1
|
Cui X, Zhang Y, Wang N, Chen Y, Xu J, Hou J. The outcome of sutured wounds compared with tissue adhesive for paediatric wound closure: A meta-analysis. Int Wound J 2023; 20:3298-3306. [PMID: 37221969 PMCID: PMC10502276 DOI: 10.1111/iwj.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/25/2023] Open
Abstract
A meta-analysis investigation was executed to measure the outcome of sutured wounds (SWs) compared with tissue adhesive (TA) for paediatric wound closure (PWC). A comprehensive literature inspection till February 2023 was applied and 2018 interrelated investigations were reviewed. The 18 chosen investigations enclosed 1697 children with PWC in the chosen investigations' starting point, 977 of them were utilising SWs, and 906 were utilising TA. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of SWs compared with TA for PWC by the dichotomous approaches and a fixed or random model. SWs had significantly higher wound cosmetic (WC) scores (mean deviation [MD], 1.70; 95% CI, 0.57-2.84, P = .003), lower wound dehiscence (WD) (OR 0.60; 95% CI, 0.06-0.43, P < .001), and lower cost (MD, -10.22; 95% CI, -10.94 to -9.50, P < .001) compared with those with TA in PWC. No significant difference was found between children utilising SWs and TA in wound infection (WI) (OR, 0.45; 95% CI, 0.15-1.30, P = .14) with no heterogeneity (I2 = 0%) in PWC. SWs had significantly higher WC scores, lower WD, and lower cost, yet, no significant difference was found in WI compared with those with TA in PWC. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations and the low number of selected investigations for the meta-analysis.
Collapse
Affiliation(s)
- Xiaomei Cui
- School of PediatricsHenan University of Traditional Chinese MedicineZhengzhouHenanChina
| | - Yuanbo Zhang
- Department of SurgeryThe Third Affiliated Hospital of Beijing University of Chinese MedicineBeijingChina
| | - Na Wang
- Institutes of Integrative MedicineFudan UniversityShanghaiChina
| | - Yafang Chen
- Department of PediatricsZhumadian Hospital of Traditional Chinese MedicineZhengzhouHenanChina
| | - Jin Xu
- Second School of Clinical MedicineThe Second Affiliated Hospital of Henan University of Chinese MedicineZhengzhouHenanChina
| | - Jianghong Hou
- Second School of Clinical MedicineThe Second Affiliated Hospital of Henan University of Chinese MedicineZhengzhouHenanChina
| |
Collapse
|
2
|
Tandon S, Ensor ND, Pacilli M, Laird AJ, Bortagaray JI, Stunden RJ, Nataraja RM. Tissue adhesive, adhesive tape, and sutures for skin closure of paediatric surgical wounds: prospective randomized clinical trial. Br J Surg 2022; 109:1087-1095. [PMID: 35913888 PMCID: PMC10364679 DOI: 10.1093/bjs/znac254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Tissue adhesive, adhesive tape, and sutures are used to close surgical incisions. However, it is unclear which produces the best results in children, and whether combination wound closure is better than sutures alone. METHODS In this parallel randomised controlled trial (ANZCTR: ACTRN12617000158369), children (aged 18 years or less) undergoing elective general surgical or urological procedures were randomized to skin closure with sutures alone, sutures and adhesive tape, or sutures and tissue adhesive. Participants were assessed 2 weeks, 6 weeks, and more than 6 months after operation. Outcomes included wound cosmesis (clinician- and parent-rated) assessed using four validated scales, parental satisfaction, and wound complication rates. RESULTS 295 patients (333 wounds) were recruited and 277 patients (314 wounds) were included in the analysis. Tissue adhesive wounds had poorer cosmesis at 6 weeks: median 10-point VAS score 7.7 with sutures alone, 7.5 with adhesive tape, and 7.0 with tissue adhesive (P = 0.014). Respective median scores on a 100-point VAS were 80.0, 77.2, and 73.8 (P = 0.010). This difference was not sustained at over 6 months. There was no difference in parent-rated wound cosmesis at 6 weeks (P = 0.690) and more than 6 months (P = 0.167): median score 9.0 with sutures alone, 10.0 with adhesive tape, and 10.0 with tissue adhesive at both stages. Parental satisfaction was similar at all points, with a median score of 5 (very satisfied) for all groups. There was one instance of wound dehiscence in the tissue adhesive group and no wound infections. CONCLUSION Short-term wound cosmesis was poorer with tissue adhesive although it is unclear whether this difference is sustained in the long-term. There were no differences between techniques for the study outcomes. REGISTRATION NUMBER ACTRN12617000158369 (ANZCTR) (https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372177&isReview=true).
Collapse
Affiliation(s)
- Sarthak Tandon
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children’s Hospital, Melbourne, Victoria, Australia
| | - Nicholas D Ensor
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children’s Hospital, Melbourne, Victoria, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children’s Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ashleigh J Laird
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children’s Hospital, Melbourne, Victoria, Australia
| | - Juan I Bortagaray
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children’s Hospital, Melbourne, Victoria, Australia
| | - Robert J Stunden
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children’s Hospital, Melbourne, Victoria, Australia
| | - Ramesh M Nataraja
- Correspondence to: Ramesh M. Nataraja, Monash Children’s Hospital and Monash University, Department of Paediatric Surgery, 246 Clayton Road, Clayton, Melbourne, Victoria, Australia, 3168 (e-mail: )
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Nthumba PM, Huang Y, Perdikis G, Kranzer K. Surgical Antibiotic Prophylaxis in Children Undergoing Surgery: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2022; 23:501-515. [PMID: 35834578 DOI: 10.1089/sur.2022.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To establish the role of surgical antibiotic prophylaxis (SAP) in the prevention of surgical site infection (SSI) in children undergoing surgery. Design: A systematic review and meta-analysis of six databases: MEDLINE (PubMed), EMBASE, CINAHL Plus, Cochrane Library, Web of Science, and Scopus. Study Selection: Included studies (irrespective of design) compared outcomes in children undergoing surgery, aged 0 to 21 years who received SAP with those who did not, with SSI as an outcome, using the U.S. Centers for Disease Control and Prevention (CDC) definitions for SSI. Data Extraction: Two independent reviewers applied eligibility criteria, assessed the risk of bias, and extracted data. Results: A total of six randomized control trials and 26 observational studies including 202,593 surgical procedures among 202,405 participants were included in the review. The pooled odds ratio of SSI was 1.20; (95% confidence interval [CI], 0.91-1.58) comparing those receiving SAP with those not receiving SAP, with moderate heterogeneity in effect size between studies (τ2 = 0.246; χ2 = 69.75; p < 0.001; I2 = 57.0%). There was insufficient data on many factors known to be associated with SSI, such as cost, length of stay, re-admission, and re-operation; it was therefore not possible to perform subanalyses on these. Conclusions: This review and metanalysis did not find a preventive action of SAP against SSI, and our results suggest that SAP should not be used in surgical wound class (SWC) I procedures in children. However, considering the poor quality of included studies, the principal message of this study is in highlighting the absence of quality data to drive evidence-based decision-making in SSI prevention in children, and in advocating for more research in this field.
Collapse
Affiliation(s)
- Peter M Nthumba
- Department of Plastic Surgery, AIC Kijabe Hospital, Kenya.,Department of Plastic Surgery, Vanderbilt Medical University Center, Nashville, Tennesse, USA
| | - Yongxu Huang
- Department of Plastic Surgery, Vanderbilt Medical University Center, Nashville, Tennesse, USA
| | - Galen Perdikis
- Department of Plastic Surgery, Vanderbilt Medical University Center, Nashville, Tennesse, USA
| | - Katharina Kranzer
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Biomedical Research and Training Institute, Harare, Zimbabwe.,Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
5
|
Tandon S, Smale M, Pacilli M, Nataraja RM. Tissue adhesive and adhesive tape for pediatric wound closure: A systematic review and meta-analysis. J Pediatr Surg 2021; 56:1020-1029. [PMID: 32888718 DOI: 10.1016/j.jpedsurg.2020.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tissue adhesive (TiA), adhesive tape (AdT), and sutures can be used to close surgical wounds and lacerations in children. However, it is unclear which technique produces the best results. METHODS In this prospectively registered study, the PubMed, Ovid MEDLINE, Cochrane Library, Centre for Reviews and Dissemination Database, and ScienceDirect databases were searched. English language studies published between January 1980 and August 2017 evaluating TiA and/or AdT for primary skin closure of surgical wounds or lacerations in patients aged ≤18 years were included. Study endpoints included clinician-rated wound cosmesis and incidence of wound complications. RESULTS Thirty-one studies were included in the systematic review and 16 studies in the meta-analysis. Amongst heterogeneous studies, AdT yielded marginally better cosmetic outcomes than TiA (p = 0.04). There was no difference in cosmesis between sutured wounds and those closed with TiA (p = 0.2). No difference in overall risk of wound infection or dehiscence was identified when comparing TiA with AdT (p = 0.3), and TiA with sutures (p = 0.9 and 0.3 respectively). CONCLUSIONS TiA, AdT, and sutures can all be used for wound closure with equivalent risk of wound infection and dehiscence. AdT appears to convey better cosmesis. Further adequately powered studies directly comparing techniques are required. LEVELS OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Sarthak Tandon
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Matthew Smale
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia; Department of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia; Department of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia.
| |
Collapse
|
6
|
Basavaraju M, Alladi A, Vepakomma D. Outcome of restricted antibiotic policy in a tertiary-level paediatric surgical unit. Afr J Paediatr Surg 2021; 18:28-32. [PMID: 33595538 PMCID: PMC8109756 DOI: 10.4103/ajps.ajps_127_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose was to evaluate the effect of a more restrictive antibiotic policy on infective complications, mainly surgical-site infection (SSI) in clean and clean contaminated surgeries in children. MATERIALS AND METHODS The study included children who underwent clean or clean contaminated surgeries over a period of 18 months with a no-antibiotic or single dose of pre-operative antibiotic protocol, respectively. These were compared to historical controls in previous 18 months where the antibiotic policy was to continue the course for 3-5 days. The outcome looked for was presence of SSI or infection related to the operated organ. RESULTS A total of 933 (study group) patients were compared to 676 historic controls (control group). In the study group, 661 of 933 were clean surgeries and 272 were clean contaminated surgeries. In the study group, 490 of the 676 were clean surgeries and 186 were clean contaminated surgeries. Clean contaminated surgeries included urological surgeries, gastrointestinal tract surgeries and neurosurgeries, whereas clean surgeries were typically day-care surgeries. Comparing the infective outcomes in each type of surgery, there was no statistical difference between cases or controls in either subgroup. CONCLUSION Antibiotic prophylaxis (AP) is not required for clean surgeries. For clean contaminated surgeries, just one dose of pre-operative AP is effective in preventing SSI.
Collapse
Affiliation(s)
- Mamatha Basavaraju
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Anand Alladi
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Deepti Vepakomma
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| |
Collapse
|
7
|
Effects of an antimicrobial stewardship intervention on perioperative antibiotic prophylaxis in pediatrics. Antimicrob Resist Infect Control 2019; 8:13. [PMID: 30675340 PMCID: PMC6334390 DOI: 10.1186/s13756-019-0464-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/03/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aims to determine the effectiveness of an Antimicrobial Stewardship Program based on a Clinical Pathway (CP) to improve appropriateness in perioperative antibiotic prophylaxis (PAP). Materials and methods This pre-post quasi-experimental study was conducted in a 12 month period (six months before and six months after CP implementation), in a tertiary Pediatric Surgical Centre. All patients from 1 month to 15 years of age receiving one or more surgical procedures were eligible for inclusion. PAP was defined appropriate according to clinical practice guidelines. Results Seven hundred sixty-six children were included in the study, 394 in pre-intervention and 372 in post-intervention. After CP implementation, there was an increase in appropriate PAP administration, as well as in the selection of the appropriate antibiotic for prophylaxis, both for monotherapy (p = 0.02) and combination therapy (p = 0.004). Even the duration of prophylaxis decreased during the post-intervention period, with an increase of correct PAP discontinuation from 45.1 to 66.7% (p < 0.001). Despite the greater use of narrow-spectrum antibiotic for fewer days, there was no increase in treatment failures (10/394 (2.5%) pre vs 7/372 (1.9%) post, p = 0.54). Conclusions CPs can be a useful tool to improve the choice of antibiotic and the duration of PAP in pediatric patients.
Collapse
|
8
|
Surgical site infection following elective nonspinal paediatric orthopaedic surgery: a prospective review. J Pediatr Orthop B 2019; 28:89-93. [PMID: 30252792 DOI: 10.1097/bpb.0000000000000549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the rate of surgical site infection (SSI) and the factors that predispose to it in children undergoing nonspinal orthopaedic surgery. Over a 6-month period, 326 children who underwent 334 nonspinal elective orthopaedic surgical procedures were prospectively reviewed for the development of surgical site infections. A total of 14 sites became infected, with an overall infection rate of 4.19%. All the infections were superficial, and the only causative organism detected was Staphylococcus aureus. Operating times longer than 1 h and surgical wounds greater than 10 cm in length were positively associated with SSIs. Although there were differences between male and females, type of admission, the use of prophylactic antibiotics, degree of wound contamination and the grades of surgeons, these differences were not statistically significant. The results of this prospective study provide valuable information that was not previously available to the practicing paediatric orthopaedic surgeon.
Collapse
|
9
|
Kawakami H, Mihara T, Nakamura N, Ka K, Goto T. Effect of an Intravenous Dexamethasone Added to Caudal Local Anesthetics to Improve Postoperative Pain: A Systematic Review and Meta-analysis With Trial Sequential Analysis. Anesth Analg 2017; 125:2072-2080. [PMID: 28914647 DOI: 10.1213/ane.0000000000002453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Caudal anesthesia has been used for postoperative pain control in pediatric surgical patients, but the duration of the analgesic effect is occasionally unsatisfactory. Intravenous steroids have been shown to be effective for postsurgical pain management after certain surgeries. The aim of this meta-analysis with trial sequential analysis (TSA) was to evaluate the analgesic effect of steroids in patients administered with caudal anesthesia. METHODS This study was a systematic review and meta-analysis. A search of published literature was conducted in the MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases and in trial registration sites. Randomized controlled trials that compared intravenous steroids with a placebo in pediatric patients who had received caudal anesthesia for surgery were included in the study. The primary outcomes from the present meta-analysis were the analgesic duration and the number of patients who required rescue analgesics. The analgesic duration and incidence of rescue use were summarized using mean difference or risk ratio with a 97.5% confidence interval (CI), respectively. If the 97.5% CI of the mean difference or risk ratio included a value of 0 or 1, respectively, we considered the difference not to be significant. We used the random effects model to combine the results. Heterogeneity was quantified with the I statistic. The quality of the trials was evaluated using the Cochrane methodology. Moreover, a TSA with a risk of type 1 error of 2.5% and power of 90% was performed. We established the minimum clinically meaningful difference of analgesic duration as 3 hours. The target sample size for meta-analysis was also calculated in the TSA. We also assessed adverse events. RESULTS Six trials with 424 patients were included; 211 patients received intravenous steroids. All trials compared dexamethasone of at least 0.5 mg/kg dose with a placebo. Dexamethasone prolonged the duration of caudal analgesia (mean difference, 244 minutes; 97.5% CI, 188-300). Heterogeneity was considerable with an I value of 94.8%. Quality of evidence was very low. The TSA suggested that only 17.0% of the target sample size had been reached, but the cumulative Z score crossed the trial sequential monitoring boundary to indicate a benefit. Rescue use was reported in 4 studies with 260 patients. Rescue use was not significantly reduced in the dexamethasone group (risk ratio, 0.53; 97.5% CI, 0.09-3.30; I, 98.7%). No increase in adverse events was reported. CONCLUSIONS Intravenous dexamethasone prolongs the analgesic duration of caudal anesthesia. Trials to investigate the effectiveness of a lower dose of the dexamethasone in prolonging analgesic effects would be of interest. Further trials with a low risk of bias are necessary.
Collapse
Affiliation(s)
- Hiromasa Kawakami
- From the Department of Anesthesiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Takahiro Mihara
- From the Department of Anesthesiology, Kanagawa Children's Medical Center, Yokohama, Japan.,Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhito Nakamura
- From the Department of Anesthesiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Koui Ka
- From the Department of Anesthesiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
10
|
Visser R, Milbrandt K, Lum Min S, Wiseman N, Hancock BJ, Morris M, Keijzer R. Applying vacuum to accomplish reduced wound infections in laparoscopic pediatric surgery. J Pediatr Surg 2017; 52:849-852. [PMID: 28245914 DOI: 10.1016/j.jpedsurg.2017.01.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The prevention of surgical site infections has received little attention in pediatric surgery. Negative pressure wound therapy is used to treat complex wounds. We hypothesized that this principle could reduce wound infection rates following laparoscopic surgery. We tested this in a randomized controlled trial. MATERIALS AND METHODS We randomized pediatric patients with an umbilical port site to a standard dressing or a vacuum dressing. The dressings were removed 48h after surgery. A nurse blinded for the treatment inspected the umbilical wound between post-operative days 7-10 for infection. Data comparison was performed using a Fisher exact test with p<0.05 defined as significant. RESULTS We recruited 90 patients over 2 years and randomized 44 to the vacuum dressing arm and 42 to the control arm. We observed a 2.8% (n=1/35) infection rate in the vacuum dressing group and 3.3% (n=1/30) in the control group (p=1.0). DISCUSSION We ended our study early when an interim analysis showed an impractical number of patients would be required to achieve sufficient power. We did not find a significant difference between the control and vacuum dressings in reducing post-operative wound infections. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Robin Visser
- Department of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kris Milbrandt
- Department of Surgery, Division of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics & Child Health and Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suyin Lum Min
- Department of Surgery, Division of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics & Child Health and Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nathan Wiseman
- Department of Surgery, Division of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics & Child Health and Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Betty-Jean Hancock
- Department of Surgery, Division of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics & Child Health and Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Melanie Morris
- Department of Surgery, Division of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics & Child Health and Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Keijzer
- Department of Surgery, Division of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics & Child Health and Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
11
|
Dimopoulou A, Papanikolaou Z, Kourlaba G, Kopsidas I, Coffin S, Zaoutis T. Surgical Site Infections and Compliance with Perioperative Antimicrobial Prophylaxis in Greek Children. Infect Control Hosp Epidemiol 2016; 35:1425-7. [DOI: 10.1086/678411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
12
|
Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Abstract
BACKGROUND The objective of the study is to study surgical site infection (SSI) rates and risk factors in a pediatric population. METHODS We conducted a prospective cohort study to estimate the SSI rate at a national pediatric referral center, covering all patients managed at the Orthopedic Surgery Department of the Niño Jesús Children's University Teaching Hospital from January 2010 through December 2012. Risk factors and antibiotic prophylaxis were monitored. A comparison between Spanish and US data was performed, with a breakdown by National Nosocomial Infection Surveillance risk indices. We also conducted a comparative study of SSI rates from 2010 to 2012 to assess the impact of the epidemiologic surveillance system. RESULTS The study population of 1079 patients had a SSI rate of 2.8%. SSI rates were calculated for spinal fusion and other musculoskeletal procedures according to the National Nosocomial Infection Surveillance risk index. In the case of other musculoskeletal procedures, our SSI rates were 0.8 times lower than the overall Spanish rate, but higher than US rates for all risk categories. For spinal fusion procedures, our SSI rates were 1.2 times higher than the Spanish rates and 3.5 times higher than National Nosocomial Infection Surveillance rates. This latter finding should be interpreted with caution because it was based on a small sample. The multivariate analysis indicated that the only predictive factors of SSI were American Society of Anesthesiologists score and age. CONCLUSIONS The surveillance program showed that for clean procedures, SSI incidence decreased from 4% in 2010 to 3.2% in 2011 and to 2.4% in 2012.
Collapse
|
14
|
Kattipattanapong W, Isaradisaikul S, Hanprasertpong C. Surgical Site Infections in Ear Surgery. Otolaryngol Head Neck Surg 2013; 148:469-74. [DOI: 10.1177/0194599812472297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective (1) To compare the rate of surgical site infections in ear surgery between groups with and without hair removal and (2) to study factors associated with surgical site infections. Study Design A preliminary, randomized, controlled trial. Setting University hospital. Subjects and Methods The study was conducted in a group of 136 patients who underwent surgery for external or middle ear disease via the post-auricular approach at Chiang Mai University Hospital from May 2010 to May 2011. Demographic data, surgical site infection within 30 days postoperatively, and associated factors were recorded. Results Fifty-eight cases were men and 78 cases women. Demographic data between the 2 groups were compared. Age, gender, the side of operated ear, types of anesthesia, emergency or elective setting, body mass index, history of alcohol and/or tobacco use, underlying diseases, operative time, and the length of hospital stay revealed no significant differences. A postoperative surgical site infection developed in 5 patients: 3 in the group with hair removal (4.5%) and 2 in the group without hair removal (2.8%) ( P value = 0.674, Fisher’s exact test). All infected cases had undergone mastoidectomy. Conclusions Surgical site infection rates between the 2 groups (with and without hair removal) demonstrated no difference. Hair removal prior to ear surgery via post-auricular incision had no effect on the rate of surgical site infection.
Collapse
Affiliation(s)
- Woraya Kattipattanapong
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suwicha Isaradisaikul
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Charuk Hanprasertpong
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|