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Sweitzer SF, Sickbert-Bennett EE, Seidelman J, Anderson DJ, Lim MR, Weber DJ. The impact of minimally invasive surgical approaches on surgical-site infections. Infect Control Hosp Epidemiol 2024; 45:557-561. [PMID: 38167421 DOI: 10.1017/ice.2023.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
We performed a literature review to describe the risk of surgical-site infection (SSI) in minimally invasive surgery (MIS) compared to standard open surgery. Most studies reported decreased SSI rates among patients undergoing MIS compared to open procedures. However, many were observational studies and may have been affected by selection bias. MIS is associated with reduced risk of surgical-site infection compared to standard open surgery and should be considered when feasible.
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Affiliation(s)
- Stephanie F Sweitzer
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Infection Prevention, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Jessica Seidelman
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Deverick J Anderson
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Moe R Lim
- Department of Orthopedics, University of North Carolina, Chapel Hill, North Carolina
| | - David J Weber
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Infection Prevention, University of North Carolina Hospitals, Chapel Hill, North Carolina
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2
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Chen IW, Weng HL, Hung KC. Letter Regarding: "Alcohol-Containing Versus Aqueous-Based Solutions for Skin Preparation in Abdominal Surgery". J Surg Res 2024; 297:161-162. [PMID: 38403530 DOI: 10.1016/j.jss.2024.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 02/27/2024]
Affiliation(s)
- I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan city, Taiwan
| | - Hsiu-Lan Weng
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan.
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3
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Kumar AS. Deep Sternal Wound Infection. Ann Thorac Surg 2024; 117:877-878. [PMID: 37852408 DOI: 10.1016/j.athoracsur.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Arkalgud Sampath Kumar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Tower 12, Flat 102, CWG Village, Noida Crossing, Delhi 110092, India.
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4
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Wei X, Chen F, Yu C, Huang S, Ou J, Mu X, Wei J. Effectiveness of lumbar braces after lumbar surgery: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 144:1523-1533. [PMID: 38363322 DOI: 10.1007/s00402-024-05219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To systematically analyze the effectiveness of lumbar braces in patients after lumbar spine surgery. METHODS The databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), were searched to identify the randomized controlled trials (RCTs), case-series or case-control studies on the use of lumbar braces after lumbar spine surgery. The two authors independently assessed the quality of the included study and extracted the data. The statistical analysis was performed using Revman 5.4 software. RESULTS 9 English papers and 1 Chinese paper were included in the present work, involving a total of 2646 patients (2181 in the experimental group and 465 in the control group). The differences in preoperative VAS, postoperative VAS, preoperative ODI, postoperative ODI, length of hospital stay, postoperative complications, and surgical comparison were not statistically significant (p > 0.05). However, postoperative surgical site infection incidence was lower in the lumbar brace group than those without lumbar brace (p < 0.05). CONCLUSION Whether or not the use of lumbar braces after lumbar fixation has a negligible impact on clinical outcomes was studied. Subsequent studies could further demonstrate whether the use of lumbar braces after lumbar surgery could reduce the incidence of surgical site infections.
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Affiliation(s)
- Xiaodong Wei
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530021, China
| | - Fuyu Chen
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530021, China
| | - Chengqiang Yu
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530021, China
| | - Shengquan Huang
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530021, China
| | - Jinxian Ou
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530021, China
| | - Xiaoping Mu
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530021, China.
| | - Jianxun Wei
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530021, China.
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Sarmiento-Altamirano D, Neira-Quezada D, Willches-Encalada E, Cabrera-Ordoñez C, Valdivieso-Espinoza R, Himmler A, Di Saverio S. The influence of preoperative e intraoperative factors in predicting postoperative morbidity and mortality in perforated diverticulitis: a systematic review and meta-analysis. Updates Surg 2024; 76:397-409. [PMID: 38282071 DOI: 10.1007/s13304-023-01738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and severity of peritonitis affect the rate of morbidity and mortality in patients undergoing a primary anastomosis (PA) or Hartmann Procedure (HP) for perforated diverticulitis. This is a systematic review and meta-analysis, conducted according to PRISMA, with an electronic search of the PubMed, Medline, Cochrane Library, and Google Scholar databases. The search retrieved 614 studies, of which 11 were included. Preoperative-Intraoperative factors including age, ASA classification, BMI, severity of peritonitis, and comorbidities were collected. Primary endpoints were mortality and postoperative complications including sepsis, surgical site infection, wound dehiscence, hemorrhage, postoperative ileus, stoma complications, anastomotic leak, and stump leakage. 133,304 patients were included, of whom 126,504 (94.9%) underwent a HP and 6800 (5.1%) underwent a PA. There was no difference between the groups with regards to comorbidities (p = 0.32), BMI (p = 0.28), or severity of peritonitis (p = 0.09). There was no difference in mortality [RR 0.76 (0.44-1.33); p = 0.33]; [RR 0.66 (0.33-1.35); p = 0.25]. More non-surgical postoperative complications occurred in the HP group (p = 0.02). There was a significant association in the HP group between the severity of peritonitis and mortality (p = 0.01), and surgical site infection (p = 0.01). In patients with perforated diverticulitis, PA can be chosen. Age, comorbidities, and BMI do not influence postoperative outcomes. The severity of peritonitis should be taken into account as a predictor of postoperative morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | - Amber Himmler
- University of California San Francisco, San Francisco, USA
| | - Salomone Di Saverio
- Department of General Surgery, San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy
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Bustamante A, Zavala A, Iglesias M, Tornero R, Machaca L, De Pawlikowski W. Quality of Life After Lower Leg Reconstruction With the Latissimus Dorsi Free Flap in Pediatric Patients. Ann Plast Surg 2024; 92:418-423. [PMID: 38527349 DOI: 10.1097/sap.0000000000003812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND The latissimus dorsi free flap is a widely used reconstructive technique for complex lower leg defects in the pediatric population due to its reliability and anatomical features. However, the impact of this technique on the postoperative quality of life in children and adolescents, who require appropriate lower extremity function during their developmental period, remains to be analyzed. METHODS Patients who underwent microsurgical lower leg reconstruction using the latissimus dorsi flap were analyzed retrospectively. The quality of life of these patients was assessed prospectively using the Lower Extremity Functional Scale (LEFS) at a minimum of 18 months after surgical reconstruction. RESULTS Sixteen pediatric patients who had severe lower extremity injuries and underwent latissimus dorsi free flap reconstruction met the inclusion criteria. The mean follow-up period was 33.9 months (22-64 months). Two patients experienced postoperative complications: one had partial flap necrosis and surgical site infection, while the other developed a surgical site infection. The LEFS scores ranged from 26 to 80, with a mean score of 64.6. Remarkably, 14 of 16 patients achieved LEFS scores consistent with at least the 10th percentile when compared with normative data. Patients with severe associated fractures presented with the lowest scores. CONCLUSIONS Based on our findings, the latissimus dorsi flap is reaffirmed to be an excellent choice for lower leg reconstruction in the pediatric population. It effectively restores the quality of life in patients who have experienced moderate to severe lower extremity injuries.
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Affiliation(s)
- Atenas Bustamante
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Abraham Zavala
- Department of Plastic and Reconstructive Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Martin Iglesias
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Ray Tornero
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Lucero Machaca
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Wieslawa De Pawlikowski
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
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7
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Sharma A, Sharma R, Sahni K, Gupta S. Composite subcuticular subcutaneous buried suture. J Am Acad Dermatol 2024; 90:e125-e126. [PMID: 37224969 DOI: 10.1016/j.jaad.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Ananya Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanika Sahni
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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8
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Donovan TJ. Sternal Wound Complications: Many Roads Lead to Rome. Ann Thorac Surg 2024; 117:878. [PMID: 38145704 DOI: 10.1016/j.athoracsur.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/23/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Terrence John Donovan
- Department of Cardiothoracic Surgery, Herzzentrum Trier, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, Trier 54292, Germany.
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9
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Nakayama DK. Pediatric Patients as a Source of Bias in Joseph Lister's Study of Antisepsis. J Pediatr Surg 2024; 59:744-746. [PMID: 38092650 DOI: 10.1016/j.jpedsurg.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 04/08/2024]
Abstract
Joseph Lister's (1827-1912) use of carbolic acid to prevent wound infection in open fractures of the extremities (1865) provided a basic science rationale for the practice of surgery. His series of 11 patients included 4 children, aged 7 to 13. Children, today known to better survive a given injury when compared with adults, may have biased his results in favor of survival, and led him to conclude that his method of carbolic-soaked dressing changes prevented fatal wound sepsis. His success with antisepsis may have been less a testament to his application of germ theory to surgery than to the physiological resilience of his young patients.
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Affiliation(s)
- Don K Nakayama
- Mercer University School of Medicine, Columbus Campus, 1633 1(ST) Avenue, Columbus GA 31901, Georgia.
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10
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Grauberger JN, Joshi N, Joo A, Phelan AL, Lalikos JF. Xeroform Stick-Down Dressing: A Novel Treatment for Pediatric Partial-Thickness Burns. Ann Plast Surg 2024; 92:S123-S128. [PMID: 38319984 DOI: 10.1097/sap.0000000000003795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Burns traditionally require frequent, painful dressing changes to minimize infection risk and promote wound healing. To improve care for our pediatric population, our institution adapted a skin graft donor site dressing into a "stick-down" burn dressing consisting of a one-time application of bacitracin and 3% bismuth tribromophenate/vaseline impregnated gauze (Xeroform) that adheres to the burn and peels off as new epithelialized skin forms. The goal of which is to minimize dressing change frequency and patient discomfort in a cost-effective, widely available manner. This study aimed to compare clinical outcomes of the stick-down versus traditional topical dressings. METHODS A retrospective cohort study of pediatric patients (age <18 year) with partial-thickness burns treated at a level I pediatric trauma center for 4 years was conducted. One hundred eleven patients were included: 74 patients treated with daily silver sulfadiazene (Silvadene) dressings matched to 37 patients treated with the Xeroform stick-down dressing using 2:1 propensity score matching. Univariate analyses used Wilcoxon rank sum and Fisher exact tests. RESULTS The cohorts had similar demographics and burn characteristics. Both groups had similar hospitalization rates (31.1% Silvadene, 32.4% Xeroform), most commonly for pain control (54.5% Silvadene, 58.3% Xeroform), with similar average daily narcotic usage (7.7 ± 12.1 morphine milliequivalents Silvadene, 5.1 ± 9.5 Xeroform; P = 0.91). The Xeroform cohort had a shorter but statistically similar hospital stay (median, 1 vs 2 days). In addition, the Xeroform cohort required significantly less dressing changes with a median of 0.5 changes compared with 12 for the Silvadene cohort ( P < 0.0001). There was no difference in time to burn reepithelialization (median, 13.0 days for Silvadene and 12.0 days for Xeroform; P = 0.20) or wound healing complications (12.5% Silvadene, 2.7% Xeroform; P = 0.15). CONCLUSIONS The Xeroform stick-down dressing has equivalent clinical outcomes to that of standard Silvadene dressings for the treatment of pediatric partial-thickness burns with the major advantages of decreasing dressing change frequency, minimizing patient distress and pain, and streamlining clinical care.
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Affiliation(s)
- Jennifer N Grauberger
- From the Division of Plastic and Reconstructive Surgery, University of Massachusetts Chan Medical School, Worcester, MA
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11
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Lin J, Peng Y, Guo L, Tao S, Li S, Huang W, Yang X, Qiao F, Zong Z. The incidence of surgical site infections in China. J Hosp Infect 2024; 146:206-223. [PMID: 37315807 DOI: 10.1016/j.jhin.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Abstract
Surgical site infections (SSIs) are a common type of healthcare-associated infection. We performed a literature review to demonstrate the incidence of SSIs in mainland China based on studies since 2010. We included 231 eligible studies with ≥30 postoperative patients, comprising 14 providing overall SSI data regardless of surgical sites and 217 reporting SSIs for a specific site. We found that the overall SSI incidence was 2.91% (median; interquartile range: 1.05%, 4.57%) or 3.18% (pooled; 95% confidence interval: 1.85%, 4.51%) and the SSI incidence varied remarkably according to the surgical site between the lowest (median, 1.00%; pooled, 1.69%) in thyroid surgeries and the highest (median, 14.89%; pooled, 12.54%) in colorectal procedures. We uncovered that Enterobacterales and staphylococci were the most common types of micro-organisms associated with SSIs after various abdominal surgeries and cardiac or neurological procedures, respectively. We identified two, nine, and five studies addressing the impact of SSIs on mortality, the length of stay (LOS) in hospital, and additional healthcare-related economic burden, respectively, all of which demonstrated increased mortality, prolonged LOS, and elevated medical costs associated with SSIs among affected patients. Our findings illustrate that SSIs remain a relatively common, serious threat to patient safety in China, requiring more action. To tackle SSIs, we propose to establish a nationwide network for SSI surveillance using unified criteria with the aid of informatic techniques and to tailor and implement countermeasures based on local data and observation. We highlight that the impact of SSIs in China warrants further study.
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Affiliation(s)
- J Lin
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China; Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - Y Peng
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - L Guo
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - S Tao
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - S Li
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - W Huang
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - X Yang
- Southern Central Hospital of Yunnan Province, Honghe, China
| | - F Qiao
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - Z Zong
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China; Center for Pathogen Research, West China Hospital, Sichuan University, Chengdu, China.
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12
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Wang N, Pei L, Zhang M, Wang G, Zheng S, Kou X, Chen H. The impact of psychological interventions on surgical site wound healing post-surgery in psoriasis patients: A meta-analysis. Int Wound J 2024; 21:e14509. [PMID: 38151959 PMCID: PMC10958094 DOI: 10.1111/iwj.14509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 12/29/2023] Open
Abstract
This meta-analysis investigates the impact of psychological interventions on the wound healing process at surgical sites in patients with psoriasis who have undergone various surgical procedures. Following the PRISMA guidelines, an extensive database search was conducted, initially identifying 679 articles, with 6 studies ultimately meeting our rigorous selection criteria. These studies, which included both Randomized Controlled Trials and observational designs, utilized a range of scales, such as the REEDA and Manchester Scar Scale (MSS), to measure the healing of surgical wounds. Statistical analyses were performed using Review Manager and SPSS, revealing that psychological interventions significantly expedited wound healing as early as 1 week post-surgery (I2 = 93%; Random: SMD = -3.01, 95% CI: [-4.35, -1.66], p < 0.01), according to the REEDA scale. At the one-month follow-up, a continued positive effect was observed on the MSS (I2 = 69%; Random: SMD = 2.31, 95% CI: [1.54, 3.08], p < 0.01). The studies demonstrated a low risk of bias, and funnel plot analysis suggested no significant publication bias. These results highlight the beneficial role of psychological support in the postoperative recovery of psoriasis patients, suggesting a need for a more integrated approach to patient care that includes psychological well-being as a component of comprehensive treatment strategies.
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Affiliation(s)
- Na Wang
- Department of DermatologyHebei University of Chinese MedicineShijiazhuangChina
- Department of DermatologyHebei Province Academy of Chinese Medicine SciencesShijiazhuangChina
| | - Lin Pei
- Geriatric DepartmentHebei Province Academy of Chinese Medicine SciencesShijiazhuangChina
| | - Mengqian Zhang
- Department of DermatologyHebei University of Chinese MedicineShijiazhuangChina
| | - Gang Wang
- Department of DermatologyHebei University of Chinese MedicineShijiazhuangChina
| | - Shumao Zheng
- Department of DermatologyHebei Province Academy of Chinese Medicine SciencesShijiazhuangChina
| | - Xiaoli Kou
- Department of DermatologyHebei Province Academy of Chinese Medicine SciencesShijiazhuangChina
| | - Hu Chen
- Department of DermatologyHebei Province Academy of Chinese Medicine SciencesShijiazhuangChina
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Neal TW, Williams FC, Jelmini J, Spresser W, Schwitzer D, Kim RY. Immediate Teeth in Fibulas Versus Standard Fibula Free Flap: A Comparison of Donor Surgical Site Infections. J Oral Maxillofac Surg 2024; 82:494-500. [PMID: 38272445 DOI: 10.1016/j.joms.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Immediate placement of dental implants with dental restoration at the leg donor site requires implant components and prosthetic materials that are not packaged sterile. PURPOSE This study aimed to determine if there was a difference in donor surgical site infection between patients that received a fibula free flap with dental implants and immediate teeth (ITFFF: immediate teeth fibula free flap) before flap transfer to the defect site when compared to standard fibula free flaps (SFFFs) without dental implant placement. STUDY DESIGN, SETTING, SAMPLE A retrospective cohort study was designed and implemented. The study population was composed of patients who underwent free fibula flap transfer for the treatment of benign or malignant conditions of the head and neck from 2015 to 2022. Patients who received immediate dental implants without teeth were excluded, since those implants are sterile and buried under soft tissue. PREDICTOR VARIABLE The surgical treatment with either ITFFF or SFFF was treated as the primary predictor variable. MAIN OUTCOME VARIABLE The primary outcome variable was postoperative donor surgical site infection. COVARIATES There were 12 covariate variables including age, sex, diabetes diagnosis, immunosuppression/prior chemotherapy treatment, body mass index, smoking status, pack year history, pathology treated, technique for fibula donor site closure, skin paddle harvest, skin paddle area (cm2), and negative pressure wound therapy. ANALYSES For the effect of the covariates on the primary predictor variable, χ2 analyses and t-tests were used. The effect of the primary predictor variable on the primary outcome was evaluated using χ2 analysis. A P value of < 0.05 was considered statistically significant. RESULTS There were 37 patients in the ITFFF group and 47 in the SFFF group. The donor site infection rate for the entire study population was 2.38%. In the ITFFF group, there was 1 donor surgical site infection (2.70%), and in the SFFF group there was also 1 donor surgical site infection (2.13%). There was no significant difference in donor surgical site infection between the groups (P = .86). CONCLUSION AND RELEVANCE This study found no difference in donor surgical site infection rates between patients who received ITFFF versus SFFF. The overall donor surgical site infection rate following fibula free flap is low.
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Affiliation(s)
- Timothy W Neal
- Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX.
| | - Fayette C Williams
- Director, Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Hospital Health Network, Fort Worth, TX
| | - Jonathan Jelmini
- Fellow, Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Health Network, Fort Worth, TX
| | - Wyatt Spresser
- Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX
| | - David Schwitzer
- Fellow, Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Health Network, Fort Worth, TX
| | - Roderick Y Kim
- Vice Director, Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Hospital Health Network, Fort Worth, TX
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14
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Werenski JO, Gonzalez MR, Fourman MS, Hung YP, Lozano-Calderon SA. ASO Visual Abstract: Does Wound VAC Temporization Offer Similar Patient-Reported Outcomes as Single-Stage Excision Reconstruction After Myxofibrosarcoma Resection? Ann Surg Oncol 2024; 31:2798. [PMID: 38253950 DOI: 10.1245/s10434-024-14922-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- Joseph O Werenski
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcos R Gonzalez
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mitchell S Fourman
- Department of Orthopaedic Surgery, Montefiore-Einstein, New York, NY, USA
| | - Yin P Hung
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Santiago A Lozano-Calderon
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Nishida N, Kawano T, Sugita K, Yano K, Kedoin C, Nagano A, Matsui M, Murakami M, Baba T, Onishi S, Harumatsu T, Yamada K, Yamada W, Torikai M, Ieiri S. Comparison of Transumbilical Laparoscopy-Assisted Appendectomy with Conventional Three-Port Laparoscopic Appendectomy Performed by Pediatric Surgeons in Training for Appendicitis in Children. J Laparoendosc Adv Surg Tech A 2024; 34:380-385. [PMID: 38573162 DOI: 10.1089/lap.2023.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Background: Transumbilical laparoscopy-assisted appendectomy (TULAA) is the technique of choice for all types of appendicitis. However, the technique is challenging for trainees to learn in comparison with performing conventional three-port laparoscopic appendectomy (CTPLA) in children. We aimed to compare the surgical outcomes of children with appendicitis treated by TULAA versus CTPLA performed by pediatric surgeons in training (PSITs). Materials and Methods: This retrospective study analyzed pediatric patients with acute appendicitis treated with CTPLA or TULAA between April 2016 and December 2022. Operative time (OT: minutes), pneumoperitoneum time (PT: minutes), blood loss (milliliter), length of hospital stay (days), and surgical site infection rate were compared between the two groups. Operative outcomes were also analyzed according to type of appendicitis such as uncomplicated and complicated cases. Results: Two hundred twenty-five laparoscopic appendectomies were performed by CTPLA (n = 94) or TULAA (n = 131). All cases were performed by PSITs and there was no open conversion cases. TULAA had a shorter OT (67.0 ± 28.4 versus 78.3 ± 21.7; P < .01) and PT (26.1 ± 17.4 versus 52.5 ± 22.1 min; P < .01). The surgical site infection rate was slightly higher in the TULAA group, but the difference was not statistically significant. In uncomplicated appendicitis (n = 164), significant differences between the CTPLA and TULAA groups were observed in OT (CTPLA versus TULAA: 70.7 ± 14.9 versus 59.1 ± 21.6, P < .01) and PT (CTPLA versus TULAA: 43.6 ± 13.1 versus 20.4 ± 13.6, P < .01). With regard to postoperative complications, only surgical site infection was significantly different between the CTPLA and TULAA groups (CTPLA: 0.0% versus TULAA: 8.2%, P < .05). In complicated cases (n = 61), there were significant differences between the groups in PT (CTPLA versus TULAA: 73.4 ± 24.9 versus 42.3 ± 17.2, P < .01) and length of hospital stay (CTPLA versus TULAA: 7.0 ± 1.3 versus 8.9 ± 4.7, P < .05). Conclusions: TULAA had a shorter OT and PT than CTPLA. TULAA for PSITs shows similar safety and feasibility to CTPLA for not only uncomplicated cases but also complicated cases.
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Affiliation(s)
- Nanako Nishida
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Chihiro Kedoin
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Ayaka Nagano
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Mayu Matsui
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Tokuro Baba
- Department of Digestive and General Surgery, University of the Ryukyus, Okinawa, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Motofumi Torikai
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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Dias Rasador AC, Mazzola Poli de Figueiredo S, Fernandez MG, Dias YJM, Martin RRH, da Silveira CAB, Lu R. Small bites versus large bites during fascial closure of midline laparotomies: a systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:104. [PMID: 38519824 DOI: 10.1007/s00423-024-03293-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Incisional ventral hernias (IVH) are common after laparotomies, with up to 20% incidence in 12 months, increasing up to 60% at 3-5 years. Although Small Bites (SB) is the standard technique for fascial closure in laparotomies, its adoption in the United States is limited, and Large Bites (LB) is still commonly performed. We aim to assess the effectiveness of SB regarding IVH. METHODS We searched for RCTs and observational studies on Cochrane, EMBASE, and PubMed from inception to May 2023. We selected patients ≥ 18 years old, undergoing midline laparotomies, comparing SB and LB for IVH, surgical site infections (SSI), fascial dehiscence, hospital stay, and closure duration. We used RevMan 5.4. and RStudio for statistics. Heterogeneity was assessed with I2 statistics, and random effect was used if I2 > 25%. RESULTS 1687 studies were screened, 45 reviewed, and 6 studies selected, including 3 RCTs and 3351 patients (49% received SB and 51% LB). SB showed fewer IVH (RR 0.54; 95% CI 0.39-0.74; P < 0.001) and SSI (RR 0.68; 95% CI 0.53-0.86; P = 0.002), shorter hospital stay (MD -1.36 days; 95% CI -2.35, -0.38; P = 0.007), and longer closure duration (MD 4.78 min; 95% CI 3.21-6.35; P < 0.001). No differences were seen regarding fascial dehiscence. CONCLUSION SB technique has lower incidence of IVH at 1-year follow-up, less SSI, shorter hospital stay, and longer fascial closure duration when compared to the LB. SB should be the technique of choice during midline laparotomies.
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Affiliation(s)
- Ana Caroline Dias Rasador
- Bahiana School of Medicine and Public Health, Dom João VI Avenue, 275, Salvador, BA, 40290-000, Brazil.
| | | | - Miguel Godeiro Fernandez
- Bahiana School of Medicine and Public Health, Dom João VI Avenue, 275, Salvador, BA, 40290-000, Brazil
| | | | | | | | - Richard Lu
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX, USA
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Xiang XB, Gao KY, Zhang WW, Li CP, Feng KK, Cao GR. Clinical efficacy analysis of surgical treatment for spinal metastasis under the multidisciplinary team using the NOMS decision system combined with the revised Tokuhashi scoring system: a randomized controlled study. J Orthop Surg Res 2024; 19:195. [PMID: 38515197 PMCID: PMC10956187 DOI: 10.1186/s13018-024-04668-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/06/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE Despite advancements in spinal metastasis surgery techniques and the rapid development of multidisciplinary treatment models, we aimed to explore the clinical efficacy of spinal metastasis surgery performed by a combined NOMS decision system-utilizing multidisciplinary team and Revised Tokuhashi scoring system, compared with the Revised Tokuhashi scoring system. METHODS Clinical data from 102 patients with spinal metastases who underwent surgery at three affiliated hospitals of Zunyi Medical University from December 2017 to June 2022 were analysed. The patients were randomly assigned to two groups: 52 patients in the treatment group involving the combined NOMS decision system-utilizing multidisciplinary team and Revised Tokuhashi scoring system (i.e., the combined group), and 50 patients in the treatment group involving the Revised Tokuhashi scoring system only (i.e., the revised TSS-only group). Moreover, there were no statistically significant differences in preoperative general data or indicators between the two groups. Intraoperative and postoperative complications, average hospital stay, mortality rate, and follow-up observation indicators, including the visual analogue scale (VAS) score for pain, Eastern Cooperative Oncology Group (ECOG) performance status, Karnofsky Performance Status (KPS) score, negative psychological assessment score (using the Self-Rating Anxiety Scale, [SAS]), and neurological function recovery score (Frankel functional classification) were compared between the two groups. RESULTS All 102 patients successfully completed surgery and were discharged. The follow-up period ranged from 12 to 24 months, with an average of (13.2 ± 2.4) months. The patients in the combined group experienced fewer complications such as surgical wound infections 3 patients(5.77%), intraoperative massive haemorrhage 2 patients(3.85%), cerebrospinal fluid leakage 2 patients(3.85%), deep vein thrombosis 4 patients(7.69%),and neurological damage 1 patient(1.92%), than patients in the revised TSS-only group (wound infections,11 patients(22%); intraoperative massive haemorrhage, 8 patients(16%);cerebrospinal fluid leakage,5 patients(10%);deep vein thrombosis,13 patients (26%); neurological damage,2 patients (4%). Significant differences were found between the two groups in terms of surgical wound infections, intraoperative massive haemorrhage, and deep vein thrombosis (P < 0.05). The average postoperative hospital stay in the combined group (7.94 ± 0.28 days) was significantly shorter than that in the revised TSS-only group (10.33 ± 0.30 days) (P < 0.05). Long-term follow-up (1 month, 3 months, 6 months, and 1 year postoperatively) revealed better clinical outcomes in the combined group than in the revised TSS-only group in terms of VAS scores, overall KPS%, neurological function status Frankel classification, ECOG performance status, and SAS scores.(P < 0.05). CONCLUSION A multidisciplinary team using the NOMS combined with the Revised Tokuhashi scoring system for spinal metastasis surgery showed better clinical efficacy than the sole use of the Revised Tokuhashi scoring system. This personalized, precise, and rational treatment significantly improves patient quality of life, shortens hospital stay, reduces intraoperative and postoperative complications, and lowers mortality rates.
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Affiliation(s)
- Xiao-Bing Xiang
- The Second Affiliated Hospital of Zunyi Medical University, Orthopedics, Zunyi, Guizhou, China
| | - Kai-Yin Gao
- The Second Affiliated Hospital of Zunyi Medical University, Orthopedics, Zunyi, Guizhou, China
| | - Wei-Wei Zhang
- The Second Affiliated Hospital of Zunyi Medical University, Orthopedics, Zunyi, Guizhou, China
| | - Cheng-Peng Li
- The Second Affiliated Hospital of Zunyi Medical University, Orthopedics, Zunyi, Guizhou, China
| | - Kai-Kai Feng
- The Second Affiliated Hospital of Zunyi Medical University, Orthopedics, Zunyi, Guizhou, China
| | - Guang-Ru Cao
- The Second Affiliated Hospital of Zunyi Medical University, Orthopedics, Zunyi, Guizhou, China.
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Ayoub E, Kutchukian S, Bigot P, Dinh A, Gondran-Tellier B, Robin H, Françot M, de Vergie S, Rigaud J, Chapuis M, Brureau L, Jousseaume C, Karray O, Kosseifi FT, Borojeni S, Descazeaud A, Asare HJ, Gaullier M, Poussot B, Tricard T, Baboudjian M, Lechevallier É, Delpech PO, Ducousso H, Bernardeau S, Bruyère F, Vallée M. Asymptomatic bacteriuria prior to partial and radical nephrectomy: To screen or not to screen? Results from the national and multicenter TOCUS database. World J Urol 2024; 42:179. [PMID: 38507063 DOI: 10.1007/s00345-024-04853-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION In the era of increased bacterial resistance, the main strategy is to reduce the prescription of antibiotics when possible. Nowadays, it is highly recommended to screen for asymptomatic bacteriuria (ABU), prior to urological surgery with potential mucosal breach or urine exposure. Screening and treating urinary colonization is a strategy widely adopted before radical and partial nephrectomy but without any evidence. Our main end point in this study is to analyze the relationship between preoperative urine culture and the risk of postoperative febrile urinary tract infection (UTI) or surgical-site infection (SSI) in partial or radical nephrectomy patients. METHODS We conducted a multicenter retrospective cohort study between January 2016 and January 2023 in 11 French tertiary referral hospitals (TOCUS database). We collected the data for 269 patients including several pre-, intra-, and post-operative variables that could potentially increase the risk of postoperative UTI and SSI including preoperative urinary culture results. RESULTS The incidence rate of postoperative UTI and SSI was 8.9% in our study. After conducting a logistic multivariate analysis, a propensity score matching analysis, and a subgroup analysis, we found no significant correlation between the urine culture and the postoperative UTI risk [OR = 1.2 (0.5-2.7) (p = 0.7)]. Only the postoperative non-infectious complications were related to a higher risk of postoperative UTI [OR = 12 (4-37), p < 0.001)]. CONCLUSION Our research shows that screening and treating for ABU prior to radical or partial nephrectomy seems to be unnecessary to prevent postoperative UTI and SSI.
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Affiliation(s)
- Elias Ayoub
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France.
| | - Stessy Kutchukian
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Pierre Bigot
- Département d'urologie Centre Hospitalier Universitaire, Angers, France
| | - Aurélien Dinh
- Service de maladies infectieuses, Centre Hospitalier Universitaire, R. Poincaré, APHP, GarchesUniversité Versailles Paris Saclay, IHU PROMETHEUS, Paris, France
- Membre du comité d'infectiologie de l'Association Française d'Urologie (CIAFU), Paris, France
| | - Bastien Gondran-Tellier
- Département d'urologie Centre Hospitalier Universitaire, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Humphrey Robin
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Marc Françot
- Département d'urologie Centre Hospitalier Universitaire, Nantes, France
| | | | - Jérôme Rigaud
- Département d'urologie Centre Hospitalier Universitaire, Nantes, France
| | - Mathilde Chapuis
- Département d'urologie Centre Hospitalier Universitaire, Guadeloupe, France
| | - Laurent Brureau
- Département d'urologie Centre Hospitalier Universitaire, Guadeloupe, France
| | - Camille Jousseaume
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Omar Karray
- Département d'urologie Centre Hospitalier, Pontoise, France
| | - Fares T Kosseifi
- Département d'urologie Centre Hospitalier Universitaire, Paris Saint Joseph, France
| | - Shahed Borojeni
- Département d'urologie Centre Hospitalier Universitaire, Paris Saint Joseph, France
| | | | - Harrison-Junior Asare
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Maxime Gaullier
- Département d'urologie Centre Hospitalier Universitaire, Strasbourg, France
| | - Baptiste Poussot
- Département d'urologie Centre Hospitalier Universitaire, Strasbourg, France
| | - Thibault Tricard
- Département d'urologie Centre Hospitalier Universitaire, Strasbourg, France
| | - Michael Baboudjian
- Département d'urologie Centre Hospitalier Universitaire, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Éric Lechevallier
- Département d'urologie Centre Hospitalier Universitaire, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Pierre-Olivier Delpech
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Héloïse Ducousso
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Simon Bernardeau
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Franck Bruyère
- Membre du comité d'infectiologie de l'Association Française d'Urologie (CIAFU), Paris, France
- Département d'urologie Centre Hospitalier Universitaire, Tours, France
| | - Maxime Vallée
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
- Membre du comité d'infectiologie de l'Association Française d'Urologie (CIAFU), Paris, France
- Université de Poitiers, unité INSERM U1070, PHAR2, 86000, Poitiers, France
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Ye H, Hu J, Li B, Yu X, Zheng X. Can the use of azithromycin during labour reduce the incidence of infection among puerperae and newborns? A systematic review and meta-analysis of randomized controlled trials. BMC Pregnancy Childbirth 2024; 24:200. [PMID: 38486177 PMCID: PMC10938810 DOI: 10.1186/s12884-024-06390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE This systematic review and meta-analysis investigated whether the use of azithromycin during labour or caesarean section reduces the incidence of sepsis and infection among mothers and newborns. DATA SOURCES We independently searched the PubMed, Web of Science, Cochrane Library and EMBASE databases for relevant studies published before February, 2024. METHODS We included RCTs that evaluated the effect of prenatal oral or intravenous azithromycin or placebo on intrapartum or postpartum infection incidence. We included studies evaluating women who had vaginal births as well as caesarean sections. Studies reporting maternal and neonatal infections were included in the current analysis. Review Manager 5.4 was used to analyse 6 randomized clinical trials involving 44,448 mothers and 44,820 newborns. The risk of bias of each included study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.Primary outcomes included the incidence of maternal sepsis and all-cause mortality and neonatal sepsis and all-cause mortality; secondary outcomes included maternal (endometritis, wound and surgical site infections, chorioamnionitis, and urinary tract infections) and neonatal outcomes (infections of the eyes, ears and skin). A random-effects model was used to test for overall effects and heterogeneity. RESULTS The pooled odds ratios (ORs) were as follows: 0.65 for maternal sepsis (95% CI, 0.55-0.77; I2, 0%; P < .00001); 0.62 for endometritis (95% CI, 0.52-0.74; I2, 2%; P < .00001); and 0.43 for maternal wound or surgical site infection (95% CI, 0.24-0.78; P < .005); however, there was great heterogeneity among the studies (I2, 75%). The pooled OR for pyelonephritis and urinary tract infections was 0.3 (95% CI, 0.17-0.52; I2, 0%; P < .0001), and that for neonatal skin infections was 0.48 (95% CI, 0.35-0.65; I2, 0%, P < .00001). There was no significant difference in maternal all-cause mortality or incidence of chorioamnionitis between the two groups. No significant differences were observed in the incidence of neonatal sepsis or suspected sepsis, all-cause mortality, or infections of the eyes or ears. CONCLUSION In this meta-analysis, azithromycin use during labour reduced the incidence of maternal sepsis, endometritis, incisional infections and urinary tract infections but did not reduce the incidence of neonatal-associated infections, except for neonatal skin infections. These findings indicate that azithromycin may be potentially beneficial for maternal postpartum infections, but its effect on neonatal prognosis remains unclear. Azithromycin should be used antenatally only if the clinical indication is clear and the potential benefits outweigh the harms.
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Affiliation(s)
- Haiyan Ye
- Department of adult intensive care unite, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Jinlu Hu
- Department of adult intensive care unite, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Bo Li
- Department of adult intensive care unite, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Xia Yu
- Department of laboratory, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xuemei Zheng
- Department of adult intensive care unite, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
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Hajibandeh S, Hajibandeh S, Maw A. Purse-string skin closure versus linear skin closure in people undergoing stoma reversal. Cochrane Database Syst Rev 2024; 3:CD014763. [PMID: 38470607 PMCID: PMC10930185 DOI: 10.1002/14651858.cd014763.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Stoma reversal is associated with a relatively high risk of surgical site infection (SSI), occurring in up to 40% of cases. This may be explained by the presence of microorganisms around the stoma site, and possible contamination with the intestinal contents during the open-end manipulation of the bowel, making the stoma closure site a clean-contaminated wound. The conventional technique for stoma reversal is linear skin closure (LSC). The purse-string skin closure (PSSC) technique (circumferential skin approximation) creates a small opening in the centre of the wound, enabling free drainage of contaminants and serous fluid. This could decrease the risk of SSI compared with LSC. OBJECTIVES To assess the effects of purse-string skin closure compared with linear skin closure in people undergoing stoma reversal. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases, and three trials registers on 21 December 2022. We also checked references, searched for citations, and contacted study authors to identify additional studies. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing PSSC and LSC techniques in people undergoing closure of stoma (loop ileostomy, end ileostomy, loop colostomy, or end colostomy) created for any indication. DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible studies, extracted data, evaluated the methodological quality of the included studies, and conducted the analyses. The most clinically relevant outcomes were SSI, participant satisfaction, incisional hernia, and operative time. We calculated odds ratios (ORs) for dichotomous data and mean differences (MDs) for continuous data, each with its corresponding 95% confidence interval (CI). We used the GRADE approach to rate the certainty of the evidence. MAIN RESULTS Nine RCTs involving 757 participants were eligible for inclusion. Eight studies recruited only adults (aged 18 years and older), and one study included people aged 12 years and older. The participants underwent elective reversal of either ileostomy (82%) or colostomy (18%). We considered all studies at high risk of performance and detection bias (lack of blinding) and four studies at unclear risk of selection bias related to random sequence generation. PSSC compared with LSC likely reduces the risk of SSI (OR 0.17, 95% CI 0.09 to 0.29; I2 = 0%; 9 studies, 757 participants; moderate-certainty evidence). The anticipated absolute risk of SSI is 52 per 1000 people who have PSSC and 243 per 1000 people who have LSC. The likelihood of being very satisfied or satisfied with stoma closure may be higher amongst people who have PSSC compared with people who have LSC (100% vs 89%; OR 20.11, 95% CI 1.09 to 369.88; 2 studies, 122 participants; low-certainty evidence). The results of the analysis suggest that PSSC compared with LSC may have little or no effect on the risk of incisional hernia (OR 0.51, 95% CI 0.07 to 3.70; I2 = 49%; 4 studies, 297 participants; very low-certainty evidence) and operative time (MD -2.67 minutes, 95% CI -8.56 to 3.22; I2 = 65%; 6 studies, 460 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS PSSC compared with LSC likely reduces the risk of SSI in people undergoing reversal of stoma. People who have PSSC may be more satisfied with the result compared with people who have LSC. There may be little or no difference between the skin closure techniques in terms of incisional hernia and operative time, though the evidence for these two outcomes is very uncertain.
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Affiliation(s)
- Shahab Hajibandeh
- General Surgery, Wales Deanery, Health Education and Improvement Wales, Nantgarw, UK
| | - Shahin Hajibandeh
- Department of General Surgery, University Hospital Coventry & Warwickshire, Coventry, UK
| | - Andrew Maw
- General Surgery, Glan Clwyd Hospital, Bodelwyddan, UK
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Miyauchi R, Miki Y, Kasashima H, Fukuoka T, Yoshii M, Tamura T, Shibutani M, Toyokawa T, Lee S, Maeda K. Effects of an artificial pancreas on postoperative inflammation in patients with esophageal cancer. BMC Surg 2024; 24:77. [PMID: 38431548 PMCID: PMC10909248 DOI: 10.1186/s12893-024-02365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSES Subtotal esophagectomy for esophageal cancer (EC) is associated with high morbidity rates. Tight glycemic control using an artificial pancreas (AP) is one of the promising strategies to reduce postoperative inflammation and morbidities. However, the effects of tight glycemic control using AP in patients with EC are yet to be fully elucidated. METHOD This study reviewed 96 patients with EC who underwent subtotal esophagectomy. The postoperative inflammation parameters and morbidity rates were compared between patients who used the AP (n = 27) or not (control group, n = 69). AP is a closed-loop system that comprises a continuous glucose monitor and an insulin pump. RESULTS The numbers of white blood cells (WBC) and Neutrophils (Neut) were noted to be lower in the AP group than in the control group, but with no significant difference. The ratio in which the number of WBC, Neut, and CRP on each postoperative day (POD) was divided by those tested preoperatively was used to standardize the results. The ratio of WBC and Neut on 1POD was significantly lower in the AP group than in the control group. The rate of surgical site infection was lower in the AP group than in the control group. CONCLUSION AP significantly decreased WBC and Neut on 1POD; this suggests the beneficial effects of AP in alleviating postoperative inflammation.
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Affiliation(s)
- Ryoko Miyauchi
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Yuichiro Miki
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan.
| | - Hiroaki Kasashima
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Mami Yoshii
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Tatsuro Tamura
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Takahiro Toyokawa
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Shigeru Lee
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
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Charbonneau J, Morin G, Paré XG, Frigault J, Drolet S, Bouchard A, Rouleau-Fournier F, Bouchard P, Thibault C, Letarte F. Loop Ileostomy Closure as a 23-Hour Stay Procedure With Preoperative Efferent Limb Enteral Stimulation: A Randomized Controlled Trial. Dis Colon Rectum 2024; 67:466-475. [PMID: 37994456 DOI: 10.1097/dcr.0000000000003111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Loop ileostomy closure is a common procedure in colorectal surgery. Often seen as a simple operation associated with a low complication rate, it still leads to lengthy hospitalizations. Reducing postoperative complications and ileus rates could lead to a shorter length of stay and even ambulatory surgery. OBJECTIVES This study aimed to assess the safety and feasibility of ileostomy closure performed in a 23-hour hospitalization setting using a standardized enhanced recovery pathway. DESIGN Randomized controlled trial. SETTINGS Two high-volume colorectal surgery centers. PATIENTS Healthy adults undergoing elective ileostomy closure from July 2019 to January 2022. INTERVENTION All patients were enrolled in a standardized enhanced recovery pathway specific to ileostomy closure, including daily irrigation of efferent limb with a nutritional formula for 7 days before surgery. Patients were randomly allocated to either conventional hospitalization (n = 23) or a 23-hour stay (n = 24). MAIN OUTCOME MEASURES Primary outcome was total length of stay and secondary outcomes were 30-day rates of readmission, postoperative ileus, surgical site infections, and postoperative morbidity and mortality. RESULTS A total of 47 patients were ultimately randomly allocated. Patients in the 23-hour hospitalization arm had a shorter median length of stay (1 vs 2 days, p = 0.02) and similar rates of readmission (4% vs 13%, p = 0.35), postoperative ileus (none in both arms), surgical site infection (0% vs 4%, p = 0.49), postoperative morbidity (21% vs 22%, p = 1.00), and mortality (none in both arms). LIMITATIONS Due to coronavirus disease 2019, access to surgical beds was greatly limited, leading to a shift toward ambulatory surgery for ileostomy closure. The study was terminated early, which affected its statistical power. CONCLUSION Loop ileostomy closures as 23-hour stay procedures are feasible and safe. Ileus rate might be reduced by preoperative intestinal stimulation with nutritional formula through the stoma's efferent limb, although specific randomized controlled trials are needed to confirm this association. See Video Abstract . CIERRE DE ILEOSTOMA EN ASA COMO PROCEDIMIENTO AMBULATORIO DE HORAS CON ESTMULO PREOPERATORIO ENTERAL EFERENTE ESTUDIO ALEATORIO CONTROLADO ANTECEDENTES:El cierre de la ileostomía en asa es un procedimiento común en la cirugía colorrectal. A menudo vista como una operación simple asociada con bajas tasas de complicaciones, aún conduce a largas hospitalizaciones. La reducción de las complicaciones postoperatorias y las tasas de íleo podría conducir a una estadía hospitalaria más corta o incluso a una cirugía ambulatoria.OBJETIVOS:El presente estudio pretende evaluar la seguridad y la viabilidad del cierre de ileostomía realizadas en un entorno de hospitalización de 23 horas utilizando una vía de recuperación mejorada y estandarizada.DISEÑO:Estudio aleatorio controladoAJUSTES:Dos centros de cirugía colorrectal de gran volúmenPACIENTES:Adultos sanos sometidos a cierre electivo de ileostomía, desde Julio de 2019 hasta Enero de 2022.INTERVENCIÓN:Todos los pacientes fueron inscritos en una vía de recuperación mejorada y estandarizada específica para el cierre de la ileostomía, incluyendo la irrigación diaria de la extremidad eferente del intestino asociada a una fórmula nutricional durante 7 días previos a la cirugía. Los pacientes fueron asignados aleatoriamente en hospitalización convencional (n = 23) o a una estadía de 23 horas (n = 24).PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la duración total de la estadía hospitalaria y los resultados secundarios fueron las tasas de reingreso a los 30 días, el íleo postoperatorio, las infecciones de la herida quirúrgica, la morbilidad y mortalidad postoperatorias.RESULTADOS:Finalmente fueron randomizados un total de 47 pacientes. Aquellos que se encontraban en el grupo de hospitalización de 23 horas tuvieron una estadía media más corta (1 día versus 2 días, p = 0,02) y tasas similares de reingreso (4% vs 13%, p = 0,35), de íleo postoperatorio (ninguno en ambos brazos), de infección del sitio quirúrgico (0 vs 4%, p = 0,49), de morbilidad postoperatoria (21% vs 22%, p > 0,99) y de mortalidad (ninguna en ambos brazos).LIMITACIONES:Debido a la pandemia SARS CoV-2, el acceso a las camas quirúrgicas fue muy limitado, lo que llevó a un cambio hacia la cirugía ambulatoria para el cierre de ileostomías. El estudio finalizó anticipadamente, lo que afectó su poder estadístico.CONCLUSIÓN:Los cierres de ileostomía en asa como procedimientos de estadía de 23 horas son factibles y seguros. La tasa de íleo podría reducirse mediante la estimulación intestinal preoperatoria a través de la rama eferente del estoma asociada a fórmulas nutricionales, por lo que se necesitan estudios randomizados específicos para confirmar esta asociación. (Traducción-Dr. Xavier Delgadillo ).
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Affiliation(s)
- Janyssa Charbonneau
- Colorectal Surgery Division, Department of Surgery, Université Laval, Quebec City, Quebec, Canada
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Agarwal A, Philips R, Fiorella M, Amin DR, Krein H, Heffelfinger R. Complications and Functional Outcomes After Esophageal Reconstruction with an Intact Larynx. Laryngoscope 2024; 134:1227-1233. [PMID: 37712564 DOI: 10.1002/lary.31055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/30/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Esophageal defects can result from primary pathologies such as malignancy or stricture, or secondary ones such as perforation due to trauma or iatrogenic injury. Techniques, management, and outcomes of reconstruction in this setting are poorly understood. Herein, we aim to highlight surgical outcomes in patients undergoing local and free flap reconstruction of esophageal defects in the setting of an intact larynx. METHODS Retrospective review of patients who underwent esophageal reconstruction with an intact larynx between 2009 and 2022 at our institution was performed. RESULTS Ten patients met inclusion criteria. Esophageal reconstruction was performed for extruded spinal hardware (n = 8), and esophageal stricture (n = 2). Four patients underwent reconstruction with free tissue transfer, and six with local pedicled flaps. There were no cases of flap failure, esophageal fistula, hematoma, or wound dehiscence. One patient had post-operative bleeding requiring return to the operating room. Three patients had a postoperative wound infection, two of whom required washout. There were no unplanned 30-day readmissions. At three months after operation, all patients who were not tube feed-dependent prior to surgery returned to oral intake. Of the four patients who were tube feed-dependent preoperatively, three were tolerating oral intake at nine months postoperatively. Nine patients (90%) had stable flexible laryngoscopy exams pre- and postoperatively with no voice changes. CONCLUSIONS Reconstruction of esophageal defects in the setting of an intact larynx can be challenging. In this series, surgical intervention with free tissue transfer and local pedicled flaps was effective in returning patients to oral intake with low long-term morbidity. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1227-1233, 2024.
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Affiliation(s)
- Aarti Agarwal
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Ramez Philips
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Michele Fiorella
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Dev R Amin
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Howard Krein
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Ryan Heffelfinger
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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Jiamset I, Uttraporn P, Suphasynth Y. Comparative outcomes between transvaginal endoscopic hysterectomy and total laparoscopic hysterectomy in patients with benign uterine disease: A single-center, retrospective, cohort, interrupted time-series study. Int J Gynaecol Obstet 2024; 164:1080-1085. [PMID: 37731329 DOI: 10.1002/ijgo.15144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES To compare the surgical outcomes of total laparoscopic hysterectomy (TLH) and transvaginal endoscopic hysterectomy (TVEH) for benign uterine diseases. METHODS This retrospective, cohort, interrupted time-series study included patients who underwent TLH between January 2013 and September 2016 and TVEH between October 2016 and June 2020. Median difference regression was used to compare the hospital length of stay (LOS) and operative time between the groups. Risk difference regression was used to analyze the proportion of patients who developed postoperative fever or vaginal stump infection. RESULTS Of the total 171 patients enrolled, 101 and 70 underwent TVEH and TLH, respectively. The mean ages of patients in the TVEH and TLH groups were 46.49 and 46.17 years, respectively. No conversion was observed. Ureteric injury occurred in one patient in the TVEH group, whereas there was no organ injury in any of the patients in the TLH group. Compared with those in the TLH group, patients in the TVEH group had a significantly shorter median operative time, shorter hospital LOS, lower morphine use, and lower postoperative febrile morbidity rates. However, no significant difference was observed in the rate of vaginal stump infection between the groups. CONCLUSION Given the shorter operative time, shorter hospital LOS, less febrile morbidity, and lower morphine use in patients with TVEH than in those with TLH, TVEH should be considered as an alternative hysterectomy procedure for benign uterine diseases.
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Affiliation(s)
- Ingporn Jiamset
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Pawara Uttraporn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Yuthasak Suphasynth
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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25
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Long L, He X, Liu Y, Lei C. Effect of two different modalities of hysterectomy on wound infection and wound dehiscence in obese patients. Int Wound J 2024; 21:e14664. [PMID: 38439170 PMCID: PMC10912368 DOI: 10.1111/iwj.14664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/29/2023] [Indexed: 03/06/2024] Open
Abstract
This research intended to investigate the influence of the operation of both kinds of hysterectomies in the risk of wound infection and the degree of wound dehiscence. Both of them were open field and laparoscope. In this research, we looked into four databases: PubMed, Web of Science, Embase and Cochrane Library. Research was conducted on various operative methods for hysterectomy in obese patients between 2000 and October 2023. Two independent investigators performed an independent review of the data, established the inclusion and exclusion criteria, and managed the results with Endnote software. It also evaluated the quality of the included literature. Finally, the data were analysed with RevMan 5.3. This study involved 874 cases, 387 cases received laparoscopy and 487 cases received open access operation. Our findings indicate that there is a significant reduction in the rate of post-operative wound infection among those who have received laparoscopy compared with who have received open surgical procedures (odds ratio [OR], 0.04; 95% confidence interval [CI], 0.01-0.15; p < 0.001); There was no statistical difference between the rate of post-operative wound dehiscence and those who received laparotomy compared with those who received open surgical procedures (OR, 0.33; 95% CI, 0.10-1.11; p = 0.07); The estimated amount of blood lost during the operation was less in the laparoscopy group compared with the open procedure (mean difference, -123.72; 95% CI, -215.16 to -32.28; p = 0.008). Generally speaking, the application of laparoscopy to overweight women who have had a hysterectomy results in a reduction in the expected amount of bleeding during surgery and a reduction in the risk of post-operative wound infections.
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Affiliation(s)
- Ling Long
- Department of Gynecological OncologyChongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer HospitalChongqingChina
| | - Xuan He
- Department of Cancer Center, Daping HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Yuyang Liu
- Department of Traditional Chinese Medicine, College of MedicineChangchun University of Traditional Chinese MedicineChongqingChina
| | - Cuirong Lei
- Department of Gynecological OncologyChongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer HospitalChongqingChina
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Du H, Gu X, Zhang Z, Dong Z, Ran X, Zhou L. Effect of right internal mammary artery versus radial artery as a second graft vessel in coronary artery bypass grafting on postoperative wound infection in patients: A meta-analysis. Int Wound J 2024; 21:e14592. [PMID: 38424286 PMCID: PMC10904365 DOI: 10.1111/iwj.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 03/02/2024] Open
Abstract
Few studies have shown that radial artery (RA), which is used as a secondary arterial graft, offers superior results compared with right internal thoracic artery (RIMA) in coronary artery bypass grafting (CABG). In a meta-analysis of observational studies starting in 2023, we looked at the effect of re-operation on postoperative infection and haemorrhage in CABG with RA vs. RIMA. The electronic database up to October 2023 was examined in the course of the research. Analysis was carried out on the clinical trials of postoperative wound infections and haemorrhage re-surgery. Among 912 trials associated with CABG, we selected 8 trials to be included in the final data analysis. The main results were secondary wound infection and re-operation after surgery. The odds ratios (OR) and confidence intervals (CIs) were computed on the basis of a randomized or fixed-effect model of wound infection and re-operation. Seven trials showed a significant reduction in the risk of wound infection in RA treated as a secondary artery transplant compared with RIMA (OR, 1.60; 95% CI, 1.03, 2.47 p = 0.04); Four trials showed that RIMA was not significantly different from RA in the rate of re-operation for postoperative bleeding (OR, 1.31; 95% CI, 0.60, 2.88 p = 0.50). In CABG, RA is used as a secondary arterial conduit graft to lower the risk of wound infection in CABG patients.
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Affiliation(s)
- Hong Du
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Xiaowei Gu
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Zhiyuan Zhang
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Zichao Dong
- Department of Cardio SurgeryWuHan Asia Cardiac Disease HospitalWuhanChina
| | - Xiaofei Ran
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Li Zhou
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
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Purssell E, Gallagher R, Gould D. Aseptic versus clean technique during wound management? Systematic review with meta-analysis. Int J Environ Health Res 2024; 34:1580-1591. [PMID: 37399368 DOI: 10.1080/09603123.2023.2229758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/22/2023] [Indexed: 07/05/2023]
Abstract
The management of wounds by health professionals usually involves aseptic technique. An alternative is the use of clean techniques where the risk of infection is minimised but use of non-sterile materials is considered permissible. This systematic review and meta-analysis compares these two approaches. Nine studies met the inclusion criteria. Overall risk of bias was judged to be low. The random-effects relative risk of infection for clean dressings rather than aseptic dressings was 0.86 (95% CI 0.67, 1.12). There was little evidence of statistical heterogeneity, although the small number of infections in either group resulted in wide confidence intervals. The 95% prediction interval for future studies was 0.63, 1.18. There was therefore no evidence showing inferiority of clean techniques compared to aseptic methods. Before clinical studies are undertaken with higher risk procedures, laboratory simulations should explore safety by investigating the potential for pathogen transmission at each stage in the dressing procedure.
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Affiliation(s)
- Edward Purssell
- School of Nursing and Midwifery, Anglia Ruskin University, Chelmsford, UK
- Little Havens Children's Hospice, Essex, UK
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Jain A, Abraham S, Krishnamurthy S, Desai K, Basappa Veerabhadraiah B. Development of PU foam dressings loaded with extract of Plectranthus amboinicus for burn wound healing. Drug Dev Ind Pharm 2024; 50:248-261. [PMID: 38317433 DOI: 10.1080/03639045.2024.2315494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To develop Plectranthus amboinicus extract loaded Polyurethane foam dressing for burn wound healing. SIGNIFICANCE Plectranthus amboinicus is traditionally used as an anti-inflammatory and wound-healing agent. Its incorporation in a PU foam dressing will offer the dual benefits of foam dressing as well as the healing potential of P. amboinicus. METHODS PU foam dressings were prepared and loaded with P. ambionicus leaf extract (PAE). The dressings were prepared with varying concentrations (0.5-2%) of extract along with Toluene diisocyanate, polypropylene glycol (PPG), and liquid paraffin. The dressings were characterized by Scanning Electron Microscopy and evaluated for Moisture Vapor Transmission Rate, absorption rate, porosity, and mechanical strength followed by in vivo burn wound-healing studies in comparison to a marketed dressing. RESULTS The MVTR was found to be optimum in formulations FD2-FD4 with values ranging from 2068.06 ± 0.99 to 2095.00 ± 0.25 g/m2/day. Absorption rate was found to be between 1.27 ± 0.01, 1.31 ± 0.00, and 1.30 ± 0.02 g/cm2 for formulations FD2-FD4. Formulations FD1, FD2, FD3, FD4 showed better porosity when compared to other formulations. Formulation FD4 was further characterized by micro-CT and a porosity of 46.32% was obtained. Tensile strength measurement indicated that the selected formulations were flexible enough to withstand regular handling during dressing changes. Acute dermal irritation performed on rabbits showed no irritation, erythema, eschar, and edema. In vivo wound-healing studies performed on albino wistar rats showed that the FD4 formulation has better wound healing property. CONCLUSION Plectranthus ambionicus-loaded PU foam dressing demonstrated promising burn wound-healing potential.
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Affiliation(s)
- Akhila Jain
- Department of Pharmaceutics, Faculty of Pharmacy, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Sindhu Abraham
- Department of Pharmaceutics, Faculty of Pharmacy, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Shwetha Krishnamurthy
- Department of Pharmaceutics, Faculty of Pharmacy, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Kesha Desai
- Department of Pharmacology, Faculty of Pharmacy, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
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Wei M, Zheng H, Xu X, Ji Y, Yu X, Lu L, Sun Y, Zhao Z, Liu X, Jiang W, Zhang X, Qiu Y, Weng Y. Assessment of Wound-Related Pain Experiences of Patients With Chronic Wounds: A Multicenter Cross-Sectional Study in Eastern China. J Wound Ostomy Continence Nurs 2024; 51:111-116. [PMID: 38527319 DOI: 10.1097/won.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE The primary aims of this study were to evaluate the prevalence of wound-related pain (WRP) in patients with chronic wounds and assess the use of pain relief measures. DESIGN A cross-sectional study. SUBJECTS AND SETTING A convenience sample of patients with chronic wounds was recruited from outpatient clinics of 12 hospitals covering 7 of 13 cities in the Jiangsu province located in eastern China from July 10 to August 25, 2020. The sample comprised 451 respondents, and their mean age was 54.85 (SD 19.16) years; 56.1% (253/451) patients were male. METHODS An investigator-designed questionnaire was used to collect pain-related information from patients. The questionnaire consisted of 4 parts: (1) basic demographic and clinical information (patient and wound characteristics); (2) wound baseline pain; (3) wound-related procedural pain and pain relief method; and (4) the effect of WRP on the patient. Pain was assessed using the Numerical Rating Scale (NRS) scored from 0 (no pain) to 10 (worst pain). Severity of pain was based on NRS scores' classification as mild (1-3), moderate (4-6), and severe (7-10). The survey was conducted from July 10 to August 25, 2020. Participants were instructed on use of the NRS and then completed the questionnaire following dressing change independently. RESULTS The 3 most common types of chronic wounds were traumatic ulcers, surgical wounds, and venous leg ulcers. The 3 most prevalent locations were lower limbs, feet, and thorax/abdomen. Of all patients, 62.5% (282/451) and 93.8% (423/451) patients experienced wound baseline pain and wound-related procedural pain, respectively. The mean score of wound baseline pain was 3.76 (SD 1.60) indicating moderate pain. During wound management, the highest pain score was 6.45 (SD 2.75) indicating severe pain; the most severe pain scores were associated with debridement. The use of drugs to relieve wound pain was low, while the use of nondrug-based analgesia was relatively high. Because of WRP, patients with chronic wounds feared dressing changes, hesitated to move, and showed a decline in sleep quality. CONCLUSIONS Wound baseline pain and wound-related procedural pain were very common in patients with chronic wounds. In the future, targeted intervention plans should be developed by combining drug-based and nondrug-based analgesia according to pain severity.
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Affiliation(s)
- Min Wei
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Huiling Zheng
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xinyue Xu
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yihong Ji
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiujuan Yu
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Lin Lu
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ying Sun
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Zhiying Zhao
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiaojun Liu
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Wei Jiang
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiya Zhang
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yansen Qiu
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yajuan Weng
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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Aubert O, Lacher M, Stolzenburg JU, Haney CM. Antimicrobial Resistance Patterns in Children with Continuous Antibiotic Prophylaxis: A Meta-analysis of Randomised Controlled Trials. Eur Urol 2024; 85:307-308. [PMID: 38092615 DOI: 10.1016/j.eururo.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Ophelia Aubert
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany.
| | - Martin Lacher
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
| | | | - Caelán Max Haney
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
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Fichera A, Mangrola AM, Olortegui KS, Rebollo Salazar DA, Stringfield SB, Kapadia MR, Madduri SS, Ogola GO, Krane MK. Long-term Outcomes of the Kono-S Anastomosis: A Multicenter Study. Dis Colon Rectum 2024; 67:406-413. [PMID: 38039388 DOI: 10.1097/dcr.0000000000003132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
BACKGROUND Postoperative recurrence remains a significant problem in Crohn's disease, and the mesentery is implicated in the pathophysiology. The Kono-S anastomosis was designed to exclude the mesentery from a wide anastomotic lumen, limit luminal distortion and fecal stasis, and preserve innervation and vascularization. OBJECTIVE To review postoperative complications and long-term outcomes of the Kono-S anastomosis in a large series of consecutive unselected patients with Crohn's disease. DESIGN Retrospective study of prospectively collected patients. SETTINGS Four tertiary referral centers. PATIENTS Consecutive patients with Crohn's disease who underwent resection with Kono-S anastomosis between May 2010 and June 2022. INTERVENTIONS Extracorporeal handsewn Kono-S anastomosis. MAIN OUTCOME MEASURES Postoperative outcomes and recurrence defined as endoscopic, clinical, laboratory, or surgical, including endoscopic, intervention. RESULTS A total of 262 consecutive patients (53.4% male) were included. The mean duration of disease at surgery was 145.1 months. One hundred thirty-five patients (51.5%) had previous abdominal surgery for Crohn's disease. Forty-four patients (17%) were actively smoking and 150 (57.3%) were on biologic therapy. Anastomotic failure occurred in 4 (1.5%), with 2 patients requiring reoperation (0.7%). Sixteen patients had postoperative surgical site infection (6.1%). With a median follow-up of 49.4 months, 20 patients (7.6%) were found to have surgical recurrence. In the multivariate analysis, perianal disease (OR = 2.83, p = 0.001), urgent/emergent surgery (OR = 3.23, p = 0.007), and postoperative use of steroids (OR = 2.29, p = 0.025) were associated with increased risk of overall recurrence. LIMITATIONS Retrospective study and variability of perioperative medical therapy. CONCLUSIONS This study showed very low postoperative complication rates despite the complexity of the patient population. There was a low rate of surgical recurrence, likely due to the intrinsic advantages of the anastomotic configuration and the low rate of postoperative septic complications. In experienced hands, the Kono-S anastomosis is a safe technique with very promising short- and long-term results. Randomized controlled trials are underway to validate this study's findings. See Video Abstract . RESULTADO A LARGO PLAZO DE LA ANASTOMOSIS KONOS UN ESTUDIO MULTICNTRICO ANTECEDENTES:La recurrencia posoperatoria sigue siendo un problema importante en la enfermedad de Crohn y el mesenterio está implicado en la fisiopatología. La anastomosis Kono-S fue diseñada para excluir el mesenterio de una anastomosis amplia, limitar la distorsión luminal y la estasis fecal y preservar la inervación y vascularización.OBJETIVO:Revisar las complicaciones posoperatorias y los resultados a largo plazo de la anastomosis Kono-S en una gran serie de pacientes consecutivos no seleccionados con enfermedad de Crohn.DISEÑO:Estudio retrospectivo de pacientes recolectados prospectivamente.ESCENARIO:Cuatro centros de referencia terciarios.PACIENTES:Pacientes consecutivos con enfermedad de Crohn sometidos a resección con anastomosis Kono-S entre mayo de 2010 y junio de 2022.INTERVENCIONES:Anastomosis Kono-S extracorpórea manual.PRINCIPALES MEDIDAS DE RESULTADO:Resultados posoperatorios y recurrencia definidos como endoscópicos, clínicos, de laboratorio o quirúrgicos, incluida la intervención endoscópica.RESULTADOS:Se incluyeron un total de 262 pacientes consecutivos (53,4% varones). La duración media de la enfermedad al momento de la cirugía fue de 145,1 meses. Ciento treinta y cinco pacientes (51,5%) habían tenido cirugía abdominal previa por enfermedad de Crohn. Cuarenta y cuatro pacientes (17%) eran fumadores activos y 150 (57,3%) estaban en tratamiento biológico. Se produjo filtración anastomótica en 4 (1,5%) y 2 pacientes requirieron reoperación (0,7%). Dieciséis pacientes tuvieron infección postoperatoria del sitio quirúrgico (6,1%). Con una mediana de seguimiento de 49,4 meses, se encontró que 20 pacientes (7,6%) tuvieron recurrencia quirúrgica. En el análisis multivariado, la enfermedad perianal (OR = 2,83, p = 0,001), la cirugía urgente/emergente (OR = 3,23, p = 0,007), el uso postoperatorio de esteroides (OR = 2,29, p = 0,025) se asociaron con un mayor riesgo de recurrencia general.LIMITACIÓN:Estudio retrospectivo. Variabilidad del tratamiento médico perioperatorio.CONCLUSIONES:Nuestro estudio mostró tasas de complicaciones postoperatorias muy bajas a pesar de la complejidad de la población de pacientes. Hubo una baja tasa de recurrencia quirúrgica, probablemente debido a las ventajas intrínsecas de la configuración anastomótica y la baja tasa de complicaciones sépticas posoperatorias. En manos experimentadas, la anastomosis Kono-S es una técnica segura con resultados muy prometedores a corto y largo plazo. Se están realizando estudios randomizados controlados para validar nuestros hallazgos. (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
| | - Anjali M Mangrola
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Kinga S Olortegui
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | | | | | - Muneera R Kapadia
- Department of Surgery, University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Supradeep S Madduri
- Department of Surgery, University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Gerald O Ogola
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Mukta K Krane
- Department of Surgery, University of Washington Medical Center, Seattle, Washington
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Brown NJ, Gendreau J, Rahmani R, Catapano JS, Lawton MT. Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques. Neurosurg Rev 2024; 47:79. [PMID: 38353750 PMCID: PMC10866748 DOI: 10.1007/s10143-024-02307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/27/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024]
Abstract
Decompressive hemicraniectomy (DHC) is a critical procedure used to alleviate elevated intracranial pressure (ICP) in emergent situations. It is typically performed to create space for the swelling brain and to prevent dangerous and potentially fatal increases in ICP. DHC is indicated for pathologies ranging from MCA stroke to traumatic subarachnoid hemorrhage-essentially any cause of refractory brain swelling and elevated ICPs. Scalp incisions for opening and closing the soft tissues during DHC are crucial to achieve optimal outcomes by promoting proper wound healing and minimizing surgical site infections (SSIs). Though the reverse question mark (RQM) scalp incision has gained significant traction within neurosurgical practice, alternatives-including the retroauricular (RA) and Kempe incisions-have been proposed. As choice of technique can impact postoperative outcomes and complications, we sought to compare outcomes associated with different scalp incision techniques used during DHC. We queried three databases according to PRISMA guidelines in order to identify studies comparing outcomes between the RQM versus "alternative" scalp incision techniques for DHC. Our primary outcome of interest in the present study was postoperative wound infection rates according to scalp incision type. Secondary outcomes included estimated blood loss (EBL) and operative duration. We identified seven studies eligible for inclusion in the formal meta-analysis. The traditional RQM technique shortened operative times by 36.56 min, on average. Additionally, mean EBL was significantly lower when the RQM scalp incision was used. Postoperatively, there was no significant association between DHC incision type and mean intensive care unit (ICU) length of stay (LOS), nor was there a significant difference in predisposition to developing wound complications or infections between the RQM and retroauricular/Kempe incision cohorts. Superficial temporal artery (STA) preservation and reoperation rates were collected but could not be analyzed due to insufficient number of studies reporting these outcomes. Our meta-analysis suggests that there is no significant difference between scalp incision techniques as they relate to surgical site infection and wound complications. At present, it appears that outcomes following DHC can be improved by ensuring that the bone flap is large enough to enable sufficient cerebral expansion and decompression of the temporal lobe, the latter of which is of particular importance. Although previous studies have suggested that there are several advantages to performing alternative scalp incision techniques during DHC, the present study (which is to our knowledge the first to meta-analyze the literature on outcomes in DHC by scalp incision type) does not support these findings. As such, further investigations in the form of prospective trials with high statistical power are merited.
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Affiliation(s)
- Nolan J Brown
- Department of Neurological Surgery, University of California-Irvine, Orange, CA, USA
| | - Julian Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
| | - Redi Rahmani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 2910 North Third Avenue, Phoenix, AZ, 85013, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 2910 North Third Avenue, Phoenix, AZ, 85013, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 2910 North Third Avenue, Phoenix, AZ, 85013, USA.
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Hachiro K, Takashima N, Suzuki T. Off-pump bilateral internal thoracic artery grafting in patients with left main coronary artery disease. J Cardiothorac Surg 2024; 19:81. [PMID: 38336822 PMCID: PMC10858637 DOI: 10.1186/s13019-024-02582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND To compare postoperative outcomes in patients with left main coronary artery disease who underwent off-pump isolated coronary artery bypass grafting for multivessel disease using either skeletonized bilateral or single internal thoracic artery (ITA). METHODS Among 1583 patients who underwent isolated coronary artery bypass grafting (CABG) in our hospital between 2002 and 2022, 604 patients with left main coronary artery disease underwent single (n = 169) or bilateral (n = 435) ITA grafting. We compared postoperative outcomes between the two groups after adjusting preoperative characteristics using inverse probability of treatment weighting. RESULTS After adjustment using inverse probability of treatment weighting method, the sum of weights was 599.74 in BITA group and 621.64 in SITA group. There was no significant difference in postoperative deep sternal wound infection (p = 0.227) and 30-day mortality (p = 0.612). Follow-up was completed in 98.7% (596/604) of the patients, and the mean follow-up duration was 6.7 years. At 10 years, the overall survival following bilateral versus single ITA grafting was 71.2% and 60.6%, respectively (log-rank test, p = 0.040), and freedom from major adverse cardiac and cerebrovascular events (MACCE) was 63.3% and 46.3%, respectively (log-rank test, p = 0.008). In multivariate Cox proportional hazard models, bilateral ITA grafting was significantly associated with a lower risk of all-cause death (hazard ratio [HR]: 0.706, 95% confidence interval [CI]: 0.504-0.987; p = 0.042) and MACCE (HR: 0.671, 95% CI: 0.499-0.902; p = 0.008). CONCLUSIONS Bilateral skeletonized ITA grafting is associated with lower rates of all-cause death and MACCE than single ITA grafting in patients with left main coronary artery disease undergoing off-pump CABG.
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Affiliation(s)
- Kohei Hachiro
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, 520-2192, Shiga, Japan.
| | - Noriyuki Takashima
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, 520-2192, Shiga, Japan
| | - Tomoaki Suzuki
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, 520-2192, Shiga, Japan
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Nolan T. Vapes for smoking cessation and the antiseptic properties of iodine and chlorhexidine. BMJ 2024; 384:q298. [PMID: 38331436 DOI: 10.1136/bmj.q298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
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Pinto RA, Soares DFM, Gerbasi L, Nahas CSR, Marques CFS, Bustamante-Lopes LA, de Camargo MGM, Nahas SC. LAPAROSCOPIC RIGHT AND LEFT COLECTOMY: WHICH PROVIDES BETTER POSTOPERATIVE RESULTS FOR ONCOLOGY PATIENTS? Arq Bras Cir Dig 2024; 36:e1792. [PMID: 38324853 PMCID: PMC10841488 DOI: 10.1590/0102-672020230074e1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND The laparoscopic approach considerably reduced the morbidity of colorectal surgery when compared to the open approach. Among its benefits, we can highlight less intraoperative bleeding, early oral intake, lower rates of surgical site infection, incisional hernia, and postoperative pain, and earlier hospital discharge. AIMS To compare the perioperative morbidity of right versus left colectomy for cancer and the quality of laparoscopic oncologic resection. METHODS Retrospective analysis of patients submitted to laparoscopic right and left colctomy between 2006 and 2016. Postoperative complications were classified using the Clavien-Dindo scale, 30 days after surgery. RESULTS A total of 293 patients were analyzed, 97 right colectomies (33.1%) and 196 left colectomies (66.9%). The averageage was 62.8 years. The groups were comparable in terms of age, comorbidities, body mass index, and the American Society of Anesthesiology (ASA) classification. Preoperative transfusion was higher in the right colectomy group (5.1% versus 0.4%, p=0.004, p<0.05). Overall, 233 patients (79.5%) had no complications. Complications found were grade I and II in 62 patients (21.1%) and grade III to V in 37 (12.6%). Twenty-three patients (7.8%) underwent reoperation. The comparison between left and right colectomy was not statistically different for operative time, conversion, reoperation, severe postoperative complications, and length of stay. The anastomotic leak rate was comparable in both groups(5.6% versus 2.1%, p=0.232, p>0.05). The oncological results were similar in both surgeries. In multiple logistic regression, ASA statistically influenced the worst results (≥ III; p=0.029, p<0.05). CONCLUSIONS The surgical and oncological results of laparoscopic right and left colectomies are similar, making this the preferred approach for both procedures.
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Affiliation(s)
- Rodrigo Ambar Pinto
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Coloproctology Unit - São Paulo (SP), Brazil
| | - Diego Fernandes Maia Soares
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Coloproctology Unit - São Paulo (SP), Brazil
| | - Lucas Gerbasi
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Coloproctology Unit - São Paulo (SP), Brazil
| | - Caio Sérgio Rizkallah Nahas
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Coloproctology Unit - São Paulo (SP), Brazil
| | | | | | | | - Sérgio Carlos Nahas
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Coloproctology Unit - São Paulo (SP), Brazil
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Cardona S, Hernández C, Bohórquez-Tarazona MP, Rubiano AM, Parra DMS. Scalp wound management: a narrative review from a neurosurgical perspective. J Wound Care 2024; 33:127-135. [PMID: 38329834 DOI: 10.12968/jowc.2024.33.2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article aims to present a narrative review of current literature about the anatomical characteristics of the scalp as well as current practices in the management of surgical, traumatic and pressure injuries in the scalp, which are common in neurosurgery practice. METHOD We searched PubMed for publications and book chapters in English from 2011 to 2021. We also included commonly referenced papers that we considered relevant to the subject with publication before these dates. We used the search terms 'laceration,' and/or 'neurosurgery' and/or, 'pressure injury,' and/or 'craniotomy,' and/or 'surgical incision' in combination with 'scalp,' and/or 'wound care.' We also searched the reference lists of publications identified by the search strategy and selected those that we judged relevant. RESULTS We pre-selected 52 articles that covered various aspects of anatomy, pathophysiology, scalp wound management, or general wound care that we considered applied to the anatomical region of our interest. After abstract review, we selected 34 articles that met our search criteria and were included in our review. CONCLUSION There is limited evidence regarding classification and care of scalp wounds. As a result, many of the current practices for scalp wound management are based on evidence derived from studies involving different anatomical regions, not considering its particular anatomy, vasculature and microbiome. Further research is needed for more comprehensive and effective protocols for the management of scalp injuries. However, this present review proposes responses to the identified gaps concerning the management of scalp wounds.
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Affiliation(s)
| | | | | | - Andrés M Rubiano
- Meditech Foundation, Barrow Neurological Institute at Phoenix Children's Hospital, US
- Valle Salud IPS Clinic Network, Colombia
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, UK
| | - Diana Marcela Sánchez Parra
- Meditech Foundation, Barrow Neurological Institute at Phoenix Children's Hospital, US
- Fellow, Global Neurosurgery and Trauma, University of Cambridge, UK
- Fundación Meditech, Cali, Colombia
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Lohuis PJFM, Maldonado-Chapa F, Santos-Santillana KM, Filipović B, Dirven R, Karakullukcku MB, Karssemakers L, Schreuder WH, Zuur CL, Timmermans J. Optimizing Wound Care after Surgery of the Head and Neck: A Review of Dressing Materials. Facial Plast Surg 2024; 40:68-79. [PMID: 36878677 DOI: 10.1055/a-2047-6356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Wound healing is a complex biological process subject to complications that might jeopardize the patient's postoperative care. Appropriately approaching surgical wounds after head and neck surgery positively influences the quality and speed of wound healing and increases patient comfort. A large variety of dressing materials currently exist that allow the care of different types of wounds. Nevertheless, there is limited literature on the most suitable types of dressings after head and neck surgery. The objective of the present article is to review the most commonly used wound dressings, their benefits, indications, and disadvantages, and to provide a systematic approach for wound care within the head and neck. The Woundcare Consultant Society distinguishes wounds into three groups: black, yellow, and red. Each type of wound represents distinctive underlying pathophysiological processes with unique needs. Utilizing this classification along with the TIME model allows a proper characterization of wounds and the identification of potential healing barriers. This evidence-based and systematic approach can facilitate and guide the head and neck surgeon in selecting a wound dressing upon acknowledging their properties, which are herein reviewed and exemplified with representative cases.
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Affiliation(s)
- Peter J F M Lohuis
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Facial Plastic and Reconstructive Surgery, Lohuis-Filipović Medial Group, Zagreb, Croatia
- Department of Facial Plastic and Reconstructive Surgery, Bergman Clinics, Hilversum, The Netherlands
- Department of Sleep Medicine, Ruysdael Clinics, Amsterdam, The Netherlands
| | - Felix Maldonado-Chapa
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Facial Plastic and Reconstructive Surgery, Lohuis-Filipović Medial Group, Zagreb, Croatia
| | - Karla M Santos-Santillana
- Department of Facial Plastic and Reconstructive Surgery, Lohuis-Filipović Medial Group, Zagreb, Croatia
| | - Boris Filipović
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Facial Plastic and Reconstructive Surgery, Lohuis-Filipović Medial Group, Zagreb, Croatia
| | - Richard Dirven
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Baris Karakullukcku
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Luc Karssemakers
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Willem H Schreuder
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte L Zuur
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jacqueline Timmermans
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Lu J, Guan F, Zhang Z, Gao Q, Li Q, Yu Z, Gu J. Comparison between gravity drainage group and suction drainage group after cervical laminoplasty: a retrospective STROBE-compliant cohort study. Br J Neurosurg 2024; 38:68-71. [PMID: 34608847 DOI: 10.1080/02688697.2021.1900538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES A retrospective study was conducted to compare gravity drainage and suction drainage after cervical laminoplasty. PATIENTS AND METHODS A total of 375 patients who underwent laminoplasty between January 2011 and December 2015 were engaged in this analysis. We investigated the patients' basic characteristics, drainage characteristics and postoperative complications. RESULTS During the initial 24 h after laminoplasty, the drainage volume in the suction drainage group was 177.31 ± 92.02 mL, and the drainage volume in the gravity drainage group was 133.33 ± 92.40 mL. The drainage volume showed significant difference (p < 0.01). The total drainage volume was 357.49 ± 195.16 mL and 250.16 ± 27.44 mL in the suction drainage group and gravity drainage group, respectively. The total drainage volume between the two groups was statistically different (p = 0.03). The postoperative Hb was significantly different between the gravity group and suction group on the first day after the operation (108.37 ± 23.92 mL vs. 87.32 ± 21.53 mL, p = 0.02). The number of patients required blood transfusion was significantly different between the two groups as well (p = 0.04). Two cases had symptomatic epidural hematomas (SEH) after laminoplaty. However, the occurrence of SEH among the two groups was not different significantly. Twelve patients had surgical site infection (SSI). Of these 12, nine had applied gravity drainage and three suction drainage. The rate of SSI was similar between the two groups (p = 0.71). CONCLUSION The initial 24 h' drainage volume and the total drainage volume increased significantly in the suction drainage group. The postoperative Hb was lower in the suction group than the gravity drainage group the first postoperative day. More patients needed blood transfusion if suction drainage was performed. The application of suction drainage cannot decrease the incidence of SSI and SEH after laminoplasty. Gravity drainage is recommended for laminoplasty.
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Affiliation(s)
- Juncheng Lu
- Hospital of Harbin Medical University, Harbin, China
| | - Fulin Guan
- Hospital of Harbin Medical University, Harbin, China
| | | | - Qichang Gao
- Hospital of Harbin Medical University, Harbin, China
| | - Qingsong Li
- Hospital of Harbin Medical University, Harbin, China
| | - Zhange Yu
- Hospital of Harbin Medical University, Harbin, China
| | - Jiaao Gu
- Hospital of Harbin Medical University, Harbin, China
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Rashid A. Yonder: Surgical site infection, opioid dependence, racial diversity, and meals on wheels. Br J Gen Pract 2024; 74:80. [PMID: 38272682 PMCID: PMC10824354 DOI: 10.3399/bjgp24x736293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Affiliation(s)
- Ahmed Rashid
- GP and Professor of Medical Education, UCL Medical School, UCL, London. @Dr_A_Rashid
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Al Naimi A. Is it the surgical intervention or was it the preoperative medical preparation? Am J Obstet Gynecol 2024; 230:272. [PMID: 37852522 DOI: 10.1016/j.ajog.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Ammar Al Naimi
- Department of Obstetrics and Gynecology, Buergerhospital - Dr. Senckenbergische Stiftung, Nibelungenallee 37-41, D-60318 Frankfurt am Main, Hessen, Germany; Department of Obstetrics and Gynecology, Goethe University of Frankfurt, Hessen, Germany.
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Karakawa R, Konishi T, Yoshimatsu H, Hashimoto Y, Matsui H, Fushimi K, Yano T, Yasunaga H. Association between body mass index and outcomes after autologous breast reconstruction: a nationwide inpatient database study in Japan. Breast Cancer Res Treat 2024; 204:69-78. [PMID: 37966699 DOI: 10.1007/s10549-023-07162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Although autologous reconstruction following breast cancer surgery is common, little is known about the association between preoperative body mass index (BMI) and short-term surgical outcomes. This study investigated the association between BMI and short-term surgical outcomes in autologous breast reconstruction using a nationwide Japanese inpatient database. METHODS We retrospectively identified female patients with breast cancer who underwent breast reconstruction using a pedicled flap or free flap from July 2010 to March 2020. Multivariable regression analyses and restricted cubic spline analyses were conducted to investigate the associations between BMI and short-term outcomes with adjustment for demographic and clinical backgrounds. RESULTS Of the 13,734 eligible patients, 7.1% and 22.2% had a BMI of < 18.5 kg/m2 and > 25 kg/m2, respectively. Compared with BMI of 18.5-21.9 kg/m2, overweight (25.0-29.9 kg/m2) and obese (≥ 30.0 kg/m2) were significantly associated with higher occurrences of takebacks (odds ratio, 1.74 [95% confidence interval, 1.28-2.38] and 2.89 [1.88-4.43], respectively) and overall complications (1.37 [1.20-1.57] and 1.77 [1.42-2.20], respectively). In the restricted cubic spline analyses, BMI showed J-shaped associations with takebacks, overall complications, local complications, and wound dehiscence. BMI also demonstrated linear associations with postoperative surgical site infection, duration of anesthesia, duration of drainage, length of stay, and hospitalization costs. CONCLUSION In autologous breast reconstruction following breast cancer surgery, a higher BMI was associated with takebacks, morbidity, a longer hospital stay, and higher total costs, whereas a lower BMI was associated with fewer surgical site infections, a shorter hospital stay, and lower total costs.
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Affiliation(s)
- Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, Japan.
| | - Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Tomoyuki Yano
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Zhang L, Zhao H, Zhang L, Ye Z, Liang W. The modified cross-suture technique for loop stoma reversal. Asian J Surg 2024; 47:993-994. [PMID: 37914650 DOI: 10.1016/j.asjsur.2023.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/01/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023] Open
Abstract
TECHNIQUE (1) A four-pointed star-shaped incision was made to separate the skin around the stoma intestine. (2) The stoma intestine was resected, and side-to-side or end-to-side anastomosis was performed to restore the continuity of the intestine. (3) The peritoneum and rectus sheath should be closed using continuous full-thickness sutures. (4) The subcutaneous fat layer and dermis layer should be sutured using purse-string sutures. Two holes should be made in the center of the sutured area. (5) The cross should be sutured intermittently on all four sides using 1-2 stitches. (6) A rubber strip should be placed in the center of the small hole. RESULTS The presence of a small hole in the center of the incision and the use of a rubber strip for drainage facilitate early fluid drainage. The design of a cross-stitched skin incision helps reduce local tension. CONCLUSION The modified cross-suture technique may reduce postoperative incision infections and associated pain, which is a suitable incision treatment method for loop stoma reversal.
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Affiliation(s)
- Lixiao Zhang
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Hongyu Zhao
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Lifei Zhang
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Zhibin Ye
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Wei Liang
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei Province, China.
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Ruiz-López PM, Fuente-Bartolomé MDL, Pérez-Zapata AI, Rodríguez-Cuéllar E, Martín-Arriscado-Arroba C, Nogueras MG, Segurola CL, Sánchez ÁT. Analysis of adverse events in general surgery. Multicenter study. Cir Esp 2024; 102:76-83. [PMID: 37967648 DOI: 10.1016/j.cireng.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/09/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Knowledge of adverse events (AE) in acute care hospitals is a particularly relevant aspect of patient safety. Its incidence ranges from 3% to 17%, and surgery is related to the occurrence of 46%-65% of all AE. MATERIAL AND METHODS An observational, descriptive, retrospective, multicenter study was conducted with the participation of 31 Spanish acute-care hospitals to determine and analyze AE in general surgery services. RESULTS The prevalence of AE was 31.53%. The most frequent types of AE were infectious (35%). Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. The majority of patients (58.42%) were attributed a category F event (temporary harm to the patient requiring initial or prolonged hospitalization); 14.69% of AE were considered severe, while 34.22% of AE were considered preventable. CONCLUSIONS The prevalence of AE in General and GI Surgery (GGIS) patients is high. Most AE were infectious, and the most frequent AE was surgical site infection. Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. Most detected AE resulted in mild or moderate harm to the patients. About one-third of AE were preventable.
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Affiliation(s)
- Pedro M Ruiz-López
- Instituto de Investigación Biomédica, I+12, Hospital Universitario 12 de Octubre, Spain
| | - Marta de la Fuente-Bartolomé
- Facultativo Especialista de Área, Servicio de Cirugía General y Aparato Digestivo, H. Universitario Infanta Elena, Madrid, Spain.
| | - Ana Isabel Pérez-Zapata
- Facultativo Especialista de Área, Servicio de Cirugía General y Aparato Digestivo, H. Royo Vilanova, Spain
| | - Elías Rodríguez-Cuéllar
- Facultativo Especialista de Área, Servicio de Cirugía General y Aparato Digestivo, H. Universitario 12 de Octubre, Spain
| | | | - Manuel Giner Nogueras
- Facultativo Especialista de Área, Servicio de Cirugía General y Aparato Digestivo, H. Clínico San Carlos, Spain
| | - Carmelo Loinaz Segurola
- Jefe de Sección, Servicio de Cirugía General y Aparato Digestivo, H. Universitario 12 de Octubre, Spain
| | - Ángel Tejido Sánchez
- Facultativo Especialista de Área, Servicio de Utología, H. Universitario 12 de Octubre, Spain
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Huang YT, Lin SC, Huang LY, Rujikajorn K, Chen PYJ, Chen JJY, Wu MY, Lin HJ, Wan L. Incidence, Risk Factors and Management of Postoperative Complications in Horizontal Strabismus Surgery. Semin Ophthalmol 2024; 39:143-149. [PMID: 37921332 DOI: 10.1080/08820538.2023.2275620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To report the incidence, risk factors and management of postoperative complications after horizontal strabismus surgery. DESIGN Retrospective Cohort study. PARTICIPANTS The study assessed 1,273 patients with 1,035 cases of exotropia and 238 cases of esotropia, with a minimum 18-month follow-up. METHODS Retrospective review of strabismus operation patients' medical records included baseline demographics, age at surgery, pre/postoperative visual acuity, and deviation. Complications were categorized as surgical site (infection, scarring, cyst, granuloma, ischemia) and strabismus-related (recurrence, diplopia), with analysis of incidence, risk factors, and management. RESULTS Among surgical site complications, the incidence of infection, pyogenic granuloma, and anterior segment ischemia were similar between the exotropia (0.3%, 0.3%, 0.2%) and esotropia (0.8%, 0%, 0.4%) groups (p = .221, 0.406, 0.515). In contrast, the esotropia group presented a higher risk of conjunctival inclusion cyst and conjunctival scar than the exotropia group, with incidences of 5.0% vs 2.2% and 6.3% vs 1.3%, respectively (p = .004, <0.001). Regarding strabismus complications, the incidence of early recurrence was not significant between the two groups, with 10.0% in the exotropia group and 10.5% in the esotropia group (p = .553). Older age and poor initial visual acuity were associated with early recurrence (p < .001). The esotropia group had a higher risk of persistent diplopia than the exotropia group, with incidences of 4.2% vs 2.0%, respectively (p = .003). CONCLUSION Esotropia carries a higher risk of conjunctival inclusion cysts, conjunctival scarring, and persistent diplopia compared to the exotropia group, while both groups exhibit similar rates of early recurrence and other surgical site complications.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, Eye Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Sheng-Chun Lin
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Li-Ying Huang
- Department of Ophthalmology, Eye Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Kewalee Rujikajorn
- Department of Ophthalmology, Eye Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Po-Yu Jay Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Jamie Jiin-Yi Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ming-Yen Wu
- Department of Ophthalmology, Eye Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hui-Ju Lin
- Department of Ophthalmology, Eye Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Lei Wan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Obstetrics and Gynecology, China Medical University, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
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Ndong A, Togtoga L, Bah MS, Ndoye PD, Niang K. Prevalence and mortality rate of abdominal surgical emergencies in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Surg 2024; 24:35. [PMID: 38267892 PMCID: PMC10809467 DOI: 10.1186/s12893-024-02319-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Abdominal surgical emergencies remain prevalent in various healthcare settings, particularly in regions with limited access to basic surgical care, such as Africa. The aim of this literature review is to systematically assess publications on abdominal surgical emergencies in adults in sub-Saharan Africa to estimate their prevalence and mortality rate. METHODOLOGY A systematic review was conducted. The latest search was performed on October 31, 2022. We estimated the pooled prevalence with a 95% confidence interval (CI) for each abdominal surgical emergency, as well as overall postoperative mortality and morbidity rates. RESULTS A total of 78 studies were included, and 55.1% were single-center retrospective and monocentric studies. The mean age of the patients was 32.5 years, with a sex ratio of 1.94. The prevalence of each abdominal surgical emergency among all of them was as follows: appendicitis: 30.0% (95% CI: 26.1-33.9); bowel obstruction: 28.6% (95% CI: 25.3-31.8); peritonitis: 26.6% (95% CI: 22.2-30.9); strangulated hernias: 13,4% (95% CI: 10,3-16,5) and abdominal trauma: 9.4% (95% CI: 7.5-11.3). The prevalence of complications was as follows: mortality rate: 7.4% (95% CI: 6.0-8.8); overall postoperative morbidity: 24.2% (95% CI: 19.4-29.0); and surgical site infection 14.4% (95% CI: 10.86-18.06). CONCLUSION Our study revealed a high prevalence of postoperative complications associated with abdominal surgical emergencies in sub-Saharan Africa. More research and efforts should be made to improve access and quality of patient care.
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Affiliation(s)
- Abdourahmane Ndong
- Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal.
- General Surgery Department, Regional Hospital Center of Saint Saint-Louis, Saint-Louis, Senegal.
| | - Lebem Togtoga
- Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - Mamadou Saïdou Bah
- Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - Papa Djibril Ndoye
- Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - Khadim Niang
- Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
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Huang MT, Qu Z, Liang PF, Liu WD, He ZY, Cui X, Guo L, Chen J, Li MJ, Huang XY, Zhang PH. [Clinical effect of modified vertical rectus abdominis myocutaneous flap in repairing skin and soft tissue defects after abdominoperineal resection for rectal cancer]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2024; 40:57-63. [PMID: 38296237 DOI: 10.3760/cma.j.cn501225-20231030-00156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Objective: To investigate the clinical effect of the modified vertical rectus abdominis myocutaneous flap in repairing the skin and soft tissue defect after abdominoperineal resection for rectal cancer. Methods: This study was a retrospective observational study. From June 2019 to July 2022, five male patients with low rectal cancer who were conformed to the inclusion criteria were admitted to the Department of Basic Surgery of Xiangya Hospital of Central South University, with ages ranging from 65 to 70 years and the sizes of the perianal skin ulcers ranging from 5 cm×4 cm to 11 cm×9 cm, and all of them underwent abdominoperineal resection. The secondary skin and soft tissue defects in the perineum with an area of 8 cm×6 cm-14 cm×12 cm (with the depth of pelvic floor dead space being 10-15 cm) were repaired intraoperatively with transplantation of modified vertical rectus abdominis myocutaneous flaps with the skin area being 9 cm×7 cm-16 cm×12 cm, the volume of the muscle being 18 cm×10 cm×5 cm-20 cm×12 cm×5 cm, and the vessel pedicle being 18-20 cm in length. During the operation, most of the anterior sheath of the rectus abdominis muscle was retained, the flap was transferred to the recipient area through the abdominal cavity, the remaining anterior sheaths of the rectus abdominis muscle on both sides of the donor area were repeatedly folded and sutured, the free edge of the transverse fascia of the abdomen was sutured with the anterior sheath of the rectus abdominis muscle, and the donor area skin was directly sutured. After the operation, the survival of the transplanted myocutaneous flap was observed. The occurrence of complications in the perineal recipient area was recorded within 2 weeks after the operation. The recovery of the perineal recipient area and the abdominal donor area was observed during follow-up, and the occurrence of complications in the donor area of the abdomen as well as the recurrence of tumors and metastasis were recorded. Results: All transplanted myocutaneous flaps in 5 patients survived after surgery. One patient had dehiscence of the incision in the perineal recipient area 2 days after surgery, which healed after 7 d with intermittent dressing changes and routine vacuum sealing drainage treatment. In the other 4 patients, no complications such as incisional rupture, incisional infection, or fat liquefaction occurred in the perineal recipient area within 2 weeks after surgery. Follow-up for 6-12 months after discharge showed that the skin of the perineal recipient area had good color, texture, and elasticity, and was not bloated in appearance; linear scars were left in the perineal recipient area and the abdominal donor area without obvious scar hyperplasia or hyperpigmentation; no complications such as incisional rupture, incisional infection, intestinal adhesion, intestinal obstruction, or weakening of the abdominal wall strength occurred in the abdominal donor area, and the abdominal appearance was good with no localized bulge or formation of abdominal hernia; there was no local recurrence of tumor or metastasis in any patient. Conclusions: The surgical approach of using the modified vertical rectus abdominis myocutaneous flap to repair the skin and soft tissue defects after abdominoperineal resection for rectal cancer is relatively simple in operation, can achieve good postoperative appearances of the donor and recipient areas with few complications, and is worthy of clinical promotion.
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Affiliation(s)
- M T Huang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Z Qu
- Department of Basic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - P F Liang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - W D Liu
- Department of Basic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Z Y He
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - X Cui
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - L Guo
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - J Chen
- Department of Basic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - M J Li
- Department of Medical Beauty Center, Hunan Provincial Institute of Occupational Disease Control, Changsha 410012, China
| | - X Y Huang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - P H Zhang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
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Narayan P. Commentary: Negative pressure wound therapy: Not so negative! J Thorac Cardiovasc Surg 2024; 167:269-270. [PMID: 35181002 DOI: 10.1016/j.jtcvs.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India.
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Fan H, Zhang ZZ, Zhang FK, Yang X, Zhang AR, Yang YZ, Cheng QH, Guo HZ. The safety and efficacy of unicompartmental knee arthroplasty in outpatient surgical centers: A systematic review and meta-analysis. J Orthop Surg (Hong Kong) 2024; 32:10225536231224829. [PMID: 38181045 DOI: 10.1177/10225536231224829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is an effective treatment method for knee osteoarthritis. With the development and implementation of enhanced recovery after surgery, UKA is now increasingly performed in outpatient surgical centers. However, there is ongoing debate regarding the safety and effectiveness of performing UKA in outpatient settings. METHODS The search was performed to retrieve randomized controlled trials and cohort studies on outpatient UKA from PubMed, Cochrane Library, EMbase, CNKI, and WanFangData databases. The search was conducted from the inception of the databases until August 31, 2023. After independent screening, data extraction, and risk of bias evaluation by two researchers, meta-analysis was performed using RevMan 5.4 software. RESULTS A total of eight studies involving 18,411 patients were included. The results showed that the postoperative transfusion rate in the outpatient group was lower than that in the inpatient group [OR = 0.36, 95%CI (0.24, 0.54), p < 0.00001], and the difference was statistically significant. However, there was no significant difference between the two groups in terms of readmission rate, reoperation rate, surgical site infection, and periprosthetic fracture. The differences were not statistically significant. CONCLUSION Compared to the traditional inpatient route, the blood transfusion rate for single-condyle replacement in the outpatient operation center is lower, and there is no significant difference in readmission rate, reoperation rate, surgical site infection, and periprosthesis fracture. The outpatient approach to UKA is safe, feasible, and highly satisfactory for patients. However, the results have certain limitations, and a rigorous preoperative complication risk assessment can minimize the risk of UKA in outpatient surgery centers. TRIAL REGISTRATION PROSPERO number CRD42023405373.
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Affiliation(s)
- Hua Fan
- First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Gansu Provincial Hospital, Lanzhou, China
| | - Zhuang-Zhuang Zhang
- First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Gansu Provincial Hospital, Lanzhou, China
| | - Fu-Kang Zhang
- First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Gansu Provincial Hospital, Lanzhou, China
| | - Xin Yang
- First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Gansu Provincial Hospital, Lanzhou, China
| | - An-Ren Zhang
- First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Gansu Provincial Hospital, Lanzhou, China
| | - Yong-Ze Yang
- First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Gansu Provincial Hospital, Lanzhou, China
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Prasidha I, Barker A, Knight R, Haertsch P. Biodegradable Temporizing Matrix for the Reconstruction of a Pyoderma Gangrenosum Wound. Dermatol Surg 2024; 50:112-114. [PMID: 37831970 DOI: 10.1097/dss.0000000000003966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Affiliation(s)
- Ines Prasidha
- Department of Plastic and Reconstructive Surgery, Wollongong Hospital, Wollongong, Australia
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Zhang M, Du H, Ma X, Zhao W. Effect evaluation of new dressing URGOTULRANGE in the treatment of pressure injury. Technol Health Care 2024; 32:143-150. [PMID: 37248926 DOI: 10.3233/thc-220604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Pressure injury (PI) is a local injury of the skin and/or soft tissue located at the bone caused by medical or other equipment and is common in long-term bedridden patients. OBJECTIVE To investigate the clinical effect of Urgotul foam dressing in the treatment of stage 3 ∼ 4 PI and deep tissue PI. METHODS A total of 38 patients with stage 3 ∼ 4 PI and deep tissue PI admitted to Jinan Central Hospital from January 2016 to December 2018 were selected and randomly divided into a control group (dressing change plus silver ion cream dressing) and an observation group (dressing change plus Urgotul Absorb non-border foam dressing), with 19 cases in each group. After 4 weeks of treatment, the pain intensity during dressing change and the treatment efficacy for PI wounds were compared between the two groups. RESULTS There were no differences in gender (P= 0.740), age (P= 0.130), single wound area (P= 0.673), consultation department (P= 0.972), stage (P= 0.740), presence of undermining (P= 0.721), deep tissue PI (P= 0.721), and systemic antibiotic therapy (P= 1.000) between the two groups, which were comparable. The treatment effect of the observation group was better than that of the control group (P= 0.003), and the pain score of the observation group was lower than that of the control group (P< 0.001). CONCLUSION Urgotul Absorb non-border foam dressing has a good effect in the treatment of stage 3 ∼ 4 PI and deep tissue PI and can relieve patients' pain, and is thus worth promoting.
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Affiliation(s)
- Mengmeng Zhang
- Department of Burns and Plastic Surgery, Central Hostpital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hongxia Du
- Department of Nursing, Central Hostpital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaoxia Ma
- Department of Digestive Endoscopy, Central Hostpital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Wenxing Zhao
- Department of Burns and Plastic Surgery, Central Hostpital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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