Surgical site infections are common complications caused by surgical interventions, where a patient gets infected due to the surgical openings and weakened immune system. However, the main reason why such a clinical question exists is the fact that there is a difference in rates of surgical site infection occurrence between inpatients and outpatients. Therefore, it is important for nurses to address the given question to ensure that the risk associated with the surgical site will be minimized or eliminated. Despite the significant achievements of modern medicine, the problems of combating surgical infection remain relevant and at present, the number of purulent diseases and purulent complications has not changed over the past few years. Surgical infection is the interaction of macro and microorganisms in surgical diseases, accompanied by both local and general reactions.
The causative agents of surgical infection are mainly pyogenic microflora. Nonspecific surgical infection by the type of microorganism can be aerobic and putrefactive, in terms of prevalence – local and general. Great importance is currently attached to non-clostridial anaerobic surgical infection. Most often, microbes enter the body through damaged skin and mucous membranes – by airborne droplets, contact, and implantation. The spread of microbes in the body from the focus of introduction is possible through hematogenous and lymphomatous. Infection can pass from one organ to another upon contact. A hospital infection is a surgical infection that affects patients who have been in a hospital for a long time.
Research Focused Literature Review
The main framework for the literature review is to analyze the difference of surgical site infections among inpatients and outpatients. Surgical infection is a complex process of interaction between macro and microorganisms, realized by local and general phenomena, signs, symptoms of the disease. Surgical infection includes infectious processes in the human body, in the treatment and prevention of which certain surgical aids are necessary or may be necessary, as well as any infectious processes that complicate surgical diseases, surgical interventions, and injuries. The relevance of providing medical care to patients with surgical site infections is obvious. There is a need for a long stay of the patient in the hospital with severe post-traumatic and postoperative complications. It occurs when multiple surgical interventions, special medical equipment, huge costs of drugs, and time are not taken into account. Frequent severe concomitant diseases in elderly and senile patients are also not fully considered. The range of medical forms with which patients enter surgical site infection departments is extremely wide. Some diseases and conditions are not mentioned at all, the existing ones are grouped according to a not always clear principle, the indicated bed-day norms do not take into account the nature of the pathology, its form, possible variants of the clinical course.
The given review shows that there is a major difference in the incidence rate among outpatient and inpatient surgical site infections, where the latter possess a higher chance of developing complications. For instance, the study on total knee arthroplasty (TKA) suggests that outpatient TKA surgeries have an equivalent recovery rate compared to a costlier rapid recovery setting for inpatient procedures (Kimball, Nichols, & Vose, 2020). This means that traditional inpatient TKA does lead to an increase in surgical site infection occurrence rates. In addition, the study that addresses surgery outcomes among physician offices, ambulatory surgical centers (ASC), and outpatient hospital departments state that the former setting showed more incidences of post-surgical hospitalizations compared to the outpatient ASCs (Ohsfeldt, Li, Schneider, Stojanovic, & Scheibling, 2017).
Lastly, it is highly critical to outline the risk factors for surgical site infections in conditions of the outpatient settings. The study of ambulatory surgery-related site infections indicates that the major risk factor for such complications was postoperative antibiotics, which significantly increased the infection rate among outpatients (Vilar-Compte et al., 2001). The given evidence of literature research demonstrates how the same surgical operations can be affected by the setting. Therefore, it is safe to consider the fact that outpatient surgeries have a lower chance of post-operative complications. In addition, the major risk factor for outpatient surgical site infections was antibiotics use, which is prevalent in the inpatient setting.
Nevertheless, it is important to specify that the level of evidence varies across the given three studies. In the first study, researchers performed a cohort study, where they compared 863 inpatients with an equal number of outpatients. The evidence level is strong in regards to payment amounts, where outpatients paid $24749 and inpatients paid $31573. In addition, the practice options are manifested in the fact that major complication incidence for outpatients was 5.2% and 6.7% for inpatients (Kimball et al., 2020). In the second research, a multivariate logistic regression model was applied in order to identify the probability adjusted to the risk. The study involved 88 patients, which underwent various postoperative interventions in various settings over 2008-2012 in Florida.
The level of evidence is strong enough to claim that physician offices lead to more surgical site infections than ASCs, but there is no difference in hospital outpatient departments (Ohsfeldt et al., 2017). In the third research, the level of evidence is only significant enough to make an assumption that antibiotics increase the risk of infection (Vilar-Compte et al., 2001). Although each individual study does not present a strong degree of evidence, they collectively demonstrate that outpatient settings are safer than the alternative. Thus, the practice options are ASCs settings with lower use of antibiotics, because these decrease the chance of postoperative complications. In the case of TKA or similar surgeries, outpatient alternatives are more favorable, because they are less costly.
Development of Recommendations
Based on the studies, it can be suggested that expensive rapid recovery inpatient settings do not worth the price paid for recovery. It is mainly due to the fact that outpatient surgeries have an equal or lower rate of surgical site infections. In addition, nurses should recommend avoiding physician office setups, especially if there are available ASCs (Ohsfeldt et al., 2017). Lastly, medical specialists can advise their patients to consider reducing the use of a large number of antibiotics in outpatient surgery settings. One of the most current approaches to the detoxification process is the method of extracorporeal immunological pharmacotherapy with incubated autologous immunocompetent cells with cytokines. It allows patients to achieve stabilization of immunity markers alongside a decrease in the reaction level of febrile and improvement of homeostasis.
However, the given approach can set several limitations of targeting the inflammation site. The latter is manifested in the fact that the next stage of inflammation, which develops with the failure of local immune defense, is a systemic inflammatory response or acute phase response at a systemic level. Pro-inflammatory cytokines affect almost all organs and systems of the body involved in the homeostasis system. The action of pro-inflammatory cytokines on the central nervous system reduces appetite, changes behavioral reactions. The onset of the effect of cytokines on the thermoregulatory center of the hypothalamus is accompanied by an increase in body temperature. An increase in temperature reduces the ability of a number of bacteria to reproduce and enhances the proliferation of lymphocytes.
The combined technology of detoxification and lymphotropic extracorporeal immunotherapy provides a new clinical result through combined detoxification of the body, which has a pronounced synergistic effect with a steady decrease in the level of endogenous intoxication and normalization of homeostasis, a decrease in mortality, and the number of secondary complications by the claimed method. The method creates more favorable conditions in the patient’s body for the detoxification process due to preliminary recovery and stimulation of lymph formation and lymph drainage. In addition, the use of an optimized method of extracorporeal immunotherapy can significantly accelerate the detoxification process by rest.
Conclusion
In conclusion, surgical site infection is a complex occurrence, which involves human tissue cells and pathogenic microorganisms. Surgical infection includes infectious processes in the human body, in the treatment and prevention of which certain surgical aids are necessary or may be necessary, as well as any infectious processes that complicate surgical diseases, surgical interventions, and injuries. The described literature review and analysis demonstrate essential factual evidence regarding the importance of a surgical setup. Outpatient surgical interventions are not less effective in terms of postoperative complications. In addition, specialized rapid recovery setups do not show significant improvements in the incidence of surgical site infection, but they are more costly. In addition, antibiotics can act as a major risk factor in outpatient settings.
References
Kimball, C., Nichols, C., & Vose, J. (2020). Outpatient versus rapid recovery inpatient knee arthroplasty: Comparison of matched cohorts. Orthopedics (Online), 43(1), 36-41.
Ohsfeldt, R. L., Li, P., Schneider, J. E., Stojanovic, I., & Scheibling, C. M. (2017). Outcomes of surgeries performed in physician offices compared with ambulatory surgery centers and hospital outpatient departments in Florida. Health Services Insights, 10, 1-19.
Vilar-Compte, D., Roldan, R., Sandoval, S., Corominas, R., De la Rosa, M., Gordillo, P., & Volkow, P. (2001). Surgical site infections in ambulatory surgery: A 5-year experience. American Journal of Infection Control, 29(2), pp. 99-103.