Incidence, risk factors and outcome of infection in a 1-year hysterectomy cohort: a prospective follow-up study

The role of antimicrobial prophylaxis in laparoscopic nephrectomy for renal cell carcinoma

BACKGROUND

To investigate the role of antimicrobial prophylaxis in laparoscopic nephrectomy for renal cell carcinoma.

METHODS

We retrospectively enrolled 1000 patients who underwent laparoscopic nephrectomy from August 2019 to November 2021 in the Peking Union Medical College Hospital. Patients were divided into group without antimicrobial prophylaxis (n = 444) and group with antimicrobial prophylaxis (n = 556). Outcomes including 30-day postoperative infection rate, the increase rate of pre- and post-operative white blood cell counts and hospital stay were analyzed.

RESULTS

The overall infection rate was 5.0% (28/556) in the group with antimicrobial prophylaxis, which was similar to 4.1% (18/444) in the group without antimicrobial prophylaxis (P = 0.461). The increase rate of pre- and post-operative white blood cell counts was significantly lower (85.5% versus 97.0%) in the group with antimicrobial prophylaxis (P = 0.004). The postoperative hospital stay was 5 (4, 6) days in both groups (P = 0.483). Logistic regression analyses identified the use of antimicrobial prophylaxis had no influence on the occurrence of infection events (odds ratio = 0.797; 95% confidence interval, 0.435-1.460; P = 0.462). Hemoglobin (odds ratio = 0.430; 95% confidence interval, 0.257-0.719; P = 0.001) and partial nephrectomy (odds ratio = 2.292; 95% confidence interval, 1.724-3.046; P < 0.001) influenced the use of antimicrobial prophylaxis independently.

CONCLUSIONS

The use of antimicrobial prophylaxis had no impact on postoperative infection in patients receiving laparoscopic nephrectomy for renal cell carcinoma.

[Adnexal torsion after abdominal hysterectomy: a first observation]

La torsion d'annexes survient classiquement sur ovaires kystiques ou tumoraux. De rares cas de torsion ont été rapports dans la littérature après hystérectomie laparoscopique. Nous rapportons la première observation de torsion d'annexe survenant sur annexe normale après hystérectomie abdominale et décrivons les particularités de cette forme clinique.

Incidence of and risk factors for febrile morbidity after laparoscopic-assisted vaginal hysterectomy

Background

The purpose of this study was to assess the incidence of and risk factors for postoperative febrile morbidity after laparoscopic-assisted vaginal hysterectomy (LAVH).

Methods

This retrospective study was carried out using the medical records of women with benign gynecologic conditions who underwent LAVH between June 2007 and May 2012 at Srinagarind Hospital in Thailand. Data were collected to assess baseline patient characteristics, occurrence of body temperature ≥38°C on two occasions at least 6 hours apart in the 24 hours following the surgical procedure, and possible risk factors related to postoperative febrile morbidity.

Results

In total, 199 women underwent LAVH during the study period. They had a mean age of 46±6 years, a mean body mass index of 24.0±3.2 kg/m², a mean surgical duration of 134±52 minutes, median estimated blood loss of 200 mL, a mean total hospital stay of 5±2 days, and a mean postoperative hospital stay of 3±2 days. Postoperative febrile morbidity was documented in 31 cases (15.6%). The cause of postoperative fever was unknown in most cases, with only two cases having an identifiable cause. The risk of postoperative febrile morbidity was highest in women treated with more than two antibacterial agents and with a regimen of more than 3 days.

Conclusion

This study shows a moderately high rate of febrile morbidity after LAVH, for which the main risk factors were use of multiple drugs and doses for antibiotic prophylaxis.

Quality-initiated prophylactic antibiotic use in laparoscopic-assisted vaginal hysterectomy

BACKGROUND

An evidence-based initiation of quality improvement activity for reducing the usage of prophylactic antibiotic in laparoscopic-assisted vaginal hysterectomy (LAVH) in a tertiary hospital.

AIMS

The authors investigated whether single or multiple doses of cefazoline were more cost-effective in preventing postoperative infection associated with LAVH.

METHODS

The study groups comprised of 310 patients who had undergone LAVH continuously in a medical centre. Patients were divided into two groups on the basis of whether they received a single dose or multiple doses (range: two to four doses) of cefazoline during the perioperative period. Postoperative infections such as pelvic cellulitis or abscess, vaginal cuff abscess, wound infection and urinary tract infection that occurred either during hospitalisation or within one month after discharge were observed and recorded. Incremental cost-effectiveness ratio (ICER) was calculated using the mean direct drug cost and the prophylactic effect of infection in both groups.

RESULTS

The prophylactic effect of infection was similar in the single-dose group and the multiple-dose group (94.6% vs 93.9%, P = 0.986). The ICER was significantly lower in the single-dose group (153.3 vs 460.4, P < 0.001).

CONCLUSIONS

The result revealed that a single dose of cefazoline is more cost-effective than multiple doses in the prevention of infection associated with LAVH. It fulfils the goal of cost minimisation and quality of care in today's environment of medical cost containment.

Japanese guidelines for prevention of perioperative infections in urological field

For urologists, it is very important to master surgical indications and surgical techniques. On the other hand, the knowledge of the prevention of perioperative infections and the improvement of surgical techniques should always be considered. Although the prevention of perioperative infections in each surgical field is a very important issue, the evidence and the number of guidelines are limited. Among them, the preparation of guidelines has progressed, especially in gastrointestinal surgery. The Center for Disease Control and Prevention (CDC) proposed guidelines for the prevention of surgical site infections, which have been used worldwide. In urology, the original guidelines were different from those of general surgery, due to many endourological procedures and urine exposure in the surgical field. The Japanese Society of UTI Cooperative Study Group has thus framed these guidelines supported by The Japanese Urological Association. The guidelines consist of the following nine techniques: open surgeries, laparoscopic surgeries, transurethral resection of bladder tumor, ureterorenoscope and transurethral lithotripsy, transurethral resection of the prostate, prostate biopsy, cystourethroscope, pediatric surgeries in the urological field, and extracorporeal shock wave lithotripsy and febrile neutropenia. These are the first guidelines for the prevention of perioperative infections in the urological field in Japan. Although most of these guidelines were made using reliable evidence, there are parts without enough evidence. Therefore, if new reliable data is reported, it will be necessary for these guidelines to be revised in the future.

Surveillance and risk factors on hysterectomy wound infection rate in Gran Canaria, Spain

OBJECTIVES

Surveillance programs for nosocomial infection control may find out opportunities for improvement. The aim of this study was to determine the incidence of surgical site infection and their potential risk factors after hysterectomy in a tertiary hospital in Gran Canaria, Spain.

STUDY DESIGN

Prospective study on patients undergoing abdominal or vaginal hysterectomy between 1st June 2000 and 31st December 2004. Surgical site infection incidence rates were calculated according to procedure, and National Nosocomial Infection Surveillance (NNIS) system risk categories. We also reviewed antimicrobial prophylaxis use and morbidity. To determine associate risk factors a multivariate analysis was performed.

RESULTS

A total of 1540 women were surveyed; neoplasm (30.5%), obesity (24.3%), and diabetes (16.2%) grouped the main morbidity. About 81 cases (5.2%) met criteria for postoperative surgical site infection (6.0% for abdominal procedure and 3.1% for vaginal procedure). Most patients (86.4%) had adequate antimicrobial prophylaxis, but inadequacy was more frequent by vaginal (17.6%) than abdominal procedure (12.0%) (p=0.005). NNIS high-risk patients had significantly higher infection rates than did low-risk patients (p=0.01). The most common causative organism isolated was Escherichia coli (17.5%). Multivariate analysis showed obesity, inadequate antimicrobial prophylaxis, and abdominal procedure as the main risk factors.

CONCLUSION

Rate of surgical site infection is high. Enhanced and multidisciplinary efforts are needed.

The effect of performance feedback on wound infection rate in abdominal hysterectomy

BACKGROUND

In many hospitals, infection of the surgical wound is the most common nosocomial infection. Its presence implies patient morbidity, a mortality risk, and an increase in procedure costs because of prolonged hospitalization.

OBJECTIVES

Our objective was to ascertain the effect of an infection control program, using performance feedback, on wound infection (WI) rate in abdominal hysterectomy.

METHODS

All patients undergoing abdominal hysterectomy in our center (Hospital A. Marcide, Ferrol, Spain) between 1999 and 2004 were prospectively followed up to determine the WI rate. A complete set of parameters, including age, underlying illnesses, cancer, diabetes mellitus, immunosuppressive therapy, albumin, American Society of Anesthesiologists preoperative assessment score (ASA) risk, days in hospital presurgery, date of surgery, hygiene and perioperative antimicrobial prophylaxis, type of surgical operation, duration of surgery, surgeon, and WI, were collected in each case. After data collection for 1999 concluded, we communicated surgical WI rates to surgeons every year. A logistic regression analysis was performed to compare WI rates with those observed in 1999.

RESULTS

A total of 980 females was enrolled in the prospective surveillance: mean age, 50.7 +/- 10.7 years. Cases included 25.8% cancer, 4.9% diabetes, 0.5% immunosuppressive therapy, 26.6% ASA 1, 58.4% ASA 2, 13.9% ASA 3. In 9 patients, emergency surgery was performed and, in 971 patients, surgery was scheduled: Total abdominal hysterectomy, 878; subtotal abdominal hysterectomy, 65; Wertheim-Meigs, 37. The factors associated with WI were albumin (OR, 0.97; 95% CI: 0.94-0.99) and antimicrobial prophylaxis (OR, 0.08; 95% CI: 0.02-0.32). The mean values for albumin and the number of patients with antimicrobial prophylaxis fluctuated from year to year. The WI rate improved from 10.7% (95% CI: 5.8-15.6) in 1999 to 6% (-43.9%) in 2004.

CONCLUSION

Performance feedback of surgical wound infection rates to individual surgeons reduces these rates.

Reclosure of the Disrupted Laparotomy Wound

OBJECTIVE

To review systematically all prospective, randomized trials published in English quantifying the success of reclosure of the disrupted laparotomy wound.

DATA SOURCES

The MEDLINE/PubMed, EMBASE, CINAHL, and Cochrane databases were searched from 1966 to 2004. References were hand-searched and their authors contacted to identify all published and unpublished eligible studies.

METHODS OF STUDY SELECTION

We included all prospective, randomized trials measuring successful reclosure of disrupted laparotomy wounds in human subjects. Studies with fascial disruption, subfascial abscess, or ongoing contamination were excluded. Of over 2,098 potentially relevant articles, 8 were included, incorporating 348 patients.

TABULATION, INTEGRATION, AND RESULTS

Two authors determined study inclusion. One investigator abstracted data, and a second checked for accuracy. The main outcome was successful healing after wound reclosure. Timing of reclosure, utility of antibiotics, and reclosure techniques were also analyzed. Successful healing after reclosure ranged between 81% and 100%. Failed healing included both superficial wound separation and reaccumulation of abscess. No serious morbidity or mortality was reported. Compared with healing by secondary intention, reclosure resulted in faster healing times (16-23 days versus 61-72 days), and in the one study that evaluated it, 6.4 fewer office visits. The optimal timing and technique for reclosure and the utility of antibiotics were inconclusive.

CONCLUSION

Reclosure of disrupted laparotomy wounds was successful in over 80% of patients. Failed reclosure resulted in no life-threatening complications. Reclosure of disrupted laparotomy wounds is safe and decreases healing times.

Adnexal torsion after laparoscopic hysterectomy: description of seven cases

STUDY OBJECTIVE

To discover the prevalence of adnexal torsion after laparoscopic hysterectomy.

DESIGN

Retrospective analysis (Canadian Task Force classification II-3).

SETTING

A tertiary referral hospital.

PATIENTS

One thousand thirty-three women underwent laparoscopic hysterectomies between the years 1995 and 2002. The mean age (+/- SD) of the women at the time of hysterectomy was 43.87 +/- 4.28 years. Intervention. Laparoscopic hysterectomy in which at least one adnexa was left intact.

MEASUREMENTS AND MAIN RESULTS

The files of all women with adnexal torsion diagnosed by laparoscopy from 1995 to 2003 were retrospectively reviewed. In seven women, adnexal torsion occurred after laparoscopic hysterectomy. Torsion occurred 2.64 (+/- 1.79) years (mean +/- SD) after hysterectomy. Torsion was treated by laparoscopy in all of the women; either oophorectomy or detorsion and ovariopexy was performed. We calculated the prevalence of this complication to be 7.91/1000.

CONCLUSION

Adnexal torsion can occur after laparoscopic hysterectomy.

Hysterectomy for gynaecological cancer: a follow-up study of subjective and objective outcome

AIMS

To evaluate morbidity and subjective outcome associated with hysterectomy either with or without pelvic or pelvic and para-aortic lymphadenectomy for gynaecological cancer.

METHODS

Ninety-nine patients who underwent hysterectomy with lymphadenectomy (n = 38) or simple hysterectomy (n = 61) for ovarian, endometrial and cervical cancer in Turku University Hospital, Turku, Finland, were followed-up prospectively to determine the incidence of complications during a 1-year period after operation. Subjective outcomes were assessed using two questionnaires, 6 weeks and 1 year after operation. Hospital records of the patients were reviewed up to 6 years after operation.

RESULTS

During their hospital stay 58% of patients in the hysterectomy with lymphadenectomy group and 56% in the simple hysterectomy group experienced some type of complication. Serious complications occurred in four patients (10.5%) in the former group and in two patients (3.3%) in the latter group. In the study population overall, the incidence of subjective complaints increased from 18% of respondents 6 weeks after operation to 55% 1 year after operation. Most patients (95 and 92%, respectively) remained satisfied with the operation at both times of evaluation.

CONCLUSIONS

More than half of the patients experienced morbidity related to surgical treatment for gynaecological cancer. The incidence of complications and subjective complaints were unaffected by the type of operation.