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)

Regional analgesia and surgical site infections after colorectal surgery: a retrospective cohort analysis

Abstract Background The effect of regional analgesia on perioperative infectious complications remains unknown. We therefore tested the hypothesis that a composite of serious infections after colorectal surgery is less common in patients with regional analgesia than in those given Intravenous Patient-Controlled Analgesia (IV-PCA) with opiates. Methods Patients undergoing elective colorectal surgery lasting one hour or more under general anesthesia at the Cleveland Clinic Main Campus between 2009 and 2015 were included in this retrospective analysis. Exposures were defined as regional postoperative analgesia with epidurals or Transversus Abdominis Plane blocks (TAP); or IV-PCA with opiates only. The outcome was defined as a composite of in-hospital serious infections, including intraabdominal abscess, pelvic abscess, deep or organ-space Surgical Site Infection (SSI), clostridium difficile, pneumonia, or sepsis. Logistic regression model adjusted for the imbalanced potential confounding factors among the subset of matched surgeries was used to report the odds ratios along with 95% confidence limits. The significance criterion was p < 0.05. Results A total of 7811 patients met inclusion and exclusion criteria of which we successfully matched 681 regional anesthesia patients to 2862 IV-PCA only patients based on propensity scores derived from potential confounding factors. There were 82 (12%) in-hospital postoperative serious infections in the regional analgesia group vs. 285 (10%) in IV-PCA patients. Regional analgesia was not significantly associated with serious infection (odds ratio: 1.14; 95% Confidence Interval 0.87‒1.49; p-value = 0.339) after adjusting for surgical duration and volume of intraoperative crystalloids. Conclusion Regional analgesia should not be selected as postoperative analgesic technique to reduce infections.

Elective incisional hernia repair: lower risk of postoperative wound infection with laparoscopic versus open repair

INTRODUCTION@#The superiority of laparoscopic repair over open repair of incisional hernias (IHs) in the elective setting is still controversial. Our study aimed to compare the postoperative outcomes of laparoscopic and open elective IH repair in an Asian population.@*METHODS@#This retrospective study was conducted in an acute general hospital in Singapore between 2010 and 2015. Inclusion criteria were IH repair in an elective setting, IHs with diameter of 3-15 cm, and location at the ventral abdominal wall. We excluded patients who underwent emergency repair, had recurrent hernias or had loss of abdominal wall domain (i.e. hernia sac containing more than 30% of abdominal contents or any solid organs). Postoperative outcomes within a year such as recurrence, pain, infection, haematoma and seroma formation were compared between the two groups.@*RESULTS@#There were 174 eligible patients. The majority were elderly Chinese women who were overweight. Open repair was performed in 49.4% of patients, while 50.6% underwent laparoscopic repair. The mean operation time for open repair was 116 minutes (116 ± 60.6 minutes) and 139 minutes (136 ± 64.1 minutes) for laparoscopic repair (P = 0.079). Within a year after open repair, postoperative wound infection occurred in 15.1% of the patients in the open repair group compared to 1.1% in the laparoscopic group (P = 0.0007). Postoperative pain, recurrence and haematoma/seroma formation were comparable.@*CONCLUSION@#Elective laparoscopic IH repair has comparable outcomes with open repair and may offer the advantage of reduced postoperative wound infection rates.

Effectiveness of supplemental oxygenation to prevent surgical site infections: A systematic review with meta-analysis / Efetividade da oxigenação suplementar para prevenção de infecção de sítio cirúrgico: revisão sistemática com metanálise / Efectividad de la oxigenación suplementaria para prevenir la infección del sitio quirúrgico: revisión sistemática con metaanálisis

Abstract Objective: to assess the effectiveness of supplemental oxygenation with high FiO2 when compared to conventional FiO2 in the prevention of surgical site infection. Method: an effectiveness systematic review with meta-analysis conducted in five international databases and portals. The research was guided by the following question: Which is the effectiveness of supplemental oxygenation with high FiO2 (greater than 80%) when compared to conventional FiO2 (from 30% to 35%) in the prevention of surgical site infections in adults? Results: fifteen randomized clinical trials were included. Although all the subgroups presented a general effect in favor of the intervention, colorectal surgeries had this relationship evidenced with statistical significance (I2=10%;X2=4.42; p=0.352). Conclusion: inspired oxygen fractions greater than 80% during the perioperative period in colorectal surgeries have proved to be effective to prevent surgical site infections, reducing their incidence by up to 27% (p=0.006). It is suggested to conduct new studies in groups of patients subjected to surgeries from other specialties, such as cardiac and vascular. PROSPERO registration No.: 178,453.

Resumo Objetivo: avaliar a efetividade da oxigenação suplementar com FiO2 elevada comparada com FiO2 convencional na prevenção de infecção de sítio cirúrgico. Método: revisão sistemática de efetividade com metanálise em cinco bases de dados e portais internacionais. A pesquisa foi norteada pela pergunta: Qual a efetividade da oxigenação suplementar com FiO2 elevada (maior que 80%) comparada com FiO2 convencional (de 30 a 35%) na prevenção de infecção de sítio cirúrgico em adultos? Resultados: foram incluídos quinze ensaios clínicos randomizados. Embora todos os subgrupos tenham apresentado um efeito geral a favor da intervenção, as cirurgias colorretais tiveram essa relação evidenciada com significância estatística (I2=10%; X2=4,42; p=0,352). Conclusão: uma fração inspirada de oxigênio maior que 80% durante o período perioperatório em cirurgias colorretais tem se mostrado efetiva para prevenir a infecção de sítio cirúrgico, reduzindo sua incidência em até 27% (p=0,006). Sugere-se a realização de novos estudos em grupos de pacientes submetidos a cirurgias de outras especialidades, tais como cardíacas e vasculares. Registro PROSPERO: 178453.

Resumen Objetivo: evaluar la efectividad de la oxigenación suplementaria con FiO2 elevada en comparación con la FiO2 convencional para prevenir la infección del sitio quirúrgico. Método: revisión sistemática de eficacia con metaanálisis en cinco bases de datos y portales internacionales. La investigación se guio por la pregunta: ¿Qué tan eficaz es la oxigenación suplementaria con FiO2 alta (más del 80%) en comparación con la FiO2 convencional (del 30 al 35%) para prevenir la infección del sitio quirúrgico en adultos? Resultados: se incluyeron quince ensayos clínicos aleatorizados. Aunque todos los subgrupos mostraron un efecto general a favor de la intervención, en las cirugías colorrectales esa relación tenía significancia estadística (I2=10%; X²=4,42; p=0,352). Conclusión: una fracción inspirada de oxígeno superior al 80% durante el perioperatorio en cirugías colorrectales ha demostrado ser eficaz en la prevención de la infección del sitio quirúrgico, reduciendo su incidencia hasta en un 27% (p=0,006). Se sugiere realizar más estudios en grupos de pacientes sometidos a cirugías en otras especialidades, como cardiaca y vascular. Registro PROSPERO: 178453.

Impact of surgical checklist and its completion on complications and mortality in urgent colorectal procedures / Impacto do uso do checklist cirúrgico e completude em complicações e mortalidade em cirurgias colorretais de urgência

ABSTRACT Objective: to assess the impact of using a surgical checklist and its completion on complications such as surgical site infection (SSI), reoperation, readmission, and mortality in patients subjected to urgent colorectal procedures, as well as the reasons for non adherence to this instrument in this scenario, in a university hospital in Ottawa, Canada. Methods: this is a retrospective, epidemiological study. We collected data from an electronic database containing information on patients undergoing urgent colorectal operations, and analyzed the occurrence of SSI, reoperation, readmission, and death in a 30 day period, as well as the completion of the checklist. We conducted a descriptive statistical analysis and logistic regression. Results: we included 5,145 records, of which 5,083 (98.8%) had complete checklists. As for the outcomes evaluated, cases with complete checklists displayed higher SSI rate, 9.1% vs. 6.5% (p=0.466), lower reoperation rate, 5% vs.11.3% (p=0.023), lower readmission rates, 7.2% vs. 11.3% (p=0.209), and lower mortality, 3.0% vs. 6.5% (p=0.108) than cases with incomplete ones. Conclusion: there was a high level of checklist completion and a larger number of the outcomes in the reduced percentage of incomplete checklists found, demonstrating the impact of its utilization on the safety of patients undergoing urgent operations.

RESUMO Objetivo: verificar o impacto do uso do checklist cirúrgico e a completude em complicações como infecção do sítio cirúrgico (ISC), reoperação, readmissão e mortalidade em pacientes submetidos a procedimentos colorretais de urgência, bem como os motivos para a não adesão a esse instrumento nesse cenário, em hospital universitário de Ottawa, Canadá. Métodos: trata-se de estudo epidemiológico retrospectivo. Os dados foram coletados em base de dados eletrônica contendo informações de pacientes submetidos a cirurgias colorretais de urgência, sendo analisada a ocorrência de ISC, reoperação, readmissão e óbito em período de 30 dias, bem como a completude do checklist. Realizou-se análise estatística descritiva e regressão logística. Resultados: incluíram-se 5.145 registros, dos quais 5.083 (98,8%) possuíam checklists completos. No que se refere aos desfechos avaliados, identificou-se nos checklists completos comparados aos incompletos, respectivamente, maior taxa das ISC de 9,1% contra 6,5% (p=0,466); menor taxa em reoperações de 5% contra 11,3% (p=0,023); em readmissões de 7,2% contra 11,3% (p=0,209); e também em mortalidade de 3,0% contra 6,5% (p=0,108). Conclusão: verificou-se alto nível de completude do checklist e maior número de desfechos no reduzido percentual de checklists incompletos encontrados, demonstrando o impacto da utilização para a segurança do paciente submetido a cirurgias de urgência.

Incidencia de infección en una cohorte histórica del registro nacional de las 1738 artroplastias de cadera operadas por artrosis en 2014 en Uruguay / Incidence of infection in a historical cohort from the national registry of 1738 hip arthroplasties operated for osteoarthritis in 2014 in Uruguay

Introducción: Las infecciones de artroplastia total de cadera tienen una incidencia baja, pero cuando suceden generan un problema sanitario no solo para el paciente, sino también para el sistema de salud. Las mismas pueden generar dolor, disminución de la capacidad funcional, pobre calidad de vida, múltiples cirugías, y en ocasiones, la muerte. Objetivos: Evaluar la incidencia nacional de infecciones en las artroplastias primarias de cadera operadas por artrosis en el 2014 en Uruguay, y los factores de riesgo vinculados al paciente, medio ambiente y acto quirúrgico, incluido el abordaje quirúrgico. Métodos: Estudio observacional analítico de todos los pacientes operados por artrosis. Se selecciona una muestra aleatoria de 633 pacientes, representativa de las 1738 artroplastias realizadas en Uruguay durante el año 2014. Mediante entrevista telefónica y revisión de historias clínicas se identificaron los pacientes con infección profunda del sitio quirúrgico. Se estimó la incidencia de infección y se realizó un análisis uni- multivariado mediante regresión logística para identificar factores asociados a la infección periprotésica profunda. Resultados: Se presentaron 8 infecciones, con una incidencia de 1,21 por ciento (IC 95 por ciento 0,59 ­ 2,20) en la población general. Los factores asociados a la infección protésica con significancia estadística fueron: a) IMC ≥ 35, p= 0,006; b) procedencia de Montevideo 2,07 por ciento (1,03 ­ 4,11) p= 0,031; c) procedencia del subsector privado 1,47 por ciento (0,77 ­ 2,78) p= 0,009; d) centro quirúrgico donde se realizó la cirugía 4,3 % (1,6 ­ 10,9) p= 0,03, e) uso de cemento con antibiótico 1,59 por ciento (0,65 ­ 3,25) p= 0,034. Se presentó sospecha de infección en 6 de 8 pacientes, en los primeros 30 días postoperatorios; a 7 de 8 pacientes se les realizó limpieza quirúrgica y solo a 1 de 8 pacientes se le realizó la revisión protésica definitiva. Conclusiones: La incidencia de infección en cirugía protésica electiva de cadera por artrosis en el Registro Nacional de Uruguay, fue similar a lo publicado en la bibliografía. De las variables frecuentemente citadas como incidentales en esta complicación, solo el índice de masa corporal fue asociado en esta serie. Llaman la atención las asociaciones dependientes de la procedencia, nivel socioeconómico y centro quirúrgico. Los resultados respecto al uso de cemento con antibiótico deben ser evaluados en estudios futuros(AU)

Introduction: Total hip arthroplasty infections have a low incidence, but when they occur they generate health problems for the patient, and for the health system. They can cause pain, decreased functional capacity, poor quality of life, multiple surgeries, and sometimes death. Objectives: To evaluate the national incidence of infections in primary hip arthroplasties operated for osteoarthritis in 2014, and the risk factors related to the patient, the environment and the surgical act, including the surgical approach. Methods: Analytical observational study of all patients operated on for osteoarthritis. A random sample of 633 patients was selected, representative of 1738 arthroplasties performed in Uruguay in 2014. Through a telephone interview and review of medical records, patients with deep infection of the surgical site were identified. The incidence of infection was estimated and univariate and multivariate analysis was performed using logistic regression to identify factors associated with deep periprosthetic infection. Results: There were 8 infections, with an incidence of 1.21 percent (95 percent CI 0.59 - 2.20) in the general population. The statistically significant factors associated with prosthetic infection were: a) BMI ≥ 35, p = 0.006; b) origin of Montevideo 2.07 percent(1.03 - 4.11) p = 0.031; c) origin of the private subsector 1.47 percent (0.77 - 2.78) p = 0.009; d) surgical center where the surgery was performed 4.3 percent(1.6 - 10.9) p = 0.03, e) use of cement with antibiotic 1.59 percent(0.65 - 3.25) p = 0.034. Suspicion of infection was presented in 6 of 8 patients, in the first 30 postoperative days; 7 of 8 patients underwent surgical cleaning and only 1 of 8 patients underwent final prosthetic revision. Conclusions: The incidence of infection in elective prosthetic hip surgery for osteoarthritis in the Uruguayan National Registry was similar to that published in the literature. Body mass index was the only variable associated as incidental to this complication in this series, out of those frequently cited. The associations depending on the origin, socioeconomic level and surgical center are striking. The results regarding the use of cement with antibiotics should be evaluated in future studies(AU)

¿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.

Effect of a surgical care bundle on the incidence of surgical site infection in colorectal surgery: a quasi-experimental intervention

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.

Surgical Site Infection after Cesarean Delivery in Times of COVID-19 / Infecção de sítio cirúrgico após cesariana em tempos de COVID-19

Abstract Objective To analyze effects of the COVID-19 pandemic on the consumption of personal protective equipment and products (PPEP), as well as the frequency of surgical site infection (SSI) among non-COVID-19 patients submitted to cesarean sections. Methods A retrospective study was conducted in a maternity unity of a public teaching hospital which was not part of the reference service for COVID-19 treatment. It compared PPEP consumption and the occurrence of SSI after cesarean sections in monthly periods before and after the occurrence of the first case of COVID-19 in Porto Alegre, state of Rio Grande do Sul, Brazil. Personal protective equipment and products consumption was measured as units of masks, gloves, gowns, and caps, and use of alcohol-based products or soap for hand sanitation asml/patient/day. The SSI index was calculated as the proportion of cases of SSI over the number of cesarean sections performed monthly during the study period. Results There was an increase in all measured items of PPEP, with consumption of disposable masks with a median of 1,450 units in the pre-COVID period, and of 2550 in the post-COVID period (a 75.9% increase). A decrease of 49% in SSI was detected, with a median of 1.74 in the pre-COVID period and of 0.89 in the post-COVID period. Conclusion The increase in consumption of PPEP could be a result of safer practices adopted by healthcare workers with the advent of COVID-19, of which the following reduction in the occurrence of SSI could be a direct consequence. Despite the severity of the crisis, one could state that extreme situations can lead to valuable reflections and opportunities for improvement.

Resumo Objetivo Analisar os efeitos da pandemia de COVID-19 sobre o consumo de equipamentos e produtos de proteção individual (EPPI), assim como a frequência de infecção de sítio cirúrgico (ISC) em pacientes não infectadas por COVID-19 submetidas a cesarianas. Métodos Foi realizado umestudo retrospectivo em umamaternidade de um hospital público de ensino que não fazia parte do serviço de referência para o tratamento do COVID-19. Foram comparados o consumo de EPPI e a ocorrência de ISC após cesárea nos períodos mensais antes e após a ocorrência do primeiro caso de COVID-19 em Porto Alegre, RS, Brasil. O consumo de EPPI foimedido emunidades demáscaras, luvas, aventais e gorros, e o uso de produtos à base de álcool ou de sabonete para higienização das mãos em ml/paciente/dia. O índice SSI foi calculado como a proporção de casos de ISC sobre o número de cesarianas realizadas mensalmente durante o período do estudo. Resultados Houve aumento em todos os itens medidos do EPPI, com o consumo de máscaras descartáveis apresentando uma mediana de 1.450 no período pré-COVID e de 2550 no período pós-COVID (aumento de 75,9%). Detectou-se também diminuição de ISC, com medianas de 1,74 no período pré-COVID e de 0,89 no período pós-COVID, com redução de 49% no valor da mediana. Conclusão O aumento do consumo de EPPI pode ser resultado de práticas mais seguras adotadas pelos profissionais de saúde com o advento do COVID-19, do qual a redução na ocorrência de ISC pode ser uma consequência direta. Apesar da gravidade da crise, pode-se afirmar que situações extremas podem gerar reflexões valiosas e oportunidades de melhorias.

Presencia de infección de sitio quirúrgico en procedimientos gineco-obstétricos en un hospital de II nivel de atención, Honduras 2017-2018 / Presence of surgical site infection in obstetric-gynecological procedures in a level II care hospital, Honduras 2017-2018

OBJETIVO: Identificar la presencia de infección de sitio quirúrgico y factores de riesgo en pacientes sometidas a cirugías Gineco-Obstétricas de forma programada o de urgencia en un hospital de II nivel de atención en Honduras. METODOLOGÍA: Estudio observacional, descriptivo, retrospectivo; recopilando 226 fichas del registro de infección de sitio quirúrgico recuperadas de los expedientes clínicos brindados por el servicio de estadística del Hospital Mario Catarino Rivas. Captando pacientes sometidas a cirugías Gineco-Obstétricas, durante el 2017 y 2018. RESULTADOS: 99 fichas cumplieron los criterios de inclusión, reportando una edad de 24 años [RIQ, 19,0 - 30,0], peso 82,0 kg [RIQ, 51,7 - 98,25], talla 154 cm [150,0 - 158,0] y el IMC de 25,8 ± 3,6 kg/m2. Un 9,1% presento antecedentes de inmunosupresión. 5,1% presento ISQ. El 55.6% de las cirugías se realizó el mismo día de ingreso del paciente. El tiempo entre la profilaxis antibiótica y el comienzo de la intervención quirúrgica es de 60 minutos [RIQ, 40,0 - 160,0]. La duración de los procedimientos quirúrgicos son de 45 minutos [RIQ, 35,0 - 55,0]. Los microrganismos aislados en los cultivos fueron Cocos gram positivos (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSIÓN: La presencia de ISQ en cirugías Gineco-Obstétricas del HMCR es del 5.1%, identificando los siguientes factores de riesgo: edad extrema, obesidad, diabetes mellitus, estado inmunitario (VIH), profilaxis antibiótica (temprana); por último, la técnica y el tiempo quirúrgico.

OBJECTIVE: To identify the presence of surgical site infection and risk factors in patients undergoing Gynecological-Obstetric surgeries on a scheduled or emergency basis in a 2nd level of care hospital in Honduras. METHODOLOGY: Observational, descriptive, retrospective study, compiling 226 data sheets of the surgical site infection record recovered from the clinical records provided by the statistics service of the "Hospital Mario Catarino Rivas". Recruiting patients undergoing Gynecological-Obstetric surgeries, during 2017 and 2018. RESULTS: 99 tabs met the inclusion criteria, reporting an age of 24 [RIQ, 19.0 - 30.0], weight 82.0 kg [RIQ, 51.7 - 98.25], size 154 cm [150.0 - 158.0] and BMI of 25.8 ± 3.6 kg/m2. 9.1% have a history of immunosuppression. 5.1% present ISQ. 55.6% of surgeries were performed on the same day as the patient's admission. The time between antibiotic prophylaxis and the onset of surgery 60 minutes [RIQ, 40.0 - 160.0]. Duration of surgical procedures 45 minutes [RIQ, 35.0 - 55.0]. Isolated micro-morphisms in crops were Cocos gram positives (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSION: The presence of ISQ in HMCR Gynecological-Obstetric surgeries is 5.1%, identifying the following risk factors: extreme age, obesity, diabetes mellitus, immune status (HIV), early antibiotic prophylaxis; finally, technique and surgical time.

Impact of surgical checklist and its completion on complications and mortality in urgent colorectal procedures / Impacto do uso do checklist cirúrgico e completude em complicações e mortalidade em cirurgias colorretais de urgência

ABSTRACT Objective: to assess the impact of using a surgical checklist and its completion on complications such as surgical site infection (SSI), reoperation, readmission, and mortality in patients subjected to urgent colorectal procedures, as well as the reasons for non adherence to this instrument in this scenario, in a university hospital in Ottawa, Canada. Methods: this is a retrospective, epidemiological study. We collected data from an electronic database containing information on patients undergoing urgent colorectal operations, and analyzed the occurrence of SSI, reoperation, readmission, and death in a 30 day period, as well as the completion of the checklist. We conducted a descriptive statistical analysis and logistic regression. Results: we included 5,145 records, of which 5,083 (98.8%) had complete checklists. As for the outcomes evaluated, cases with complete checklists displayed higher SSI rate, 9.1% vs. 6.5% (p=0.466), lower reoperation rate, 5% vs.11.3% (p=0.023), lower readmission rates, 7.2% vs. 11.3% (p=0.209), and lower mortality, 3.0% vs. 6.5% (p=0.108) than cases with incomplete ones. Conclusion: there was a high level of checklist completion and a larger number of the outcomes in the reduced percentage of incomplete checklists found, demonstrating the impact of its utilization on the safety of patients undergoing urgent operations.

RESUMO Objetivo: verificar o impacto do uso do checklist cirúrgico e a completude em complicações como infecção do sítio cirúrgico (ISC), reoperação, readmissão e mortalidade em pacientes submetidos a procedimentos colorretais de urgência, bem como os motivos para a não adesão a esse instrumento nesse cenário, em hospital universitário de Ottawa, Canadá. Métodos: trata-se de estudo epidemiológico retrospectivo. Os dados foram coletados em base de dados eletrônica contendo informações de pacientes submetidos a cirurgias colorretais de urgência, sendo analisada a ocorrência de ISC, reoperação, readmissão e óbito em período de 30 dias, bem como a completude do checklist. Realizou-se análise estatística descritiva e regressão logística. Resultados: incluíram-se 5.145 registros, dos quais 5.083 (98,8%) possuíam checklists completos. No que se refere aos desfechos avaliados, identificou-se nos checklists completos comparados aos incompletos, respectivamente, maior taxa das ISC de 9,1% contra 6,5% (p=0,466); menor taxa em reoperações de 5% contra 11,3% (p=0,023); em readmissões de 7,2% contra 11,3% (p=0,209); e também em mortalidade de 3,0% contra 6,5% (p=0,108). Conclusão: verificou-se alto nível de completude do checklist e maior número de desfechos no reduzido percentual de checklists incompletos encontrados, demonstrando o impacto da utilização para a segurança do paciente submetido a cirurgias de urgência.

Does total hip arthroplasty provide better outcomes than hemiarthroplasty for the femoral neck fracture? A systematic review and meta-analysis / 中华创伤杂志(英文版)

PURPOSE@#By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality, dislocation, infection, reoperation rate, and thromboembolic event.@*METHODS@#The PubMed, EMBASE databases, and Cochrane library were systematically searched from the inception dates to April 1, 2020 for relevant randomized controlled trials in English language using the keywords: "total hip arthroplasty", "hemiarthroplasty" and "femoral neck fracture" to identify systematic reviews and meta-analyses. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration' stools, and discussed any disagreements. The third reviewer was consulted for any doubts or uncertainty. We derived risk ratios and 95% confidence intervals. Mortality was defined as the primary outcome. Secondary outcomes were other complications, dislocation, infection, reoperation rate, and thromboembolic event.@*RESULTS@#This meta-analysis included 10 studies with 1419 patients, which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation, infection rate, and thromboembolic event. However, there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up.@*CONCLUSION@#Based on our results, we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.

¿Cúan segura es la dermatología quirúrgica?. Trabajo de investigación prospectivo sobre sus complicaciones realizado en una sala de procedimientos / How safe is dermatologic surgery? Prospective reserach work on complications in dermatologic surgery located in an office-based setting

Antecedentes: Aunque las complicaciones globales en la dermatología quirúrgica referidas en la bibliografía mundial son bajas (1,64- 4,58%), las publicaciones regionales con datos prospectivos sobre ellas son escasas y, a nivel nacional, inexistentes. Objetivos: Estimar la incidencia de complicaciones intraquirúrgicas (CI) y posquirúrgicas (CP) en los procedimientos de cirugía dermatológica y caracterizarlas en el ámbito de una sala de procedimientos de un hospital de referencia de la Ciudad Autónoma de Buenos Aires. Diseño: Trabajo de investigación descriptivo, prospectivo, observacional y longitudinal. Materiales y métodos: Se recolectó información demográfica del paciente y operativa en el momento del procedimiento quirúrgico. Se clasificaron las complicaciones quirúrgicas que se presentaron hasta un mes posterior al procedimiento en los pacientes intervenidos en la sección de Dermatología Quirúrgica del Hospital F. J. Muñiz, en el período comprendido entre febrero de 2015 y marzo de 2018. Resultados: Se halló una incidencia de 0% (IC 95%: 0 a 0,4) para las CI y de 4,4% (IC 95%: 3,2 a 5,9) para las CP en una serie de 765 pacientes (937 procedimientos). La CP más frecuente fue dehiscencia (68%), seguida de infección (16%), variantes de sangrado (9%) y necrosis (7%). Ninguna fue grave ni incluyó muerte, hospitalización o secuelas permanentes. Conclusiones: La dermatología quirúrgica en el ámbito de una sala de procedimientos es segura y el porcentaje de complicaciones es bajo comparable con lo publicado en la bibliografía internacional. (AU)

Background: Although the global complications in surgical dermatology referred to in the worldwide literature are low (1.64- 4.58%), regional publications with prospective data on them are scarce and nationally non-existent. Objectives: Estimate the incidence of intra-surgical complications (IC) and post-surgical complications (PC) in dermatological surgery procedures and characterize them within the scope of a reference hospital in the Autonomous City of Buenos Aires. Design: Descriptive, prospective, observational and longitudinal research work. Materials and methods: Demographic information of the patient and operative data were collected at the time of the surgical procedure. Surgical complications that occurred up to one month after the procedure on patients undergoing surgery in the surgical dermatology section of the F. J. Muñiz Hospital between February 2015 to March 2018 were classified. Results: The incidence found was 0% (95% CI 0-0.4) for IC and 4.4% (95% CI 3.2-5.9) for PC in a series of 765 patients (937 procedures). The most frequent PC was dehiscence (68%), followed by infection (16%), bleeding variants (9%) and necrosis (7%). Neither the PC were severe, not included death, hospitalization or permanent sequelae. Conclusions: Office based dermatologic surgery is safe and the percentage of complications is low, comparable to that published in the international literature. (AU)

Morbidade e mortalidade no fechamento de estomas: revisão de 10 anos / Morbidity and mortality of stoma closure: a 10-year review

Introdução: O fechamento de estomas, embora rotineiramente performado, ainda não pode ser considerado um procedimento simples. Nós reportamos, desta forma, a morbidade, mortalidade e fatores de riscos associados a este procedimento em um período de dez anos. Métodos: Revisão retrospectiva de 252 prontuários (149 homens; 103 mulheres), com uma média de 56 anos de idade (18 a 89 anos), que foram submetidos a fechamento de estomas, com análise de complicações clínicas e cirúrgicas, características relacionadas ao estoma, entre outros. Admissão em UTI, complicações precoces (até 30 dias) (classificação de Clavien-Dindo), e tardias, além de óbito, foram analisados. Os testes T de Student, ANOVA, Qui-Quadrado de Pearson, exato de Fischer e de Mann-Whitney foram utilizados para análise paramétrica e não-paramétrica. Resultados: Tumores colorretais (64%) e diverticulite (10%) foram as principais causas para a confecção do estoma. 112 (44,4%) dos pacientes tiveram pelo menos uma complicação cirúrgica. As complicações precoces foram infecção de ferida operatória (13%), fistula e deiscência anastomótica/intestinal (9%), abscessos de cavidade ou parede abdominais (8,3%); tardiamente houveram 36 casos de hérnia incisional (14,2%) e uma estenose intestinal (0,3%). Comorbidades levaram a 10% maior probabilidade de ter uma ou mais complicações cirúrgicas, e todas as cinco mortes ocorreram nestes pacientes (2%). Estomas de intestino grosso, maior tempo operatório e admissão em UTI estiveram significamente relacionados a aumento da morbidade. Conclusão: Pacientes com comorbidades e estomas de intestino grosso tiveram mais risco de complicações. Cuidados pré e perioperatórios, e melhor seleção de pacientes são importantes na redução da morbimortalidade.(AU)

Introduction: Although routinely performed, stoma closure cannot as yet be considered a simple procedure. We report here the morbidity, mortality and risk factors associated with this procedure over a 10-year period. Methods: The medical records of 252 patients (149 men; 103 women), with a mean age of 56 years (18 to 89 years), who underwent stoma closure were retrospectively reviewed for postoperative clinical and surgical complications, stoma-related features, among others. ICU admission, early surgical complications (within 30 days) according to the Clavien-Dindo classification, late surgical complications, and death were analyzed. Student's t-test, ANOVA, Pearson's chi-square test, Fisher's exact test, and MannWhitney U test were used for parametric and nonparametric data. Results: Colorectal tumors (64%) and diverticulitis (10%) were the main reasons for stoma surgery. Overall, 112 (44.4%) patients had at least one surgical complication. Early complications included surgical wound infection (13%), fistula and anastomotic/ intestinal dehiscence (9%), and abdominal wall or intra-abdominal abscesses (8.3%). Late complications included 36 (14.2%) cases of incisional hernia and one case (0.3%) of stricture. Patients with comorbidities were 10% more likely to have one or more surgical complications, and all 5 deaths occurred in these patients (2%). Large-bowel ostomies, longer operative time and ICU admission were significantly related to increased morbidity. Conclusion: Patients with an increased number of comorbidities and large-bowel ostomies are at higher risk for complications. Pre- and perioperative care and accurate patient selection are important to reduce morbidity and mortality.(AU)

Endophthalmitis after cataract surgery: results from seven years of epidemiological surveillance / Endoftalmites após cirurgia de catarata: resultado de sete anos de vigilância epidemiológica

Abstract Purpose: This study aims to describe the incidence, clinical presentation, and evolution of endophthalmitis cases occurred at an ophthalmologic center in Brazil. Methods: This is a review of medical records of patients undergoing cataract surgery from 2008 to 2014. Clinical variables associated with the outcome of postoperative endophthalmitis were evaluated. Results: during the study period, 27,609 cataract surgeries were performed. It was identified 35 cases of endophthalmitis. The overall incidence of endophthalmitis was 0.13%, with an annual variation from 0.04% to 0.27%. The main signs and symptoms in patients with endophthalmitis were ocular pain and low visual acuity associated with conjunctival hyperemia and hypopyon. Gram-positive microorganisms were the most frequent etiological agents. All patients received an intra-vitreous injection of antibiotics as immediate treatment. The final visual acuity was equal to or worse than the ability to count the examiner's fingers in 57.1% of the patients. Evisceration or enucleation was required in 3 patients. Conclusion: The incidence of endophthalmitis and the majority of signs and symptoms found in this study were in agreement with literature in the field. Although the incidence rate is low, the loss of vision experienced by most patients with endophthalmitis after cataract surgery highlights the need for efforts to prevent infection and early diagnosis to avoid such complications.

Resumo Objetivo: Descrever a incidência, a apresentação clínica e a evolução dos casos de endoftalmites ocorridos em um centro oftalmológico no Brasil. Métodos: Trata-se de uma revisão de prontuários dos pacientes submetidos à cirurgia de catarata no período de 2008 a 2014. Foram avaliadas as variáveis clínicas associadas ao desfecho de endoftalmite pós-operatória. Resultados: durante o período do estudo, foram realizadas 27.609 cirurgias de catarata. Foram identificados 35 casos de endoftalmite. A incidência global de endoftalmite foi de 0,13%, com variação anual de 0,04% a 0,27%. Os principais sinais e sintomas em pacientes com endoftalmite foram dor ocular e baixa acuidade visual associado à hiperemia conjuntival e hipópio. Os microrganismos gram-positivos foram os agentes etiológicos mais frequentes. Todos os pacientes receberam uma injeção intravítreo de antibióticos como tratamento imediato. A acuidade visual final foi igual ou pior que a capacidade de contar os dedos do examinador em 57,1% dos pacientes. Evisceração ou enucleação foi necessário em 3 pacientes. Conclusão: A incidência de endoftalmite e a maioria dos sinais e sintomas encontrados neste estudo estão de acordo com os reportados na literatura. Embora a taxa de incidência seja baixa, a perda de visão experimentada pela maioria dos pacientes com endoftalmite após a cirurgia de catarata destaca a necessidade de esforços para medidas de prevenção de infecção e diagnóstico precoce para evitar tais complicações.

Post-surgical atypical mycobacteriosis in 125 patients in Rio de Janeiro

Abstract INTRODUCTION: The growing incidence of post-surgical atypical mycobacteriosis (PSAM) may be related to the increased use of low- and medium-complexity video-assisted surgery. METHODS: Between April 2007 and June 2009, 125 patients were referred from the State Health Department of Rio de Janeiro for the treatment of confirmed, probable, or suspected PSAM. RESULTS: Laparoscopic cholecystectomy was the most frequent surgical procedure (48.8%) among patients. Clarithromycin, ethambutol, and terizidone were used to treat 113 patients for a mean duration of 226 days. CONCLUSIONS: Despite the need for multidrug therapy and long treatment duration, most included patients adhered to treatment and experienced cure without relapse.

Cenário ambulatorial de pacientes com sítio cirúrgico infectado após intervenção cardíaca / Escenario ambulatorial de pacientes con sitio cirugía infectado después intervención cardíaca / Ambulatory setting of patients with surgical site infections after a cardiac intervention

Resumo OBJETIVO Verificar o perfil clínico-cirúrgico e os resultados de pacientes acompanhados em um ambulatório de ferida operatória após cirurgia cardíaca. MÉTODOS Coorte histórica com pacientes submetidos à cirurgia cardíaca e acompanhados por um ano em um ambulatório de feridas de um hospital especializado em cardiologia. Foram analisados os micro-organismos predominantes nas infecções, os produtos utilizados nos curativos, tempo de acompanhamento e o tipo de terapêutica instituída nos curativos. RESULTADOS Entre os 150 pacientes, predominaram sexagenários (61,7 ± 11,4 anos), hipertensos (75%), diabéticos (44,7%). Evidenciou-se 12 pacientes com mediastinite (8%) e 44 com infecção de sítio cirúrgico (29,3%). Utilizou-se para realização dos curativos os ácidos graxos (80%) e alginato de cálcio (19%). O tempo de acompanhamento foi de 35 ±71 dias. CONCLUSÃO Pacientes sexagenários, hipertensos, diabéticos e revascularizados constituíram a população acompanhada no ambulatório de feridas. As taxas de ISC e mediastinite encontradas foram aceitáveis e semelhantes às da literatura.

Resumen OBJETIVO Verificar el perfil clínico-quirúrgico y los resultados de pacientes acompañados en un ambulatorio de heridas operatorias después de cirugía cardiaca. MÉTODO Cohorte histórica con pacientes sometidos a la cirugía cardiaca y acompañados por un año en el ambulatorio de heridas de un hospital especializado en cardiología. Fueron analizados los microorganismos predominantes en las infecciones, los productos utilizados en las curaciones, el tiempo de seguimiento, o el tipo de tratamiento utilizado en las curaciones. RESULTADOS Entre los 150 pacientes predominaron el sexo masculino (58%), sexagenarios (61,7 ± 11,4 años), hipertensos (75%), diabéticos (44.7%). Se evidenciaron 12 pacientes con mediastinitis (8%) y 44 con infección en el sitio quirúrgico (29.3%). Se utilizó en las curaciones fueron los ácidos grasos (80%) y el alginato de calcio (19%). El tiempo medio de seguimiento fue de 35 ± 71 días. CONCLUSIÓN Los pacientes sexagenarios, hipertensos, diabéticos y revascularizados constituyeron la población acompañada en el ambulatorio de heridas. Las tasas de ISC y mediastinitis encontradas fueron aceptables y similares a las de la literatura.

Abstract OBJECTIVE Verifying the clinical-surgical profile and the results of patients monitored in an surgical wound ambulatory after a cardiac surgeries. METHODS This is a historical cohort research with patients submitted to cardiac surgery and monitored for a year in an outpatient surgical wound clinic from a hospital specialized in cardiology. The study analyzed the prevalent microorganisms in infections, the products used in the dressings, the time of follow-up, and the type of therapy established in the dressings. RESULTS Among the 150 patients, most were sexagenarians (61.7 ± 11.4 years), hypertensive patients (75%), and diabetic (44.7%). There were 12 patients with mediastinitis (8%) and 44 with surgical site infection (29.3%). Fatty acids (80%) and calcium alginate (19%) were used for wound healing. The mean follow-up time was 35 ± 71 days. CONCLUSION Sexagenary, hypertensive, diabetic and revascularized patients constituted the population monitored in the wounds outpatient clinic. The SSI and mediastinitis rates found were acceptable and similar to those in literature.

Infecção de sítio cirúrgico após cirurgia bariátrica: resultados de uma abordagem com pacote de cuidados / Surgical site infection in bariatric surgery: results of a care bundle

RESUMO Objetivo: apresentar uma análise descritiva dos resultados de um pacote de cuidados aplicado em pacientes obesos submetidos à cirurgia bariátrica, no que diz respeito ao controle de infecção. Métodos: um pacote de cuidados foi estruturado, visando a conter as taxas de infecção de sítio cirúrgico (ISC) em pacientes submetidos à cirurgia bariátrica. O pacote incluiu interrupção de tabagismo, banho com clorexidina 4% duas horas antes da cirurgia, cefazolina 2g em bolus na indução anestésica associada à administração da mesma droga com dose de 1g em infusão contínua, tricotomia apropriada, controle glicêmico, oxigênio suplementar, normotermia, controle da dor com morfina intrarraquidiana e remoção do curativo estéril 48 horas após a cirurgia. Todos os pacientes foram seguidos por 30 dias. Resultados: entre os 1.596 pacientes incluídos, 334 (20,9%) foram submetidos à cirurgia aberta e 1.262 (79,1%) à cirurgia videolaparoscópica. As taxas de ISC foram de 0,5% no grupo submetido à cirurgia laparoscópica e de 3% nos submetidos à cirurgia aberta. A incidência geral de ISC foi de 1%. Infecções intra-abdominal, do trato respiratório e do trato urinário ocorreram em 0,9%, 1,1% e 1,5% da amostra, respectivamente. Faixas mais elevadas de índice de massa corporal foram associadas a maiores incidências de ISC (p=0,001). Entre os pacientes com diabetes, 2,2% desenvolveram ISC, enquanto a taxa de infecção entre os não diabéticos foi de apenas 0,6%. Conclusão: o pacote de cuidados instituído, estruturado por estratégias centrais baseadas em evidências, associadas à medidas secundárias, foi capaz de manter baixas taxas de ISC após cirurgia bariátrica.

ABSTRACT Objective: to present a descriptive analysis of the results of a care bundle applied to obese patients submitted to bariatric surgery, regarding infection control. Methods: a care bundle was designed to control surgical site infection (SSI) rates in patients undergoing bariatric surgery. The bundle included smoking cessation, bathing with 4% chlorhexidine two hours before surgery, cefazolin (2g bolus) in anesthetic induction associated with a continuous infusion of the same drug at a dose of 1g over a two-hour period, appropriate trichotomy, glycemic control, supplemental oxygen, normothermia, intraspinal morphine for the relief of pain, and sterile dressing removal 48 hours after surgery. All patients were followed up for 30 days. Results: among the 1,596 included patients, 334 (20.9%) underwent open surgery and 1,262 (79.1%) underwent videolaparoscopic surgery. SSI rates were 0.5% in the group submitted to laparoscopic surgery and 3% in the one submitted to open surgery. The overall incidence of SSI was 1%. Intra-abdominal, respiratory tract, and urinary tract infections occurred in 0.9%, 1.1%, and 1.5% of the sample, respectively. Higher body mass index was associated with higher incidence of SSI (p=0.001). Among patients with diabetes, 2.2% developed SSI, while the rate of infection among non-diabetics was only 0.6%. Conclusion: the established care bundle, structured by core evidence-based strategies, associated with secondary measures, was able to maintain low SSI rates after bariatric surgery.