Surgical Site Infection in a Teaching Hospital: a Prospective Study

Objectives: To investigate the risk factors for surgical site infection together with the identification of the etiological pathogens and their antimicrobial susceptibility at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Methods: A prospective case series study conducted at King Khalid University Hospital to all patients admitted to the surgical wards during the period between January 1st and September 30th 2007. The demographic data, diagnostic criteria, associated risk factors and laboratory data including gram stain, culture results and antimicrobial susceptibility of swabs from the surgical sites were collected. Results: Out of the one hundred and thirty one patients recruited in the study, nine patients showed evidence of sepsis yielding an infection rate of 6.8%. Emergency operations and associated diabetes showed significantly higher rates of infection compared to their counterparts. The most commonly isolated bacteria were: E. coli, Pseudomonas aurigenosa and Staphylococcus aureus.Conclusion: The rate of surgical site infection was 6.8% which was comparable to that reported literature. E. coli was the most commonly isolated bacteria. Neither MRSA nor Acinetobacter species were common isolates. The rate of infection in diabetics and those who underwent emergency operations was significantly higher than others. Other comorbidities did not directly affect the rate of surgical site infection in our series

Effect of bispectral index [BIS] monitoring on postoperative recovery and sevoflurane consumption among morbidly obese patients undergoing laparoscopic gastric banding

Early and uneventful postoperative recovery of morbidly obese patients remains a challenge for anesthesiologists. It could be valuable to titrate the administration of inhaled anesthetic, such as sevoflurane, in morbid obese patients, in order to shorten emergence using bispectral index [BIS] monitoring. It would be a great advantage if BIS permitted a more rapid recovery and less consumption in morbidly obese patients with a high cost inhaled agent. The aim of the study is to show whether the titration of sevoflurane based on the BIS monitoring would allow shortening of recovery time in morbidly obese patients and to evaluate whether BIS monitoring would contribute to reduce the amount of sevofLurane administered while providing an adequate anesthesia. Thirty morbidly obese ASA I and II patients undergoing laparoscopic gastric banding [LAGB] procedures were studied. In the first group [15 patients], patients were anesthetized without the use of BIS [non BIS or control group], and sevoflurane being administered according to standard clinical practice [control group]. In the second group [15 patients], sevoflurane was titrated to maintain a BIS value between 40 and 60 during surgery, and then 60-70 during 15 min prior to the end of surgery [BIS group]. Recovery times were recorded. Time to extubation was also noted, as well as the time to achieve a modified Aldrete score of 9 were evaluated subsequently at 10-min intervals until 3 h after surgery by nurses who had no knowledge of the study. Sevoflurane consumption was calculated using the vaporizer weighing method. Awakening and extubation times were significantly shorter in the BIS group [P <0.05]. In the BIS [vs. non BIS] group, there were no significant differences observed in the time to obtain an Aldrete score of 9. The sevoflurane consumption and cost in the BIS group were lower than in the non BIS group [P <0.05]. Bispectral index monitoring during anesthesia for morbidly obese patients provides statistically significant reduction in recovery times. It also has the added advantage in decreasing sevoflurane consumption

Rectal carcinoma in Riyadh Central Hospital

Patients with rectal carcinoma were studied retrospectively in Riyadh Central Hospital, Riyadh, Saudi Arabia over a 4 year period [1985-1988]. There were 53 patients, 34% of whom were below the age of 40. Diagnosis was made after an average of 6.9 months following the first symptoms. This late presentation also reflects the fact that only 58% presented with potentially curable disease. Colostomy was not accepted by 13% of this group, thus losing the chance of possible cure. The diagnostic yield and cure rate should rise if awareness of the disease among medical practitioners and the general population is aroused in our region. Stoma associations can offer health education in this field and are indispensible to the total care of patients with rectal carcinoma

Colorectal carcinoma: review of 110 cases

Over the 4-year period [1045 to 1408H], 110 cases of colorectal carcinoma were treated at Riyadh Central Hospital. The charts were reviewed with particular reference to the epidemiological characteristics. There were 59 [54%] Saudi patients with an average age of 51 years. Thirty-one percent of the patients were under 40. The male to female ratio was 2:1. The disease was found to involve the left side of the colon in 60% of the patients, while the right colons was involved in 35%. A curative resection was attempted in 38 [35%] patients. Mortality in the 77 patients who underwent surgery was 9%. It appears that colorectal carcinoma in the Saudi population affects a younger age group than that observed in the West, with a good percentage [35%] of right-sided colonic cancer. Because the familial non-polyposis from colonic cancer in this group of patients, we recommend that surveillance be directed to the respective families so that asymptomatic patients can be identified in an early stage of the disease