ABSTRACT
To improve patient safety and prevent complications, WHO introduced surgical safety checklist (WHO SSC). However, the actual effect of WHO SSC on patient morbidity, particularly surgical site infections (SSI), and mortality on post-operative patients is one of the least studied area. Our study was to measure the effects surgical safety checklists have in reducing morbidities and complications, particularly surgical site infections, post-operative length of stay and mortality resulting from the surgical procedures. Methods: A prospective observational comparative study was conducted among all patients who underwent elective general surgical procedures from 01st July 2015 to 30th June 2016 in the Main OT Complex (OT1 and OT2), Indoor Surgical Wards and higher dependency units (ITU & CCU) of IPGMER & SSKM Hospital, Kolkata, after applying proper exclusion criteria. Pre-implementation (before implementation of WHO Surgical Safety Checklist) data was collected for first 6 months, then WHO Surgical Safety Checklist was implemented over next 6 months. Pre and post-implementation cohorts were compared and analysed. Results: Total 382 patients (187 Control group and 195 implementation group) were included. Both groups matched regarding age, sex, type of surgery, type of anaesthesia, post-operative length of stay. However, incidence of SSI significantly decreased (30.48% to 16.41%, p value 0.002, <0.05, statistically significant). Overall complication rate, unplanned return to operating room (OR) also decreased though the results were statistically not significant. Conclusion: Implementation of WHO SSC decreases morbidity related to SSI significantly. Further studies are required to assess the effects on mortality and unplanned return to OR.
ABSTRACT
Presence of haematoma, serous fluid, and dead space in a wound increase the risk of infection as they act as a culture media. Multiple options had been mentioned to reduce these risks. We tried to assess the incidence of SSI following placement of closed suction drains following elective surgeries. Methods: A prospective observational study was conducted in the Department of General Surgery, IPGMER & SSKM Hospital, Kolkata from January 2016 to June 2017. Patients who were given a subcutaneous suction drain after an elective general surgical procedure were included in the study. Patients unwilling to take part in the study, patients from paediatric age group, on steroids, with Class 4 wounds and those underwent Laparoscopic Surgery were excluded. Outcome was measured in the form of presence or absence of SSI and data was analysed. Results: No statistically significant decrease of incidence of SSI was found in terms of different age, sex, socio-economic status, duration of hospital stays, smoking or alcoholism. Increased incidence of SSI was detected among Diabetics even after using closed suction drainage. Conclusion: Placement of closed suction drain did not significantly reduce incidence of SSI following elective general surgical procedures.
ABSTRACT
Identification and protection of Facial Nerve is of prime importance during surgery of parotid glands. Several techniques are available in literature to identify and preserve FN. We present here a case series with dissection of FN in a novel technique during parotidectomy which has significantly lowered the morbidity due to injury of the FN. Methods: All data, from all the patients who underwent Parotidectomy in our unit (conducted or supervised by a single surgeon) in the Department of General Surgery, IPGMER and SSKM Hospital, Kolkata, between March 2014 to March 2019, using our novel technique for identification and protection of FN, was retrospectively analysed. Outcome measurement was expressed in terms of type of surgery, duration, estimated blood loss, any intra-operative or post-operative complications, length of hospital stay, duration of drain in place, Histopathological (HPE) reports, size of the tumour, margin and lymph node status, Facial Nerve weakness and other complications. Results: Total 13 patients underwent Parotidectomy (Total or Superficial) following our technique of identifying and protecting Facial Nerve (FN). Four of them had temporary FN paresis in immediate post-op period. None of the patients had FN paresis on follow-up at 1 year. Conclusion: The novel technique described in our study for identification and protection of FN is a promising technique for Parotid Surgery.