Surgical-site infection risk in oncologic digestive surgery

Removal of Horizontally Impacted Mandibular Third Molars With Large Root Bifurcations Using a Modified Tooth Sectioning Method

PURPOSE

The purpose of this study was to introduce the method and first results of a modified tooth sectioning technique for the extraction of horizontally impacted mandibular third molars (M3Ms) with large root bifurcation.

PATIENTS AND METHODS

A total of 300 horizontally impacted M3Ms with large root bifurcation in medically healthy patients were included in this prospective study. Patients were divided into 2 groups: the modified method group (test group), in which the M3M was sectioned between the distal root and the remainder of the tooth at the point of root bifurcation; and the conventional method group (control group), in which the M3M was sectioned between the crown and the root at the cementoenamel junction. Operation duration, postoperative reactions, complications, and patient satisfaction were analyzed and compared between the 2 groups.

RESULTS

Each group included 150 M3Ms which were all successfully extracted. Operation durations in the test and control group were 10.48 ± 3.78 and 15.09 ± 4.24 minutes, respectively (P < .05). The test group had significantly better results than the control group with regard to postoperative reactions and complications (P < .05). Patients in the test group had higher satisfaction ratings regarding operation duration and the healing process than those in the control group (P < .05).

CONCLUSIONS

The modified method of tooth sectioning between the distal root and the remainder of the tooth can efficiently eliminate resistance from the bone and adjacent mandibular second molar and allow for just 1 sectioning of the M3M in most cases, which could make the operation straightforward and safe.

Surgical site infection after digestive surgery in a single tertiary hospital in Indonesia: six years of data

BACKGROUND Surgical site infection (SSI) is responsible for increasing cost, morbidity, and mortality related to surgical operations, and has continued to be a significant problem even in hospitals with advanced facilities. This study aimed to describe the SSI among patients after digestive surgery. METHODS From 2012 to 2017, all abdominal surgeries with SSI in Cipto Mangunkusumo Hospital, except obstetrics and gynecology cases, were included in the study. Demographic characteristics, nutritional status, preoperative and intraoperative conditions, wound contamination/SSI type, and mortality data were reported. RESULTS From 4,893 abdominal surgeries during the period, 135 subjects (2.8%) developed SSI with 42.2% of cases were the clean-contaminated type. Most of the cases were males (66.7%), aged between 25–65 years old (80.0%), subjective goal assessment B (46.7%), had normal weight (57.8%), had longer duration of surgery (70.4%), and had preoperative stay between 2–15 days (65.2%). Most of the SSI patients survived (77.8%). CONCLUSIONS Even though the SSI in Cipto Mangunkusumo Hospital was low, it still needs improvement in preoperative care, intraoperative care, and SSI awareness. Therefore, further studies are required to understand how to reduce the incidence, risk, and SSI-related mortality.

Predictors of surgical site infection after radical cystectomy: should we enhance surgical antibiotic prophylaxis?

PURPOSE

To compare surgical site infections (SSI) rate after radical cystectomy (RC) over time and ascertain whether antibiotic prophylaxis should be enhanced.

METHODS

All medical records of RC patients in a single tertiary uro-oncology center between 2007 and 2017 were analyzed. SSI was defined using the criteria of the US Centers for Disease Control and Prevention. All bacterial culture results and antimicrobial resistance rates were recorded. Lastly, multivariable logistic regression analysis was performed to ascertain SSI predictors.

RESULTS

RC was performed in 405 patients, of which 96 (23.7%) developed SSI. No differences were demonstrated in the mean age, gender, NIDDM prevalence, neoadjuvant chemotherapy, positive preoperative urine culture, bowel preparation, and surgery time between both groups. However, statistically significant higher median BMI, age-adjusted Charlson Comorbidity score, usage of ceftriaxone preoperatively, and intensive care unit (ICU) hospitalization were noted in SSI patients. Overall, 62/96 (63.5%) SSI patients had a positive wound culture, with only 16.7% of the pathogens being sensitive to their perioperative antibiotics. Lastly, on multivariable analysis rising BMI, preoperative ceftriaxone and ICU hospitalization were associated with a higher SSI rate.

CONCLUSIONS

Preoperative BMI reduction, and maximal preoperative medical optimization in an attempt to lower ICU admittance rates, should be part of the ideal strategy for lowering SSI rates. Additionally, preoperative antibiotics should be enhanced to harbor-wide spectrum coverage, based on local resistance rates.

An Assessment Scale for Patients with Postoperative Superficial Incisional Surgical Site Infection: a Cross-Sectional Study

Superficial incisional surgical site infection (SSI) is a common postoperative complication in surgical patients. The aim of this study was to assess the predictive power of an assessment scale for identifying patients at risk of superficial incisional SSI. A cross-sectional survey was conducted at the Department of Surgery at the Medical Research Institute Hospital, Alexandria University. A sample of 150 adult patients aged from 18 to 65 years, who undergoing general surgeries that had clean sutured surgical wounds, was randomly selected. Forty-six patients (30.7%) had SSI. The total score can significantly discriminate between positive and negative superficial incisional SSI patients with diagnostic accuracy of AUC (SE) = 0.66 (0.048). Each score more than the cutoff point (11.5) will increase the risk of surgical site infection development by 2.5 times (OR (95% CI) = 2.5 (1.26-3.1)). The developed assessment scale can discriminate between patients who are at risk of superficial incisional SSI and those who are not. It can be used as a preliminary screening tool for subsequent investigation for the presence of infection.