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Schwarz L, Gillibert A, Rondeaux J, Lacroix E, Sa Cunha A, Joannes-Boyau O. Study protocol of the FRENCH24-ANIS study: postoperative anti-infective strategy following pancreaticoduodenectomy in patients with preoperative biliary stents-an intergroup FRENCH-ACHBT-SFAR prospective randomized controlled trial. BMC Surg 2024; 24:237. [PMID: 39169298 PMCID: PMC11340185 DOI: 10.1186/s12893-024-02507-y] [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: 01/21/2024] [Accepted: 07/16/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Despite advances in surgical techniques and care, pancreatoduodenectomy (PD) continues to have high morbidity and mortality rates. Complications such as sepsis, hemorrhage, pulmonary issues, shock, and pancreatic fistula are common postoperative challenges. A key concern in PD outcomes is the high incidence of infectious complications, especially surgical site infections (SSI) and postoperative pancreatic fistula (POPF). Bacteriobilia, or bile contamination with microorganisms, significantly contributes to these infections, increasing the risk of early postoperative complications. The occurrence of SSI in patients who undergo hepatobiliary and pancreatic (HPB) surgeries such as PD is notably higher than that in patients who undergo other surgeries, with rates ranging from 20 to 55%. Recent research by D'Angelica et al. revealed that, compared to cefoxitin, piperacillin/tazobactam considerably lowers the rate of postoperative SSI. However, these findings do not indicate whether extending the duration of antibiotic treatment is beneficial for patients at high risk of bacterial biliary contamination. In scenarios with a high risk of SSI, the specific agents, doses and length of antibiotic therapy remain unexplored. The advantage of prolonged antibiotic prophylaxis following PD has not been established through prospective studies in PD patients following biliary drainage. METHODS This is an intergroup FRENCH-ACHBT-SFAR multicenter, open-labelled randomized, controlled, superiority trial comparing 2 broad-spectrum antibiotic (piperacillin/tazobactam) treatment modalities to demonstrate the superiority of 5-day postoperative antibiotic therapy to antibiotic prophylaxis against the occurrence of surgical site infections (SSI) following pancreaticoduodenectomy in patients with preoperative biliary stents. The primary endpoint of this study is the overall SSI rate, defined according to the ACS NSQIP, as a composite of superficial SSI, deep incisional SSI, and organ/space SSI. In addition, we will analyze overall morbidity, antibiotic resistance profiles, the pathogenicity of bacteriological and fungal cocontamination, the impact of complications after bile drainage and neoadjuvant treatment on the bacteriological and fungal profile of biliculture and cost-effectiveness. CONCLUSION This FRENCH24-ANIS study aims to evaluate 5-day post-operative antibiotic therapy combined with antibiotic prophylaxis on the occurrence of surgical site infections (SSI) following pancreaticoduodenectomy in patients with preoperative biliary stents. TRIAL REGISTRATION ClinicaTrials.gov number, NCT06123169 (Registration Date 08-11-2023); EudraCT number 2021-006991-18; EUCT Number: 2024-515181-14-00.
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Affiliation(s)
- Lilian Schwarz
- Department of Digestive Surgery, Rouen University Hospital, 1 Rue de Germont, Rouen, 76000, France.
- Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Rouen, 76000, France.
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Rouen, 76000, France
| | - Julie Rondeaux
- Department of Digestive Surgery, Rouen University Hospital, 1 Rue de Germont, Rouen, 76000, France
| | - Elie Lacroix
- Department of Biostatistics, Rouen University Hospital, Rouen, 76000, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
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Charles A, Malani PN. Skin Antisepsis to Prevent Surgical Site Infections: Implications for Global Surgery. JAMA 2024; 332:550. [PMID: 38884966 DOI: 10.1001/jama.2024.9622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Affiliation(s)
- Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill
- Associate Editor, JAMA
| | - Preeti N Malani
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Deputy Editor, JAMA
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Bhangu A. The need to accelerate research and guidance to reduce surgical site infection. J Wound Care 2024; 33:S3. [PMID: 39140799 DOI: 10.12968/jowc.2024.33.sup8.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Affiliation(s)
- Aneel Bhangu
- NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Bhangu A. The need to accelerate research and guidance to reduce surgical site infection. J Wound Care 2024; 33:S3. [PMID: 39140709 DOI: 10.12968/jowc.2024.33.8.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Affiliation(s)
- Aneel Bhangu
- NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Mammo TN, Feyssa MD, Nofal MR, Gebeyehu N, Shiferaw MA, Tesfaye A, Fikre T, Woldeamanuel H, Alemu SB, Miller K, Haile ST, Weiser TG. A Perioperative Quality Improvement Program for Cesarean Delivery in Ethiopia: A Stepped-Wedge Cluster Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2428910. [PMID: 39163043 PMCID: PMC11337075 DOI: 10.1001/jamanetworkopen.2024.28910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 06/25/2024] [Indexed: 08/21/2024] Open
Abstract
Importance Infections and complications following cesarean delivery are a significant source of maternal mortality in Ethiopia. Objective To study the effectiveness of a program to strengthen compliance with perioperative standards and reduce postoperative complications following cesarean delivery. Design, Setting, and Participants This stepped-wedge cluster randomized clinical trial included patients undergoing cesarean delivery from August 24, 2021, to January 31, 2023, at 9 hospitals organized into 5 clusters in Ethiopia. Intervention Clean Cut, a multimodal surgical quality improvement program that includes process-mapping 6 perioperative standards and creating site-specific, systems-level improvements. The control period was the period before implementation of the intervention. Main Outcomes and Measures The primary end point was surgical site infection rate, and secondary end points were maternal mortality and perinatal mortality and a composite outcome of infections and both mortality outcomes. All were assessed at 30 days postoperatively in the intervention and control groups, adjusting for clustering and demographics. Compliance with standards and the relationship between compliance and outcomes were also compared between the 2 arms. Results Among 9755 women undergoing cesarean delivery, 5099 deliveries (52.3%) occurred during the control period (2722 emergency cases [53.4%]) and 4656 (47.7%) during the intervention period (2346 emergency cases [50.4%]). Mean (SD) patient age was 27.04 (0.05) years. Thirty-day follow-up was completed for 5153 patients (52.8%). No significant reduction in infection rates was detected after the intervention (OR, 0.84; 95% CI, 0.55-1.27; P = .40). Intraoperative infection prevention standards improved significantly in the intervention arm vs control arm for compliance with at least 5 of the 6 standards (odds ratio [OR], 2.95; 95% CI, 2.40-3.62; P < .001). Regardless of trial arm, high compliance was associated with reduced odds of maternal (OR, 0.32; 95% CI, 0.11-0.93; P = .04) and perinatal (OR, 0.64; 95% CI, 0.47-0.89; P = .008) mortality. Conclusions and Relevance In this stepped-wedge cluster randomized clinical trial of patients undergoing cesarean delivery, no significant reductions in surgical site infections were observed. However, compliance with perioperative standards improved following the intervention. Trial Registration ClinicalTrials.gov Identifier: NCT04812522; Pan-African Clinical Trials Registry Identifier: PACTR202108717887402.
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Affiliation(s)
- Tihitena Negussie Mammo
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
- Lifebox Foundation, Addis Ababa, Ethiopia
| | - Mekdes Daba Feyssa
- St Paul’s Hospital Millenium Medical College, Addis Ababa, Ethiopia
- Ethiopian Society of Obstetricians & Gynecologists, Addis Ababa, Ethiopia
- Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Maia R. Nofal
- Lifebox Foundation, Addis Ababa, Ethiopia
- Department of Surgery, Stanford University, Stanford, California
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | | | - Matiyas Asrat Shiferaw
- Lifebox Foundation, Addis Ababa, Ethiopia
- St Paul’s Hospital Millenium Medical College, Addis Ababa, Ethiopia
| | | | - Tesfaneh Fikre
- Ethiopian Society of Obstetricians & Gynecologists, Addis Ababa, Ethiopia
| | | | | | - Kate Miller
- Quantitative Science Unit, Department of Medicine, Stanford University, Stanford, California
| | | | - Thomas G. Weiser
- Lifebox Foundation, Addis Ababa, Ethiopia
- Department of Surgery, Stanford University, Stanford, California
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Depuydt M, Van Egmond S, Petersen SM, Muysoms F, Henriksen N, Deerenberg E. Systematic review and meta-analysis comparing surgical site infection in abdominal surgery between triclosan-coated and uncoated sutures. Hernia 2024; 28:1017-1027. [PMID: 38713430 PMCID: PMC11297069 DOI: 10.1007/s10029-024-03045-5] [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: 01/16/2024] [Accepted: 04/13/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Surgical site infection (SSI) is a frequent complication after abdominal surgery and impacts morbidity, mortality and medical costs. This systematic review evaluates whether the use of triclosan-coated sutures for closing the fascia during abdominal surgery reduces the rate of SSI compared to uncoated sutures. METHODS A systematic review and meta-analysis were conducted using the PRISMA guidelines. On February 17, 2024, a literature search was performed in Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Embase. Randomized controlled trials (RCTs) on abdominal fascial closure in human adults, comparing triclosan-coated and uncoated sutures, were included. The risk of bias was assessed using the Cochrane RoB 2 tool. Pooled meta-analysis was performed using RevMan. RESULTS Out of 1523 records, eleven RCTs were included, with a total of 10,234 patients: 5159 in the triclosan-coated group and 5075 in the uncoated group. The incidence of SSI was statistically significantly lower in the triclosan-coated group (14.8% vs. 17.3%) with an odds ratio (OR) of 0.84 (95% CI [0.75, 0.93], p = 0.001). When polydioxanone was evaluated separately (coated N = 3999, uncoated N = 3900), triclosan-coating reduced SSI; 17.5% vs. 20.1%, OR 0.86 (95% CI [0.77; 0.96], p = 0.008). When polyglactin 910 was evaluated (coated N = 1160, uncoated N = 1175), triclosan-coating reduced the incidence of SSI; 5.4% vs. 7.8%, OR 0.67 (95% CI [0.48; 0.94], p = 0.02). CONCLUSION According to the results of this meta-analysis the use of triclosan-coated sutures for fascial closure statistically significantly reduces the incidence of SSI after abdominal surgery with a risk difference of about 2%.
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Affiliation(s)
- Martijn Depuydt
- General Surgery, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium.
- Department of Surgery, University of Ghent, Ghent, Belgium.
| | - Sarah Van Egmond
- Department of Surgery, Franciscus Gasthuis and Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | | | - Filip Muysoms
- General Surgery, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium
| | - Nadia Henriksen
- Hepatic and Digestive Diseases, Herlev University Hospital, Copenhagen, Denmark
| | - Eva Deerenberg
- Department of Surgery, Franciscus Gasthuis and Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
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Harrison E, Kathir Kamarajah S. Global evaluation and outcomes of cholecystectomy: protocol for a multicentre, international, prospective cohort study (GlobalSurg 4). BMJ Open 2024; 14:e079599. [PMID: 39059804 PMCID: PMC11287069 DOI: 10.1136/bmjopen-2023-079599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/17/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Cholecystectomy is one of the most common operations performed worldwide. Although laparoscopic surgery has been the 'gold-standard' approach for this operation, there is a paucity of global evidence around the variations of safe provision of cholecystectomy, including low-income and middle-income countries. This international collaborative study will allow contemporaneous data collection on the quality of cholecystectomies using measures covering infrastructure, care processes and outcomes, with the primary aim define the global variation in compliance with preoperative, intraoperative and postoperative audit standards. METHODS AND ANALYSIS Global Evaluation of Cholecystectomy Knowledge and Outcomes is a prospective, international, multicentre, observational cohort study delivered by the GlobalSurg Collaborative. Consecutive patients undergoing cholecystectomy between 31 July 2023 and 19 November 2023 will be recruited, with follow-up at 30 days and 1-year postoperatively. The study will be undertaken at any hospital providing emergency or elective surgical services for biliary disease. The primary endpoint of this study is compliance with preoperative, intraoperative and postoperative audit standards. Secondary outcomes include rates of 30-day complications, achievement of critical view of safety and rates of gallbladder cancer. ETHICS AND DISSEMINATION This project will not affect clinical practice and has been classified as clinical audit following research ethics review at University Hospital Birmingham NHS Trust. The protocol will be disseminated through the international GlobalSurg and CovidSurg network. TRIAL REGISTRATION NUMBER NCT06223061.
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Affiliation(s)
- Ewen Harrison
- University of Edinburgh Western General Hospital, Edinburgh, UK
| | - Sivesh Kathir Kamarajah
- NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, Birmingham, UK
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Lin B, Zhang H, Sun S, Lin C, Chi Y. Application and Prognostic Analysis of Vacuum Sealing Drainage in the Incision Infection in Patients With Stage II-III Colorectal Cancer. Am Surg 2024:31348241265133. [PMID: 39030681 DOI: 10.1177/00031348241265133] [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: 07/21/2024]
Abstract
INTRODUCTION This study aims to explore the application value of vacuum sealing drainage (VSD) technology in the treatment of incision infection dehiscence after surgery in patients with stage II-III colorectal cancer and analyze its impact on prognosis. METHODS This retrospective study included patients who experienced incision infection dehiscence after surgery for colorectal cancer between February 2014 and August 2019. Clinical and pathological data, short-term outcomes, and long-term outcomes were compared between the traditional group and the VSD group. RESULTS A total of 97 patients were included in this study. There was no significant difference in clinical and pathological data between the traditional group and the VSD group (P > 0.05). The VSD group had fewer dressing changes, lower pain scores during dressing changes, and better granulation tissue growth grading than the traditional group, with statistical significance (P < 0.05). The VSD group started adjuvant chemotherapy earlier and had a higher proportion of ≥4 cycles of chemotherapy. The three-year overall survival rate in the VSD group was better than the traditional group, but the difference was not statistically significant (P > 0.05). CONCLUSION The application of VSD technology can promote granulation tissue growth, accelerate incision healing, and facilitate patients to complete subsequent adjuvant chemotherapy. However, further verification of its long-term impact on prognosis requires longer-term follow-up results.
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Affiliation(s)
- Bao Lin
- Department of Gastrointestinal Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, China
| | - Hongjian Zhang
- Department of Gastrointestinal Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, China
| | - Shijie Sun
- Department of Gastrointestinal Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, China
| | - Changqing Lin
- Department of Gastrointestinal Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, China
| | - Yuanlong Chi
- Department of Gastrointestinal Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, China
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Nofal MR, Tesfaye A, Gebeyehu N, Masersha MN, Hayredin I, Belayneh K, Getahun B, Starr N, Abebe K, Sebsebe Y, Alemu SB, Mammo TN, Weiser TG. A Prospective Quality Improvement Program to Reduce Prolonged Postoperative Antibiotic Prophylaxis in Ethiopia. Surg Infect (Larchmt) 2024. [PMID: 38990697 DOI: 10.1089/sur.2024.059] [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: 07/13/2024] Open
Abstract
Introduction: Although postoperative antibiotic prophylaxis has not been shown to prevent surgical site infections, prolonged antibiotic administration is common in low- and middle-income countries. We developed a quality improvement program to reduce unnecessary postoperative antibiotics through hospital-specific guideline development and the use of a brief, multidisciplinary discussion of antibiotic indication, choice, and duration during clinical rounds. We assessed reduction in the number of patients receiving ≥24 h of antibiotic prophylaxis after clean and clean-contaminated surgery. Methods: We piloted the program at a referral hospital in Ethiopia from February to September 2023. After a 6-week baseline assessment, multidisciplinary teams adapted international guidelines for surgical prophylaxis to local disease burden, medication availability, and cost restrictions; stakeholders from surgical departments provided feedback. Surgical teams implemented a "timeout" during rounds to apply these guidelines to patient care; compliance with the timeout and antibiotic administration was assessed throughout the study period. Results: We collected data from 636 patients; 159 (25%) in the baseline period and 477 (75%) in the intervention period. The percentage of patients receiving ≥24 h of antibiotic prophylaxis after surgery decreased from 50.9% in the baseline period to 40.9% in the intervention period (p = 0.027) and was associated with a 0.5 day reduction in postoperative length of stay (p = 0.047). Discussion: This antibiotic stewardship pilot program reduced postoperative antibiotic prophylaxis in a resource-constrained setting in Sub-Saharan Africa and was associated with shorter length of stay. This program has the potential to reduce unnecessary antibiotic use in this population.
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Affiliation(s)
- Maia R Nofal
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Surgery, Stanford University, Palo Alto, California, USA
- Lifebox, Addis Ababa, Ethiopia
- Global Health Equity Scholars Program (D43TW010540), Fogarty International Center, Washington, District of Columbia, USA
| | - Assefa Tesfaye
- Lifebox, Addis Ababa, Ethiopia
- St. Peter's Specialized Hospital, Addis Ababa, Ethiopia
| | - Natnael Gebeyehu
- Lifebox, Addis Ababa, Ethiopia
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Benti Getahun
- St. Peter's Specialized Hospital, Addis Ababa, Ethiopia
| | - Nichole Starr
- Lifebox, Addis Ababa, Ethiopia
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Kaleb Abebe
- St. Peter's Specialized Hospital, Addis Ababa, Ethiopia
| | | | - Senait Bitew Alemu
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Tihitena Negussie Mammo
- Lifebox, Addis Ababa, Ethiopia
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Thomas G Weiser
- Department of Surgery, Stanford University, Palo Alto, California, USA
- Lifebox, Addis Ababa, Ethiopia
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Poylin VY, Tyselskyi V, Pereyra MN, Kebkalo A. You don't need to be a millionaire: pragmatic approach to implementing infection control and bowel recovery pathways in low resource environment. Surg Endosc 2024:10.1007/s00464-024-11031-2. [PMID: 38987481 DOI: 10.1007/s00464-024-11031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Vitaliy Y Poylin
- Division of Gastrointestinal Surgery, Northwestern University Feinberg School of Medicine, Northwestern Medical Group, Northwestern Medicine, 676 N. St. Clair St., Suite 650, Chicago, IL, 60611, USA.
| | - Volodymyr Tyselskyi
- Department of Endoscopic and Robotic Surgery, Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Maria Navaez Pereyra
- Department of Surgery, Northwestern Feinberg School of Medicine, 676 N. St. Clair St., Suite 650, Chicago, IL, 60611, USA
| | - Andrey Kebkalo
- Department of Endoscopic and Robotic Surgery, Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
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Zhao S, Zhou H, He M. Considerations regarding a prediction model of surgical site infection after gastrointestinal surgery. Int J Surg 2024; 110:4528-4529. [PMID: 38597389 PMCID: PMC11254212 DOI: 10.1097/js9.0000000000001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Shenglin Zhao
- Office of Chongqing Cancer Prevention and Treatment
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China
| | - Hong Zhou
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China
| | - Mei He
- Office of Chongqing Cancer Prevention and Treatment
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China
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Jahangir F, Haghdoost A, Moameri H, Okhovati M. Incidence and Risk Factors of Surgical Site Infection in Abdominal Surgeries: A Scoping Review of Cohort and Case-Control Studies. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:402-412. [PMID: 39114633 PMCID: PMC11300942 DOI: 10.30476/ijms.2024.100819.3338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 08/10/2024]
Abstract
Background Abdominal surgery is considered a high-risk procedure for the development of surgical site infection (SSI). Few studies have evaluated the relative importance of surgical site infection risk factors in terms of consistency in abdominal surgery. Therefore, this comprehensive review article mapped and summarized the evidence aimed to determine the relative importance of the risk factors and incidence of SSIs in abdominal surgery. Methods A literature review was conducted using electronic databases and search engines such as Scopus, PubMed, and Web of Science up to March 16, 2023. There was no language restriction for the papers to be included in the study. The relative consistency of the risk factors was measured and evaluated using the methodology of the Joanna Briggs Institute. Original peer-reviewed cohort and case-control studies were included if all types of SSIs were included. Meta-analysis was performed to determine the pooled estimates of SSI incidences. Results Of 14,237 identified records, 107 articles were included in the review. The pooled incidence of SSI was 10.6% (95% CI: 9.02-12.55%, χ2=12986.44, P<0.001). Operative time and higher wound class were both significant consistent risk factors for SSI incidence. Patients' educational status, malnutrition, functional status, and history of neurological/psychiatric disorders were all candidates for consistent risk factors, with insufficient evidence. Conclusion The findings of the present study indicated that SSI in abdominal surgery was a multifactorial phenomenon with a considerable risk and had different risk factors with various relative importance. Determining the relative importance of the risk factors for the prevention and control of SSI is strongly recommended.This manuscript has been released as a preprint at the research square: (https://doi.org/10.21203/rs.3.rs-3219597/v1).
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Affiliation(s)
- Fereidoun Jahangir
- Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Nursing, Hazrat Zahra (P.B.U.H) Abadeh School of Nursing, Shiraz University of Medical Sciences, Shiraz, Iran
| | - AliAkbar Haghdoost
- Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hossein Moameri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Okhovati
- Department of Health Management, Policy and Economics, School of Medical Management and Information, Kerman University of Medical Sciences, Kerman, Iran
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Ichida K, Noda H, Maemoto R, Mizusawa Y, Matsuzawa N, Tamaki S, Abe I, Endo Y, Inoue K, Fukui T, Takayama Y, Muto Y, Futsuhara K, Watanabe F, Miyakura Y, Mieno M, Rikiyama T. Contrasting seasonality of the incidence of incisional surgical site infection after general and gastroenterological surgery: an analysis of 8436 patients in a single institute. J Hosp Infect 2024; 151:140-147. [PMID: 38950864 DOI: 10.1016/j.jhin.2024.06.003] [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: 04/04/2024] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND While seasonality of hospital-acquired infections, including incisional SSI after orthopaedic surgery, is recognized, the seasonality of incisional SSI after general and gastroenterological surgeries remains unclear. AIM To analyse the seasonality and risk factors of incisional SSI after general and gastroenterological surgeries. METHODS This was a retrospective, single-institute, observational study using univariate and multivariate analyses. The evaluated variables included age, sex, surgical approach, surgical urgency, operation time, wound classification, and the American Society of Anesthesiologists physical status (ASA-PS). FINDINGS A total of 8436 patients were enrolled. General surgeries (N = 2241) showed a pronounced SSI incidence in summer (3.9%; odds ratio (OR): 1.87; 95% confidence interval (CI): 1.05-3.27; P = 0.025) compared to other seasons (2.1%). Conversely, gastroenterological surgeries (N = 6195) showed a higher incidence in winter (8.3%; OR: 1.38; 95% CI: 1.10-1.73; P = 0.005) than in other seasons (6.1%). Summer for general surgery (OR: 1.90; 95% CI: 1.12-3.24; P = 0.018) and winter for gastroenterological surgery (1.46; 1.17-1.82; P = 0.001) emerged as independent risk factors for incisional SSI. Open surgery (OR: 2.72; 95% CI: 1.73-4.29; P < 0.001) and an ASA-PS score ≥3 (1.64; 1.08-2.50; P = 0.021) were independent risk factors for incisional SSI in patients undergoing gastroenterological surgery during winter. CONCLUSION Seasonality exists in the incisional SSI incidence following general and gastroenterological surgeries. Recognizing these trends may help enhance preventive strategies, highlighting the elevated risk in summer for general surgery and in winter for gastroenterological surgery.
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Affiliation(s)
- K Ichida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - H Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - R Maemoto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Y Mizusawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - N Matsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - S Tamaki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - I Abe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Y Endo
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - K Inoue
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - T Fukui
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Y Takayama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Y Muto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - K Futsuhara
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - F Watanabe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Y Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - M Mieno
- Department of Medical Statistics, Center for Information, Jichi Medical University, Shimotsuke, Japan
| | - T Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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14
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Doğan CZ, Yalçın N, Cennet Ö, Metan G, Demirkan K, Yorgancı K. Optimization of appropriate antimicrobial prophylaxis in general surgery: a prospective cohort study. Eur J Med Res 2024; 29:340. [PMID: 38890673 PMCID: PMC11186073 DOI: 10.1186/s40001-024-01938-w] [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: 05/13/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Surgical site infections (SSI) are characterized by infections occurring in the surgical incision site, organ or cavity in the postoperative period. Adherence to surgical antimicrobial prophylaxis (SAP) is paramount in mitigating the occurrence of SSIs. In this study, we aimed to evaluate the appropriateness of SAP use in patients undergoing surgical procedures in the field of general surgery according to the American Society of Health-System Pharmacists (ASHP) guideline and to determine the difference between the pre-training period (pre-TP) and the post-training period (post-TP) organized according to this guideline. METHODS It is a single-center prospective study conducted in general surgery wards between January 2022 and May 2023, with 404 patients pre-TP and 406 patients post-TP. RESULTS Cefazolin emerged as the predominant agent for SAP, favored in 86.8% (703/810) of cases. Appropriate cefazolin dosage increased significantly from 41% (129 patients) in pre-TP to 92.6% (276 patients) in post-TP (p < 0.001), along with a rise in adherence to recommended timing of administration from 42.2% (133 patients) to 62.8% (187 patients) (p < 0.001). The proportion of patients receiving antibiotics during hospitalization in the ward postoperatively decreased post-TP (21-14.3%; p = 0.012), as did antibiotic prescription at discharge (16.8-10.3%; p = 0.008). The incidence of SSI showed a slight increase from 9.9% in pre-TP to 13.3% in post-TP (p = 0.131). CONCLUSIONS Routine training sessions for surgeons emerged as crucial strategies to optimize patient care and enhance SAP compliance rates, particularly given the burden of clinical responsibilities faced by surgical teams.
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Affiliation(s)
- Cansu Zeynep Doğan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06230, Ankara, Turkey
| | - Nadir Yalçın
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06230, Ankara, Turkey.
| | - Ömer Cennet
- Department of General Surgery, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06230, Ankara, Turkey
| | - Kaya Yorgancı
- Department of General Surgery, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
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15
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Sartelli M, Tascini C, Coccolini F, Dellai F, Ansaloni L, Antonelli M, Bartoletti M, Bassetti M, Boncagni F, Carlini M, Cattelan AM, Cavaliere A, Ceresoli M, Cipriano A, Cortegiani A, Cortese F, Cristini F, Cucinotta E, Dalfino L, De Pascale G, De Rosa FG, Falcone M, Forfori F, Fugazzola P, Gatti M, Gentile I, Ghiadoni L, Giannella M, Giarratano A, Giordano A, Girardis M, Mastroianni C, Monti G, Montori G, Palmieri M, Pani M, Paolillo C, Parini D, Parruti G, Pasero D, Pea F, Peghin M, Petrosillo N, Podda M, Rizzo C, Rossolini GM, Russo A, Scoccia L, Sganga G, Signorini L, Stefani S, Tumbarello M, Tumietto F, Valentino M, Venditti M, Viaggi B, Vivaldi F, Zaghi C, Labricciosa FM, Abu-Zidan F, Catena F, Viale P. Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use. World J Emerg Surg 2024; 19:23. [PMID: 38851757 PMCID: PMC11162065 DOI: 10.1186/s13017-024-00551-w] [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: 03/26/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024] Open
Abstract
Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients' safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts' opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents the executive summary of the consensus conference and comprises three sections. The first section focuses on the general principles of diagnosis and treatment of IAIs. The second section provides twenty-three evidence-based recommendations for the antimicrobial therapy of IAIs. The third section presents eight clinical diagnostic-therapeutic pathways for the most common IAIs. The document has been endorsed by the Italian Society of Surgery.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100, Macerata, Italy.
| | - Carlo Tascini
- Infectious Diseases Clinic, Santa Maria Della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Azienda Ospedaliero Universitaria Pisana, University Hospital, Pisa, Italy
| | - Fabiana Dellai
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Luca Ansaloni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Massimo Antonelli
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze Dell'Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Boncagni
- Anesthesiology and Intensive Care Unit, Macerata Hospital, Macerata, Italy
| | - Massimo Carlini
- Department of General Surgery, S. Eugenio Hospital, Rome, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Arturo Cavaliere
- Unit of Hospital Pharmacy, Viterbo Local Health Authority, Viterbo, Italy
| | - Marco Ceresoli
- General and Emergency Surgery, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Alessandro Cipriano
- Department of Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical Surgical and Critical Care, University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | | | - Francesco Cristini
- Infectious Diseases Unit, AUSL Romagna, Forlì and Cesena Hospitals, Forlì, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Eugenio Cucinotta
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
| | - Lidia Dalfino
- Anesthesia and Intensive Care Unit, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University of Bari, Bari, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze Dell'Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Forfori
- Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Paola Fugazzola
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Lorenzo Ghiadoni
- Department of Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
- Department on Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonino Giarratano
- Department of Precision Medicine in Medical Surgical and Critical Care, University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Alessio Giordano
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, AOU Policlinico Umberto 1, Sapienza University of Rome, Rome, Italy
| | - Gianpaola Monti
- Department of Anesthesia and Intensive Care, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | - Miriam Palmieri
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100, Macerata, Italy
| | - Marcello Pani
- Hospital Pharmacy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ciro Paolillo
- Emergency Department, University of Verona, Verona, Italy
| | - Dario Parini
- General Surgery Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Daniela Pasero
- Department of Emergency, Anaesthesia and Intensive Care Unit, ASL1 Sassari, Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Nicola Petrosillo
- Infection Prevention and Control Service, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Alessandro Russo
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
- Infectious and Tropical Disease Unit, "Renato Dulbecco" Teaching Hospital, Catanzaro, Italy
| | - Loredana Scoccia
- Hospital Pharmacy Unit, Macerata Hospital, AST Macerata, Macerata, Italy
| | - Gabriele Sganga
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Liana Signorini
- Unit of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | - Mario Tumbarello
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Fabio Tumietto
- UO Antimicrobial Stewardship-AUSL Bologna, Bologna, Italy
| | | | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Bruno Viaggi
- Intensive Care Department, Careggi Hospital, Florence, Italy
| | | | - Claudia Zaghi
- General, Emergency and Trauma Surgery Department, Vicenza Hospital, Vicenza, Italy
| | | | - Fikri Abu-Zidan
- Statistics and Research Methodology, The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Fausto Catena
- Emergency and General Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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16
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K B, R S, J S, Satyanesan J. Surgical Site Infections in Gastrointestinal Surgeries: Estimation of Prevalence, Risk Factors and Bacteriological Profile. Cureus 2024; 16:e62589. [PMID: 39027770 PMCID: PMC11256213 DOI: 10.7759/cureus.62589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Surgical site infections (SSIs) are one of the leading causes of operation-related adverse effects. To create an effective hospital infection program, information about a local pattern is essential. The ever-changing pattern of infections and inappropriate use of antibiotics has predisposed to the development of drug-resistant strains and has made the management of SSIs arduous. AIMS AND OBJECTIVES The purpose of this study is to estimate prevalence and identify risk factors and commonest organisms associated with SSIs. METHODOLOGY In this analytical cross-sectional study, the relationship between various risk factors and the development of SSIs was evaluated in patients undergoing elective surgery and staying at least seven days postoperatively in the Department of Surgical Gastroenterology and Liver transplant for a study duration of two months. Diagnosis of SSIs was based on modified CDC criteria. Wound pus was followed by blood collection in suspected secondary septicemia. MacConkey and blood agar were used to culture pus; brain heart infusion broth was used for blood samples. Antimicrobial susceptibility testing was carried out using Mueller-Hinton agar by the Kirby-Bauer method. RESULTS Twelve out of 50 had developed postsurgical wound infections where Gram-negative organisms prevailed over Gram-positive ones. The associated risk factors identified in this study are age, BMI, wound class, American Society of Anesthesiologists (ASA) score, preprocedural WBC count >10,000, and the duration of surgery. Escherichia coli is the causative microbe for the majority of infections (35.7%). Gram-negative bacteria isolated in this study were extended-spectrum β-lactamase (ESBL) producers. Multidrug-resistant organisms were predominant. Conclusion: The present study identified an SSI rate of 24% in gastrointestinal surgeries. The sensitivity and resistance pattern of the organisms isolated will help in measures to be taken to devise a proper and effective current hospital antibiotic prophylaxis policy.
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Affiliation(s)
- Bargavi K
- Medicine, Stanley Medical College, Chennai, IND
| | - Secunda R
- Surgical Gastroenterology, Stanley Medical College, Chennai, IND
| | - Saravanan J
- Surgical Gastroenterology, Stanley Medical College, Chennai, IND
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17
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Fukai S, Mizusawa Y, Noda H, Tsujinaka S, Maeda Y, Hasebe R, Eguchi Y, Kanemitsu R, Matsuzawa N, Abe I, Endo Y, Fukui T, Takayama Y, Ichida K, Inoue K, Muto Y, Watanabe F, Futsuhara K, Miyakura Y, Rikiyama T. Superiority trial for the development of an ideal method for the closure of midline abdominal wall incisions to reduce the incidence of wound complications after elective gastroenterological surgery: study protocol for a randomized controlled trial. Trials 2024; 25:327. [PMID: 38760769 PMCID: PMC11100179 DOI: 10.1186/s13063-024-08167-w] [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: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial closure of midline abdominal wall incisions to reduce the incidence of wound complications, especially for incisional hernia. However, this is based on low-certainty evidence. We could not find any recommendations for skin closure. The wound closure technique is an important determinant of the risk of wound complications, and a comprehensive approach to prevent wound complications should be developed. METHODS We propose a single-institute, prospective, randomized, blinded-endpoint trial to assess the superiority of the combination of continuous suturing of the fascia without peritoneal closure and continuous suturing of the subcuticular tissue (study group) over that of interrupted suturing of the fascia together with the peritoneum and interrupted suturing of the subcuticular tissue (control group) for reducing the incidence of midline abdominal wall incision wound complications after elective gastroenterological surgery with a clean-contaminated wound. Permuted-block randomization with an allocation ratio of 1:1 and blocking will be used. We hypothesize that the study group will show a 50% reduction in the incidence of wound complications. The target number of cases is set at 284. The primary outcome is the incidence of wound complications, including incisional surgical site infection, hemorrhage, seroma, wound dehiscence within 30 days after surgery, and incisional hernia at approximately 1 year after surgery. DISCUSSION This trial will provide initial evidence on the ideal combination of fascial and skin closure for midline abdominal wall incision to reduce the incidence of overall postoperative wound complications after gastroenterological surgery with a clean-contaminated wound. This trial is expected to generate high-quality evidence that supports the current guidelines for the closure of abdominal wall incisions from the European and American Hernia Societies and to contribute to their next updates. TRIAL REGISTRATION UMIN-CTR UMIN000048442. Registered on 1 August 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055205.
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Affiliation(s)
- Shota Fukai
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuki Mizusawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Hiroshi Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan.
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yukihisa Maeda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Ryuji Hasebe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yusuke Eguchi
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Rina Kanemitsu
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Natsumi Matsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Iku Abe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuhei Endo
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Taro Fukui
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuji Takayama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Kosuke Ichida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Koetsu Inoue
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuta Muto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Fumiaki Watanabe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Kazushige Futsuhara
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
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18
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Joannides A, Korhonen TK, Clark D, Gnanakumar S, Venturini S, Mohan M, Bashford T, Baticulon R, Bhagavatula ID, Esene I, Fernández-Méndez R, Figaji A, Gupta D, Khan T, Laeke T, Martin M, Menon D, Paiva W, Park KB, Pattisapu JV, Rubiano AM, Sekhar V, Shabani H, Sichizya K, Solla D, Tirsit A, Tripathi M, Turner C, Depreitere B, Iaccarino C, Lippa L, Reisner A, Rosseau G, Servadei F, Trivedi R, Waran V, Kolias A, Hutchinson P. An international, prospective observational study on traumatic brain injury epidemiology study protocol: GEO-TBI: Incidence. NIHR OPEN RESEARCH 2024; 3:34. [PMID: 37881453 PMCID: PMC10593326 DOI: 10.3310/nihropenres.13377.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 10/27/2023]
Abstract
Background The epidemiology of traumatic brain injury (TBI) is unclear - it is estimated to affect 27-69 million individuals yearly with the bulk of the TBI burden in low-to-middle income countries (LMICs). Research has highlighted significant between-hospital variability in TBI outcomes following emergency surgery, but the overall incidence and epidemiology of TBI remains unclear. To address this need, we established the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry, enabling recording of all TBI cases requiring admission irrespective of surgical treatment. Objective The GEO-TBI: Incidence study aims to describe TBI epidemiology and outcomes according to development indices, and to highlight best practices to facilitate further comparative research. Design Multi-centre, international, registry-based, prospective cohort study. Subjects Any unit managing TBI and participating in the GEO-TBI registry will be eligible to join the study. Each unit will select a 90-day study period. All TBI patients meeting the registry inclusion criteria (neurosurgical/ICU admission or neurosurgical operation) during the selected study period will be included in the GEO-TBI: Incidence. Methods All units will form a study team, that will gain local approval, identify eligible patients and input data. Data will be collected via the secure registry platform and validated after collection. Identifiers may be collected if required for local utility in accordance with the GEO-TBI protocol. Data Data related to initial presentation, interventions and short-term outcomes will be collected in line with the GEO-TBI core dataset, developed following consensus from an iterative survey and feedback process. Patient demographics, injury details, timing and nature of interventions and post-injury care will be collected alongside associated complications. The primary outcome measures for the study will be the Glasgow Outcome at Discharge Scale (GODS) and 14-day mortality. Secondary outcome measures will be mortality and extended Glasgow Outcome Scale (GOSE) at the most recent follow-up timepoint.
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Affiliation(s)
- Alexis Joannides
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
| | - Tommi Kalevi Korhonen
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
- Neurocenter, Neurosurgery, Oulu University Hospital & University of Oulu, Oulu, Pohjois-Pohjanmaa, Finland
| | - David Clark
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
| | - Sujit Gnanakumar
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
| | - Sara Venturini
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
| | - Midhun Mohan
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
| | - Thomas Bashford
- Health Systems Design Group, Department of Engineering, University of Cambridge, Cambridge, UK
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ronnie Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital & University of the Philippines Manila, Manila, Philippines
| | - Indira Devi Bhagavatula
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru, Karnataka, India
| | - Ignatius Esene
- Division of Neurosurgery, Faculty of Health Sciences, The University of Bamenda, Bambili, Cameroon
| | - Rocío Fernández-Méndez
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
| | - Anthony Figaji
- Division of Neurosurgery and Neurosciences Institute, University of Cape Town, Cape Town, South Africa
| | - Deepak Gupta
- Department of neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Tariq Khan
- Department of Neurosurgery, North Western General and Research Hospital, Peshawar, Pakistan
| | - Tsegazeab Laeke
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - David Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Wellingson Paiva
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Kee B. Park
- Global Neurosurgery Initiative-Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jogi V. Pattisapu
- University of Central Florida College of Medicine, Orlando, Florida, USA
- Department of Neurosurgery, King George Hospital, Visakhapatnam, Andra Pradesh, India
| | | | - Vijaya Sekhar
- Department of Neurosurgery, King George Hospital, Visakhapatnam, Andra Pradesh, India
| | - Hamisi Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Kachinga Sichizya
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Davi Solla
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Abenezer Tirsit
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Carole Turner
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
| | - Bart Depreitere
- Department of Neurosciences, University Hospital Leuven, UZ, Leuven, Belgium
| | - Corrado Iaccarino
- School of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Division of Neurosurgery, University Hospital of Modena, Modena, Italy
- Emergency Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy
| | - Laura Lippa
- Department of Neurosurgery, Ospedale Niguarda, Milan, Italy
| | - Andrew Reisner
- Departments of Neurosurgery and Pediatrics, Children's Healthcare of Atlanta & Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gail Rosseau
- Barrow Global, Barrow Neurosurgical Institute, Phoenix, Arizona, USA
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas Research Hospital-IRCCS & Humanitas University, Rozzano, Milan, Italy
| | - Rikin Trivedi
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
| | - Vicknes Waran
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Angelos Kolias
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
| | - Peter Hutchinson
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
| | - NIHR Global Health Research Group on Acquired Brain and Spine Injury
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
- Neurocenter, Neurosurgery, Oulu University Hospital & University of Oulu, Oulu, Pohjois-Pohjanmaa, Finland
- Health Systems Design Group, Department of Engineering, University of Cambridge, Cambridge, UK
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital & University of the Philippines Manila, Manila, Philippines
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru, Karnataka, India
- Division of Neurosurgery, Faculty of Health Sciences, The University of Bamenda, Bambili, Cameroon
- Division of Neurosurgery and Neurosciences Institute, University of Cape Town, Cape Town, South Africa
- Department of neurosurgery, All India Institute of Medical Sciences, New Delhi, India
- Department of Neurosurgery, North Western General and Research Hospital, Peshawar, Pakistan
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Orion MedTech Ltd. CIC, Cambridge, UK
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of Sao Paulo, São Paulo, Brazil
- Global Neurosurgery Initiative-Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- University of Central Florida College of Medicine, Orlando, Florida, USA
- Department of Neurosurgery, King George Hospital, Visakhapatnam, Andra Pradesh, India
- Neurosciences Institute, El Bosque University, Bogotá, Colombia
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
- Department of Neurosciences, University Hospital Leuven, UZ, Leuven, Belgium
- School of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Division of Neurosurgery, University Hospital of Modena, Modena, Italy
- Emergency Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy
- Department of Neurosurgery, Ospedale Niguarda, Milan, Italy
- Departments of Neurosurgery and Pediatrics, Children's Healthcare of Atlanta & Emory University School of Medicine, Atlanta, Georgia, USA
- Barrow Global, Barrow Neurosurgical Institute, Phoenix, Arizona, USA
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Neurosurgery, Humanitas Research Hospital-IRCCS & Humanitas University, Rozzano, Milan, Italy
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - The GEO-TBI Collaborative
- NIHR Global Health Research Group on Acquired Brain & Spine Injury, University of Cambridge, Cambridge, UK
- Neurocenter, Neurosurgery, Oulu University Hospital & University of Oulu, Oulu, Pohjois-Pohjanmaa, Finland
- Health Systems Design Group, Department of Engineering, University of Cambridge, Cambridge, UK
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital & University of the Philippines Manila, Manila, Philippines
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru, Karnataka, India
- Division of Neurosurgery, Faculty of Health Sciences, The University of Bamenda, Bambili, Cameroon
- Division of Neurosurgery and Neurosciences Institute, University of Cape Town, Cape Town, South Africa
- Department of neurosurgery, All India Institute of Medical Sciences, New Delhi, India
- Department of Neurosurgery, North Western General and Research Hospital, Peshawar, Pakistan
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Orion MedTech Ltd. CIC, Cambridge, UK
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of Sao Paulo, São Paulo, Brazil
- Global Neurosurgery Initiative-Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- University of Central Florida College of Medicine, Orlando, Florida, USA
- Department of Neurosurgery, King George Hospital, Visakhapatnam, Andra Pradesh, India
- Neurosciences Institute, El Bosque University, Bogotá, Colombia
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
- Department of Neurosciences, University Hospital Leuven, UZ, Leuven, Belgium
- School of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Division of Neurosurgery, University Hospital of Modena, Modena, Italy
- Emergency Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy
- Department of Neurosurgery, Ospedale Niguarda, Milan, Italy
- Departments of Neurosurgery and Pediatrics, Children's Healthcare of Atlanta & Emory University School of Medicine, Atlanta, Georgia, USA
- Barrow Global, Barrow Neurosurgical Institute, Phoenix, Arizona, USA
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Neurosurgery, Humanitas Research Hospital-IRCCS & Humanitas University, Rozzano, Milan, Italy
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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19
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Varghese C, Harrison EM, O'Grady G, Topol EJ. Artificial intelligence in surgery. Nat Med 2024; 30:1257-1268. [PMID: 38740998 DOI: 10.1038/s41591-024-02970-3] [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: 01/24/2024] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
Artificial intelligence (AI) is rapidly emerging in healthcare, yet applications in surgery remain relatively nascent. Here we review the integration of AI in the field of surgery, centering our discussion on multifaceted improvements in surgical care in the preoperative, intraoperative and postoperative space. The emergence of foundation model architectures, wearable technologies and improving surgical data infrastructures is enabling rapid advances in AI interventions and utility. We discuss how maturing AI methods hold the potential to improve patient outcomes, facilitate surgical education and optimize surgical care. We review the current applications of deep learning approaches and outline a vision for future advances through multimodal foundation models.
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Affiliation(s)
- Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Greg O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Eric J Topol
- Scripps Research Translational Institute, La Jolla, CA, USA.
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20
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Mueller TC, Kehl V, Dimpel R, Blankenstein C, Egert-Schwender S, Strudthoff J, Lock JF, Wiegering A, Hadian A, Lang H, Albertsmeier M, Neuberger M, Von Ehrlich-Treuenstätt V, Mihaljevic AL, Knebel P, Pianka F, Braumann C, Uhl W, Bouchard R, Petrova E, Bork U, Distler M, Tachezy M, Izbicki JR, Reissfelder C, Herrle F, Vay C, Knoefel WT, Buia A, Hanisch E, Friess H, Reim D. Intraoperative Wound Irrigation for the Prevention of Surgical Site Infection After Laparotomy: A Randomized Clinical Trial by CHIR-Net. JAMA Surg 2024; 159:484-492. [PMID: 38381428 PMCID: PMC10882507 DOI: 10.1001/jamasurg.2023.7985] [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: 08/21/2023] [Accepted: 11/25/2023] [Indexed: 02/22/2024]
Abstract
Importance Surgical site infections frequently occur after open abdominal surgery. Intraoperative wound irrigation as a preventive measure is a common practice worldwide, although evidence supporting this practice is lacking. Objective To evaluate the preventive effect of intraoperative wound irrigation with polyhexanide solution. Design, Setting, and Participants The Intraoperative Wound Irrigation to Prevent Surgical Site Infection After Laparotomy (IOWISI) trial was a multicenter, 3-armed, randomized clinical trial. Patients and outcome assessors were blinded to the intervention. The clinical trial was conducted in 12 university and general hospitals in Germany from September 2017 to December 2021 with 30-day follow-up. Adult patients undergoing laparotomy were eligible for inclusion. The main exclusion criteria were clean laparoscopic procedures and the inability to provide consent. Of 11 700 screened, 689 were included and 557 completed the trial; 689 were included in the intention-to-treat and safety analysis. Interventions Randomization was performed online (3:3:1 allocation) to polyhexanide 0.04%, saline, or no irrigation (control) of the operative wound before closure. Main Outcome and Measures The primary end point was surgical site infection within 30 postoperative days according to the US Centers for Disease Control and Prevention definition. Results Among the 689 patients included, 402 were male and 287 were female. The median (range) age was 65.9 (18.5-94.9) years. Participants were randomized to either wound irrigation with polyhexanide (n = 292), saline (n = 295), or no irrigation (n = 102). The procedures were classified as clean contaminated in 92 cases (8%). The surgical site infection incidence was 11.8% overall (81 of 689), 10.6% in the polyhexanide arm (31 of 292), 12.5% in the saline arm (37 of 295), and 12.8% in the no irrigation arm (13 of 102). Irrigation with polyhexanide was not statistically superior to no irrigation or saline irrigation (hazard ratio [HR], 1.23; 95% CI, 0.64-2.36 vs HR, 1.19; 95% CI, 0.74-1.94; P = .47). The incidence of serious adverse events did not differ among the 3 groups. Conclusions and Relevance In this study, intraoperative wound irrigation with polyhexanide solution did not reduce surgical site infection incidence in clean-contaminated open abdominal surgical procedures compared to saline or no irrigation. More clinical trials are warranted to evaluate the potential benefit in contaminated and septic procedures, including the emergency setting. Trial Registration drks.de Identifier: DRKS00012251.
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Affiliation(s)
- Tara Catharina Mueller
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Rebekka Dimpel
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christiane Blankenstein
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Silvia Egert-Schwender
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Judith Strudthoff
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Johan Friso Lock
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Ali Hadian
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - Michael Neuberger
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - Viktor Von Ehrlich-Treuenstätt
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - André L. Mihaljevic
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Phillip Knebel
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Pianka
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum Hospitals, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum Hospitals, Bochum, Germany
| | - Ralf Bouchard
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ekaterina Petrova
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ulrich Bork
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases, Dresden, Germany: German Cancer Research Center, Heidelberg; Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University of Dresden, Helmholtz Center Dresden-Rossendorf, Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases, Dresden, Germany: German Cancer Research Center, Heidelberg; Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University of Dresden, Helmholtz Center Dresden-Rossendorf, Dresden, Germany
| | - Michael Tachezy
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R. Izbicki
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Reissfelder
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Florian Herrle
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Vay
- Department of General, Visceral, Thoracic, and Pediatric Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of General, Visceral, Thoracic, and Pediatric Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander Buia
- Asklepios Clinic Langen, Department of General, Visceral and Thoracic Surgery, Langen, Germany
| | - Ernst Hanisch
- Asklepios Clinic Langen, Department of General, Visceral and Thoracic Surgery, Langen, Germany
| | - Helmut Friess
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Daniel Reim
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
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21
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Abdu Seid M, Mengstie MA, Agegnehu Teshome A, Abdu K, Abtew YD. Post-operative site infections among surgical patients at Southern Ethiopia: A prospective cohort study. Heliyon 2024; 10:e28650. [PMID: 38586391 PMCID: PMC10998209 DOI: 10.1016/j.heliyon.2024.e28650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
Objective The current study was conducted to estimate the magnitude of SSI among surgically treated patients and identify the predictors associated with it. Background summary: Despite the fact that surgical site infection (SSI) is still a global health care-associated infection related to patients' discomfort, morbidity, and mortality, it is the most preventable nosocomial infection if all necessary measures are taken into account. Methods An institution-based prospective cohort study was conducted at a large teaching hospital in southern Ethiopia. Patients admitted to the surgical ward with a non-traumatic acute abdomen were participants in the study and were followed prospectively for 30 days. The collected data was entered into Epi-Data 4 and exported to STATA 16 for analysis. A logistic regression (bi-variable and multivariable) model was computed to detect the association between SSI and predictors. In the final model, variables with a p-value <0.05 were declared statistically significant. Results In this study, a total of 169 patients were enrolled. More than 3/4th (78.9%) of them were male, and the mean ± SD age of participants was 42.14 ± 12.5 years. Eighteen participants (10.5%) suffered from surgical site infection (SSI). Predictors of SSI were ever smoking [AOR = 3.9; 95% CI (1.2-16.5)], American Society of Anesthesiologists score ≥3 [AOR = 8.9; 95% CI (1.7-45.5)], appendectomy [AOR = 7.7; 95% CI (1.3-45.7)], and co-morbid diabetes [AOR = 13.8; 95% CI (2.6-72.1)]. Conclusion The magnitude of SSI was considerable in the study setting. Predictors of SSI were smoking, ASA score, appendectomy, and co-morbid diabetes. We strongly recommend that health-care professionals provide health education and patient counseling on smoking and health-seeking behaviors. Considering co-morbid conditions before surgery has paramount importance. Moreover, further large-scale studies are suggested.
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Affiliation(s)
- Mohammed Abdu Seid
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, P. O. Box: 272, Debre Tabor, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, P. O. Box: 272, Debre Tabor, Ethiopia
| | - Assefa Agegnehu Teshome
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, P. O. Box: 272, Debre Tabor, Ethiopia
| | - Kedir Abdu
- Department of Information System, College of Informatics, Wollo University, Ethiopia
| | - Yonas Derso Abtew
- Department of Physiology, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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22
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Kirengo TO, Dossajee H, Onyango EM, Rachakonda RH, Schneider B, Sela DP, Hosseinzadeh Z, Nadeem Z, Obonyo NG. Catalysing global surgery: a meta-research study on factors affecting surgical research collaborations with Africa. Syst Rev 2024; 13:89. [PMID: 38500200 PMCID: PMC10946148 DOI: 10.1186/s13643-024-02474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/28/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION In December 2019, the COVID-19 pandemic highlighted the urgent need for rapid collaboration, research, and interventions. International research collaborations foster more significant responses to rapid global changes by enabling international, multicentre research, decreasing biases, and increasing study validity while reducing overall research time and costs. However, there has been low uptake of collaborative research by African institutions and individuals. AIM To systematically review facilitating factors and challenges to collaborative surgical research studies conducted in Africa. METHODOLOGY A meta-research review using PubMed®/MEDLINE and Embase on surgical collaboration in Africa from 1st of January 2011 to 31st of September 2021 in accordance to PRISMA guidelines. Surgical studies by collaborative groups involving African authors and sites were included (55 papers). Data on the study period, geographical regions, and research scope, facilitating factors, and challenges were extracted from the studies retrieved from the search. RESULTS Most of the collaborations in Africa occurred with European institutions (76%). Of the 54 African countries, 63% (34/54) participated in surgical collaborations. The highest collaboration frequency occurred in South Africa (11%) and Nigeria (8%). However, most publications originated from Eastern Africa (43%). Leveraging synergies between high- and low- to middle-income countries (LMICs), well-defined structures, and secure data platforms facilitated collaboration. However, the underrepresentation of collaborators from LMICs was a significant challenge. CONCLUSION Available literature provides critical insights into the facilitating factors and challenges of research collaboration with Africa. However, there is a need for a detailed prospective study to explore the themes highlighted further. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2022 CRD42022352115 .
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Affiliation(s)
- Thomas O Kirengo
- Imara Hospital, Embu, Kenya.
- Kenya Medical Association, Nairobi, Kenya.
| | - Hussein Dossajee
- MP Shah Hospital, Nairobi, Kenya
- Kenya Medical Association, Nairobi, Kenya
| | - Evans M Onyango
- Ministry of Health, Kajiado County, Kenya
- Kenya Medical Association, Nairobi, Kenya
| | - Reema H Rachakonda
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Bailey Schneider
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Declan P Sela
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Zahra Hosseinzadeh
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Zohaib Nadeem
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Nchafatso G Obonyo
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Kenya Medical Association, Nairobi, Kenya
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23
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Ledda V, George C, Glasbey J, Labib P, Li E, Lu A, Kudrna L, Nepogodiev D, Picciochi M, Williams I, Bhangu A. Uncertainties and opportunities in delivering environmentally sustainable surgery: the surgeons' view. Anaesthesia 2024; 79:293-300. [PMID: 38207004 DOI: 10.1111/anae.16195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 01/13/2024]
Abstract
Surgery is a carbon-heavy activity and creates a high volume of waste. Surgical teams around the world want to deliver more environmentally sustainable surgery but are unsure what to do and how to create change. There are many interventions available, but resources and time are limited. Capital investment into healthcare and engagement of senior management are challenging. However, frontline teams can change behaviours and drive wider change. Patients have a voice here too, as they would like to ensure their surgery does not harm their local community but are concerned about the effects on them when changes are made. Environmentally sustainable surgery is at the start of its journey. Surgeons need to rapidly upskill their generic knowledge base, identify which measures they can implement locally and take part in national research programmes. Surgical teams in the NHS have the chance to create a world-leading programme that can bring change to hospitals around the world. This article provides an overview of how surgeons see the surgical team being involved in environmentally sustainable surgery.
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Affiliation(s)
- V Ledda
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - C George
- Department of Anaesthesia, Christian Medical College and Hospital, Ludhiana, India
| | - J Glasbey
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - P Labib
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - E Li
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - A Lu
- Department of Anaesthesia, North West School of Anaesthesia, Manchester, UK
| | - L Kudrna
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - D Nepogodiev
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - M Picciochi
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - I Williams
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - A Bhangu
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
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Ali SM, Misra L, Sahoo MR, V S V, Mahapatra A, Rout B, Mishra SS. Bundle approach in emergency surgery for prevention of surgical site infections: a double-blinded randomized controlled trial. Langenbecks Arch Surg 2024; 409:62. [PMID: 38358547 DOI: 10.1007/s00423-024-03243-w] [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: 08/11/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Many studies have demonstrated significant antibiotic resistance by commonly isolated organisms. This is an eye-opener for the clinicians, who prescribe antibiotics day in and out. This situation shifts our attention towards the usage of antiseptic measures, which can at times play an important role in preventing and treating various infections. METHOD This is a double-blinded randomized controlled study that compares the bundle approach to the conventional approach for the prevention of surgical site infections in patients of peritonitis undergoing midline laparotomy in emergency. The bundle approach includes three measures, namely, painting of surgical site with chlorhexidine, dabbing the wound with povidone-iodine after the closure of the rectus sheath, and application of chlorhexidine-impregnated gauze piece over the skin wound. RESULTS The total sample size was 64 (32 in each arm). The rate of surgical site infection was significantly lower in the test arm (21.8%) as compared to the conventional arm (46.8%). The mean length of hospital stay was shorter by one day in the test arm, although, not significant. The isolates from the peritoneal fluid culture and wound culture were mostly gram-negative organisms. Most of the organisms exhibited resistance toward third generation cephalosporins, fluoroquinolones, and aminoglycosides. CONCLUSION Antibiotic resistance is a burning concern in today's world. Alternative methods of preventing infection in the form of using antiseptics should be sought. Although our study was limited to emergency cases, this bundle approach can be implemented in elective cases as well.
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Affiliation(s)
- SManwar Ali
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Leesa Misra
- Department of Obstetrics and Gynaecology, Government Medical College, Jajpur, Odisha, India
| | - Manash Ranjan Sahoo
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India.
| | | | - Ashoka Mahapatra
- Department of Microbiology, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Bikram Rout
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
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Joannides AJ, Korhonen TK, Clark D, Gnanakumar S, Venturini S, Mohan M, Bashford T, Baticulon R, Bhagavatula ID, Esene I, Fernández-Méndez R, Figaji A, Gupta D, Khan T, Laeke T, Martin M, Menon D, Paiva W, Park KB, Pattisapu JV, Rubiano AM, Sekhar V, Shabani HK, Sichizya K, Solla D, Tirsit A, Tripathi M, Turner C, Depreitere B, Iaccarino C, Lippa L, Reisner A, Rosseau G, Servadei F, Trivedi RA, Waran V, Kolias A, Hutchinson P. Consensus-Based Development of a Global Registry for Traumatic Brain Injury: Establishment, Protocol, and Implementation. Neurosurgery 2024; 94:278-288. [PMID: 37747225 DOI: 10.1227/neu.0000000000002661] [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: 02/20/2023] [Accepted: 07/05/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Global disparity exists in the demographics, pathology, management, and outcomes of surgically treated traumatic brain injury (TBI). However, the factors underlying these differences, including intervention effectiveness, remain unclear. Establishing a more accurate global picture of the burden of TBI represents a challenging task requiring systematic and ongoing data collection of patients with TBI across all management modalities. The objective of this study was to establish a global registry that would enable local service benchmarking against a global standard, identification of unmet need in TBI management, and its evidence-based prioritization in policymaking. METHODS The registry was developed in an iterative consensus-based manner by a panel of neurotrauma professionals. Proposed registry objectives, structure, and data points were established in 2 international multidisciplinary neurotrauma meetings, after which a survey consisting of the same data points was circulated within the global neurotrauma community. The survey results were disseminated in a final meeting to reach a consensus on the most pertinent registry variables. RESULTS A total of 156 professionals from 53 countries, including both high-income countries and low- and middle-income countries, responded to the survey. The final consensus-based registry includes patients with TBI who required neurosurgical admission, a neurosurgical procedure, or a critical care admission. The data set comprised clinically pertinent information on demographics, injury characteristics, imaging, treatments, and short-term outcomes. Based on the consensus, the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry was established. CONCLUSION The GEO-TBI registry will enable high-quality data collection, clinical auditing, and research activity, and it is supported by the World Federation of Neurosurgical Societies and the National Institute of Health Research Global Health Program. The GEO-TBI registry ( https://geotbi.org ) is now open for participant site recruitment. Any center involved in TBI management is welcome to join the collaboration to access the registry.
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Affiliation(s)
- Alexis J Joannides
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Tommi K Korhonen
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
- Neurocenter, Neurosurgery, Oulu University Hospital & University of Oulu, Oulu , Finland
| | - David Clark
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Sujit Gnanakumar
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Sara Venturini
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Midhun Mohan
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Thomas Bashford
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge , Cambridgeshire , UK
- Health Systems Design Group, Department of Engineering, University of Cambridge, Cambridge , UK
| | - Ronnie Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital & University of the Philippines Manila, Manila , Philippines
| | - Indira Devi Bhagavatula
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru , Karnataka , India
| | - Ignatius Esene
- Division of Neurosurgery, Faculty of Health Sciences, The University of Bamenda, Bambili , Cameroon
| | - Rocío Fernández-Méndez
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Anthony Figaji
- Division of Neurosurgery, Neurosciences Institute, University of Cape Town, Cape Town , South Africa
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi , India
| | - Tariq Khan
- Department of Neurosurgery, North Western General and Research Hospital, Peshawar , Pakistan
| | - Tsegazeab Laeke
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa , Ethiopia
| | - Michael Martin
- Orion MedTech Ltd. CIC, Cambridge , Cambridgeshire , UK
- Obex Technologies Ltd., Cambridge , Cambridgeshire , UK
| | - David Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge , Cambridgeshire , UK
| | - Wellingson Paiva
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo , Brazil
| | - Kee B Park
- Department of Global Health and Social Medicine, Global Neurosurgery Initiative-Program in Global Surgery and Social Change, Harvard Medical School, Boston , Massachusetts , USA
| | - Jogi V Pattisapu
- University of Central Florida College of Medicine, Orlando , Florida , USA
- Department of Neurosurgery, King George Hospital, Visakhapatnam , Andhra Pradesh , India
| | - Andres M Rubiano
- Neurosciences Institute, El Bosque University, Bogotá , Colombia
| | - Vijaya Sekhar
- Department of Neurosurgery, King George Hospital, Visakhapatnam , Andhra Pradesh , India
- Current Affiliation: Department of Neurosurgery, Government General Hospital & Rangaraya Medical College, Kakinada , Andhra Pradesh , India
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam , Tanzania
| | - Kachinga Sichizya
- Department of Neurosurgery, University Teaching Hospital, Lusaka , Zambia
| | - Davi Solla
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo , Brazil
| | - Abenezer Tirsit
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa , Ethiopia
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Carole Turner
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | | | - Corrado Iaccarino
- Department of Biomedical, Metabolic and Neural Sciences, School of Neurosurgery, University of Modena and Reggio Emilia, Modena , Italy
- Division of Neurosurgery, University Hospital of Modena, Modena , Italy
- Emergency Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia , Italy
| | - Laura Lippa
- Department of Neurosurgery, Ospedale Niguarda, Milan , Italy
| | - Andrew Reisner
- Departments of Neurosurgery and Pediatrics, Children's Healthcare of Atlanta & Emory University School of Medicine, Atlanta , Georgia , USA
| | - Gail Rosseau
- Barrow Global, Barrow Neurological Institute, Phoenix , Arizona , USA
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA
| | - Franco Servadei
- Humanitas Research Hospital-IRCCS & Humanitas University, Rozzano, Milan , Italy
| | - Rikin A Trivedi
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Vicknes Waran
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur , Malaysia
| | - Angelos Kolias
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Peter Hutchinson
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
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Pata F, Tutino R, Picciariello A, Cantarella F. Editorial: Colorectal surgery and proctology: past, present, and future. Front Surg 2024; 11:1373867. [PMID: 38371881 PMCID: PMC10870640 DOI: 10.3389/fsurg.2024.1373867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Affiliation(s)
- Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- Department of Surgery, AO Annunziata, Cosenza, Italy
| | - Roberta Tutino
- Department of General and Emergency Surgery, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | | | - Francesco Cantarella
- CPEP (Centre for Proctology and Perineology), Ospedali Privati Forlì, Forlì, Italy
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Kerray FM, Abahuje E, Tambyraja AL, Yule SJ. We asked the experts: The evolving role of non-technical skills for surgery in low- and middle-income countries. World J Surg 2024; 48:316-319. [PMID: 38686780 DOI: 10.1002/wjs.12046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Fiona M Kerray
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh BioQuarter, Edinburgh, Scotland
- Edinburgh Vascular Service, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Egide Abahuje
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Andrew L Tambyraja
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh BioQuarter, Edinburgh, Scotland
- Edinburgh Vascular Service, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Steven J Yule
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh BioQuarter, Edinburgh, Scotland
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Starr N, Gebeyehu N, Nofal MR, Forrester JA, Tesfaye A, Mammo TN, Weiser TG. Scalability and Sustainability of a Surgical Infection Prevention Program in Low-Income Environments. JAMA Surg 2024; 159:161-169. [PMID: 38019510 PMCID: PMC10687710 DOI: 10.1001/jamasurg.2023.6033] [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: 04/29/2023] [Accepted: 08/07/2023] [Indexed: 11/30/2023]
Abstract
Importance Surgical infections are a major cause of perioperative morbidity and mortality, particularly in low-resource settings. Clean Cut, a 6-month quality improvement program developed by the global nonprofit organization Lifebox, has demonstrated improvements in postoperative infectious complications. However, the pilot program required intense external programmatic and resource support. Objective To examine the improvement in adherence to infection prevention and control standards and rates of postoperative infections in hospitals in the Clean Cut program after implementation strategies were updated and program execution was refined. Design, Setting, and Participants This cohort study evaluated and refined the Clean Cut implementation strategy to enhance scalability based on a qualitative study of its pilot phase, including formalizing programmatic and educational materials, building an automated data entry and analysis platform, and reorganizing hospital-based team composition. Clean Cut was introduced from January 1, 2019, to February 28, 2022, in 7 Ethiopian hospitals that had not previously participated in the program. Prospective data initiated on arrival in the operating room were collected, and patients were followed up through hospital discharge and with 30-day follow-up telephone calls. Exposure Implementation of the refined Clean Cut program. Main Outcomes and Measures The primary outcome was surgical site infection (SSI); secondary outcomes were adherence to 6 infection prevention standards, mortality, hospital length of stay, and other infectious complications. Results A total of 3364 patients (mean [SD] age, 26.5 [38.0] years; 2196 [65.3%] female) from 7 Ethiopian hospitals were studied (1575 at baseline and 1789 after intervention). After controlling for confounders, the relative risk of SSIs was reduced by 34.0% after program implementation (relative risk, 0.66; 95% CI, 0.54-0.81; P < .001). Appropriate Surgical Safety Checklist use increased from 16.3% to 43.0% (P < .001), surgeon hand and patient skin antisepsis improved from 46.0% to 66.0% (P < .001), and timely antibiotic administration improved from 17.8% to 39.0% (P < .001). Surgical instrument (38.7% vs 10.2%), linen sterility (35.5% vs 12.8%), and gauze counting (89.2% vs 82.5%; P < .001 for all comparisons) also improved significantly. Conclusions and Relevance A modified implementation strategy for the Clean Cut program focusing on reduced external resource and programmatic input from Lifebox, structured education and training materials, and wider hospital engagement resulted in outcomes that matched our pilot study, with improved adherence to recognized infection prevention standards resulting in a reduction in SSIs. The demonstration of scalability reinforces the value of this SSI prevention program.
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Affiliation(s)
- Nichole Starr
- Department of Surgery, University of California, San Francisco
- Lifebox Foundation, New York, New York
| | - Natnael Gebeyehu
- Lifebox Foundation, New York, New York
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maia R. Nofal
- Lifebox Foundation, New York, New York
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
- Department of Surgery, Stanford University, Palo Alto, California
| | | | - Assefa Tesfaye
- Lifebox Foundation, New York, New York
- Department of Surgery, St Peter’s Specialized Hospital, Addis Ababa, Ethiopia
| | - Tihitena Negussie Mammo
- Lifebox Foundation, New York, New York
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Thomas G. Weiser
- Lifebox Foundation, New York, New York
- Department of Surgery, Stanford University, Palo Alto, California
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Glasbey J, Ademuyiwa A, Bhatt A, Biccard B, Blazeby J, Brocklehurst P, Chakrabortee S, Allen Ingabire JC, Dossou FM, Durán I, Dutta R, Ghosh D, Gyamfi F, Haque P, Hardy P, Horton M, Hyman G, Jain R, Ladipo-Ajayi O, Lawani I, Lawani S, Kachapila M, Lillywhite R, Macefield R, Magill L, Martin J, Mathers J, McLean K, Mistry P, Mittal R, Monahan M, Moore R, Morton D, Ojo M, Ntirenganya F, Ofori E, Pearse R, Peón A, Pinkney T, de la Medina AR, Ronald T, Roman D, Runingamugabo E, Sitch A, Slade A, Tabiri S, Smith D, Bhangu A, Glasbey J, Sitch A, Slade A, To DK, Bhangu A, Hardy P, Ademuyiwa AO, Ismail L, Ghosh D, de la Medina AR, Moore R, Ntirenganya F, Tabiri S, Runingamugabo E, Patrawala S, Prah A, Oko C, Kroese K, Lawani I, Dossou FM, Dzemta C, Kandokponou CMB, Lawani S, Behanzin H, Kpangon C, Ofori BA, Tabiri S, Saba AH, Limann G, Acquah DK, Alhassan SM, Mohammed S, Emmanuel OA, Musah Y, Edwin Y, Kunfah S, Mustapha Y, Francis AA, Ayingayure E, Limann G, Amponsah-Manu F, Agyemang E, Agyekum V, Adjei-Acquah E, Twerefour EY, Koomson B, Boateng RA, Acquah AO, Ofosu-Akromah R, Adam-Zakariah LI, Adu-Aryee NA, Wordui T, Larbi CC, Enoch AA, Elijah M, Christian K, Kwame AG, Percy B, Bismark KE, Brian G, Ruth M, Hussey R, Dadzie S, Appiah AD, Yeboah G, Yeboah C, Amoako J, Acquah R, Sowah NA, Kusiwaa A, Asabre E, Ballu C, Barimah CG, Owusu F, Sie-Broni C, Adobea V, Owusu PY, Zume M, Labaran AH, Adu-Brobbey R, Morna MT, Debrah SA, Maison POM, Nortey M, Enti D, Amoako-Boateng MP, Appiah AB, Ofori EO, Kpankpari R, Boakye B, Quartson EM, Koggoh P, Agbeko AE, Gyamfi FE, Arthur J, Yorke J, Gyasi-Sarpong CK, Dally C, Lovi AK, Amoah M, Nimako B, Sagoe R, Davor A, Galley F, Adinku M, Boakye-Yiadom J, Acquaye J, Appiah J, Acheampong DO, Haruna I, Boateng EA, Ayodeji EK, Tuffuor S, Kwarley N, Tufuor Y, Abdulai RD, Dankwah F, Armah R, Ofosuhene D, Osei-Poku D, Temitope AE, Gakpetor DA, Gawu VS, Asare C, Tackie E, Ankomah J, Nyarko IO, Robertson Z, Godwin S, Boakye AA, Fosu G, Assah-Adjei F, Haque P, Jain R, Bhatt A, Dhiman J, Dutta R, Ghosh D, Daniel E, K P, Madankumar L, Mittal R, Nagomy I, Prasad S, Mathew AJ, Prakash D, Jacob P, Anachy JP, Mathew A, Thomas J, Alexander PV, Zechariah P, Aruldas ND, Mehraj A, Ahmed HI, Wani RA, Parray FQ, Chowdri NA, De la Medina AR, Maldonado LMP, Vazquez DSG, Sánchez IID, Lara MJM, de la Fuente ANS, Flores AOC, Gallo MEB, Ojeda AG, Velasco MEJ, Miguelena LH, Ortiz RJC, Gonzalez GIH, Romero MH, Krauss RIH, Sansores LAD, Avendaño AC, Aguirre CC, Gomez IB, Mejia HO, Ojeda AG, Flores OEO, González García de Rojas EA, Belmontes KJP, Camacho FJB, Hernández AB, Aguirre LR, Galaviz REM, Orozco CF, Bueno WGÁ, Marbello FSR, Acevedo DEL, Valadez MH, Arellano ALB, Ramírez-González LR, Ramírez BGG, Robles EV, García RIR, Navarro JVP, Torres EJC, Solano DRD, Peón AN, Menindez RDL, Gamez RR, Muñoz MCP, Belie O, Adeleye V, Ademuyiwa A, Adeniyi O, Akinajo O, Akinboyewa D, Alakaloko F, Atoyebi O, Balogun O, Bode C, Elebute O, Ezenwankwo F, Adedotun A, Ihediwa G, Kuku J, Ladipo-Ajayi O, Makanjuola A, Nwokocha S, Ogein O, Ojewola R, Oladimeji A, Olajide T, Alasi I, Oluseye O, Seyi-Olajide J, Soibi-Harry A, Williams E, Vincent AM, Duru NJ, Onyekachi KU, Ashley C, Mgbemena CV, Ojo M, Oluyemisi O, Ikuewunmi I, Adebunmi A, Bassey EG, Ohazurike EO, Amao OM, Oluwaseun OB, Doris E, Stephen O, Gbenga-Oke C, Olayioye O, Oluyemisi O, Oluremi K, Abunimye E, Oyegbola C, Kayode O, Orowale AA, Williams OM, Omisanjo OA, Faboya OM, Imam ZO, Oshodi OA, Oshodi YA, Ogunyemi AA, Ajai OT, Nwaenyi FC, Adisa AO, Aderounmu AA, Wuraola FO, Sowande O, Abdur-Rahman LO, Bello JO, Raji HO, Adeleke NA, Lawal SA, Afolabi RT, Lawal A, Ekwunife OH, Egwuonwu OA, Uche CF, Muhammad ABAB, Muhammad SS, Takai IUIU, Aliyu Salele MAS, Ukata OG, Magashi MKMK, Abdullahi LBLB, Muideen BABA, Ado KA, Anyawu LJCLJC, Olori S, Sani SA, Osagie OO, Mbajiekwe N, Aisuodionoe-Shadrach O, Akaba GO, Ameh L, Ameh L, Adebayo FO, Uanikhoba M, Ogbo FO, Tabuanu NO, Lawal TA, Abdus-Salam RA, Ajao AE, Takure AO, Ayandipo OO, Ekwuazi HO, Abayomi O, Lawal OO, Olagunju S, Egbuchulem KI, Adebayo SA, Elemile P, Usang UE, Udosen JE, Edet EE, Inyang AW, Olory EM, Udie GU, Chiejina GO, Marwa AD, Iseh FJ, Ogbeche SA, Isa MO, Ezomike UO, Ekenze SO, Eze MI, Izuka EO, Ede JK, Enemuo VC, Mbadiwe OM, Mbah NG, Imanishimwe A, Habumuremyi S, Ntirenganya F, Allen Ingabire JC, Ncogoza I, Munyaneza E, Haragirimana JDD, Urimubabo CJ, Mukanyange V, Nyirahabimana J, Mutabazi E, Mpirimbanyi C, Mwenedata O, Maniraguha HL, Izabiriza E, Dusabe M, Zirikana J, Uwizeyimana F, Mutuyimana J, Rwagahirima E, Imanishimwe A, Tubasiime R, Munyaneza A, Habumuremyi S, Kanyarukiko S, Ndegamiye G, Mukaneza F, Uwimana JC, Nyirangeri P, Mukantibaziyaremye D, Hirwa AD, Mbonimpaye S, Muroruhirwe P, Mukakomite C, Kabanda E, Moore R, Nhlabathi NA, Fourtounas M, Adams MA, Hyman G, Nxumalo HS, Sentholang N, Sethoana ME, Mathe MN, Ally Z, Flint M, Biccard B, Ademuyiwa AO, Adisa AO, Bhangu A, Brocklehurst P, Chakrabortee S, Hardy P, Harrison E, Allen Ingabire JC, Haque PD, Ismail L, Glasbey J, Ghosh D, Gyamfi FE, Li E, Lillywhite R, de la Medina AR, Moore R, Magill L, Morton D, Nepogodiev D, Ntirenganya F, Pinkney T, Omar O, Simoes J, Smith D, Tabiri S, Ademuyiwa AO, Ismail L, Ghosh D, de la Medina AR, Moore R, Ntirenganya F, Tabiri S, Ademuyiwa A, Bhangu A, Brant F, Brocklehurst P, Chakrabortee S, Ghosh D, Glasbey J, Hardy P, Harrison E, Heritage E, Ismail L, Kroese K, Lapitan C, Lillywhite R, Lissauer D, Magill L, de la Medina AR, Mistry P, Monahan M, Moore R, Morton D, Nepogodiev D, Ntirenganya F, Omar O, Pinkney T, Roberts T, Smith D, Tabiri S, Winkles N, Hardy P, Omar O, Runigamugabo E, Verjee A, Sodonougbo P, Assouto P, Fiogbe M, Koco H, Metchinhoungbe S, Sogbo H, Behanzin H, Seto DM, Tandje Y, Kangni S, Kpangon C, Akpla M, Chobli HH, Kovohouande B, Agboton G, Ahossi R, Ngabo RB, Bisimwa N, Kandokponou CMB, Dokponou M, Dossou FM, Dzemta C, Gaou A, Goudou R, Hedefoun E, Houtoukpe S, Kamga F, Kiki-Migan E, Lawani S, Lawani I, Loko R, Moutaïrou A, Ogouyemi P, Soumanou F, Tamadaho P, Zounon MA, Adagrah LA, Alhassan BBA, Amoako-Boateng MP, Appiah AB, Asante-Asamani A, Boakye B, Debrah SA, Enti D, Ganiyu RA, Koggoh P, Kpankpari R, Opandoh INM, Manu MA, Manu MPO, Mensah S, Morna MT, Nkrumah J, Nortey M, Ofori EO, Quartson EM, Adjei-Acquah E, Agyekum V, Agyemang E, Akesseh RA, Amponsah-Manu F, Ofosu-Akromah R, Acquah AO, Adam-Zakariah LI, Asabre E, Boateng RA, Koomson B, Kusiwaa A, Twerefour EY, Ankomah J, Assah-Adjei F, Boakye AA, Fosu G, Serbeh G, Gyan KY, Nyarko IO, Robertson Z, Armah R, Asare C, Gakpetor DA, Gawu VS, Obbeng A, Ofosuhene D, Osei-Poku D, Puozaa D, Tackie E, Temitope AE, Acquah R, Amoako J, Appiah AD, Aseti M, Banka C, Dadzie S, Essien D, Gyamfi FE, Hussey R, Kwarteng J, Sowah NA, Yeboah G, Yeboah C, Addo KG, Akosa EA, Boakye P, Coompson CL, Gyamfi B, Kontor BE, Kyeremeh C, Manu R, Mensah E, Solae FI, Toffah GK, Acheampong DO, Acquaye J, Adinku M, 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Kanyarukiko S, Mukaneza F, Mukantibaziyaremye D, Munyaneza A, Ndegamiye G, Tubasiime R, Dusabe M, Izabiriza E, Maniraguha HL, Mpirimbanyi C, Mutuyimana J, Mwenedata O, Rwagahirima E, Uwizeyimana F, Zirikana J, Hirwa AD, Kabanda E, Mbonimpaye S, Mukakomite C, Muroruhirwe P, Bucyibaruta G, Bunogerane GJ, Habumuremyi S, Haragirimana JDD, Imanishimwe A, Allen Ingabire JC, Mukanyange V, Munyaneza E, Mutabazi E, Ncogoza I, Ntirenganya F, Nyirahabimana J, Urimubabo C, Adams MA, Crawford R, Ede CJ, Fourtounas M, Hyman G, Khan Z, Kwati M, Mathe MN, Moore R, Nhlabathi NA, Nxumalo HS, Pattinson P, Sentholang N, Sethoana ME, Stassen ME, Thornley L, Wondoh P, Birtles C, Ivy M, Mbavhalelo C, Ally Z, Adewunmi AS, Cook J, Jayne D, Laurberg S, Brown J, Cousens S, Smart N. Accuracy of the Wound Healing Questionnaire in the diagnosis of surgical-site infection after abdominal surgery in low- and middle-income countries. Br J Surg 2024; 111:znad446. [PMID: 38747515 PMCID: PMC10895408 DOI: 10.1093/bjs/znad446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Telemedicine is being adopted for postoperative surveillance but requires evaluation for efficacy. This study tested a telephone Wound Healing Questionnaire (WHQ) to diagnose surgical site infection (SSI) after abdominal surgery in low- and middle-income countries. METHOD A multi-centre, international, prospective study was embedded in the FALCON trial; a factorial RCT testing measures to reduce SSI in seven low- and middle-income countries (NCT03700749). It was conducted according to a pre-registered protocol (SWAT126) and reported according to STARD guidelines. The reference test was in-person review by a trained clinician at 30 postoperative days according to US Centres for Disease Control criteria. The index test was telephone administration of an adapted WHQ at 27 to 30 postoperative days by a researcher blinded to the outcome of in-person review. The sum of item response scores generated an overall score between 0 and 29. The primary outcome was the diagnostic accuracy of the WHQ, defined as the proportion of SSI correctly identified by the telephone WHQ, and summarized using the area under the receiving operator characteristic curve (AUROC) and diagnostic test accuracy statistics. RESULTS Patients were included from three upper-middle income (396 patients, 13 hospitals), three lower-middle income (746 patients, 19 hospitals), and one low-income country (54 patients, 4 hospitals). 90.3% (1088 of 1196) patients were successfully contacted. Those with non-midline incisions (adjusted odds ratio: 0.36, 95% c.i. 0.17 to 0.73, P=0.005) or a confirmed diagnosis of SSI on in-person assessment (odds ratio: 0.42, 95% c.i. 0.20 to 0.92, P=0.006) were harder to reach. The questionnaire correctly discriminated between most patients with and without SSI (AUROC 0.869, 95% c.i. 0.824 to 0.914), which was consistent across subgroups. A representative cut-off score of ≥4 displayed a sensitivity of 0.701 (0.610-0.792), specificity of 0.911 (0.878-0.943), positive predictive value of 0.723 (0.633-0.814) and negative predictive value of 0.901 (0.867-0.935). CONCLUSION SSI can be diagnosed using a telephone questionnaire (obviating in-person assessment) in low resource settings.
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Wennerblom JH, Bratlie SO, Bjornsson B, Lundgren L, Sandström P, Tingstedt B, Andersson R, Andersson B, Williamsson C, Sparrelid E, Holmberg M, Ghorbani P, Gkekas I, Kuemmerli C, Bolli M, Andreou A, Wenning AS, Gloor B, Peloso A, Toso C, Oldani G, Moeckli B, Wassmer CH, Cristaudi A, Pietro MH, Majno-Hurst PE, Roesel R, Abbassi F, Tarantino I, Steffen T, Ferrari C, Schmidt J, Meier O, Weber M, Gutknecht S, Jonas JP, Clavien PA, Al-Haj A, Aljaber A, Kayali AA, Kadoura L, Nashed E, Helaly H, Kayali H, Alhashemi M, Aloulou M, Alshaghel M, Mahli N, Al-Abed O, Azizeh O, Torab SS, Alkhaleel W, Aliwy MA, Alannaz O, Ghazal A, Masri R, Douba Z, Saad AS, Abdulmonem A, Shaban M, Alhouri AN, Alhouri A, Soliman A, Houri HNA, Houri HA, Omran S, Abbas A, Chaaban M, Kudmani MAA, Chaaban MK, Alhmaidi R, Yousef A, Youssef A, Nasri M, Alkhateb H, Almjersah A, Hassan N, Moussa A, Hamdan A, Hammed A, Alloush A, Hassan BH, Issa H, Dahhan HT, Souliman M, Hammed S, Tobba TM, Hamdan A, Ayoub S, Yu MC, Yang PC, Wu CH, Bouaziz H, Rahal K, Slim S, Karim A, Baraket O, Kchaou A, Houssem A, Said MA, Mabrouk MB, Hamida KB, Ghalleb M, Mahmoud AB, Maghrebi H, Kacem MJ, Tez M, Eminesariipek N, çetiindağ Ö, Tüzüner A, Karayalçin K, Emral AC, Dikmen K, Kerem M, Bayhan H, Türkoğlu MA, Iflazoğlu N, özet A, Aday U, öfkeli Ö, Gumusoglu A, Kabuli HA, Karabulut M, Peker K, Saglam S, Rahimi FSİ, Hanefa F, Isik A, Goksoy E, Dulundu E, Atici AE, Ozocak AB, Yegen C, Dural AC, Sahbaz NA, Ulgur HS, Aydin H, Ozkan OF, Duzgun O, çelik M, Pekmezci S, çoker A, Uguz A, Unalp OV, Sert I, Ertekin S, Ozbilgin M, Aydoğan S, Tekin E, Calik B, Yesilyurt D, Atici SD, Arıkan TB, Arıkan T, Gonullu E, Dikicier E, Capoglu R, Bayhan Z, Alfurais S, Colak E, Polat S, Çiftci AB, Milburn J, Jones C, Vass D, Taylor M, Dasari BVM, Kausar A, Sultana A, Subar D, Nunes Q, Skipworth J, Nwogwugwu O, van Laarhoven S, Kourdouli A, Awan AA, Bhatti I, Latif J, Hand F, Robertson F, Holroyd D, Holroyd D, Jamieson N, Lim W, Chang D, Frampton A, 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A, Patel S, Cunningham S, Callery M, Kent T, Raut C, Wang J, Fairweather M, Sulciner M, Hirji S, Clancy T, Nebbia M, Qadan M, Musser A, Hogg M, Rodriquez J, Hamner J, Hennessy L, Dinerman A, Gupta A, Kimbrough C, Thompson R, Zeh HJ, Radi I, Polanco PM, Moris D, Lidsky ME, Lee D, Piper J, Gnerlich J, Tuvin D, Sticca R, Ganai S, Gusani N, Krinock D, Giorgakis E, Hardgrave H, Spencer-Cole RT, Klutts G, Hardgrave H, Nigh J, Nigh J, Andrade JCB, Mavros M, Osborn T, Ferrone C, O'Connor V, Boone B, Harris B, Schmidt C, Schrope B, Chabot J, Kluger M, Lasso ET, Nevler A, Yeo C, Ponzini F, Lavu H, Lamm R, Bowne W, Kyser N, Galanopoulos C, Abbasi A, Park J, Sham J, Dickerson L, Pillarisetty V, Sucandy I, Ross S, Winslow E, Hawksworth J, Radkani P, Fishbein T, Munoz AS, Lindberg J, Martins PN, Al-saban RAM, Al-Saban R, Al-Kubati W, Ghallab AAA, Alsanany GM, Almarashi H, Al-Samawi H, Al-Asadi MAMM, Alsayadi R, Hail S, Shream S, Bajjah HM, Al-Ameri S, Bajjah H, Al-Ameri SAAS, Al-Dowsh NA, AlDowsh NA, Al-Khawlani Q, Murshed YAA, Al-Shehari M, Jahaf AAD, Al-sharabi EAE, Aldumaini H, Alattas Z, Almassaudi A, Bajjah HMAH, Albakry R, Al-Naggar H, Shream SAA, Affary AA, Al-Markiz E, Al-Eryani F, Farhat H, Qadasi QA, Alwafy K, Abdualqader MYM, Ali RAAY, Albar A, Bleem HA, Galeb KSA, Ghushaim M, Sabbar M, Esmail M, Ali RAY, Salem RHM, Salem R, Saif W, Al-Faiq S, Alsharabi E, Hameed ATA, Almekhlafi T, Omairan A, Almarkiz E, Abduljawad H, Mansaleh O, Al-Melhani W, Abdualqader M, Al-Abdi R, Alwan HM, Mbanje C, Chihaka O. Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries. Br J Surg 2024; 111:znad330. [PMID: 38743040 PMCID: PMC10771125 DOI: 10.1093/bjs/znad330] [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: 07/02/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 05/16/2024]
Abstract
BACKGROUND Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide. METHODS This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters. RESULTS A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared with 19 per cent in very high-HDI countries. CONCLUSION Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761).
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Nofal MR, Zhuang AY, Gebeyehu N, Starr N, Haile ST, Woldeamanuel H, Tesfaye A, Alemu SB, Bekele A, Mammo TN, Weiser TG, Abdukadir AA, Abebe BM, Admasu AK, Alito TA, Ambulkar R, Arimino S, Arusi M, Aynalem N, Bajaj V, Delelo TS, Gutu M, Habte F, Hurrisa GA, Kunte A, Rocabado K, Shiferaw MA, Harrell-Shreckengost C, Tiruneh A, Zamorano R, Abreha M, Aguilera C, Lima B, Kebede H. An observational cohort study on the effects of extended postoperative antibiotic prophylaxis on surgical-site infections in low- and middle-income countries. Br J Surg 2024; 111:znad438. [PMID: 38198157 PMCID: PMC10782210 DOI: 10.1093/bjs/znad438] [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: 09/25/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Worldwide, approximately one in six inpatient antibiotic prescriptions are for surgical-infection prophylaxis, including postoperative prophylaxis. The WHO recommends against prolonged postoperative antibiotics to prevent surgical-site infection. However, in many low- and middle-income countries, postoperative antibiotic prophylaxis is common due to perceptions that it protects against surgical-site infection and data informing recommendations against antibiotic administration are largely derived from high-income countries. The aim of this study was to describe postoperative antibiotic-prescribing patterns and related surgical-site infection rates in hospitals in low- and middle-income countries. METHODS Patients from 19 hospitals in Ethiopia, Madagascar, India, and Bolivia with wound class I and II operations were included. Data on antibiotic administration, indication, surgical-site infection, length of hospital stay, and adherence to perioperative infection-prevention standards were collected by trained personnel. The association between postoperative antibiotic prophylaxis for greater than or equal to 24 h and surgical-site infection was analysed via modified robust Poisson regression, controlling for patient and procedural factors and degree of adherence to perioperative infection-prevention practices. RESULTS Of 8714 patients, 92.9% received antibiotics for prophylaxis after surgery and 27.7% received antibiotics for greater than or equal to 24 h. Patients receiving postoperative prophylaxis for greater than or equal to 24 h did not have lower surgical-site infection rates (Relative risk 1.09 (95% c.i. 0.89 to 1.33); P = 0.399), but the length of hospital stay was 1.4 days longer (P < 0.001). CONCLUSION Prolonged postoperative antibiotics did not reduce surgical-site infection, but pervasive use was associated with a longer length of hospital stay, in resource-limited healthcare systems. With the growing threat of antimicrobial resistance, surgical initiatives to implement antimicrobial stewardship programmes in low- and middle-income countries are critical.
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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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Fiore M, Corrente A, Di Franco S, Alfieri A, Pace MC, Martora F, Petrou S, Mauriello C, Leone S. Antimicrobial approach of abdominal post-surgical infections. World J Gastrointest Surg 2023; 15:2674-2692. [PMID: 38222012 PMCID: PMC10784838 DOI: 10.4240/wjgs.v15.i12.2674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/24/2023] [Accepted: 11/21/2023] [Indexed: 12/27/2023] Open
Abstract
Abdominal surgical site infections (SSIs) are infections that occur after abdominal surgery. They can be superficial, involving the skin tissue only, or more profound, involving deeper skin tissues including organs and implanted materials. Currently, SSIs are large global health problem with an incidence that varies significantly depending on the United Nations' Human Development Index. The purpose of this review is to provide a practical update on the latest available literature on SSIs, focusing on causative pathogens and treatment with an overview of the ongoing studies of new therapeutic strategies.
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Affiliation(s)
- Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Antonio Corrente
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Sveva Di Franco
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Aniello Alfieri
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Maria Caterina Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Francesca Martora
- Unit of Virology and Microbiology, “Umberto I” Hospital, Nocera Inferiore 84018, Italy
| | - Stephen Petrou
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Claudio Mauriello
- Department of General Surgery, “Santa Maria delle Grazie” Hospital, Pozzuoli 80078, Italy
| | - Sebastiano Leone
- Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino 83100, Italy
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Are C, Murthy SS, Sullivan R, Schissel M, Chowdhury S, Alatise O, Anaya D, Are M, Balch C, Bartlett D, Brennan M, Cairncross L, Clark M, Deo SVS, Dudeja V, D'Ugo D, Fadhil I, Giuliano A, Gopal S, Gutnik L, Ilbawi A, Jani P, Kingham TP, Lorenzon L, Leiphrakpam P, Leon A, Martinez-Said H, McMasters K, Meltzer DO, Mutebi M, Zafar SN, Naik V, Newman L, Oliveira AF, Park DJ, Pramesh CS, Rao S, Subramanyeshwar Rao T, Bargallo-Rocha E, Romanoff A, Rositch AF, Rubio IT, Salvador de Castro Ribeiro H, Sbaity E, Senthil M, Smith L, Toi M, Turaga K, Yanala U, Yip CH, Zaghloul A, Anderson BO. Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide. Lancet Oncol 2023; 24:e472-e518. [PMID: 37924819 DOI: 10.1016/s1470-2045(23)00412-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 11/06/2023]
Abstract
The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.
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Affiliation(s)
- Chandrakanth Are
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Shilpa S Murthy
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Makayla Schissel
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjib Chowdhury
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Olesegun Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Daniel Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Madhuri Are
- Division of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charles Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, Global Cancer Surgery: pragmatic solutions to improve USA
| | - David Bartlett
- Department of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Matthew Clark
- University of Auckland School of Medicine, Auckland, New Zealand
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Dudeja
- Division of Surgical Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Domenico D'Ugo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Armando Giuliano
- Cedars-Sinai Medical Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Washington DC, USA
| | - Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Pankaj Jani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | | | - Laura Lorenzon
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Premila Leiphrakpam
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Augusto Leon
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Kelly McMasters
- Division of Surgical Oncology, Hiram C Polk, Jr MD Department of Surgery, University of Louisville, Louisville, KY, USA
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Vibhavari Naik
- Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Lisa Newman
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | | | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Saieesh Rao
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | | | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Eman Sbaity
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Irvine, CA, USA
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Masakazi Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Kiran Turaga
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ujwal Yanala
- Surgical Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Ulasi I, Aigbovo E, Michael A, Ayandipo O, Fowotade A, Ishiyaka U, Ezeme C, Olagunju N, Ikwu C. THE EFFECT OF SKIN ANTISEPSIS AFTER PRIMARY SKIN CLOSURE ON THE INCIDENCE OF SURGICAL SITE INFECTION AFTER ABDOMINAL SURGERY FOR SEPSIS: A PRELIMINARY REPORT OF A RANDOMISED CONTROLLED TRIAL. Ann Ib Postgrad Med 2023; 21:46-56. [PMID: 38706616 PMCID: PMC11065193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/30/2023] [Indexed: 05/07/2024] Open
Abstract
Background The role of skin antisepsis after skin closure in abdominal surgery for sepsis is not well reported. This study assessed the effect of skin antisepsis following primary skin closure on surgical site infection (SSI) after contaminated and dirty abdominal surgery. Methods This was a randomised controlled trial involving adult patients undergoing laparotomy for sepsis. Patients were randomised into a Control (C) group where the wound edge was cleaned once with 70% isopropyl alcohol before being covered with a dry sterile gauze dressing and a Povidone-iodine (PI) group in whom the wound edge was cleaned once with 70% isopropyl alcohol, then covered with a 10% povidone iodine-soaked gauze dressing. Both groups were compared for the presence of SSI. Statistical significance was set at a p value of < 0.05. Results Thirty-seven patients (C group = 18; PI group = 19) were recruited. The median age was 36 years (Interquartile range, IQR = 72) with a male-to-female ratio of 2.7:1. The overall incidence of SSI was 48.6% (n = 18), comparable between the C group (n=10, 55.6%) and PI group (n = 8; 42.1%) (p = 0.413). In-hospital mortality rate was 10.8 % (n = 4), equally distributed between the groups (p = 1.000). The length of hospital stay was 8 days (IQR = 15) in the C group and 7 days in the PI group (IQR =9) (p = 0.169). Conclusion In laparotomy for sepsis, skin antisepsis after primary skin closure had no effect on the incidence of surgical site infection.
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Affiliation(s)
- I.B Ulasi
- Department of Surgery, University College Hospital, Ibadan
| | - E.O Aigbovo
- Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan
| | - A.I Michael
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University College Hospital, Ibadan
| | - O.O Ayandipo
- Division of Oncological Surgery, Department of Surgery, University College Hospital, Ibadan
| | - A. Fowotade
- Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan
| | - U.M Ishiyaka
- Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan
| | - C. Ezeme
- Department of Surgery, University College Hospital, Ibadan
| | - N.A Olagunju
- Department of Surgery, University College Hospital, Ibadan
| | - C.K Ikwu
- Department of Surgery, University College Hospital, Ibadan
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Mizusawa Y, Noda H, Ichida K, Fukai S, Matsuzawa N, Tamaki S, Abe I, Endo Y, Fukui T, Takayama Y, Inoue K, Muto Y, Watanabe F, Miyakura Y, Rikiyama T. A postoperative body weight increase is a novel risk factor for incisional hernia of midline abdominal incision after elective gastroenterological surgery. Langenbecks Arch Surg 2023; 408:452. [PMID: 38032404 DOI: 10.1007/s00423-023-03193-9] [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: 10/06/2023] [Accepted: 11/26/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Midline abdominal incisions (MAIs) are widely used in both open and minimally invasive surgery. Incisional hernia (IH) accounts for most long-term postoperative wound complications. This study explored the risk factors for IH due to MAI in patients with clean-contaminated wounds after elective gastroenterological surgery. METHODS The present study targeted patients enrolled in 2 randomized controlled trials to evaluate the efficacy of intraoperative interventions for incisional SSI prevention after gastroenterological surgery for clean-contaminated wounds. The patients were reassessed, and pre- and intraoperative variables and postoperative outcomes were collected. IH was defined as any abdominal wall gap, regardless of bulge, in the area of a postoperative scar that was perceptible or palpable on clinical examination or computed tomography according to the European Hernia Society guidelines. The risk factors for IH were identified using univariate and multivariate analyses. RESULTS The study population included 1,281 patients, of whom 273 (21.3%) developed IH. Seventy-four (5.8%) patients developed incisional SSI. Multivariate logistic regression analysis revealed that female sex (odds ratio [OR], 1.39; 95% confidence interval [CI] 1.03-1.86, p = 0.031), high preoperative body mass index (OR, 1.81; 95% CI 1.19-2.77, p = 0.006), incisional SSI (OR, 2.29; 95% CI 1.34-3.93, p = 0.003), and postoperative body weight increase (OR, 1.49; 95% CI 1.09-2.04, p = 0.012) were independent risk factors for IH due to MAI in patients who underwent elective gastroenterological surgery. CONCLUSION We identified postoperative body weight increase at one year as a novel risk factor for IH in patients with MAI after elective gastroenterological surgery.
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Affiliation(s)
- Yuki Mizusawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Hiroshi Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan.
| | - Kosuke Ichida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Shota Fukai
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Natsumi Matsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Sawako Tamaki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Iku Abe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuhei Endo
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Taro Fukui
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuji Takayama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Koetsu Inoue
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuta Muto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Fumiaki Watanabe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
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Birgand G, Dhar P, Holmes A. The threat of antimicrobial resistance in surgical care: the surgeon's role and ownership of antimicrobial stewardship. Br J Surg 2023; 110:1567-1569. [PMID: 37758500 PMCID: PMC10638523 DOI: 10.1093/bjs/znad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Gabriel Birgand
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Regional Center for Infection Prevention and Control, Region of Pays de la Loire, Nantes University Hospital, Nantes, France
- Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, Nantes Université, Nantes, France
| | - Puneet Dhar
- Surgical Gastroenterology, Amrita Hospital, Faridabad, India
| | - Alison Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Faculty of Health Sciences, University of Liverpool, Liverpool, UK
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Aruparayil N, Gnanaraj J, Mishra A, Bains L, Corrigan N, Brown J, Ensor T, King R, Shinkins B, Jayne D. Gasless laparoscopy in rural India-registry outcomes and evaluation of the learning curve. Surg Endosc 2023; 37:8227-8235. [PMID: 37653156 PMCID: PMC10615921 DOI: 10.1007/s00464-023-10392-4] [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: 05/08/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND A program of gasless laparoscopy (GL) has been implemented in rural North-East India. To facilitate safe adoption, participating rural surgeons underwent rigorous training prior to independent clinical practice. An online registry was established to capture clinical data on safety and efficacy and to evaluate initial learning curves for gasless laparoscopy. METHODS Surgeons who had completed the GL training program participated in the online RedCap Registry. Patients included in the registry provided informed consent for the use of their data. Data on operative times, conversion rates, perioperative complications, length of stay, and hospital costs were collected. Fixed reference cumulative sum (CUSUM) model was used to evaluate the learning curve based on operative times and conversion rates published in the literature. RESULTS Four surgeons from three rural hospitals in North-East India participated in the registry. The data were collected over 12 months, from September 2019 to August 2020. One hundred and twenty-three participants underwent GL procedures, including 109 females (88.6%) and 14 males. GL procedures included cholecystectomy, appendicectomy, tubal ligation, ovarian cystectomy, diagnostic laparoscopy, and adhesiolysis. The mean operative time was 75.3 (42.05) minutes for all the surgeries. Conversion from GL to open surgery occurred in 11.4% of participants, with 8.9% converted to conventional laparoscopy. The main reasons for conversion were the inability to secure an operative view, lack of operating space, and adhesions. The mean length of stay was 3 (2.1) days. The complication rate was 5.7%, with one postoperative death. The CUSUM analysis for GL cholecystectomy showed a longer learning curve for operative time and few conversions. The learning curve for GL tubal ligation was relatively shorter. CONCLUSION Gasless laparoscopy can be safely implemented in the rural settings of Northeast India with appropriate training programs. Careful case selection is essential during the early stages of the surgical learning curve.
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Affiliation(s)
- N Aruparayil
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
- St. James's University Hospital, Level 7, Clinical Sciences Building, Leeds, LS9 7TF, UK.
| | | | - A Mishra
- Maulana Azad Medical College, Delhi, India
| | - L Bains
- Maulana Azad Medical College, Delhi, India
| | - N Corrigan
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - J Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - T Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - R King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - B Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - D Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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Kapira S, Aron MB, Mphande I, Chonongera G, Khongo BD, Zaniku HR, Mkandawire S, Nkhoma W, Tengatenga L, Munyaneza F, Kachimanga C. Evaluating the uptake and effect of Surgical Safety Checklist implementation in a rural hospital, Neno District, Malawi. BMJ Open Qual 2023; 12:e002426. [PMID: 37989354 PMCID: PMC10661078 DOI: 10.1136/bmjoq-2023-002426] [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: 05/30/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The WHO introduced the Surgical Safety Checklist (SSC) in 2008, which has been proven to enhance collaboration and patient safety before, during and after surgical procedures. However, the impact of using SSC has not been assessed in a rural setting in Malawi. We aimed to evaluate the uptake of SSC in Neno District, Malawi. METHODS We conducted a cross-sectional hospital-based retrospective chart review of 468 surgical cases from July 2021 to March 2022 in two hospitals in Neno District. We collected data using Excel and used R software for analysis. We used descriptive statistics to characterise the surgeries. We used χ2 test and Wilcoxon signed-rank test to test the association between SSC use and independent variables. We fitted logistic regression to assess predictors of SSC use and complications. RESULTS Of 468 surgical cases, 92% (n=431) were done as emergency procedures. The median age was 23 years (IQR: 19-29) and 94% (n=439) were female. Overall, 38% of surgeries (n=176) used the SSC and of these, 98% were in emergency procedures. We found an association between the use of SSC and the age of the client (p=0.018), type of procedure, name of the procedure, healthcare worker cadre, time procedure performed and complications (p<0.001). However, no association was observed between SSC use and outcome (p>0.05). The odds of using SSC were higher in emergency surgeries, surgeries performed at night; however, they were lower among temporary employees and anaesthetists with a diploma (p<0.001). The odds of experiencing complications were 1.71 times greater when using SSC compared with surgeries without SSC (p=0.029). CONCLUSIONS The use of an SSC in a rural area was promising, despite its fluctuating use and this needs programme improvement. Further studies are highly recommended to understand the fluctuation in the use of the SSC.
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Affiliation(s)
| | - Moses Banda Aron
- Monitoring and Evaluation, Partners In Health, Neno, Malawi
- Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | | | | | - Haules Robbins Zaniku
- Neno District Health Office, Ministry of Health, Neno, Malawi
- Kamuzu University of Health Sciences, School of Global and Public Health, Blantyre, Malawi
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Qiu X, Luo H, Huang G. Roles of negative pressure wound therapy for scar revision. Front Physiol 2023; 14:1194051. [PMID: 37900944 PMCID: PMC10602717 DOI: 10.3389/fphys.2023.1194051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
The purpose of this study is to review the research progress of negative pressure wound therapy (NPWT) for scar revision and discuss the prospects of its further study and application. The domestic and foreign literatures on NPWT for scar revision were reviewed. The mechanism and application were summarized. NPWT improves microcirculation and lymphatic flow and stimulates the growth of granulation tissues in addition to draining secretions and necrotic tissue. As a significant clinical therapy in scar revision, NPWT reduces tension, fixes graft, and improves wound bed. In the field of scar revision, NPWT has been increasingly used as an innovative and constantly improving technology.
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Affiliation(s)
- Xiaotong Qiu
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
- Department of Burns and Plastic Surgery, Jinan Central Hospital, Jinan, China
| | - Haoming Luo
- Department of Thyroid Head Neck and Maxillofacial Surgery, The Third Hospital of Mianyang & Sichuan Mental Health Center, Mianyang, China
| | - Guobao Huang
- Department of Burns and Plastic Surgery, Jinan Central Hospital, Jinan, China
- Department of Burns and Plastic Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
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McLean KA, Goel T, Lawday S, Riad A, Simoes J, Knight SR, Ghosh D, Glasbey JC, Bhangu A, Harrison EM. Prognostic models for surgical-site infection in gastrointestinal surgery: systematic review. Br J Surg 2023; 110:1441-1450. [PMID: 37433918 PMCID: PMC10564404 DOI: 10.1093/bjs/znad187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/11/2023] [Accepted: 05/20/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Identification of patients at high risk of surgical-site infection may allow clinicians to target interventions and monitoring to minimize associated morbidity. The aim of this systematic review was to identify and evaluate prognostic tools for the prediction of surgical-site infection in gastrointestinal surgery. METHODS This systematic review sought to identify original studies describing the development and validation of prognostic models for 30-day SSI after gastrointestinal surgery (PROSPERO: CRD42022311019). MEDLINE, Embase, Global Health, and IEEE Xplore were searched from 1 January 2000 to 24 February 2022. Studies were excluded if prognostic models included postoperative parameters or were procedure specific. A narrative synthesis was performed, with sample-size sufficiency, discriminative ability (area under the receiver operating characteristic curve), and prognostic accuracy compared. RESULTS Of 2249 records reviewed, 23 eligible prognostic models were identified. A total of 13 (57 per cent) reported no internal validation and only 4 (17 per cent) had undergone external validation. Most identified operative contamination (57 per cent, 13 of 23) and duration (52 per cent, 12 of 23) as important predictors; however, there remained substantial heterogeneity in other predictors identified (range 2-28). All models demonstrated a high risk of bias due to the analytic approach, with overall low applicability to an undifferentiated gastrointestinal surgical population. Model discrimination was reported in most studies (83 per cent, 19 of 23); however, calibration (22 per cent, 5 of 23) and prognostic accuracy (17 per cent, 4 of 23) were infrequently assessed. Of externally validated models (of which there were four), none displayed 'good' discrimination (area under the receiver operating characteristic curve greater than or equal to 0.7). CONCLUSION The risk of surgical-site infection after gastrointestinal surgery is insufficiently described by existing risk-prediction tools, which are not suitable for routine use. Novel risk-stratification tools are required to target perioperative interventions and mitigate modifiable risk factors.
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Affiliation(s)
- Kenneth A McLean
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tanvi Goel
- India Hub, NIHR Global Health Research Unit on Global Surgery, Ludhiana, India
| | - Samuel Lawday
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Aya Riad
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Joana Simoes
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Stephen R Knight
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Dhruva Ghosh
- India Hub, NIHR Global Health Research Unit on Global Surgery, Ludhiana, India
| | - James C Glasbey
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Aneel Bhangu
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Ewen M Harrison
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
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Shah D, Padshala R, Chaudhary SR, Khan S, Mallik S, Varrassi G. Predicting Superficial Surgical Site Infections: A Study of the Risk Factors and an Assessment Scale From Western India. Cureus 2023; 15:e47657. [PMID: 38021607 PMCID: PMC10669653 DOI: 10.7759/cureus.47657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Superficial surgical site infections (SSSIs) are very common nosocomial infections that can complicate a range of surgeries, resulting in increased morbidity and mortality, and an overall decreased benefit of surgical interventions, along with exorbitant expenditure of healthcare resources. An assessment scale could help in the segregation of the high-risk patient population, and appropriate resources could be directed toward them. Methods A prospective observational study was carried out in a tertiary care hospital in Western India with 200 participants. Certain probable preoperative, intraoperative, and postoperative risk factors for SSSIs were assessed for significance of association, and each patient was given a score according to the assessment scale. The predictive power of the scale was calculated. Results Body mass index (BMI), preoperative laboratory investigations, and preoperative hospital stay showed a significant association with the complication. Clean-contaminated wounds had a higher incidence of postoperative SSSIs as compared to clean wounds. Postoperatively, fever and the presence of open drains predisposed the patient to complications. The assessment scale was found to have a positive predictive value of 40.94% and a negative predictive value (NPV) of 86.30%. Conclusion The factors that could significantly prevent the development of SSSIs are normal preoperative laboratory investigations, less than three days of preoperative hospital stay, and avoiding the use of open drains. The high NPV of the assessment scale means that it can be used as a screening tool to segregate high-risk patients.
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Affiliation(s)
- Dharmendra Shah
- Department of General Surgery, Medical College Baroda, Vadodara, IND
| | - Renish Padshala
- Department of General Surgery, Medical College Baroda, Vadodara, IND
| | | | - Shahin Khan
- Department of General Surgery, Medical College Baroda, Vadodara, IND
| | - Shashwat Mallik
- Department of General Surgery, Medical College Baroda, Vadodara, IND
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Dong B, Chen J, Song M, You C, Lei C, Fan Y. The hepatic and pancreatic tumour resection risk factors for surgical site wound infections: A meta-analysis. Int Wound J 2023; 20:3140-3147. [PMID: 37194335 PMCID: PMC10502255 DOI: 10.1111/iwj.14190] [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: 03/19/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 05/18/2023] Open
Abstract
A meta-analysis was conducted to measure hepatic and pancreatic tumour resection (HPTR) risk factors (RFs) for surgical site wound infections (SSWIs). A comprehensive literature inspection was conducted until February 2023, and 2349 interrelated investigations were reviewed. The nine chosen investigations included 22 774 individuals who were in the chosen investigations' starting point, 20 831 of them were with pancreatic tumours (PTs), and 1934 with hepatic tumours (HTs). Odds ratio (OR) and 95% confidence intervals (CIs) were used to compute the value of the HPTR RFs for SSWIs using dichotomous and continuous approaches, and a fixed or random model. HT patients with biliary reconstruction had significantly higher SSWI (OR, 5.81; 95% CI, 3.42-9.88, P < .001) than those without biliary reconstruction. Nevertheless, there was no significant difference between individuals with PT who underwent pancreaticoduodenectomy and those who underwent distal pancreatectomy in SSWI (OR, 1.63; 95% CI, 0.95-2.77, P = .07). HT individuals with biliary reconstruction had significantly higher SSWI compared with those without biliary reconstruction. Nevertheless, there was no significant difference between PT individuals who underwent pancreaticoduodenectomy and those who underwent distal pancreatectomy in SSWI. However, owing to the small number of selected investigations for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Biao Dong
- Department of Neurosurgerythe Fifth Hospital of WuhanWuhanHubeiChina
| | - Jing Chen
- Department of General MedicineErqiao Street Community Health Service Center affiliated of the Fifth Hospital of WuhanWuhanHubeiChina
| | - Mina Song
- Department of Anesthesiologythe Fifth Hospital of WuhanWuhanHubeiChina
| | - Changjiang You
- Department of Emergencythe Fifth Hospital of WuhanHubeiChina
- Department of General MedicineQin Duankou Street Community Health Service Center of the Fifth Hospital of WuhanWuhanHubeiChina
| | - Changjiang Lei
- Department of Oncologythe Fifth Hospital of WuhanWuhanHubeiChina
| | - Ying Fan
- Department of Outpatient Officethe Fifth Hospital of WuhanWuhanHubeiChina
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Ekwunife OH, Coleman PS, Mabanza KT, Suleiman IE, Mulbah RG, Mohammed S, Doe AN, Bekele BG, Cassel AK, Weh-Wesseh MY, Sahr OS, Ngaoja FL, Jabateh FA. Overview of Rate and Risk Factors of Surgical Site Infection in a Tertiary Hospital in Liberia: A Prospective Cohort Study. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:87-92. [PMID: 38449557 PMCID: PMC10914110 DOI: 10.4103/jwas.jwas_65_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/12/2023] [Indexed: 03/08/2024]
Abstract
Background Surgical site infection (SSI) is accountable for a third of postoperative deaths and for 8% of all deaths due to hospital-acquired infections. There is a wide disparity in the incidence and burden of SSI in low and high-income countries. Objectives To assess the rates and risk factors of SSI in a tertiary hospital in a resource-limited sub-Saharan African country and generate institutional baseline data for future monitoring and interventions. Materials and Methods This was a descriptive prospective cohort study done at John F Kennedy Memorial Hospital, a tertiary hospital in Monrovia, Liberia, from October 18 to December 18, 2021. Consecutive participants, including children and adults that had surgical operations within the study period, were recruited. Criteria for diagnosis of SSI were as defined by the Centre for Disease Control (1999). Data were collected on the demography of the participants, type of surgery done, presence of SSI, comorbidities, and risk factors for SSI. Results Of the 111 patients analyzed, thirty-two patients had SSI giving a hospital incident rate of 28.8%. This comprises superficial SSI (22/31; 71.0%), deep SSI (6/31; 19.4%), and organ/space SSI (3/31; 9.7%). Twelve out of 42 females (28.6%) and 20 of 69 males (29.0%) had SSI. There is no statistically significant difference in gender SSI rate (P = 0.963). SSI occurred more in dirty wounds (13/23; 56.5%), compared to contaminated wounds (6/11, 54.6%), clean contaminated (7/22; 31.8%), and clean wounds (6/55, 10.9%). There is a statistical difference in the rate of SSI among the wound classes (P = 0.001). The infection rate is also more in emergency surgeries (18/39, 46.2%) compared to elective surgeries (14/72, 19.4%), and it is significant (P = 0.003). Statistically, there was no significant difference between the two skin preparation agents used (P = 0.351). The abdomen was the most common site of surgical incision and had the highest rate of SSI (24/79; 30.4%) (P = 0.045). There was no statistical difference in SSI rate between those whose hairs were removed in the ward or in the theatre (P = 0.114); length of incision (P = 0.297), or duration of surgery (P = 0.715) (see table for classification and rates). Conclusion The SSI rate in our study is high at 28.8%. Abdominal surgeries, emergencies, and wound class accounted for the majority of the SSIs. The baseline data will be useful in developing infection control strategies.
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Affiliation(s)
| | - Peter Sonpon Coleman
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
| | - Kibuka Tresor Mabanza
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
| | - Ibrahim Eneye Suleiman
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
| | - Robert G Mulbah
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
| | - Shamsuddeen Mohammed
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
| | - Alvin Nah Doe
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
| | - Biruk Gima Bekele
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
| | - Ayun Kotokai Cassel
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
| | - Mewaseh Yah Weh-Wesseh
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
| | - Oscar Saturday Sahr
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
| | - Faya Leno Ngaoja
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
| | - Francis Abu Jabateh
- Department of Surgery, John F Kennedy Memorial Medical Centre Monrovia, Monrovia, Liberia
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Biccard BM, Smith D, Peters S, Boutall A, Wilson G, Coetzee E, Flint M, Gumede S, Rayamajhi S, Bannister S, Daniel N, Fourtounas M, Moore R, Sentholang N, Osayomwanbo O, Ifeanyi kene A, Yakubu SY, Chukwu A, Tolani M, Adinoyi YM, Aliyu A, Salahu D, Isa kabir, Salisu I, Adigun T, Adenekan A, Williams E, Bhatia PK, Chaudhary R, Kothari N, Misra S, Pareek P, Poonia DR, Rathod KK, Rodha MS, Sharma N, Sharma N, Chandra Soni S, Varshney VK, Vishnoi JR, Balija SS, Goyal A, Hudda F, Joshva M, Seenivasagam RK, Shajahan S, Sharma S, Singh SK, Talwar P, Tripathi DK, Bhatt, Daniel S, Dhiman J, George C, Ghosh DN, Goyal S, Hans P, Haque PD, Jain D, Kaur H, Kumar K, Mahajan A, Michael V, Rajappa R, Rajkumar A, Suroy A, Thind RS, Veetil SK, Aggarwal AM, Dhamija P, Garry GK, Gupta H, Jakhar R, Kumar A, Kumar K, Kumar P, Singh G, Chowdhury S, Desai N, Goswami J, Mathai S, Patro V. Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries. BJA OPEN 2023; 7:100207. [PMID: 37655933 PMCID: PMC10457493 DOI: 10.1016/j.bjao.2023.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 09/02/2023]
Abstract
Background This study assessed the potential cost-effectiveness of high (80-100%) vs low (21-35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a -$6 (95% confidence interval [CI]: -$13 to -$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a -$11 (95% CI: -$15 to -$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a -$93 (95% CI: -$132 to -$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a -1.05 (95% CI: -1.14 to -0.90) percentage point reduction in SSIs. Conclusion High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.
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Fowler AJ, Brayne AB, Pearse RM, Prowle JR. Long-term healthcare use after postoperative complications: an analysis of linked primary and secondary care routine data. BJA OPEN 2023; 7:100142. [PMID: 37638082 PMCID: PMC10457466 DOI: 10.1016/j.bjao.2023.100142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/24/2023] [Accepted: 04/21/2023] [Indexed: 08/29/2023]
Abstract
Background Postoperative complications are associated with reduced long-term survival. We characterise healthcare use changes after sentinel postoperative complications. Methods We linked primary and secondary care records of patients undergoing elective surgery at four East London hospitals (2012-7) with at least 90 days follow-up. Complication codes (wound infection, urinary tract infection, pneumonia, new stroke, and new myocardial infarction) recorded within 90 days of surgery were identified from primary or secondary care. Outcomes were change in healthcare contact days in the 2 yr before and after surgery, and 2 yr mortality. We report rate ratios (RaR) with 95% confidence intervals and adjusted for baseline healthcare use and confounders using negative binomial regression. Results We included 49 913 patients (median age 49 yr [inter-quartile range {IQR}: 34-64]), 27 958 (56.0%) were female. Amongst 3883 (7.8%) patients with complications (median age 58 [IQR: 43-72]), there were 18.4 days per year in contact with healthcare before surgery and 25.3 days after surgery (RaR: 1.38 [1.37-1.39]). Patients without complications (median age 48 [IQR: 33-63]) had 12.3 days per year in contact with healthcare before surgery and 14.0 days after surgery (RaR: 1.14 [1.14-1.15]). The adjusted incidence rate ratio of days in contact with healthcare associated with complications was 1.67 (1.49-1.87). More patients (391; 10.1%) with complications died within 2 yr than those without (1428; 3.1%). Conclusions Patients with postoperative complications are older with greater healthcare use before surgery. However, their absolute and relative increases in healthcare use after surgery are greater than patients without complications.
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Affiliation(s)
- Alexander J. Fowler
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Chelmsford, Essex, UK
| | - Adam B. Brayne
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- University Hospitals Plymouth, Derriford Road, Plymouth, Devon, UK
| | - Rupert M. Pearse
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John R. Prowle
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Agrawal A, Ramachandraiah MK, Shanthappa AH, Agarawal S. Effectiveness of Gentamicin Wound Irrigation in Preventing Surgical Site Infection During Lumbar Spine Surgery: A Retrospective Study at a Rural Teaching Hospital in India. Cureus 2023; 15:e46094. [PMID: 37900478 PMCID: PMC10611903 DOI: 10.7759/cureus.46094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) are an opposing result of surgery and account for the majority of healthcare-related infections worldwide. It is one of the most common complications associated with open-spine surgery and is associated with high rates of mortality and high demand for healthcare resources. Surgical site infections are the result of a variety of reasons, which is why a range of prevention strategies have been proposed. Intraoperative wound irrigation (IOWI) is a simple procedure that involves moving a solution through an open wound to help hydrate the tissue. It is a type of prophylactic wound irrigation. It removes and dilutes bodily fluids, bacteria, and cellular debris. It may also act as a bactericidal agent when used with antibiotics and antiseptics. AIMS AND OBJECTIVES To evaluate the incidence of SSI in lumbar spine surgeries by comparing IOWI with normal saline containing gentamicin (NS-G) and normal saline (NS) alone. MATERIALS AND METHOD A hospital-based retrospective study was conducted among 40 patients who underwent elective lumbar spine surgery at the Department of Orthopaedics, RL Jalappa Hospital Centre, Kolar, Karnataka, India. RESULT Out of the total participants enrolled, 60% were males and 40% were females. There was no statistically significant difference found between mean age, mean BMI, mean hemoglobin level, mean WBC counts, and mean fasting blood sugar (FBS) levels among both groups. The overall prevalence of SSI among patients was 25%. In Group A (NS-G), the prevalence of SSI was 15%, and in Group B (NS), it was 35%. In total, 17.5% of study participants had superficial SSI, while 7.5% had deep SSI. CONCLUSION Gentamicin, an aminoglycoside antibiotic, is bactericidal and efficient against gram-positive organisms like Staphylococcus, the most frequent pathogen causing SSI in spine surgery. During lumbar spine surgery, IOWI with saline and gentamicin before closure is more effective in preventing SSI than simple saline irrigation.
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Affiliation(s)
- Ayush Agrawal
- Orthopaedics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Manoj K Ramachandraiah
- Orthopaedics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Arun H Shanthappa
- Orthopaedics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Sandesh Agarawal
- Orthopaedics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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Hou Y, Collinsworth A, Hasa F, Griffin L. Incidence and impact of surgical site complications on length of stay and cost of care for patients undergoing open procedures. Surg Open Sci 2023; 14:31-45. [PMID: 37599673 PMCID: PMC10436177 DOI: 10.1016/j.sopen.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/25/2023] [Accepted: 05/10/2023] [Indexed: 08/22/2023] Open
Abstract
Background Surgical site complications (SSCs) can have serious and life-threatening consequences for patients; however, their frequency and impact on healthcare utilization across surgical procedures, particularly for non-infectious SSCs, are unknown. This study examined incidence of overall SSCs and non-infectious SSCs in patients undergoing open surgical procedures in the United States and their effect on length of stay (LOS) and costs. Methods This retrospective study utilizing 2019-2020 data from Medicare and Premier Health Database identified patients with SSCs during hospitalization or within 90 days of discharge. Propensity score matching was used to calculate incremental LOS and costs attributable to SSCs. Mean LOS and costs attributable to SSCs for the index admission, readmissions, and outpatient visits were summed by procedure and Charlson Comorbidity Index score to estimate the overall impact of an SSC on LOS and costs across healthcare settings. Results Overall and non-infectious SSC rates were 7.3 % and 5.3 % respectively for 2,696,986 Medicare and 6.7 % and 5.0 % for 1,846,254 Premier open surgeries. Total incremental LOS and cost per SSC were 7.8 days and $15,339 for Medicare patients and 6.2 days and $17,196 for Premier patients. Incremental LOS and cost attributable to non-infectious SSCs were 6.5 days and $12,703 and 5.2 days and $14,477 for Medicare and Premier patients respectively. Conclusions This study utilizing two large national databases provides strong evidence that SSCs, particularly non-infectious SSCs, are not uncommon in open surgeries and result in increased healthcare utilization and costs. These findings demonstrate the need for increased adoption of evidence-based interventions that can reduce SSC rates.
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Mvoula L, Irizarry E. Tolerance to and Postoperative Outcomes With Early Oral Feeding Following Elective Bowel Surgery: A Systematic Review. Cureus 2023; 15:e42943. [PMID: 37667705 PMCID: PMC10475250 DOI: 10.7759/cureus.42943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/06/2023] Open
Abstract
Although practice guidelines recommend resuming oral feeding immediately after gastrointestinal surgery, many practitioners remain reluctant to order early oral feeding (EOF). Therefore, this review aimed to clarify the tolerance to and postoperative outcomes with EOF among patients undergoing bowel surgery. A systematic review of the literature published between January 1990 and July 2022 with the time of oral intake (early or delayed until resolution of ileus) as the exposure variable was conducted using PubMed and Scopus databases. Outcomes of interest included tolerance to EOF and postoperative adverse effects or complications. After screening 1,667 research articles, 18 randomized control trials, six prospective case series, and four cohort studies met our inclusion criteria, collectively representing data from 2,647 patients in eleven countries. These studies indicate that while most patients tolerate EOF, 5-25% may not tolerate EOF until the fourth postoperative day (POD). Moreover, EOF, at best, has no advantage over delayed feeding in terms of vomiting, nausea, nasogastric tube requirement, or other postoperative complications. In addition, early return of bowel function, lower risk of diarrhea, and lower pain score with EOF are inconsistently reported, and shorter hospitalization with EOF may be limited to those who tolerate oral feeding on POD 0 or 1. Nevertheless, shorter hospitalization with EOF could reduce the cost of hospitalization. A substantial number of patients may not be able to tolerate oral feeding after bowel surgery until POD 4, and in patients who tolerate EOF, the only clear benefit is a shorter length of hospitalization.
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Affiliation(s)
- Lord Mvoula
- Surgery, Lincoln Medical and Mental Health Center, Bronx, USA
| | - Evelyn Irizarry
- Colorectal Surgery, Lincoln Medical and Mental Health Center, Bronx, USA
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Mwangi W, Kaddu R, Njoki Muiru C, Simiyu N, Patel V, Sulemanji D, Otieno D, Okelo S, Chikophe I, Pisani L, Dona DPG, Beane A, Haniffa R, Misango D, Waweru-Siika W. Organisation, staffing and resources of critical care units in Kenya. PLoS One 2023; 18:e0284245. [PMID: 37498872 PMCID: PMC10374136 DOI: 10.1371/journal.pone.0284245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/27/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To describe the organisation, staffing patterns and resources available in critical care units in Kenya. The secondary objective was to explore variations between units in the public and private sectors. MATERIALS AND METHODS An online cross-sectional survey was used to collect data on organisational characteristics (model of care, type of unit, quality- related activities, use of electronic medical records and participation in the national ICU registry), staffing and available resources for monitoring, ventilation and general critical care. RESULTS The survey included 60 of 75 identified units (80% response rate), with 43% (n = 23) located in government facilities. A total of 598 critical care beds were reported with a median of 6 beds (interquartile range [IQR] 5-11) per unit, with 26% beds (n = 157) being non functional. The proportion of ICU beds to total hospital beds was 3.8% (IQR 1.9-10.4). Most of the units (80%, n = 48) were mixed/general units with an open model of care (60%, n = 36). Consultants-in-charge were mainly anesthesiologists (69%, n = 37). The nurse-to-bed ratio was predominantly 1:2 with half of the nurses formally trained in critical care. Most units (83%, n = 47) had a dedicated ventilator for each bed, however 63% (n = 39) lacked high flow nasal therapy. While basic multiparametric monitoring was ubiquitous, invasive blood pressure measurement capacity was low (3% of beds, IQR 0-81%), and capnography moderate (31% of beds, IQR 0-77%). Blood gas analysers were widely available (93%, n = 56), with 80% reported as functional. Differences between the public and private sector were narrow. CONCLUSION This study shows an established critical care network in Kenya, in terms of staffing density, availability of basic monitoring and ventilation resources. The public and private sector are equally represented albeit with modest differences. Potential areas for improvement include training, use of invasive blood pressure and functionality of blood gas analysers.
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Affiliation(s)
- Wambui Mwangi
- Department of Anesthesia and Intensive Care, Nyeri County Referral Hospital, Nyeri, Kenya
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
| | - Ronnie Kaddu
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Intensive Care Unit, Aga Khan Mombasa Hospital, Mombasa, Kenya
| | - Carolyne Njoki Muiru
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Egerton University Surgery Department, Nakuru Level V ICU, Nakuru, Kenya
- Department of Anesthesia and Critical Care, AAR Hospital, Nairobi, Kenya
| | - Nabukwangwa Simiyu
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Intensive Care, Kisii County Referral Hospital, Kisii, Kenya
| | - Vishal Patel
- Department of Anesthesia and Intensive Care, MP Shah Hospital, Nairobi, Kenya
| | - Demet Sulemanji
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Critical Care, AAR Hospital, Nairobi, Kenya
| | - Dorothy Otieno
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
| | - Stephen Okelo
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Critical Care, Maseno University, Maseno, Kenya
| | - Idris Chikophe
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Critical Care, Kenyatta National Hospital, Nairobi, Kenya
| | - Luigi Pisani
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | | | - Abi Beane
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - Rashan Haniffa
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - David Misango
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia, Aga Khan University, Nairobi, Kenya
| | - Wangari Waweru-Siika
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia, Aga Khan University, Nairobi, Kenya
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