Índice neutrófilo linfocito como predictor de infección del sitio quirúrgico en cirugía abdominal urgente

Introducción: Las infecciones del sitio quirúrgico representan una carga significativa en relación con la morbilidad, la mortalidad y costos adicionales. Por lo tanto, la prevención es importante. Objetivo: Comparar el índice neutrófilos-linfocitos con la escala SENIC para predecir infección del sitio quirúrgico en pacientes que sufrieron una cirugía abdominal de urgencia. Materiales y Métodos: Estudio transversal analítico, realizado en el Hospital de Alta Especialidad de Veracruz en expedientes de pacientes post-operados de urgencia, valorándose la escala SENIC (que incluye tipo de cirugía, duración del procedimiento, grado de asepsia de la intervención y 3 o más diagnósticos posoperatorios) y el índice neutrófilos-linfocitos (definido como la razón neutrófilos sobre linfocitos). Resultados: La edad promedio de los pacientes fue de 47,7 ± 18,7 años, con un predominio del sexo masculino 83 (62%), la estancia hospitalaria media fue de 29,7 ± 14,7 días, los procedimientos fueron la laparotomía exploradora en 57 (42,2%) y la apendicectomía en 26 (19,2%). Se aisló Escherichia coli en 27 (30%). Se obtuvo una sensibilidad de 69% y especificidad de 58% para el índice neutrófilos-linfocitos y para SENIC una sensibilidad 45% y una especificidad de 73%. Las estadísticas C para el índice neutrófilos-linfocitos y SENIC fueron 0,603 (IC: 0,524 − 0,682) y 0,668 (IC 95%: 0,588 − 0,749), respectivamente. Discusión y Conclusión: Ambos métodos muestran una precisión predictiva similar para infección del sitio quirúrgico, si bien calcular el índice neutrófiloslinfocitos es mucho más rápido y sencillo.

Introduction: Surgical site infections represent a significant burden in relation to morbidity, mortality, and additional costs. Therefore, prevention is important. Objective: To compare the neutrophil-lymphocyte index with the SENIC scale to predict surgical site infection in patients who underwent emergency abdominal surgery. Materials and Methods: Analytical cross-sectional study, carried out at the Hospital de Alta Especialidad de Veracruz in records of emergency post-operative patients, evaluating the SENIC scale (which includes type of surgery, duration of the procedure, degree of asepsis of the intervention and 3 or more postoperative diagnoses) and the neutrophil-to-lymphocyte ratio (defined as the ratio of neutrophils to lymphocytes). Results: The average age of the patients was 47.7 ± 18.7 years, with a predominance of males 83 (62%); the mean hospital stay was 29.7 ± 14.7 days, the procedures were exploratory laparotomy in 57 (42.2%) and appendectomy in 26 (19.2%). Escherichia coli was isolated in 27 (30%). A sensitivity of 69% and specificity of 58% was obtained for the neutrophil-lymphocyte index and for SENIC a sensitivity of 45% and a specificity of 73%. The C statistics for the neutrophil-lymphocyte ratio and SENIC were 0.603 (CI: 0.524 − 0.682) and 0.668 (95% CI: 0.588 − 0.749), respectively. Discussion and Conclusion: Both methods show similar predictive accuracy for surgical site infection, although calculating the neutrophil-lymphocyte ratio is much faster and easier.

Risk factors associated with surgical site infection in patients with musculoskeletal cancer / Fatores de risco associados à infecção de sítio cirúrgico em portadores de câncer musculoesquelético / Factores de riesgo asociados a la infección del sitio quirúrgico en pacientes con cáncer musculoesquelético

Background and objectives: surgical site infections (SSI) continue to be a major concern in orthopedic oncology and pose as great a challenge as cancer recurrence, despite the preventive potential of surgery. SSI can be avoided if evidence-based measures are taken. The objective was to assess the frequency of infections in oncological orthopedic surgeries and associated risk factors and inflammatory markers in a reference hospital in the state of Pernambuco. Methods: the frequency of SSI, the identification of isolated microorganisms, the risk factors and the profile of Th1 and Th2 inflammatory markers (IL-2, IL-4, IL-6, IL-10, TNF and IFN-Ƴ) in patients with musculoskeletal cancer were analyzed. Results: SSI were found in 9.1% of patients undergoing orthopedic surgery. Bivariate analysis revealed that a surgical team comprising more than five members (p=0.041) and the need for intraoperative transfusion (p=0.012) were correlated with a higher risk of SSI. The measurement of ultrasensitive C-reactive protein levels to assess the inflammatory response after SSI showed results that were superior to the reference values for each sample, ranging from >5 to >200mg/dl by the immunoturbidimetric method. Of the IL-2, INFγ and TNF (Th1) and IL-4, IL-6, IL-10 (Th2) levels, only interleukin 6 showed high levels, between 6.68 and 58.76 pg/mL. Conclusion: the study found that surgical team with five or more members and blood transfusion were factors associated with the development of SSI in orthopedic surgery in patients with musculoskeletal cancer. Among the inflammatory markers, interleukin 6 (IL-6) showed the highest correlation with the outcome.(AU)

Justificativa e objetivos: as infecções do sítio cirúrgico (ISC) continuam sendo uma grande preocupação na oncologia ortopédica e representam um desafio tão grande quanto a recorrência do câncer, apesar do potencial preventivo da cirurgia. As ISC podem ser evitadas se forem tomadas medidas baseadas em evidências. O objetivo foi avaliar a frequência de infecções em cirurgias ortopédicas oncológicas e os fatores de risco e marcadores inflamatórios associados em um hospital de referência no estado de Pernambuco. Métodos: foram analisados a frequência de ISC, a identificação de microrganismos isolados, os fatores de risco e o perfil de marcadores inflamatórios Th1 e Th2 (IL-2, IL-4, IL-6, IL-10, TNF e IFN-Ƴ) em pacientes portadores de câncer musculoesquelético. Resultados: as ISC foram encontradas em 9,1% dos pacientes submetidos à cirurgia ortopédica. A análise bivariada revelou que uma equipe cirúrgica composta por mais de cinco membros (p=0,041) e a necessidade de transfusão intraoperatória (p=0,012) foram correlacionadas com maior risco de ISC. A dosagem dos níveis de proteína C reativa ultrassensível para avaliação da resposta inflamatória após ISC apresentou resultados superiores aos valores de referência para cada amostra, variando de >5 a >200mg/dl pelo método imunoturbidimétrico. Dos níveis de IL-2, INFγ e TNF (Th1) e IL-4, IL-6, IL-10 (Th2), apenas a interleucina 6 apresentou níveis elevados, entre 6,68 e 58,76 pg/mL. Conclusão: o estudo constatou que equipe cirúrgica com cinco ou mais membros e transfusão sanguínea foram fatores associados ao desenvolvimento de ISC em cirurgia ortopédica em pacientes com câncer musculoesquelético. Entre os marcadores inflamatórios, interleucina 6 (IL-6) apresentou maior correlação com o desfecho.(AU)

Justificación y objetivos: las infecciones del sitio quirúrgico (ISQ) siguen siendo una preocupación importante en la oncología ortopédica y representan un desafío tan grande como la recurrencia del cáncer, a pesar del potencial preventivo de la cirugía. Las ISQ se pueden prevenir si se toman medidas basadas en la evidencia. El objetivo fue evaluar la frecuencia de infecciones en cirugías ortopédicas oncológicas y los factores de riesgo y marcadores inflamatorios asociados en un hospital de referencia en el estado de Pernambuco. Métodos: se analizaron la frecuencia de ISQ, la identificación de microorganismos aislados, los factores de riesgo y el perfil de marcadores inflamatorios Th1 y Th2 (IL-2, IL-4, IL-6, IL-10, TNF e IFN-Ƴ) en pacientes con cáncer musculoesquelético. Resultados: se encontraron ISQ en el 9,1% de los pacientes sometidos a cirugía ortopédica. El análisis bivariado reveló que un equipo quirúrgico compuesto por más de cinco miembros (p=0,041) y la necesidad de transfusión intraoperatoria (p=0,012) se correlacionaron con un mayor riesgo de ISQ. La medición de los niveles de proteína C reactiva ultrasensible para evaluar la respuesta inflamatoria después de la ISQ presentó resultados superiores a los valores de referencia para cada muestra, variando de >5 a >200 mg/dl por el método inmunoturbidimétrico. De los niveles de IL-2, INFγ y TNF (Th1) e IL-4, IL-6, IL-10 (Th2), solo la interleucina 6 mostró niveles elevados, entre 6,68 y 58,76 pg/mL. Conclusión: el estudio encontró que el equipo quirúrgico con cinco o más miembros y la transfusión el estudio encontró que un equipo quirúrgico con cinco o más miembros y transfusión de sangre fueron factores asociados con el desarrollo de ISQ en cirugía ortopédica en pacientes con cáncer musculoesquelético. Entre los marcadores inflamatorios, la interleucina 6 (IL-6) mostró la mayor correlación con el resultado.(AU)

Prevalencia y análisis de factores de infección de sitio quirúrgico en clínica de heridas / Prevalence and Analysis of Surgical Site Infection Factors in Wound Clinic

Introducción: La infección de herida quirúrgica causa altas tasas de morbilidad y repercute sobre los índices de mortalidad. Constituye la primera infección intrahospitalaria entre pacientes quirúrgicos del total de infecciones nosocomiales y la primera entre los pacientes quirúrgicos. Existen factores de riesgo como la clasificación ASA, la diabetes mellitus, la hipertensión arterial y los días de estancia hospitalaria, los cuales influyen en su desarrollo. Objetivo: Determinar la prevalencia de infecciones de sitio quirúrgico por cirugías realizadas en el Hospital Dr. Carlos Canseco de Tampico, ciudad del estado mexicano de Tamaulipas. Métodos: Diseño observacional, analítico, transversal y retrospectivo de 54 pacientes con diagnóstico de infección de sitio quirúrgico. Las variables de estudio se clasificaron como dependientes (género, edad, lugar de origen, días de estancia hospitalaria, peso, índice de masa corporal) e independientes (diagnóstico, procedimiento quirúrgico realizado y clasificación ASA otorgada). Resultados: La población de 40 a 50 años fue la más afectada, con mayor predominancia sobre el género femenino. La Clasificación ASA II y III presentaron mayor prevalencia de infección de sitio quirúrgico, sobre todo en cirugías electivas (28 por ciento). Mientras mayor fue la estancia hospitalaria, mayor fue la probabilidad de desarrollar infección de sitio quirúrgico. Conclusiones: La prevalencia de infección en el sitio quirúrgico en pacientes operados por los distintos servicios quirúrgicos no es similar a la reportada por otros autores. La Clasificación ASA II y III presentaron infección del sitio quirúrgico con más frecuencia, mientras que la comorbilidad más llamativa de este estudio fue el índice de masa corporal como factor de riesgo que no debe pasar desapercibido(AU)

Introduction: Surgical wound infection causes high morbidity rates and impacts mortality rates. It is the first in-hospital infection among surgical patients of all nosocomial infections and the first among surgical patients. There are risk factors that influence its development, such as the ASA classification, diabetes mellitus, arterial hypertension and days of hospital stay. Objective: To determine the prevalence of surgical site infections from surgeries performed at Hospital Dr. Carlos Canseco, of Tampico, a city in the Mexican state of Tamaulipas. Methods: An observational, analytical, cross-sectional and retrospective study was carried out with 54 patients with a diagnosis of surgical site infection. The study variables were classified as dependent variables (gender, age, place of origin, days of hospital stay, weight and body mass index) and independent variables (diagnosis, surgical procedure performed, and given ASA classification). Results: The population aged 40 to 50 years was the most affected, with a greater predominance of the female gender. ASA classification II and III had a higher prevalence of surgical site infection, above all in elective surgeries (28 %). The longer the hospital stay, the higher the probability of developing surgical site infection. Conclusions: The prevalence of surgical site infection in patients operated on by the different surgical services is not similar to that reported by other authors. ASA Classification II and III presented surgical site infection more frequently, while the most remarkable comorbidity in this study was body mass index as a risk factor that should not go unnoticed(AU)

An economic model to assess the value of triclosan-coated sutures in reducing the risk of surgical site infection in a mastectomy in India

Background: The comparison of triclosan-coated sutures (TCS) was made with conventional nonantimicrobial-coated sutures (NCS) to reduce surgical site infection (SSI). This study demonstrates the efficacy and economic outcome of TCS versus NCS for SSIs in mastectomy in India. Methods: In this retrospective analysis, 100 patients were included for both conditions桾CS and NCS梖rom a private and public hospital in India. A systematic literature search of available evidence for both SSI incidences and TCS efficacy data in India were gathered. We collected cost data from a private and public hospital, respectively, for mastectomy in India. The cost-effectiveness of TCS in comparison with the conventional NCS was calculated using a decision-tree deterministic model. We performed a one-way sensitivity analysis to compare TCS with NCS. Results: Cost savings with the use of TCS increased with an increase in SSI incidence and an increase in efficacy for mastectomies in both public and private hospitals. We found a base cost saving of Indian rupees (INR) 27,299 at a private hospital and INR 2,958 at a public hospital for mastectomies. The incremental cost of TCS suture was 0.01% in a private hospital whereas 0.17% in a public hospital. Conclusion: The use of TCS resulted in reduced SSI incidence and cost savings for mastectomy in India.

FACTORS AFFECTING SURGICAL SITE INFECTION IN OPEN GASTROINTESTINAL SURGERY

Surgical site infection is more prevalent in open gastrointestinal surgery which will affect hospital stay and morbidity and mortality of patients.In our study,we are comparing the factors which will directly or indirectly causes SSI.By knowing the factors which causing SSI,We can decreases the incidence of surgical site infection.

Health economic evaluation of patients with postoperative complications after colorectal surgery / 中华消化外科杂志

Postoperative complications of colorectal surgery are one of the most important reasons affecting patients' postoperative health and also an important factor increasing the burden of medical care. It can give policymakers a basis to the optimization of medical resources by clarifying the health economic burden of different postoperative complications through health economic evalua-tion. Through a detailed search of domestic and foreign literatures, the authors summarize and analyze the increased medical costs and prolonged hospital stays associated with postoperative anastomotic leak, surgical site infection, and postoperative ileus. Furthermore, the authors identify shortcomings in existing clinical studies of different mediacal centers for colorectal postoperative complications, in order to better guide future clinical researches related to colorectal postoperative complications.

Chinese experts consensus on the management of surgical site infection in solid organ transplantation (2022 edition) / 器官移植

The quality of solid organ transplantation has been improved significantly in China in recent years. However, surgical site infection (SSI) is still a main factor affecting the survival of solid organ transplantation recipients. With the joint efforts of experts in fields of organ transplantation, infectious diseases, critical care medicine, laboratory medicine and clinical pharmacy, this expert consensus systematically summarizes the experiences of SSI management in solid organ transplantation in China, focusing on basic management principles, epidemiology, risk factors, special pathogen infection and diagnostic techniques of SSI. It aims to standardize the prevention measures of SSI in transplantation centers to reduce the incidence and mortality of SSI in solid organ transplantation recipients.

Chinese Medicine Plaster as A New Treatment for Surgical Site Infection in Patients with Cesarean Delivery: A Randomized, Double-Blind, Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the efficacy of Chinese plaster containing rhubarb and mirabilite on surgical site infection (SSI) in patients with cesarean delivery (CD) by performing a randomized controlled trial.@*METHODS@#This randomized controlled trial included 560 patients with CD due to fetal head descent enrolled at a tertiary teaching center between December 31, 2018 and October 31, 2021. Eligible patients were randomly assigned to a Chinese medicine (CM) group (280 cases) or a placebo group (280 cases) by a random number table, and were treated with CM plaster (made by rhubarb and mirabilite) or a placebo plaster, respectively. Both courses of treatment lasted from the day 1 of CD, followed day 2 until discharge. The primary outcome was the total number of patients with superficial, deep and organ/space SSI. The secondary outcome was duration of postoperative hospital stay, antibiotic intake, and unplanned readmission or reoperation due to SSI. All reported efficacy and safety outcomes were confirmed by a central adjudication committee that was unaware of the study-group assignments.@*RESULTS@#During the recovery process after CD, the rates of localized swelling, redness and heat were significantly lower in the CM group than in the placebo group [7.55% (20/265) vs. 17.21% (47/274), P<0.01]. The durution of postoperative antibiotic intake was shorter in the CM group than in the placebo group (P<0.01). The duration of postoperative hospital stay was significantly shorter in the CM group than in the placebo group (5.49 ± 2.68 days vs. 8.96 ± 2.35 days, P<0.01). The rate of postoperative C-reactive protein elevation (≽100 mg/L) was lower in the CM group than in the placebo group [27.6% (73/265) vs. 43.8% (120/274), P<0.01]. However, there was no difference in purulent drainage rate from incision and superficial opening of incision between the two groups. No intestinal reactions and skin allergies were found in the CM group.@*CONCLUSIONS@#CM plaster containing rhubarb and mirabilite had an effect on SSI. It is safe for mothers and imposes lower economic and mental burdens on patients undergoing CD. (Registration No. ChiCTR2100054626).

Revisión sistemática con metaanálisis. Iodo povidona / Systematic Review with Meta-Analysis. Povidone Iodine

Introducción: La descontaminación preoperatoria de la piel es parte de la práctica quirúrgica estándar. La infección del sitio quirúrgico implica un gasto adicional a los sistemas de salud y un incremento en la morbilidad y mortalidad de los pacientes sometidos a cirugía. El iodo povidona es un desinfectante muy utilizado para eliminar la carga bacteriana cutánea. Objetivo: Constatar si el iodo povidona es mejor que otros desinfectantes cutáneos en la reducción de las infecciones del sitio quirúrgico. Métodos: Se realizó una búsqueda en Google Académico, PubMed y Embase utilizando los términos Mesh; iodo povidona, infección del sitio quirúrgico, cirugía, antisépticos locales, unidos por el operador booleano AND y los filtros Adultos, desde 2015, y ensayos clínicos controlados. Se aplicó la escala de Jadad para riesgo de sesgos y el Consort 2010 y la lista de chequeo PRISMA para determinar la calidad del estudio. El riesgo relativo fue la medida de efecto para un IC95 y un error de 0,05. Se incluyeron 8 ensayos clínicos controlados, n= 4800 casos, con la distribución de eventos en los grupos experimental 140/2402 y control 141/2398, para una diferencia no significativa p=0,444. La heterogeneidad fue I2=62,57 por ciento. Conclusiones: No existieron diferencias entre el iodo povidona y el resto de los desinfectantes para disminuir el porcentaje de infecciones del sitio quirúrgico en este estudio(AU)

Introduction: Preoperative skin decontamination is part of standard surgical practice. Surgical site infection implies an additional cost to health systems and an increase in morbidity and mortality of patients undergoing surgery. Povidone iodine is a widely used disinfectant to eliminate the bacterial load on the skin. Objective: To verify if povidone iodine is better than other skin disinfectants in reducing surgical site infections. Methods: A search of articles and controlled clinical trials published since 2015 was carried out in Google Scholar, PubMed and Embase and using terms of the Mesh such as povidone iodine, surgical site infection, surgery, local antiseptics, joined by the Boolean operator AND in addition to Adult filters. The Jadad scale for risk of bias and Consort 2010 and PRISMA checklist were applied to determine the quality of the study. Relative risk was the measure of effect for CI95 and an error of 0.05. Eight controlled clinical trials were included, n= 4800 cases, with the distribution of events in the experimental groups 140/2402 and control 141/2398, for a non-significant difference p=0.444. Heterogeneity was I2=62.57 percent. Conclusions: There were no differences between povidone iodine and the rest of the disinfectants to reduce the percentage of surgical site infections in this study(AU)

Caracterización de las infecciones posoperatorias en un servicio de cirugía general / Characterization of Postoperative Infections in a General Surgery Service

Introducción: Las infecciones del sitio quirúrgico u operatorio constituyen un grave problema sanitario por lo que su prevención y tratamiento representan un reto para las instituciones hospitalarias. Objetivo: Describir las características de las infecciones posoperatorias según las principales causas relacionadas con su aparición. Métodos: Se realizó un estudio descriptivo y observacional con 207 pacientes ingresados y operados de cirugías mayores que presentaron infecciones posoperatorias en el Servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, durante 2018-2020. Resultados: La tasa global de infecciones posquirúrgicas fue de 4,18 pr ciento. Las infecciones incisionales superficiales, seguidas de las profundas fueron las más frecuentes. El número de pacientes infectados se triplicó en los operados con urgencia respecto a los electivos, con predominio de los apendicectomizados. El tiempo quirúrgico y la estadía hospitalaria promedio se elevaron en los pacientes infectados. Fallecieron 12 integrantes de la casuística, atribuible a la infección generalizada y el choque séptico. Conclusiones: La aparición de las infecciones posquirúrgicas se relacionan con factores dependientes del enfermo; de la propia cirugía como es la calificación del cirujano actuante, así como la presencia de factores de riesgos preoperatorios y durante la intervención. La infección incisional superficial es la más frecuente, en tanto que la mayoría de los pacientes que fallecen corresponden a aquellos con infección de órganos y espacios(AU)

Introduction: Surgical (or operative) site infections are a serious health problem, a reason why their prevention and treatment represent a challenge for hospital institutions. Objective: To describe the characteristics of postoperative infections according to the main causes related to their occurrence. Methods: A descriptive and observational study was carried out with 207 patients admitted and operated on in major surgeries who presented postoperative infections in the general surgery service of Saturnino Lora Provincial Teaching Hospital of Santiago de Cuba, during 2018-2020. Results: The overall rate of postoperative infections was 4.18 percent. Superficial incisional infections, followed by deep incisional infections, were the most frequent. The number of infected patients was tripled in those operated on urgently compared to electively, with a predominance of appendectomized patients. Surgical time and average hospital stay were higher in infected patients. 12 members of the casuistics have passed, attributable to generalized infection and septic shock. Conclusions: The occurrence of postoperative infections is related to factors depending on the patient; on the surgery itself, such as the qualification of the surgeon; as well as on the presence of preoperative and intraoperative risk factors. Superficial incisional infection is the most frequent, while most of the patients who die correspond to those with infection of organs and spaces(AU)

To compare Gross & Ferguson and Mitchell-Banks repair techniques in children with congenital inguinal hernia.

Aims: To compare operating time, early complication(s) and outcome of Gross & Ferguson and Mitchell-Banks repair techniques in children with congenital inguinal hernia. Materials and Methods: A prospective randomized study including boys aged 1-12 years, was conducted over one year. The patients were allocated in two interventional groups based on the repair viz. Gross and Ferguson and Mitchell-Banks group. After hernia repair, the patients were followed up on the day of surgery and at one week for early complications. Results: Fifty patients were enrolled. Mean operating time in Mitchell-Banks technique was significantly more than Gross and Ferguson technique (p=0.00012). The incidence of fever in two groups was similar. Scrotal edema was statistically significant in MB group on both Post-Operative Day -1 and 7 (p=0.023 and p=0.034). No patient in either group had wound infection or scrotal hematoma on POD-1. One subject (2%) had scrotal hematoma in MB group on POD-7. A total of 12 subjects (24%) had Surgical Site Infection on POD-7. There was statistically higher incidence of SSI on Day-7 in GF group (32%) as compared to MB group (16%) (p=0.018). Conclusion: GF technique had lesser operating time, less incidence of scrotal edema and hematoma though higher rate of surgical site infections. In this respect, GF technique can be used as a simple and safe procedure.

A CLINICAL STUDY OF ABDOMINAL WOUND DEHISCENCE

INTRODUCTION:-AWD (abdominal wound dehiscence) is a word that is widely used to describe the separation of different layers of an abdominal wound before it has healed completely. Acute laparotomy wound failure and burst abdomen are two more words that are used interchangeably. Wound dehiscence happens when a wound does not develop the necessary strength to withstand the demands exerted on it. Dehiscence happens when sutures are disrupted by external pressures, absorbable sutures dissolve too quickly, or tight sutures rip through tissues due to excessive strain. AWD has been a long-standing problem for which no surgical unit has offered a complete solution (i.e. none of the surgical units worldwide has reported 0 percent failure rate). However, numerous institutes around the world have been successful in achieving and maintaining failure rates considerably below 1%. These ?gures, on the other hand, do not deter researchers from continuing their efforts to solve the problem. In the last ten years, there have been a slew of publications attempting to explain how to solve this problem. The goal of this study is to assess the prevalence of abdominal wound dehiscence in relation to various risk factors, co-morbidities, and treatment options. The study aimed at ?nding out the AIM:- prevalence of abdominal wound dehiscence with respect to demographic factors, nature of preceding surgery and different risk factors and also to study the effective management of abdominal wound dehiscence. An Observational study METHODS:- on 60 patients comprising all patients admitted to Silchar medical College and Hospital a tertiary care center in Assam within the study period of 1st January 2021 to 31st July 2021 with diagnosed abdominal wound Dehiscence after undergoing surgical interventions. :-The majority of the patients in this study were between the ages of 41 and 50. Majority were male. RESULTS 81.67% were operated as emergency surgery. 66.67% have undergone procedures which are classi?ed as contaminated. (80%) were operated with mid line incision. 58% patients with peritonitis due to hollow viscus perforation. 58.33% had hypoalbuminemia. Malnutrition, DM, HT, pulmonary diseases, anemia etc. are important risk factors for wound dehiscence. CONCLUSION:-Because of the poor blood supply at Linea Alba, individuals who had a midline laparotomy had a higher risk of wound dehiscence than those who had a paramedian laparotomy. Wound dehiscence is more likely in people with a BMI greater than 25, compared to those with a BMI less than 25. In this study wound dehiscence is mainly associated with complications like hypoproteinemia and pulmonary complications and anaemia.

Periprosthetic Knee Infection - Part 1: Risk Factors, Classification and Diagnosis / Infecção periprotética do joelho - Parte 1: Fatores de risco, classificação e diagnóstico

Abstract Infection is one of the most feared complications in the postoperative period of knee arthroplasties. With the progressive aging of the population and the increased incidence of degenerative joint diseases, there is an exponential increase in the number of arthroplasties performed and, consequently, in the number of postoperative infections. The diagnosis of these should follow a hierarchical protocol, with welldefined criteria, which lead to diagnostic conclusion, thus guiding the most appropriate treatment. The aim of the present update article is to present the main risk factors, classifications and, mainly, to guide diagnostic investigation in an organized manner.

Resumo A infecção é uma das complicações mais temidas no pós-operatório de artroplastias do joelho. Com o envelhecimento populacional progressivo e o aumento da incidência de doenças degenerativas articulares, observa-se um aumento exponencial do número de artroplastias realizadas e, consequentemente, do número de infecções pós-operatórias. O diagnóstico destas devem seguir um protocolo hierarquizado, com critérios bem definidos, que conduzam à conclusão diagnóstica, orientando, assim, o tratamento mais adequado. O objetivo do presente artigo de atualização é apresentar os principais fatores de risco, as classificações e, principalmente, guiar de forma organizada a investigação diagnóstica.

Periprosthetic Knee Infection - Part 2: Treatment / Infecção periprotética do joelho - Parte 2: Tratamento

Abstract Several treatment modalities are proposed for periprosthetic infections, with variable success rates. However, efficacy is related to the appropriate selection of cases for each type of treatment. Debridement with implant retention is indicated in acute infections with fixed implant, and its success depends on the type of infection, comorbidities of the host, and virulence of the etiological agent. One- or two-stage revision is required in cases in which biofilm is forming, or of implant loosening. The choice between performing the review in one or two stages depends on factors such as etiological agent identification, pathogen virulence, local and systemic host factors. Rescue procedures such as arthrodesis, amputation, resection arthroplasty or even antibioticsuppressionarereservedforcasesinwhichtheinfectionhasnotbeeneradicated.

Resumo Diversas modalidades de tratamento são propostas para as infecções periprotéticas, com índices de sucesso variáveis. No entanto, a eficácia está relacionada à seleção adequada dos casos para cada tipo de tratamento. O desbridamento com retenção do implante é indicado em infecções agudas com implante fixo, e seu sucesso depende do tipo de infecção, das comorbidades do hospedeiro e da virulência do agente etiológico. A revisão em um ou dois estágios se impõem nos casos em que haja formação de biofilme, ou nos quais se tenha afrouxamento do implante. A escolha entre realizar a revisão em um ou dois estágios depende de fatores como identificação do agente etiológico, virulência do patógeno, fatores locais e sistêmicos do hospedeiro. Os procedimentos de salvamento como artrodese, amputação, artroplastia de ressecção ou, ainda, supressão antibiótica são reservados para os casos em que não se conseguiu erradicação da infecção.

Preparación mecánica intestinal, ¿se justifica en la actualidad? Artículo de revisión / Mechanical bowel preparation, is it currently justified? Review article

La preparación intestinal se ha utilizado en cirugía de colon y recto por una variedad de razones, se cree que un colon limpio facilita la manipulación del intestino, permite el paso y disparo de engrapadoras quirúrgicas y permite la colonoscopia intraoperatoria, si es necesario. Sin embargo, el aspecto más estudiado y debatido de la preparación intestinal es su papel en la reducción de la morbilidad quirúrgica, es decir, las infecciones del sitio quirúrgico (ISQ). La cirugía de colon y recto tiene una de las tasas más altas de ISQ reportadas para todos los tipos de cirugía electiva, con revisiones recientes que muestran tasas que varían del 5,4% al 23,2%, con una media ponderada del 11,4%. (1). La preparación mecánica del intestino (PMI) se usó como un medio para disminuir la concentración bacteriana intraluminal con la esperanza de reducir las tasas de infección. Eventualmente, se agregaron antibióticos no absorbibles a las preparaciones intestinales para reducir aún más el contenido bacteriano intestinal(AU)

Bowel preparation has been used in colon and rectal surgery for a variety of reasons. A clean colon is thought to facilitate bowel manipulation, enable passage and firing of surgical staplers, and allow for intraoperative colonoscopy, if needed. The most studied and debated aspect of bowel preparation, however, is its role in reducing surgical morbidity, namely surgical site infections(SSIs). Colon and rectal surgery has among the highest rates of SSIs reported for all types of elective surgery, with recent reviews demonstrating rates varying from 5.4% to 23.2%, with a weighted mean of 11.4%(AU)

Risk factors of postoperative surgical site infection in colon cancer based on a single center database / 中华胃肠外科杂志

Objective: To explore the incidence and risk factors of postoperative surgical site infection (SSI) after colon cancer surgery. Methods: A retrospective case-control study was performed. Patients diagnosed with colon cancer who underwent radical surgery between January 2016 and May 2021 were included, and demographic characteristics, comorbidities, laboratory tests, surgical data and postoperative complications were extracted from the specialized prospective database at Department of General Surgery, Peking Union Medical College Hospital. Case exclusion criteria: (1) simultaneously multiple primary colon cancer; (2) segmental resection, subtotal colectomy, or total colectomy; (3) patients undergoing colostomy/ileostomy during the operation or in the state of colostomy/ileostomy before the operation; (4) patients receiving natural orifice specimen extraction surgery or transvaginal colon surgery; (5) patients with the history of colectomy; (6) emergency operation due to intestinal obstruction, perforation and acute bleeding; (7) intestinal diversion operation; (8) benign lesions confirmed by postoperative pathology; (9) patients not following the colorectal clinical pathway of our department for intestinal preparation and antibiotic application. Univariate analysis and multivariate analysis were used to determine the risk factors of SSI after colon cancer surgery. Results: A total of 1291 patients were enrolled in the study. 94.3% (1217/1291) of cases received laparoscopic surgery. The incidence of overall SSI was 5.3% (69/1291). According to tumor location, the incidence of SSI in the right colon, transverse colon, left colon and sigmoid colon was 8.6% (40/465), 5.2% (11/213), 7.1% (7/98) and 2.1% (11/515) respectively. According to resection range, the incidence of SSI after right hemicolectomy, transverse colectomy, left hemicolectomy and sigmoid colectomy was 8.2% (48/588), 4.5% (2/44), 4.8% (8 /167) and 2.2% (11/492) respectively. Univariate analysis showed that preoperative BUN≥7.14 mmol/L, tumor site, resection range, intestinal anastomotic approach, postoperative diarrhea, anastomotic leakage, postoperative pneumonia, and anastomotic technique were related to SSI (all P<0.05). Multivariate analysis revealed that anastomotic leakage (OR=22.074, 95%CI: 6.172-78.953, P<0.001), pneumonia (OR=4.100, 95%CI: 1.546-10.869, P=0.005), intracorporeal anastomosis (OR=5.288, 95%CI: 2.919-9.577,P<0.001) were independent risk factors of SSI. Subgroup analysis showed that in right hemicolectomy, the incidence of SSI in intracorporeal anastomosis was 19.8% (32/162), which was significantly higher than that in extracorporeal anastomosis (3.8%, 16/426, χ(2)=40.064, P<0.001). In transverse colectomy [5.0% (2/40) vs. 0, χ(2)=0.210, P=1.000], left hemicolectomy [5.4% (8/148) vs. 0, χ(2)=1.079, P=0.599] and sigmoid colectomy [2.1% (10/482) vs. 10.0% (1/10), χ(2)=2.815, P=0.204], no significant differences of SSI incidence were found between intracorporeal anastomosis and extracorporeal anastomosis (all P>0.05). Conclusions: The incidence of SSI increases with the resection range from sigmoid colectomy to right hemicolectomy. Intracorporeal anastomosis and postoperative anastomotic leakage are independent risk factors of SSI. Attentions should be paid to the possibility of postoperative pneumonia and actively effective treatment measures should be carried out.

Prevention of SSI in Cardiac Surgery by Using Intraoperative Measures for High-Risk Patients as Standard Precautions against Mediastinitis / 日本心臓血管外科学会雑誌

Background : Risk factors for surgical site infection (SSI) are thought to include poorly controlled diabetes mellitus, dialysis, and a long operating time, but patients without risk factors can also develop infection. Therefore, it is possible that SSI could be prevented by routinely using the precautions against SSI developed for high-risk patients. We investigated the route and pathogenetic mechanism of mediastinitis, which is the most frequent SSI after cardiac surgery. We hypothesized that mediastinitis occurred when the deep sternal marrow was contaminated by skin bacteria. Based on this hypothesis, we investigated the efficacy of various intraoperative prophylactic methods for preventing mediastinitis. Methods : We evaluated 658 patients undergoing cardiac surgery at our institution between April 2011 and July 2016. They were classified into two groups. Group C comprised 406 patients who received standard insertion of a sternal retractor after sternotomy. Group S was 252 patients in whom a retractor was inserted after covering the sternal marrow with oxidized cellulose hemostats and belt-like thin towels, with surplus parts of the towels being used to fill subcutaneous dead space at the superior and inferior margins of the midline wound. We investigated the following 10 risk factors for mediastinitis: diabetes (HbA1c≥7.5), renal failure (Cr≥2), smoking, obesity (BMI≥30), reoperation, urgent/emergency operation, intubation in the preoperative period, long operating time (≥8 h), reopening the chest for hemostasis, and coronary artery bypass grafting (CABG). Factors associated with mediastinitis were determined using univariate modeling analysis followed by multi-variate logistic regression analysis. Results : Mediastinitis occurred in 13 patients (2.0%). The significant risk factor for mediastinitis were urgent/emergency operation and CABG, but 1 patient had no risk factors. A univariate analysis showed statistical significance in CABG, presence of maneuver covering the sternal marrow, JapanSCORE-II in mortality and deep sternum infection (DSI). Reopening the chest for hemostasis, CABG, aortic aneurysm, plural risk factors, and JapanSCORE-II in DSI were identified as a risk factor by multiple logistic regression, not all factors showed a significant difference. Mediastinitis only occurred in group C, and it was significantly less frequent in group S with additional precautions against infection including propensity score matching analysis (p<0.05). Conclusion : When the bone marrow of the transected sternum was covered tightly to protect it from contamination by skin bacteria during cardiac surgery, the frequency of postoperative mediastinitis was significantly reduced.

Influencing factors of surgical site infection after abdominal surgery / 中华消化外科杂志

Objective:To investigate the influencing factors of surgical site infection (SSI) after abdominal surgery.Methods:The retrospective cross-sectional study was conducted. The clinical data of 567 patients undergoing abdominal surgery in 6 medical centers, including 445 cases in the Zhengzhou Central Hospital Affiliated to Zhengzhou University, 54 cases in the the First Affiliated Hospital of Zhengzhou University, 49 cases in the Shangqiu First People's Hospital, 10 cases in the Luoyang Central Hospital, 5 cases in the First Affiliated Hospital of Henan University of Science and Technology and 4 cases in the Henan Provincial People's Hospital, from June 1 to June 30, 2020 were collected. There were 284 males and 283 females, aged (51±18)years. Observation indicators: (1) incidence of SSI after surgery; (2) influencing factors of SSI. Follow-up was conducted using outpatient examination and telephone interview to detect the incidence of SSI. Patients without implant were followed up within postoperative 30 days, and patients with implant were followed up within postoperative 1 year. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measure-ment data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was performed using the chi-square test or Fisher exact probability. Univariate analysis was performed using the corresponding statistical methods. Multivariate analysis was performed using the Logistic stepwise regression model advance method. Results:(1) Incidence of SSI after surgery. All the 567 patients were followed up after surgery as planned. There were 27 cases with SSI after surgery including 9 cases with superficial incision infection, 9 cases with deep incision infection, 9 cases with organ/gap infection. Of the 27 cases with SSI after surgery, 18 cases with positive results of incisional microbial culture including 8 cases with positive results of Escherichia coli, 6 cases with positive results of Klebsiella pneumonia, 3 cases with positive results of Enterococcus faecium and 1 case with positive result of Pseudomonas aeruginosa. (2) Influencing factors of SSI. Results of univariate analysis showed that age, preoperative hemoglo-bin, preoperative albumin, preoperative fasting blood glucose, preoperative intestinal preparation, surgical type, surgical site, surgical incision type, duration of intensive cure unite, duration of post-operative hospital stay, duration of total hospital stay, operation time, hospital expense were related factors affecting the incidence of SSI of patients undergoing abdominal surgery ( χ2=40.12, Z=?4.22, ?2.21, ?4.75, χ2=7.07, 16.43, 38.06, 17.50, Z=?4.43, ?4.42, ?7.14, ?7.15, ?5.90, P<0.05) and the American Association of Anesthesiologists Classification, preoperative oral antibiotics, surgical methods and postoperative intensive care unit stay were related factors affecting the incidence of SSI of patients undergoing abdominal surgery ( P<0.05). Results of multivariate analysis showed that age, preopera-tive fasting blood glucose, preoperative intestinal preparation, surgical type, surgical site as appendix and rectum, surgical methods, surgical incision type as infective incision and polluted incision, operation time were independent factors affecting the incidence of SSI of patients undergoing abdo-minal surgery ( odds ratio=7.69, 1.21, 0.27, 5.82, 5.19, 19.08, 0.23, 27.76, 4.97, 1.01, 95% confidence intervals as 2.04?28.95, 1.04?1.41, 0.08?0.94, 1.36?24.85, 1.10?24.43, 4.48?81.25, 0.06?0.87, 2.54?303.53, 1.12?22.14, 1.01?1.02, P<0.05). Conclusion:Age, preoperative fasting blood glucose, preoperative intestinal preparation, surgical type, surgical site as appendix and rectum, surgical methods, surgical incision type as infective incision and polluted incision, operation time are independent factors affecting the incidence of SSI of patients undergoing abdominal surgery.

¿Está exenta de consecuencias adversas la perforación iatrogénica de la vesícula biliar durante la colecistectomía laparoscópica electiva? / Iatrogenic gallbladder perforation during elective laparoscopic cholecystectomy, is it exempt from adverse consequences?

Resumen Objetivo: Este estudio se llevó a cabo para valorar las consecuencias de la perforación iatrogénica de la vesícula biliar (PIVB), investigando su asociación con complicaciones posoperatorias, uso de antibióticos y drenajes, duración de la cirugía y estancia posoperatoria. Materiales y Método: Se incluyeron 1.703 pacientes con colecistectomía laparoscópica electiva, divididos en dos grupos: con PIVB (Grupo 1; n = 321) y sin PIVB (Grupo 2; n = 1.382). Se compararon los resultados entre ambos grupos. Resultados: El porcentaje de PIVB fue de 18,85%. El vertido aislado de bilis ocurrió en 241 pacientes (14,15%) y el de bilis y cálculos en 80 pacientes (4,64%). La incidencia de infección del sitio quirúrgico no fue diferente entre ambos grupos. La incidencia de PIVB fue mayor en varones (43,3% vs 31,3%), pacientes con adherencias perivesiculares (17,75% vs. 10,5%) y pacientes con diagnóstico histológico de colecistitis aguda (11,52% vs. 4,92%). La PIVB se asoció significativamente con mayor duración de la cirugía (77,3 vs. 65,4 minutos), mayor uso de drenajes y antibióticos y mayor estancia posoperatoria. No hubo complicaciones tardías. Discusión y Conclusión: La PIVB no aumenta la incidencia de infección, pero se asocia con un mayor uso de drenajes y antibióticos, mayor duración de la cirugía y mayor estancia posoperatoria.

Aim: This study was conducted to evaluate the outcomes in patients with iatrogenic gallbladder perforation (IGP), investigating its association with postoperative complications, use of antibiotics and drains, operative time and postoperative stay. Materials and Method: 1703 patients who underwent elective laparoscopic cholecystectomy were included and divided in two groups: with IGP (Group 1, n = 321) and without IGP (Group 2, n = 1382). We compared the outcomes between both groups. Results: The IGP rate was 18.85%. Isolated bile spillage occurred in 241 patients (14.15%), and stone spillage in 80 patients (4.64%). The incidence of surgical site infections was not different between both groups. The IGP rate was significantly higher in male (43.3% vs 31.3%), in patients with perivesicular adhesions (17.75% vs 10.5%) and in patients with histologic diagnosis of acute cholecystitis (11.52% vs 4.92%). Operative time was significantly longer in patients with IGP (77.3 vs 65.4 minutes). Intraoperative drain and antibiotic use, as well as postoperative stay were, also, significantly higher in patients with IGP. There was not any late complication. Conclusión: Bile and gallstones spillage do not lead to an increase in surgical site infections, but is associated with an increased use of antibiotics and drains, longer operative time and longer postoperative stay.

A Comparative Study of Single Dose and Multiple Dose Antibiotic Prophylaxis In Caesarean Section

Background: Rampant antibiotic use brought about its own set of problems like the rise in incidence of antibiotic resistant strains, allergies and other complications of antibiotic use. Unfortunately, in many of our set ups we are still stuck in prolonged post-operative antibiotic regimes. This study aims to fill those lacunae and thereby aid our gradual shift away from over reliance on prolonged antibiotic usage in prevention of surgical site infection (SSI). Hence, we decided to investigate the efficacy of the use of a single prophylactic intravenous dose of antibiotic vis a vis multiple doses in reducing post-operative infective morbidity in caesarean sections. Methodology:The study included 200 patients at term, satisfying the inclusion and exclusion criteria, reporting to the labour room and undergoing caesarean section. The patients were then divided into two groups of 100 each by simple randomization. Patients in Group Awere given a single dose IVantibiotics 30 minutes before the skin incision and Group B cases were given the first dose of IVantibiotics 30 minutes before the skin incision and continued for next 2 days, after that patient received oral antibiotics for next 3 days. Results: The present study did not show any significant difference in the post-operative infection incidence between the single dose and multiple dose schedule. Conclusion: Our study noted, there was no difference in the outcome as regards post-operative infectious morbidity in patients of both the groups. Hence, based on the findings of our study we conclude that single dose prophylactic antibiotic should be the norm for caesarean sections.