Barbed versus conventional suture in elective posterior spine surgery.

PURPOSE: Barbed sutures are tissue control devices that can reduce operating room time and costs. We analyzed the utility of barbed sutures in posterior spinal surgery in order to prove non-inferiority to conventional methods for wound closure. METHODS: A cohort of patients undergoing elective posterior spinal surgery in which barbed (prospective) versus conventional sutures (retrospective) were used was analyzed. The primary endpoint was the occurrence of wound healing complications or the need for surgical revision. Secondary endpoints included postoperative stay, readmission rate, and duration and cost of wound closure. RESULT: A total of 483 patients participated in the study, 183 in the Barbed group and 300 in the Conventional group. Wound dehiscence or seroma occurred in 3.8% and 2.7% of the Barbed and Conventional groups, respectively (p = 0.6588). Both superficial (1.6% versus 4.0%, P = 0.2378) and deep infections (2.7% versus 4.7%, p = 0.4124) occurred similarly in both groups. Overall, the rate of re-intervention due to wound healing problems was also similar (4.9% versus 5.3%, p = 0.9906), as well as, total median hospital stay, postoperative stay and 30-day re-admission rates. The average duration of wound closure (1.66 versus 4.16 min per level operated, p < 0.0001) strongly favored the Barbed group. The mean cost of wound closure per patient was higher in the Barbed group (43.23 € versus 22.67 €, p < 0.0001). CONCLUSIONS: In elective posterior spinal procedures, the use of barbed sutures significantly reduced the duration of wound closure. The wound healing process was not hindered and the added cost related to the suture material was small.

Polvo de vancomicina tópico para la prevención de infección de herida quirúrgica en cirugía electiva de columna por vía posterior / Vancomycin powder for the prevention of surgical site infection in posterior elective spinal surgery

OBJETIVO: Evaluar la efectividad y seguridad del polvo de vancomicina tópico como profilaxis de infección de herida quirúrgica (IHQ) en cirugía de columna electiva por abordaje posterior. MATERIAL Y MÉTODOS: Estudio unicéntrico cuasiexperimental de comparación pre- y postintervención. El grupo postintervención recibió profilaxis antibiótica estándar preoperatoria junto a 1g de polvo de vancomicina en el lecho quirúrgico antes del cierre de la herida. El grupo preintervención solo recibió la profilaxis intravenosa. RESULTADOS: Participaron 150 pacientes en cada grupo. Ocurrieron 12 infecciones (7 superficiales, 5 profundas) en el grupo postintervención y 16 infecciones (7 superficiales, 9 profundas) en el grupo preintervención. El riesgo de IHQ profunda se redujo del 6% al 3,3% (OR 0,54; IC 95% 0,17-1,65; p = 0,411) con el tratamiento. El porcentaje de IHQ profunda por gramnegativos-positivos fue del 80-20% en el grupo tratado con vancomicina y del 33-67% en los no tratados (p = 0,265). No se produjeron efectos adversos locales ni sistémicos por el tratamiento. CONCLUSIÓN: La profilaxis con polvo de vancomicina en cirugía electiva de columna por abordaje posterior no redujo de forma significativa la incidencia de IHQ superficial o profunda. Se constató una tendencia al aumento de IHQ profunda por microorganismos gramnegativos en los tratados con vancomicina

OBJECTIVE: To assess the effectiveness and safety of vancomycin powder as surgical site infection (SSI) prophylaxis in posterior bilateral elective spinal surgery. MATERIALS AND METHODS: Single-center quasi-experimental pre and postintervention comparative cohort study. The post-intervention group received standard intravenous antibiotic prophylaxis plus 1g of vancomycin powder into the surgical field before wound closure, and the pre-intervention group only the intravenous prophylaxis. RESULTS: 150 patients were included in each group. Twelve SSI (7 superficial and 5 deep) occurred in the post-intervention group and 16 SSI (7 superficial and 9 deep) in the pre-intervention group. The risk of deep SSI decreased from 6.0% to 3.3% (OR 0,54, 95%CI 0.17-1.65, p = 0.411) with vancomycin powder. The percentage of deep SSI due to gram negative-positive germs were 80%-20% and 33%-67% for the post- and pre-intervention groups, respectively (p = 0.265). No local or systemic adverse effects occurred attributable to vancomycin powder. CONCLUSIÓN: In posterior elective spinal surgery, prophylaxis with vancomycin powder did not result in a significantly reduced incidence of superficial and deep SSI. There was a trend towards a higher incidence of deep SSI caused by gram negative microorganisms among those treated with vancomycin

Vancomycin powder for the prevention of surgical site infection in posterior elective spinal surgery. / Polvo de vancomicina tópico para la prevención de infección de herida quirúrgica en cirugía electiva de columna por vía posterior.

OBJECTIVE: To assess the effectiveness and safety of vancomycin powder as surgical site infection (SSI) prophylaxis in posterior bilateral elective spinal surgery. MATERIALS AND METHODS: Single-center quasi-experimental pre and postintervention comparative cohort study. The post-intervention group received standard intravenous antibiotic prophylaxis plus 1g of vancomycin powder into the surgical field before wound closure, and the pre-intervention group only the intravenous prophylaxis. RESULTS: 150 patients were included in each group. Twelve SSI (7 superficial and 5 deep) occurred in the post-intervention group and 16 SSI (7 superficial and 9 deep) in the pre-intervention group. The risk of deep SSI decreased from 6.0% to 3.3% (OR 0,54, 95%CI 0.17-1.65, p=0.411) with vancomycin powder. The percentage of deep SSI due to gram negative-positive germs were 80%-20% and 33%-67% for the post- and pre-intervention groups, respectively (p=0.265). No local or systemic adverse effects occurred attributable to vancomycin powder. CONCLUSION: In posterior elective spinal surgery, prophylaxis with vancomycin powder did not result in a significantly reduced incidence of superficial and deep SSI. There was a trend towards a higher incidence of deep SSI caused by gram negative microorganisms among those treated with vancomycin.

Medidas de protección radiológica: implicaciones en el diseño de quirófanos de neurocirugía / Radiation protection measures: Implications on the design of neurosurgery operating rooms

Objetivo: Describir pros y contras de diversas medidas de protección radiológica y sus implicaciones en el diseño de un quirófano de neurocirugía. Material y métodos: Se realizó una reforma estructural del quirófano de neurocirugía a propósito de la adquisición y uso de un O-arm. Se ampliaron las medidas y blindajes del quirófano, y se instaló una mampara blindada y abatible en su interior. Se midieron dosis de radiación delante y detrás de la mampara. Resultados: La mampara proporciona una radioprotección integral para todo el personal de quirófano (dosis < 5μSv a 2,5 m del gantry por cada exploración con O-arm; 0,0μSv tras la mampara por cada exploración de O-arm; dosis acumulada anual tras la mampara, indetectable), obvia la necesidad de delantales plomados y dosímetros personales y minimiza la circulación de personal. El aumento del tamaño del quirófano permite almacenar los equipos dentro y minimiza el riesgo de colisión o contaminación. Los quirófanos rectangulares permiten aumentar la distancia al foco emisor de radiación. Conclusiones: El blindaje de paredes, techos y suelos, la forma rectangular y la superficie lo más amplia posible, la presencia de una mampara plomada y abatible, y los sistemas de seguridad que impiden una irrupción inesperada en el quirófano mientras se está irradiando son cuestiones relevantes a tener en cuenta en el diseño del quirófano de neurocirugía

Objective: To describe pros and cons of some radiation protection measures and the implications on the design of a neurosurgery operating room. Material and methods: Concurring with the acquisition and use of an O-arm device, a structural remodeling of our neurosurgery operating room was carried out. The theater was enlarged, the shielding was reinforced and a foldable leaded screen was installed inside the operating room. Radiation doses were measured in front of and behind the screen. Results: The screen provides whole-body radiation protection for all the personnel inside the theater (effective dose <5μSv at 2,5 m from the gantry per O-arm exploration; 0,0μSv received behind the screen per O-arm exploration; and undetectable cumulative annual radiation dose behind the screen), obviates the need for leaded aprons and personal dosimeters, and minimizes the circulation of personnel. Enlarging the size of the operating room allows storing the equipment inside and minimizes the risk of collision and contamination. Rectangular rooms provide greater distance from the source of radiation. Conclusion: Floor, ceiling and walls shielding, a rectangular-shaped and large enough theater, the presence of a foldable leaded screen, and the security systems precluding an unexpected irruption into the operating room during irradiation are relevant issues to consider when designing a neurosurgery operating theater

[Radiation protection measures: Implications on the design of neurosurgery operating rooms]. / Medidas de protección radiológica: implicaciones en el diseño de quirófanos de neurocirugía.

OBJECTIVE: To describe pros and cons of some radiation protection measures and the implications on the design of a neurosurgery operating room. MATERIAL AND METHODS: Concurring with the acquisition and use of an O-arm device, a structural remodeling of our neurosurgery operating room was carried out. The theater was enlarged, the shielding was reinforced and a foldable leaded screen was installed inside the operating room. Radiation doses were measured in front of and behind the screen. RESULTS: The screen provides whole-body radiation protection for all the personnel inside the theater (effective dose <5µSv at 2,5 m from the gantry per O-arm exploration; 0,0µSv received behind the screen per O-arm exploration; and undetectable cumulative annual radiation dose behind the screen), obviates the need for leaded aprons and personal dosimeters, and minimizes the circulation of personnel. Enlarging the size of the operating room allows storing the equipment inside and minimizes the risk of collision and contamination. Rectangular rooms provide greater distance from the source of radiation. CONCLUSION: Floor, ceiling and walls shielding, a rectangular-shaped and large enough theater, the presence of a foldable leaded screen, and the security systems precluding an unexpected irruption into the operating room during irradiation are relevant issues to consider when designing a neurosurgery operating theater.

Factores motivacionales en la elección de los estudios de Enfermería / Motivating factors for the selection of Nursing as a career

Objetivo: describir los factores motivacionales (tradicionales, prácticos y profesionales) en la elección de los estudios de Enfermería. Analizarlas diferencias generacionales, así como las vías de acceso a la carrera utilizadas. Material y método: estudio descriptivo transversal. La población de estudio fueron: profesionales de Enfermería de cuatro unidades hospitalarias(n= 104) del Hospital General Yagüe de Burgos, y estudiantes de 2º curso (n= 48) de la Escuela de Enfermería de Burgos. La recogida de los datos se realizó a través de dos cuestionarios anónimos reelaboración propia, previamente pilotados. Para el análisis bivariantese utilizó el coeficiente de contingencia. Resultados: participaron 106 profesionales y 51 estudiantes. El70,8% de los encuestados afirmó haber estudiado la carrera por vocación. Los estudiantes habían tenido experiencias laborales previas en el mundo sanitario en mayor porcentaje que los profesionales (p=0,002), también en mayor porcentaje tenían un familiar que trabaja en la rama sanitaria (p= 0,047), y habían elegido esta carrera por presentar buenas expectativas de trabajo (p= 0,007). Existían diferencias estadísticamente significativas (p= 0,013) entre grupos generacionales en lo relativo a “Elegir estudiar Enfermería nuevamente” (65,5% delos profesionales con más de 22 años experiencia laboral, frente al94% de los estudiantes).Conclusiones: la mayoría de los encuestados estudia Enfermería “por vocación y/o deseo de ayudar a los demás”, independientemente de la edad y de los años de profesión, ante lo cual se puede resaltar el carácter vocacional de esta profesión a lo largo del tiempo. No obstante, es entre los profesionales más experimentados donde el porcentaje que no volvería a estudiar esta carrera es mayor, lo que pone de manifiesto que con el paso de los años puede haber un desencanto profesional (AU)

Objective: to describe the motivating factors (traditional, practical and professional) for the selection of the Nursing career. To analyze generational differences, as well as the ways used to access the career. Material and method: transversal descriptive study. The population of this study was: Nursing professionals in four hospital units (n= 104)at the Hospital General Yagüe in Burgos, and 2nd year students (n= 48)from the Nursing School in Burgos. Data collection was conducted through two self-prepared anonymous questionnaires, which had previously undergone a pilot test. The contingency quotient was used for the bivariate analysis. Results: the study included 106 professionals and 51 students. A70.8% of the participants claimed they have studied the career by vocation. Students had previous working experience in the healthcare area to a higher proportion than professionals (p= 0.002), and also hadsome relative who was working in the healthcare area to a higher proportion(p= 0.047), and had chosen this career because it presented good job expectations (p= 0.007). There were statistically significant differences (p= 0.013) between generational groups regarding “Choosing again to study Nursing” (65.5% of professionals with over 22 years of working experience, vs. 94% of students).Conclusions: the majority of the participants have chosen the Nursing career by vocation and/or desire to help others, regardless of their age and years of practice; this highlights the vocational nature of this profession over time. However, there is a higher proportion of professionals with longer experience who would not study this career again, showing that there may be some professional disappointment as years go by (AU)