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Costa M, Avila MJ, Vivanco-Suarez J, Karas P, Monteith S, Patel A. Minimally Invasive Technique for Chiari I Decompression Without Durotomy: Surgical Technique and Preliminary Case Series. World Neurosurg 2024; 188:e145-e154. [PMID: 38759783 DOI: 10.1016/j.wneu.2024.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Chiari I malformation, marked by severe headaches and potential brainstem/spinal cord issues, often requires surgical intervention when conservative methods fail. This study introduces a minimally invasive surgery (MIS) Chiari decompression technique utilizing a 3-blade retractor, aiming to reduce postoperative discomfort and optimize outcomes. METHODS Chiari type I malformation patients who underwent a MIS technique were included. Technique consisted of a minimal-soft tissue opening using a 3-blade retractor, suboccipital craniectomy, C1 laminectomy, and resection of the atlantooccipital band without a durotomy. RESULTS Ten patients were treated. Mean age was 43.3 years, with 7 female patients. All patients presented with occipital headaches; 50% retroorbital pain; 40% neck, upper back, or shoulder pain; and 30% limb paresthesias. Median pre-surgical modified Rankin Scale (mRS) was 3 (2-4) and pain visual analog score (VAS) was 7 (5-9). Mean operative time was 59 (59-71) minutes, with mean blood loss of 88.5 (50-140) mL. In our sample, 90% of patients were discharged the same surgical day (mean 7.2 [5.3-7.7] hours postoperative). No immediate or delayed postoperative complications were evidenced. At 6 months, 90% of patients had mRS 0-1. At last follow-up the mean VAS was 1.5 (range: 0-4, P < 0.001). CONCLUSIONS The MIS 3-blade flexible retractor technique for Chiari decompression is feasible, provides wide visualization angles of the suboccipital region and C1 arch, allows 2-surgeon work, and minimizes skin and soft tissue disruption. This combination may diminish postoperative discomfort, reduce the risk of surgical site infections, and optimize outcomes.
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Affiliation(s)
- Matias Costa
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
| | - Mauricio J Avila
- Division of Neurosurgery, Saint Louis University, St. Louis, Missouri, USA
| | - Juan Vivanco-Suarez
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Patrick Karas
- Department of Neurological Surgery, University of Texas Medical Branch, Texas, USA
| | - Stephen Monteith
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Akshal Patel
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
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Abdel Halim AS, Ali MAM, Al Mamari R, Al Raisi F, Boufahja F, Chaudhary AA, Hegazy WAH. A Retrospective Exploration of Pre-operative Antibiotic Prophylaxis with Cefazolin in Cesarean Sections: Implications for Obstetrics and Gynecologic Surgery. Surg Infect (Larchmt) 2024. [PMID: 38957977 DOI: 10.1089/sur.2024.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Background: Post-partum infection is a major contributor to maternal mortality and is responsible for approximately 10% of maternal fatalities worldwide. The risk of infection is substantially higher in cesarean section procedures. Approximately 8% of women who undergo cesarean sections are susceptible to infection. Although the body of evidence supporting the regular pre-operative utilization of prophylactic antibiotic treatment is steadily expanding, its usefulness in cesarean sections has not yet been standardized, and post-partum infection is still a serious medical challenge. We aimed to retrospectively assess the prophylactic effectiveness of cefazolin in combination with other antibiotic agents in cesarean sections. Materials and Methods: Both uni-variable and multi-variable analyses were conducted to identify factors that may affect cefazolin pre-operative antibiotic prophylaxis in elective cesarean section operations. The uni-variable analysis included timing of administration, operation duration, body mass index (BMI), and wound type. A multi-variable logistic regression model was then created to determine which variables provide independent information in the context of other variables. Results: Time of administration did not affect prophylactic cefazolin efficacy. However, prophylactic cefazolin was 1.43 and 1.77 times more effective when the operation lasted for 45 minutes or more, compared with operations that were shorter than 45 minutes. Patients with a BMI ranging from 18 to 29 kg/m2 showed increased efficacy of prophylactic cefazolin compared with obese patients with a BMI exceeding 30 kg/m2. The effectiveness of prophylactic cefazolin decreased by 95% in patients with clean-contaminated surgical incisions compared with those with clean surgical incisions. Conclusions: Our findings demonstrate that administering pre-operative prophylactic antibiotic agents to women undergoing cesarean section resulted in a reduction in post-partum infections, thereby reducing maternal mortality. Furthermore, optimal timing of administration, re-dosing if necessary, length of prophylactic medication, and dosing adjustments for obese patients are crucial factors in preventing surgical site infections and promoting antimicrobial stewardship.
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Affiliation(s)
- Alyaa S Abdel Halim
- Department of Biochemistry, Faculty of Science, Ain Shams University, Abbassia, Egypt
| | - Mohamed A M Ali
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
- Department of Biochemistry, Faculty of Science, Ain Shams University, Abbassia, Egypt
| | - Ruqiya Al Mamari
- Pharmacy Program, Department of Pharmacy Practice and Pharmaceutics, Oman College of Health Sciences, Muscat, Oman
| | - Fatma Al Raisi
- Pharmacy Program, Department of Pharmacology, Oman College of Health Sciences, Muscat, Oman
| | - Fehmi Boufahja
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Anis Ahmad Chaudhary
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Wael A H Hegazy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
- Department of Pharmaceutical Sciences, Pharmacy Program, Oman College of Health Sciences, Muscat, Oman
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Kiser AC, Shi J, Bucher BT. An explainable long short-term memory network for surgical site infection identification. Surgery 2024; 176:24-31. [PMID: 38616153 PMCID: PMC11162927 DOI: 10.1016/j.surg.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/23/2024] [Accepted: 03/03/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Currently, surgical site infection surveillance relies on labor-intensive manual chart review. Recently suggested solutions involve machine learning to identify surgical site infections directly from the medical record. Deep learning is a form of machine learning that has historically performed better than traditional methods while being harder to interpret. We propose a deep learning model, a long short-term memory network, for the identification of surgical site infection from the medical record with an attention layer for explainability. METHODS We retrieved structured data and clinical notes from the University of Utah Health System's electronic health care record for operative events randomly selected for manual chart review from January 2016 to June 2021. Surgical site infection occurring within 30 days of surgery was determined according to the National Surgical Quality Improvement Program definition. We trained the long short-term memory model along with traditional machine learning models for comparison. We calculated several performance metrics from a holdout test set and performed additional analyses to understand the performance of the long short-term memory, including an explainability analysis. RESULTS Surgical site infection was present in 4.7% of the total 9,185 operative events. The area under the receiver operating characteristic curve and sensitivity of the long short-term memory was higher (area under the receiver operating characteristic curve: 0.954, sensitivity: 0.920) compared to the top traditional model (area under the receiver operating characteristic curve: 0.937, sensitivity: 0.736). The top 5 features of the long short-term memory included 2 procedure codes and 3 laboratory values. CONCLUSION Surgical site infection surveillance is vital for the reduction of surgical site infection rates. Our explainable long short-term memory achieved a comparable area under the receiver operating characteristic curve and greater sensitivity when compared to traditional machine learning methods. With explainable deep learning, automated surgical site infection surveillance could replace burdensome manual chart review processes.
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Affiliation(s)
- Amber C Kiser
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT.
| | - Jianlin Shi
- Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Brian T Bucher
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT; Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Schafer M, Dixon H, Palladino K, Baumann S, Martinson J, Bolland M, Lakdawala M, Yassin M. Automated traffic monitoring of neurosurgical operating room. Am J Infect Control 2024; 52:630-634. [PMID: 38281684 PMCID: PMC11223673 DOI: 10.1016/j.ajic.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Operating room (OR) traffic disrupts airflow and increases particle count, which predisposes patients to surgical site infections, particularly in longer surgeries with hardware placement. The aim of this study is to evaluate the rate of traffic during neurosurgical procedures, as well as reasons for and perceptions of OR traffic. METHODS This is a single-center, multimethod study monitoring neurosurgical OR traffic through direct observation, automated monitoring, and interviews. Traffic was observed between the skin incision and closure. Personal interviews with OR teams including surgeons, anesthesia, and nurses were conducted to evaluate their perceptions of the frequency of OR traffic and reasons for OR traffic. RESULTS Direct observation reported OR door opening an average of 18 times, with 20 people entering or exiting per hour. The exact reason for traffic was not verified in all traffic cases and was able to be confirmed in only a third of the cases. Automated monitoring resulted in an average of 31 people entering or exiting the OR per hour. The procedure length was significantly associated with the number of people entering or exiting the OR per hour (P < .0001). Interviews highlighted that OR teams reported traffic to be significantly lower than observed and automated monitoring results, with approximately <6 people entering or exiting per hour. CONCLUSIONS OR traffic is higher than staff expected, and updated processes are required to reduce the number of times the OR door opens. Implementing automated observation of OR traffic could reduce the OR traffic and the risk for surgical site infection.
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Affiliation(s)
- Mathea Schafer
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA; University of Pittsburgh School of Public Health, Infectious Diseases, Microbiology, Behavioral and Community Health Sciences Departments, Pittsburgh, PA
| | - Heather Dixon
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA
| | - Katie Palladino
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA
| | - Sara Baumann
- University of Pittsburgh School of Public Health, Infectious Diseases, Microbiology, Behavioral and Community Health Sciences Departments, Pittsburgh, PA
| | - Jeremy Martinson
- University of Pittsburgh School of Public Health, Infectious Diseases, Microbiology, Behavioral and Community Health Sciences Departments, Pittsburgh, PA
| | - Monica Bolland
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA; University of Pittsburgh School of Medicine, Anesthesiology and Perioperative Medicine Department and Division of Infectious Disease, Pittsburgh, PA
| | - Marilyn Lakdawala
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA
| | - Mohamed Yassin
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA; University of Pittsburgh School of Public Health, Infectious Diseases, Microbiology, Behavioral and Community Health Sciences Departments, Pittsburgh, PA; University of Pittsburgh School of Medicine, Anesthesiology and Perioperative Medicine Department and Division of Infectious Disease, Pittsburgh, PA.
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Deng S, Xie J, Niu T, Wang J, Han G, Xu J, Liu H, Li Z. Association of modic changes and postoperative surgical site infection after posterior lumbar spinal fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08329-z. [PMID: 38816538 DOI: 10.1007/s00586-024-08329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/21/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Postoperative surgical site infection is one of the most serious complications following spine surgery. Previous studies have reported Modic changes (MC) represent a subclinical infection. This study aims to investigate the relation between Modic changes and surgical site infection after posterior lumbar fusion surgery. METHODS We retrospectively reviewed the records of 424 patients who received posterior lumbar fusion. Preoperative clinical and radiological parameters were recorded. Primary outcome was the rate of postoperative surgical site infection. Covariates included age, body mass index (BMI), sex, hypertension, diabetes mellitus, chronic heart failure, Pfirrmann classification, fused levels, and operation duration. The presence of Modic changes was used as an exposition variable, and adjusted for other risk factors in multivariate analyses. RESULTS Of the 424 patients, 30 (7%) developed an acute surgical site infection. Infection had no relation to age, sex, BMI, and comorbidities. There were 212 (50%) patients with MC, and 23 (10.8%) had a surgical site infection, compared to 212 (50%) patients without MC in which there were 7 (3.3%) surgical site infections. MC was associated with surgical site infection in univariate analysis (odds ratio [OR] = 3.56, 95% confidence interval [CI]: 1.49-8.50, p = 0.004) and multivariate logistic regression analysis (OR = 3.05, 95% CI: 1.26-7.37, p = 0.013). There was statistically significant between specific type (p = 0.035) and grade of MCs (p = 0.0187) and SSI. CONCLUSIONS MCs may be a potential risk factor for SSI following posterior lumbar spinal intervertebral fusion. Type I and grade C MCs showed a higher infection rate compared with other MC types and grades.
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Affiliation(s)
- Siping Deng
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Jiahua Xie
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
- Department of Spine Surgery, The Seventh Affiliated Hospital of Southern Medical University, Foshan, 528244, China
| | - Tianzuo Niu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Jianru Wang
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Guowei Han
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Jinghui Xu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Hui Liu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
| | - Zemin Li
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
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Jiang J, Ren F. Effect of probiotics and synbiotics on complications of wound infection after colorectal surgery: A meta-analysis. Int Wound J 2024; 21:e14838. [PMID: 38577937 PMCID: PMC10996049 DOI: 10.1111/iwj.14838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/01/2024] [Indexed: 04/06/2024] Open
Abstract
Wound infection is a serious complication that impacts the prognosis of patients after colorectal surgery (CS). Probiotics and synbiotics (Pro and Syn) are live bacteria that produce bacteriostatic agents in the intestinal system and have a positive effect on postoperative wound infections. The purpose of this study was to evaluate the effect of Pro and Syn on complications of wound infection after CS. In November 2023, we searched relevant clinical trial reports from Pubmed, Cochrane Library, and Embase databases and screened the retrieved reports, extracted data, and finally analysed the data by using RevMan 5.3. A total of 12 studies with 1567 patients were included in the study. Pro and Syn significantly reduced total infection (OR, 0.44; 95% CI, 0.35, 0.56; p < 0.00001), surgical incision site infection (SSI) (OR, 0.61; 95% CI, 0.45, 0.81; p = 0.002), pneumonia (OR, 0.43; 95% CI, 0.25, 0.72; p = 0.001), urinary tract infection (OR, 0.28; 95% CI, 0.14, 0.56; p = 0.0003), and Pro and Syn did not reduce anastomotic leakage after colorectal surgery (OR, 0.84; 95% CI, 0.50, 1.41; p = 0.51). Pro and Syn can reduce postoperative wound infections in patients with colorectal cancer, which benefits patients' postoperative recovery.
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Affiliation(s)
- Junqiu Jiang
- Pharmaceutical DepartmentThe Second Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Feng Ren
- Department of Laboratory MedicineThe Second Affiliated Hospital of Dalian Medical UniversityDalianChina
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Bayraktar HS, Okyay MF. Effects of Oleuropein Oral Intake on Infected Fat Grafts: Experimental Study. Aesthetic Plast Surg 2024; 48:1218-1228. [PMID: 37658188 DOI: 10.1007/s00266-023-03612-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/13/2023] [Indexed: 09/03/2023]
Abstract
AIM The aim of this study was to evaluate the effects of oleuropein oral intake on infected fat grafts and fat graft survival. MATERIALS AND METHODS 32 Wistar albino rats were divided into four groups: 0. none treated, 1. serum oral intake, 2. antibiotic oral intake, and 3. oleuropein oral intake. The dorsal regions of the rats were separated into four quadrants as right and left cranial, and right and left caudal to determine each quadrant where fat grafts were placed. Right cranial and caudal quadrants were infected with the methicillin-susceptible Staphylococcus aureus (MSSA) strain. The left cranial and caudal quadrants were infected with the Pseudomonas aeruginosa strain. On the 7th day and end of the 3rd month, fibroblast density, inflammation, and fat survival were demonstrated immunohistochemically with FGF, CD68, and perilipin (PP), respectively. RESULTS On the 7th day, for P. aureginosa-infected grafts, oleuropein was shown higher rates in CD68 and PP staining compared to the antibiotic group (p < 0.05, p < 0.001, respectively). At the end of the 3rd month, for P. aureginosa and S. aureus-infected grafts, the oleuropein group was demonstrated improved PP staining rates compared to the antibiotic group (p < 0.01, p < 0.01, respectively). CONCLUSION Oleuropein as a natural olive leaf extract with potent antioxidant, anti-inflammatory, and antimicrobial features is an alternative and supportive agent for both treatment and prophylaxis of surgical site infections like the antibiotics of chemical synthesis. P. aeruginosa and S. aureus surgical site infections could treat and prevent safely and effectively by oleuropein, particularly in early and late periods after surgery. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Hamdullah Suphi Bayraktar
- Hatay Mustafa Kemal University Experimental Research Application and Research Center, 31000, Hatay, Turkey.
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Liu F, Zhou J, Wu X. Effects of evidence-based nursing on surgical site wound infection in patients undergoing acute appendicitis surgery: A meta-analysis. Int Wound J 2024; 21:e14539. [PMID: 38506317 PMCID: PMC10952117 DOI: 10.1111/iwj.14539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 03/21/2024] Open
Abstract
This study aimed to comprehensively evaluate the effects of evidence-based nursing (EBN) intervention on wound infection and postoperative complications in patients after appendectomy for acute appendicitis (AA), with the expectation of providing a theoretical basis for postoperative care in AA. Randomised controlled trials (RCTs) on the postoperative application of EBN in patients with AA were searched in PubMed, Web of Science, Cochrane Library, Embase, China Biomedical Literature Database, Wanfang and China National Knowledge Infrastructure from the inception of databases to October 2023. Two authors screened and evaluated the literature based on the inclusion and exclusion criteria, and data were extracted from the final included literature. Stata software (version 17.0) was employed for data analysis. In total, 29 RCTs involving 2848 patients with AA were included, with 1424 in the EBN group and 1424 in the conventional care group. The analyses revealed that patients with AA who experienced EBN were significantly less likely to develop postoperative wound infections (odds ratio [OR] = 0.23, 95% confidence intervals [CIs]: 0.14-0.38, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15-0.26, p < 0.001) as opposed to conventional care. Available evidence suggests that EBN can effectively reduce the risk of wound infection and postoperative complications in patients undergoing appendectomy for AA, thereby improving patient prognosis. This finding is worth promoting in the clinical practice.
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Affiliation(s)
- Feng Liu
- Department of EmergencyThe People's Hospital of Chongqing Liangjiang New AreaChongqingChina
| | - Juan Zhou
- Department of General SurgeryThe People's Hospital of Chongqing Liangjiang New AreaChongqingChina
| | - Xue‐Lian Wu
- Department of Child HealthcareThe People's Hospital of Chongqing Liangjiang New AreaChongqingChina
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Frountzas M, Michalopoulou V, Georgiou G, Kanata D, Matiatou M, Kimpizi D, Matthaiou G, Spiliotopoulos S, Vouros D, Toutouzas KG, Theodoropoulos GE. The Impact of Mechanical Bowel Preparation and Oral Antibiotics in Colorectal Cancer Surgery (MECCA Study): A Prospective Randomized Clinical Trial. J Clin Med 2024; 13:1162. [PMID: 38398474 PMCID: PMC10889669 DOI: 10.3390/jcm13041162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/28/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Colorectal cancer surgery has been associated with surgical site infections (SSIs), leading to an increase in postoperative morbidity, length of stay and total cost. The aim of the present randomized study was to investigate the relationship between the preoperative administration of oral antibiotic therapy and SSI rate, as well as other postoperative outcomes in patients undergoing colorectal cancer surgery. Material and Methods: Patients who underwent colorectal cancer surgery in a university surgical department were included in the present study. Patients were randomized into two groups using the "block randomization" method. The intervention group received three doses of 400 mg rifaximin and one dose of 500 mg metronidazole per os, as well as mechanical bowel preparation the day before surgery. The control group underwent only mechanical bowel preparation the day before surgery. The study has been registered in ClinicalTrials.gov (NCT03563586). Results: Two hundred and five patients were finally included in the present study, 97 of whom received preoperative antibiotic therapy per os (intervention group). Patients of this group demonstrated a significantly lower SSI rate compared with patients who did not receive preoperative antibiotic therapy (7% vs. 16%, p = 0.049). However, preoperative antibiotic administration was not correlated with any other postoperative outcome (anastomotic leak, overall complications, readmissions, length of stay). Conclusions: Preoperative antibiotic therapy in combination with mechanical bowel preparation seemed to be correlated with a lower SSI rate after colorectal cancer surgery.
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Affiliation(s)
- Maximos Frountzas
- Colorectal Unit, First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Victoria Michalopoulou
- Colorectal Unit, First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgia Georgiou
- Colorectal Unit, First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Despoina Kanata
- Colorectal Unit, First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Matiatou
- Colorectal Unit, First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Despina Kimpizi
- Colorectal Unit, First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgia Matthaiou
- Colorectal Unit, First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Spilios Spiliotopoulos
- Colorectal Unit, First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios Vouros
- Colorectal Unit, First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos G Toutouzas
- Colorectal Unit, First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George E Theodoropoulos
- Colorectal Unit, First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Sasaki Y, Kurishima A, Miyamoto C, Hataji K, Tezuka T, Katsuragawa H. Evaluation after implementation of chemical bowel preparation for surgical site infections in elective colorectal cancer surgery and role of antimicrobial stewardship pharmacist: Retrospective cohort study. J Pharm Health Care Sci 2024; 10:11. [PMID: 38374208 PMCID: PMC10875839 DOI: 10.1186/s40780-024-00333-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND We evaluated the predictive factors for surgical site infections (SSIs) in elective colorectal cancer surgery and the role of antimicrobial stewardship (AS) pharmacists in modifying the clinical pathway. MAIN BODY Between February 2017 and January 2022, 414 elective colorectal cancer surgeries were performed. The results of multivariate analysis by SSI incidence were adjusted odds ratio (aOR): 0.45; 95% confidence interval (CI): 0.22-0.96 (P = 0.039) for sex (female), aOR: 0.27; 95% CI: 0.13-0.58 (P < 0.001) for laparoscopy, aOR: 0.42; 95% CI: 0.19-0.91 (P = 0.029) for chemical bowel preparation. The median (interquartile range) postoperative length of stay was 12 (10.0-18.5) vs. 10 (9.0-13.0) days before and after the clinical pathway was modified (P < 0.001). CONCLUSION The role of AS pharmacists was primarily to conduct a literature search to explore whether SSIs could be ameliorated by pharmacotherapy, coordinate the addition of chemical bowel preparation, and epidemiologically confirm their effectiveness.
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Affiliation(s)
- Yasuhiro Sasaki
- Department of Pharmacy, Tama-Nambu Chiiki Hospital, Tokyo Metropolitan Organization, 1-2, Nakazawa 2-Chome, Tama, Tokyo, 206-0036, Japan.
| | - Akira Kurishima
- Division of Public Health, Teikyo University Graduate School of Public Health, 2-11, Kaga 1-Chome, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Chieko Miyamoto
- Department of Nursing, Tama-Nambu Chiiki Hospital, Tokyo Metropolitan Organization, 1-2, Nakazawa 2-Chome, Tama, Tokyo, 206-0036, Japan
| | - Kenichiro Hataji
- Department of Surgery, Tama-Nambu Chiiki Hospital, Tokyo Metropolitan Organization, 1-2, Nakazawa 2-Chome, Tama, Tokyo, 206-0036, Japan
| | - Toru Tezuka
- Department of Endoscopy, Tama-Nambu Chiiki Hospital, Tokyo Metropolitan Organization, 1-2, Nakazawa 2-Chome, Tama, Tokyo, 206-0036, Japan
| | - Hideo Katsuragawa
- Department of Surgery, Tama-Nambu Chiiki Hospital, Tokyo Metropolitan Organization, 1-2, Nakazawa 2-Chome, Tama, Tokyo, 206-0036, Japan
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Wang X, Li S, Huo D, Wang S, Wang W, He H, Zhang Q, Li J, Wang X. Healthcare associated infection management in 62 intensive care units for patients with congenital heart disease in China, a survey study. Int J Surg 2024; 110:01279778-990000000-01027. [PMID: 38320095 PMCID: PMC11020057 DOI: 10.1097/js9.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES All patients with congenital heart disease (CHD) receive postoperative management in ICUs. Infection prevention and control (IPC) has a significant impact on prognosis. This study provides a preliminary understanding of the fundamental aspects of IPC in ICUs following CHD surgery in China. METHODS From September to October 2023, we initiated a survey on HAI management in hospitals that perform CHD surgeries independently. The questionnaires were jointly completed by the ICU physicians and IPC personnel. Duplicate or unqualified questionnaires were excluded from the study. The contents of our questionnaires covered hospital and ICU capacity, performance of the infection control department, HAI surveillance, implementation of IPC measures, and antimicrobial stewardship (AMS). Qualified questionnaires were compared according to the volume of annual CHD surgeries performed in different ICUs. Group 1 was defined as volume > 300 cases and group 2 was defined as volume ≤300 cases. RESULTS 62 of the 118 questionnaires were completed, with a response rate of 53%. The CHD surgical volume in 2022 of the 62 hospitals was 36342, accounting for 52% of the annual CHD surgical volume (69672) across the country. The postoperative infection rates obtained from the 15 ICUs varied from 1.3% to 15%, with a median rate of 4.5%. A total of 16 ICUs provided data on drug-resistant bacteria, Klebsiella pneumoniae exhibiting the highest frequency. More than 95% of ICUs have established complete HAI management systems. Information-based HAI surveillance was conducted in 89% of ICUs. Approximately 67% of ICUs stopped prophylactic antibiotics within 48 hours after surgery. In complex cases, carbapenems were administered empirically in 89% of ICUs. Group 1 had an advantage over group 2 in preventing multidrug-resistant organisms (all instruments should be used alone 100% vs. 86%, P=0.047; cleaning and disinfection of environmental surfaces, 100% vs. 81%, P=0.035; antibiotic consumption control 85% vs. 61%, P=0.044) and in preventing surgical site infections (perioperative blood glucose monitoring, 88% vs. 67%, P=0.048). However, Group 1 did not perform well in preventing catheter-related bloodstream infection (delayed catheter removal due to convenience of laboratory tests, 31% vs. 6%, P=0.021) and catheter-associated urinary tract infection (delayed catheter removal due to muscle relaxant administration, 88% vs. 58%, P=0.022). CONCLUSIONS A relatively complete HAI management system has been established throughout the country in ICUs for CHD patients. Information-based surveillance of HAI needs to be promoted, and actions should be taken to facilitate the implementation of IPC measures and AMS bundles. Training and feedback are critical for implementing IPC measures.
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Affiliation(s)
- Xiaofeng Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Shuo Li
- Department of Infection Control, Peking University First Hospital
| | - Da Huo
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Shilin Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Wenlong Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Hongxia He
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Qian Zhang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Jiantao Li
- Department of Infection Control, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Xu Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
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Galosi AB, Delle Fave RF, Perpepaj L, Milanese G, Polisini G, Mantovan M, Brocca C, Palantrani V, Tramanzoli P, Antezza A, De Angelis MV, Giulioni C, Castellani D. Does Alexis Wound Protector/Retractor Reduce the Risk of Surgical Site Infections After Open Radical Cystectomy for Bladder Cancer? Results From a Single Center, Comparative Study. Urology 2024; 184:162-168. [PMID: 37940079 DOI: 10.1016/j.urology.2023.09.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To assess if Alexis dual-ring wound protector/retractor reduced the incidence of superficial and deep incisional infection following open radical cystectomy (ORC). METHODS Since January 2020, all procedures were performed using the Alexis retractor. We retrospectively reviewed our ORC database and compared patients who were operated on with Alexis with the same number of consecutive patients operated with a stainless steel retractor in the previous period. Data are presented as median and (interquartile range). RESULTS Seventy-four patients underwent RC with Alexis (group 1) and 74 with stainless steel retractor (group 2). Median age was 73.0(13) in group 1, 73.5(14) in group 2 (P = .338). There were 59(79.7%) men in both groups. The groups were comparable in terms of comorbidities, body mass index, American Society of Anesthesiology score, and neoadjuvant chemotherapy rate. There was no statistically significant difference in type of lymph node dissection and urinary diversion, total surgical time. Postoperative stay was shorter in group 1 [8(4) days vs 9(4) in group 2, P = .012]. Group 2 had a significantly higher rate of both superficial (8.1% vs 18.9%, P = .045) and deep incisional infection (2.7% vs 14.9%, P = .009). At multivariable analysis, body mass index (OR 1.129 95% CI 1.162-1.283, P = .043) was significantly associated with higher odds of superficial incisional infection. The use of Alexis was significantly associated with lower odds of having both superficial (OR 0.274 95%CI 0.033-0.781, P = .023) and deep incisional infection (OR 0.159 95% CI 0.034-0.745, P = .020). CONCLUSION The use of Alexis significantly reduces the rate of superficial and deep incisional infection following ORC.
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Affiliation(s)
- Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Rocco Francesco Delle Fave
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Leonard Perpepaj
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Giulio Milanese
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy; Urology Unit, AST 5, Ascoli Piceno, Italy
| | - Giordano Polisini
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Matteo Mantovan
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Brocca
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Vanessa Palantrani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Pietro Tramanzoli
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Angelo Antezza
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Maria Vittoria De Angelis
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Giulioni
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
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13
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Thapa N, Basukala S, Regmi SK, Shrestha O, Paudel S, Chaudhary K, Metha B, K. C. M, Thapa S, Bista S. Postoperative surgical site infection after preoperative use of razor versus clipper for hair removal in inguinal hernia surgery: A quasi-randomized clinical trial. Health Sci Rep 2024; 7:e1830. [PMID: 38274137 PMCID: PMC10808942 DOI: 10.1002/hsr2.1830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/21/2023] [Accepted: 01/04/2024] [Indexed: 01/27/2024] Open
Abstract
Trail Design Quasi-randomized clinical trial. Methods Participants: This study includes adult patients (≥18 years) who gave written consent for preoperative site preparation using razors or clippers. Exclusions comprised individuals <18 years, bilateral hernias, prior laparoscopic hernia repair, steroid/chemotherapy use, diagnosed chronic obstructive pulmonary disease, and incomplete medical documentation. Intervention: Patients who underwent hernia surgery during the initial week of the study underwent site preparation using a razor, while in subsequent weeks underwent site preparation using a clipper. This randomization was maintained throughout the study. Uniform site preparation was done by consistent staff. Postpreparation interviews, follow-up interviews of the patients, and unbiased evaluation of digital photographs were conducted by nonoperating surgeon panels. Outcome: Preoperative, patient response, degree of skin trauma, quality of hair removal, and association between site preparation-like parameters were compared and analyzed between two groups using Statistical Package for Social Sciences-25. Blinding: In this study, blinding was not done and the primary investigator was aware of the two groups. Results The total number of participants was 320. The mean age of the Razor group was 45.36 ± 14.68 years and that of Clipper was 44.42 ± 13.77 (p < 0.98). The incidence of surgical site infection (SSI) was 23 (14.4%) in the razor group and 8(5%) in the clipper group, (p = 0.01). Skin trauma was found more in the razor group as compared to the clipper group. Also, the analysis of the provided data revealed that 65% of participants who experienced sustained cuts developed SSI. Conclusion In summary, the practice of preoperative hair removal on-site preparation using a razor is associated with the incidence of skin trauma but overall shave quality at the operative site was better in the razor group with an apparent increased risk of SSI. Based on these findings, it would be better for surgeons to decide on an operation for either razors or clippers for preoperative preparation.
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Affiliation(s)
- Niranjan Thapa
- Department of SurgeryCollege of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Sunil Basukala
- Department of SurgeryNepalese Army Institute of Health SciencesKathmanduNepal
| | - Shiva K. Regmi
- Department of SurgeryCollege of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Oshan Shrestha
- Department of SurgeryCollege of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Sandip Paudel
- Department of SurgeryCollege of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Kabita Chaudhary
- Department of SurgeryCollege of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Bipin Metha
- Department of SurgeryCollege of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Manoj K. C.
- Department of SurgeryCollege of Medicine, Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Suman Thapa
- Department of SurgeryNepalese Army Institute of Health SciencesKathmanduNepal
| | - Sachhyatkar Bista
- Department of AnaesthesiaNepalese Army Institute of Health SciencesKathmanduNepal
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14
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Ferreira J, Joos E, Bhandari M, Dixon E, Brown CJ. Routine Sterile Glove and Instrument Change at the Time of Abdominal Wound Closure to Prevent Surgical Site Infection: Reviewing the ChEETAh Trial. J Am Coll Surg 2024; 238:139-143. [PMID: 37721383 DOI: 10.1097/xcs.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Julia Ferreira
- From the Harvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada (Ferreira)
| | - Emilie Joos
- Division of General Surgery, Vancouver General Hospital, Vancouver, Canada (Joos)
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Canada (Bhandari)
| | - Elijah Dixon
- Department of Surgery, University of Calgary, Calgary, Canada (Dixon)
| | - Carl J Brown
- Division of General Surgery, St Paul's Hospital, University of British Columbia, Vancouver, Canada (Brown)
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15
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Guenter R, Zheng-Pywell R, Herring B, Murphy M, Foote J, Benner K, Rose JB. Preclinical safety evaluation of continuous UV-A lighting in an operative setting. PLoS One 2023; 18:e0291083. [PMID: 37976243 PMCID: PMC10656011 DOI: 10.1371/journal.pone.0291083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 08/21/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Germicidal ultraviolet (UV-C) light has been shown as an effective modality for disinfection in laboratory settings and in the operative room. Traditionally, short-wavelength UV-C devices, which have previously been shown to cause DNA damage, are utilized only for disinfection in pre- and post-operative settings and are not continuously active during operations. Continuous use of intraoperative UV light has potential to decrease pathogens and subsequent surgical site infections (SSIs), which arise in approximately 5-15% of operative cases. SSIs are a significant determinant of patient morbidity, readmission rates, and overall cost. Therefore, a method of UV light disinfection with a low risk of DNA damage is needed so that greater antimicrobial protection can be afforded to patients during the entirety of their surgical procedures. A new disinfection device that harnesses longer-wavelength UV-A light to disinfect the surgical field throughout the entirety of the procedure, including pre- and post-operation has been developed. METHODS This study aimed to determine if UV-A light administered intraoperatively was safe, as defined by the minimal presence of DNA damage and safe amounts of reflection upon medical personnel. Using in vitro models, we examined the differential impacts of UV-C and UV-A light on DNA damage and repair pathways. In a murine model, we looked at the production of DNA damage photoproduction in relation to UV-A versus UV-C exposure. RESULTS Our results show UV-A light does not induce a significant amount of DNA damage at the cellular or tissue level. Furthermore, a preclinical porcine study showed that surgical personnel were exposed to safe levels of UV-A irradiance from an overhead UV-A light used during an operation. The amount of UV-A transmitted through surgical personal protective equipment (PPE) also remained within safe levels. CONCLUSIONS In conclusion, we found that UV-A may be safe for intraoperative use.
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Affiliation(s)
- Rachael Guenter
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rui Zheng-Pywell
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Brendon Herring
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Madisen Murphy
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jeremy Foote
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kevin Benner
- GE Current, a Daintree Company, East Cleveland, Ohio, United States of America
| | - J. Bart Rose
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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16
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Khosla H, Seche W, Ammerman D, Elyahoodayan S, Caputo GA, Hettinger J, Amini S, Feng G. Development of antibacterial neural stimulation electrodes via hierarchical surface restructuring and atomic layer deposition. Sci Rep 2023; 13:19778. [PMID: 37957282 PMCID: PMC10643707 DOI: 10.1038/s41598-023-47256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023] Open
Abstract
Miniaturization and electrochemical performance enhancement of electrodes and microelectrode arrays in emerging long-term implantable neural stimulation devices improves specificity, functionality, and performance of these devices. However, surgical site and post-implantation infections are amongst the most devastating complications after surgical procedures and implantations. Additionally, with the increased use of antibiotics, the threat of antibiotic resistance is significant and is increasingly being recognized as a global problem. Therefore, the need for alternative strategies to eliminate post-implantation infections and reduce antibiotic use has led to the development of medical devices with antibacterial properties. In this work, we report on the development of electrochemically active antibacterial platinum-iridium electrodes targeted for use in neural stimulation and sensing applications. A two-step development process was used. Electrodes were first restructured using femtosecond laser hierarchical surface restructuring. In the second step of the process, atomic layer deposition was utilized to deposit conformal antibacterial copper oxide thin films on the hierarchical surface structure of the electrodes to impart antibacterial properties to the electrodes with minimal impact on electrochemical performance of the electrodes. Morphological, compositional, and structural properties of the electrodes were studied using multiple modalities of microscopy and spectroscopy. Antibacterial properties of the electrodes were also studied, particularly, the killing effect of the hierarchically restructured antibacterial electrodes on Escherichia coli and Staphylococcus aureus-two common types of bacteria responsible for implant infections.
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Affiliation(s)
- Henna Khosla
- Department of Mechanical Engineering, Villanova University, Villanova, PA, 19085, USA
| | - Wesley Seche
- Pulse Technologies Inc., Research and Development, Quakertown, PA, 18951, USA
| | - Daniel Ammerman
- Department of Chemistry and Biochemistry, Rowan University, Glassboro, NJ, 08028, USA
| | - Sahar Elyahoodayan
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, 90089, USA
| | - Gregory A Caputo
- Department of Chemistry and Biochemistry, Rowan University, Glassboro, NJ, 08028, USA
| | - Jeffrey Hettinger
- Department of Physics and Astronomy, Rowan University, Glassboro, NJ, 08028, USA
| | - Shahram Amini
- Pulse Technologies Inc., Research and Development, Quakertown, PA, 18951, USA.
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA.
| | - Gang Feng
- Department of Mechanical Engineering, Villanova University, Villanova, PA, 19085, USA
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17
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White C, Kurtz S, Lusk L, Wilson B, Britton V, Hayden K, Hunt S, Hyland J, Kittrell W, Maddox J, Tanner A, Tucker V. Implementation of a Colorectal Surgical Site Infection Prevention Bundle and Checklist: A Quality Improvement Project. AORN J 2023; 118:297-305. [PMID: 37882597 DOI: 10.1002/aorn.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/10/2022] [Accepted: 11/25/2022] [Indexed: 10/27/2023]
Abstract
After noting an elevated surgical site infection rate in 2019 associated with colorectal surgeries, leaders at two Central Virginia health system hospitals convened an interdisciplinary team to audit current practices and research infection prevention strategies. After identifying a lack of standardization in care processes for colorectal surgery patients and reviewing the literature on colorectal bundles, the team created a bundle focusing on the use of antibiotics, chlorhexidine gluconate wipes or baths, separate closing instrument trays, nasal decolonization, bowel preparation, and maintaining patient normothermia. After synthesis and stakeholder input, the team implemented the colorectal bundle along with a checklist for all users to complete to ensure compliance and standardization of practice and for auditing purposes. Implementation results were positive: the total number of colorectal infections decreased from nine in 2020 to three in 2021. Education was critical to securing staff member engagement for successful implementation of and compliance with the bundle.
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18
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Escandón L, Matsui C, Tanaka T, Nishimura T, Imai T, Mizuno H. Case Report of Gas Gangrene after Reconstructive Surgery with Anterolateral Thigh Flap for Resection of Oral Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5381. [PMID: 37964920 PMCID: PMC10642894 DOI: 10.1097/gox.0000000000005381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/20/2023] [Indexed: 11/16/2023]
Abstract
Necrotizing fasciitis (NF) type I is an acute subcutaneous tissue infection that can promptly disseminate generating crepitus. If not accurately diagnosed and expeditiously treated, it becomes a life-threatening infection. In this report, we present a 65-year-old man who developed a case of NF after a hemiglossectomy resecting a tumor in the dorsal surface of the tongue. A biopsy was performed, and he was pathologically diagnosed with squamous cell carcinoma (T2N1M0). The patient underwent preoperative oral cleaning. Right hemiglossectomy was performed by cervical dissection, pull-through style, with tooth removal on the right mandible and a left anterolateral femoral flap reconstruction. Routine intraoperative lavage was performed with 2000 mL of saline solution. Cefazolin 1gr was administered two times per day postoperatively. Four days after primary surgery, the flap circulation was inadequate; therefore, a computed tomography scan was taken, which indicated gas in the ventral neck area. Tooth extraction was the suspected etiology. Debridement was performed; the abscess was drained and cultured, indicating the presence of Staphylococcus haemolyticus and Escherichia coli. It seems that the abscess was not formed by NF, but rather by leachate reservoir associated with the head and neck tumor. After debridement, re-reconstruction was performed with a deltopectoral flap and pectoralis major myocutaneous flap. When NF is present after a neck dissection, there is a risk of disruption due to the direct invasion and inflammation into the carotid artery. Therefore, it is important to provide adequate oral cleaning care before the surgery and early suspicion of the diagnosis.
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Affiliation(s)
| | - Chihiro Matsui
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takakuni Tanaka
- Department of Oral and Maxillofacial Surgery, Toyooka Public Hospital, Hyogo, Japan
| | - Takayoshi Nishimura
- Department of Oral and Maxillofacial Surgery, Toyooka Public Hospital, Hyogo, Japan
| | - Takumi Imai
- Department of Oral and Maxillofacial Surgery, Toyooka Public Hospital, Hyogo, Japan
| | - Hiroshi Mizuno
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
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19
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Rasteniene R, Simenaite G, Brukiene V. Maxillofacial infections in lithuanian hospitalised children and adolescents: a 17-years retrospective study. Eur Arch Paediatr Dent 2023; 24:603-611. [PMID: 37452905 DOI: 10.1007/s40368-023-00824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To analyse the epidemiology, treatment, and microbiological findings of hospitalised Lithuanian children and adolescents admitted due to maxillofacial infections over a 17-years period. METHODS 428 medical records of paediatric (under the age of 18) patients hospitalised at Vilnius University Hospital from 2003 to 2019 due to a maxillofacial infection were reviewed. The data concerning patient sociodemographic characteristics, aspects related to a hospital stay, treatment modalities, microbiological findings, and sensitivity to antibiotics, were collected and analysed. RESULTS The most prevalent condition was odontogenic maxillofacial space infection (28.7%), followed by lymphadenitis (21.7%). The mean (sd) age was 10.86 (4.8) years and the male-to-female ratio was 1.37:1. The majority of patients (83.4%) underwent surgical treatment. The mean (sd) hospital stay was 5.49 (2.9) days. The longest hospital stay was observed in the case of odontogenic maxillofacial space infections. A longer period of hospitalisation was generally associated with the presence of anaerobes and their resistance to antibiotics as well as multiple space involvement in deep neck space infections and a permanent causative tooth in odontogenic cases. The most commonly isolated microbiological species was Staphylococcus aureus spp. CONCLUSION The most common origin of maxillofacial infection was odontogenic among investigated Lithuanian children and adolescents. In the majority of cases, a penicillin group antibiotic was prescribed. Streptococci were the predominant bacteria in the cases of odontogenic infection, while Staphylococci were the most prevalent among non-odontogenic cases. Nearly 40.0% of isolated microorganisms were resistant to penicillin. High resistance to metronidazole was identified among anaerobic bacteria.
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Affiliation(s)
- R Rasteniene
- Faculty of Medicine, Institute of Odontology, University of Vilnius, Žalgirio Str. 117, 08217, Vilnius, Lithuania.
| | - G Simenaite
- Faculty of Medicine, Institute of Odontology, University of Vilnius, Žalgirio Str. 117, 08217, Vilnius, Lithuania
| | - V Brukiene
- Faculty of Medicine, Institute of Odontology, University of Vilnius, Žalgirio Str. 117, 08217, Vilnius, Lithuania
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20
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Wang TN, An BW, Wang TX, Tamer R, Yuce TK, Hassanein RT, Haisley KR, Perry KA, Sweigert PJ. Assessing the effects of smoking status on outcomes of elective minimally invasive paraesophageal hernia repair. Surg Endosc 2023; 37:7238-7246. [PMID: 37400691 DOI: 10.1007/s00464-023-10185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/30/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Patients are often advised on smoking cessation prior to elective surgical interventions, but the impact of active smoking on paraesophageal hernia repair (PEHR) outcomes is unclear. The objective of this cohort study was to evaluate the impact of active smoking on short-term outcomes following PEHR. METHODS Patients who underwent elective PEHR at an academic institution between 2011 and 2022 were retrospectively reviewed. The National Surgical Quality Improvement Program (NSQIP) database from 2010 to 2021 was queried for PEHR. Patient demographics, comorbidities, and 30-day post-operative data were collected and maintained in an IRB-approved database. Cohorts were stratified by active smoking status. Primary outcomes included rates of death or serious morbidity (DSM) and radiographically identified recurrence. Bivariate and multivariable regressions were performed, and p value < 0.05 was considered statistically significant. RESULTS 538 patients underwent elective PEHR in the single-institution cohort, of whom 5.8% (n = 31) were smokers. 77.7% (n = 394) were female, median age was 67 [IQR 59, 74] years, and median follow-up was 25.3 [IQR 3.2, 53.6] months. Rates of DSM (non-smoker 4.5% vs smoker 6.5%, p = 0.62) and hernia recurrence (33.3% vs 48.4%, p = 0.09) did not differ significantly. On multivariable analysis, smoking status was not associated with any outcome (p > 0.2). On NSQIP analysis, 38,284 PEHRs were identified, of whom 8.6% (n = 3584) were smokers. Increased DSM was observed among smokers (non-smoker 5.1%, smoker 6.2%, p = 0.004). Smoking status was independently associated with increased risk of DSM (OR 1.36, p < 0.001), respiratory complications (OR 1.94, p < 0.001), 30-day readmission (OR 1.21, p = 0.01), and discharge to higher level of care (OR 1.59, p = 0.01). No difference was seen in 30-day mortality or wound complications. CONCLUSION Smoking status confers a small increased risk of short-term morbidity following elective PEHR without increased risk of mortality or hernia recurrence. While smoking cessation should be encouraged for all active smokers, minimally invasive PEHR in symptomatic patients should not be delayed on account of patient smoking status.
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Affiliation(s)
- Theresa N Wang
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA.
| | - Bryan W An
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Tina X Wang
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Robert Tamer
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
| | - Tarik K Yuce
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
| | - Roukaya T Hassanein
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
| | - Kelly R Haisley
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
| | - Kyle A Perry
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
| | - Patrick J Sweigert
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
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Cukierman DS, Cata JP, Gan TJ. Enhanced recovery protocols for ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:285-303. [PMID: 37938077 DOI: 10.1016/j.bpa.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION In the United States, ambulatory surgeries account for up to 87% of all surgical procedures. (1) It was estimated that 19.2 million ambulatory surgeries were performed in 2018 (https://www.hcup-us.ahrq.gov/reports/statbriefs/sb287-Ambulatory-Surgery-Overview-2019.pdf). Cataract procedures and musculoskeletal surgeries are the most common surgical interventions performed in ambulatory centers. However, more complex surgical interventions, such as sleeve gastrectomies, oncological, and spine surgeries, and even arthroplasties are routinely performed as day cases or in a model of an ambulatory extended recovery. (2-5) The ambulatory surgery centers industry has grown since 2017 by 1.1% per year and reached a market size of $31.2 billion. According to the Ambulatory Surgery Center Association, there is a potential to save $57.6 billion in Medicare costs over the next decade (https://www.ibisworld.com/industry-statistics/market-size/ambulatory-surgery-centers-united-states/). These data suggest an expected rise in the volume of ambulatory (same day) or extended ambulatory (23 h) surgeries in coming years. Similar increases are also observed in other countries. For example, 75% of elective surgeries are performed as same-day surgery in the United Kingdom. (6) To reduce costs and improve the quality of care after those more complex procedures, ambulatory surgery centers have started implementing patient-centered, high-quality, value-based practices. To achieve those goals, Enhanced Recovery After Surgery (ERAS) protocols have been implemented to reduce the length of stay, decrease costs, increase patients' satisfaction, and transform clinical practices. The ERAS fundamentals for ambulatory surgery are based on five pillars, including (1) preoperative patient counseling, education, and optimization; (2) multimodal and opioid-sparing analgesia; (3) nausea and vomiting, wound infection, and venous thromboembolism prophylaxis; (4) maintenance of euvolemia; and (5) encouragement of early mobility. Those pillars rely on interdisciplinary teamwork led by anesthesiologists, surgery-specific workgroups, and safety culture. (2) Research shows that a team of ambulatory anesthesiologists is crucial in improving postoperative nausea and vomiting (PONV) and pain control. (7) This review will summarize the current evidence on the elements and clinical importance of implementing ERAS protocol for ambulatory surgery.
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Affiliation(s)
- Daniel S Cukierman
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Tong Joo Gan
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
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Abstract
The human microbiome is vast and is present in spaces previously thought to be sterile such as the lungs. A healthy microbiome is diverse and functions in an adaptive way to support local as well as organism health and function. Furthermore, a normal microbiome is essential for normal immune system development rendering the array of microbes that live in and on the human body key components of homeostasis. A wide array of clinical conditions and interventions including anesthesia, analgesia, and surgical intervention may derange the human microbiome in a maladaptive fashion with bacterial responses spanning decreased diversity to transformation to a pathogenic phenotype. Herein, we explore the normal microbiome of the skin, gastrointestinal tract, and the lungs as prototype sites to describe the influence of the microbiomes in each of those locations on health, and how care may derange those relations.
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23
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He H, Zhang Z. Honey dressing: a missed way for orthopaedic wound care. INTERNATIONAL ORTHOPAEDICS 2022; 46:2989. [PMID: 36121445 DOI: 10.1007/s00264-022-05582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/10/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Haichao He
- Department of Orthopaedics, Dongyang People's Hospital, Wenzhou Medical University Affiliated Dongyang Hospital, 60 Wuning West Road, Dongyang, 322100, Zhejiang, China
| | - Zhengliang Zhang
- Department of Orthopaedics, Dongyang People's Hospital, Wenzhou Medical University Affiliated Dongyang Hospital, 60 Wuning West Road, Dongyang, 322100, Zhejiang, China.
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Veziant J, Bonnet M, Occean BV, Dziri C, Pereira B, Slim K. Probiotics/Synbiotics to Reduce Infectious Complications after Colorectal Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients 2022; 14:nu14153066. [PMID: 35893922 PMCID: PMC9332115 DOI: 10.3390/nu14153066] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023] Open
Abstract
Aim: The aims of this systematic review and meta-analysis were to assess to what extent probiotics/synbiotics reduce infectious complications after colorectal surgery and whether probiotics or synbiotics should be considered as perioperative measures preventing or reducing infectious complications after CRS and should be included in enhanced recovery programmes (ERP). Secondary aims were to answer practical questions precisely on the best formulation and the type and timing of probiotics or synbiotics in CRS. Method: This systematic review and quantitative meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Inclusion criteria were randomised trials comparing perioperative probiotics/synbiotics with a placebo or standard care in elective colorectal surgery. Exclusion criteria were non-randomised trials. Overall infectious complications and surgical site infections (SSIs including both deep abdominal infections and wound (skin or under the skin) infections) were the primary outcomes. Secondary outcomes were pulmonary and urinary infections, wound infections, and anastomotic leaks. The databases consulted were Medline, Cochrane Database of Systematic Reviews, Scopus, and Clinical Trials Register. Risk of bias was assessed according to the GRADE approach. The analysis calculated the random effects estimates risk ratio (RR) for each outcome. Results: 21 trials were included; 15 evaluated probiotics, and 6 evaluated synbiotics. There were significantly fewer infectious complications (risk ratio (RR) 0.59 [0.47–0.75], I2 = 15%) and fewer SSI (RR 0.70 [0.52–0.95], I2 = 0%) in the probiotic or synbiotic group. There were also significantly fewer pulmonary infections (RR 0.35 [0.20–0.63]) and urinary infections RR 0.41 [0.19–0.87]) as opposed to anastomotic leaks (RR 0.83 [0.47–1.48]) and wound infections (RR 0.74 [0.53–1.03]). Sensitivity analyses showed no significant difference between probiotics and synbiotics in reducing postoperative infections (RR 0.55 [0.42–0.73] versus RR 0.69 [0.42–1.13], p = 0.46). Conclusions: Based on the finding of this study, probiotics/synbiotics reduce infectious complications after colorectal surgery. The effect size was more pronounced for pulmonary and urinary infections. From a practical aspect, some of the questions related to formulations and duration of probiotics or synbiotics need to be answered before including them definitively in enhanced recovery after colorectal surgery programmes.
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Affiliation(s)
- Julie Veziant
- Department of Digestive and Oncological Surgery, University Hospital Lille, 59000 Lille, France;
- The Francophone Group for Enhanced Recovery after Surgery, GRACE, 63110 Beaumont, France
- M2iSH UMR 1071 Inserm/Clermont Auvergne University, USC-INRAE 2018, CRNH, 63000 Clermont-Ferrand, France;
| | - Mathilde Bonnet
- M2iSH UMR 1071 Inserm/Clermont Auvergne University, USC-INRAE 2018, CRNH, 63000 Clermont-Ferrand, France;
| | - Bob V. Occean
- Department of Statistics, University Hospital, 30000 Nîmes, France;
| | - Chadly Dziri
- Honoris Medical Simulation Center, Tunis 1000, Tunisia;
| | - Bruno Pereira
- Department of Statistics, University Hospital CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Karem Slim
- The Francophone Group for Enhanced Recovery after Surgery, GRACE, 63110 Beaumont, France
- Department of Digestive Surgery, University Hospital CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
- Correspondence:
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