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Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures.

Grabe, Magnus LU ; Botto, Henry; Cek, Mete; Tenke, Peter; Wagenlehner, Florian M E; Naber, Kurt G and Bjerklund Johansen, Truls E (2011) In World Journal of Urology
Abstract
PURPOSE: To assess the patient and identify the risk factors for infectious complications in conjunction with urological procedures and suggest a model for classification of the procedures. METHOD: Review of literature, critical analysis of data and tentative model for reducing infectious complications. RESULTS: Risk factors are bound to the patient and to the procedure itself and are associated with the environment where the healthcare is provided. Assuming a clean environment and sterile operation field, a five-level assessment ladder related to the patient and type of surgery is useful, considering: (1) the ASA score, (2) the general risk factors, (3) the individual endogenous and exogenous risk factors, (4) the class of surgery and the... (More)
PURPOSE: To assess the patient and identify the risk factors for infectious complications in conjunction with urological procedures and suggest a model for classification of the procedures. METHOD: Review of literature, critical analysis of data and tentative model for reducing infectious complications. RESULTS: Risk factors are bound to the patient and to the procedure itself and are associated with the environment where the healthcare is provided. Assuming a clean environment and sterile operation field, a five-level assessment ladder related to the patient and type of surgery is useful, considering: (1) the ASA score, (2) the general risk factors, (3) the individual endogenous and exogenous risk factors, (4) the class of surgery and the potential bacterial contamination burden and (5) the level of severity and difficulty of the surgical intervention. A cumulative approach will identify the level of risk for each patient and define preventive measures, such as the type of antibiotic prophylaxis or therapeutic measures before surgery. There are data suggesting that the higher the ASA score, the higher is the risk of infectious complication. Age, dysfunction of the immune system, hypo-albuminaemia/malnutrition and overweight, uncontrolled blood glucose level and smoking are independent general risk factors, whilst bacteriuria, indwelling catheter treatment, urinary tract stone disease, urinary tract obstruction and a history of urogenital infection are specific urological risk factors. There is inconclusive evidence for most other reported risk factors. The level of contamination of the surgical field is of utmost importance as are the procedure-related factors, and the sum of these have to be reflected on for the subsequent perioperative management of the patient. CONCLUSIONS: It is essential to identify and control risk factors to minimize infectious complications in conjunction with urological procedures. Our knowledge is limited and clinical research and quality registries analysing risk factors must be undertaken. We propose a working basis for assessment of patients' risk factors and classification of urological procedures. (Less)
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author
organization
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type
Contribution to journal
publication status
published
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in
World Journal of Urology
publisher
Springer
external identifiers
  • WOS:000302405800006
  • PMID:21779836
  • Scopus:84856225372
ISSN
1433-8726
DOI
10.1007/s00345-011-0722-z
language
English
LU publication?
yes
id
9ac5864a-7949-40fe-a664-6961dac65c05 (old id 2058329)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21779836?dopt=Abstract
date added to LUP
2011-08-01 20:23:46
date last changed
2017-01-01 07:50:20
@article{9ac5864a-7949-40fe-a664-6961dac65c05,
  abstract     = {PURPOSE: To assess the patient and identify the risk factors for infectious complications in conjunction with urological procedures and suggest a model for classification of the procedures. METHOD: Review of literature, critical analysis of data and tentative model for reducing infectious complications. RESULTS: Risk factors are bound to the patient and to the procedure itself and are associated with the environment where the healthcare is provided. Assuming a clean environment and sterile operation field, a five-level assessment ladder related to the patient and type of surgery is useful, considering: (1) the ASA score, (2) the general risk factors, (3) the individual endogenous and exogenous risk factors, (4) the class of surgery and the potential bacterial contamination burden and (5) the level of severity and difficulty of the surgical intervention. A cumulative approach will identify the level of risk for each patient and define preventive measures, such as the type of antibiotic prophylaxis or therapeutic measures before surgery. There are data suggesting that the higher the ASA score, the higher is the risk of infectious complication. Age, dysfunction of the immune system, hypo-albuminaemia/malnutrition and overweight, uncontrolled blood glucose level and smoking are independent general risk factors, whilst bacteriuria, indwelling catheter treatment, urinary tract stone disease, urinary tract obstruction and a history of urogenital infection are specific urological risk factors. There is inconclusive evidence for most other reported risk factors. The level of contamination of the surgical field is of utmost importance as are the procedure-related factors, and the sum of these have to be reflected on for the subsequent perioperative management of the patient. CONCLUSIONS: It is essential to identify and control risk factors to minimize infectious complications in conjunction with urological procedures. Our knowledge is limited and clinical research and quality registries analysing risk factors must be undertaken. We propose a working basis for assessment of patients' risk factors and classification of urological procedures.},
  author       = {Grabe, Magnus and Botto, Henry and Cek, Mete and Tenke, Peter and Wagenlehner, Florian M E and Naber, Kurt G and Bjerklund Johansen, Truls E},
  issn         = {1433-8726},
  language     = {eng},
  month        = {07},
  publisher    = {Springer},
  series       = {World Journal of Urology},
  title        = {Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures.},
  url          = {http://dx.doi.org/10.1007/s00345-011-0722-z},
  year         = {2011},
}