ABSTRACT
Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.
Subject(s)
Humans , Surgical Wound Infection/prevention & control , Surgical Wound Infection/epidemiology , Colorectal Surgery/adverse effects , Patient Care Bundles , Incidence , Retrospective Studies , Risk FactorsABSTRACT
Para aclarar el efecto supresivo que podrían tener los ciclos cortos de glucocorticoides sobre el eje hipotálamo-hipófisis-suprarrenal (H-H-S) se realizó un estudio prospectivo experimental, controlado, incluyendo en forma aleatoria 49 niños que consultaron al servicio de urgencias por presentar crisis asmática, y a quienes se les administró un ciclo corto de prednisolona a dosis de 1 mg/Kg/día durante 5 días. Se tomó una muestra para la medición del cortisol sérico inicial fue de 32 más o menos 24.2 microgr/dl, y el cortisol sérico posterior a la corticoterapia fue de 5.8 más o menos 3.3 microgr/dl. Aplicando la prueba t-student se encontró una diferencia significativa con p<0.0001. 35 pacientes (71.4 por ciento) tuvieron cortisol sérico bajo, lo que sugiere supresión del eje H-H-S. En tres pacientes (6.1 por ciento) se encontraron valores en el límite inferior normal. Los demás pacientes evidenciaron valores séricos normales. En conclusión, los ciclos cortos de glucocorticoides en niños pueden ocasionar supresión del eje H-H-S.