: A consecutive series of patients hospitalized for more than 1 day (n=2,989). RESULTS: The outcome best predicted by the SENIC and NNIS indices was assessed by estimating the area under the receiver operating characteristic (ROC) curve. The areas under the ROC curves for nosocomial infection and in-hospital death were higher for the NNIS index than they were for the SENIC index (P<.05). The NNIS index predicted in-hospital death better than it predicted surgical site infection (area under the ROC curve+/-SE, 0.836+/-0.022 vs 0.689+/-0.017; P=.001). CONCLUSIONS: The NNIS index is superior to the SENIC index for all adverse postsurgical outcomes. Its ability to predict in-hospital mortality is clearly better than its ability to predict surgical site infection.
Assuntos
Mortalidade Hospitalar , Hospitalização , Medição de Risco , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Estudos de Coortes , Modelos Logísticos , Valor Preditivo dos Testes , Estudos Prospectivos , Índice de Gravidade de Doença , Infecção da Ferida Cirúrgica/mortalidadeRESUMO
AIMS: To analyse whether alcohol drinking increases admission to intensive care and in-hospital mortality in general surgery. DESIGN AND PARTICIPANTS: A prospective cohort study on a consecutive series of 1505 hospitalized patients in a Service of General Surgery of a tertiary hospital. MEASUREMENTS: Drinking pattern was defined by quantity, frequency and volume of drinking. Information on relevant confounders was obtained: smoking, body mass index, nutritional status (measured by serum albumin), cholesterol and its fractions, severity of the underlying disease and all therapeutic measures. Multivariate logistic regression was applied to assess the relationship between drinking and both admission to intensive care and in-hospital death. RESULTS: Twenty-nine (1.9%) patients died and 33 (2.1%) were admitted to the intensive care unit (ICU). Drinking was heavier in men, patients without antecedents of cancer, with lower preoperative risk assessment scores, number of co-morbidities and age and higher serum albumin levels. After adjusting for age, severity of underlying disease, smoking and serum albumin, male drinkers of 72+ g/day had an increased risk of being admitted to ICU, the effect being stronger for week-day drinking (odds ratio, OR = 8.48; 95% confidence interval, CI = 1.68-42.8). A significant association was also seen between week-day drinking (72+ g/day) and death in men (OR = 7.19, 95% CI = 1.43-36.1). Numbers for women were too small to evaluate. CONCLUSION: Heavy drinking increases admission to intensive care and in-hospital mortality in hospitalized male patients undergoing general surgery procedures.
Assuntos
Consumo de Bebidas Alcoólicas/mortalidade , Cuidados Críticos/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/mortalidade , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha/epidemiologiaRESUMO
OBJECTIVE: To analyze whether tobacco smoking is related to nosocomial infection, admission to the intensive care unit, in-hospital death, and length of stay. DESIGN: A prospective cohort study. SETTING: The Service of General Surgery of a tertiary-care hospital. PATIENTS: A consecutive series of patients admitted for more than 1 day (N = 2,989). RESULTS: Sixty-two (2.1%) patients died and 503 (16.8%) acquired a nosocomial infection, of which 378 (12.6%) were surgical site and 44 (1.5%) were lower respiratory tract. Smoking (mainly past smoking) was associated with a worse health status (eg, longer preoperative stay and higher American Society of Anesthesiologists score). A long history of smoking (> or = 51 pack-years) increased postoperative admission to the intensive care unit (adjusted odds ratio [OR] = 2.86; 95% confidence interval [CI95], 1.21 to 6.77) and in-hospital mortality (adjusted OR = 2.56; CI95, 1.10 to 5.97). There was no relationship between current smoking and surgical-site infection (adjusted OR = 0.99; CI95, 0.72 to 1.35), whereas a relationship was observed between past smoking and surgical-site infection (adjusted OR = 1.46; CI95, 1.02 to 2.09). Current smoking and, to a lesser degree, past smoking augmented the risk of lower respiratory tract infection (adjusted OR = 3.21; CI95, 1.21 to 8.51). Smokers did not undergo additional surgical procedures more frequently during hospitalization. In the multivariate analysis, length of stay was similar for smokers and nonsmokers. CONCLUSION: Smoking increases in-hospital mortality, admission to the intensive care unit, and lower respiratory tract infection, but not surgical-site infection. Deleterious effects of smoking are also observed in past smokers and they cannot be counteracted by hospital cessation programs.
Assuntos
Infecção Hospitalar/etiologia , Complicações Pós-Operatórias/etiologia , Fumar/efeitos adversos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Idoso , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Infecções Respiratórias/etiologia , Fatores de RiscoRESUMO
HYPOTHESIS: The levels of cholesterol, its fractions (high-density lipoprotein cholesterol [HDL-C] and low-density lipoprotein cholesterol [LDL-C]), and serum albumin reflect nutritional status and are related to in-hospital death, nosocomial infection, and length of stay in the hospital. DESIGN: A prospective cohort study of hospitalized patients. SETTING: The Service of General Surgery of a tertiary hospital. PATIENTS: A consecutive series of 2989 patients admitted for more than 1 day. MAIN OUTCOME MEASURES: Nosocomial infection, in-hospital death, and length of stay. RESULTS: During follow-up, 62 (2%) of the patients died, 382 (13%) developed a nosocomial infection, and 257 (9%) developed a surgical site infection. Serum albumin (lowest quintile vs highest quintile: adjusted odds ratio [OR], 1.9; 95% confidence interval, 1.2-2.9) and HDL-C (lowest quintile vs highest quintile: OR, 2.0; 95% confidence interval, 1.3-3.0) levels showed an inverse and highly significant relationship with nosocomial infection (mainly due to surgical site infection) in crude and multivariate analyses (controlling for the Study on the Efficacy of Nosocomial Infection Control [SENIC] index, the American Society of Anesthesiologists' score, cancer, and age). Regarding total and LDL-C levels, only their lowest quintiles increased the risk of nosocomial infection. Serum albumin and HDL-C levels showed an inverse trend (P<.001) with mortality, with high multivariate-adjusted ORs in the lowest quintile (serum albumin: OR, 5.8; 95% confidence interval, 0.8-44.6; HDL-C: OR, 7.2; 95% confidence interval, 0.9-55.0), whereas no trend was appreciated with other cholesterol fractions or ratios. Serum albumin, HDL-C, and LDL-C levels showed independent, significant (P<.001), and inverse relationships with length of stay. CONCLUSION: The levels of serum albumin and cholesterol fractions, mainly HDL-C, which are routinely measured at hospital admission, are predictors of in-hospital death, nosocomial infection, and length of stay.