OR Manager - September 2019 - 40

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At a Glance
Dirty scopes raise patient safety
concerns
Contaminated duodenoscopes have
transmitted drug-resistant infections to
hundreds of patients, and now some
experts are urging the Food & Drug Administration
to force manufacturers to
develop duodenoscopes that can be
properly sterilized or single-use duodenoscopes,
or take duodenoscopes
off the market, the August 6 New York
Times Reports.
Similar transmissions of infections
have been tied to bronchoscopes (see
cover story).
Ambu, a Danish company, already
markets single-use bronchoscopes, and
the company anticipates having a disposable
duodenoscope and additional
endoscopes on the market in the US by
2020.
-https://www.nytimes.
com/2019/08/06/health/
duodenoscopes-infections-hospitalsantibiotics.html.
Reducing
pulmonary
complications after surgery
In this study, aggressive pulmonary
treatment after surgery with oscillation
and lung expansion (OLE) reduced the
rate of postoperative pulmonary complications
in high-risk patients having open
thoracic, aortic, or upper abdominal surgery.
A
total of 419 patients (209 with
OLE treatment and 210 without) were
included in the analysis.
Treatment with OLE decreased:
* postoperative pulmonary complications
from 22.9% to 15.8%
* ventilator time from 23.7 to 8.5
hours
* hospital length of stay from 8.4 to
6.8 days.
There were no differences in ICU
length of stay, cases of pneumonia, or
mortality.
-Huynh T T, Liesching T N, Cereda M.
J Am Coll Surg. Published online
July 27, 2019.
Effect of BMI on SSI risk
This study found a trend of increasing
risk of surgical site infections (SSIs)
for almost all surgery types when body
mass index (BMI) increased from normal
to morbidly obese.
Of 387,919 patients analyzed in
the Dutch national surveillance network
PREZIES, 1% were underweight, 30%
had normal weight, 40% were overweight,
27% were obese, and 2% were
morbidly obese.
The increase in SSIs was most profound
in procedures with clean wounds,
with relative risks for morbidly obese
patients ranging up to 7.8 for deep SSIs
after total hip procedures.
In chest and abdominal procedures,
the impact was larger for superficial
than deep SSIs.
The results demonstrate a need for
preventive programs targeting SSIs in
overweight and obese patients, the researchers
say.
-Meijs A P, Koek M B G, Vos M C,
et al. Infect Control Hosp Epidemiol.
2019;40(9):991-996.
Postoperative opioid use
In this study of opioid-naïve patients
having major surgery, researchers found
a number of patient characteristics associated
with greater opioid use in the
first month after surgery.
Of 1,181 patients analyzed, the following
were significantly associated
with increased postoperative opioid consumption:
*
younger age
* nonwhite race
* lack of college degree
* higher anxiety
* greater sleep disturbance
* heavy alcohol use
* current tobacco use
* larger initial opioid prescription size.
Future studies should look at the
use of nonopioid drugs and behavioral
therapies preoperatively in these higherrisk
patients, the researchers say.
-Larach D B, Sahara M J, As-Sanie S, et
al. Ann Surg. Published online
May 2, 2019.
40
OR Manager | September 2019
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OR Manager - September 2019

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