Peri-Operative Medicine

Nurse staffing and burnout associated with hospital acquired infections

In this analysis from 160 acute care hospitals in Pennsylvania, lower staff-to-patient ratios were associated with higher rates of UTI and surgical site infections (SSIs), but an even stronger association was found between nursing burnout rates and these infections. They estimate for every 10% increase in nurse burnout, UTI and SSI increased by 1 and 2 per 1,000 patients respectively. Higher staffing ratios and addressing nursing burnout rates could have an effect on some hospital acquired infections (abstract)

Cataract surgery reduces hip fractures

In this large retrospective analysis of Medicare beneficiaries with cataracts, those who had cataract surgery had a 16% lower risk of hip fracture compared to those who did not have cataract surgery (odds ratio 0.84, CI 0.81 to 0.87). Cataract removal can reduce the risk of subsequent hip fractures (abstract)

New anticoagulants versus enoxaparin after hip/knee surgery

In this large meta-analysis of randomized trials of VTE prophylaxis after hip/knee surgery, compared to enoxaparin, the risk of symptomatic VTE was lower was rivaroxaban and similar with dabigatran and apixaban; but the risk of bleeding with higher with rivaroxaban, similar with dabigatran, and lower with apixaban. Overall, the treatments did not differ on net clinical outcome (abstract).

Risk of AMI after hip/knee surgery

This large retrospective cohort found the risk of AMI was markedly elevated within the 2 weeks after elective hip surgery (hazard ratio 26) and 2 weeks after elective knee surgery (hazard ratio 31). It remained elevated for 2-6 weeks after hip surgery (hazard ratio 5) but not for the 2-6 weeks after knee surgery (compared to controls). The authors suggest ongoing AMI risk assessment for patients up to 6 weeks after hip surgery and up to 2 weeks after knee surgery (abstract)

Pre-op alcohol cessation may reduce complications

In this small meta-analysis of 2 randomized controlled trials, pre-operative alcohol cessation reduced the odds of peri-operative complications (Odds ratio 0.22, 95% CI 0.08 to 0.61), but did not have any effect on in-hospital or 30 day mortality (abstract).