Addressing COVID-19 in the surgical ICU: Incidence of antibodies in healthcare personnel at a quaternary care center

Background: There is concern that frontline healthcare personnel (HCP) are at increased risk of exposure to COVID-19 compared to the general population. Multiple studies have demonstrated significant seroprevalence of COVID-19 antibodies in HCP. Increased seropositivity has been associated with reduced use of personal protective equipment (PPE) along with reported PPE shortages. This investigation aims to determine the seroprevalence of COVID-19 in frontline HCP working at a quaternary care center that was heavily impacted by the initial surge of COVID-19, while also identifying underlying factors associated with increased seropositivity. Methods & Materials: HCP who participated in the management of COVID-19 patients were recruited from April 27 to May 13 of 2020. Unidentifiable demographic data was collected, including a questionnaire to identify potential exposure, symptoms, medical comorbidities, and adherence to PPE usage on a scale of 1 to 5 (1 being always, 5 being never). Serological testing was performed using CMC-19D SARS-CoV-2 (COVID-19) Rapid Antibody Test manufactured by Audacia Bioscience. Seropositivity was captured by formation of a dark band at the G (IgG) and C (control) positions on the test device, while IgM alone was considered a false positive. Pearson chi-squared and Fisher exact tests were performed to analyze categorical variables. SPSS version 27.0 was used for statistical analysis (SPSS, Armonk, NY). Conclusion: Overall seropositivity of IgG antibodies was 10.6%. Non-ICU personnel showed higher seroprevalence compared to ICU personnel, this may be attributed to decreased reported adherence to strict PPE usage in non-ICU areas compared to ICU areas during patient contact. Compared to MICU, SICU personnel appeared to be less compliant with frequency of PPE use outside patient rooms. Adherence to PPE usage outside patient contact was a predictor of seropositivity, and non-ICU personnel had a tendency toward high seroprevalence.https://scholarlycommons.henryford.com/sarcd2021/1003/thumbnail.jp

Use of Epidural Analgesia as an Adjunct in Elective Abdominal Wall Reconstruction: A Review of 4983 Cases

CONTEXT: Use of epidural analgesia in patients undergoing elective abdominal wall reconstruction is common. OBJECTIVE: To assess the impact of epidural analgesia in patients undergoing abdominal wall reconstruction. DESIGN: All patients who underwent elective ventral hernia repair from 2005 to 2014 were retrospectively identified. Patients were divided into two groups by the postoperative use of epidural analgesics as an adjunct analgesic method. Preoperative comorbidities, American Society of Anesthesiologists status, operative findings, postoperative pain management, and venothromboembolic prophylaxis were extracted from the database. Logistic regressions were performed to assess the impact of epidural use. MAIN OUTCOME MEASURES: Severity of pain on postoperative days 1 and 2. RESULTS: During the study period, 4983 patients were identified. Of those, 237 patients (4.8%) had an epidural analgesic placed. After adjustment for differences between groups, use of epidural analgesia was associated with significantly lower rates of 30-day presentation to the Emergency Department (adjusted odds ratio [AOR] = 0.53, 95% confidence interval [CI] = 0.32-0.87, adjusted p = 0.01). Use of epidural analgesia resulted in higher odds of abscess development (AOR = 5.89, CI = 2.00-17.34, adjusted p \u3c 0.01) and transfusion requirement (AOR = 2.92, CI = 1.34-6.40, adjusted p \u3c 0.01). Use of epidural analgesia resulted in a significantly lower pain score on postoperative day 1 (3 vs 4, adjusted p \u3c 0.01). CONCLUSION: Use of epidural analgesia in patients undergoing abdominal wall reconstruction may result in longer hospital stay and higher incidence of complications while having no measurable positive clinical impact on pain control

Use of Epidural Analgesia as an Adjunct in Elective Abdominal Wall Reconstruction: A Review of 4983 Cases

CONTEXT: Use of epidural analgesia in patients undergoing elective abdominal wall reconstruction is common. OBJECTIVE: To assess the impact of epidural analgesia in patients undergoing abdominal wall reconstruction. DESIGN: All patients who underwent elective ventral hernia repair from 2005 to 2014 were retrospectively identified. Patients were divided into two groups by the postoperative use of epidural analgesics as an adjunct analgesic method. Preoperative comorbidities, American Society of Anesthesiologists status, operative findings, postoperative pain management, and venothromboembolic prophylaxis were extracted from the database. Logistic regressions were performed to assess the impact of epidural use. MAIN OUTCOME MEASURES: Severity of pain on postoperative days 1 and 2. RESULTS: During the study period, 4983 patients were identified. Of those, 237 patients (4.8%) had an epidural analgesic placed. After adjustment for differences between groups, use of epidural analgesia was associated with significantly lower rates of 30-day presentation to the Emergency Department (adjusted odds ratio [AOR] = 0.53, 95% confidence interval [CI] = 0.32-0.87, adjusted p = 0.01). Use of epidural analgesia resulted in higher odds of abscess development (AOR = 5.89, CI = 2.00-17.34, adjusted p \u3c 0.01) and transfusion requirement (AOR = 2.92, CI = 1.34-6.40, adjusted p \u3c 0.01). Use of epidural analgesia resulted in a significantly lower pain score on postoperative day 1 (3 vs 4, adjusted p \u3c 0.01). CONCLUSION: Use of epidural analgesia in patients undergoing abdominal wall reconstruction may result in longer hospital stay and higher incidence of complications while having no measurable positive clinical impact on pain control

Association of Unplanned Reintubation with Higher Mortality in Old, Frail Patients: A National Surgical Quality-Improvement Program Analysis

BACKGROUND: Unplanned postoperative reintubation increases the risk of mortality, but associated factors are unclear. OBJECTIVE: To elucidate factors associated with increased mortality risk in patients with unplanned postoperative reintubation. DESIGN: Retrospective study. Patients older than 40 years who underwent unplanned reintubation from 2005 to 2010 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Multiple regression models were used to examine the impact on mortality of factors that included the modified frailty index (mFI) we developed, American Society of Anesthesiologists (ASA) score, age decile, and days to reintubation. MAIN OUTCOME MEASURE: Mortality. RESULTS: A total of 17,051 postoperative reintubations in adults were analyzed. Overall mortality was 29.4% (n = 5009). On postoperative day 1, 4434 patients were reintubated and 878 (19.8%) died. On postoperative day 7 and beyond, 6329 patients were reintubated and 2215 (35.0%) died. Increasing mFI resulted in increasing incidence of mortality (mFl of 0 = 20.5% mortality vs mFl of 0.37-0.45 = 41.7% mortality). As ASA score increased from 1 to 5, reintubation was associated with a mortality of 12.1% to 41.6%, respectively. Similarly, increasing age decile was associated with increasing incidence of mortality (40-49 years, 17.9% vs 80-89 years, 42.1%). After adjustment for confounding factors, mFI, ASA score, age decile, and increasing number of days to reintubation were independently and significantly associated with increased mortality in the study population. CONCLUSION: Among patients who underwent unplanned reintubation, older and more frail patients had an increased risk of mortality

Outcomes of component separation for ventral hernia repair in an emergent setting: Analysis of the American College of Surgeons (ACS) NSQIP

INTRODUCTION: Large ventral hernias are encountered in the emergent setting, and the best management strategy is unclear. Component separation (CS) is a technique that can be used for repair of large ventral hernias. We sought to investigate and compare outcomes of elective CS with emergent CS using a large national database. METHODS: All patients undergoing elective and emergent ventral hernia repair with CS between 2005 and 2014 were identified utilizing the ACS NSQIP database. CPT codes used to identify ventral hernia repair were 49565 and 49560 and 15734 for CS. RESULTS: In the study period, 6, 286 patients underwent non-emergent ventral hernia repair with CS and 74 patients underwent emergent ventral hernia repair. Demographics were similar overall with the exception of wound class. As expected, emergent CS had higher wound class (clean/contaminated and higher). There were no differences in superficial incisional surgical site infection (SSI) (7.0% vs 5.4%, p = 0.760), organ/space SSI (3.0% vs 5.4%, p = 0.387), or perioperative blood transfusions (5.8% vs 12.2%, p = 0.068). Stratified by wound class, there were no differences in superficial incisional SSI, organ space SSI, or wound disruption between emergent and elective CS. CONCLUSIONS: While rarely performed emergently, immediate postoperative wound complications for emergency CS appear similar to those with elective CS. A 1-stage abdominal wall reconstruction in the emergent setting may represent a viable option for large or complex ventral hernia repair in select patients

Predictors of Clavien 4 Complications and Mortality After Necrosectomy: Analysis of the NSQIP Database

BACKGROUND: Acute severe pancreatitis is one of the most common gastrointestinal reasons for admission to hospitals in the USA. Up to 20 % of these patients will progress to necrotizing pancreatitis requiring intervention. The aim of this study is to identify specific preoperative factors for the development of Clavien 4 complications and mortality in patients undergoing pancreatic necrosectomy. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) participant use files were reviewed from 2007 to 2012 to identify patients who underwent a pancreatic necrosectomy. Postoperative complications were stratified into Clavien 4 (ICU level complications) and Clavien 5 (mortality). Univariate and multivariate analyses were performed. RESULTS: A total of 1156 patients underwent a pancreatic necrosectomy from 2007 to 2012. Overall, 42 % of patients experienced a Clavien 4 complication. Mortality rate was 9.5 %. Nonindependent functional status and ASA class were highly significant (p \u3c 0.001) in univariate analysis. Frailty and emergency surgery status (p \u3c 0.001), as well as increased blood urea nitrogen (BUN) and alkaline phosphatase and decreased albumin (p \u3c 0.05) demonstrated independent significance of Clavien 4 complications and mortality in multivariate analysis. CONCLUSION: This study identified specific preoperative variables that place patients at increased risk of Clavien 4 complications and mortality after necrosectomy. Identification of high-risk patients can aid in selection of appropriate treatment strategies and allow for informed preoperative discussion regarding surgical risk