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Kirkham AM, Candeliere J, Nagpal SK, Stelfox HT, Kubelik D, Hajjar G, MacFadden DR, McIsaac DI, Roberts DJ. A systematic review and meta-analysis of outcomes associated with development of surgical site infection after lower-limb revascularization surgery. Vascular 2024:17085381241290039. [PMID: 39363559 DOI: 10.1177/17085381241290039] [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: 10/05/2024]
Abstract
OBJECTIVES Although surgical site infection (SSI) is a commonly used quality metric after lower-limb revascularization surgery, outcomes associated with development of this complication are poorly characterized. We conducted a systematic review and meta-analysis of studies reporting associations between development of an SSI after these procedures and clinical outcomes and healthcare resource use. METHODS We searched MEDLINE, Embase, CENTRAL, and Evidence-Based Medicine Reviews (inception to April 4th, 2023) for studies examining adjusted associations between development of an SSI after lower-limb revascularization surgery and clinical outcomes and healthcare resource use. Two investigators independently screened abstracts and full-text citations, extracted data, and assessed risk of bias. Data were pooled using random-effects models. Heterogeneity was assessed using I2 statistics. GRADE was used to assess estimate certainty. RESULTS Among 6671 citations identified, we included 11 studies (n = 61,628 total patients) that reported adjusted-associations between development of an SSI and 13 different outcomes. Developing an SSI was associated with an increased adjusted-risk of hospital readmission (pooled adjusted-risk ratio (aRR) = 3.55; 95% CI (confidence interval) = 1.40-8.97; n = 4 studies; n = 13,532 patients; I2 = 99.0%; moderate certainty), bypass graft thrombosis within 30-days (pooled aRR = 2.09; 95% CI = 1.41-3.09; n = 2 studies; n = 23,240 patients; I2 = 51.1%; low certainty), reoperation (pooled aRR = 2.69; 95% CI = 2.67-2.72; n = 2 studies; n = 23,240 patients; I2 = 0.0%; moderate certainty), bleeding requiring a transfusion or secondary procedure (aRR = 1.40; 95% CI = 1.26-1.55; n = 1 study; n = 10,910 patients; low certainty), myocardial infarction or stroke (aRR = 1.21; 95% CI = 1.02-1.43; n = 1 study; n = 10,910 patients; low certainty), and major (i.e., above-ankle) amputation (pooled aRR = 1.93; 95% CI = 1.26-2.95; n = 4 studies; n = 32,859 patients; I2 = 83.0; low certainty). Development of an SSI >30-days after the index operation (aRR = 2.20; 95% CI = 1.16-4.17; n = 3 studies; n = 21,949 patients; low certainty) and prosthetic graft infection (aRR = 6.72; 95% CI = 3.21-12.70; n = 1 study; n = 272 patients; low certainty) were both associated with an increased adjusted-risk of major amputation. Prosthetic graft infection was also associated with an increased adjusted-risk of mortality >30-days after the index procedure (aRR = 6.40; 95% CI = 3.32-12.36; n = 1 study; n = 272 patients; low certainty). CONCLUSIONS This systematic review and meta-analysis suggests that development of an SSI after lower-limb revascularization surgery significantly increases patient morbidity and healthcare resource use. SSI is therefore a valuable quality metric after these surgeries. However, current estimates are based on heterogenous, low-to-moderate certainty evidence and should be confirmed by large, multicenter, cohort studies.
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Affiliation(s)
- Aidan M Kirkham
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jasmine Candeliere
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Sudhir K Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Medicine, and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Dalibor Kubelik
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - George Hajjar
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Derek R MacFadden
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Derek J Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Mangan J, Michelson JD, Schottel PC, Barnum M, Blankstein M. Antibiotic administration for open reduction internal fixation of closed ankle fractures: Is one preoperative dose enough? J Foot Ankle Surg 2024:S1067-2516(24)00221-7. [PMID: 39306231 DOI: 10.1053/j.jfas.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/30/2024] [Accepted: 09/14/2024] [Indexed: 09/26/2024]
Abstract
Although preoperative antibiotics are used routinely in ankle fracture surgery, there is considerable variability in postoperative antibiotic dosing regimens amongst surgeons. The aim of this study is to compare the rate of surgical site infection (SSI) in patients receiving one dose of preoperative antibiotics to patients who received more than one dose of antibiotics. A single-center Level I Trauma Center retrospective review of patients with isolated closed ankle fractures who underwent open reduction internal fixation over a 10-year period was performed. Demographics data and risk factors were obtained from the electronic medical record. SSI was detected using a text-mining algorithm on all postoperative clinic notes. Factors associated with the development of SSI or increased antibiotic dosing were evaluated. Eight-hundred and twenty-six patients were included in the analysis. There was no correlation between infection rate and any of the potential risk factors evaluated. Two-hundred and ninety-two patients received only one dose of antibiotics preoperatively and 534 patients received more than one antibiotic dose. The rate of SSI was not significantly different between the single-dose cohort (5.8 %) and the multi-dose cohort (3.9 %) (p=0.215). Routine use of postoperative antibiotics in open reduction internal fixation of closed ankle fractures did not decrease the rate of SSI, regardless of associated comorbidities. LEVEL OF EVIDENCE: : Level III (therapeutic retrospective cohort study).
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Affiliation(s)
- Jack Mangan
- Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT 05405, USA.
| | - James D Michelson
- Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT, USA
| | - Patrick C Schottel
- Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT, USA
| | - Michael Barnum
- Department of Orthopedic Surgery, Orlando Health, Orlando, FL, USA
| | - Michael Blankstein
- Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT, USA
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Li D, Li J, Xu Y, Ling C, Qiu Y, Zhu Z, Liu Z. Topical vancomycin powder for the prevention of surgical site infections in spinal deformity surgery: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08494-1. [PMID: 39269667 DOI: 10.1007/s00586-024-08494-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 09/05/2024] [Accepted: 09/10/2024] [Indexed: 09/15/2024]
Abstract
PURPOSE To assess the effectiveness and safety of topical vancomycin powder (VP) in preventing surgical site infections (SSIs) in spinal deformity surgeries. METHODS A literature search was conducted on Web of Science, PubMed, and Cochrane Library databases for comparative studies of VP in spinal deformity surgeries published before February 2024. Two reviewers independently screened eligible articles based on the inclusion and exclusion criteria, assessed study quality, and extracted data. Data analysis was performed using Review Manager 5.4 software. RESULTS Of all 143 papers screened, a meta-analysis was conducted on 10 articles, which included a total of 8,166 surgeries. The results of the meta-analysis indicated that the incidence of deep SSI in VP group was 0.28 times that in non-VP group (p < 0.001). In the subgroup analysis, VP treatment significantly reduced the risk of deep SSI in both adult spinal deformity (ASD) (RR 0.40, 95% CI 0.21-0.77, p = 0.006) and pediatric scoliosis (PS) (RR 0.25, 95% CI 0.16-0.38, p < 0.001) surgeries. However, this effect was not observed in neuromuscular scoliosis (NMS) patients (RR 0.66, 95% CI 0.26-1.66, p = 0.38). Bacterial culture results indicated that VP treatment significantly reduced polymicrobial infections (p = 0.007) and gram-positive infections (p = 0.001). CONCLUSION From the literature available at present, VP was associated with reduced deep SSIs rates in spinal deformity patients. However, particular attention should be paid to the lack of the effectiveness of VP in NMS patients. The current literature did not report local cytotoxicity or renal toxicity related to VP in spinal deformity patients.
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Affiliation(s)
- Dong Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Jie Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Yanjie Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Chen Ling
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Clinical College of Jiangsu University, Nanjing, 210008, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.
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Liang M, Luo Y, Wang X, Chen C, Chen P, Xiong Z, Liu L, Jiang M, Zhang H. Breast Cancer Patient Flap Management After Mastectomy: A Best Practice Implementation Project. Clin Breast Cancer 2024:S1526-8209(24)00251-9. [PMID: 39353800 DOI: 10.1016/j.clbc.2024.09.004] [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: 04/17/2024] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Breast cancer is a prevalent malignancy in women, with mastectomy as the main surgery. Common postmastectomy complications are seroma (15%-81%), infections (2.9%-3.8%), and flap necrosis (10%-18%), severely impacting quality of life and costs. However, there's a lack of standardized flap care protocols and limited staff knowledge. OBJECTIVES This study aims to apply best evidence for flap management post-mastectomy to standardize practices, reduce complications, and enhance patient's quality of life. METHODS This project followed JBI PACES and GRiP principles, implementing evidence-based practices in a Chinese tertiary hospital between January and May 2023. It entailed evidence identification, integration into clinical context, protocol development, baseline audits, barrier/enabler analysis. The study compared pre- and post-evidence implementation rates of flap complications, healthcare staff's knowledge/skill scores on mastectomy flap management, and audit indicator adherence by both staff and patients. RESULTS After evidence application, flap ischemia/necrosis rates dropped from 8.57% to 5.56% (P < .001), wound infection rates after surgery reduced from 5.71% to 2.78% (P < .001), and seroma rates decreased from 17.14% to 2.78% (P < .001). Healthcare staff's knowledge and skill scores for flap management following mastectomy increased from 50.67 ±18.32 preimplementation to 98.33 ± 4.01 (t = -13.90, P < .001). Audit criterion compliance rates increased from 8.57% to 94.29% to between 91.67% and 100%, with statistically significant differences in all 15 criteria (P < .001). CONCLUSIONS Evidence-based management of flaps after mastectomy improves healthcare staff's knowledge and skills, enhances nursing quality, effectively reduces flap complications in patients, and boosts their quality of life.
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Affiliation(s)
- Minshan Liang
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, China; Department of Breast Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuanzhen Luo
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, China; Department of Breast Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaojun Wang
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, China; Department of Breast Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chunhua Chen
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, China; Department of Breast Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Piao Chen
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, China; Department of Breast Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhenchong Xiong
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, China; Department of Breast Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Liu
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, China; Department of Nursing, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Mengxiao Jiang
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Huiting Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, China; Department of Breast Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
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McKechnie T, Shi V, Huang E, Huo B, Doumouras A, Amin N, Eskicioglu C, Hong D. Double-row staple technology versus triple-row staple technology for colorectal surgery: A systematic review and meta-analysis. Surgery 2024; 176:633-644. [PMID: 38876899 DOI: 10.1016/j.surg.2024.04.039] [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: 01/17/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Some observational data have suggested that anastomotic leak may be reduced with triple-row staple technology compared to double-row staple technology. We aimed to investigate this further by performing a systematic review comparing double- and triple-row staple technology for colorectal anastomoses. METHODS This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to November 2023. Articles were eligible for inclusion if they were comparing double-row staple and triple-row staple technology for left-sided colo-colic, colorectal, or coloanal anastomosis. The main outcomes included anastomotic leak, anastomotic hemorrhage, 30-day mortality, and reoperation. Meta-analyses with inverse variance random effects were performed. Certainty of evidence was assessed with Grading of Recommendations, Assessment, Development, and Evaluations. RESULTS After reviewing 340 relevant citations, 6 retrospective cohort studies met inclusion. Overall, 19,372 patients (mean age: 60.2 years, 52.7% female sex) had anastomoses with double-row staple technology, and 2,298 patients (mean age: 61.3 years, 50.3% female sex) with triple-row staple technology. Most operations were anterior resections (double-row: 55.3%; triple-row: 43.6%). Across all included studies, the risk of anastomotic leak was reduced with triple-row staple technology (6.3% vs 7.5%, risk ratio 0.54, 95% confidence interval 0.31-0.94, P = .03, I2=75%). There were no significant differences in anastomotic hemorrhage (risk ratio 0.47, 95% confidence interval 0.15-1.49, P = .20, I2 = 57%), 30-day mortality (risk ratio 0.66, 95% confidence interval 0.17-2.55, P = .55, I2 = 0%), or reoperation (risk ratio 1.05, 95% confidence interval 0.42-2.64, P = .91, I2 = 56%). CONCLUSION Triple-row staple technology may reduce the risk of anastomotic leak in left-sided colorectal anastomoses.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Victoria Shi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Elena Huang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bright Huo
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. https://twitter.com/brighthuo
| | - Aristithes Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. https://twitter.com/Doctor_Doum
| | - Nalin Amin
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. https://twitter.com/Drbariatricsx
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Ali A, Abdullah M, Shiraz MI, Amir MA, Shahid AR, Naseer BB, Larik MO, Baloch SA, Mumtaz ANM, Waseem AM. The efficacy of wound edge protectors in reducing surgical site infections in gastrointestinal surgeries: An updated systematic review and meta-analysis. Curr Probl Surg 2024; 61:101552. [PMID: 39168538 DOI: 10.1016/j.cpsurg.2024.101552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/25/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Asad Ali
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Abdullah
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Moeez Ibrahim Shiraz
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Ali Amir
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Abdul Rehman Shahid
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan.
| | - Bilal Bin Naseer
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Omar Larik
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Salman Akbar Baloch
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Ameer Noor Mehdi Mumtaz
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Ali Mustafa Waseem
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
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Ramola M, Ramola M, Singh J, Khurana L, Chhabra S, Garg R, Singh U, Nath K. Comparative Analysis of Duroplasty Techniques in Decompressive Craniectomy: The CANDID Study. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01275. [PMID: 39132991 DOI: 10.1227/ons.0000000000001306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/25/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVE At present, there is no consensus regarding the most optimal dural substitute to use for duroplasty in primary decompressive craniectomy (PDC) for traumatic brain injury (TBI). The author's objective was to conduct a retrospective analysis comparing 2 techniques of PDC: duroplasty using anterior-based vascularized galea pericranium (VP group) with synthetic dural substitute duroplasty (SR group). METHODS From April 2015 to February 2022, 379 craniotomies were done for TBI. The outcome of eligible 97 consecutive patients receiving PDC treatment were examined. Out of 97, 60 received vascularized galea pericranium and 37 received synthetic dural graft for dural augmentation. Propensity matching generated 28 pairs (56 patients) for analysis. The primary outcome was extended Glasgow Outcome Scale (GOS-E) measured at 6 months after injury. Secondary outcomes included were incidence of surgical complications (neurosurgical site infections, and hemorrhagic and hydrodynamic complications), surgical time, days in intensive care unit, hospital length of stay, hospital mortality, and GOS-E at 1 year after injury. RESULTS Patients in VP group, compared with those in SR group had better GOS-E score at 6 months (P = .011) and 1 year (P = .026). Hospital mortality (P = .342), days in intensive care unit (P = .574), hospital stay (P = .155), surgical time (P = .131), medical and surgical complications including neurosurgical infections, and hemorrhagic and hydrodynamic complications did not differ significantly in both groups. Complication of brain abscess was found exclusively in the SR group (P = .327). CONCLUSION In this retrospective study, adults who underwent PDC for TBI using anterior-based vascularized galea pericranial graft were associated with better clinical outcomes at 6 months and 1 year compared with standard repair group using synthetic dural substitute (G patch).
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Affiliation(s)
- Mahesh Ramola
- Department of Neurosurgery, S.G.R.R. Institute of Medical & Health Sciences, Dehradun, Uttarakhand, India
| | - Monika Ramola
- Department of Gynecology and Obstetrics, S.G.R.R. Institute of Medical & Health Sciences, Dehradun, Uttarakhand, India
| | - Jagjeet Singh
- Department of Neurosurgery, S.G.R.R. Institute of Medical & Health Sciences, Dehradun, Uttarakhand, India
| | - Lavleen Khurana
- Department of Neurosurgery, S.G.R.R. Institute of Medical & Health Sciences, Dehradun, Uttarakhand, India
| | - Sarab Chhabra
- Department of Neurosurgery, S.G.R.R. Institute of Medical & Health Sciences, Dehradun, Uttarakhand, India
| | - Ritish Garg
- Department of Neurosurgery, S.G.R.R. Institute of Medical & Health Sciences, Dehradun, Uttarakhand, India
| | - Udisha Singh
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kavindra Nath
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Van Der Merwe Z, Wilton SD, Sandy-Hodgetts K. Risk factors associated with surgical site infection following orthopaedic surgery in South Africa and Sub-Saharan Africa: a scoping review protocol. J Wound Care 2024; 33:S4-S8. [PMID: 39140712 DOI: 10.12968/jowc.2024.0102] [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] [Indexed: 08/15/2024]
Abstract
OBJECTIVE The objective of the scoping review will be to understand and describe risk factors associated with surgical site infection (SSI) in an orthopaedic surgery population in Sub-Saharan Africa and South Africa. This paper describes the protocol that will be used for the scoping review. METHOD A comprehensive literature search will be conducted using MEDLINE (PubMed), CINAHL (EBSCO), Embase and Cochrane Libraries to identify articles meeting the inclusion criteria, including both published and grey literature, in order to provide a broad overview of the reported risk factors associated with patients who have undergone an orthopaedic surgery with an outcome of SSI within 90 days of a procedure. Additional studies will be sourced by exploring the reference list of included eligible studies. By using a combination of the Population, Exposure, Outcome framework, terms and synonyms related to each category, in different variations, along with Boolean operators (AND, OR, NOT) in the search strategy, identified comprehensive and relevant literature for the scoping review. RESULTS It is anticipated the results will provide a baseline of risk factors that will inform the development of a risk assessment tool for clinical use. CONCLUSION This protocol will inform the development of a scoping review to describe factors associated with SSIs following orthopaedic surgery in Sub-Saharan Africa and South Africa.
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Affiliation(s)
| | - Steve D Wilton
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Perth, Western Australia
- Perron Institute for Neurological and Translational Science, The University of Western Australia, Nedlands, Western Australia
| | - Kylie Sandy-Hodgetts
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Perth, Western Australia
- Senior Research Fellow, School of Biomedical Sciences, University of Western Australia
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Ferrari F, Tamburro R, Longo M, Brioschi FA, Auletta L, Stefanello D. Effect of cranial tibial artery laceration on radiographic bone healing and perioperative complications in dogs undergoing tibial plateau leveling osteotomy. Res Vet Sci 2024; 175:105322. [PMID: 38851052 DOI: 10.1016/j.rvsc.2024.105322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/30/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024]
Abstract
During tibial plateau leveling osteotomy (TPLO), the laceration of the cranial tibial artery (LCTA) may occur, and the ligation of the cranial tibial artery might lead to impaired blood supply to the osteotomy site. The present case-control study aimed to evaluate the effect of LCTA on TPLO healing and the occurrence of perioperative complications. The incidence and predisposing factors to LCTA were also investigated. Fourteen cases experiencing LCTA were retrospectively enrolled from medical records of two veterinary teaching hospitals (LCTA group), whereas 28 randomly selected TPLOs that did not experience LCTA were included in the control group. Signalment data, proximal tibial epiphysis conformation, osteotomy features, perioperative complications, and bone healing were compared between the two groups. Bone healing was evaluated using the modified radiographic union scale for tibial fracture and the visual analog scale. The mean incidence was 9.6%. Bodyweight was significantly higher in the LCTA group compared to the control group (P = 0.009). Dogs belonging to the LCTA groups were significantly younger (P = 0.01). Intraoperative hypotension was significantly overreported in the LCTA group (P = 0.0001). None of the other variables differed significantly between the two groups. Dogs' size seems to be a predisposing factor, with dogs weighing >15 kg having 22 times more chance of experiencing LCTA. Due to the well-developed collateral blood supply of the canine hindlimb, LCTA and the closure of the cranial tibial artery did not appear to delay the radiographic bone healing or affect the incidence of perioperative complications.
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Affiliation(s)
- Francesco Ferrari
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milano, via dell'Università 6, 29600 Lodi, Italy.
| | - Roberto Tamburro
- Department of Veterinary Medicine, University of Teramo, Località Piano d'Accio, 64100 Teramo, Italy.
| | - Maurizio Longo
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milano, via dell'Università 6, 29600 Lodi, Italy.
| | - Federica Alessandra Brioschi
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milano, via dell'Università 6, 29600 Lodi, Italy.
| | - Luigi Auletta
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milano, via dell'Università 6, 29600 Lodi, Italy.
| | - Damiano Stefanello
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milano, via dell'Università 6, 29600 Lodi, Italy.
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10
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Sahni K, Hosamani S, Ghuliani D, Baisoya S. Evaluation of Negative Pressure Dressings for Closed Surgical Incisions in Decreasing Surgical Site Infections After Emergency Laparotomy: A Randomized Controlled Study. Cureus 2024; 16:e67500. [PMID: 39310489 PMCID: PMC11416178 DOI: 10.7759/cureus.67500] [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: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
Objectives The aim of this study is to compare the effectiveness of negative pressure dressings (NPDs) versus conventional dressings for closed surgical incisions after emergency midline laparotomy, focusing on their impact on surgical site infection (SSI) rates, wound dehiscence, hospital stay duration, and cosmetic outcomes. Methods The randomized controlled study was conducted over 24 months, involving 80 patients aged 18-65 years who had peritonitis and underwent emergency midline laparotomies. Patients with diabetes mellitus, a BMI >35 kg/m², immunocompromised conditions, or those requiring re-exploration within 30 days of surgery were excluded. The participants were randomly assigned into two groups using a computer-generated randomization table: Group A, the case group, consisted of 40 patients who received NPDs, while Group B, the control group, included 40 patients who received conventional dressings. Data were recorded in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, NY, USA), with a p-value of <0.05 considered statistically significant. Results The overall occurrence of SSIs within the 30-day follow-up period was significantly lower in the NPD group compared to the conventional dressing group (30% vs. 70%, p < 0.05). The mean duration of hospital stay was 14.85 ± 10.43 days for the NPD group and 15.4 ± 9.75 days for the control group, with no statistically significant difference (p = 0.712). The mean Vancouver Scar Scale score was 5.3 ± 2.47 in the NPD group and 6.5 ± 2.14 in the control group, also showing no statistically significant difference (p = 0.11). Conclusions NPDs significantly reduced the incidence of SSIs compared to conventional dressings, but they did not have a significant impact on scar cosmesis or the duration of hospital stay.
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Affiliation(s)
- Kartik Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Deepak Ghuliani
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Shikha Baisoya
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
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11
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Serra-Aracil X, Gómez-Torres I, Torrecilla-Portoles A, Serracant-Barrera A, García-Nalda A, Pallisera-Lloveras A. Minimally invasive left colectomy with total intracorporeal anastomosis versus extracorporeal anastomosis. A single center cohort study. Stage 2b IDEAL framework for evaluating surgical innovation. Langenbecks Arch Surg 2024; 409:225. [PMID: 39028427 PMCID: PMC11271420 DOI: 10.1007/s00423-024-03387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Performing intracorporeal anastomoses in minimally invasive colon surgery appears to provide better short-term outcomes for patients with colon cancer. The aim of the study is to compare surgical aspects and short-term outcomes between intracorporeal and extracorporeal techniques in left colectomies with both laparoscopic and robotic approaches and evaluate advantages and disadvantages of intracorporeal anastomosis according to IDEAL framework (Exploration, stage 2b). METHODS This is a single center, ambispective cohort study comparing total intracorporeal anastomosis (TIA) and standard surgery with extracorporeal anastomosis (EA). Patients with colon cancer treated by left colectomy, sigmoidectomy and high anterior resection by total intracorporeal anastomosis between May 2020 and January 2023 without exclusion criteria were prospectively included in a standardized database. Short-term outcomes in the group undergoing TIA were compared with a historical EA cohort. The main assessment outcomes were intraoperative complications, postoperative morbidity according to the Clavien-Dindo scale and the comparison of pathological. We conducted a preliminary comparative study within the TIA group between approaches, a primary analysis between the two anastomotic techniques, and a propensity score matched analysis including only the laparoscopic approach, between both anastomotic techniques. RESULTS Two hundred and forty-six patients were included: 103 who underwent TIA, 35 of them with laparoscopic approach and 68 with robotic approach, and a comparison group comprising another 103 eligible consecutive patients who underwent laparoscopic EA. There were no statistically significant differences between the two groups in terms of demographic variables. No statistically significant differences were observed in anastomotic dehiscence. Intraoperative complications are fewer in the TIA group, with a higher C-Reactive Protein levels. Relevant anastomotic bleeding and the number of retrieved lymph nodes were higher in EA group. Nevertheless, no differences were observed in terms of overall morbidity. CONCLUSION Minimally invasive left colectomy with intracorporeal resection and anastomosis is technically feasible and safe suing either a laparoscopic or a robotic approach. Clinical data from this cohort demonstrate outcomes comparable to those achieved through the conventional EA procedure in relation to postoperative morbidity and oncological efficacy, with indications suggesting that the utilization of robotic-assisted techniques may play a contributing role in enhancing overall treatment outcomes.
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Affiliation(s)
- Xavier Serra-Aracil
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain.
- Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli Institute for Research and Innovation I3PT, Parc Tauli University Hospital, Sabadell, Spain.
| | - Irene Gómez-Torres
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain.
| | - Andrea Torrecilla-Portoles
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain
- Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli Institute for Research and Innovation I3PT, Parc Tauli University Hospital, Sabadell, Spain
| | - Anna Serracant-Barrera
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain
- Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli Institute for Research and Innovation I3PT, Parc Tauli University Hospital, Sabadell, Spain
| | - Albert García-Nalda
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain
- Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli Institute for Research and Innovation I3PT, Parc Tauli University Hospital, Sabadell, Spain
| | - Anna Pallisera-Lloveras
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain
- Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli Institute for Research and Innovation I3PT, Parc Tauli University Hospital, Sabadell, Spain
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12
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Bottosso S, Sidoti GB, Vita L, Scian A, Bonat Guarini L, Renzi N, Ramella V, Papa G. A Multi-Center Retrospective Observational Analysis of Three-Year Experience of Our Protocol for Prevention and Monitoring of Surgical Site Infections in Implant-Based Breast Reconstruction. Cancers (Basel) 2024; 16:2439. [PMID: 39001499 PMCID: PMC11240831 DOI: 10.3390/cancers16132439] [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: 04/26/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND With the rise in the mastectomy rate, the number of patients who choose to undergo postmastectomy reconstruction has been increasing, and implant-based procedures are the most performed methods for postmastectomy breast reconstruction. Among the possible complications, the most feared is the loss of reconstruction. It can be related to several reasons, but one of the most common is infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, increased incidence of capsular contracture, and unsatisfactory aesthetics results, with a huge psychological impact on patients. AIMS The primary intent of this study is to analyze the status of infection rates at our institution and evaluate the effectiveness of our prevention protocol since its introduction. Secondly, we compared data of the surgical site infections (SSIs) after implant-based breast reconstruction at Trieste Hospital, where the protocol has been employed since 2020, and in another center, where plastic surgeons of our team are involved, with different prevention procedures. METHODS AND RESULTS We enrolled 396 female patients, who underwent implant-based breast reconstruction, using definitive mammary implants or breast tissue expanders, with or without ADM (acellular dermal matrix), both for breast cancer and risk-reducing surgery in BRCA1/2 patients. Patients treated at the Hospital of Trieste, with the use of the prevention protocol, were considered the experimental group (group 1), while patients treated in Gorizia by the same breast team with standardized best-practice rules, but without the use of the prevention protocol, were considered the control group (group 2). Infected patients were 5 in the first group (1.7%) and 8 in the second one (7.9%), with a global infection rate of 3.2%. CONCLUSION After the introduction of our prevention protocol, we faced a lower incidence of infection after breast surgery with implants or tissue expanders.
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Affiliation(s)
- Stefano Bottosso
- Plastic Surgery Department, Ospedale di Cattinara, ASUGI, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Giulia Benedetta Sidoti
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
| | - Ludovica Vita
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
| | - Alessandro Scian
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
| | - Luigi Bonat Guarini
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
| | - Nadia Renzi
- Plastic Surgery Department, Ospedale di Cattinara, ASUGI, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Vittorio Ramella
- Plastic Surgery Department, Ospedale di Cattinara, ASUGI, Strada di Fiume, 447, 34149 Trieste, Italy
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
| | - Giovanni Papa
- Plastic Surgery Department, Ospedale di Cattinara, ASUGI, Strada di Fiume, 447, 34149 Trieste, Italy
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
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13
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Dilday J, McGillen P, Park S, Gallagher S, Lee H, Schellenberg M, Matsushima K, Inaba K, Martin MJ. Is barbed better? Evaluation of triclosan-coated barbed suture on wound complications following emergency laparotomy. J Trauma Acute Care Surg 2024; 97:149-157. [PMID: 38595220 DOI: 10.1097/ta.0000000000004341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Emergent laparotomy is associated with significant wound complications including surgical site infections (SSIs) and fascial dehiscence. Triclosan-coated barbed (TCB) suture for fascial closure has been shown to reduce local complications but primarily in elective settings. We sought to evaluate the effect of TCB emergency laparotomy fascial closure on major wound complications. METHODS Adult patients undergoing emergency laparotomy were prospectively evaluated over 1 year. Patients were grouped into TCB versus polydioxanone (PDS) for fascial closure. Subanalysis was performed on patients undergoing single-stage laparotomy. Primary outcomes were SSI and fascial dehiscence. Multivariate analysis identified independent factors associated with SSI and fascial dehiscence. RESULTS Of the 206 laparotomies, 73 (35%) were closed with TCB, and 133 (65%) were closed with PDS. Trauma was the reason for laparotomy in 73% of cases; damage-control laparotomy was performed in 27% of cases. The overall rate of SSI and fascial dehiscence was 18% and 10%, respectively. Operative strategy was similar between groups, including damage-control laparotomy, wound vac use, skin closure, and blood products. Surgical site infection events trended lower with TCB versus PDS closure (11% vs. 21%, p = 0.07), and fascial dehiscence was significantly lower with TCB versus PDS (4% vs. 14%, p < 0.05). Subanalysis of trauma and nontrauma cases showed no difference in SSI or fascial dehiscence. Multivariable analysis found that TCB decreased the likelihood of fascial dehiscence (odds ratio, 0.07; p < 0.05) following emergency laparotomy. Increased odds of fascial dehiscence were seen in damage-control laparotomy (odds ratio, 3.1; p < 0.05). CONCLUSION Emergency laparotomy fascial closure with TCB showed significantly decreased rates of fascial dehiscence compared with closure with PDS and a strong trend toward lower SSI events. Triclosan-coated barbed suture was independently associated with decreased fascial dehiscence rates after emergency laparotomy. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Joshua Dilday
- From the Division of Trauma and Acute Care Surgery (J.D.), Medical College of Wisconsin, Milwaukee, Wisconsin; and Division of Trauma and Surgical Critical Care (P.M., S.P., S.G., H.L., M.S., K.M., K.I., M.J.M.), LAC+USC Medical Center, University of Southern California, Los Angeles, California
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14
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Grabowski M, Otto R, Tammer I, Jechorek D, Ptok H, Al-Madhi S, Croner R, Meyer F. Surgical Outcome and Microbial Colonization of Standardized Smear Locations after Pancreatic Head Resection (Pylorus-Preserving Pancreatoduodenectomy, PPPD) for Chronic Pancreatitis and Pancreatic Head Carcinoma. J Clin Med 2024; 13:3810. [PMID: 38999378 PMCID: PMC11242269 DOI: 10.3390/jcm13133810] [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: 01/29/2024] [Revised: 03/29/2024] [Accepted: 04/10/2024] [Indexed: 07/14/2024] Open
Abstract
Introduction: Patients with chronic pancreatitis (CP) as well as with pancreatic head carcinoma (CA) undergo the surgical intervention named "pylorus-preserving pancreatoduodenectomy according to Traverso-Longmire (PPPD)", which allowed a comparative analysis of the postoperative courses. The hypothesis was that patients with CA would have worse general as well as immune status than patients with CP due to the severity of the tumor disease and that this would be reflected in the more disadvantageous early postoperative outcome after PPPD. Methods: With the aim of eliciting the influence of the different diagnoses, the surgical outcome of all consecutive patients who underwent surgery at the Dept. of General, Abdominal, Vascular and Transplant Surgery at the University Hospital at Magdeburg between 2002 and 2015 (inclusion criterion) was recorded and comparatively evaluated. Early postoperative outcome was characterized by general and specific complication rate indicating morbidity, mortality, and microbial colonization rate, in particular surgical site infection (SSI, according to CDC criteria). In addition, microbiological findings of swabs and cultures from all compartments as well as preoperative and perioperative parameters from patient records were retrospectively documented and used for statistical comparison in this systematic retrospective unicenter observational study (design). Results: In total, 192 cases with CA (68.1%) and 90 cases with CP (31.9%) met the inclusion criteria of this study. Surprisingly, there were similar specific complication rates of 45.3% (CA) vs. 45.6% (CP; p = 0.97) and in-hospital mortality, which differed only slightly at 3.65% (CA) vs. 3.3% (CP; p = 0.591); the overall complication rate tended to be higher for CA at 23.4% vs. 14.4% (CP; p = 0.082). Overall, potentially pathogenic germs were detected in 28.9% of all patients in CP compared to 32.8% in CA (p = 0.509), and the rate of SSI was 29.7% (CA) and 24.4% (CP; p = 0.361). In multivariate analysis, CA was found to be a significant risk factor for the development of SSI (OR: 2.025; p = 0.048); the underlying disease had otherwise no significant effect on early postoperative outcome. Significant risk factors in the multivariate analysis were also male sex for SSI and microbial colonization, and intraoperatively transfused red cell packs for mortality, general and specific complications, and surgical revisions. Conclusions: Based on these results, a partly significant, partly trending negative influence of the underlying disease CA, compared to CP, on the early postoperative outcome was found, especially with regard to SSI after PPPD. This influence is corroborated by the international literature.
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Affiliation(s)
- Max Grabowski
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University Medical School with University Hospital, 39120 Magdeburg, Germany; (M.G.); (S.A.-M.)
| | - Ronny Otto
- Institute of Quality Assurance in Operative Medicine, 39120 Magdeburg, Germany
| | - Ina Tammer
- Synlab Medical Care Center Berlin GmbH, 10829 Berlin, Germany
| | - Dörthe Jechorek
- Institute of Pathology, Otto-von-Guericke University Medical School with University Hospital, 39120 Magdeburg, Germany
| | - Henry Ptok
- Department of General and Abdominal Surgery, Municipal Hospital (“Ernst-von Bergmann-Klinikum”), 14467 Potsdam, Germany
| | - Sara Al-Madhi
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University Medical School with University Hospital, 39120 Magdeburg, Germany; (M.G.); (S.A.-M.)
| | - Roland Croner
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University Medical School with University Hospital, 39120 Magdeburg, Germany; (M.G.); (S.A.-M.)
| | - Frank Meyer
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University Medical School with University Hospital, 39120 Magdeburg, Germany; (M.G.); (S.A.-M.)
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15
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Brady S, Mott A, Carlisle K, Abhishek A, Adamson J, Coates L, van Duren B, Emery P, Goodman SM, Hewitt C, Li J, Mandefield L, Parkinson G, Marzo-Ortega H, Maxwell J, Nanchahal J, Rangan A, Richards D, Ronaldson S, Shepherd S, Taylor J, Wilkinson JM, Pandit H, Mankia KS. PERI-operative biologic DMARD management: Stoppage or COntinuation during orthoPaEdic operations (the PERISCOPE trial) - a study protocol for a pragmatic, UK multicentre, superiority randomised controlled trial with an internal pilot, economic evaluation and nested qualitative study. BMJ Open 2024; 14:e084997. [PMID: 38910007 PMCID: PMC11328622 DOI: 10.1136/bmjopen-2024-084997] [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: 02/02/2024] [Accepted: 05/01/2024] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION Biological disease-modifying antirheumatic drugs (bDMARDs) have revolutionised the treatment of inflammatory arthritis (IA). However, many people with IA still require planned orthopaedic surgery to reduce pain and improve function. Currently, bDMARDs are withheld during the perioperative period due to potential infection risk. However, this predisposes patients to IA flares and loss of disease control. The question of whether to stop or continue bDMARDs in the perioperative period has not been adequately addressed in a randomised controlled trial (RCT). METHODS AND ANALYSIS PERISCOPE is a multicentre, superiority, pragmatic RCT investigating the stoppage or continuation of bDMARDs. Participants will be assigned 1:1 to either stop or continue their bDMARDs during the perioperative period. We aim to recruit 394 adult participants with IA. Potential participants will be identified in secondary care hospitals in the UK, screened by a delegated clinician. If eligible and consenting, baseline data will be collected and randomisation completed. The primary outcome will be the self-reported PROMIS-29 (Patient Reported Outcome Measurement Information System) over the first 12 weeks postsurgery. Secondary outcome measures are as follows: PROMIS - Health Assessment Questionnaire (PROMIS-HAQ), EQ-5D-5L, Disease activity: generic global Numeric Rating Scale (patient and clinician), Self-Administered Patient Satisfaction scale, Health care resource use and costs, Medication use, Surgical site infection, delayed wound healing, Adverse events (including systemic infections) and disease-specific outcomes (according to IA diagnosis). The costs associated with stopping and continuing bDMARDs will be assessed. A qualitative study will explore the patients' and clinicians' acceptability and experience of continuation/stoppage of bDMARDs in the perioperative period and the impact postoperatively. ETHICS AND DISSEMINATION Ethical approval for this study was received from the West of Scotland Research Ethics Committee on 25 April 2023 (REC Ref: 23/WS/0049). The findings from PERISCOPE will be submitted to peer-reviewed journals and feed directly into practice guidelines for the use of bDMARDs in the perioperative period. TRIAL REGISTRATION NUMBER ISRCTN17691638.
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Affiliation(s)
- Samantha Brady
- Department of Health Sciences, University of York, York, UK
| | - Andrew Mott
- Department of Health Sciences, University of York, York, UK
| | - Katie Carlisle
- Department of Health Sciences, University of York, York, UK
| | | | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - Laura Coates
- NDORMS, Oxford Brookes University Faculty of Health and Life Sciences, Oxford, UK
| | - Bernard van Duren
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds NIHR Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Susan Marion Goodman
- Cornell University Joan and Sanford I Weill Medical College, New York City, New York, USA
| | | | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | | | | | - Helena Marzo-Ortega
- Leeds NIHR Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Maxwell
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Amar Rangan
- Department of Health Sciences, University of York, York, UK
- University of Oxford, Oxford, UK
| | | | | | - Susan Shepherd
- Leeds NIHR Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, York, UK
| | | | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Chapel Allerton Hospital, Leeds, UK
| | - Kulveer Singh Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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16
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Woelfle CA, Shah RP, Neuwirth AL, Herndon CL, Levine WN, Cooper HJ. 2-Octyl-Cyanoacrylate Mesh Dressings for Total Joint Arthroplasty: Dressing Design Influences Risks of Wound Complications. J Arthroplasty 2024:S0883-5403(24)00650-8. [PMID: 38914145 DOI: 10.1016/j.arth.2024.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Recent liquid adhesive skin closure systems with a mesh patch and a 2-octyl cyanoacrylate liquid formula have shown promising results in total joint arthroplasty. Chemical accelerators are typically included to promote the rapid polymerization of 2-octyl cyanoacrylate. The goal of the study is to distinguish designs and wound complication differences between 2 similar systems. METHODS An 18-week retrospective study was conducted from July to December 2023, including 207 total hip arthroplasty and 212 total knee arthroplasty cases from 4 attending surgeons at 1 institution that used 1 of 2 dressing designs. Both dressings had a 2-octyl cyanoacrylate liquid adhesive formula that applied topically to a polyester-based mesh overlaying the wound. Mesh A (used in 274 cases) included an accelerator, a quaternary ammonium salt, on the mesh patch, whereas Mesh B (used in 145 cases) included a similar accelerator within the adhesive applicator. RESULTS Wound complications (3.2 versus 7.6%; X2 = 3.86; df = 1; P = .049), early periprosthetic joint infections (0 versus 2.8%; X2 = 7.63; df = 1; P = .006), and 90-day reoperations for wound complications (0.4 versus 3.4%; X2 = 6.39; df = 1; P = .011) were significantly lower in patients who received Mesh A versus B, respectively. There was no difference in superficial surgical site infections (0.7 versus 0%; X2 = 1.06; df = 1; P = .302) or allergy rates (3.3 versus 4.1%; X2 = 0.12; df = 1; P = .655) between Mesh A and B. CONCLUSIONS We observed significantly different performance in wound complications, early postoperative periprosthetic joint infections, and 90-day reoperation between the 2 designs. Having the accelerator in the applicator rather than on the mesh patch may lead to premature polymerization before bonding appropriately with the mesh to create the desired wound closure and seal. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Catelyn A Woelfle
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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17
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Pizza F, Maida P, Bertoglio C, Antinori A, Mongardini FM, Cerbara L, Sordelli I, Alampi BD, Marte G, Morini L, Grimaldi S, Gili S, Docimo L, Gambardella C. Two-meshes approach in posterior component separation with transversus abdominis release: the IMPACT study (Italian Multicentric Posterior-separation Abdominal Complex hernia Transversus-release). Hernia 2024; 28:871-881. [PMID: 38568350 DOI: 10.1007/s10029-024-03001-3] [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: 12/19/2023] [Accepted: 02/20/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Surgical management of large ventral hernias (VH) has remained a challenge. Various techniques like anterior component separation and posterior component separation (PCS) with transversus abdominis release (TAR) have been employed. Despite the initial success, the long-term efficacy of TAR is not yet comprehensively studied. Authors aimed to investigate the early-, medium-, and long-term outcomes and health-related quality of life (QoL) in patients treated with PCS and TAR. METHODS This multicenter retrospective study analyzed data of 308 patients who underwent open PCS with TAR for primary or recurrent complex abdominal hernias between 2015 and 2020. The primary endpoint was the rate of hernia recurrence (HR) and mesh bulging (MB) at 3, 6, 12, 24, and 36 months. Secondary outcomes included surgical site events and QoL, assessed using EuraHS-QoL score. RESULTS The average follow-up was 38.3 ± 12.7 months. The overall HR rate was 3.5% and the MB rate was 4.7%. Most of the recurrences were detected by clinical and ultrasound examination. QoL metrics showed improvement post-surgery. CONCLUSIONS This study supports the long-term efficacy of PCS with TAR in the treatment of large and complex VH, with a low recurrence rate and an improvement in QoL. Further research is needed for a more in-depth understanding of these outcomes and the factors affecting them.
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Affiliation(s)
- F Pizza
- Asl Napoli2 Nord Department of Surgery, Hospital 'Rizzoli', Naples, Italy.
| | - P Maida
- Casa Di Cura Privata Malzoni, Surgery Avellino, Campania, Italy
| | - C Bertoglio
- Division of General Surgery, ASST Ovest Milanese, Hospital of Magenta, 20013, Magenta, Italy
| | - A Antinori
- U.O.C. Di Chirurgia Generale 1 Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - F M Mongardini
- Division of General, Mininvasive and Bariatric Surgery, Campania 'Luigi Vanvitelli', Naples, Italy
| | - L Cerbara
- Institute for Research On Population and Social Policies, National Research Council of Italy, Rome, Italy
| | - I Sordelli
- Casa Di Cura Privata Malzoni, Surgery Avellino, Campania, Italy
| | - B D Alampi
- ASST GOM NIGUARDA, Chirurgia Generale Oncologica e Mininvasiva, Milan, Italy
| | - G Marte
- Ospedale del Mare Aslnapoli1, Naples, Italy
| | - L Morini
- ASST GOM NIGUARDA, Chirurgia Generale Oncologica e Mininvasiva, Milan, Italy
| | - S Grimaldi
- ASST GOM NIGUARDA, Chirurgia Generale Oncologica e Mininvasiva, Milan, Italy
| | - S Gili
- Asl Napoli3 Sud Department of Surgery, Hospital 'San Leonardo', Castellammare, Italy
| | - L Docimo
- Division of General, Mininvasive and Bariatric Surgery, Campania 'Luigi Vanvitelli', Naples, Italy
| | - C Gambardella
- Division of General, Mininvasive and Bariatric Surgery, Campania 'Luigi Vanvitelli', Naples, Italy
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Beckmann A, Poehlmann M, Mayr P, Krane M, Boehm J. The Burden of Obesity in Cardiac Surgery: A 14 years' Follow-Up of 14.754 Patients. J Obes 2024; 2024:5564810. [PMID: 38779349 PMCID: PMC11111293 DOI: 10.1155/2024/5564810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Aims The prevalence of obesity is rapidly increasing during the past decades. While previous research has focused on the early outcome after cardiac surgery or specific complications, the current study covers the whole burden of obesity in the field of cardiac surgery over short term and long term. Endpoints of the study were all-cause mortality, perioperative outcome, and wound-healing disorders (WHDs). Methods 14.754 consecutive patients who underwent cardiac surgery over a 14 years' time period were analyzed. BMI classifications were used according to the WHO definition. Results Mean survival was 11.95 years ± 0.1; CI 95% [12.04-12.14]. After adjustment for clinical baseline characteristics, obesity classes' I-III (obesity) did not affect 30-day mortality or all-cause mortality during the whole observational period. After adjustment for known risk factors, the risk for WHDs doubled at least in obesity patients as follows: obesity I (OR = 2.06; CI 95% [1.7-2.5]; p < 0.0001), obesity II (OR = 2.5; CI 95% [1.83-3.41]; p < 0.0001), and obesity III (OR = 4.12; CI 95% [2.52-6.74]; p < 0.0001). The same applies to the risk for sternal reconstruction that is substantially elevated in obesity I (OR = 2.23; CI 95% [1.75-2.83]; p < 0.0001), obesity II (OR = 2.81; CI 95% [1.91-4.13]; p < 0.0001), and obesity III (OR = 2.31; CI 95% [1.08-4.97]; p=0.03). No significant correlation could be found between obesity and major adverse events in the perioperative course like renal failure, ventilation >24 h, re-exploration, or cerebrovascular events. Conclusions Cardiac surgery is safe in obesity as short- and long-term mortality are not increased, and major adverse events during the perioperative course are similar to control patients. The burden of obesity lies in substantially increased rates of wound-healing disorders and sternal reconstructions.
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Affiliation(s)
- Alexander Beckmann
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Lazarettstrasse 36, Munich 80636, Germany
| | - Maximilian Poehlmann
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Lazarettstrasse 36, Munich 80636, Germany
| | - Patrick Mayr
- Institute for Cardiac Anesthesiology, German Heart Center Munich, Munich, Germany
| | - Markus Krane
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Lazarettstrasse 36, Munich 80636, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Johannes Boehm
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Lazarettstrasse 36, Munich 80636, Germany
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19
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Holze M, Loos M, Hüttner F, Tenckhoff S, Feisst M, Knebel P, Klotz R, Mehrabi A, Michalski C, Pianka F. Cavitron ultrasonic surgical aspirator (CUSA) compared with conventional pancreatic transection in distal pancreatectomy: study protocol for the randomised controlled CUSA-1 pilot trial. BMJ Open 2024; 14:e082024. [PMID: 38637127 PMCID: PMC11029322 DOI: 10.1136/bmjopen-2023-082024] [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: 11/12/2023] [Accepted: 03/08/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) remains the most common and serious complication after distal pancreatectomy. Many attempts at lowering fistula rates have led to unrewarding insignificant results as still up to 30% of the patients suffer from clinically relevant POPF. Therefore, the development of new innovative methods and procedures is still a cornerstone of current surgical research.The cavitron ultrasonic surgical aspirator (CUSA) device is a well-known ultrasound-based parenchyma transection method, often used in liver and neurosurgery which has not yet been thoroughly investigated in pancreatic surgery, but the first results seem very promising. METHODS The CUSA-1 trial is a randomised controlled pilot trial with two parallel study groups. This single-centre trial is assessor and patient blinded. A total of 60 patients with an indication for open distal pancreatectomy will be intraoperatively randomised after informed consent. The patients will be randomly assigned to either the control group with conventional pancreas transection (scalpel or stapler) or the experimental group, with transection using the CUSA device. The primary safety endpoint of this trial will be postoperative complications ≥grade 3 according to the Clavien-Dindo classification. The primary endpoint to investigate the effect will be the rate of POPF within 30 days postoperatively according to the ISGPS definition. Further perioperative outcomes, including postpancreatectomy haemorrhage, length of hospital stay and mortality will be analysed as secondary endpoints. DISCUSSION Based on the available literature, CUSA may have a beneficial effect on POPF occurrence after distal pancreatectomy. The rationale of the CUSA-1 pilot trial is to investigate the safety and feasibility of the CUSA device in elective open distal pancreatectomy compared with conventional dissection methods and gather the first data on the effect on POPF occurrence. This data will lay the groundwork for a future confirmatory multicentre randomised controlled trial. ETHICS AND DISSEMINATION The CUSA-1 trial protocol was approved by the ethics committee of the University of Heidelberg (No. S-098/2022). Results will be published in an international peer-reviewed journal and summaries will be provided in lay language to study participants and their relatives. TRIAL REGISTRATION NUMBER DRKS00027474.
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Affiliation(s)
- Magdalena Holze
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- SDGC, The Study Centre of the German Surgical Society, Heidelberg, Germany
| | - Martin Loos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Hüttner
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Nürnberg, Nurnberg, Germany
| | - Solveig Tenckhoff
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- SDGC, The Study Centre of the German Surgical Society, Heidelberg, Germany
| | - Manuel Feisst
- Institute for Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Rosa Klotz
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- SDGC, The Study Centre of the German Surgical Society, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christoph Michalski
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Frank Pianka
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- SDGC, The Study Centre of the German Surgical Society, Heidelberg, Germany
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Pecorelli N, Guarneri G, Vallorani A, Limongi C, Licinio AW, Di Salvo F, Crippa S, Partelli S, Balzano G, Falconi M. Recovery of health-related quality of life after laparoscopic versus open distal pancreatectomy. Surg Endosc 2024; 38:327-338. [PMID: 37759144 DOI: 10.1007/s00464-023-10453-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Limited data comparing recovery of health-related quality of life (HRQoL) after laparoscopic (LDP) versus open distal pancreatectomy (ODP) are available. The aim of this study was to assess the impact of laparoscopy on postoperative HRQOL after DP using the Patient-Reported Outcomes Measurement Information System (PROMIS). METHODS Data from consecutive patients who underwent DP (2020-2022) enrolled in a prospective clinical trial were reviewed. Patients completed PROMIS-29 plus 2 profile preoperatively, at postoperative day (POD) 15, 30, 90, and 180. Linear regression analysis adjusting for confounders including preoperative PROMIS scores, age, gender, ASA score, diagnosis, and multivisceral resection was used to estimate mean between-group differences (MD) in postoperative PROMIS domains T scores. RESULTS Overall, 202 patients (118 laparoscopic, 86 open) underwent DP (median age 66 years, pancreatic cancer 41%, multivisceral resection 10%, median LOS 6 days). At POD15, LDP was associated with higher physical function (MD 5.6) and participation in social roles and activities scores (MD 3.8), reduced fatigue (MD - 2.7) and sleep disturbance (MD - 3.8) compared to ODP. At POD30, LDP patients had higher physical function (MD 5.2) and participation in social roles and activities scores (MD 6.0), reduced fatigue (MD - 3.5), and anxiety (MD - 4.0) compared to ODP. No between-group differences were found in HRQoL domains at POD90 and 180. Six months after surgery, the proportions of patients who had not recovered to preoperative physical function, participation in social roles and activities, fatigue, pain interference, sleep disturbance, cognitive function, depression, and anxiety were 31%, 31%, 28%, 20%, 15%, 14%, 8%, and 7%, respectively. CONCLUSIONS According to PROMIS, LDP resulted in improved physical and social functioning and reduced anxiety and fatigue up to 30 days after surgery compared to ODP. At 6 months after surgery, recovery of physical domains is still incomplete in up to 30% of patients.
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Affiliation(s)
- Nicolò Pecorelli
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Giovanni Guarneri
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | | | | | | | - Francesca Di Salvo
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Stefano Crippa
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Partelli
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Gianpaolo Balzano
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Massimo Falconi
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Huang H, Shi J, Zheng M, Su S, Chen W, Ming J, Ren T, Qu D. Pathogen detection in suspected spinal infection: metagenomic next-generation sequencing versus culture. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4220-4228. [PMID: 37237239 DOI: 10.1007/s00586-023-07707-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/21/2023] [Accepted: 04/06/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE The aim is to compare the pathogen detection performance of metagenomic next-generation sequencing (mNGS) and the culturing of percutaneous needle biopsy samples obtained from an individual with a suspected spinal infection. METHODS A retrospective study of 141 individuals with a suspected spinal infection was conducted, and mNGS was performed. The microbial spectra and detection performance between mNGS and the culturing-based method were compared, and the effects of antibiotic intervention and biopsy on the detection performance were assessed. RESULTS The microorganisms isolated most commonly via the culturing-based method were Mycobacterium tuberculosis (n = 21), followed by Staphylococcus epidermidis (n = 13). The most common microorganisms detected via mNGS were Mycobacterium tuberculosis complex (MTBC) (n = 39), followed by Staphylococcus aureus (n = 15). The difference in the type of detected microorganisms between culturing and mNGS was observed only in Mycobacterium (P = 0.001). mNGS helped identify potential pathogens in 80.9% of cases, which was significantly higher than the positivity rate of 59.6% observed for the culturing-based method (P < 0.001). Moreover, mNGS had a sensitivity of 85.7% (95% CI, 78.4% to 91.3%), a specificity of 86.7% (95% CI, 59.5% to 98.3%), and sensitivity gains of 35% (85.7% vs. 50.8%; P < 0.001) during culturing, while no differences were observed in the specificity (86.7% vs. 93.3%; P = 0.543). In addition, antibiotic interventions significantly lowered the positivity rate of the culturing-based method (66.0% vs. 45.5%, P = 0.021) but had no effects on the results of mNGS (82.5% vs. 77.3%, P = 0.467). CONCLUSION The use of mNGS could result in a higher detection rate compared to that observed with the culturing-based method in an individual with spinal infection and is particularly valuable for evaluating the effects of a mycobacterial infection or previous antibiotic intervention.
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Affiliation(s)
- Haihong Huang
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiawei Shi
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Minghui Zheng
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Orthopaedic Surgery, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shenghui Su
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weidong Chen
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Ming
- Department of Anesthesiology, Nan Fang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Tao Ren
- Department of Orthopaedic Surgery, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dongbin Qu
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
- Department of Orthopaedic Surgery, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Marzoug OA, Anees A, Malik EM. Assessment of risk factors associated with surgical site infection following abdominal surgery: a systematic review. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2023; 5:e000182. [PMID: 37529828 PMCID: PMC10387634 DOI: 10.1136/bmjsit-2023-000182] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/20/2023] [Indexed: 08/03/2023] Open
Abstract
Objective Surgical site infections (SSIs) are among the most common healthcare-associated infections occurring following 1%-3% of all surgical procedures. Their rates are the highest following abdominal surgery. They are still associated with increased morbidity and healthcare costs despite the advancement in the medical field. Many risk factors for SSIs following abdominal surgery have been identified. The aim of this study is to comprehensively assess these risk factors as published in peer-reviewed journals. Design A systematic review was conducted with accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Setting The databases for search were PubMed and Cochrane Library, in addition to reference lists. Studies were retrieved and assessed for their quality. Data were extracted in a designed form, and a stratified synthesis of data was conducted to report the significant risk factors. Participants Patients undergoing general abdominal surgery. Intervention The intervention of general abdominal surgery. Main outcome measures To identify and assess the risk factors for SSI following abdominal surgery. Results Literature search yielded 813 articles, and the final screening process identified 11 eligible studies. The total number of patients is 11 996. The rates of SSI ranged from 4.09% to 26.7%. Nine studies were assessed to be of high quality, the remaining two studies have moderate quality. Stratified synthesis of data was performed for risk factors using summary measures (OR/risk ratio, 95% CI, and p value). Male sex and increased body mass index (BMI) were identified as significant demographic risk factors, and long operative time was among the major significant procedure-related risk factors. Conclusions Male sex, increased BMI, diabetes, smoking, American Society of Anesthesiologists classification of >2, low albumin level, low haemoglobin level, preoperative hospital stay, long operative time, emergency procedure, open surgical approach, increased wound class, intraoperative blood loss, perioperative infection, perioperative blood transfusion, and use of drains are potential independent risk factors for SSI following abdominal surgery.
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Affiliation(s)
- Omer A Marzoug
- Department of Anatomy, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ahmed Anees
- Department of Anatomy, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Elfatih M Malik
- Department of Community Medicine, University of Khartoum, Khartoum, Sudan
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Nayan A, Sarang B, Khajanchi M, Roy N, Jesudian G, Menon N, Patil M, Kataria R, Manoharan R, Tongaonkar R, Dev Y, Gadgil A. Exploring the perioperative infection control practices & incidence of surgical site infections in rural India. Antimicrob Resist Infect Control 2023; 12:65. [PMID: 37422654 PMCID: PMC10329309 DOI: 10.1186/s13756-023-01258-4] [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: 01/31/2022] [Accepted: 05/29/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) affect around a third of patients undergoing surgeries worldwide, annually. It is heterogeneously distributed with a higher burden in low and middle-income countries. Although rural and semi-urban hospitals cater to 60-70% of the Indian population, scarce data regarding SSI rates are available from such hospitals. The study aimed to determine the prevalent SSI prevention practices and existing SSI rates in the smaller rural and semi-urban hospitals in India. METHODS This is a prospective study performed in two phases involving surgeons and their hospitals from Indian rural and semi-urban regions. In the first phase, a questionnaire was administered to surgeons enquiring into the perioperative SSI prevention practices and five interested hospitals were recruited for phase two which documented the rate of SSIs and factors affecting them. RESULTS There was full compliance towards appropriate perioperative sterilisation practices and postoperative mop count practice at the represented hospitals. But prophylactic antimicrobials were continued in the postoperative period in more than 80% of the hospitals. The second phase of our study documented an overall SSI rate of 7.0%. The SSI rates were influenced by the surgical wound class with dirty wounds recording six times higher rate of infection than clean cases. CONCLUSIONS SSI prevention practices and protocols were in place in all the less-resourced hospitals surveyed. The SSI rates are comparable or lower than other LMIC settings. However, this is accompanied by poor implementation of the antimicrobial stewardship guidelines.
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Affiliation(s)
- Anveshi Nayan
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Bhakti Sarang
- Department of Surgery, Terna Medical College & Hospital, New Mumbai, India
- WHO Collaboration Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Monty Khajanchi
- WHO Collaboration Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
- Department of Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Nobhojit Roy
- WHO Collaboration Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India.
- Dept of Global Public Health, Karolinska Institute, Stockholm, Sweden.
| | - Gnanaraj Jesudian
- Association of Rural Surgeons of India, Chennai, India
- International Federation of Rural Surgeons, Tiruchirappalli, India
| | - Nandakumar Menon
- Department of Surgery, ASHWINI Gudalur Adivasi Hospital, Gudalur, Nilgiris, Tamil Nadu, India
| | - Mulki Patil
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, India
| | - Raman Kataria
- Department of Surgery, Jan Swasthya Sahyog, Bilaspur, Chattisgarh, India
| | - Ravikumar Manoharan
- Department of Surgery, Tribal Health Initiative, Sittilingi, Tamilnadu, India
| | - Rajesh Tongaonkar
- Department of Surgery, Dr Tongaonkar Hospital, Dondaicha, Dhule, India
| | - Ya Dev
- Department of Surgery, Government Medical College, Kollam, Kerala, India
| | - Anita Gadgil
- WHO Collaboration Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
- Department of Surgery, BARC Hospital, Mumbai, India
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24
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OKAZAWA YU, KOJIMA YUTAKA, TAKEHARA KAZUHIRO, NOJIRI SHOUKO, AMEMIYA KOTA, TSUCHIYA YUKI, HONJO K, TAKAHASHI R, KAWAI MASAYA, SUGIMOTO KIICHI, TAKAHASHI MAKOTO, SAKAMOTO KAZUHIRO. Study of Purse-string Skin Closure Plus Negative-pressure Wound Therapy for Stoma Closure. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:599-605. [PMID: 39081383 PMCID: PMC11284288 DOI: 10.14789/jmj.jmj22-0015-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/29/2022] [Indexed: 08/02/2024]
Abstract
Background Although purse-string skin closure (PSC) is an effective method for stoma closure considering wound infection, the period for scarring will be prolonged. The aim of this study was to assess whether negative-pressure wound therapy (NPWT) can reduce the wound-scarring period for PSC after stoma closure. Methods Patients who underwent stoma closure between January 2015 and August 2020 at our department were retrospectively assessed. Patients in the control group received only PSC, and patients in the NPWT group received both PSC and NPWT using the VAC® or PICO®. The primary endpoint of this study was the short-term reduction ratio (RR). The RR is calculated by the length, width, and depth of the wound of the stoma closure site. The secondary endpoints were scarring period and wound-related complications such as surgical site infection, dermatitis, bleeding, enterocutaneous fistula, and ventral hernia. Results Of the 53 patients included in this study, 21 had their stoma closed by PSC and 32 had their stoma closed by PSC plus NPWT. No significant differences were observed in patient characteristics or peri-operative states. The RR in the NPWT group was significantly smaller than that in the PSC group at 7 postoperative days (p=0.04). There was no difference in scarring period between the two groups (p=0.11).The rates of postoperative wound-related complications were similar in the two groups (control group: 4 (19%), NPWT group: 7 (21.9%), p=1.0). Conclusions Our study suggests that PSC plus NPWT might be more effective for wound healing after stoma closure than only PSC.
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Affiliation(s)
- YU OKAZAWA
- Corresponding author: Yu Okazawa, Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, TEL: +81-3-3813-3111 FAX: +81-3-3813-0731 E-mail:
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25
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Ametejani M, Masoudi N, Homapour F, Rezaei S, Moosavi SA, Kafili E, Heidarlou AJ. Association between Pre-Operative 25-Hydroxy Vitamin D Deficiency and Surgical Site Infection after Right Hemicolectomy Surgery. Surg Infect (Larchmt) 2022; 23:829-833. [PMID: 36219723 DOI: 10.1089/sur.2022.122] [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: 11/12/2022] Open
Abstract
Background: Surgical site infection (SSI) is one of the most important and costly complications of surgical operations. The present study hypothesized that vitamin D deficiency is associated with an increased risk of SSI, and this current study investigated this hypothesis. Patients and Methods: A prospective cohort study was performed with adult patients undergoing open right hemicolectomy operation with stapled anastomosis between February 2018 and March 2021 in the surgery ward of Imam Khomeini hospital. A logistic regression test examined and analyzed the connection between serum 25-OH vitamin D levels and post-operative wound infections. Results: This study comprised 315 participants who met the inclusion criteria. Pre-operative serum vitamin D levels were <30 ng/mL in 107 participants (34%) and ≥30 ng/mL in 208 participants (66%). The mean serum vitamin D level was 35.66 ± 13.26 ng/mL among the study population. Increased vitamin D deficiency was linked with elevated odds of surgical wound infection incidence among the patients after surgery (odds ratio [OR], 5.49; 95% confidence interval [CI], 2.06-14.6; p = 0.001). Conclusions: Pre-operative vitamin D level strongly affects post-operative SSI in patients with colon cancer. This study highlighted the importance of conducting further research to determine the possible advantages of vitamin D in preventing incision infection after surgery.
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Affiliation(s)
- Morteza Ametejani
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| | - Naser Masoudi
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| | - Farhad Homapour
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seifollah Rezaei
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| | - Seyed Amin Moosavi
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| | - Ehsan Kafili
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| | - Ali Jafari Heidarlou
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
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Zwaans JJM, Raven W, Rosendaal AV, Van Lieshout EMM, Van Woerden G, Patka P, Haagsma JA, Rood PPM. Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial. Emerg Med J 2022; 39:650-654. [PMID: 35882525 DOI: 10.1136/emermed-2021-211540] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with traumatic wounds frequently present to the ED. Literature on whether to treat these wounds sterile or non-sterile is sparse. Non-sterile treatment has the advantage of saving resources and costs, and could be of value in health settings where sterile materials are not readily available. Our objective was to compare the rate of wound infection after suturing traumatic lacerations with non-sterile gloves and dressings versus sterile gloves, dressings and drapes in the ED. We hypothesised that non-sterile gloves and dressings would be non-inferior to sterile gloves, dressings and drapes. The non-inferiority margin was set at 2%. METHODS A multicentre single-blinded randomised controlled trial testing for non-inferiority of non-sterile gloves and dressings versus sterile gloves, dressings and drapes for suturing of traumatic wounds was performed in 3 EDs in The Netherlands. Adults with uncomplicated wounds were included from July 2012 to December 2016. At the time of treatment, patient and wound characteristics and management were documented. The outcome was wound infection, which was identified during follow-up in the treating ED at 5-14 days postprocedure. RESULTS From 2468 eligible patients, 1480 were randomised in a sterile (n=747) or non-sterile (n=733) protocol. Baseline characteristics were similar in both study arms. The observed wound infection rate in the non-sterile group was 5.7% (95% CI 4.0% to 7.5%) vs 6.8% (95% CI 5.1% to 8.8%) in the sterile group. The mean difference of the wound infection rate of the two groups was -1.1% (95% CI -3.7% to 1.5%). CONCLUSION Although recruitment ceased prior to reaching our planned sample size, the findings suggest that there is unlikely to be a large difference between the non-sterile gloves, dressings and sterile gloves, dressings and drapes for suturing of traumatic wounds in the ED. TRIAL REGISTRATION NUMBER NL 34798.078.11, NTR3541.
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Affiliation(s)
- Juliette J M Zwaans
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wouter Raven
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur V Rosendaal
- Department of Emergency Medicine, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Geesje Van Woerden
- Department of Emergency Medicine, Haaglanden Medisch Centrum, Den Haag, The Netherlands
| | - Peter Patka
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Pleunie P M Rood
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Microbiological Profile and Drug Resistance Analysis of Postoperative Infections following Orthopedic Surgery: A 5-Year Retrospective Review. Adv Orthop 2022; 2022:7648014. [PMID: 35832198 PMCID: PMC9273459 DOI: 10.1155/2022/7648014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background The distribution of postoperative orthopedic infection and their susceptibility pattern to antibiotics vary regionally and change over time. The incidence of methicillin-resistant Staphylococcus aureus infection is rising worldwide. Therefore, knowledge of the frequency of the causative microorganisms and their susceptibility to antibiotics are necessary for an improved therapeutic outcome. This study aims to study the frequency and distribution of postoperative orthopedic infection and their resistance pattern to antibiotics. Methods The study utilized a retrospective design that took place over a period of 5 years from 2016 and 2020 at a tertiary care hospital. The bacterial culture testing was performed by a recommended method. Descriptive statistics were used to analyze the data. Results A total of 158 patients (100 males and 58 females) with positive cultures of postoperative orthopedic infection were included. The most common infective organism was Staphylococcus aureus, 64 patients (38.1%); coagulase-negative staphylococci, 40 patients (23.8%); Klebsiella species, 14 patients (8.3%); and Enterococcus species, Escherichia coli, and Pseudomonas aeruginosa in 10 patients (6%). Data also showed that gram-positive bacteria were detected in 118 patients (70.8%), while gram-negative microorganisms were found in 50 patients (29.8%). Among Staphylococcus aureus, 79.7% were MRSA, and vancomycin was the most effective antibiotic in staphylococcus infections. The antibiotics with the greatest sensitivity to gram-positive bacteria were vancomycin, linezolid, tigecycline, moxifloxacin, and nitrofurantoin, while the antibiotics for gram-negative bacteria with greater sensitivity were tigecycline, amikacin, ertapenem, imipenem, and cefotaxime. Conclusion Staphylococcus aureus is the most common postoperative orthopedic infection, which was predominantly MRSA with vancomycin being the most effective antibiotic. In addition, the results showed a high resistance pattern to the commonly used antibiotics, leaving few choices. Antibiotic agents should be carefully selected according to specific drug sensitivity through routine monitoring of drug resistance patterns and to help formulate hospital antibiotic policy.
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Wijeysundera DN, Alibhai SMH, Ladha KS, Puts MTE, Chesney TR, Daza JF, Ehtesham S, Hladkowicz E, Lebovic G, Mazer CD, van Vlymen JM, Wei AC, McIsaac DI. Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults. BMJ Open 2022; 12:e062524. [PMID: 35732384 PMCID: PMC9226941 DOI: 10.1136/bmjopen-2022-062524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Older adults prioritise surviving surgery, but also preservation of their functional status and quality of life. Current approaches to measure postoperative recovery, which focus on death, complications and length of hospitalisation, may miss key relevant domains. We propose that postoperative disability is an important patient-centred outcome to measure intermediate-to-long recovery after major surgery in older adults. METHODS AND ANALYSIS The Functional Improvement Trajectories After Surgery (FIT After Surgery) study is a multicentre cohort study of 2000 older adults (≥65 years) having major non-cardiac surgery. Its objectives are to characterise the incidence, trajectories, risk factors and impact of new significant disability after non-cardiac surgery. Disability is assessed using WHO Disability Assessment Schedule (WHODAS) 2.0 instrument and participants' level-of-care needs. Disability assessments occur before surgery, and at 1, 3, 6, 9 and 12 months after surgery. The primary outcome is significantly worse WHODAS score or death at 6 months after surgery. Secondary outcomes are (1) significantly worse WHODAS score or death at 1 year after surgery, (2) increased care needs or death at 6 months after surgery and (3) increased care needs or death at 1 year after surgery. We will use multivariable logistic regression models to determine the association of preoperative characteristics and surgery type with outcomes, joint modelling to characterise longitudinal time trends in WHODAS scores over 12 months after surgery, and longitudinal latent class mixture models to identify clusters following similar trajectories of disability. ETHICS AND DISSEMINATION The FIT After Surgery study has received research ethics board approval at all sites. Recruitment began in December 2019 but was placed on hold in March 2020 because of the COVID-19 pandemic. Recruitment was gradually restarted in October 2020, with 1-year follow-up expected to finish in 2023. Publication of the primary results is anticipated to occur in 2024.
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Affiliation(s)
- Duminda N Wijeysundera
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Internal Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karim S Ladha
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Tyler R Chesney
- Division of General Surgery, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julian F Daza
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sahar Ehtesham
- Applied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Emily Hladkowicz
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Gerald Lebovic
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - C David Mazer
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Janet M van Vlymen
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alice C Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
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Persson A, Atroshi I, Tyszkiewicz T, Hailer N, Lazarinis S, Eisler T, Brismar H, Mukka S, Kernell PJ, Mohaddes M, Sköldenberg O, Gordon M. EPOS trial: the effect of air filtration through a plasma chamber on the incidence of surgical site infection in orthopaedic surgery: a study protocol of a randomised, double-blind, placebo-controlled trial. BMJ Open 2022; 12:e047500. [PMID: 35115346 PMCID: PMC8814745 DOI: 10.1136/bmjopen-2020-047500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is controversy regarding the importance of air-transmitted infections for surgical site infections (SSIs) after orthopaedic surgery. Research has been hindered by both the inability in blinding the exposure, and by the need for recruiting large enough cohorts. The aim of this study is to investigate whether using a new form of air purifier using plasma air purification (PAP) in operating rooms (ORs) lowers the SSI rate or not. METHODS AND ANALYSIS Multicentre, double-blind, cluster-randomised, placebo-controlled trial conducted at seven hospitals in 2017-2022. All patients that undergo orthopaedic surgery for minimum 30 min are included. Intervention group: patients operated in OR with PAP devices turned on. CONTROL GROUP patients operated in OR with PAP devices turned off. Randomisation: each OR will be randomised in periods of 4 weeks, 6 weeks or 8 weeks to either have the devices on or off. PRIMARY OUTCOME any SSI postoperatively defined as a composite endpoint of any of the following: use of isoxazolylpenicillin, clindamycin or rifampicin for 2 days or more, International Classification of Diseases codes or Nordic Medico-Statistical Committee codes indicating postoperative infection. In a second step, we will perform a chart review on those patients with positive indicators of SSI to further validate the outcome. Secondary outcomes are described in the Methods section. Power: we assume an SSI rate of 2%, an SSI reduction rate of 25% and we need approximately 45 000 patients to attain a power of 80% at a significance level of 0.05. ETHICS AND DISSEMINATION The study is approved by the Swedish Ethical Review Authority. The interim analysis results from the study will be presented only to the researchers involved unless the study thereafter is interrupted for whatever reason. Publication in a medical journal will be presented after inclusion of the last patient. TRIAL REGISTRATION NUMBER NCT02695368.
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Affiliation(s)
- Anders Persson
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
| | - Isam Atroshi
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Hässleholm-Kristianstad Hospitals, Kristianstad, Sweden
| | - Thomas Tyszkiewicz
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Hässleholm-Kristianstad Hospitals, Kristianstad, Sweden
| | - Nils Hailer
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - Stergios Lazarinis
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - Thomas Eisler
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
| | - Harald Brismar
- Department of Clinical Science Intervention and Technology, Karolinska Institute, Huddinge, Sweden
- Department of Orthopaedics and Biotechnology, Karolinska Universitetsjukhuset i Huddinge, Huddinge, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
- Umeå University Hospital, Umeå, Sweden
| | - Per-Juan Kernell
- GHP Ortho Center Stockholm, Löwenströmska Hospital, Upplands Väsby, Sweden
| | - Maziar Mohaddes
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University Of Gothenburg, Gothenburg, Sweden
| | - Olof Sköldenberg
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
| | - Max Gordon
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
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Boll G, Callas P, Bertges DJ. Meta-analysis of prophylactic closed-incision negative pressure wound therapy for vascular surgery groin wounds. J Vasc Surg 2022; 75:2086-2093.e9. [PMID: 34999218 DOI: 10.1016/j.jvs.2021.12.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Previous meta-analysis of randomized control trials evaluating the efficacy of closed incision negative pressure wound therapy (ciNPWT) on vascular surgery groin wounds reported a reduction in surgical site infections (SSI). Our aim was to perform a comprehensive, updated meta-analysis after the largest multicenter randomized control trial (RCT) on the subject to date reported no benefit of ciNPWT. METHODS A systematic review identified RCTs that compared the primary outcome of incidence of postoperative SSIs of groin incisions treated with ciNPWT or standard dressings. Secondary outcomes included wound dehiscence, composite incidence of seroma / lymph leak / hematoma, need for reoperation, in-hospital mortality, need for readmission and hospital length of stay. Odds ratios were compared across studies using random effects meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias tool, Harbord test and trim-and-fill analysis. RESULTS Eight RCTs comprised of 1125 incisions (n = 555 [49.3%] ciNPT, n = 570 [50.7%] control) were included. RCTs included 3 studies inside and 5 outside of the United States. ciNPWT was associated with a significant reduction in rate of SSIs (OR 0.39; 95% CI 0.24-0.63; p < 0.001). There was no significant difference in rate of wound dehiscence (OR 1.11, 95% CI 0.67-1.83, p = 0.68), composite incidence of seroma, lymph leak or hematoma (OR 0.49, 95% CI 0.13-1.76, p= 0.27), need for reoperation (OR 0.68, 95% CI 0.40-1.16, p = 0.16), or need for readmission (OR 0.60, 95% CI 0.30-1.21, p = 0.15). It was not possible to quantitatively evaluate in-hospital mortality or hospital length of stay. Risk of bias assessment identified high risk of bias regarding participant blinding in all studies, low risk in randomization and outcome reporting, and variability between studies in other methodologies. There was no evidence of publication bias. CONCLUSIONS Meta-analysis of pooled data suggest prophylactic use of ciNPWT for vascular groin incisions is associated with reduced rates of SSIs, with the greatest benefits seen in trials with higher baseline rates of infection in the control group.
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Affiliation(s)
- Griffin Boll
- Department of Surgery, University of Vermont Medical Center, Burlington, VT
| | - Peter Callas
- Medical Biostatistics, University of Vermont, Burlington, VT
| | - Daniel J Bertges
- Department of Surgery, University of Vermont Medical Center, Burlington, VT.
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Jung JH, Jeon YR, Song JH, Chung S. Antibiotic use in nasal bone fracture: a single-center retrospective study. Arch Craniofac Surg 2022; 22:319-323. [PMID: 34974687 PMCID: PMC8721428 DOI: 10.7181/acfs.2021.00535] [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: 10/22/2021] [Accepted: 12/14/2021] [Indexed: 11/11/2022] Open
Abstract
Background Prophylactic antibiotics are used to prevent surgical wound infection; however, proper indications must be followed with careful consideration of the risks and benefits, especially in clean or clean-contaminated wounds. Nasal bone fractures are the most common type of facial bone fracture. The most common method for treating nasal bone fracture is closed reduction, which is performed inside the nasal cavity without an incision. The purpose of this study was to determine the need for antibiotic use in the closed reduction of nasal bone fractures. Methods A retrospective study was conducted using data from the National Insurance Service Ilsan Hospital of the Republic of Korea between 2016 and 2018. The records of patients who underwent closed reduction of nasal bone fracture were reviewed and classified according to sex, age, comorbidities, perioperative antibiotic usage, postoperative complications, nasal packing, anesthesia type, surgeon’s specialty, and operation time. Results Among the 373 patients studied, the antibiotic prescription rate was 67.3%. Just 0.8% of patients were prescribed preoperative antibiotics only, 44.0% were prescribed postoperative antibiotics only, and 22.5% were prescribed both preoperative and postoperative antibiotics. There were no cases that satisfied the definition of “surgical site infection.” Furthermore, 2.1% of infection-related complications (e.g., mucosal swelling, synechia, and anosmia) occurred only in the antibiotic usage group. The use of nasal packing, anesthesia type, and surgeon’s specialty did not show any difference in infection-related complication rates. Conclusion According to the study findings, the routine use of perioperative antibiotics is not recommended in uncomplicated nasal bone fracture surgery.
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Affiliation(s)
- Ji Hyuk Jung
- Department of Plastic and Reconstructive Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yeo Reum Jeon
- Department of Plastic and Reconstructive Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Joon Ho Song
- Department of Plastic and Reconstructive Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seum Chung
- Department of Plastic and Reconstructive Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Ernest EC, Hellar A, Varallo J, Tibyehabwa L, Bertram MM, Fitzgerald L, Katoto A, Mshana S, Simba D, Gwitaba K, Boddu R, Alidina S, Giiti G, Kihunrwa A, Balandya B, Urassa D, Hussein Y, Damien C, Wackenreuter B, Barash D, Morrison M, Reynolds C, Christensen A, Makuwani A. Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention. BMJ Glob Health 2021; 6:e006788. [PMID: 34876458 PMCID: PMC8655579 DOI: 10.1136/bmjgh-2021-006788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/01/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Despite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs). METHODS We conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15. RESULTS The SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions. CONCLUSION Our findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.
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Affiliation(s)
| | | | | | | | | | | | - Adam Katoto
- JHPIEGO, Dar es Salaam, Tanzania, United Republic of
| | - Stella Mshana
- JHPIEGO, Dar es Salaam, Tanzania, United Republic of
| | - Dorcas Simba
- JHPIEGO, Dar es Salaam, Tanzania, United Republic of
| | | | - Rohini Boddu
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Geofrey Giiti
- Department of Surgery, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania, United Republic of
| | - Albert Kihunrwa
- Department of Obstetrics and Gynaecology, Bugando Medical Centre, Mwanza, Tanzania, United Republic of
| | - Belinda Balandya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - David Urassa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Yahya Hussein
- President Office Regional Authority and Local Government, Dar es Salaam, Tanzania, United Republic of
| | - Caroline Damien
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania, United Republic of
| | | | - David Barash
- Developing Health Globally, GE Foundation, Fairfield, Connecticut, USA
| | - Melissa Morrison
- The ELMA Philanthropies Services (U.S.), New York, New York, USA
| | | | | | - Ahmed Makuwani
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania, United Republic of
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Domecky P, Rejman Patkova A, Mala-Ladova K, Maly J. Inflammatory blood parameters as prognostic factors for surgical site infection after primary hip or knee arthroplasty: a systematic review protocol. BMJ Open 2021; 11:e046027. [PMID: 34548343 PMCID: PMC8458324 DOI: 10.1136/bmjopen-2020-046027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Surgical site infection (SSI) is a potential complication of surgical procedure. SSI after implant surgery is a disaster both for patients and surgeons. Although predictive tools for SSI are available, none of them estimate early infection based on inflammatory blood parameters. The inflammatory process can be measured using several parameters including interleukin-6, C reactive protein, neutrophil to lymphocyte ratio, white cell count, erythrocyte sedimentation rate or procalcitonin. This systematic review aims to determine whether inflammatory blood parameters could be used as significant predictive factors for SSI after primary hip or knee arthroplasty. METHODS AND ANALYSIS A systematic review of randomised controlled trials, cross-sectional studies, case-control studies and cohort studies, published in English, will be searched in the following electronic bibliographic databases: MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials and Web of Science. Studies performed in adult patients of all ages who underwent knee or hip arthroplasty, studies containing data on the risk/prognostic factors for preknee or postknee or hip arthroplasty SSI and studies with a minimum follow-up of 30 days after surgery will be included. A standardised form will be used to extract data from the included studies comprising study characteristics, participant characteristics, details of the intervention, study methodology and outcomes. Quality Assessment of Diagnostic Accuracy tool, second version, and Standards for Reporting of Diagnostic Accuracy Studies checklist will be used to assess risk of bias. Heterogeneity will be assessed using Cochran χ² statistic and I2 statistics where applicable. Grading of Recommendations Assessment, Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance will be used to report findings. ETHICS AND DISSEMINATION No ethics approval is required. The findings will be disseminated at national and international scientific sessions, also to be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020147925.
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Affiliation(s)
- Petr Domecky
- Department of Social and Clinical Pharmacy, Charles University Faculty of Pharmacy in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Anna Rejman Patkova
- Department of Social and Clinical Pharmacy, Charles University Faculty of Pharmacy in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Charles University Faculty of Pharmacy in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Josef Maly
- Department of Social and Clinical Pharmacy, Charles University Faculty of Pharmacy in Hradec Kralove, Hradec Kralove, Czech Republic
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Luwang AL, Saha PK, Rohilla M, Sikka P, Saha L, Gautam V. Chlorhexidine-alcohol versus povidone-iodine as preoperative skin antisepsis for prevention of surgical site infection in cesarean delivery-a pilot randomized control trial. Trials 2021; 22:540. [PMID: 34404473 PMCID: PMC8369632 DOI: 10.1186/s13063-021-05490-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives To compare the efficacy of chlorhexidine–alcohol and povidone–iodine as preoperative antiseptic skin preparation for prevention of surgical site infection (SSI) after cesarean delivery (CD). Materials and methods A total of 311 eligible women who underwent CS were recruited in the study after fulfilling all the eligibility and exclusion criteria. Patients were randomized into two groups (153 in chlorhexidine–alcohol group and 158 in povidone–iodine group) by a computer-generated randomization table. Patients were followed for a period of 30 days in postoperative period to monitor for SSI. Results The rate of SSI in the chlorhexidine–alcohol group is 5.4% and that of the povidone–iodine group is 8.6%. E. coli, K. pneumoniae, and Acinetobacter baumannii were the most common organisms isolated. E. coli was found in 9.5% of the total SSI cases. Conclusions The study found that the patients who received chlorhexidine–alcohol as skin antiseptic had less chance of developing SSI than those who received povidone–iodine; however, it did not reach a statistical significance. Trial registration Clinical Trials Registry of India CTRI/2018/05/014294. Registered on May 31, 2018
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Affiliation(s)
- Athokpam Lenin Luwang
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India
| | - Pradip Kumar Saha
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India.
| | - Minakshi Rohilla
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India
| | - Lekha Saha
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India
| | - Vikas Gautam
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India
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Akın M, Topaloğlu S, Özel H, Avşar FM, Akın T, Polat E, Karabulut E, Hengirmen S. Awareness and wound assesment decrease surgical site infections. Turk J Surg 2021. [DOI: 10.47717/turkjsurg.2021.5059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine prac- ticality of SSI risk assessment methods (SENIC and NNIS) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure and evaluation of the contribution of wound assesment to the reduction of wound infection.
Material and Methods: Patients were followed with a prospective data chart through four year. Correlation of SENIC and NNIS together with ASEPSIS were performed.
Results: During the study period, 275 SSI occurred. SSIs were determined within the 21 days-period after operations. Correlation between SENIC with ASEPSIS (rs= 0.41, p< 0.001) was found better than that for NNIS with ASEPSIS (rs= 0.37, p< 0.001). Type of operation (emergency vs. elective), body mass index, operation class and American Society of Anesthesiologists scores were found independently predictive factors for SSI. The forth year SSI rate was found to be significantly lower than the other years (p< 0.001).
Conclusion: This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS method. In addi- tion, surgical wound assesment and awarness of the wound infection rates, have decreased the SSI rates over the years.
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Probst P, Schuh F, Dörr-Harim C, Sander A, Bruckner T, Klose C, Rossion I, Nickel F, Müller-Stich BP, Mehrabi A, Hackert T, Büchler MW, Diener MK. Protocol for a randomised controlled trial to compare postoperative complications between minimally invasive and open DIStal PAnCreaTectomy (DISPACT-2 trial). BMJ Open 2021; 11:e047867. [PMID: 33619204 PMCID: PMC7903091 DOI: 10.1136/bmjopen-2020-047867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In recent years, minimally invasive distal pancreatectomy (MIDP) has been used with increasing frequency to accelerate patient recovery. Distal pancreatectomy has an overall morbidity rate of 30%-40%. The known advantages of minimally invasive techniques must be rigorously compared with those of open surgery before they can be completely implemented into clinical practice. METHODS AND ANALYSIS DISPACT-2 is a multicentre randomised controlled trial comparing minimally invasive (conventional laparoscopic or robotic assisted) with open distal pancreatic resection in patients undergoing elective surgery for benign as well as malign diseases of the pancreatic body and tail. After screening for eligibility and obtaining informed consent, a total of 294 adult patients will be preoperatively randomised in a 1:1 ratio. The primary hypothesis is that MIDP is non-inferior to open distal pancreatectomy in terms of postoperative mortality and morbidity expressed as the Comprehensive Complication Index (CCI) within 3 months after index operation, with a non-inferiority margin of 7.5 CCI points. Secondary endpoints include pancreas-specific complications, oncological safety and patient reported outcomes. Follow-up for each individual patient will be 2 years. ETHICS AND DISSEMINATION The DISPACT-2 trial has been approved by the Ethics Committee of the medical faculty of Heidelberg University (S-693/2017). Results of the primary endpoint will be available in 2024 and will be published at national and international meetings. Full results will be made available in an open access, peer-reviewed journal. The website www.dispact.de contains up-to-date information regarding the trial. TRIAL REGISTRATION NUMBER DRKS00014011.
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Affiliation(s)
- Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- The Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Fabian Schuh
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- The Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Colette Dörr-Harim
- The Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Anja Sander
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Inga Rossion
- The Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus K Diener
- The Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Heidelberg, Germany
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Taherpour N, Mehrabi Y, Seifi A, Eshrati B, Hashemi Nazari SS. Epidemiologic characteristics of orthopedic surgical site infections and under-reporting estimation of registries using capture-recapture analysis. BMC Infect Dis 2021; 21:3. [PMID: 33397322 PMCID: PMC7784323 DOI: 10.1186/s12879-020-05687-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/07/2020] [Indexed: 12/05/2022] Open
Abstract
Background Surgical Site Infections (SSIs) are among the leading causes of the postoperative complications. This study aimed at investigating the epidemiologic characteristics of orthopedic SSIs and estimating the under-reporting of registries using the capture-recapture method. Methods This study, which was a registry-based, cross-sectional one, was conducted in six educational hospitals in Tehran during a one-year period, from March, 2017 to March, 2018. The data were collected from two hospital registries (National Nosocomial Infection Surveillance System (NNIS) and Health Information Management database (HIM)). First, all orthopedic SSIs registered in these sources were used to perform capture-recapture (N = 503). Second, 202 samples were randomly selected to assess patients` characteristics. Results Totally, 76.24% of SSIs were detected post-discharge. Staphylococcus aureus (11.38%) was the most frequently detected bacterium in orthopedic SSIs. The median time between the detection of a SSI and the discharge was 17 days. The results of a study done on 503 SSIs showed that the coverage of NNIS and HIM was 59.95 and 65.17%, respectively. After capture-recapture estimation, it was found that about 221 of orthopedic SSIs were not detected by two sources among six hospitals and the real number of SSIs were estimated to be 623 ± 36.58 (95% CI, 552–695) and under-reporting percentage was 63.32%. Conclusion To recognize the trends of SSIs mortality and morbidity in national level, it is significant to have access to a registry with minimum underestimated data. Therefore, according to the weak coverage of NNIS and HIM among Iranian hospitals, a plan for promoting the national Infection Prevention and Control (IPC) programs and providing updated protocols is recommended.
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Affiliation(s)
- Niloufar Taherpour
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Seifi
- Department of Infectious Diseases, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Eshrati
- Center for Preventive Medicine, Department of Social Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Evin Ave, Tehran, Postal code: 198353-5511, Iran.
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Ebogo Titus N, Nzinga J, Nchufor N, Njuma T, Ntih L, Sena G, Pisoh C. Epidemiology of surgical site infection following abdominal surgeries at a reference hospital in North-West Cameroon. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2021; 11:1-6. [PMID: 35983259 PMCID: PMC9380788 DOI: 10.4103/jwas.jwas_51_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
Abstract
Background: Aim: Materials and Methods: Results: Conclusion:
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Evaluation of risk factors for surgical site infection after cesarean section. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.797459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sandy-Hodgetts K, Parsons R, Norman R, Fear MW, Wood FM, White SW. Effectiveness of negative pressure wound therapy in the prevention of surgical wound complications in the cesarean section at-risk population: a parallel group randomised multicentre trial-the CYGNUS protocol. BMJ Open 2020; 10:e035727. [PMID: 33077559 PMCID: PMC7574944 DOI: 10.1136/bmjopen-2019-035727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Caesarean delivery is steadily becoming one of the more common surgical procedures in Australia with over 100 000 caesarean sections performed each year. Over the last 10 years in Australia, the caesarean section rate has increased from 28% in 2003 to 33% in 2013. On the international stage, the Australian caesarean delivery rates are higher than the average for the Organisation for Economic Co-operation and Development, Australia ranked as 8 out of 33 and is second to the USA. Postoperative surgical site infections (SSIs) and wound complications are the most common and costly event following a caesarean section. Globally, complication rates following a caesarean delivery vary from 4.9% to 9.8%. Complications such as infection and wound breakdown affect the postpartum mother's health and well-being, and contribute to healthcare costs for clinical management that often spans the acute, community and primary healthcare settings. Published level one studies using advanced wound dressings in the identified 'at-risk' population prior to surgery for prophylactic intervention are yet to be forthcoming. METHODS AND ANALYSIS A parallel group randomised control trial of 448 patients will be conducted across two metropolitan hospitals in Perth, Western Australia, which provide obstetric and midwifery services. We will recruit pregnant women in the last trimester, prior to their admission into the healthcare facility for delivery of their child. We will use a computer-generated block sequence to randomise the 448 participants to either the interventional (negative pressure wound therapy (NPWT) dressing, n=224) or comparator arm (non-NPWT dressing, n=224). The primary outcome measure is the occurrence of surgical wound dehiscence (SSWD) or SSI. The Centres for Disease Control reporting definition of either superficial or deep infection at 30 days will be used as the outcome measure definition. SWD will be classified as per the World Union of Wound Healing Societies grading system (grade I-IV). We will assess recruitment rate, and adherence to intervention and follow-up. We will assess the potential effectiveness of NPWT in the prevention of postpartum surgical wound complications at three time points during the study; postoperative days 5, 14 and 30, after which the participant will be closed out of the trial. We will use statistical methods to determine efficacy, and risk stratification will be conducted to determine the SWD risk profile of the participant. Follow-up at day 30 will assess superficial and deep infection, and wound dehiscence (grade I-IV) and the core outcome data set for wound complications. This study will collect health-related quality of life (European Quality of Life 5-Dimensions 5-Level Scale), mortality and late complications such as further surgery with a cost analysis conducted. The primary analysis will be by intention-to-treat. This clinical trial protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and the Consolidated Standards of Reporting Trials guidelines. ETHICS AND DISSEMINATION Ethics approval was obtained through St John of God Health Care (HREC1409), Western Australia Department of Health King Edward Memorial Hospital (HREC3111). Study findings will be published in peer-reviewed journals and presented at international conferences. We used the SPIRIT checklist when writing our study protocol. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry (ACTRN12618002006224p).
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Affiliation(s)
- Kylie Sandy-Hodgetts
- Skin Integrity Research Institute, School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Richard Parsons
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Richard Norman
- School of Public Health, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona M Wood
- Fiona Stanley and Princess Margaret Hospitals, Burns Service of Western Australia, Perth, Western Australia, Australia
| | - Scott W White
- Department of Obstetrics and Gynaecology, The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
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Galvain T, Chitnis A, Paparouni K, Tong C, Holy CE, Giannoudis PV. The economic burden of infections following intramedullary nailing for a tibial shaft fracture in England. BMJ Open 2020; 10:e035404. [PMID: 32847903 PMCID: PMC7451536 DOI: 10.1136/bmjopen-2019-035404] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Determine the impact of infections on direct costs and healthcare resource use in England for patients undergoing intramedullary nailing (IMN) for tibial shaft fractures. DESIGN Non-concurrent cohort based on retrospectively collected data with 2-year follow-up. SETTING England. PARTICIPANTS The study population included adult patients (≥18 years) in England with a diagnosis of tibial shaft fracture (International Classification of Diseases-10, S822) in the inpatient setting between May 2003 and June 2017 followed by a procedure for IMN for tibial shaft fracture within 30 days. Patient data were derived from the Clinical Practice Research Datalink linked to National Health Service Hospital Episode Statistics datasets. PRIMARY INDEPENDENT VARIABLE Infection. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was total inpatient costs from index stay admission through 1 year of follow-up. Secondary outcome included cumulative total healthcare costs, and resource utilisation at 30 days, 90 days, 1 year and 2 years. RESULTS Overall, 805 patients met the inclusion criteria. At index inpatient stay, 3.7% had a post-IMN infection, rising to 11.7% at 1 year. One-year inpatient costs were 80% higher for patients with infection (p<0.001). Total costs were estimated to be £14 756 (95% CI £13 123 to £16 593) for patients with infection versus £8279 (95% CI £7946 to £8626). Length of stay (LOS), readmission and reoperation were the key drivers of healthcare costs (all p<0.001). After adjustment, LOS was higher by 109% (95% CI 62% to 169%), from 10.5 days to 21.9 days, for patients with infection. The odds of being readmitted or requiring reoperation were higher by 5.18 times (95% CI 3.01 to 9.13) and 2.47 times (95% CI 1.48 to 4.09), respectively, for patients with infection versus those without infection. CONCLUSIONS Post-IMN infection significantly increases inpatient costs, LOS, readmissions and reoperations associated with tibial fracture fixation. Healthcare burden could be reduced through novel surgical site infection prevention strategies.
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Affiliation(s)
- Thibaut Galvain
- Department of Health Economics and Market Access, Johnson and Johnson Medical Devices, Issy-les-Moulineaux, France
| | - Abhishek Chitnis
- Department of Real World Analytics and Research, Johnson and Johnson Medical Devices, New Brunswick, New Jersey, USA
| | - Konstantina Paparouni
- Department of Health Economics and Market Access, DePuy Synthes, Zuchwil, Switzerland
| | - Cindy Tong
- Department of Health Economics and Market Access, Johnson and Johnson Medical Devices, Somerville, New Jersey, USA
| | - Chantal E Holy
- Department of Real World Analytics and Research, Johnson and Johnson Medical Devices, New Brunswick, New Jersey, USA
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
- School of Medicine, University of Leeds, Leeds, West Yorkshire, UK
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Mulder T, Kluytmans-van den Bergh M, Vlaminckx B, Roos D, de Smet AM, de Vos Tot Nederveen Cappel R, Verheijen P, Brandt A, Smits A, van der Vorm E, Bathoorn E, van Etten B, Veenemans J, Weersink A, Vos M, van 't Veer N, Nikolakopoulos S, Bonten M, Kluytmans J. Prevention of severe infectious complications after colorectal surgery using oral non-absorbable antimicrobial prophylaxis: results of a multicenter randomized placebo-controlled clinical trial. Antimicrob Resist Infect Control 2020; 9:84. [PMID: 32539786 PMCID: PMC7294517 DOI: 10.1186/s13756-020-00745-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Surgical site infections (SSIs) are common complications after colorectal surgery. Oral non-absorbable antibiotic prophylaxis (OAP) can be administered preoperatively to reduce the risk of SSIs. Its efficacy without simultaneous mechanical cleaning is unknown. METHODS The Precaution trial was a double-blind, placebo-controlled randomized clinical trial conducted in six Dutch hospitals. Adult patients who underwent elective colorectal surgery were randomized to receive either a three-day course of preoperative OAP with tobramycin and colistin or placebo. The primary composite endpoint was the incidence of deep SSI or mortality within 30 days after surgery. Secondary endpoints included both infectious and non-infectious complications at 30 days and six months after surgery. RESULTS The study was prematurely ended due to the loss of clinical equipoise. At that time, 39 patients had been randomized to active OAP and 39 to placebo, which reflected 8.1% of the initially pursued sample size. Nine (11.5%) patients developed the primary outcome, of whom four had been randomized to OAP (4/39; 10.3%) and five to placebo (5/39; 12.8%). This corresponds to a risk ratio in the intention-to-treat analysis of 0.80 (95% confidence interval (CI) 0.23-2.78). In the per-protocol analysis, the relative risk was 0.64 (95% CI 0.12-3.46). CONCLUSIONS Observational data emerging during the study provided new evidence for the effectiveness of OAP that changed both the clinical and medical ethical landscape for infection prevention in colorectal surgery. We therefore consider it unethical to continue randomizing patients to placebo. We recommend the implementation of OAP in clinical practice and continuing monitoring of infection rates and antibiotic susceptibilities. TRIAL REGISTRATION The PreCaution trial is registered in the Netherlands Trial Register under NL5932 (previously: NTR6113) as well as in the EudraCT register under 2015-005736-17.
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Affiliation(s)
- Tessa Mulder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marjolein Kluytmans-van den Bergh
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, The Netherlands
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | - Bart Vlaminckx
- Department of Medical Microbiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Daphne Roos
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Anne Marie de Smet
- Department of Intensive Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Paul Verheijen
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Alexandra Brandt
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anke Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Eric van der Vorm
- Department of Medical Microbiology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Erik Bathoorn
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boudewijn van Etten
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacobien Veenemans
- Department of Medical Microbiology, Admiraal de Ruyter Hospital, Goes, the Netherlands
| | - Annemarie Weersink
- Department of Medical Microbiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Margreet Vos
- Department of Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nils van 't Veer
- Department of Clinical Pharmacy, Amphia Hospital, Breda, The Netherlands
| | - Stavros Nikolakopoulos
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Medical Microbiology, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Jan Kluytmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands.
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Zhou ZF, Fang JB, Wang HF, He Y, Yu YJ, Xu Q, Ge YF, Zhang MZ, Hu SF. Effects of intraoperative PEEP on postoperative pulmonary complications in high-risk patients undergoing laparoscopic abdominal surgery: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e028464. [PMID: 31672709 PMCID: PMC6830676 DOI: 10.1136/bmjopen-2018-028464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Postoperative pulmonary complications (PPCs), strongly associated with higher mortality risk, can develop in up to 58% of patients undergoing abdominal surgery. More and more evidence shows that the use of a lung-protective ventilation strategy has a lung protection effect in patients undergoing abdominal surgery, however, the role of positive end-expiratory pressure (PEEP) during the intraoperative period in preventing PPCs for laparoscopic surgery is not clearly defined. METHODS AND ANALYSIS A total of 208 patients with a high risk of PPC, undergoing laparoscopic abdominal surgery, will be enrolled and randomised into a standard PEEP (6-8 cm H2O) group and a low PEEP (≤2 cm H2O) group. Both groups will receive a fraction of inspired oxygen of 0.50 and a tidal volume of 8 mL/kg ideal body weight (IBW). Standard perioperative fluid management and analgesic treatments are applied in both groups. The primary end point is PPC within 7 days after surgery. Secondary end points are the modified Clinical Pulmonary Infection Score, postoperative extrapulmonary complications, postoperative surgical complications, intensive care unit length of stay, hospital length of stay, 30-day mortality. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medicine College) (registration number KY2018026) on 22 October 2018. The first participant was recruited on 15 April 2019 and the estimated completion date of the study is October 2021. The results of this trial will be submitted to a peer-reviewed journal. TRIAL REGISTRATION NUMBER http://www.chictr.org.cn, ID: ChiCTR1800019865. Registered on 2 December 2018; preresults.
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Affiliation(s)
- Zhen-Feng Zhou
- Department of Anesthesiology, Zhejiang Provincial People,s Hospital (People,s Hospital of Hangzhou Medicine College), Hangzhou, China
| | - Jun-Biao Fang
- Department of Anesthesiology, Zhejiang Provincial People,s Hospital (People,s Hospital of Hangzhou Medicine College), Hangzhou, China
| | - Hong-Fa Wang
- Department of Anesthesiology, Zhejiang Provincial People,s Hospital (People,s Hospital of Hangzhou Medicine College), Hangzhou, China
| | - Ying He
- Department of Anesthesiology, Zhejiang Provincial People,s Hospital (People,s Hospital of Hangzhou Medicine College), Hangzhou, China
| | - Yong-Jian Yu
- Department of Anesthesiology, Zhejiang Provincial People,s Hospital (People,s Hospital of Hangzhou Medicine College), Hangzhou, China
| | - Qiong Xu
- Department of Anesthesiology, Zhejiang Provincial People,s Hospital (People,s Hospital of Hangzhou Medicine College), Hangzhou, China
| | - Yun-Fen Ge
- Department of Anesthesiology, Zhejiang Provincial People,s Hospital (People,s Hospital of Hangzhou Medicine College), Hangzhou, China
| | - Miao-Zun Zhang
- General Surgery, Ningbo Medical center Lihuili Hospital, Ningbo, China
| | - Shuang-Fei Hu
- Department of Anesthesiology, Zhejiang Provincial People,s Hospital (People,s Hospital of Hangzhou Medicine College), Hangzhou, China
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Xu H, Yu L, Li Y, Gong Z. Prolonged surgical duration, higher body mass index and current smoking increases risk of surgical site infection after intra-articular fracture of distal femur. ANZ J Surg 2019; 89:723-728. [PMID: 31087540 DOI: 10.1111/ans.15263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/31/2019] [Accepted: 04/04/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND This study aimed to investigate incidence of surgical site infection (SSI) following the surgery of intra-articular fractures of distal femur. METHODS Between July 2014 and December 2017, inpatient medical records of consecutive patients who had intra-articular fractures of distal femur treated by open reduction and plate/screw fixation were inquired to identify whether they had a SSI. After discharge, patients who had a SSI and were readmitted for treatment of SSI were also allocated to the case group. Univariate and multivariate logistic regression analyses were performed to determine whether some clinical factors were independently associated with SSI, after adjustment for confounding variables. RESULTS During the study period, 434 patients were evaluated and 21 patients were confirmed to develop a SSI, indicating the accumulated incidence of 4.8% within 1 year. A total of six deep and 15 superficial SSIs were identified, with respective incidence being 1.4% and 3.4%. The most common causative pathogen was Staphylococcus aureus (8, 50.0%), followed by mixed bacteria (5, 31.3%). Open fracture, prolonged surgical duration, increased body mass index and current smoking were identified as independent risk factors for development of SSI (P < 0.05). CONCLUSIONS It should be noted that it was likely difficult to modify these risk factors, but they do prove useful for preoperative counselling of patients and their relatives regarding their own risk profile of SSI, and the perioperative medical optimization.
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Affiliation(s)
- Hang Xu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lili Yu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yansen Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Foot and Ankle Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhixin Gong
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Nelson G, Bakkum-Gamez J, Kalogera E, Glaser G, Altman A, Meyer LA, Taylor JS, Iniesta M, Lasala J, Mena G, Scott M, Gillis C, Elias K, Wijk L, Huang J, Nygren J, Ljungqvist O, Ramirez PT, Dowdy SC. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. Int J Gynecol Cancer 2019; 29:651-668. [PMID: 30877144 DOI: 10.1136/ijgc-2019-000356] [Citation(s) in RCA: 391] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery. METHODS A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. CONCLUSIONS The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.
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Affiliation(s)
- Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jamie Bakkum-Gamez
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eleftheria Kalogera
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Gretchen Glaser
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Alon Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jolyn S Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria Iniesta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Javier Lasala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Scott
- Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, Virginia, USA
| | - Chelsia Gillis
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Elias
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lena Wijk
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jeffrey Huang
- Department of Anesthesiology, Oak Hill Hospital, Brooksville, Florida, USA
| | - Jonas Nygren
- Departments of Surgery and Clinical Sciences, Ersta Hospital and Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Chida K, Watanabe J, Suwa Y, Suwa H, Momiyama M, Ishibe A, Ota M, Kunisaki C, Endo I. Risk factors for incisional surgical site infection after elective laparoscopic colorectal surgery. Ann Gastroenterol Surg 2019; 3:202-208. [PMID: 30923790 PMCID: PMC6422835 DOI: 10.1002/ags3.12229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) is a common morbidity in patients undergoing colorectal surgery, and the focus of previous studies has primarily been on incisional SSI. Most reports thus far have focused on open surgery rather than on laparoscopic colorectal surgery (Lap CR). Therefore, the aim of the present study was to identify the risk factors for incisional SSI in patients undergoing elective Lap CR. METHODS This retrospective study was conducted to evaluate the occurrence and risk factors of incisional SSI for elective Lap CR. From January 2008 to June 2018, 1825 consecutive patients with a preoperative diagnosis of colorectal cancer who underwent Lap CR were analyzed at a single institution. RESULTS Incidence of incisional SSI was 3.3%. Postoperative hospital stay (days) was significantly longer in the incisional SSI group than in the non-incisional SSI group (8 [6-12] vs 10 [8-19], P < 0.001). Incisional SSI were significantly associated with five operative factors: blood loss (g) (P < 0.014), midline wound length (mm) (P = 0.038), suture materials (P = 0.014), suture technique (interrupted vs continuous mass closure, P = 0.003), and organ/space SSI (P = 0.041). Multivariate analysis showed that continuous mass closure (odds ratio 0.290; 95% confidence interval 0.101-0.831, P = 0.021) was the only factor independently associated with the incidence of incisional SSI. CONCLUSIONS Incidence of incisional SSI was comparable to that in previous reports. Continuous mass closure decreased the risk of incisional SSI in elective Lap CR.
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Affiliation(s)
- Keigo Chida
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Jun Watanabe
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Yusuke Suwa
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Hirokazu Suwa
- Department of SurgeryYokosuka Kyosai HospitalYokosukaJapan
| | | | - Atsushi Ishibe
- Department of Gastroenterological SurgeryGraduate School of MedicineYokohama City UniversityYokohamaJapan
| | - Mitsuyoshi Ota
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Chikara Kunisaki
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Itaru Endo
- Department of Gastroenterological SurgeryGraduate School of MedicineYokohama City UniversityYokohamaJapan
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Childs C, Wright N, Willmott J, Davies M, Kilner K, Ousey K, Soltani H, Madhuvrata P, Stephenson J. The surgical wound in infrared: thermographic profiles and early stage test-accuracy to predict surgical site infection in obese women during the first 30 days after caesarean section. Antimicrob Resist Infect Control 2019; 8:7. [PMID: 30637101 PMCID: PMC6323776 DOI: 10.1186/s13756-018-0461-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/27/2018] [Indexed: 01/04/2023] Open
Abstract
Background Prophylactic antibiotics are commonly prescribed intra-operatively after caesarean section birth, often at high doses. Even so, wound infections are not uncommon and obesity increases the risk. Currently, no independent wound assessment technology is available to stratify women to low or high risk of surgical site infection (SSI).Study Aim: to investigate the potential of non-invasive infrared thermography (IRT), performed at short times after surgery, to predict later SSI. Methods IRT was undertaken in hospital on day 2 with community follow up (days 7, 15, 30) after surgery. Thermal maps of wound site and abdomen were accompanied by digital photographs, the latter used for wound assessment by six experienced healthcare professionals. Confirmatory diagnosis of SSI was made on the basis of antibiotic prescribing by the woman's community physician with logistic regression models derived to model dichotomous outcomes. Results Fifty-three women aged 21-44 years with BMI 30.1-43.9 Kg.m- 2 were recruited. SSI rate (within 30 days) was 28%. Inter-rater variability for 'professional' opinion of wound appearance showed poor levels of agreement. Two regions of interest were interrogated; wound site and abdomen. Wound site temperature was consistently elevated (1.5 °C) above abdominal temperature with similar values at days 2,7,15 in those who did and did not, develop SSI. Mean abdominal temperature was lower in women who subsequently developed SSI; significantly so at day 7. A unit (1 °C) reduction in abdominal temperature was associated with a 3-fold raised odds of infection. The difference between the sites (wound minus abdomen temperature) was significantly associated with odds of infection; with a 1 °C widening in temperature associated with an odds ratio for SSI of 2.25 (day 2) and 2.5 (day 7). Correct predictions for wound outcome using logistic regression models ranged from 70 to 79%. Conclusions IRT imaging of wound and abdomen in obese women undergoing c-section improves upon visual (subjective) wound assessment. The proportion of cases correctly classified using the wound-abdominal temperature differences holds promise for precision and performance of IRT as an independent SSI prognostic tool and future technology to aid decision making in antibiotic prescribing.
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Affiliation(s)
- Charmaine Childs
- Faculty of Health and Wellbeing, Montgomery House, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S102BP England
| | - Nicola Wright
- Faculty of Health and Wellbeing, Montgomery House, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S102BP England
| | - Jon Willmott
- Department of Electronic and Electrical Engineering, Portobello Centre, University of Sheffield, Sheffield, S1 4ET England
| | - Matthew Davies
- Department of Electronic and Electrical Engineering, Portobello Centre, University of Sheffield, Sheffield, S1 4ET England
| | - Karen Kilner
- Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S10 2BP England
| | - Karen Ousey
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH England
| | - Hora Soltani
- Faculty of Health and Wellbeing, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S10 2BP England
| | - Priya Madhuvrata
- Obstetrics and Gynaecology, Jessop Hospital, Tree Root Walk, Sheffield, S10 2SF England
| | - John Stephenson
- Biomedical Statistics, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH England
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Fujibayashi A, Niwa T, Tsuchiya M, Takeichi S, Suzuki K, Ohta H, Yonetamari J, Niwa A, Yamamoto M, Hatakeyama D, Baba H, Suzuki A, Murakami N. Antimicrobial stewardship intervention for the clinical pathways improves antimicrobial prophylaxis in surgical or non-surgical invasive therapies. Int J Clin Pract 2018; 73:e13293. [PMID: 30414352 DOI: 10.1111/ijcp.13293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/02/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The standard duration of administration of antimicrobial prophylaxis in surgery and non-surgical invasive therapy was shortened according to the promotion of appropriate use. Here, we conducted an intervention to optimise antimicrobial prophylaxis by revising all relevant clinical pathways based on the most recent guidelines. METHODS We conducted a single-centre, prospective cohort study in patients who received antimicrobial prophylaxis to evaluate outcomes following revision of the clinical pathways for antimicrobial prophylaxis. Antibiotic consumption and the duration of antibiotic administration were compared before and after revising the clinical pathways. RESULTS Thirty-five of 171 clinical pathways were considered inappropriate for antimicrobial use and were optimised. After this revision, the duration of antibiotic administration was significantly shortened (before revision: 3 [1-5] days vs after revision: 2 [1-3] days, median [interquartile range], P < 0.001). The rate of discontinuation of antibiotics within 48 h after surgery or non-surgical invasive therapy was significantly higher after the revision (62.4% vs 81.8%, P < 0.001). In contrast, the incidence of surgical site infection (SSI) was not significantly different before and after the revision (5.7% vs 4.3%, P = 0.177). A multivariate Cox proportional analysis indicated that revision of the clinical pathways was one of the prognostic factors associated with the discontinuation of antibiotics within 48 h after surgery or non-surgical invasive therapy (hazard ratio, 0.69; 95% confidence interval, 0.63-0.76, P < 0.001). CONCLUSIONS Our findings suggest that revising all relevant clinical pathways was highly effective in reducing antibiotic consumption and shortening the antibiotic administration period without increasing the incidence of SSIs.
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Affiliation(s)
- Ayasa Fujibayashi
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Takashi Niwa
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Mayumi Tsuchiya
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Syuri Takeichi
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Keiko Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Hirotoshi Ohta
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Jun Yonetamari
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Ayumi Niwa
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Masayo Yamamoto
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Daijiro Hatakeyama
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Hisashi Baba
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Nobuo Murakami
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
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Danwang C, Mazou TN, Tochie JN, Nzalie RNT, Bigna JJ. Global prevalence and incidence of surgical site infections after appendectomy: a systematic review and meta-analysis protocol. BMJ Open 2018; 8:e020101. [PMID: 30166288 PMCID: PMC6119422 DOI: 10.1136/bmjopen-2017-020101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 06/04/2018] [Accepted: 08/09/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Acute appendicitis is a surgical emergency and the most frequent aetiology of acute surgical abdominal pain in developed countries. Universally, its widely approved treatment is appendectomy. Like all surgical procedures, appendectomy can be associated with many complications among which are surgical site infections (SSIs).Despite the increasing number of appendectomies done around the world and the associated morbidities related to SSI after appendectomy, there is still scarcity of data concerning the global epidemiology of SSI after appendectomy. The current review aims at providing a summary of the published data on epidemiology of SSI after appendectomy. METHODS AND DESIGN We will include randomised controlled trials, cohort studies, case-control and cross-sectional studies. Electronic databases including Embase, MEDLINE and ISI Web of Science (Science Citation Index) will be searched for relevant abstracts of studies published between 1 January 2000 and 30 December 2017, without language restriction. The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After screening of abstracts, study selection, data extraction and assessment of risk of bias, we shall assess the studies individually for clinical and statistical heterogeneity. Appropriate meta-analytic techniques will then be used to pool studies judged to be clinically homogenous. Visual inspection of funnel plots and Egger's test will be used to detect publication bias. Results will be presented by country and continent. ETHICS AND DISSEMINATION Since primary data are not collected in this study, ethical approval is not required. This review is expected to provide relevant data to help in quantifying the global burden of SSI after appendectomy. The final report will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER CRD42017075257.
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Affiliation(s)
- Celestin Danwang
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Temgoua Ngou Mazou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Joel Noutakdie Tochie
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- School of Public Health, Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France
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50
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Brink AJ, Messina AP, Feldman C, Richards GA, van den Bergh D. From guidelines to practice: a pharmacist-driven prospective audit and feedback improvement model for peri-operative antibiotic prophylaxis in 34 South African hospitals. J Antimicrob Chemother 2017; 72:1227-1234. [PMID: 27999061 DOI: 10.1093/jac/dkw523] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/07/2016] [Indexed: 11/14/2022] Open
Abstract
Background Few data exist on the implementation of process measures to facilitate adherence to peri-operative antibiotic prophylaxis (PAP) guidelines in Africa. Objectives To implement an improvement model for PAP utilizing existing resources, in order to achieve a reduction in surgical site infections (SSIs) across a heterogeneous group of 34 urban and rural South African hospitals. Methods A pharmacist-driven, prospective audit and feedback strategy involving change management and improvement principles was utilized. This 2.5 year intervention involved a pre-implementation phase to test a PAP guideline and a 'toolkit' at pilot sites. Following antimicrobial stewardship committee and clinician endorsement, the model was introduced in all institutions and a survey of baseline SSI and compliance rates with four process measures (antibiotic choice, dose, administration time and duration) was performed. The post-implementation phase involved audit, intervention and monthly feedback to facilitate improvements in compliance. Results For 70 weeks of standardized measurements and feedback, 24 206 surgical cases were reviewed. There was a significant improvement in compliance with all process measures (composite compliance) from 66.8% (95% CI 64.8-68.7) to 83.3% (95% CI 80.8-85.8), representing a 24.7% increase ( P < 0.0001). The SSI rate decreased by 19.7% from a mean group rate of 2.46 (95% CI 2.18-2.73) pre-intervention to 1.97 post-intervention (95% CI 1.79-2.15) ( P = 0.0029). Conclusions The implementation of process improvement initiatives and principles targeted to institutional needs utilizing pharmacists can effectively improve PAP guideline compliance and sustainable patient outcomes.
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Affiliation(s)
- Adrian J Brink
- Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Angeliki P Messina
- Department of Quality Leadership, Netcare Hospitals Ltd, Johannesburg, South Africa
| | - Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy A Richards
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dena van den Bergh
- Department of Quality Leadership, Netcare Hospitals Ltd, Johannesburg, South Africa
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