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British Journal of Hospital Medicine... Nov 2023A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should... (Review)
Review
A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should postoperative wound packing be undertaken considering the rates of pain experienced, wound healing and abscess recurrence? The literature search identified 159 papers on Ovid, Embase and Medline and 48 on PubMed. These were independently screened, and three articles were included in this review as these offered the best information to answer the question. One was a systematic review without meta-analysis, one was a randomised controlled trial and one was a multicentre observational study. Review of these articles led the authors to conclude that routine postoperative packing of perianal abscesses following incision and drainage is costly, associated with increased pain and confers no protection against recurrence of abscesses or formation of fistulae.
Topics: Adult; Humans; Abscess; Drainage; Multicenter Studies as Topic; Observational Studies as Topic; Pain; Postoperative Period; Randomized Controlled Trials as Topic; Skin Diseases
PubMed: 38019208
DOI: 10.12968/hmed.2023.0308 -
Cirugia Espanola Jul 2022Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results...
What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations.
Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3 surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed.
Topics: Humans; Postoperative Complications; Postoperative Period; Surgeons; Surgical Wound Infection; Surveys and Questionnaires
PubMed: 35283055
DOI: 10.1016/j.cireng.2022.03.001 -
The Journal of Arthroplasty Aug 2021Perioperative corticosteroid administration is associated with reduced postoperative nausea, pain, and enhanced recovery after surgery. However, potential complications... (Meta-Analysis)
Meta-Analysis
Postoperative Infection Risk in Total Joint Arthroplasty After Perioperative IV Corticosteroid Administration: A Systematic Review and Meta-Analysis of Comparative Studies.
BACKGROUND
Perioperative corticosteroid administration is associated with reduced postoperative nausea, pain, and enhanced recovery after surgery. However, potential complications including wound and periprosthetic joint infections remain a concern for surgeons after total joint arthroplasty (TJA).
METHODS
A systematic review of the search databases PubMed, Google Scholar, and EMBASE was made in January 2021 to identify comparative studies evaluating infection risk after perioperative corticosteroid administration in TJA. PRISMA guidelines were used for this review. Meta-analysis was used to assess infection risk in accordance with joint and corticosteroid dosing regimen used.
RESULTS
201 studies were returned after initial search strategy, with 29 included for review after application of inclusion and exclusion criteria. Studies were categorized as using low- or high-dose corticosteroid with single or repeat dosing regimens. Single low-dose corticosteroid administration was not associated with an increased risk of infection (P = .4; CI = 0.00-0.00). Single high-dose corticosteroid was not associated with an increased infection risk (P = .3; CI = 0.00-0.01) nor did repeat low-dose regimens result in increased risk of infection (P = .8; CI = -0.02-0.02). Studies assessing repeat high-dosing regimens reported no increased infection, with small numbers of participants included. No significant risk difference in infection risk was noted in hip (P = .59; CI = -0.03-0.02) or knee (P = .2; CI = 0.00-0.01) arthroplasty. Heterogeneity in patient profiles included in studies to date was noted.
CONCLUSION
Use of perioperative corticosteroid in TJA does not appear to be associated with increased risk of postoperative infection in patients with limited comorbidities. Further research is warranted to evaluate postoperative complications after TJA in these at-risk patient populations.
Topics: Adrenal Cortex Hormones; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Postoperative Nausea and Vomiting; Postoperative Period
PubMed: 33902983
DOI: 10.1016/j.arth.2021.03.057 -
The Journal of Craniofacial Surgery May 2022This paper aims to review clinical benefits of decompressive craniectomy (DC) in both adult and paediatric populations; its indications and factors contributing to its... (Review)
Review
This paper aims to review clinical benefits of decompressive craniectomy (DC) in both adult and paediatric populations; its indications and factors contributing to its postoperative success. The Glasgow Outcome Scale and the Modified Rankin Scale are the most commonly used scales to assess the long-term outcome in patients post DC. In adult traumatic brain injury patients, 2 randomized clinical trials were carried out; DECRA (Decompressive Craniectomy in Diffuse Traumatic Brain Injury) and RESCUEicp (Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of inter cranial pressure) employing collectively 555 patients. Despite the differences in these trials, their initial results affirm DC can lead to reduced mortality and more favorable outcomes. In ischemic stroke adult patients, different clinical trials of HAMLET (Dutch trial of Hemicraniectomy after middle cerebral artery infarction with life-threatening Edema), DESTINY (German trial of Decompressive Surgery for the treatment of Malignant Infarct of the Middle Cerebral Artery), and DECIMAL (French trial of Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarcts) suggested that DC improves survival compared with best medical management, but with an increased proportion of treated individuals surviving with moderate or severe disability. With regard to the size of bone to be removed, the larger the defect the better the results with a minimum diameter of 11 to 12 cm of bone flap. Cranioplasty timing varies and ranges from 6 weeks to more than 12 months post DC, depending on completion of medical treatment, clinical recovery, resolution of any infection, and an evaluation of soft tissues at the defect site.
Topics: Adult; Brain Injuries, Traumatic; Child; Decompressive Craniectomy; Humans; Middle Cerebral Artery; Postoperative Period; Skull; Treatment Outcome
PubMed: 34320589
DOI: 10.1097/SCS.0000000000008041 -
Journal of Plastic, Reconstructive &... Jul 2020Optimum timing of postoperative showering varies. Earlier showering improves patient satisfaction, but the impact of the timing of showering on postoperative infection... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Optimum timing of postoperative showering varies. Earlier showering improves patient satisfaction, but the impact of the timing of showering on postoperative infection is unclear. We conducted a systematic literature review and meta-analysis to investigate the outcomes of various postoperative showering practices.
METHODS
We searched PubMed to identify relevant human clinical studies in English, and searched these for additional references. Articles were reviewed for patient demographics, surgical specialty and procedure, wound closure method, placement of drains, showering protocol, and rates of infection and complications. Only randomized controlled trials were analyzed. A random-effects meta-analysis model was used to determine overall infection and complication rates between patients allowed to shower within the first 48 h postoperatively or later.
RESULTS
Out of 357 studies, seven and five were included in the infection and complications rate meta-analyses, respectively. A total of 1,881 and 958 patients were included in each analysis; 605 and 477 patients in each analysis were allowed to shower on or before postoperative day 2 ("early"), while the remainder were prohibited from showering until postoperative day 3 to beyond one week ("delayed") postoperatively. There was no difference in infection (p = 0.45, [-0.0052, 2 × 0.007 95% CI]) or complication rate (p = 0.36, [-0.0046, 2 × 0.005 95% CI]) with earlier vs. delayed showering protocols.
CONCLUSION
Published literature demonstrates no increase in the overall rate of wound infections or complications when patients showered earlier in the postoperative period. Additional randomized studies are needed to determine the ideal time for postoperative showering. These data should be considered by surgeons while determining when to permit patients to shower after surgery.
Topics: Baths; Humans; Postoperative Period; Randomized Controlled Trials as Topic; Surgical Wound Infection; Time Factors
PubMed: 32307234
DOI: 10.1016/j.bjps.2020.02.007 -
Khirurgiia 2023Sternotomy is the most common surgical approach for cardiac surgery. Incidence of postoperative sternal diastasis and wound suppuration ranges from 0.11 to 10%. We...
Sternotomy is the most common surgical approach for cardiac surgery. Incidence of postoperative sternal diastasis and wound suppuration ranges from 0.11 to 10%. We present a variant of one-stage surgical treatment of patients with these postoperative complications. Surgical tactics and features of postoperative period are described in detail. Pathogenetic approach to the treatment is substantiated. This approach can be used in patients with aseptic diastasis of the sternum and sternomediastinitis.
Topics: Humans; Postoperative Complications; Postoperative Period; Sternotomy; Sternum; Suppuration
PubMed: 37313707
DOI: 10.17116/hirurgia2023061103 -
Surgery Apr 2022There is wide variability and considerable controversy regarding the classification of appendicitis and the need for postoperative antibiotics. This study aimed to...
BACKGROUND
There is wide variability and considerable controversy regarding the classification of appendicitis and the need for postoperative antibiotics. This study aimed to assess interrater agreement with respect to the classification of appendicitis and its influence on the use of postoperative antibiotics amongst surgeons and surgical trainees.
METHODS
A survey comprising 15 intraoperative images captured during appendectomy was distributed to surgeons and surgical trainees. Participants were asked to classify severity of disease (normal, inflamed, purulent, gangrenous, perforated) and whether they would prescribe postoperative antibiotics. Statistical analysis included percent agreement, Krippendorff's alpha for interrater agreement, and logistic regression.
RESULTS
In total, 562 respondents completed the survey: 206 surgical trainees, 217 adult surgeons, and 139 pediatric surgeons. For classification of appendicitis, the statistical interrater agreement was highest for categorization as gangrenous/perforated versus nongangrenous/nonperforated (Krippendorff's alpha = 0.73) and lowest for perforated versus nonperforated (Krippendorff's alpha = 0.45). Fourteen percent of survey respondents would administer postoperative antibiotics for an inflamed appendix, 44% for suppurative, 75% for gangrenous, and 97% for perforated appendicitis. Interrater agreement of postoperative antibiotic use was low (Krippendorff's alpha = 0.28). The only significant factor associated with postoperative antibiotic utilization was 16 or more years in practice.
CONCLUSIONS
Surgeon agreement is poor with respect to both subjective appendicitis classification and objective utilization of postoperative antibiotics. This survey demonstrates that a large proportion (59%) of surgeons prescribe antibiotics after nongangrenous or nonperforated appendectomy, despite a lack of evidence basis for this practice. These findings highlight the need for further consensus to enable standardized research and avoid overtreatment with unnecessary antibiotics.
Topics: Adult; Anti-Bacterial Agents; Appendectomy; Appendicitis; Appendix; Child; Humans; Postoperative Period; Retrospective Studies
PubMed: 34774292
DOI: 10.1016/j.surg.2021.10.006 -
Transplant Infectious Disease : An... Aug 2019Infection is one of the most significant complications following heart transplantation (HT). The aim of this study was to identify specific risk factors for early... (Observational Study)
Observational Study
INTRODUCTION
Infection is one of the most significant complications following heart transplantation (HT). The aim of this study was to identify specific risk factors for early postoperative infections in HT recipients, and to develop a multivariable predictive model to identify HT recipients at high risk.
METHODS
A single-center, observational, and retrospective study was conducted. The dependent variable was in-hospital postoperative infection. We examined demographic and epidemiological data from donors and recipients, surgical features, and adverse postoperative events as independent variables. Backwards, stepwise multivariable logistic regression with a P-value < 0.05 was used to identify clinical factors independently associated with the risk of in-hospital postoperative infections following HT.
RESULTS
Six hundred seventy-seven patients were included in this study. During the in-hospital postoperative period, 348 episodes of infection were diagnosed in 239 (35.9%) patients. Seven variables were identified as independent clinical predictors of early postoperative infection after HT: history of diabetes mellitus, previous sternotomy, preoperative mechanical ventilation, primary graft failure, major surgical bleeding, use of mycophenolate mofetil, and use of itraconazole. Based on the results of multivariable models, we constructed a 7-variable (8-point) score to predict the risk of in-hospital postoperative infection in HT recipients, which showed a reasonable ability to predict the risk of in-hospital postoperative infection in this population. Prospective external validation of this new score is warranted to confirm its clinical applicability.
CONCLUSIONS
In-hospital postoperative infection is a common complication after HT, affecting 35% of patients who underwent this procedure at our institution. Diabetes mellitus, previous sternotomy, preoperative mechanical ventilation, primary graft failure, major surgical bleeding, use of mycophenolate mofetil, and itraconazole were all independent clinical predictors of early postoperative infection after HT.
Topics: Adult; Aged; Bacterial Infections; Cross Infection; Female; Heart Transplantation; Humans; Length of Stay; Male; Middle Aged; Postoperative Complications; Postoperative Period; Predictive Value of Tests; Retrospective Studies; Risk Factors
PubMed: 31077542
DOI: 10.1111/tid.13104 -
BMC Surgery Feb 2020The aim of this study was to investigate the correlation between lumbar multifidus fat infiltration and lumbar postoperative surgical site infection (SSI). Several...
BACKGROUND
The aim of this study was to investigate the correlation between lumbar multifidus fat infiltration and lumbar postoperative surgical site infection (SSI). Several clinical studies have found that spine postoperative SSI is associated with age, diabetes, obesity, and multilevel surgery. However, few studies have focused on the correlation between lumbar multifidus fat infiltration and SSI.
METHOD
A retrospective review was performed on patients who underwent posterior lumbar interbody fusion (PLIF) between 2011 and 2016 at our hospital. The patients were divided into SSI and non-SSI groups. Data of risk factors [age, diabetes, obesity, body mass index (BMI), number of levels, and surgery duration] and indicators of body mass distribution (subcutaneous fat thickness and multifidus fat infiltration) were collected. The degree of multifidus fat infiltration was analyzed on magnetic resonance images using Image J.
RESULTS
Univariate analysis indicated that lumbar spine postoperative SSI was associated with urinary tract infection, subcutaneous fat thickness, lumbar multifidus muscle (LMM) fat infiltration, multilevel surgery (≥2 levels), surgery duration, drainage duration, and number of drainage tubes. In addition, multiple logistic regression analysis revealed that spine SSI development was associated with sex (male), age (> 60 years), subcutaneous fat thickness, LMM fat infiltration, and drainage duration. Receiver operating characteristic curve analysis indicated that the risk of SSI development was higher when the percentage of LMM fat infiltration exceeded 29.29%. Furthermore, Pearson's correlation analysis demonstrated that LMM fat infiltration was correlated with age but not with BMI.
CONCLUSION
Indicators of body mass distribution may better predict SSI risk than BMI following PLIF. Lumbar Multifidus fat infiltration is a novel spine-specific risk factor for SSI development.
Topics: Adult; Aged; Body Mass Index; Case-Control Studies; Drainage; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Obesity; Paraspinal Muscles; Postoperative Period; Retrospective Studies; Risk Factors; Subcutaneous Fat; Surgical Wound Infection
PubMed: 32093662
DOI: 10.1186/s12893-019-0655-9 -
In Vivo (Athens, Greece) 2022The COVID-19 pandemic has significantly influenced the management of oncogynecologic patients in regard to time of diagnosis, to delay of treatment, therapeutic strategy...
BACKGROUND/AIM
The COVID-19 pandemic has significantly influenced the management of oncogynecologic patients in regard to time of diagnosis, to delay of treatment, therapeutic strategy and postoperative complications. The aim of the study was to investigate the impact of preoperative SARS-Cov2 infection on the postoperative outcome after debulking surgery for ovarian cancer.
PATIENTS AND METHODS
Between June 2021 and September 2021, 12 patients with antecedents of COVID-19 infection and ovarian cancer were submitted to surgery at "Dr. I. Cantacuzino" Hospital, Bucharest, Romania. Their outcomes were compared to those reported in a similar group of patients submitted to surgery during the same period in the absence of COVID-19 infection.
RESULTS
Although preoperative data showed no statistically significant differences between the two groups, intraoperative length and estimated blood loss were higher in the COVID-19 group and so were the postoperative complications, the most commonly encountered ones being reported by wound infection, postoperative hemoperitoneum and pneumonia. However, the differences did not reach statistical significance.
CONCLUSION
Preoperative COVID-19 infection seems to slightly increase the risk of postoperative complications after debulking surgery for ovarian cancer.
Topics: COVID-19; Carcinoma, Ovarian Epithelial; Female; Humans; Ovarian Neoplasms; Pandemics; Postoperative Complications; Postoperative Period; RNA, Viral; Retrospective Studies; SARS-CoV-2
PubMed: 35478135
DOI: 10.21873/invivo.12835