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Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures

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Abstract

Purpose

To assess the patient and identify the risk factors for infectious complications in conjunction with urological procedures and suggest a model for classification of the procedures.

Method

Review of literature, critical analysis of data and tentative model for reducing infectious complications.

Results

Risk factors are bound to the patient and to the procedure itself and are associated with the environment where the healthcare is provided. Assuming a clean environment and sterile operation field, a five-level assessment ladder related to the patient and type of surgery is useful, considering: (1) the ASA score, (2) the general risk factors, (3) the individual endogenous and exogenous risk factors, (4) the class of surgery and the potential bacterial contamination burden and (5) the level of severity and difficulty of the surgical intervention. A cumulative approach will identify the level of risk for each patient and define preventive measures, such as the type of antibiotic prophylaxis or therapeutic measures before surgery. There are data suggesting that the higher the ASA score, the higher is the risk of infectious complication. Age, dysfunction of the immune system, hypo-albuminaemia/malnutrition and overweight, uncontrolled blood glucose level and smoking are independent general risk factors, whilst bacteriuria, indwelling catheter treatment, urinary tract stone disease, urinary tract obstruction and a history of urogenital infection are specific urological risk factors. There is inconclusive evidence for most other reported risk factors. The level of contamination of the surgical field is of utmost importance as are the procedure-related factors, and the sum of these have to be reflected on for the subsequent perioperative management of the patient.

Conclusions

It is essential to identify and control risk factors to minimize infectious complications in conjunction with urological procedures. Our knowledge is limited and clinical research and quality registries analysing risk factors must be undertaken. We propose a working basis for assessment of patients’ risk factors and classification of urological procedures.

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Conflict of interest

This review was done without any financial support. The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, Skåne University Hospital, S-20502, Malmö, Sweden

    Magnus Grabe

  2. Department of Urology, Hôpital Foch, Suresnes Cedex, France

    Henry Botto

  3. Department of Urology, Trakya University, Edirne, Turkey

    Mete Cek

  4. Department of Urology, Jahn Ference Del-Pesti Korhaz, Budapest, Hungary

    Peter Tenke

  5. Department of Urology, University of Giessen, Giessen, Germany

    Florian M. E. Wagenlehner

  6. Technical University of Munich, Munich, Germany

    Kurt G. Naber

  7. Department of Urology, Århus University Hospital, Århus University, Skejby, Århus, Denmark

    Truls E. Bjerklund Johansen

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  1. Magnus Grabe
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  2. Henry Botto
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  3. Mete Cek
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  4. Peter Tenke
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Correspondence to Magnus Grabe.

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Grabe, M., Botto, H., Cek, M. et al. Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures. World J Urol 30, 39–50 (2012). https://doi.org/10.1007/s00345-011-0722-z

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  • DOI: https://doi.org/10.1007/s00345-011-0722-z

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