1
|
Downey R, Verma K, Edwards A, Hall C. Enhanced recovery after non-elective colorectal surgery: Is it time for emergency general surgeons to follow suit? Am J Surg 2024; 238:115835. [PMID: 39059337 DOI: 10.1016/j.amjsurg.2024.115835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/21/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Surgical dogma suggests that enhanced recovery (ERAS) pathways are not feasible in the non-elective setting. This study challenges that dogma with the implementation of ERAS in non-elective colorectal surgery. METHODS Single center review of all colorectal operations was performed following implementation of ERAS in non-elective colorectal surgery. Compliance and outcomes between elective and non-elective operations were compared. RESULTS 142 elective and 116 non-elective operations were performed with a compliance rate of 84 % and 46 %, respectively. Acceptable compliance was achieved with 7 metrics in the non-elective cohort. Elective operations were associated with an average LOS of 3 days and a 1 % SSI rate, compared to 8 days and 15 % in the non-elective group. On multivariate analysis, five ERAS metrics were associated with SSI. CONCLUSIONS ERAS pathways are often neglected in non-elective surgery. Acute Care Surgeons should recognize the ERAS principles that are appropriate for their patient population and implement these strategies into practice.
Collapse
Affiliation(s)
- Ryan Downey
- Baylor Scott & White Memorial Hospital Temple, TX, USA
| | - Kunal Verma
- Baylor Scott & White Memorial Hospital Temple, TX, USA
| | | | - Chad Hall
- Baylor Scott & White Memorial Hospital Temple, TX, USA.
| |
Collapse
|
2
|
Woodfield JC, Clifford K, Schmidt B, Thompson‐Fawcett M. Has network meta-analysis resolved the controversies related to bowel preparation in elective colorectal surgery? Colorectal Dis 2022; 24:1117-1127. [PMID: 35658069 PMCID: PMC9796252 DOI: 10.1111/codi.16194] [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: 03/03/2022] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 01/01/2023]
Abstract
AIM There are discrepancies in the guidelines on preparation for colorectal surgery. While intravenous antibiotics (IV) are usually administered, the use of mechanical bowel preparation (MBP) and/or oral antibiotics (OA) is controversial. A recent network meta-analysis (NMA) demonstrated that the addition of OA reduced incisional surgical site infections (iSSIs) by more than 50%. We aimed to perform a NMA including only the highest quality randomized clinical trials (RCTs) in order to determine the ranking of different treatment strategies and assess these RCTs for methodological problems that may affect the conclusions of the NMAs. METHOD A NMA was performed according to PRISMA guidelines. RCTs of adult patients undergoing elective colorectal surgery with appropriate antibiotic cover and with at least 250 participants recruited, clear definition of endpoints and duration of follow-up extending beyond discharge from hospital were included. The search included Medline, Embase, Cochrane and SCOPUS databases. Primary outcomes were iSSI and anastomotic leak (AL). Statistical analysis was performed in Stata v.15.1 using frequentist routines. RESULTS Ten RCTs including 5107 patients were identified. Treatments compared IV (2218 patients), IV + OA (460 patients), MBP + IV (1405 patients), MBP + IV + OA (538 patients) and OA (486 patients). The likelihood of iSSI was significantly lower for IV + OA (rank 1) and MBP + IVA + OA (rank 2), reducing iSSIs by more than 50%. There were no differences between treatments for AL. Methodological issues included differences in definition, assessment and frequency of primary endpoint infections and the limited number of participants included in some treatment options. CONCLUSION While this NMA supports the addition of OA to IV to reduce iSSI it also highlights unanswered questions and the need for well-designed pragmatic RCTs.
Collapse
Affiliation(s)
- John C. Woodfield
- Department of Surgical Sciences, Otago Medical School–Dunedin CampusUniversity of OtagoDunedinNew Zealand
| | - Kari Clifford
- Department of Surgical Sciences, Otago Medical School–Dunedin CampusUniversity of OtagoDunedinNew Zealand
| | - Barry Schmidt
- Department of Surgical Sciences, Otago Medical School–Dunedin CampusUniversity of OtagoDunedinNew Zealand
| | - Mark Thompson‐Fawcett
- Department of Surgical Sciences, Otago Medical School–Dunedin CampusUniversity of OtagoDunedinNew Zealand
| |
Collapse
|
3
|
Mao L, Zhou S, Liao J, Zhou X, Wang J. Effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery: A meta-analysis. Int Wound J 2022; 20:813-821. [PMID: 36117245 PMCID: PMC9927917 DOI: 10.1111/iwj.13928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
We performed a meta-analysis to evaluate the effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery. A systematic literature search up to June 2022 was performed and 6026 subjects with lower gastrointestinal surgery at the baseline of the studies; 3090 of them were using the wound protector, and 2936 were using no wound protector. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery using the dichotomous methods with a random or fixed-effect model. The surgical site wound infection was significantly lower with single-ring wound protectors (OR, 0.53; 95% CI, 0.39-0.83, P = .004), and dual-ring wound protectors (OR, 0.44; 95% CI, 0.35-0.56, P < .001) in subjects with lower gastrointestinal surgery compared with no wound protector. The surgical site wound infection was significantly lower with single-ring wound protectors, and dual-ring wound protectors in subjects with lower gastrointestinal surgery compared with no wound protector. The analysis of outcomes should be with caution because of the low sample size of 5 out of 28 studies in the meta-analysis and a low number of studies in certain comparisons.
Collapse
Affiliation(s)
- Leiming Mao
- Department of Traditional Chinese Internal MedicineGuizhou University of Traditional Chinese MedicineGuizhouChina
| | - Sufang Zhou
- Department of GastroenterologyThe First Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuizhouChina
| | - Jiajia Liao
- Department of Traditional Chinese Internal MedicineGuizhou University of Traditional Chinese MedicineGuizhouChina
| | - Xiangyu Zhou
- Department of Traditional Chinese Internal MedicineGuizhou University of Traditional Chinese MedicineGuizhouChina
| | - Jincheng Wang
- Department of Traditional Chinese Internal MedicineGuizhou University of Traditional Chinese MedicineGuizhouChina
| |
Collapse
|
4
|
Hu QL, Ko CY. Prevention of Perioperative Surgical Site Infection. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
|
5
|
Li X, Lin H, Zhu L, Chen J, Lei S, Li B, Su S. OUP accepted manuscript. BJS Open 2022; 6:6583542. [PMID: 35543265 PMCID: PMC9092446 DOI: 10.1093/bjsopen/zrac065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/22/2022] [Accepted: 04/12/2022] [Indexed: 11/14/2022] Open
Abstract
Background Surgical site infection (SSI) is a common complication after abdominal surgery. The effectiveness of wound edge protectors in reducing infection of the surgical sites is still unclear. The purpose of this study was to determine the clinical effectiveness of a wound edge protector (WEP) in reducing SSI rates after abdominal surgery. Methods PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched to obtain relevant articles published up to September 2021. Publications were retrieved if they contain primary data on the use of WEPs in reducing SSI compared with standard care in patients undergoing abdominal surgery. Subgroup analyses were performed for different WEP types, surgical sites, and levels of contamination. The outcome of interest was a clinically defined SSI. Qualitative variables were pooled using risk ratios (RRs). Results Twenty-two eligible randomized clinical trials involving 4492 patients were included in this meta-analysis. WEP was associated with the reduced incidence of overall SSI (RR = 0.66; 95 per cent c.i. 0.53 to 0.83; P = 0.0003), and superficial SSI (RR = 0.59; 95 per cent c.i. 0.38 to 0.91; P = 0.02). In addition, WEP also successfully reduced the risk of SSI in clean-contaminated wounds (RR = 0.61; 95 per cent c.i. 0.40 to 0.93; P = 0.02) as well as in contaminated wounds (RR = 0.47; 95 per cent c.i. 0.33 to 0.67; P < 0.0001); however, WEP did not reduce SSI incidence in colorectal surgery (RR = 0.68; 95 per cent c.i. 0.46 to 1.01; P = 0.05). Conclusion This study suggests that WEP was efficient in reducing superficial SSI. Both double-ringed and single-ringed devices were efficient in reducing SSI. WEP was effective in reducing SSI incidence in clean-contaminated and contaminated surgery; however, its use does not reduce the SSI rate in colorectal surgery.
Collapse
Affiliation(s)
- Xujia Li
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Haomin Lin
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Lin Zhu
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jing Chen
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Sujuan Lei
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Bo Li
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Song Su
- Correspondence to: Song Su, Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China (e-mail: )
| |
Collapse
|
6
|
Muniandy J, Azman A, Murugasan V, Alwi RI, Zuhdi Z, Jarmin R, Osman S. Cost analysis of utilising wound edge protector in open appendicectomy to prevent surgical site infection. Ann Med Surg (Lond) 2021; 68:102573. [PMID: 34354831 PMCID: PMC8321950 DOI: 10.1016/j.amsu.2021.102573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background The rate of surgical site infection (SSI) differ with variable nature with appendicitis with a global incidence of up to 11%. Several randomised trials describe a significant reduction in incisional SSI using wound edge protectors (WEP), mainly in elective procedures. This study was designed to analyse WEP use in emergency open appendicectomy. Method This randomised controlled trial enrolled 200 patients who underwent emergency open appendicectomy. Permuted block randomisation was used to assign subjects to either mechanical retraction or double ring WEP. The primary endpoints were SSI rates and cost analysis between the methods. Results The incidence of SSI was similar, n = 7 (7.4%) in the control group and n = 8 (8.4%) in the WEP group, and demonstrates no statistically significant difference (p > 0.05). Cost analysis showed a statistically significant (p < 0.001) higher total cost in the WEP group, MYR 456.00 (414.75, 520.00) as compared to the control group, MYR 296.00 (296.00, 300.00). However, the median cost of managing patients complicated with SSI was significantly lower at MYR 750.50 (558.75, 946.50) in the WEP group when compared to the control group MYR 1453.00 (1119.00, 2592.00) (p = 0.008). Conclusion The use of WEP does not reduce the incisional SSI rate, and it is not cost-effective for application in all open appendicectomies. However, when faced with incisional SSI, the use of WEP had a significantly lower cost in incisional SSI management. Selective WEP use is economical in clinically suspected perforated appendicitis when laparoscopic appendicectomy approach is unsuitable. Wound edge protector use does not reduce the SSI rate in emergency open appendicectomy. It is economical for management of incisional SSI with use of wound edge protector used for open appendicectomy. Selective use of wound edge protector in clinically suspected perforated appendicitis would be more cost-effective.
Collapse
Affiliation(s)
- Jothinathan Muniandy
- Department of Surgery, Sultanah Aminah General Hospital, Johor Bahru, Johor, Malaysia.,Department of Surgery, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Azlanudin Azman
- Department of Surgery, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Vishali Murugasan
- Department of Surgery, Sultanah Aminah General Hospital, Johor Bahru, Johor, Malaysia
| | - Rizal Imran Alwi
- Department of Surgery, Sultanah Aminah General Hospital, Johor Bahru, Johor, Malaysia
| | - Zamri Zuhdi
- Department of Surgery, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Razman Jarmin
- Department of Surgery, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | |
Collapse
|
7
|
De Simone B, Sartelli M, Coccolini F, Ball CG, Brambillasca P, Chiarugi M, Campanile FC, Nita G, Corbella D, Leppaniemi A, Boschini E, Moore EE, Biffl W, Peitzmann A, Kluger Y, Sugrue M, Fraga G, Di Saverio S, Weber D, Sakakushev B, Chiara O, Abu-Zidan FM, ten Broek R, Kirkpatrick AW, Wani I, Coimbra R, Baiocchi GL, Kelly MD, Ansaloni L, Catena F. Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines. World J Emerg Surg 2020; 15:10. [PMID: 32041636 PMCID: PMC7158095 DOI: 10.1186/s13017-020-0288-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/01/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. METHODS The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES. RESULTS Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI. CONCLUSIONS The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.
Collapse
Affiliation(s)
- Belinda De Simone
- Department of General Surgery, Azienda USL-IRCSS di Reggio Emilia, Guastalla Hospital, Via Donatori di sangue 1, 42016 Guastalla, RE Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, 62100 Macerata, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56124 Pisa, Italy
| | - Chad G. Ball
- Department of Surgery and Oncology, Hepatobiliary and Pancreatic Surgery, Trauma and Acute Care Surgery, University of Calgary Foothills Medical Center, Calgary, Alberta T2N 2T9 Canada
| | - Pietro Brambillasca
- Anesthesia and Critical Care Department, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit and Trauma Center, Cisanello Hospital, Pisa, Italy
| | | | - Gabriela Nita
- Unit of General Surgery, Castelnuovo ne’Monti Hospital, AUSL, Reggio Emilia, Italy
| | - Davide Corbella
- Anesthesia and Critical Care Department, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland
| | - Elena Boschini
- Medical Library, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health and University of Colorado, Denver, USA
| | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps memorial Hospital, La Jolla, CA USA
| | - Andrew Peitzmann
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, Ireland
| | - Gustavo Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | | | - Dieter Weber
- Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Boris Sakakushev
- University Hospital St George First, Clinic of General Surgery, Plovdiv, Bulgaria
| | - Osvaldo Chiara
- State University of Milan, Acute Care Surgery Niguarda Hospital, Milan, Italy
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | | | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Raul Coimbra
- Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | | | - Micheal D. Kelly
- Department of General Surgery, Albury Hospital, Albury, NSW 2640 Australia
| | - Luca Ansaloni
- Department of Emergency and Trauma Surgery, Bufalini Hospital, 47521 Cesena, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, University Hospital of Parma, 43100 Parma, Italy
| |
Collapse
|
8
|
Li HZ, Xu XH, Wang DW, Lin YM, Lin N, Lu HD. Negative pressure wound therapy for surgical site infections: a systematic review and meta-analysis of randomized controlled trials. Clin Microbiol Infect 2019; 25:1328-1338. [DOI: 10.1016/j.cmi.2019.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 12/29/2022]
|
9
|
Moszkowicz D, Hobeika C, Collard M, Bruzzi M, Beghdadi N, Catry J, Duchalais E, Manceau G, Voron T, Lakkis Z, Allard MA, Cauchy F, Maggiori L. Operating room hygiene: Clinical practice recommendations. J Visc Surg 2019; 156:413-422. [DOI: 10.1016/j.jviscsurg.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
10
|
|
11
|
Zhao C, Wu X, Huang J, Chen C, Yu J, Fang M, Wang G, Ren J. Hybrid material for open abdomen: saving the wound from intestinal fistula. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:109. [PMID: 31535210 DOI: 10.1007/s10856-019-6311-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
Treatment of an open abdomen (OA) wound combined with an intestinal fistula is a challenge in the clinic. Here, inspired by the antibacterial activity of graphene (G) and its derivatives, we present a hybrid patch based on the ability of graphene and polycaprolactone (PCL) to kill bacteria and save the cells in a wound. Benefiting from the antibacterial ability of graphene oxide (GO), cells could survive in the presence of bacteria. With the increased ability to protect cells, this patch accelerated wound healing in an OA and intestinal fistula wound model. Additionally, the sub-acute toxicity score showed no extra damage to organs. In conclusion, the employment of the hybrid material for an OA and an intestinal fistula wound healing is encouraging. A hybrid patch based on graphene oxide and polycaprolactone electrospun was generated for open abdomen and fistula wound. The application of the hybrid patch could save the cells from bacteria which contribute to accelerating wound healing.
Collapse
Affiliation(s)
- Cheng Zhao
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China.
| | - Jinjian Huang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Canwen Chen
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Jiafei Yu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Miao Fang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Gefei Wang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China.
| |
Collapse
|
12
|
Efficacy of a Dual-ring Wound Protector for Prevention of Surgical Site Infections After Pancreaticoduodenectomy in Patients With Intrabiliary Stents: A Randomized Clinical Trial. Ann Surg 2019; 268:35-40. [PMID: 29240005 DOI: 10.1097/sla.0000000000002614] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a dual-ring wound protector for preventing incisional surgical site infection (SSI) among patients with preoperative biliary stents undergoing pancreaticoduodenectomy (PD). METHODS AND ANALYSIS This study was a parallel, dual-arm, double-blind randomized controlled trial. Adult patients with a biliary stent undergoing elective PD at 2 tertiary care institutions were included (February 2013 to May 2016). Patients were randomly assigned to receive a surgical dual-ring wound protector or no wound protector, and also the current standard of care. The main outcome measure was incisional SSI, as defined by the Centers for Disease Control and Prevention criteria, within 30 days of the index operation. RESULTS A total of 107 patients were recruited (mean age 67.2 years; standard deviation 12.9; 65% male). No significant differences were identified between the intervention and control groups (age, sex, body mass index, preoperative comorbidities, American Society of Anesthesiologists class, prestent cholangitis). There was a significant reduction in the incidence of incisional SSI in the wound protector group (21.1% vs 44.0%; relative risk reduction 52%; P = 0.010). Patients with completed PD also displayed a decrease in incisional SSI with use of the wound protector compared with those palliated surgically (27.3% vs 48.7%; P = 0.04). Multivariate analysis did not identify any significant modifying factor relationships (estimated blood loss, duration of surgery, hospital site, etc.) (P > 0.05). CONCLUSION Among adult patients with intrabiliary stents, the use of a dual-ring wound protector during PD significantly reduces the risk of incisional SSI.
Collapse
|
13
|
Bruyere F, Pilatz A, Boehm A, Pradere B, Wagenlehner F, Vallee M. Associated measures to antibiotic prophylaxis in urology. World J Urol 2019; 38:9-15. [DOI: 10.1007/s00345-019-02854-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/15/2019] [Indexed: 01/20/2023] Open
|
14
|
Lawson J, McGill A, Meares H, Coleman H, Riveros C, Martin A. Wound protectors for improved exposure in open hernia repair. Hernia 2019; 23:1215-1219. [PMID: 31115722 DOI: 10.1007/s10029-019-01952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 04/11/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Achieving adequate surgical exposure is fundamental to good surgical practice. Traditionally, in the repair of ventral and open inguinal hernias, this has been accomplished with the aid of self-retaining retractors or by extending the incision length. We propose that using disposable wound protectors, surgical exposure will be improved for a given incision length in the repair of ventral and open inguinal hernias, compared to traditional methods. METHOD Through the use of an animal tissue model, we compared incisions of varying lengths and measured the dimensions of the exposure achieved with disposable wound protectors (Alexis™) and a Mollison self-retainer. We calculated the surface area and, therefore, exposure gained using the specified wound retraction devices and compared the results. RESULTS The average superficial surface area of wound with a self-retainer compared to the small and extra-small disposable wound protector was 2.65 cm2 vs 2.27 cm2 (small) and 2.2 cm2 (extra-small) for 2 cm incision length, 3.6 cm2 vs 4.93 cm2 and 4.2 cm2 for 3 cm incision length, 5.19 cm2 vs 8.25 cm2 and 6.27 cm2 for 4 cm incision length, 6.17 cm2 vs 12.25 cm2 and 9.07 cm2 for 5 cm incision length, and 8.75 cm2 vs 16.73 cm2 and 10.78 cm2 for 6 cm incision length [p = 0.038 (small) and p = 0.049 (extra-small)]. Our results show a statistically significant increase in surface area of a wound for each incision length when a disposable wound protector was used for exposure, compared to a self-retainer. CONCLUSION Our results demonstrate that the use of disposable wound protectors provides superior surgical exposure for a given incision length compared to traditional techniques in the repair of ventral and open inguinal hernia repairs.
Collapse
Affiliation(s)
- J Lawson
- The Maitland Hospital, 560 High Street, Maitland, NSW, 2320, Australia.
| | - A McGill
- The Maitland Hospital, 560 High Street, Maitland, NSW, 2320, Australia
| | - H Meares
- The Maitland Hospital, 560 High Street, Maitland, NSW, 2320, Australia
| | - H Coleman
- The Maitland Hospital, 560 High Street, Maitland, NSW, 2320, Australia
| | - C Riveros
- The Maitland Hospital, 560 High Street, Maitland, NSW, 2320, Australia
| | - A Martin
- The Maitland Hospital, 560 High Street, Maitland, NSW, 2320, Australia
| |
Collapse
|
15
|
Ge X, Tang S, Qi W, Liu W, Lv J, Cao Q, Zhou W, Cai X. Prevalence and predictors of surgical site infections after bowel resection for Crohn's disease: the role of dual-ring wound protector. Int J Colorectal Dis 2019; 34:879-887. [PMID: 30868209 DOI: 10.1007/s00384-019-03275-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical site infections (SSIs) have become a leading cause of preventable morbidity and mortality in surgery. The aim was to evaluate the efficacy of a dual-ring wound protector to prevent the SSIs in Crohn's disease (CD) after bowel resection. METHODS This retrospective observational study included all CD patients undergoing bowel resection at the Inflammatory Bowel Disease Center between January 2015 and June 2018 at Sir Run Run Shaw Hospital. Risk factors of SSIs were evaluated by assessing preoperative clinical characteristics and perioperative treatments in univariate and multivariate analyses. Outcomes for CD patients with and without the wound protector were compared. RESULTS Three hundred forty-four CD patients were enrolled in this study, 121 (35.2%) patients had postoperative complications, of whom, 72 (20.9%) patients developed SSIs (12.8% patients with incisional SSI and 8.1% patients with organ/space SSI). There was a significant reduction in the incidence of incisional SSI in the wound protector group (8.1% vs 16.8%, p < 0.05). No significant differences were identified in organ/space SSI between groups with and without wound protector (6.3% vs 9.8%, p = 0.232). Incisional SSI correlated with preoperative albumin, C-reactive protein, white blood cell, age (≤ 16), penetrating disease behavior, surgical history, open surgery, stoma creation, estimated blood loss, infliximab, and wound protector (p < 0.05). Multivariate analysis identified the wound protector to be one of independent factors for preventing incisional SSIs (OR 0.357, 95% CI 0.161-0.793, p < 0.05). CONCLUSION Among the CD patients with bowel resection, the use of a dual-ring wound protector during surgery significantly reduced the risk of incisional SSI.
Collapse
Affiliation(s)
- Xiaolong Ge
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.,Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Shasha Tang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Weilin Qi
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.,Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Wei Liu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.,Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Jiemin Lv
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Qian Cao
- Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China.,Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Wei Zhou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China. .,Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China.
| | - Xiujun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| |
Collapse
|
16
|
Liu JB, Baker MS, Thompson VM, Kilbane EM, Pitt HA. Wound protectors mitigate superficial surgical site infections after pancreatoduodenectomy. HPB (Oxford) 2019; 21:121-131. [PMID: 30077524 DOI: 10.1016/j.hpb.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/27/2018] [Accepted: 07/02/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Whether the choice of antibiotic prophylaxis, the type of incision, or the use of wound protectors decreases surgical site infections (SSIs) in patients undergoing pancreatoduodenectomy (PD) remains unknown. METHODS Patients undergoing open, elective PD between January 1, 2016 and June 30, 2017 were identified from the American College of Surgeons' National Surgical Quality Improvement Program registry. Multivariable logistic regression models were constructed to determine the association of antibiotic prophylaxis type, incision type, and wound protector use on the incidence of any, superficial, and organ/space SSIs, and to profile hospitals. RESULTS Overall, 5969 patients were included from 140 hospitals. The overall rate of SSI was 20.3% (n = 1213). Superficial SSIs occurred in 432 (7.2%) patients and organ/space SSIs in 841 (14.1%). Wound protector use was associated with 23% lower odds of experiencing any SSIs (OR 0.77, 95% CI 0.60-0.98), reflective of the decreased odds associated with superficial SSIs (OR 0.65, 95% CI 0.44-0.97), but not organ/space SSIs (OR 0.89, 95% CI 0.68-1.17). Highest-performing hospitals frequently utilized broad-spectrum antibiotics, midline incisions, and wound protectors. CONCLUSION Wound protectors reduced superficial, but not organ/space, infections in patients undergoing pancreatoduodenectomy. Routine use of wound protectors in patients undergoing proximal pancreatectomy is recommended.
Collapse
Affiliation(s)
- Jason B Liu
- American College of Surgeons, Chicago, IL, USA; Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Marshall S Baker
- Department of Surgery, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | | | | | - Henry A Pitt
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
| |
Collapse
|
17
|
Systematic review and meta-analysis of randomized controlled trials of the clinical effectiveness of impervious plastic wound protectors in reducing surgical site infections in patients undergoing abdominal surgery. Surgery 2018; 164:939-945. [DOI: 10.1016/j.surg.2018.05.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 11/19/2022]
|
18
|
Yoshioka T, Kondo Y, Fujiwara T. Successful wound treatment using negative pressure wound therapy without primary closure in a patient undergoing highly contaminated abdominal surgery. Surg Case Rep 2018; 4:85. [PMID: 30069647 PMCID: PMC6070448 DOI: 10.1186/s40792-018-0493-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The indications for negative pressure wound therapy (NPWT) continue to expand, and NPWT has become a powerful tool for the treatment of interactive wounds. Recently, the use of NPWT over closed incisions has been shown to prevent surgical site infection (SSI) in patients undergoing contaminated or acute care surgery as prophylactic NPWT. In this article, we present our successful experience using NPWT without primary skin closure for wound treatment after a highly contaminated enterological surgery. The procedure we present in this case report is considerably different from the conventional prophylactic NPWT and a novel method in the field of gastrointestinal surgery. CASE PRESENTATION A 33-year-old man with Crohn's disease underwent a dirty, infected enterological surgical procedure for the treatment of abdominal wall abscess and multiple fistulas around his colonic stoma. The stoma reconstruction and wound debridement resulted in a broad skin defect, and the incision was strategically left open. In addition to the infected wound condition (class IV), Crohn's disease itself is a risk factor for SSI; consequently, we induced NPWT immediately after the surgery and closed the incision from both ends in a stepwise manner using sutures each time we changed the dressing. This procedure was effective, enabling complete healing and closure at the surgical site on postoperative day 14 without infection or a skin defect. CONCLUSION For highly contaminated enterological surgery, purposely leaving the incision open and starting NPWT immediately after the procedure is an effective strategy for early wound closure and the prevention of SSI.
Collapse
Affiliation(s)
- Takahiro Yoshioka
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Yoshitaka Kondo
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| |
Collapse
|
19
|
Kieser DC, Wyatt MC, Beswick A, Kunutsor S, Hooper GJ. Does the type of surgical drape (disposable versus non-disposable) affect the risk of subsequent surgical site infection? J Orthop 2018; 15:566-570. [PMID: 29881195 DOI: 10.1016/j.jor.2018.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022] Open
Abstract
Aims Determine whether disposable or reusable drapes are better at reducing surgical site infection (SSI) rates. Methods A systematic review of the English literature from inception to 2018 with search terms relating to infection and drapes in orthopaedic and spine surgery. Results No orthopaedic or spinal surgery studies assessed the risk of SSI between reusable or disposable drapes. However, two articles, with conflicting results, compared current reusable and disposable drapes in other surgical disciplines. Conclusion There is no evidence to support a difference between reusable or disposable drapes to reduce the risk of SSI in orthopaedic and spinal surgery.
Collapse
Affiliation(s)
- David C Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, New Zealand
| | - Michael C Wyatt
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
| | - Andrew Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
| | - Setor Kunutsor
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, New Zealand
| |
Collapse
|
20
|
Ooi S, Stupart D, Gillies H, Watters D. Does the Alexis wound retractor increase the risk of blood splashes to the eyes? Early closure of a double blinded randomised controlled trial. Contemp Clin Trials Commun 2018; 10:199-200. [PMID: 30023452 PMCID: PMC6046451 DOI: 10.1016/j.conctc.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sally Ooi
- University Hospital Geelong, Australia
| | - Douglas Stupart
- University Hospital Geelong, Australia
- Deakin University, Australia
- Corresponding author. Dept. Surgery, University Hospital Geelong, Bellerine Street, Geelong, VIC 3220, Australia.
| | | | - David Watters
- University Hospital Geelong, Australia
- Deakin University, Australia
| |
Collapse
|
21
|
Itatsu K, Yokoyama Y, Sugawara G, Kamiya S, Terasaki M, Morioka A, Iyomasa S, Shirai K, Ando M, Nagino M. The Benefits of a Wound Protector in Preventing Incisional Surgical Site Infection in Elective Open Digestive Surgery: A Large-Scale Cohort Study. World J Surg 2018; 41:2715-2722. [PMID: 28608019 DOI: 10.1007/s00268-017-4082-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the benefits of wound protectors (WPs) in preventing incisional surgical site infection (I-SSI) in open elective digestive surgery using data from a large-scale, multi-institutional cohort study. METHODS Patients who had elective digestive surgery for malignant neoplasms between November 2009 and February 2011 were included. The protective value of WPs against I-SSI was evaluated. RESULTS A total of 3201 patients were analyzed. A WP was used in 1022 patients (32%). The incident rate of I-SSI (not including organ/space SSI) was 9%. In the univariate and the multivariate analyses for perioperative risk factors for I-SSI, the use of WP was an independent favorable factor that reduced the incidence of I-SSI (odds ratio 0.73, 95% confidence interval 0.55-0.98. P = 0.038). The subgroup forest plot analyses revealed that WP reduced the risk of I-SSI only in patients aged 74 years or younger, males, non-obese patients (body mass index <25 kg/m2), patients with an American Society of Anesthesiologists score of 1/2, patients with a previous history of laparotomy, non-smokers, and patients who underwent colon and rectum operations. In patients who underwent colorectal surgery, the postoperative hospital stay was significantly shorter in patients with WP than those without WP (median 13 vs. 15 days, P = 0.040). In terms of the depth of SSI, WP only prevented superficial I-SSI and did not reduce the incidence of deep I-SSI. CONCLUSIONS WP is a useful device for preventing superficial I-SSI in open elective digestive surgery. TRIAL REGISTRATION NUMBER UMIN000004723.
Collapse
Affiliation(s)
- Keita Itatsu
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Department of Surgery, Kamiiida Daiichi General Hospital, Nagoya, Japan
| | - Yukihiro Yokoyama
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Gen Sugawara
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoaki Kamiya
- Department of Surgery, Tsushima Municipal Hospital, Tsushima, Japan
| | - Masaki Terasaki
- Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Atsushi Morioka
- Department of Surgery, Kumiai Kosei Hospital, Takayama, Japan
| | | | - Kazuhisa Shirai
- Department of Surgery, Yamashita Hospital, Ichinomiya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Masato Nagino
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| |
Collapse
|
22
|
Suh I, Long SA, Coe J, Koehler J, Fry D, Welton ML. The Efficacy of a Novel Surgical Device in Preventing Intraoperative Wound Contamination in an In Vivo Porcine Model. J Laparoendosc Adv Surg Tech A 2018; 28:445-451. [DOI: 10.1089/lap.2017.0403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Insoo Suh
- Department of Surgery, University of California, San Francisco, California
| | - Sarah A. Long
- Fogarty Institute for Innovation, Mountain View, California
| | - Jonathan Coe
- Prescient Surgical, Inc., San Carlos, California
| | | | - Donald Fry
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark L. Welton
- Department of Surgery, Stanford University, Stanford, California
| |
Collapse
|
23
|
Prävention postoperativer Wundinfektionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:448-473. [PMID: 29589090 DOI: 10.1007/s00103-018-2706-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
24
|
Wound protectors in reducing surgical site infections in lower gastrointestinal surgery: an updated meta-analysis. Surg Endosc 2017; 32:1111-1122. [DOI: 10.1007/s00464-017-6012-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022]
|
25
|
A systematic review of clinical effectiveness of wound edge protector devices in reducing surgical site infections in patients undergoing abdominal surgery. Updates Surg 2017; 69:21-28. [DOI: 10.1007/s13304-017-0415-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 01/02/2017] [Indexed: 01/21/2023]
|
26
|
Aureden K, Barnes S, Myers F. Looking Forward--Infection Prevention in 2016. AORN J 2016; 102:596-601. [PMID: 26616320 DOI: 10.1016/j.aorn.2015.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
|
27
|
American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg 2016; 224:59-74. [PMID: 27915053 DOI: 10.1016/j.jamcollsurg.2016.10.029] [Citation(s) in RCA: 571] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/05/2016] [Indexed: 02/08/2023]
|
28
|
Chen Q, Chen L, Chen G, Pu Y, Xing C. Wound-edge protection devices in gastrointestinal surgery: a meta-analysis. J Surg Res 2016; 206:472-480. [PMID: 27884345 DOI: 10.1016/j.jss.2016.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/22/2016] [Accepted: 08/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The role of wound-edge protection devices (WEPDs) in wound infection prevention is still controversial. The aim of this meta-analysis was to assess the protective efficiency of WEPDs in gastrointestinal surgery in a pooled analysis of randomized controlled trials. MATERIALS AND METHODS A variety of sources were searched for randomized controlled trials evaluating the protective efficiency of WEPDs in gastrointestinal surgery. Subgroup analysis and meta-regressions were conducted to investigate the possible influence of the type of WEPD on the size of intervention effect. This review was conducted in accordance with a prespecified protocol based on the guidance of the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. RESULTS Sixteen studies with 3663 patients were included. The WEPDs usage led to a significant decrease in surgical wound infection (risk ratio [RR] = 0.64; 95% confidence interval [CI]: 0.46-0.87; P = 0.005; I2 = 63%), with the dual-ring design usage yielding a more significant reduction in surgical wound infection (RR = 0.24; 95% CI: 0.11-0.50; P = 0.0002; I2 = 29%), whereas the single-ring design usage yielding a nonsignificant result (RR = 0.78; 95% CI: 0.58-1.04; P = 0.09; I2 = 53%). CONCLUSIONS Double-ring WEPD, but not single-ring design, reduces wound infection rate significantly in gastrointestinal surgery. Therefore, the use of single-ring WEPD should be reconsidered.
Collapse
Affiliation(s)
- Qiang Chen
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lei Chen
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Gang Chen
- Department of Integration Traditional Chinese Medicine and Western Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yuwei Pu
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chungen Xing
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| |
Collapse
|
29
|
Infection control in colon surgery. Langenbecks Arch Surg 2016; 401:581-97. [DOI: 10.1007/s00423-016-1467-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/16/2016] [Indexed: 01/27/2023]
|
30
|
Zhou YM, Chen ZY, Li XD, Xu DH, Su X, Li B. Preoperative Antibiotic Prophylaxis Does Not Reduce the Risk of Postoperative Infectious Complications in Patients Undergoing Elective Hepatectomy. Dig Dis Sci 2016; 61:1707-13. [PMID: 26715500 DOI: 10.1007/s10620-015-4008-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/14/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Postoperative infection is not uncommon after hepatectomy. This study assessed the effectiveness of preoperative antibiotic prophylaxis in elective hepatectomy in a randomized clinical trial setting. METHODS A total of 120 patients who were scheduled to undergo elective hepatectomy were equally randomized to receive either intravenous cefuroxime 1.5 g (group A) or placebo (group B) within 30 min prior to skin incision. RESULTS Overall, postoperative infection occurred in 26 (21.6 %) of the 120 patients. There was no statistically significant difference between groups A and B in the incidence of overall infection (23.3 vs. 20.0 %, P = 0.658), surgical site infection (13.3 vs. 15 %, P = 0.793), and remote site infection (13.3 vs. 11.7 %, P = 0.783). CONCLUSION The use of preoperative antibiotic prophylaxis as a routine practice in patients undergoing elective hepatectomy is unnecessary because it does not reduce the risk of postoperative infectious complications.
Collapse
Affiliation(s)
- Yan-Ming Zhou
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhen-Yi Chen
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xiu-Dong Li
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Dong-Hui Xu
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xu Su
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Bin Li
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.
| |
Collapse
|
31
|
Dellinger EP. Teamwork and Collaboration for Prevention of Surgical Site Infections. Surg Infect (Larchmt) 2016; 17:198-202. [DOI: 10.1089/sur.2015.260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
32
|
Ahmed K, Bashar K, Connelly TT, Fahey T, Walsh SR. Reducing Surgical Site Infections in Abdominal Surgery: Are Ring Retractors Effective? A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2016; 17:138-51. [DOI: 10.1089/sur.2015.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Khalid Ahmed
- Department of Surgery, National University of Ireland, Galway, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Khalid Bashar
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | | | - Tom Fahey
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stewart R. Walsh
- Department of Surgery, National University of Ireland, Galway, Ireland
| |
Collapse
|
33
|
Gheorghe A, Moran G, Duffy H, Roberts T, Pinkney T, Calvert M. Health Utility Values Associated with Surgical Site Infection: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:1126-37. [PMID: 26686800 DOI: 10.1016/j.jval.2015.08.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/29/2015] [Accepted: 08/03/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is a costly postoperative complication whose impact on patients' health-related quality of life is highly uncertain and has not been summarized to date. OBJECTIVE The objective was to summarize the evidence base on SSI health utility values reported in patient-level studies and decision models. METHODS A systematic review of SSI utility values reported in patient-level and decision modeling studies was carried out. Studies in which utility values for SSI were either invoked (e.g., model-based economic evaluations) or elicited (e.g., valuation exercises), or at least one non-preference-based instrument was administered to patients with SSI after open surgery were included. Mapping algorithms were used, where appropriate, to calculate utilities from primary data. Results were summarized narratively, and the quality of the utility values used in the included modeling studies was assessed. RESULTS Of 6552 records identified in the database search, 28 studies were included in the review: 19 model-based economic evaluations and 9 patient-level studies. SSI utility decrements ranged from 0.04 to 0.48, of which 19 ranged from 0.1 to 0.3. SSI utility decrements could be calculated for three patient-level studies, and their values ranged from 0.05 (7 days postoperatively) to 0.124 (1 year postoperatively). In most modeling studies, SSI utilities were informed by authors' assumptions or by secondary sources. CONCLUSIONS SSI may substantially affect patients' health utility and needs to be considered when modeling decision problems in surgery. The evidence base for SSI utilities is of questionable quality and skewed toward orthopedic surgery. Further research must concentrate on producing reliable estimates for patients without orthopedic problems.
Collapse
Affiliation(s)
- Adrian Gheorghe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
| | - Grace Moran
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Helen Duffy
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Thomas Pinkney
- Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie Calvert
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
34
|
Are wound ring protectors effective in reducing surgical site infection post appendectomy? A systematic review and meta-analysis. Ir J Med Sci 2015; 185:35-42. [PMID: 26560110 DOI: 10.1007/s11845-015-1381-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/02/2015] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Surgical site infection (SSI) is one of the main causes of postoperative morbidity and mortality. Appendectomy for acute appendicitis is one of the most commonly performed surgical interventions worldwide. The use of ring retractors to protect the wound edge from contaminated intra-abdominal contents may be an effective method to reduce SSI. AIM The aim of this systematic review and meta-analysis is to determine whether the use of wound ring retractors reduces SSI rates after open appendectomy. METHODS A systematic review of randomized controlled trials (RCTs) and meta-analysis of ring retractors was undertaken using the PRISMA guidelines. PubMed, Cochrane RCTs Central Register, CINAHL, and ISRCTN registry were searched for eligible studies. Only studies in which open appendectomy was undertaken were included. The Cochrane Collaboration's RevMan 5.3 was used for analysis. A subgroup analysis by degree of appendiceal inflammation was performed. RESULTS Four RCTs inclusive of 939 patients met eligibility requirements. One trial used single ring while three used double ring protectors. Differences in the definition of SSI, skin preparation, and type and duration of prophylactic antibiotic were found between the 4 studies. The use of ring retractors show some evidence of SSI reduction risk ratio 0.44 [95 % CI (0.21, 0.90)]. On sub-analysis, ring retractor was more effective in more severe degrees of appendiceal inflammation i.e., the contaminated group. CONCLUSION Our review suggests some benefit in using ring retractors to reduce SSI post appendectomy; however the small number and variable quality of the studies suggest the need for more RCTs to confirm these results.
Collapse
|
35
|
|
36
|
Multicenter double-blinded randomized controlled trial of standard abdominal wound edge protection with surgical dressings versus coverage with a sterile circular polyethylene drape for prevention of surgical site infections: a CHIR-Net trial (BaFO; NCT01181206). Ann Surg 2015; 260:730-7; discussion 737-9. [PMID: 25379844 DOI: 10.1097/sla.0000000000000954] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether circular plastic wound edge protectors (CWEPs) significantly reduce the rate of surgical site infections (SSIs) in comparison to standard surgical towels in patients undergoing laparotomy. BACKGROUND SSIs cause substantial morbidity, prolonged hospitalization, and costs and remain one of the most frequent surgical complications. CWEPs have been proposed as a measure to reduce the incidence of SSIs. METHODS In this randomized controlled, multicenter, 2-arm, parallel-group design, patient- and observer-blinded trial patients undergoing open elective abdominal surgery were assigned to either intraoperative wound coverage with a CWEP or standard coverage with surgical towels. Primary endpoint was superiority of intervention over control in terms of the incidence of SSIs within a 30-day postoperative period. RESULTS Between September 2010 and November 2012, 608 patients undergoing laparotomy were randomized at 16 centers across Germany. Three patients in the device group and 11 patients in the control group did not undergo laparotomy. Patients' and procedural characteristics were well balanced between the 2 groups. Forty-eight patients discontinued the study prematurely, mainly because of relaparotomy (control, n=9; intervention, n=9) and death (control, n=4; intervention, n=7). A total of 79 patients experienced SSIs within 30 days of surgery, 27 of 274 (9.9%) in the device group and 52 of 272 (19.1%) in the control group (odds ratio=0.462, 95% confidence interval: 0.281-0.762; P=0.002). Subgroup analyses indicate that the effect could be more pronounced in colorectal surgery, and in clean-contaminated/contaminated surgeries. CONCLUSIONS Our trial shows that CWEPs are effective at reducing the incidence of SSIs in elective and clean or clean-contaminated open abdominal surgery.
Collapse
|
37
|
Wound edge protectors in open abdominal surgery to reduce surgical site infections: a systematic review and meta-analysis. PLoS One 2015; 10:e0121187. [PMID: 25816365 PMCID: PMC4376627 DOI: 10.1371/journal.pone.0121187] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/28/2015] [Indexed: 11/26/2022] Open
Abstract
Importance Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality. Objective To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections. Evidence Review A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted. Findings We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51–0.83; p = 0.0007; I2 = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44–0.97; p = 0.04; I2 = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15–0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54–0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28–0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57–0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24–0.82; p = 0.001; I2 = 72%). Conclusions and Relevance Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to explore their effectiveness in different risk constellations.
Collapse
|
38
|
|
39
|
Zhang MX, Sun YH, Xu Z, Zhou P, Wang HX, Wu YY. Wound edge protector for prevention of surgical site infection in laparotomy: an updated systematic review and meta-analysis. ANZ J Surg 2015; 85:308-14. [PMID: 25648953 DOI: 10.1111/ans.12997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Ming-Xia Zhang
- Department of Infection Control; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Yi-Hui Sun
- Department of Infection Control; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Zheng Xu
- Department of Infection Control; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Ping Zhou
- Department of Infection Control; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Hong-Xia Wang
- Department of Library; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Yong-You Wu
- Department of General Surgery; The Second Affiliated Hospital of Soochow University; Suzhou China
| |
Collapse
|
40
|
Abstract
Colon and rectal resections are among the most common surgical procedures performed in the United States. Complication rates of up to 25% have been reported and result in a substantial impact on quality of life and cost of care. Recently, the Surgical Care Improvement Program (SCIP) has promoted guidelines to prevent postoperative and potentially preventable complications. A comprehensive evidenced-based review of these guidelines and other perioperative strategies for practicing colorectal surgeons is the basis of this review.
Collapse
Affiliation(s)
- Juan Lucas Poggio
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
41
|
Abstract
The aim of this study was to review the role
of clinical trial networks in orthopaedic surgery. A total of two
electronic databases (MEDLINE and EMBASE) were searched from inception
to September 2013 with no language restrictions. Articles related
to randomised controlled trials (RCTs), research networks and orthopaedic
research, were identified and reviewed. The usefulness of trainee-led
research collaborations is reported and our knowledge of current
clinical trial infrastructure further supplements the review. Searching
yielded 818 titles and abstracts, of which 12 were suitable for
this review. Results are summarised and presented narratively under
the following headings: 1) identifying clinically relevant research
questions; 2) education and training; 3) conduct of multicentre
RCTs and 4) dissemination and adoption of trial results. This review
confirms growing international awareness of the important role research
networks play in supporting trials in orthopaedic surgery. Multidisciplinary
collaboration and adequate investment in trial infrastructure are crucial
for successful delivery of RCTs. Cite this article: Bone Joint Res 2014;3:169–74.
Collapse
Affiliation(s)
- A Rangan
- The James Cook University Hospital, Marton Road, Middlesborough, TS4 3BW, UK
| | - L Jefferson
- University of York, York Trials Unit, Department of Health Sciences, York, YO10 5DD, UK
| | - P Baker
- The James Cook University Hospital, Marton Road, Middlesborough, TS4 3BW, UK
| | - L Cook
- University of York, York Trials Unit, Department of Health Sciences, York, YO10 5DD, UK
| |
Collapse
|
42
|
van Genderen ME, Paauwe J, de Jonge J, van der Valk RJP, Lima A, Bakker J, van Bommel J. Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: a prospective observational study in adults. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R114. [PMID: 24894892 PMCID: PMC4229808 DOI: 10.1186/cc13905] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 05/16/2014] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Altered peripheral perfusion is strongly associated with poor outcome in critically ill patients. We wanted to determine whether repeated assessments of peripheral perfusion during the days following surgery could help to early identify patients that are more likely to develop postoperative complications. METHODS Haemodynamic measurements and peripheral perfusion parameters were collected one day prior to surgery, directly after surgery (D0) and on the first (D1), second (D2) and third (D3) postoperative days. Peripheral perfusion assessment consisted of capillary refill time (CRT), peripheral perfusion index (PPI) and forearm-to-fingertip skin temperature gradient (T(skin-diff)). Generalized linear mixed models were used to predict severe complications within ten days after surgery based on Clavien-Dindo classification. RESULTS We prospectively followed 137 consecutive patients, from among whom 111 were included in the analysis. Severe complications were observed in 19 patients (17.0%). Postoperatively, peripheral perfusion parameters were significantly altered in patients who subsequently developed severe complications compared to those who did not, and these parameters persisted over time. CRT was altered at D0, and PPI and T(skin-diff) were altered on D1 and D2, respectively. Among the different peripheral perfusion parameters, the diagnostic accuracy in predicting severe postoperative complications was highest for CRT on D2 (area under the receiver operating characteristic curve = 0.91 (95% confidence interval (CI) = 0.83 to 0.92)) with a sensitivity of 0.79 (95% CI = 0.54 to 0.94) and a specificity of 0.93 (95% CI = 0.86 to 0.97). Generalized mixed-model analysis demonstrated that abnormal peripheral perfusion on D2 and D3 was an independent predictor of severe postoperative complications (D2 odds ratio (OR) = 8.4, 95% CI = 2.7 to 25.9; D2 OR = 6.4, 95% CI = 2.1 to 19.6). CONCLUSIONS In a group of patients assessed following major abdominal surgery, peripheral perfusion alterations were associated with the development of severe complications independently of systemic haemodynamics. Further research is needed to confirm these findings and to explore in more detail the effects of peripheral perfusion-targeted resuscitation following major abdominal surgery.
Collapse
|
43
|
Dowswell G, Bartlett DC, Futaba K, Whisker L, Pinkney TD. How to set up and manage a trainee-led research collaborative. BMC MEDICAL EDUCATION 2014; 14:94. [PMID: 24886546 PMCID: PMC4229745 DOI: 10.1186/1472-6920-14-94] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 05/02/2014] [Indexed: 05/07/2023]
Abstract
BACKGROUND Ensuring that doctors in training acquire sufficient knowledge, experience and understanding of medical research is a universal and longstanding issue which has been brought into sharper focus by the growth of evidence based medicine. All healthcare systems preparing doctors in training for practice have to balance the acquisition of specific clinical attitudes, knowledge and skills with the wider need to ensure doctors are equipped to remain professionally competent as medical science advances. Most professional medical bodies acknowledge that this requires trainee doctors to experience some form of research education, not only in order to carry out original research, but to acquire sufficient academic skills to become accomplished research consumers in order to remain informed throughout their professional practice. There are many barriers to accomplishing this ambitious aim. DISCUSSION This article briefly explains why research collaboratives are necessary, describes how to establish a collaborative, and recommends how to run one. It is based on the experiences of the pioneering West Midlands Research Collaborative and draws on the wider literature about the organisation and delivery of high quality research projects. Practical examples of collaborative projects are given to illustrate the potential of this form of research organisation. SUMMARY The new trainee-led research collaboratives provide a supportive framework for planning, ownership and delivery of high quality multicentre research. This ensures clinical relevance, increases the chances of research findings being translated into changes in practice and should lead to improved patient outcomes. Research collaboratives also enhance the research skills and extend the scientific horizons of doctors in training.
Collapse
Affiliation(s)
- George Dowswell
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | | | - Kaori Futaba
- West Midlands Research Collaborative (WMRC), Birmingham, UK
| | - Lisa Whisker
- West Midlands Research Collaborative (WMRC), Birmingham, UK
| | | |
Collapse
|
44
|
Gheorghe A, Roberts TE, Pinkney TD, Bartlett DC, Morton D, Calvert M. The cost-effectiveness of wound-edge protection devices compared to standard care in reducing surgical site infection after laparotomy: an economic evaluation alongside the ROSSINI trial. PLoS One 2014; 9:e95595. [PMID: 24748154 PMCID: PMC3991705 DOI: 10.1371/journal.pone.0095595] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/28/2014] [Indexed: 11/18/2022] Open
Abstract
Background Wound-edge protection devices (WEPDs) have been used in surgery for more than 40 years to reduce surgical site infection (SSI). No economic evaluation of WEPDs against any comparator has ever been conducted. The aim of the paper was to assess whether WEPDs are cost-effective in reducing SSI compared to standard care alone in the United Kingdom. Methods and Findings An economic evaluation was conducted alongside the ROSSINI trial. The study perspective was that of the UK National Health Service and the time horizon was 30 days post-operatively. The study was conducted in 21 UK hospitals. 760 patients undergoing laparotomy were randomised to either WEPD or standard care and 735 were included in the primary analysis. The main economic outcome was cost-effectiveness based on incremental cost (£) per quality adjusted life year (QALY) gained. Patients in the WEPD arm accessed health care worth £5,420 on average and gained 0.02131 QALYs, compared to £5,130 and 0.02133 QALYs gained in the standard care arm. The WEPD strategy was more costly and equally effective compared to standard care, but there was significant uncertainty around incremental costs and QALYs. The findings were robust to a range of sensitivity analyses. Conclusions There is no evidence to suggest that WEPDs can be considered a cost effective device to reduce SSI. Their continued use is a waste of limited health care resources.
Collapse
Affiliation(s)
- Adrian Gheorghe
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tracy E. Roberts
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
| | - Thomas D. Pinkney
- Academic Department of Surgery, University of Birmingham, Birmingham, United Kingdom
- West Midlands Research Collaborative, Birmingham, United Kingdom
| | | | - Dion Morton
- Academic Department of Surgery, University of Birmingham, Birmingham, United Kingdom
- West Midlands Research Collaborative, Birmingham, United Kingdom
| | - Melanie Calvert
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
- West Midlands Research Collaborative, Birmingham, United Kingdom
- * E-mail:
| | | |
Collapse
|
45
|
Ruiz Tovar J, Badia JM. Prevention of Surgical Site Infection in Abdominal Surgery. A Critical Review of the Evidence. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.cireng.2013.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
46
|
|
47
|
Roxburgh CS, Richards CH, O'Neill S, Ramsay G, Velineni R, Robson AJ, Watt DG, Mittapalli D, Milburn JA, Robertson AG, Jamieson NB. A national survey of attitudes to research in Scottish General Surgery Trainees. Scott Med J 2014; 59:9-15. [PMID: 24434857 DOI: 10.1177/0036933013518142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Given the importance placed on awareness and participation in research by Speciality and Training organisations, we sought to survey Scottish trainee attitudes to exposure to research practice during training and research in or out of programme. METHODS An online survey was distributed to core and specialist trainees in general surgery in Scotland. RESULTS Over a 4-month period, 108 trainees (75 ST/SPRs and 33 CTs) completed the survey. In their current post, most were aware of ongoing research projects (77%) and 55% were aware of trial recruitment. Only 47% attend regular journal clubs. Most believe that they are expected to present (89%) and publish (82%) during training. Most (59%) thought that participation in research is well supported. 57% were advised to undertake time out of programme research, mostly by consultants (48%) and training committee (36%). Of the 57 with time out of programme research experience, most did so in early training (37%) or between ST3-5 (47%). 28 out of the 36 (78%) without a national training number secured one after starting research. Most undertook research in a local academic unit (80%) funded by small grants (47%) or internally (33%). Most research (69%) was clinically orientated (13/55 clinical, 25/55 translational). 56% of those completing time out of programme research obtained an MD or PhD. About 91% thought that research was relevant to a surgical career. CONCLUSIONS Most trainees believe that research is an important part of training. Generally, most trainees are exposed to research practices including trial recruitment. However, <50% attend regular journal clubs, a pertinent point, given the current 'exit exam' includes the assessment of critical appraisal skills.
Collapse
Affiliation(s)
- C S Roxburgh
- Clinical Lecturers in Surgery, Academic Unit of Surgery, University of Glasgow and West of Scotland, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
[Prevention of surgical site infection in abdominal surgery. A critical review of the evidence]. Cir Esp 2014; 92:223-31. [PMID: 24411561 DOI: 10.1016/j.ciresp.2013.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 07/19/2013] [Accepted: 08/01/2013] [Indexed: 11/22/2022]
Abstract
Surgical site infection (SSI) is associated with prolonged hospital stay, increased morbidity, mortality and sanitary costs, and reduced patients quality of life. Many hospitals have adopted guidelines of scientifically-validated processes for prevention of surgical site and central-line catheter infections and sepsis. Most of these guidelines have resulted in an improvement in postoperative results. A review of the best available evidence on these measures in abdominal surgery is presented. The best measures are: avoidance of hair removal from the surgical field, skin decontamination with alcoholic antiseptic, correct use of antibiotic prophylaxis (administration within 30-60 min before incision, use of 1(st) or 2(nd) generation cephalosporins, single preoperative dosis, dosage adjustments based on body weight and renal function, intraoperative re-dosing if the duration of the procedure exceeds 2 half-lives of the drug or there is excessive blood loss), prevention of hypothermia, control of perioperative glucose levels, avoid blood transfusion and restrict intraoperative liquid infusion.
Collapse
|
49
|
Alijanipour P, Karam J, Llinás A, Vince KG, Zalavras C, Austin M, Garrigues G, Heller S, Huddleston J, Klatt B, Krebs V, Lohmann C, McPherson EJ, Molloy R, Oliashirazi A, Schwaber M, Sheehan E, Smith E, Sterling R, Stocks G, Vaidya S. Operative environment. J Orthop Res 2014; 32 Suppl 1:S60-80. [PMID: 24464899 DOI: 10.1002/jor.22550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
50
|
Pinkney TD, Calvert M, Bartlett DC, Gheorghe A, Redman V, Dowswell G, Hawkins W, Mak T, Youssef H, Richardson C, Hornby S, Magill L, Haslop R, Wilson S, Morton D. Impact of wound edge protection devices on surgical site infection after laparotomy: multicentre randomised controlled trial (ROSSINI Trial). BMJ 2013; 347:f4305. [PMID: 23903454 PMCID: PMC3805488 DOI: 10.1136/bmj.f4305] [Citation(s) in RCA: 182] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine the clinical effectiveness of wound edge protection devices in reducing surgical site infection after abdominal surgery. DESIGN Multicentre observer blinded randomised controlled trial. PARTICIPANTS Patients undergoing laparotomy at 21 UK hospitals. INTERVENTIONS Standard care or the use of a wound edge protection device during surgery. MAIN OUTCOME MEASURES Surgical site infection within 30 days of surgery, assessed by blinded clinicians at seven and 30 days and by patient's self report for the intervening period. Secondary outcomes included quality of life, duration of stay in hospital, and the effect of characteristics of the patient and operation on the efficacy of the device. RESULTS 760 patients were enrolled with 382 patients assigned to the device group and 378 to the control group. Six patients in the device group and five in the control group did not undergo laparotomy. Fourteen patients, seven in each group, were lost to follow-up. A total of 184 patients experienced surgical site infection within 30 days of surgery, 91/369 (24.7%) in the device group and 93/366 (25.4%) in the control group (odds ratio 0.97, 95% confidence interval 0.69 to 1.36; P=0.85). This lack of benefit was consistent across wound assessments performed by clinicians and those reported by patients and across all secondary outcomes. In the secondary analyses no subgroup could be identified in which there was evidence of clinical benefit associated with use of the device. CONCLUSIONS Wound edge protection devices do not reduce the rate of surgical site infection in patients undergoing laparotomy, and therefore their routine use for this role cannot be recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN 40402832.
Collapse
Affiliation(s)
- Thomas D Pinkney
- West Midlands Research Collaborative, Old Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|