Association of Hospital Altitude and Postoperative Infectious Complications After Major Operations

Aasen, Davis M.; Wiedel, Cole A.; Maroni, Paul; Cohen, Mark E.; Meng, Xiangju; Meguid, Robert A.

doi:10.1089/ham.2019.0062

Cited by 3 publications

(13 citation statements)

References 9 publications

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“…The current study demonstrated a significantly increased incidence of SSIs (1.16% vs 0.86%; OR, 1.34; 95% CI, 1.17-1.53; P <0.0001) and PJIs (0.91% vs 0.58%; OR, 1.56; 95% CI, 1.34-1.81; P <0.0001) at high altitude. A recent study by Aasen et al 1) focused on the association of hospital altitude and postoperative infectious complications after major operations. This study included various types of procedures including urological, vascular, plastic-reconstructive, and orthopedic and compared the rates of SSIs and urinary tract infections (UTIs) at varying levels of altitudes 1) .…”

Section: Discussionmentioning

confidence: 99%

“…A recent study by Aasen et al 1) focused on the association of hospital altitude and postoperative infectious complications after major operations. This study included various types of procedures including urological, vascular, plastic-reconstructive, and orthopedic and compared the rates of SSIs and urinary tract infections (UTIs) at varying levels of altitudes 1) . Their results, when stratifying by 1,000-ft increments, showed no statistically significant difference in SSI or UTIs and even demonstrated decreased pneumonia incidence at higher altitudes 1) .…”

Section: Discussionmentioning

confidence: 99%

“…This study included various types of procedures including urological, vascular, plastic-reconstructive, and orthopedic and compared the rates of SSIs and urinary tract infections (UTIs) at varying levels of altitudes 1) . Their results, when stratifying by 1,000-ft increments, showed no statistically significant difference in SSI or UTIs and even demonstrated decreased pneumonia incidence at higher altitudes 1) . The difference in the results by Aasen et al 1) versus those of this study may be largely attributed to the difference in surgery types.…”

Section: Discussionmentioning

confidence: 99%

“…It has been postulated that in higher altitude environments, the decrease in the partial pressure of oxygen can have an effect on postoperative outcomes 1) . With a decrease in the partial pressure of oxygen at higher altitudes, systemic variations in the oxygen-hemoglobin curve and oxygen saturation percentages can lead to a state of constant endothelial cell damage and repair 2 3 4 5) .…”

Section: Introductionmentioning

confidence: 99%

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A Higher Altitude Is Associated with Increased Incidence of Infections following Primary Total Hip Arthroplasty

et al. 2021

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Purpose The purpose of this study was to evaluate whether patients undergoing primary total hip arthroplasty (THA) at a higher elevation have higher rates of: 1) in-hospital length of stay (LOS); 2) surgical site infections (SSIs); 3) periprosthetic joint infections (PJIs); and 4) costs. Materials and Methods The Medicare claims database was used to identify patients who underwent primary THA at an altitude higher than 4,000 feet (ft). High-altitude patients were matched to patients who underwent primary THA at an altitude less than 100 ft, yielding 24,958 and 124,765 patients respectively. Outcomes that were assessed included in-hospital LOS, SSIs, PJIs, and costs of care. A P -value less than 0.001 was considered statistically significant. Results Patients in the study group had significantly longer in-hospital LOS (4 days vs 3 days, P <0.0001). In addition, patients in the study group had a significantly higher incidence and odds of developing SSIs (1.16% vs 0.86%; odds ratio [OR], 1.34; P <0.0001) and PJIs (0.91% vs 0.58%; OR, 1.56; P <0.0001) within 90-days following the index procedure, compared to matched controls. Higher altitude patients incurred higher day of surgery ($16,139.76 vs $15,279.42; P <0.0001) and 90-day costs ($18,647.51 vs $16,401.62; P <0.0001). Conclusion This study demonstrated that primary THA procedures performed at an elevation higher than 4,000 ft are associated with longer in-hospital LOS, higher rates of SSIs, PJIs, and costs of care. Orthopedists and other healthcare professionals can use this information to provide adequate education for these patients regarding the potential complications that may occur following their procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Higher Altitude Is Associated with Increased Incidence of Infections following Primary Total Hip Arthroplasty

et al. 2021

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“…Thus, analyses using techniques such as clustering by the institution or provider to account for unmeasured confounding are not possible within the NSQIP PUF data unless specific arrangements are made with the ACS NSQIP governing body whereby they conduct site-identified data analysis and provide extramural researchers with deidentified results. 11 However, individual institution's data from before submission to the ACS do include patient identifiers, and the ACS has provided a mechanism for central data analysis in some specific instances. Further, to decrease the possibility of patient identification, the data set does not include information on the date or time of the case beyond the year of the dataset, making time-sensitive analyses more granular than annual not possible.…”

Section: Limitationsmentioning

confidence: 99%

Administrative and clinical databases: General thoracic surgery perspective on approaches and pitfalls

Kidane

Wakeam

Meguid

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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Database research has become so common that it has essentially become the lingua franca of clinical research. Since the vast majority of studies using databases are observational in nature, various statistical methods are employed to control for the inherent biases in such nonrandomized data. However, even the most sophisticated causal inference technique cannot overcome limitations that are inherent to the nature of the data and how they are collected. Most databases are created with a particular purpose, which leads to limitations in the ways they can be used for research. Organizations and professional societies have created databases for national and international benchmarking and research, the archetypical example being the Society of Thoracic Surgeons (STS) cardiac surgery database, which was subsequently expanded to include general thoracic surgery and pediatric cardiac surgery. These databases all have some element of "pay to play"; they depend on subscription fees paid by the institutions that comprise the membership and contribute data. As such, they cannot be considered population-based, as they only represent the cases contributed to them. However, in general, they are clinical, outcomes-focused, high-quality, and reliable and in certain instances can be used for high-quality policy, clinical epidemiology, and quality improvement work.Thus, we posit that databases are often created to serve 1 of 2 fundamental functions: (1) research to answer questions and (2) benchmarking/quality. In this paper, we discuss various examples of different types of big clinical and administrative databases; more importantly, we discuss how the construction and nature of said databases affects the extent to which they can accomplish these fundamental functions. This paper is meant as a companion piece to that of Subramanian and colleagues, which focused on introducing the concept of clinical versus administrative data and described some of the commonly used databases. Thus, readers should refer to that paper for descriptions of commonly used databases such as National Inpatient Sample, Surveillance, Epidemiology, and End Results, and the National Cancer Database. 1

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Effect of Altitude Level on Surgical Outcomes of Laparoscopic Sleeve Gastrectomy for Patients With Morbid Obesity: A Multicentre Prospective Study

Nakeeb

Sorogy

Hamed

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: This study aimed to evaluate the impact of altitude level on surgical outcomes of laparoscopic sleeve gastrectomy (LSG) for patients with morbid obesity. Methods:At the normal altitude level, 808 patients underwent LSG, and 467 patients underwent LSG in high-altitude regions. The primary outcome was evaluated based on the postoperative morbidity rate. Secondary outcomes were evaluated based on operating time, mortality, hospital stay, percentage of total weight loss (TWL), and comorbidities improvement.Results: No significant differences were noted in-hospital stay, time to start oral intake, gastric leakage, overall complications, and hospital mortality between the 2 groups. Deep vein thrombosis, pulmonary embolism, and mesenteric vascular occlusion were significantly higher in high altitude [11 (1.3%) vs. 14 (3%), P = 0.04; 8 (0.7%) vs. 11 (2.4%), P = 0.01; 4 (0.5%) vs. 8 (1.7%), P = 0.03, respectively]. Patients with normal altitude recorded a better %TWL than those at high altitude after 12 months (41 ± 9 vs. 39 ± 9.6, P = 0.002) and after 24 months (41 ± 8 vs. 40 ± 9, P = 0.009). In both groups, a significant improvement was noted in comorbidity after LSG. Conclusion:The %TWL significantly achieved with LSG in normal and high altitudes. After 12 and 24 months, the %TWL is significantly higher with LSG at normal altitudes. High altitude is associated with a high incidence of deep vein thrombosis, pulmonary embolism, and superior mesenteric vascular occlusion with LSG.

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Association of Hospital Altitude and Postoperative Infectious Complications After Major Operations

Cited by 3 publications

References 9 publications

A Higher Altitude Is Associated with Increased Incidence of Infections following Primary Total Hip Arthroplasty

A Higher Altitude Is Associated with Increased Incidence of Infections following Primary Total Hip Arthroplasty

Administrative and clinical databases: General thoracic surgery perspective on approaches and pitfalls

Effect of Altitude Level on Surgical Outcomes of Laparoscopic Sleeve Gastrectomy for Patients With Morbid Obesity: A Multicentre Prospective Study

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