Reducing Surgical Site Infection and Sepsis after Hysterectomy: Cefazolin Compared with Cefazolin Plus Metronidazole

Study Objective: To evaluate if cefazolin plus metronidazole before a hysterectomy will be more effective in prevention of surgical site infection (SSI) and sepsis compared to the existing recommendation of preoperative cefazolin alone. Design: Retrospective chart review. Setting: Henry Ford Health System (HFHS). Patients or Participants: Data was collected for 1485 adult patients who received hysterectomies within HFHS for benign and malignant conditions. The control group (group 1) was obtained via retrospective chart review to include patients who had a hysterectomy between January 2019 and June 2020 and received cefazolin alone as antibiotic prophylaxis. The treatment group (group 2) included patients who had a hysterectomy between July 2020 and January 2022 and received preoperative cefazolin plus metronidazole. Interventions: Addition of metronidazole to cefazolin as antibiotic prophylaxis prior to hysterectomy. Measurements and Main Results: Of the 1485 patients, 789 (53.1%) were given cefazolin alone and 696 (46.9% were given cefazolin plus metronidazole. There was a total of six (0.4%) patients who experienced sepsis and 37 (2.5%) who had a site infection across both groups. There was a decrease in both sepsis and SSI in group 2, however it did not reach statistical significance. The model for the risk of sepsis is adjusted for obesity (BMI ≥30), procedure length \u3e2 hours, and gynecologic cancer. We found that there were no significant differences in the risk of sepsis between the two treatment groups after adjusting for these risk factors (p=0.736). The model for the risk of site infection is adjusted for diabetes, obesity, smoking status, procedure length, and gynecologic cancer. We found that there were no significant differences in the risk of site of infection between the two treatment groups (p=0.451). Conclusion: The addition of metronidazole to the standard antibiotic prophylaxis regimen for hysterectomy did not significantly reduce the rate of surgical site infections or sepsis within our health system

Association of Patient Characteristics, Diabetes, BMI, and Obesity With Severe COVID-19 in Metropolitan Detroit, MI

Identification of specific risk factors for severe coronavirus disease 2019 (COVID-19) is crucial for prevention of poor outcomes and mortality. This retrospective cohort study of patients hospitalized with COVID-19 demonstrated that older age, male sex, Black race, diabetes, elevated BMI, and elevated inflammatory markers were correlated with critical illness in COVID-19. Older age, male sex, diabetes, and inflammatory markers, but not elevated BMI, were associated with mortality. Despite having greater odds of critical illness, Black patients had lower odds of death than White patients. Older age, male sex, diabetes, and elevated inflammatory markers were significantly associated with venous thromboembolism. These findings suggest a need to aggressively identify and manage modifiable risk factors (i.e., diabetes and elevated BMI) and encourage vaccination of at-risk individuals to prevent poor outcomes from COVID-19

Disparities in Referrals to End-of-Life Care in Eligible Hepatocellular Carcinoma Patients

BACKGROUND: Hepatocellular Carcinoma (HCC) is a malignancy with increasing incidence and morbidity. For patients with a poor prognosis, engagement with advanced care planning and end-of life (EOL) services (I.e., palliative care, hospice) can address physical, financial, and social complications of a terminal diagnosis. Minimal data exist on the demographics of the patients being referred to and enrolling in EOL services for HCC. AIMS: We aim to report the relationship between demographics and EOL service referral. METHODS: Retrospective review of a prospectively maintained high-volume liver center registry of patients diagnosed with HCC from 2004 to 2022. EOL services eligible patients were defined as BCLC stage C or D, evidence of metastases, and/or transplant ineligible. RESULTS: Black patients were more likely to be referred than white patients (OR 1.47 (1.03, 2.11)). Once referred, patients were significantly more likely to be enrolled if they had insurance coverage, though no other factors in models were significant. There were no significant differences in survival among those referred who did or did not enroll, after controlling for other factors. CONCLUSION: Black patients were more likely to be referred compared to white patients and patients who were insured were more likely to be enrolled. Whether this is indicative of black patients being appropriately referred at a higher rate, being offered EOL care instead of aggressive treatment, or other unknown factors warrants further study

Antecedent Immunosuppressive Therapy for Immune-Mediated Inflammatory Diseases in the Setting of a COVID-19 Outbreak

BACKGROUND: Finite clinical data and understanding of COVID-19 immunopathology has led to limited, opinion-based recommendations for management of immune-mediated inflammatory disease (IMID) patients on immunosuppressive (IS) therapeutics. OBJECTIVE: Determine if IS therapeutic type impacts COVID-19 risk among IMID patients. METHODS: We conducted a retrospective cohort analysis of Henry Ford Health System (HFHS) patients tested for COVID-19 between February 1 RESULTS: Of 213 IMID patients, 36.2% tested positive for COVID-19, who had no greater odds of being hospitalized or requiring ventilation relative to the general population. No IS therapeutic worsened the course of disease after multivariate correction, though multi-drug regimens and biologics predicted an increased and decreased rate of hospitalization, respectively, with the latter driven by TNFα inhibitors. LIMITATIONS: A single-center study somewhat limits generalization to community-based settings. Only patients tested for COVID-19 were analyzed. CONCLUSION: IS therapies for IMIDs are not associated with a significantly greater risk of SARS-CoV-2 or severe sequelae when controlling for other factors, and TNFα inhibitors may decrease odds of severe infection

ACCELERATED PROTOCOL FOR MYOCARDIAL INFARCTION (MI) RULE-OUT WITHIN 1-HOUR OF PRESENTATION REDUCES HEALTHCARE RESOURCE UTILIZATION - SECONDARY ANALYSIS OF RACE-IT TRIAL

Background: We compared healthcare resource utilization between a 3-hour standard care protocol for exclusion of myocardial infarction (MI) in the Emergency Department (ED) to a more rapid 0/1-hour high-sensitivity cardiac troponin (hs-cTnI) accelerated protocol. Methods: This was a secondary analysis of the RACE-IT trial, a stepped-wedge randomized trial performed across 9 EDs in the Henry Ford Health System (Detroit, MI) from 7/2020-3/2021. A hs-cTnI assay was used (Beckman Coulter, 99th percentile 18 ng/L). In the accelerated protocol, MI was excluded if hs-cTnI was \u3c 4 ng/L at presentation, or = 4 ng/L at presentation with a 1-hour value \u3c 8 ng/L. In the standard care protocol, MI was excluded if hs-cTnI values were ≤18 ng/L at 0 and 3 hours. Outcomes included ED discharge, cardiac stress testing, cardiology consultation, and cardiac revascularization within 30 days. Generalized linear mixed models were used to compare the two arms. Results: A total of 23,949 patients were analyzed, including 10,444 in the accelerated protocol and 13,505 in the standard care arm. Patients in the accelerated arm had higher odds of ED discharge, and lower odds of stress testing and cardiology consultation (table). There was no difference in odds of coronary angiograms or revascularization procedures. Conclusion: Patients that had MI excluded by the 0/1-hour protocol had higher odds of ED discharge, and lower odds of stress testing and cardiology consultation when compared to the standard care 3-hour protocol