Outcomes After the Implementation of Practice Management Guidelines for the Treatment of Cardiovascular Implantable Device Pocket Infections
| Autor: | Erica A. Loomis, Mariela Rivera, Henry J. Schiller, EeeLN H. Buckarma |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Pacemaker Artificial medicine.medical_specialty Prosthesis-Related Infections medicine.medical_treatment Practice management 030204 cardiovascular system & hematology 03 medical and health sciences Wound care 0302 clinical medicine Hematoma Negative-pressure wound therapy Acute care medicine Humans 030212 general & internal medicine Device Removal Aged Retrospective Studies Aged 80 and over business.industry Multimodal therapy Guideline Middle Aged medicine.disease Defibrillators Implantable Surgery Practice Guidelines as Topic Female business Surgical site infection Negative-Pressure Wound Therapy |
| Zdroj: | Journal of Surgical Research. 232:643-646 |
| ISSN: | 0022-4804 |
| Popis: | BACKGROUND Treatment of cardiovascular implantable device pocket infections (CIDPIs) requires a multimodal approach that includes antimicrobials, device explantation, and local wound care. Our institution implemented a practice management guideline (PMG) to standardize the care of CIDPIs and engage our acute care surgeons in 2013. Our PMG includes wound culture, complete capsulectomy, pulse lavage, and the placement of a negative pressure wound therapy appliance at the time of device extraction. Forty-eight hours later, wounds are irrigated and closed in a delayed primary fashion over drains. Our objective was to compare the outcomes of patients who underwent device extraction before and after the implementation of the PMG for the treatment of CIDPIs. METHODS An IRB-approved retrospective review of 155 patients at our institution from 2012 to 2015 who underwent device explantation. Evaluated outcomes measured included days from device explant to wound closure, and postoperative complications. Outcomes data were analyzed before (pre-PMG) and after (post-PMG) enactment of the PMG. RESULTS Fifty-eight patients (42 males; mean age 68 years) were managed prior to PMG implementation; 97 (72 males; mean age 67) were managed after. Mean days from device explantation to wound closure were compared (pre-PMG 6 ± 3.5 and post-PMG 2.8 ± 1.8), and time to closure was reduced by 3-d post-PMG implementation (P |
| Databáze: | OpenAIRE |
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