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QUESTION ASKED: What is the real rate of surgical site infection (SSI) after surgery for gynecologic malignancy and benign gynecologic disease?SUMMARY ANSWER: Overall SSI rates differed greatly between the University HealthSystem Consortium (UHC), National Surgical Quality Improvement Program (NSQIP) and National Healthcare Safety Network (NHSN) (1.5%, 8.8%, and 2.8% respectively, P , .001) due to wide variation in reporting methodology. Variation was notable among deep (UHC, 0.7%; NSQIP, 4.7%; NHSN, 1.3%; P , .001) and organ space infections (UHC, 0.4%; NSQIP, 4.4%; NHSN, 1.4%; P , .001) as well as when the reporting agencies were compared with institutional chart review by the authors. Also, because of differences in reporting methodology, only 19 cases (24.4%) were included in more than one database and only one case was included in all three databases (1.3%).WHAT WE DID: We compared SSI rates after gynecologic surgery obtained from the UHC, NSQIP and NHSN databases and the reporting methodologies used by these agencies among themselves. We also compared the SSI rates reported by these agencies to the SSI rate obtained from chart review.WHAT WE FOUND: There was significant variation in the rate of SSI after gynecologic surgery reported by national reporting agencies. Variations in reporting methodology also resulted in limited overlap between reporting agencies in identification of cases with SSI. BIAS, CONFOUNDING FACTORS, DRAWBACKS:A limitation of this analysis is that these data are from a single institution and relate to SSI after surgery for gynecologic malignancy and benign gynecologic disease. Results may not be generalizable for the rate of SSI after surgery in other institutions or specialties. Finally, care must be taken when comparing the reported rates of SSI across agencies as there is variation in the denominators on the basis of the differing inclusion and exclusion criteria. REAL-LIFE IMPLICATIONS:There is discordance among national reporting agencies tracking the rate of SSI. Adopting standardized metrics across agencies could improve consistency and accuracy in assessing SSI rates. When planning an initiative to improve SSI rates and patient outcomes, it is important to assess which metric and reporting method will be most useful and appropriate (Fig). AbstractPurpose Surgical site infections (SSIs) are associated with patient morbidity and increased health care costs. Although several national organizations including the University HealthSystem Consortium (UHC), the National Surgical Quality Improvement Program (NSQIP), and the National Healthcare Safety Network (NHSN) monitor SSI, there is no standard reporting methodology.

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In the United States during the year 2015, approximately 61,560 patients are expected to be diagnosed with kidney cancer and 14,080 to die from the disease. We present the case of a patient with renal cell carcinoma who suffered severe perioperative bleeding and coagulopathy after emergency sternotomy. We also engage in relevant aspects of perioperative anesthesia care including the considerations and management of coagulopathy, liver failure and renal failure in the oncologic patient. The case is a 49-year-old man with vena cava tumor thrombus who underwent radiologic tumor embolization, left radical nephrectomy, and inferior vena cava (IVC) thrombectomy. Postoperatively, he developed sepsis, multiple organ failure, and a pericardial effusion requiring pericardiocentesis. During pericardiocentesis, he suffered an iatrogenic left entricular perforation, requiring an emergency sternotomy and left ventricular repair. Cancer patients are often challenging for surgical and anesthesia teams, emergency care requires an organized and comprehensive approach. The use of recombinant factor VIIa NovoSeven can help in managing severe postoperative bleeding after cardiothoracic surgery in oncologic patients, but further studies should be done to confirm this.