The impact of non-closure of the platysma muscle layer on the cosmesis of thyroidectomy scar – a randomised double-blind controlled trial

BACKGROUND: The relevance of closing the platysma muscle layer after open thyroidectomy has received little interest in terms of research. The objective was to determine whether non-closure of the platysma muscle layer after open thyroidectomy impacts significantly on the cosmetic outcome of the resulting collar scar. METHODS: In this prospective randomised controlled clinical trial, patients were assigned randomly to have the platysma muscle layer closed or not closed. The primary endpoint was the cosmesis of the collar scar six weeks after surgery assessed using the patient and observer scar assessment scale (POSAS). Additional endpoints included operation time and early postoperative wound complications. RESULTS: Ninety-two patients were recruited, with 46 randomised to each group. The patient scar assessment subscale (PSAS) of the POSAS showed no significant difference in the scar cosmesis between the two groups six weeks after surgery (median PSAS: 16.5 vs 17.5; p = 0.514). The observer scar assessment subscale (OSAS) showed that the platysma muscle layer closure group had marginally better scars (median OSAS: 15 vs 17; p = 0.045). The size of the goitre did not make any significant difference in the scar cosmesis. There was no significant difference in the incidence of early postoperative wound complications as well as the median operation time. CONCLUSION: Not closing the platysma muscle layer had no significant impact on the scar cosmesis six weeks after open thyroidectomy, with no significant difference in the incidence of early postoperative wound complications and the operation time.

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

BACKGROUND

The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.

METHODS

ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.

RESULTS

The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.

CONCLUSIONS

This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.

CLINICAL TRIAL REGISTRATION

NCT03044899.

The use of microcomputers in Nigerian libraries and information centres

This study provides information on microcomputer resources scatter and reveals some of the uses in Nigerian libraries. Data collection was by structured questionnaire and follow-up interview. Of the 157 questionnaires sent out, 53% useable returns were recorded. The returns scatter covered twenty of the then twenty-one states in the Federation.

Results revealed that on the average, one out of every two libraries has a microcomputer in Nigeria. The total of 43 microcomputers in Nigerian libraries is spread over 22 such centres. A few libraries have computerised some traditional functions such as cataloguing and indexing. Computers are used mostly for administrative functions such as word process ing. IBM and its compatibles, and Epson brands have been more popular in the spread of microcomputers and printers in Nigeria.

Recommendations emanating from the study include Aca demic libraries need not wait until they acquire minis or mainframe computers before they computerise. Using a net work of microcomputers with a super microcomputer as a server can be very useful. The running cost of such a system can be sustained by an average budget. Research libraries that give in-depth and useful service to their patrons have been more successful in their automation projects. To remain rele vant in the scheme of things, research libraries must continue to rely on computer power to enable them to provide useful services. Public libraries in developing economies should move with the times and improve their services by providing pack aged and simplified research results on health, agriculture and socio-economics for true development among the grass- root people they serve. To be able to carry this out effectively, they would certainly need the services of computers. IBM microcomputers and their compatibles have come to stay Libraries should consider acquiring these for their automation projects. Networking them is the in-thing now—a better op tion than acquiring a mini or a mainframe computer. Libraries automating their services should seek advice from other li braries that have automated at every stage of their computeri sation projects in order to avoid unnecessary mistakes and waste of scarce funds.